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The Deepest Well: Healing the Long-Term Effects of Childhood Adversity
Dr. Nadine Burke Harris was already known as a crusading physician delivering targeted care to vulnerable children. But it was Diego — a boy who had stopped growing after a sexual assault — who galvanized her journey to uncover the connections between toxic stress and lifelong illnesses.
The news of Burke Harris’s research is just how deeply our bodies can be imprinted by ACEs—adverse childhood experiences like abuse, neglect, parental addiction, mental illness, and divorce. Childhood adversity changes our biological systems, and lasts a lifetime. For anyone who has faced a difficult childhood, or who cares about the millions of children who do, the scientific insight and innovative, acclaimed health interventions in The Deepest Well represent hope for preventing lifelong illness for those we love and for generations to come.
The news of Burke Harris’s research is just how deeply our bodies can be imprinted by ACEs—adverse childhood experiences like abuse, neglect, parental addiction, mental illness, and divorce. Childhood adversity changes our biological systems, and lasts a lifetime. For anyone who has faced a difficult childhood, or who cares about the millions of children who do, the scientific insight and innovative, acclaimed health interventions in The Deepest Well represent hope for preventing lifelong illness for those we love and for generations to come.
272 pages, Hardcover
First published January 23, 2018
About the author
Nadine Burke Harris
6 books358 followersA pioneer in the field of medicine, pediatrician Dr. Nadine Burke Harris is a leader in the movement to transform how we respond to early childhood adversity and the resulting toxic stress that dramatically impacts our health and longevity. By exploring the science behind childhood adversity, she offers a new way to understand the adverse events that affect all of us throughout our lifetimes. As the founder/CEO of the Center for Youth Wellness, she has brought these scientific discoveries and her new approach to audiences at the Mayo Clinic, American Academy of Pediatrics, Google Zeitgeist and Dreamforce. Nadine’s TED Talk, “How childhood trauma affects health across a lifetime,” has been viewed more than 3 million times. Her work has been profiled in the New Yorker, in Paul Tough’s best-selling book, How Children Succeed: Grit, Curiosity, and the Hidden Power of Character, and in Jamie Redford’s feature film, “Resilience”. Dr. Burke Harris’s work has also earned her the Arnold P. Gold Foundation Humanism in Medicine Award presented by the American Academy of Pediatrics and the Heinz Award for the Human Condition.
Additionally, she serves as an expert advisor on the Too Small to Fail initiative to improve the lives of children, and on the American Academy of Pediatrics National Advisory Board For Screening. And finally,
Dr. Burke Harris is writing a book on the issue of Childhood Adversity and Health called the Deepest Well that is expected to be a bestseller and will be released in January 2018.
from https://centerforyouthwellness.org/ou...
Additionally, she serves as an expert advisor on the Too Small to Fail initiative to improve the lives of children, and on the American Academy of Pediatrics National Advisory Board For Screening. And finally,
Dr. Burke Harris is writing a book on the issue of Childhood Adversity and Health called the Deepest Well that is expected to be a bestseller and will be released in January 2018.
from https://centerforyouthwellness.org/ou...
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Displaying 1 - 30 of 1,030 reviews
March 16, 2018
I was so excited to read this book - the science of trauma and adversity are fascinating, important topics, and I was excited that the book had buzz that might bring more awareness to the research. And while the science, and the description of research and clinical cases in this book are excellently done, two pieces of the book were huge turn-offs for me:
1. The "me me me" style of the writing. Everything is about the author. Her feelings, her fund-raising, her fancy dinner parties. I kept having the urge to say, "Pipe down, I'm trying to read about science!" The real killer for me was when she started to detail her Oscar de la Rente dress. This is a book about the severe and lasting effects of childhood trauma. It is totally tone-deaf to start talking about fancy dresses and high heels.
2. The complete lack of actionable items. The author mentions off-hand a couple of times that things like sleep and exercise are good if you have high ACE scores, which, while I'm sure it's true, is true for essentially all humanity? She doesn't get into the science of why those things work, or give any steps for implementing them if the trauma impairment is making it difficult, which it likely would. Worse, she presents no call to action for what implementing broader ACE treatment would look like - not in policy, or education, or home life.
Overall, at the end of the book I was left wishing there was a book out there that actually did what this book claims to do - offering "vitally important hope for preventing lifelong illness for those we love and for generations to come."
1. The "me me me" style of the writing. Everything is about the author. Her feelings, her fund-raising, her fancy dinner parties. I kept having the urge to say, "Pipe down, I'm trying to read about science!" The real killer for me was when she started to detail her Oscar de la Rente dress. This is a book about the severe and lasting effects of childhood trauma. It is totally tone-deaf to start talking about fancy dresses and high heels.
2. The complete lack of actionable items. The author mentions off-hand a couple of times that things like sleep and exercise are good if you have high ACE scores, which, while I'm sure it's true, is true for essentially all humanity? She doesn't get into the science of why those things work, or give any steps for implementing them if the trauma impairment is making it difficult, which it likely would. Worse, she presents no call to action for what implementing broader ACE treatment would look like - not in policy, or education, or home life.
Overall, at the end of the book I was left wishing there was a book out there that actually did what this book claims to do - offering "vitally important hope for preventing lifelong illness for those we love and for generations to come."
January 27, 2018
This book is poorly titled. "The Deepest Well: Healing the Long-Term Effects of Childhood Adversity" explains through storytelling what the ACE studies are and what they represent. Healing long-term effects is not addressed. At all.
There is much better information available to read about ACE studies if you are interested, that can easily be found online, without the muddiness of the storytelling format.
There is much better information available to read about ACE studies if you are interested, that can easily be found online, without the muddiness of the storytelling format.
May 10, 2020
From the title, what was expected:
a book that deepened my understanding of the ACE (Adverse Childhood Experience) scores, how high ACE scores effect us (physically, emotionally, culturally) and ways to heal from said trauma.
What was offered: None of the above.
Look, I had some serious doubts when I was knee deep in this book and this Stanford trained Dr. was wailing about how so many of her clients (children from some of the most disadvantaged neighborhoods in the area) were struggling in a myriad of ways and she was utterly perplexed. The kind Dr. is announcing these issues as if she just could not remotely understand the cause or why it was happening.
This was perplexing because Vincent J Felitti MD and his team started the ACE study (on accident, which makes it even cooler) at Kaiser Permanente's obesity clinic in San Diego, California waaaay back in the 1980's. This is pretty well-covered ground in the medical field. I find it hard that a pediatric resident at Stanford in the 00's would not be aware of the ACE study? A huge part of this book is Dr. Burke Harris DISCOVERING something that the medical world has known about for over 30 years.
The rest of the book was a huge People article: what I wore, what things looked like, who was there, who invited me, why I went, why it was important, what I said, personal life antecdotes...
If you are interested in ACE's and their impact, and interested in developmental trauma, do not buy this book. It won't be of any use, unless you too have literally never heard of ACE scores or trauma.
These books are far superior (not by any means an exhaustive list):
The Body Keeps the Score: Brain, Mind, and Body in the Healing of Trauma
by Bessel Van der Kolk MD
Healing Developmental Trauma: How Early Trauma Affects Self-Regulation, Self-Image, and the Capacity for Relationship
by Laurence Heller, Aline Lapierre
Childhood Disrupted: How Your Biography Becomes Your Biology, and How You Can Heal
by Donna Jackson Nakazawa, Callie Beaulieu
Complex PTSD: From Surviving to Thriving
by Pete Walker, Paul Brion
Adult Children of Emotionally Immature Parents: How to Heal from Distant, Rejecting, or Self-Involved Parents
by Lindsay C. Gibson
A couple of authors who write on healing from complex-PTSD or high ACE scores:
Beverly Engle
Deirdre Fey
Peter Levine
a book that deepened my understanding of the ACE (Adverse Childhood Experience) scores, how high ACE scores effect us (physically, emotionally, culturally) and ways to heal from said trauma.
What was offered: None of the above.
Look, I had some serious doubts when I was knee deep in this book and this Stanford trained Dr. was wailing about how so many of her clients (children from some of the most disadvantaged neighborhoods in the area) were struggling in a myriad of ways and she was utterly perplexed. The kind Dr. is announcing these issues as if she just could not remotely understand the cause or why it was happening.
This was perplexing because Vincent J Felitti MD and his team started the ACE study (on accident, which makes it even cooler) at Kaiser Permanente's obesity clinic in San Diego, California waaaay back in the 1980's. This is pretty well-covered ground in the medical field. I find it hard that a pediatric resident at Stanford in the 00's would not be aware of the ACE study? A huge part of this book is Dr. Burke Harris DISCOVERING something that the medical world has known about for over 30 years.
The rest of the book was a huge People article: what I wore, what things looked like, who was there, who invited me, why I went, why it was important, what I said, personal life antecdotes...
If you are interested in ACE's and their impact, and interested in developmental trauma, do not buy this book. It won't be of any use, unless you too have literally never heard of ACE scores or trauma.
These books are far superior (not by any means an exhaustive list):
The Body Keeps the Score: Brain, Mind, and Body in the Healing of Trauma
by Bessel Van der Kolk MD
Healing Developmental Trauma: How Early Trauma Affects Self-Regulation, Self-Image, and the Capacity for Relationship
by Laurence Heller, Aline Lapierre
Childhood Disrupted: How Your Biography Becomes Your Biology, and How You Can Heal
by Donna Jackson Nakazawa, Callie Beaulieu
Complex PTSD: From Surviving to Thriving
by Pete Walker, Paul Brion
Adult Children of Emotionally Immature Parents: How to Heal from Distant, Rejecting, or Self-Involved Parents
by Lindsay C. Gibson
A couple of authors who write on healing from complex-PTSD or high ACE scores:
Beverly Engle
Deirdre Fey
Peter Levine
February 7, 2018
Five stars , I guess , for the concept and the fact that this research has helped so many kids over the years .
one star for the misleading title : I was expecting more of a work book and tips. There were, I suppose , two of them hidden.
meditate and exercise .
one star for the misleading title : I was expecting more of a work book and tips. There were, I suppose , two of them hidden.
meditate and exercise .
June 6, 2023
This is a book everyone should read, but it is not necessarily an easy read. This brought back much of the pain I still keep tucked away.
Most people intuitively understand that unresolved childhood trauma can impact the mind and body of an individual. There's no surprise there. We know about the connection between trauma in childhood and risky behavior, alcoholism, drug addiction and eating disorders in adult life. What we are not aware of is that there is a connection between early life adversity and well-known killers like heart disease or cancer.
As an educator, I have spent time with a lot of children, and one thing I am certain of is children are very resilient. Whatever they may experience they naturally adapt to them. What Dr. Harris has done here is examine Adverse Childhood Experiences (ACE) which include:
1. Emotional abuse (recurrent)
2. Physical abuse (recurrent)
3. Sexual abuse (contact)
4. Physical neglect
5. Emotional neglect
6. Substance abuse in the household (e.g., living with an alcoholic or a person with a substance abuse problem)
7. Mental illness in the household (e.g., living with someone who suffered from depression or mental illness or who had attempted suicide)
8. Mother treating violently
9. Divorce or parental separation
10. Criminal behavior in the household (e.g., a household member going to prison)
The impact this can have on health (and other areas) in adult life is frightening. Contradicting Nietzsche ("What doesn't kill you, makes you stronger"), in the case of ACE, they may not immediately kill you, but make the individual physically weak by damaging health in the long run. The relationship between ACEs and poor health outcomes mean that the higher a person’s ACE score, the greater the risk to his or her health.
What I learned:
The diagnosis of toxic stress doesn’t yet exist in the medical literature.
Toxic stress has an impact on the child's brain. Children who experience multiple traumatic events (witnessing violence and suffering emotional, physical or sexual abuse), develop stress-response systems that alter from adaptive and lifesaving to maladaptive and health-damaging.
The research shows more symptoms a child had, the higher his/her cortisol levels were and the smaller the volume of his/her hippocampus.
If an infant does not have a caregiver’s reciprocal eye contact, stimulating facial expressions, snuggles, and kisses, hormonal and neurologic damage can occur, and that can prevent a child from growing and developing normally.
Our stress response system is carefully calibrated and highly individualized by both genetics and early experiences.
There is a strong connection between childhood abuse and household dysfunction and many leading causes of death in adults like heart disease and cancer. higher the ACE score, there is a higher risk in of developing autoimmune diseases such as arthritis, lupus or diabetes and an even greater risk of asthma, allergies, migraines, bronchitis, and ulcer (this is a long list).
Epigenetics are treatable, and the stress response can often be brought back under control through therapy, meditation, and exercise.
By taking the ACE test, adults will be able to understand their bodies and break the cycle by becoming effective shields for the next generation (their children).
Most people intuitively understand that unresolved childhood trauma can impact the mind and body of an individual. There's no surprise there. We know about the connection between trauma in childhood and risky behavior, alcoholism, drug addiction and eating disorders in adult life. What we are not aware of is that there is a connection between early life adversity and well-known killers like heart disease or cancer.
As an educator, I have spent time with a lot of children, and one thing I am certain of is children are very resilient. Whatever they may experience they naturally adapt to them. What Dr. Harris has done here is examine Adverse Childhood Experiences (ACE) which include:
1. Emotional abuse (recurrent)
2. Physical abuse (recurrent)
3. Sexual abuse (contact)
4. Physical neglect
5. Emotional neglect
6. Substance abuse in the household (e.g., living with an alcoholic or a person with a substance abuse problem)
7. Mental illness in the household (e.g., living with someone who suffered from depression or mental illness or who had attempted suicide)
8. Mother treating violently
9. Divorce or parental separation
10. Criminal behavior in the household (e.g., a household member going to prison)
The impact this can have on health (and other areas) in adult life is frightening. Contradicting Nietzsche ("What doesn't kill you, makes you stronger"), in the case of ACE, they may not immediately kill you, but make the individual physically weak by damaging health in the long run. The relationship between ACEs and poor health outcomes mean that the higher a person’s ACE score, the greater the risk to his or her health.
What I learned:
The diagnosis of toxic stress doesn’t yet exist in the medical literature.
Toxic stress has an impact on the child's brain. Children who experience multiple traumatic events (witnessing violence and suffering emotional, physical or sexual abuse), develop stress-response systems that alter from adaptive and lifesaving to maladaptive and health-damaging.
The research shows more symptoms a child had, the higher his/her cortisol levels were and the smaller the volume of his/her hippocampus.
If an infant does not have a caregiver’s reciprocal eye contact, stimulating facial expressions, snuggles, and kisses, hormonal and neurologic damage can occur, and that can prevent a child from growing and developing normally.
Our stress response system is carefully calibrated and highly individualized by both genetics and early experiences.
There is a strong connection between childhood abuse and household dysfunction and many leading causes of death in adults like heart disease and cancer. higher the ACE score, there is a higher risk in of developing autoimmune diseases such as arthritis, lupus or diabetes and an even greater risk of asthma, allergies, migraines, bronchitis, and ulcer (this is a long list).
Epigenetics are treatable, and the stress response can often be brought back under control through therapy, meditation, and exercise.
By taking the ACE test, adults will be able to understand their bodies and break the cycle by becoming effective shields for the next generation (their children).
March 10, 2019
Although the title is somewhat misleading (the author explains in great detail the adversity itself, not so much how to heal its effects decades later), the book was extremely enlightening and offered me a much deeper insight into the mind-body connection and how our early childhood experiences affect our biology and even our DNA. Our adverse childhood experiences impact our behavior, our ability to learn and our health, with some of the effects showing up much later in life. Studies show that a huge percentage of all the people on Earth have faced at least one toxic stress issue (Adverse Childhood Experience or ACE) and more than 10% have four or more of the possible ten stressors currently defined (Physical abuse, Sexual abuse, Emotional abuse, Physical neglect, Emotional neglect, Intimate partner violence, Mother treated violently, Substance misuse within household, Household mental illness, Parental separation or divorce, Incarcerated household member). ACEs have a dose-response relationship with many health problems. As researchers followed participants over time, they discovered that a person’s cumulative ACEs score has a strong, graded relationship to numerous health, social, and behavioral problems throughout their lifespan, including substance use disorders, auto-immune diseases, risky lifestyle behaviors, asthma, cancer, cardiovascular diseases, fibromyalgia, learning difficulties etc. Compared to an ACE score of zero, having four adverse childhood experiences was associated with a seven-fold (700%) increase in alcoholism, a doubling of risk of being diagnosed with cancer, and a four-fold increase in emphysema; an ACE score above six was associated with a 30-fold (3000%) increase in attempted suicide.
So yeah, although I wasn't really that much interested in Dr. Harris' detailed struggles to finance her clinic, I gained an immense amount of knowledge and I am deeply grateful for the chance to find at last some explanations for many issues which are troubling most of us (and which, if not taken care of, could trouble our kids in the future). Her writing style was delightful, the anecdotes she told were just enough to spice up the scientific issues she was illuminating, and her narration was excellent.
So yeah, although I wasn't really that much interested in Dr. Harris' detailed struggles to finance her clinic, I gained an immense amount of knowledge and I am deeply grateful for the chance to find at last some explanations for many issues which are troubling most of us (and which, if not taken care of, could trouble our kids in the future). Her writing style was delightful, the anecdotes she told were just enough to spice up the scientific issues she was illuminating, and her narration was excellent.
February 7, 2018
A must-read for anyone who cares about children and the future of our society!! Thanks to Dr. Burke Harris's engaging storytelling, this was a book that I literally could not put down.
January 21, 2023
A topic very near and dear to my heart as I try to overcome the childhood adversity and adverse childhood experiences I experienced myself. I was only barely aware of adverse childhood experiences (ACEs) prior to reading Hillbilly Elegy by J. D. Vance, and being only one generation removed from ‘the hills’ myself, realized there was a lot I once thought was ‘normal’ for children that was not, in fact, normal. Whereas ACEs were only briefly addressed in Vance’s autobiography of childhood adversity, Dr. Harris lays them out in great detail and layman’s terms, and the implications of ACEs and toxic/dysregulated stress responses on adults. Suddenly many of the diagnoses that I have make a lot more sense than simply ‘bad luck,’ mysterious and poorly understood ‘brain chemical imbalances,’ or autoimmunity issues from an immune system constantly on overdrive. It has also helped me to recognize these potentials in my own patients, family members, and the relatively serious health risks posed by ACEs that carry on into adulthood. Before learning about ACEs and dysfunctional families, I wouldn’t have been able to tell you (and you wouldn’t have been able to convince me) that my childhood wasn’t normal. It is only in the last couple years (I am 33 at the time of this reading), that I have revisited my past and came to question many of the things I thought were ‘normal’ in childhood. I hope that someday, despite my loss of neuroplasticity, that I will be better able to regulate my stress, recognize and mitigate the effects of ACEs and childhood adversity, and lower my future health risks, many of which are shockingly severe and more likely from having been a victim of my past.
Second reading in 2023: I’ve completed EMDR therapy and revisited this book. My life is almost completely different than it was compared to when I first read this. I would hardly call myself anxious at all anymore, which I wouldn’t have been able to imagine when I first read this book. I don’t have a poisonous internal monologue telling me all the potential ways that I could, or currently am failing to live up to some impossible standard poisoning my thoughts. I’ve finally been able to overcome the adversity of my childhood and reprocess the traumatic memories of my childhood, to which I owe a debt to this book an others like ‘The Body Keeps the Score.’
So how does the book measure up four years later?It’s still an excellent book, though I wish the author elaborated more on steps that adults can take to mitigate toxic stress and their own dysregulated stress response from ACEs in more detail. However, I understand that isn’t the focus of the book, and the focus of the book is on children. I’ve since given away at least a dozen copies of this book, pretty much to anyone I know who will read it as well as patients on the Behavioral Health Unit that I work on who either think they could benefit from it and can’t finish it in the duration that they are there, or don’t have the energy/mental wherewithal to read it during their stay. I wish there was a better book targeted towards adult solutions out there, but I am unaware of it at this point. I’ll keep looking, but until then I’ll still keep screening people for ACEs and recommending that they read The Deepest Well to better understand themselves and how to mitigate the damage wrought by childhood adversity.
Second reading in 2023: I’ve completed EMDR therapy and revisited this book. My life is almost completely different than it was compared to when I first read this. I would hardly call myself anxious at all anymore, which I wouldn’t have been able to imagine when I first read this book. I don’t have a poisonous internal monologue telling me all the potential ways that I could, or currently am failing to live up to some impossible standard poisoning my thoughts. I’ve finally been able to overcome the adversity of my childhood and reprocess the traumatic memories of my childhood, to which I owe a debt to this book an others like ‘The Body Keeps the Score.’
So how does the book measure up four years later?It’s still an excellent book, though I wish the author elaborated more on steps that adults can take to mitigate toxic stress and their own dysregulated stress response from ACEs in more detail. However, I understand that isn’t the focus of the book, and the focus of the book is on children. I’ve since given away at least a dozen copies of this book, pretty much to anyone I know who will read it as well as patients on the Behavioral Health Unit that I work on who either think they could benefit from it and can’t finish it in the duration that they are there, or don’t have the energy/mental wherewithal to read it during their stay. I wish there was a better book targeted towards adult solutions out there, but I am unaware of it at this point. I’ll keep looking, but until then I’ll still keep screening people for ACEs and recommending that they read The Deepest Well to better understand themselves and how to mitigate the damage wrought by childhood adversity.
February 15, 2018
Here's the thing: there's not nearly as much about "healing" as there are about "causes". So the title is misleading.
July 22, 2018
Standing ovation for Dr. Burke Harris. For retaining, trusting, and pursuing common sense and gut feelings even when the research wasn't there (yet). For avoiding the fallacy that years of education and multiple advanced degrees hold all there is to know. For remaining a curious and passionate learner, investigator, and questioner of even her own knowledge - allowing her to see what others had concluded to be final diagnoses as symptoms of something much deeper. For humbly seeking out a community with whom to join forces and standing firm when many were inhospitable to the consideration of adverse childhood events (ACEs) in medicine. Dr. Burke Harris makes the science more than accessible, writing with a blend of gravity and lightheartedness that is invigorating. This book was a series of "Aha!" moments as she so clearly delineated the physiologic effects of toxic stress - down to the cellular and synaptic level - and its manifest symptoms that are misinterpreted on an hourly basis in doctors' offices the world over. Dr. Burke Harris manages to discuss every kind of taboo adversity with empathy and grace, using the hard logic of science to free people from emotional burdens of confusion and shame - equipping them with knowledge and the tools to break cycles of toxic stress and heal from ACEs. This content is important. And it is not just applicable to a subset of the population - we are all involved. To better understand public health crises, to better understand education crises, to increase your understanding of humanity - read this book.
September 21, 2019
When statistics have faces they feel a lot heavier. p122
Even a brief look at the statistics would give anyone reason to think this will be a heavy book. The enormity of the problem is staggering. But the remarkable Nadine Burke Harris has given us blueprint of possibilities and her book, as troubling as it, is infused with optimism and joie de vivre. Herself having grown up in adversary, she is definitely a woman with a mission, with the courage to speak truth and not only an inspiration to everyone who encounters her, but also a resource for the countless individuals, families, and entire communities who have and will benefit from her work.
The focus goes beyond behavioural or mental health outcome. p34
It was NBH's sensitivity that aroused her interest in finding a pattern among predictable sets of problems in the chaotic neighbourhood in which the clinic was situated. When she factored in the chaos and made the obvious conclusions, she was on to something. Among the sparse literature on the subject of the impact of childhood adversary on current behaviour and future health risks, she found one study that became a cornerstone for her work to improve the lives of her patients. The researchers gave a simple 10 point questionnaire to be included on all admissions and new patient charts. You will have to read the book to get the whole lowdown, and until then you can find her on YouTube. It was no surprise to me that she is a confident and fiery speaker. We need be thankful that she chose to become a doctor and tireless advocate rather than an actress or supermodel.
Personally, I am not a big fan of the Western medical model and I deplore the mass drugging of the nations by big Pharma. I am wary of most interventions that require a daily dosage, and of people in authority that do not take my interests into consideration. Dr. Burke Harris , with her wise and compassionate approach, blows open the vacuum in the heart of the current system, with its focus on symptoms and diagnosis out of context of the patients circumstances.
One of the surprises revealed by what is referred to here as the ACE test is that trauma is indifferent to race, class, and what part of town. Witnessing or being a subject of violence, constant emotional abuse, raging, absent, indifferent or appalling parents, or parents whose loving attention is twisted by alcohol: these are among the ACE questions to be answered with a check beside yes or no. If yes, its most likely that the cascade of chemicals released in the brain under trauma will set off a chain reaction. The more severe and repeated the trauma, the more embedded the dysfunction this can cause. DR NBH's prescription is multifaceted and includes mindfulness meditation and nutrition and hinges on the buffer of a caring adult for children under threat. Poverty does of course exacerbate a bad situation; but a bad situation is unfortunately what an increasing number of children are born into.
In giving this book a 5 I am aware of my standard: can this book live on a shelf with Dostoevsky and Virgina Woolf? I can only think they might have benefited from it.
June 11, 2018
I found this book quite informative. It explains how adversities during childhood can actually form your mental health, and affect your physical health. if you are looking for a book that goes into great detail about childhood adversities, I highly recommend this.
November 26, 2023
I give up. DNF at 30%.
Fist, the title of this book is misleading. I almost didn't check it out at all because the title made is sound like some kind of new-agey self-help workbook. Our library website provided a more detailed description that implied the book was about the Adverse Childhood Experiences (ACEs) research conducted by Kaiser and the CDC that link long term health conditions and early death with extreme early childhood abuse/neglect. Unfortunately, that wasn't an accurate description either.
I really don't know what this is. I expected science, if not a history of the ACEs studies (there were hundreds of them after the most famous Kaiser-CDC one), then at least an objective and factual synthesis of the pertinent data and some insight into how that data might be used to create public policy or improve healthcare. This book is...memoir? There's barely a sentence in the first 30% that doesn't contain the words I, me, my, mine. A third of the way into the book, and she's just now mentioning the Kaiser-CDC studies and expressing surprise that she didn't know about them. Up to the point of the book when I just gave up in annoyance, she's been talking about herself, her clinic, her past, her clinic's wallpaper (not kidding), and teasing this surprise connection between her patients' health and environment as if it's some major epiphany that only she ever has had.
The author finally (finally!) asks a rhetorical question of why she never heard of the Kaiser studies in med school. An excellent question. I don't work in any related field, but I've known about those studies since the early 2000s. For that matter, I remember attending lectures on the subject in my undergrad classes which were prior to the big CDC studies. This info didn't fall out of the sky from nowhere in the 2000s, nor did she "discover" it.
In any event, 1/3 of the book is more than enough to get to the point -- ANY point -- and stop talking about the clinic wallpaper or how she talks to herself in Jamaican or an overly-detailed description of her clinic's male therapist. Yes, it's lovely that he looks like Chris Pine and dresses like a model. It's also irrelevant. (And if a male author had written a description of that tone about a female coworker, it would be tagged as sexist and inappropriate.)
There has to be a better book on this subject out there. I'm baffled by the high ratings for this one. It's not informative about science, and it's certainly not interesting as a memoir.
_______________________
Note: I don't usually mark DNFs as read unless I get more than 30% into it. I will sometimes give a rating to DNFs if I feel they are particularly poorly written or annoying.
Fist, the title of this book is misleading. I almost didn't check it out at all because the title made is sound like some kind of new-agey self-help workbook. Our library website provided a more detailed description that implied the book was about the Adverse Childhood Experiences (ACEs) research conducted by Kaiser and the CDC that link long term health conditions and early death with extreme early childhood abuse/neglect. Unfortunately, that wasn't an accurate description either.
I really don't know what this is. I expected science, if not a history of the ACEs studies (there were hundreds of them after the most famous Kaiser-CDC one), then at least an objective and factual synthesis of the pertinent data and some insight into how that data might be used to create public policy or improve healthcare. This book is...memoir? There's barely a sentence in the first 30% that doesn't contain the words I, me, my, mine. A third of the way into the book, and she's just now mentioning the Kaiser-CDC studies and expressing surprise that she didn't know about them. Up to the point of the book when I just gave up in annoyance, she's been talking about herself, her clinic, her past, her clinic's wallpaper (not kidding), and teasing this surprise connection between her patients' health and environment as if it's some major epiphany that only she ever has had.
The author finally (finally!) asks a rhetorical question of why she never heard of the Kaiser studies in med school. An excellent question. I don't work in any related field, but I've known about those studies since the early 2000s. For that matter, I remember attending lectures on the subject in my undergrad classes which were prior to the big CDC studies. This info didn't fall out of the sky from nowhere in the 2000s, nor did she "discover" it.
In any event, 1/3 of the book is more than enough to get to the point -- ANY point -- and stop talking about the clinic wallpaper or how she talks to herself in Jamaican or an overly-detailed description of her clinic's male therapist. Yes, it's lovely that he looks like Chris Pine and dresses like a model. It's also irrelevant. (And if a male author had written a description of that tone about a female coworker, it would be tagged as sexist and inappropriate.)
There has to be a better book on this subject out there. I'm baffled by the high ratings for this one. It's not informative about science, and it's certainly not interesting as a memoir.
_______________________
Note: I don't usually mark DNFs as read unless I get more than 30% into it. I will sometimes give a rating to DNFs if I feel they are particularly poorly written or annoying.
April 30, 2020
This is not a self- help book, which is what some reviewers seem to have been expecting when they started it. It's a very accessibly written review of the science of Adverse Childhood Experiences and one pediatrician's process for becoming an advocate for medical professionals having a fuller view of their patients.
The audiobook is read by the author.
****
I read this to help a friend of mine prep a course for PNP students. Here are some of the reflective questions that I came up with for discussion:
NBH talked about her frustration related to finding out about the importance of ACEs on her own because her training focused on going through established protocols that were focused on biological functioning. Talk about the tension between “following the script” versus taking time to hear more about your patients’ lives and experiences.
Refine your current definition of patient resistance through an individual and community trauma lens.
What are some ways that medical professional may be seen as “bears in the forest?”
NBH reflects on how living with an unpredictable mother helped her develop a superpower related to being attuned to nonverbal cues in a situation. If you think back to your own early life, what superpowers did you develop through adversity?
Throughout the book, NBH identifies different partners in her work with children and ACEs. Who were the important partners and how would you build a team in an ideal practice?
The audiobook is read by the author.
****
I read this to help a friend of mine prep a course for PNP students. Here are some of the reflective questions that I came up with for discussion:
NBH talked about her frustration related to finding out about the importance of ACEs on her own because her training focused on going through established protocols that were focused on biological functioning. Talk about the tension between “following the script” versus taking time to hear more about your patients’ lives and experiences.
Refine your current definition of patient resistance through an individual and community trauma lens.
What are some ways that medical professional may be seen as “bears in the forest?”
NBH reflects on how living with an unpredictable mother helped her develop a superpower related to being attuned to nonverbal cues in a situation. If you think back to your own early life, what superpowers did you develop through adversity?
Throughout the book, NBH identifies different partners in her work with children and ACEs. Who were the important partners and how would you build a team in an ideal practice?
July 2, 2018
Profound.
It's the key to understanding your challenges, your parents' challenges, and a brilliant and compassionate insight into how our bodies and brains work - no tear jerking, no pity, no pathologizing anyone. Simply an honest and educational look at how divorce, violence, verbal abuse, and many other stressful parts of our collective childhoods affect how we form attachment, manage stress and self regulate. I want to give this to everyone I know and start a discussion.
It's the key to understanding your challenges, your parents' challenges, and a brilliant and compassionate insight into how our bodies and brains work - no tear jerking, no pity, no pathologizing anyone. Simply an honest and educational look at how divorce, violence, verbal abuse, and many other stressful parts of our collective childhoods affect how we form attachment, manage stress and self regulate. I want to give this to everyone I know and start a discussion.
June 17, 2020
“If one hundred people all drink from the same well and 98 of them develop diarrhea, I can write prescription after prescription for antibiotics, or I can stop and ask, ‘What the hell is in this well?’”
With this statement, Dr. Nadine Burke Harris stresses a fundamental concept that I hope to carry with me as a future physician: treat the underlying problems, not just the symptoms. It is a concept that also makes up the heart of her book, The Deepest Well.
The term “ACEs” has been around since the 1990s to describe adverse child experiences. Studies done in the 90s indicated that there is a strong correlation between a child’s exposure to traumatic experiences and their likelihood of developing certain diseases in adulthood, and that 67% of the population has at least 1 ACE. What was new about this book, and Dr. Harris’s work, is relating ACEs to the biological effects of toxic stress on children - and outlining tangible ways the medical community can start to take these effects into account in practice to change the outcomes of children with high ACE scores.
For people who have studied biology, much of what Dr. Harris explains regarding the biological mechanisms of stress is very familiar. Even so, she manages to keep this interesting for all readers with her colorful analogies and anecdotes (at one point, Dr. Harris compares the role of the immune system to the jobs of the Secretary of State and Defense rolled into one). (And if you’re not well-versed in the biological mechanisms of stress, even better. She explains it beautifully.) Dr. Harris is funny, relatable, and persistent in her commitment towards her cause, which comes across clearly in the book (also, she’s just a badass, inspiring, female physician - who doesn’t love that??).
I found the true strength of this book to be Dr. Harris’s deep commitment to her patients and to making change. She works to get the perspective of pediatricians, psychiatrists, therapist, social workers, teachers, and parents (among others) when treating her patients. This is the future of medicine. Her vision is of a future where ACEs screenings are done in every physicians office, and awareness of ACEs is incorporated into teacher training as well.
Not everyone in the medical community will believe in ACEs screenings the way Harris does. And she details some of this struggle in the book, and there is still much work to be done. But our health systems now incorporate PKU, sickle cell, and red reflex examinations (among other tests) in the newborn screenings because people fought to get them there. Mental health screenings are becoming common practice at physicians’ offices because the importance of these screenings was realized. In the same way, I have no doubt that in 5, 10, maybe 15 years (as more research is done and tangible implementation practices are developed), ACEs screenings will become common practice in pediatricians’ offices. By emphasizing the biological mechanisms underlying toxic stress, Harris makes a compelling case for how early intervention can make all the difference in the life of a child.
With this statement, Dr. Nadine Burke Harris stresses a fundamental concept that I hope to carry with me as a future physician: treat the underlying problems, not just the symptoms. It is a concept that also makes up the heart of her book, The Deepest Well.
The term “ACEs” has been around since the 1990s to describe adverse child experiences. Studies done in the 90s indicated that there is a strong correlation between a child’s exposure to traumatic experiences and their likelihood of developing certain diseases in adulthood, and that 67% of the population has at least 1 ACE. What was new about this book, and Dr. Harris’s work, is relating ACEs to the biological effects of toxic stress on children - and outlining tangible ways the medical community can start to take these effects into account in practice to change the outcomes of children with high ACE scores.
For people who have studied biology, much of what Dr. Harris explains regarding the biological mechanisms of stress is very familiar. Even so, she manages to keep this interesting for all readers with her colorful analogies and anecdotes (at one point, Dr. Harris compares the role of the immune system to the jobs of the Secretary of State and Defense rolled into one). (And if you’re not well-versed in the biological mechanisms of stress, even better. She explains it beautifully.) Dr. Harris is funny, relatable, and persistent in her commitment towards her cause, which comes across clearly in the book (also, she’s just a badass, inspiring, female physician - who doesn’t love that??).
I found the true strength of this book to be Dr. Harris’s deep commitment to her patients and to making change. She works to get the perspective of pediatricians, psychiatrists, therapist, social workers, teachers, and parents (among others) when treating her patients. This is the future of medicine. Her vision is of a future where ACEs screenings are done in every physicians office, and awareness of ACEs is incorporated into teacher training as well.
Not everyone in the medical community will believe in ACEs screenings the way Harris does. And she details some of this struggle in the book, and there is still much work to be done. But our health systems now incorporate PKU, sickle cell, and red reflex examinations (among other tests) in the newborn screenings because people fought to get them there. Mental health screenings are becoming common practice at physicians’ offices because the importance of these screenings was realized. In the same way, I have no doubt that in 5, 10, maybe 15 years (as more research is done and tangible implementation practices are developed), ACEs screenings will become common practice in pediatricians’ offices. By emphasizing the biological mechanisms underlying toxic stress, Harris makes a compelling case for how early intervention can make all the difference in the life of a child.
August 15, 2023
What might learning problems, ADHD, asthma, obesity, and cardiovascular disease have in common. Nadine Burke Harris, building on Fellitti et al. (1998), notes that these superficially unrelated physical and psychological problems are related to a series of Adverse Childhood Experiences (e.g., child abuse and neglect; having a parent in prison, with a psychiatric disorder or abusing substances; domestic violence or divorcing parents).
Problems associated with adverse childhood experiences (ACE). Source: advokids
Burke Harris argues that there should be universal screening for ACEs, as this would allow us to make effective diagnoses (that "ADHD" is, instead, a trauma response). It would also enable us to intervene effectively:
Take the ACE quiz. Adversity transcends race, class, gender, and country.
Problems associated with adverse childhood experiences (ACE). Source: advokids
Burke Harris argues that there should be universal screening for ACEs, as this would allow us to make effective diagnoses (that "ADHD" is, instead, a trauma response). It would also enable us to intervene effectively:
1. Reduce trauma"You shift the frame, you change the lens, and all at once the world is revealed, and nothing is the same" (p. 212).
2. Strengthen the caregiver's ability to be a healthy buffer
3. Teach strategies that can "reset" the stress response and heal a person (sleep, exercise, mindfulness, healthy relationships, challenge irrational thinking, etc.)
Take the ACE quiz. Adversity transcends race, class, gender, and country.
March 5, 2024
been wondering where i’ve seen this author’s work before; i was sure i read something else by her, but no it was a tedtalk! probably the tedtalk that stuck with me the most after college. changed the way i think about + interact with children, and sparked a deep interest in developmental psychology. i’m so glad to see she’s written a book further elaborating her theories. a great read, and although i understand the value of anecdotal experiences, i wish this book leaned more into biological/scientific explanations.
June 15, 2023
This book left me in tears at multiple points but it also has encouraged and excited me to think about my own approach to teaching. I work at a Title 1 school but so many of my students "not from a poor background or rough neighborhood" have an ACE score of at least 1 and I can see it in a million ways. I was caught off guard by the mis diagnosis of ADHD in students with toxic stress. More than anything this book makes me want to hug my students, breathe with them, and then go to recess but also hug myself, breathe and go for a walk. (Also the author is Jamaican so pop off!!)
February 12, 2023
The research content of this book is so incredibly interesting. I was so investing in seeing why and how childhood adversity has such long term affects. However, that content is mixed in with a lot of fluff and filler. This book is written with far too much personal explanation, almost more written as a leadership or biography book than informational. I found myself constantly wanting the author to get to the point of the problem and ways we can work to healing. Overall, I still think this book is worth the read for those trying to learn more about the effects of childhood adversity, it just wasn’t my favorite.
March 9, 2019
the study of adverse childhood events (ACEs) on long-term health is a fascinating and important realm of medicine. burke harris's book does a good job unpacking the idea and sharing real-life examples, and the science behind how the body is actually affected on cellular levels (not just the 'it's all in your head' dismissal so many people hear). but the book falls short in its lack of guidance for actual 'healing'. burke harris clearly notes the keys to improved outcomes that can be taught and implemented for parents and young children in the midst of ACE trauma - which was helpful to read about. for adults (and, more specifically, adults who are not parents/parenting) struggling with long-term effects of ACEs, though, there is little on offer. i can see burke harris expanding the ideas of this book into a very useful workbook-type edition, with exercises and worksheets to support healing (like the CBT-based, terribly named Mind Over Mood, Second Edition: Change How You Feel by Changing the Way You Think) - that would be cool.
September 24, 2019
What a confusing book. I would be more forgiving if it were billed as a memoir about a pioneer in ACE care provision. But the title leads one to believe that the author will be discussing ways to heal the long term effects of childhood adversity. She does give us six ways (sleep, exercise, mental health, nutrition, mindfulness, and healthy relationships) but they are buried in stories of fundraising, dinner parties, conferences, etc.
This book will be useful for health professionals who are seeking the path to provide ACE programs but it wasn’t helpful for a person suffering with ACES seeking a path to wellness. For that, I suggest Childhood, Disrupted but Donna Jackson Nakazawa.
This book will be useful for health professionals who are seeking the path to provide ACE programs but it wasn’t helpful for a person suffering with ACES seeking a path to wellness. For that, I suggest Childhood, Disrupted but Donna Jackson Nakazawa.
February 24, 2022
An interesting and condemning look at the effects and potential solutions of childhood adversity.
I thought it would be more clinical and less storytelling. I was hoping for a slightly more “public health” oriented book.
I think one of my newest pet peeves after having read a fair amount of trauma literature; trauma books like this that talk about how terrible the effects of trauma are without talking about what people can do to get better. It’s like writing a book about the dangers of quicksand without talking about how to get out of quicksand. At some point it’s just empty handwringing.
I thought it would be more clinical and less storytelling. I was hoping for a slightly more “public health” oriented book.
I think one of my newest pet peeves after having read a fair amount of trauma literature; trauma books like this that talk about how terrible the effects of trauma are without talking about what people can do to get better. It’s like writing a book about the dangers of quicksand without talking about how to get out of quicksand. At some point it’s just empty handwringing.
June 25, 2020
I am thoroughly convinced that Dr. Nadine Burke Harris and her work are bringing about the next revolution in medicine, public health, education, and beyond. I am so grateful that I found this book; it so perfectly showed me an intersection of my passions for education, pediatric medicine, and social justice issues. Dr. Burke Harris has such a firm understanding of the neuroscience behind toxic stress and can describe it in such an accessible way. I think I found my new professional crush...
February 17, 2019
It makes so much sense that childhood adversity can cause health issues in childhood and later in adulthood. I get it. Childhood adversity is a problem that affects children (and later adults) in all walks of life. The ace score will definitely be on my mind as I work with children and their families. Well done!
March 28, 2018
Favorite book of the year so far. ACE's impacts us all and their impacts are astonishing. I talked to my doctor (and my children's doctor) about the work and they had not heard of it...which surprised me and it didn't...i'm going to help spread this gospel.
June 16, 2022
I recognised Dr. Burke Harris’ name from a TED talk I had watched during my undergraduate psychology degree. Her clear passion for understanding the psychological, but also physical effects of adverse childhood experiences was fascinating, and this book was a continuation of that. The ACEs questionnaire, of which most of her work (clinical and research) is founded on is a screening tool used to determine an individuals risk of a variety of conditions. For instance, the initial study by Fellitti and colleagues found that a person with 4 or more ACEs was twice as likely to develop heart disease, cancer and three and a half times more likely to develop COPD and obesity than a person with 0 ACEs. Further, a person with 4 ACEs are 32.6 TIMES MORE LIKELY TO HAVE BEEN DIAGNOSED WITH ADHD AND BEHAVIOURAL PROBLEMS. Another fascinating finding was that ACEs are not common, in fact the initial and subsequent studies found that approximately 67% of the population had at least one category, and 12.6% had four or more categories (and this was in a primarily white, educated, middle class sample).
One may wonder why ACEs are liked to physical health outcomes, and while researchers are still determining a clear link a lot of it has to do with the effects of ‘toxic stress’. Namely, childhood adversity can trigger chronic inflammation and hormonal changes, which alter the way DNA is read and how cells replicate (in essence, stress influences epigenetics; fascinating stuff). There is also a disruption of feedback inhibition, which means that instead of shutting the supply of stress when a certain point is reached, cortisol is continuously blasted through the body.
Ways of using this research to the benefit of others:
- Primary care doctors should screen for ACEs and have easy access to mental-health services (something that is nearly impossible at this time in Australia). When screening it is not necessary to get into detail in regards to ACEs, you may ask the patient to list how many they experienced without ticking which ones. Through screening and normalising ACEs we can provide a way for individuals to do something about it.
- Working with a multidisciplinary team is also termed ‘team-based care’ is best practice. This allows each healthcare professional to focus on their unique job without wearing too many hats. For example, a primary care doctor can focus on screening and the physical components, while referring to mental health services, or nutrition services when necessary.
- CPP (child parent psychotherapy) is an excellent method for dealing with childhood trauma, especially with young children and babies (yes babies need treatment too even if they don’t remember the trauma). CPP takes into consideration all of the pressures that both child and parent have to deal with. This allows patients to make connections between traumas of their past and the stressors of their present, so they can better recognise their triggers and manage their symptoms. In essence, the quality of the relationship and health of the attachment between patient and child is fundamental to well-being. (Look up Dr. Lieberman for more).
- Early intervention is always better when it comes to toxic stress, if it is screened early intervention more effectively rewire the brain (when synaptic and cellular plasticity are highest) to prevent stress responses from becoming dysfunctional. However, the good news is that hormonal changes occurring in adolescence and new parenthood open up new windows that are believed to be sensitive periods.
One may wonder why ACEs are liked to physical health outcomes, and while researchers are still determining a clear link a lot of it has to do with the effects of ‘toxic stress’. Namely, childhood adversity can trigger chronic inflammation and hormonal changes, which alter the way DNA is read and how cells replicate (in essence, stress influences epigenetics; fascinating stuff). There is also a disruption of feedback inhibition, which means that instead of shutting the supply of stress when a certain point is reached, cortisol is continuously blasted through the body.
Ways of using this research to the benefit of others:
- Primary care doctors should screen for ACEs and have easy access to mental-health services (something that is nearly impossible at this time in Australia). When screening it is not necessary to get into detail in regards to ACEs, you may ask the patient to list how many they experienced without ticking which ones. Through screening and normalising ACEs we can provide a way for individuals to do something about it.
- Working with a multidisciplinary team is also termed ‘team-based care’ is best practice. This allows each healthcare professional to focus on their unique job without wearing too many hats. For example, a primary care doctor can focus on screening and the physical components, while referring to mental health services, or nutrition services when necessary.
- CPP (child parent psychotherapy) is an excellent method for dealing with childhood trauma, especially with young children and babies (yes babies need treatment too even if they don’t remember the trauma). CPP takes into consideration all of the pressures that both child and parent have to deal with. This allows patients to make connections between traumas of their past and the stressors of their present, so they can better recognise their triggers and manage their symptoms. In essence, the quality of the relationship and health of the attachment between patient and child is fundamental to well-being. (Look up Dr. Lieberman for more).
- Early intervention is always better when it comes to toxic stress, if it is screened early intervention more effectively rewire the brain (when synaptic and cellular plasticity are highest) to prevent stress responses from becoming dysfunctional. However, the good news is that hormonal changes occurring in adolescence and new parenthood open up new windows that are believed to be sensitive periods.
July 18, 2020
UNBELIEVABLY IMPORTANT BOOK TO READ if you're in education (or just a human being in this crazy world).
I'd heard of the ACEs (Adverse Childhood Experiences) test or scores but OMG I just had no idea that the premise is that ACEs can cause toxic stress and impact our biology--our neurological system, immune system, hormonal system, cardiovascular system, even how our body reads our DNA-- in ways that we are not fully in control of especially without a network of support. This in turn can impact life choices that we make as children, adolescents, adults and our ability to function in society.
Dr. Nadine Burke Harris, currently the first surgeon general of CA and the author, is brilliant in how she has organized this book. There are lots of stories to draw us in and make us want to read more, but she also explains the scientific research and the science in a reader-friendly way. The driving narrative is the growth in her own understanding of this issue and her pursuit of bringing this information to the world.
Dr. Harris makes the argument that ACEs is not about a certain group of people - poor, people of color, etc. It's a global issue, an issue that is pervasive in all communities. Even as I was sharing what I was learning with friends, I was shocked when two of them paused and said, "That's me. I probably have a high ACEs score." SHOCKED.
BUT we can help. I was worried that Dr. Harris's "prescription" would be out of bounds for me. I mean I'm not able to set up a clinic with the type of care the Center for Youth Wellness, but I finished the book feeling like I could contribute to the welfare of people in my community who struggle because of toxic stress.
This is a book that's transformed my world and will influence my work with educators and children in the schools.
I'd heard of the ACEs (Adverse Childhood Experiences) test or scores but OMG I just had no idea that the premise is that ACEs can cause toxic stress and impact our biology--our neurological system, immune system, hormonal system, cardiovascular system, even how our body reads our DNA-- in ways that we are not fully in control of especially without a network of support. This in turn can impact life choices that we make as children, adolescents, adults and our ability to function in society.
Dr. Nadine Burke Harris, currently the first surgeon general of CA and the author, is brilliant in how she has organized this book. There are lots of stories to draw us in and make us want to read more, but she also explains the scientific research and the science in a reader-friendly way. The driving narrative is the growth in her own understanding of this issue and her pursuit of bringing this information to the world.
Dr. Harris makes the argument that ACEs is not about a certain group of people - poor, people of color, etc. It's a global issue, an issue that is pervasive in all communities. Even as I was sharing what I was learning with friends, I was shocked when two of them paused and said, "That's me. I probably have a high ACEs score." SHOCKED.
BUT we can help. I was worried that Dr. Harris's "prescription" would be out of bounds for me. I mean I'm not able to set up a clinic with the type of care the Center for Youth Wellness, but I finished the book feeling like I could contribute to the welfare of people in my community who struggle because of toxic stress.
This is a book that's transformed my world and will influence my work with educators and children in the schools.
January 3, 2023
I think this is a must read for everyone. The book talks about childhood adversity and how it intersects with medical care. She focuses on bringing awareness of the problem along with advocating for the implementation of the “adverse childhood experiences” ACE test more widely among the medical field to help when individuals and kids go to doctor. I feel this book was easy to read and understand and had good storytelling.
April 11, 2021
It has been a long time since I read a book cover to cover in one day - this was deserving of such an honor! Passionately and factually written, it serves as an excellent reminder to the impact ACEs have on our society as a whole.
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