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

Nonfiction | Book | Adult | Published in 2018

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Summary

Chapter Summaries & Analyses

Introduction and Part 1

Part 2

Part 3

Part 4 and Epilogue

Key Figures

Themes

Index of Terms

Important Quotes

Essay Topics

Themes

Storytelling and Science

Nadine Burke Harris has two central stories to tell in The Deepest Well—the story of how she brought her insights about ACEs and toxic stress to national attention and the science that explains the link between ACEs and toxic stress. Because her audience is likely to be neither scientists nor elites who know the ins and outs of public health and brain science, Burke Harris skillfully uses anecdotes from medical and scientific history as well as other narratives to make her two central stories accessible.

The framing medical anecdote for the story is about Diego, a child Burke Harris encounters early in her tenure at Bayview. Burke Harris’s narration of Diego’s story is tender and heart-rending. She describes him as cute and loveable but dealing with the physical and psychological burden of having survived terrible abuse. Centering the story of this vulnerable child and Rosalia, a mother who ultimately serves as a buffer for her child, instantly reveals the stakes of this conversation. Although Burke Harris mentions in passing the health disparities that exist between Bayview and the more affluent neighborhoods nearby, her inclusion of a specific story forces an understanding of the people behind those numbers.

While these anecdotes about patients serve to humanize discussion of what the data shows about ACEs, a basic understanding of important medical and public health concepts is necessary to accept Burke Harris’s contention that the toxic stress response is the biological mechanism that makes ACEs so harmful. Therefore, she includes sprints through the science but sheds the brightest light on why the biology is important through stories from scientific history and experimental results recounted almost as if they were mysteries. The well in the title comes from her framing narrative, the story of how John Snow stopped cholera in its tracks by finding out that germs, not miasmas, explained how a disease was spreading. Rather than a dry explication of the shift from germ to miasma theory, Burke Harris centers Snow as a character, and this approach allows her lay audience to understand a key concept of public health.

As another powerful storytelling approach, Burke Harris uses narratives such as the parable of the bears. Chapter 4 is dense with scientific terms, but as Burke Harris works through these terms, she translates them into aspects of the story about living with bears at varying distances. The bears appear again as Burke Harris explains why she sees the toxic stress response as universal. Because most have encountered real wild animals or at least fairytale bears that symbolize danger in stories about children, her use of this narrative creates a hook on which she hangs the science and public policy debates. The overall effect of these anecdotes and storytelling approaches is that what’s at stake and the science itself become more comprehensible.

Reimagining Science

Burke Harris is an able storyteller in explaining the science of ACEs, but she also consistently offers a counter-story to popular ideas about science and scientists. For much of American history, formal learning about science was less about inquiry and more about mastering content and facts. As Burke Harris recounts the story of how she helped ACEs and toxic stress become a part of the conversation about public health, she reveals in an understandable way what it really looks like to practice science.

Burke Harris’s practice of science is driven by inquiry—questions that arise organically from her observations as she treats patients in Bayview. Her chapters often open and close with such questions. By presenting the story of how she got people to talk (and read) about ACEs as a series of questions that she stumbles her way to answering, Burke Harris helps show that curiosity is a key tool of the scientist.

People commonly associate science with certainty and hard facts, but Burke Harris tempers that idea by showing how often chance and emotions affect the growth of scientific knowledge. Burke Harris’s encounter with Diego is pure chance, but his case sets her on the path to working on ACEs. Serendipity—a chance event that leads to a good outcome—is present in Felitti’s ACE study as well, a point Burke Harris explains by discussing how a misspoken word led Felitti to ask about a patient’s adverse experiences as he researched obesity and mortality. In addition, Burke includes many examples of how emotion inspires her to persist in her clinical work and in the work she does on a national level, which she describes later in the book.

Burke Harris sometimes explicitly highlights principles of science as inquiry driven, which means that researchers uncover results that don’t line up with their hypotheses, leading them to ask new questions. In Chapter 2, she tells a story about how the unusual data on tadpoles’ level of stress hormones at Hayes’s frog lab led him and his team to study the effect of the timing of stress on tadpoles’ development. His findings, which Burke Harris happened to know about because of her undergraduate work in his lab, proved crucial to her work, illustrating another important aspect of science in the wild—relationships and collaboration.

Although the major focus of The Deepest Well is to reveal why ACEs are important, Burke Harris’s work also offers a better understanding of what it means to be a modern scientist. Scientists (and doctors) work in teams; few toil in labs alone. Furthermore, scientists must often think about how their work shapes the world outside the lab. The hobnobbing Burke Harris does shows that intervening in public health depends on both scientific and people skills, for example. Burke Harris sometimes encounters roadblocks between stereotypical notions of science and science as she practices it (this accounts for her insight that a gap existed between people who study statistics and people who work within communities), but her approach in resolving conflicts between these notions of what science is about shows how both are important to problem-solving. Burke Harris’s successes and the future she imagines in the epilogue reveal the potential of understanding science as inquiry and as a creative practice—helping communities heal from the effect of ACEs.

The Connection Between the Past and the Present

The book’s introduction explicitly references a powerful American myth—the rag-to-riches story, “Horatio-Alger-like stories about people who have experienced early hardships and have either overcome or, better yet, been made stronger by them” (xv). Her book presents a complicated answer to the question of whether we’re simply the products of our pasts.

Burke Harris argues that this narrative about overcoming one’s past to become successful in the present is part of Americans’ “cultural DNA,” so much so that people’s inability to overcome their pasts has assumed “moral overtones” that leave a “huge part of the story missing” (xv). The Deepest Well’’s major premise is that the missing piece is in our bodies—the way that the body carries with it the mark of ACEs’ effect on our stress response. In a biological sense, we can’t ever leave our pasts behind because of what toxic stress does to our bodies. Part 2 of the book, “Diagnosis,” establishes the science behind this link between the past and the present.

Although Burke Harris carefully shows the biological sense in which our bodies today are the result of our pasts, she also takes care to complicate that account. She avoids arguing that we’re only the result of our pasts or our bodies. She does this throughout the book, but the story of Diego is where she shows how to shift the givens even if ACEs happen when one is quite young and damage the stress response. Diego, we learn at the end of the book, still occasionally wrestles—sometimes mightily—with the enduring effect of trauma he experienced at four and trauma in his life in the present. Still, the intervention to which his mother and the clinicians lead him empowers him to manage the effect of the past on his present. The idea that we can moderate what ACEs do to us helps push back against the despair that even Burke Harris is subject to as she looks at the damage in her patients and their communities.

Burke Harris also develops the theme of the connection between the past and the present through her own life story. The book itself and even passing familiarity with her biography show that the ACE in Burke Harris’s life didn’t prevent her from being successful. Burke Harris explicitly talks about how dealing with her mother, who struggled with her psychological health, taught her valuable skills that have served her well in her professional life.

On the other hand, Burke Harris takes care to show that surviving this trauma left its mark—her brother had a stroke and she herself initially struggled to manage her depression after a pregnancy loss in part because of her fears of becoming like her mother. Her brother Louis didn’t apparently survive his trauma. The varied outcomes of the lives of the Burke siblings provides a complicated answer to the question of whether we can ever entirely escape our pasts. The answer is that sometimes we can, but only with the right help and knowledge of just how the past makes us who we are in our minds and bodies.

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

Themes

Storytelling and Science

Reimagining Science

The Connection Between the Past and the Present

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