The Deepest Well: Healing the Long-Term Effects of Childhood Adversity

An adverse childhood experience (ACE) is a traumatic event that can shape a child’s physical and mental health throughout the remainder of that person’s life. Examples of ACEs are divorce or separation of one’s parents, having an incarcerated parent, having a caretaker with a psychological illness or chemical dependency, or surviving any form of abuse (physical, sexual, or verbal). Burke Harris’s work in Bayview convinces her that significant numbers of ACEs are drivers of long-term stress responses that result in poor health outcomes for her patients. (See the two survey instruments in the book’s appendices.)

Biological determinism is the idea that things like genetics or one’s body determine how one behaves. Important critiques of biological determinism include that using it as a lens may ignore the influence of the environment and that it often encourages unquestioning acceptance of discriminatory ideas about oppressed groups. As her ideas became more visible, Burke Harris was forced to confront critics who believed her emphasis on ACEs and toxic stress reinforced the concept of biological determinism; community activists believed she was labeling children dealing with ACEs as brain damaged, thus taking attention away from activists’ fight to improve the environment (political and physical) that leads to poor outcomes.

The underlying process that causes an observable effect in the body is a “biological mechanism”—what Burke Harris often refers to as “the why.” Burke Harris recognized early in her work in Bayview that something was producing poor health outcomes for her patients, but she couldn’t treat them effectively until she understood that the stress response resulting from high numbers of adverse childhood events was the biological mechanism for these that resulted in these health conditions.

An effect is “dose dependent” when an observer can predict the effect or magnitude of an effect based on the amount or length of the dose (such as exposure to radiation). Burke Harris’s research on adverse childhood events reveals to her, for example, that the higher number of ACEs a person has, the more likely they are to have poor health outcomes.

Epigenetics is a field of science that studies the interaction between one’s genetic code and the environment. While a longstanding debate concerns whether environment (nurture) or one’s genetic code (nature) exercises a greater influence on one’s life and health, people who study epigenetics advance the idea that the environment, including stress, interacts with one’s genes: Genes may be switched on or off, depending on what is happening in the environment. ACEs in childhood can alter the genetic expression in children, resulting in lifelong changes that may be detrimental to the child’s health. In addition, Burke Harris argues that these changes can cascade down through generations. The toxic stress responses of children may thus be the direct result of ways of being and of epigenetic changes in their parents and caretakers.

A health disparity is a poor health outcome that affects one group (a particular race, class, gender, or community, for example) more than the general population. In The Deepest Well, Burke Harris’s work allows her to track several significant health disparities among the working-class people of color in Bayview.

Homeostasis means “balance.” The biological processes that regulate the bodies of living beings, including humans, maintain a fine balance that allows a being to respond to stress in the environment such that the body can continue functioning optimally. When stressors are long-term or extreme, these biological processes and adaptations to the environment disturb that balance, leading to illness and poor health outcomes. Burke Harris’s central thesis is that ACEs resulting from prolonged exposure to stresses in the environment prevent the bodies of her patients from reaching a healthy homeostasis.

Labeling normal physical, cultural, or psychological differences among people as problems that must be treated medically is medicalization. Burke Harris and others working on the effect of toxic stress on health outcomes face criticism that they’re treating common human experiences as diseases.

Public health is a discipline that focuses on improving the health of people and their communities by preventing illness as well as identifying and addressing the causes of illness on a community or societal level. An important part of the practice of public health is addressing health disparities (poor health outcomes that are disproportionately present in one societal group). Burke Harris is trained as a doctor, but her specific training in public health leads her to examine her patients in the context of their communities.