The Deepest Well: Healing the Long-Term Effects of Childhood Adversity by Dr. Nadine Burke Harris is a marvelously written book, like a detective story you can’t put down. The personal examples the author provides are riveting as are the stories of many of her patients and their families. Perhaps most importantly, Harris’ voice is warm and real, and complex issues and data are presented in an easily comprehendible way.
The Deepest Well is the go-to book about ACE scores (Adverse Childhood Experiences) and the health consequences of unresolved trauma. Dr. Harris is a pediatrician with a mission: To awaken society to the medical consequences of toxic stress—“prolonged activation of the stress-response systems [that] disrupt the development of brain architecture and other organ systems” (55). While we already know about many of the mental health consequences, she’s here to communicate the costs to our physical health as well.
Key to Dr. Harris’ work was discovering the 1998 article “Relationship of Childhood Abuse and Household Dysfunction to Many of the Leading Causes of Death in Adults: the Adverse Childhood Experiences (ACE) Study” by Dr. Vincent Felitti, Dr. Robert Anda, and colleagues. This study sponsored by Kaiser Permanente, San Diego and the CDC (Center for Disease Control) involving a sample of over 17,000 adults–mostly Caucasian and college-educated—revealed that 1) ACEs are very common and that 2) the higher one’s ACE score, the more at risk one is for serious negative health outcomes.
The ACE Study Questionnaire included questions about whether one experienced any of the following issues growing up in one’s family: ongoing emotional abuse; ongoing physical abuse; sexual abuse; substance abuse in the household; separation from one’s mother; mental illness in the household (Harris 37), and more. The answer YES to a question increases one’s ACE score by one point. The study concluded that the higher the score, the more one is at risk for heart disease, cancer, COPD (Chronic Obstructive Pulmonary Disease), and other serious health problems.
An area that is missing in The Deepest Well is a direct discussion of preverbal trauma and, if unresolved, its health consequences for adults. As far as I can tell, the ACE questionnaire does not ask about early surgeries, invasive medical procedures, diseases, or birth trauma. In the book’s Appendix 2 though, the ACE questionnaire developed for the Center for Youth Wellness, Dr. Harris’ organization, to be completed by a parent or caregiver, includes a question about whether the child has ever “had a serious medical procedure or life-threatening Illness.” I was relieved to see this. Why a similar question is not included in the questionnaire for adults is puzzling to say the least.
Despite this omission, The Deepest Well is a timely and important book, a tour de force really, sounding a much-needed alarm: Toxic stress is literally killing us. Dr. Harris insists that one of the most powerful moves to abate this public health crisis is the implementation of universal pediatric ACE screening. See if you agree. Then, if you dare, tally your own ACE score. See where you and your family fit into the ACE story. The gift of doing this is a more profound understanding your past and, therefore, your present. To take it further, you could save a life.
Thank you for this book review, Wendy. As you mention, there will be few people who cannot tick any of the stress factors mentioned. As with so many things, most of us are not greatly affected by one ACE, or by several if recognised early and well managed. But with our society becoming increasingly dysfunctional we must expect and are seeing a growing incidence of ptsd and its more obvious symptoms including personal and family breakdown, obesity and other addictions.
As you know, I share your dismay at (as you report) preverbal trauma not being mentioned let alone discussed in the book and more generally. This despite its reality being acknowledged, albeit not my many in the mainstream of the medical and psychology professions. Yet I have not come across any refutation of what has been published about preverbal trauma and related ptsd by the late Louis Tinnin, Bessel van der Kolk and others. This leaves me asking: is what seems like the silent treatment caused by disinterest, fear of engagement, or what?