In a line: A fascinating insight into how trauma and Adverse Childhood Experiences (ACEs) impact the health and well-being of children and adults. Written like a mystery, peppered with real stories, it follows Nadine’s struggle to link research with her own observations of the health and well-being of her young patients and find solutions that work. What she learns changes everything and she goes on to champion the issue of ACEs at a national and global level.
What’s In the Book
Reading like a medical detective novel (think House), The Deepest Well tells the story of Dr Nadine Burke Harris and how she was driven to get to the real problems affecting the physical and mental health of her young patients. It starts with a story, weaves in research, clinical observations, stories of recent and historical medical breakthroughs (like solving the cholera epidemic in Soho, London) and her struggle to have ACEs taken seriously.
‘Everyday I witnessed my tiny patients dealing with overwhelming trauma and stress; as a human being, I was brought to my knees by it. As a scientist and doctor, I got up off those knees and began asking questions.’
pg xviii The Deepest Well
Nadine collects clues and deepens her (and our) understanding of stress and trauma in each chapter. She discovers the 1998 ACE study in adults, research into how stress impacts the body, immune system and brain, how toxic stress can affect our very DNA (epigenetics) and more. Never satisfied until she has all the answers, this is a very thorough exploration of the impacts of stress and their immediate and long-term effects. As she learns, she begins implementing ACE screening in her clinic to help her really understand the factors driving the symptoms she was being asked to heal.
As a book on ACEs, toxic stress, brains, and how trauma in childhood can have immediate and far-reaching impacts on everything from eczema to the likelihood of being diagnosed with ADHD or behavioural difficulties (thirty times more likely if you have four or more ACEs) and then into the teenage risks of smoking, pregnancy, high risk behaviours and rippling into autoimmune diseases and food allergies in adults, this book is a fascinating must-read.
‘If an infant doesn’t have a caregiver’s reciprocal eye contact, stimulating facial expressions, snuggles and kisses, hormonal and neurological damage can occur, and that can prevent a child from growing and developing normally.’
p78-79 The Deepest Well
Nadine also compares children whose health suffers and those who seem to cope without significant health issues but who experienced similar trauma (the 9/11 study is surprising). She soon discovers that some children are immunised against the stress in their environment or home life because of their relationship with a loving caregiver or parent.
‘We all know that adversity, tragedy and hardship are a part of life… What the research tells us is that those daily challenges can be overcome with the right support from a loving caregiver.
p53 The Deepest Well
This becomes a core focus of her clinic’s two-fold approach to improving the health of young people:
- Reduce the adversity and stress in their lives
- Strengthen the caregiver to be a healthy buffer
This was one of the light-bulb moments for me in reading this book. I realised that I haven’t spent enough time working on myself, on my own triggers and weaknesses to ensure that I am able to be the healthy buffer for my children. I realised that some of the issues I am dealing with are mine and mine alone. Note to self: remember to put on your own oxygen mask first!
Having read how toxic stress affects both the mind and body of a child, I was surprised that the steps her clinic uses to solve or reduce it’s impact are seemingly simple and obvious:
- Sleep
- Exercise
- Nutrition
- Mindfulness
- Mental health (particularly they use child parent psychotherapy CPP)
- Healthy relationships
Their first approach with every patient is to focus on both the child and caregiver getting good quality sleep. As a parent, I nodded my head in recognition, knowing just how important sleep is if I am to parent therapeutically. As her knowledge and influence grows, Nadine begins to realise that whilst her focus is health, that ACEs go beyond that – they are not just a health issue, but they are also an educational issue.
In order to be able to pay attention and learn in school, a kid needed to engage his prefontal cortex (the conductor), which meant the amygdala alarm had to be silent. Safety and stability would be key…
p185 The Deepest Well
Whilst the book provides a thorough and well researched picture about toxic stress and it’s impact, the book is also about spreading the word (her TED talk has had millions of views). Nadine wants recognition of ACEs and their impact to be worldwide, so that everyone can understand how childhood trauma changes the mind and body of a young person, and what they can do about it. For only when ACEs are fully understood can policy, politics, voluntary and government agencies, social workers, teachers, law enforcement and more come together to heal the young people who need it.
What I liked about The Deepest Well
- The storytelling is superb – packed with real life stories of children and adults whose lives have been changed because of childhood adversity, whilst dealing with complex issues
- It reads like a detective story – as Dr Nadine searches for an answer that explains what she is observing in her young clients at her medical clinic (I like a good mystery)
- The insights into the impact of cortisol (a stress hormone) are fascinating and detailed – there is almost no part of the body or brain that is unaffected
- Nadine has a passion for health and her community that shines through on every page and makes her a very likeable hero
- Whilst covering all the issues that can arise from adverse childhood experiences, the author remains upbeat and hopeful
- The book isn’t too Disney or “happily ever after”. Nadine is realistic about the challenges – the story of Diego shows that solving this problem involves playing the long-game
Could It Be Even Better?
I learnt a huge amount from reading this book, which was rich in details about the depth and scope of the impact of toxic stress in children.
Whilst the book’s subtitle is “healing the long-term effects of childhood adversity” I felt that I wanted to know far more about solving the problem.
It was good to know that I am already doing some of the six steps to healing (sleep, exercise, nutrition). But these areas were short on detail – such as how much sleep or how to ensure good quality sleep in traumatised children. Nadine suggests an hour of moderate exercise a day (and cautions against intense exercise), but is that formal exercise like walking or does running around outside count? I was left constantly wanting more help, more details, more solutions.
Nevermind when she mentioned techniques such as mindfulness (4)…
Nadine discusses how she drew the conclusion that meditation piqued her interest, summarising research proving it is useful to enhance sleep, improve the immune system and decrease inflammation as well as decreasing cortisol. All these issues are negatively impacted by trauma and stress. She talks about running yoga and mindfulness classes for teenager girls and how well they responded. Great (I thought). But that was with 15 year-olds! Would it still be relevant to my children, or can I start elsewhere? The more I read, the more questions I had about what I could do that remained frustratingly unanswered.
So whilst this book is a stunning foundation into understanding just how toxic stress and trauma can impact a developing person, and the ripple effects it can cause throughout their lives, it feels sadly lacking in similar details of solutions that we can use as parents to children of adverse childhood experiences.
In Summary
The Deepest Well is a story about insight, about courage, about creating a groundswell of understanding of Adverse Childhood Experiences. It is fascinating and frustrating – I learnt so much about toxic stress and its impact on everything from DNA to the immune system and brain. Yet I was left wanting to know far more about what I can do as a parent to heal or reverse the impact of trauma.