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

Burke Harris had several experiences that convinced her that it was time to think more holistically in addressing the effect of ACEs on health outcomes. Witnessing a drug deal near the clinic reminded her of the pervasive nature of violence in her patients’ community. Kamala Harris (the American vice-president as of the writing of this guide) was then a district attorney who figured out that youth who dropped out of school were more likely to be murder victims, making staying in school a viable crime prevention strategy. Harris convinced Burke Harris that she needed to start a center. Having a center would allow Burke Harris and her staff to push the medical establishment to routinely screen for ACEs and practice early intervention to blunt the effect of toxic stress in childhood.

Harris introduced Burke Harris to Victor Carrion, a child psychiatrist whose work influenced Burke Harris’s approach to tracking ACE effects. Carrion and his team were ready to use rigorous study design to provide data on what Burke Harris was seeing anecdotally in her practice. However, the clinic in Bayview was simply too small and understaffed for this work to happen. With help from Daniel Lurie of Tipping Points Community, an anti-poverty nonprofit, Burke Harris and her growing team of collaborators raised $4.3 million in start-up funds for what became the Center for Youth Wellness (CYW).

Burke Harris was excited about this funding. She left her role as director of Bayview and became the CEO of CYW. Her new role immediately forced her to confront bureaucracy and resistance to her plans. When she applied to the zoning commission for permission to expand the clinic to provide a full menu of services, she was disappointed when Bayview activists claimed that the site had environmental toxins, and proving this untrue delayed the clinic’s expansion.

One activist, whom Burke Harris identifies only as “Sister J,” seemed to be a source of the pushback in the community. Sister J or people associated with her circulated fliers that claimed Burke Harris was attempting to experiment on Bayview’s children; some of the rumors that circulated about the center’s mission had explicit anti-immigrant rhetoric aimed at “othering” Burke Harris because of her father’s Jamaican origins. Sister J and others like her, according to Burke Harris, often opposed projects like Burke Harris’s with the intent of securing cushy jobs as consultants, although they sometimes seemed genuinely motivated in helping their communities.

An unproductive meeting with Sister J left Burke Harris feeling defeated, at least until Paul Tough, a journalist who covered nonprofits with high profiles, told Burke Harris that such attacks were common. Burke Harris and her staff mobilized clients and community members to speak in support of the zoning permit. Supporters of the clinic flooded the zoning commission meeting, and the city granted the permit. The lessons Burke Harris drew from this challenging moment were that community support was key to the center’s success and that one of the strengths of Bayview was that people looked out for each other.

The “sexiest man alive” in the title of this chapter is Robert Guthrie, a physician who was galvanized by personal experience to push for universal screening for phenylketonuria (PKU). PKU is a disorder in which the inability to metabolize phenylalanine, a common amino acid, leads to severe mental disabilities if not treated early by eliminating foods that contain the substance. Guthrie’s push was successful in part because he helped revolutionize the screening tool—a simple blood test that required just a few drops of blood from a newborn’s heel—to detect the phenylalanine. The results of the test were accurate, and the test was cheap. As a result, PKU testing is now standard.

Sue Sheridan, a mother whose baby son suffered irreparable damage when doctors didn’t address his jaundice at birth, was another key figure who influenced Burke Harris’s approach to getting children the help they needed. She raised awareness among parents and the medical establishment about the necessity of early intervention for jaundice.

Guthrie and Sheridan’s work shaped Burke Harris’s desire to change pediatric practice by making screening for ACEs early, routine, and universal. Babies and toddlers have brains that are respond well to stimuli. Neuroplasticity (the ability of the brain to change in response to these stimuli) is at a peak in childhood, for ill or for good. Early childhood and (to a lesser extent) adolescence, pregnancy, and new parenthood are also moments when the body and brain can respond to intervention measures such as exercise, nutrition, and mediation to improve the ability to manage stress responses.

This knowledge informed Burke Harris’s treatment approach at the center. Its staff routinely screened clients for ACEs (see the book’s appendices). Those with high ACEs and their parents received treatment from a multidisciplinary team of practitioners who could address the complicated effects of those ACEs. An encounter with Lila, a baby who failed to gain weight, as well as Molly and Ryan, Lila’s parents, helped Burke Harris understand that just having the score—and not necessarily forcing parents to have intense conversations about those specific experiences—was helpful. This bit of information was enough to enable Burke Harris to focus on medical care and leave other kinds of support to people with expertise in those areas.

Burke and her team further refined the screening tool by adding broader experiences like community violence and discrimination to the possible count of ACE numbers and no longer asking clients to tick off specific ACEs. This “de-identified” screening tool gave doctors like Burke Harris a quick indicator that a child was likely to have a toxic stress response and then treat accordingly. By the late 2010s, the screening protocol could be completed in three minutes. The center posted the tool online for use by patients and other practitioners, who downloaded the tool in large numbers. The center used this response to establish a network of clinicians to study how to use the tool and develop earlier and more effective intervention techniques.

As Burke Harris increasingly devoted time to fundraising for the center, she began to move in elite circles that she only imagined as a child riding in the back of the car as her mother drove the family past mansions. However, even as her TED talks and her interactions with wealthy philanthropists raised her public profile, she always remained aware of her responsibility to advocate for people like her patients in Bayview.

As a result of her fundraising work, Burke Harris gained a peer group of highly accomplished women, many of them wealthy, white, and influential in their spheres and careers. Burke Harris developed deep personal relationships with these women, and they became a brain trust that helped her hash out problems in her work, including how to get the news out that toxic stress responses weren’t just a problem of poor communities or people of color: Everyone was subject to the effects of ACEs and toxic stress.

Caroline, one of the women in this brain trust, shared one night over dinner how her accomplishments as a company founder and entrepreneur were no protection against an emotionally abusive relationship that exposed her son, Karl, to ACEs. For Karl, this early exposure had the predictable outcome of behavioral problems at school, poor impulse control, and a diagnosis of ADHD. Caroline finally left her abusive marriage when her then-seven-year-old son implored her to leave.

After leaving, Caroline learned how much her ex-husband’s abuse affected not just her but also her son. However, the more she took care of herself through exercise, therapy, and yoga, the better her son’s ability to manage his stress responses became. These stories helped Burke Harris understand that even affluent people have ACEs, although the reputational damage from revealing these experiences make them likely to hide the experiences.

Burke Harris always knew that people didn’t want to talk about ACEs because they’re painful. The extended dialogue and storytelling that emerged once ACEs were part of the conversation between Burke Harris and Caroline revealed to Burke Harris that the universality of ACEs and our responses to them connects everyone—regardless of zip code, class, or color. This connection had the potential to create more opportunities to intervene in the toxic stress responses for everyone.