Adverse childhood experiences (ACEs) such as abuse, neglect, mental illness in the household, loss of caregiver, homelessness and bullying have long been known as toxic to the developing child. But no one understood the full effects and possible healing before Dr. Harris entered the scene. A pediatrician with a master’s in public health from Harvard, working in a rough neighborhood of San Francisco, she implemented basic care where there had been only one doctor for over ten thousand children.
But she was puzzled. Why did that community, where she saw marvelous families struggling mightily, have such a dramatically reduced life expectancy? Why was a child raised there 2 ½ times more likely to develop pneumonia than a child in a wealthier area, and 6 times as likely to develop asthma? Why would serious health problems plague these children into adulthood? She eloquently describes distress over her patients: “At the beginning, they are equal, these beautiful bundles of potential, and knowing that they won’t always be is enough to break your heart.”
Her crystal-clear writing can be humorous too: “like a soap-opera wife whose husband was stepping out with the nanny, I would understand it only in hindsight.” Most people know that the human stress response has helped the species survive, cueing the first people to run when the lion roared. Cortisol helped the body by increasing blood sugar so the brain could think and inhibiting growth and reproduction during food shortages. But children exposed to high doses of stress have “overloaded systems” which can cause long-range health problems and significantly shorter life spans.
This attempt to describe complex processes in a short space with accessible language obviously has its limits, and should nudge the reader to the original text, which reads like a fascinating mystery. With sheer delight, Dr. Harris found exhaustive research done in 1998, linking ACEs to the leading causes of death in adults. Children who experience prolonged adversity and terrifying situations have a de-regulated, near-constant blast of cortisol, or in Harris’ metaphor: “the body’s stress thermostat is broken” and the brain shows measurable changes. The best intervention? An adult caregiver, who serves as a buffer and in many cases, needs therapy as well.
With high energy, Harris relates how she and her team created an ACE screening (which she hopes every doctor will require for every routine physical). They learned how effective it was to talk about the trauma, even with very young children, to avoid their creating an explanation that blamed themselves. The best therapy treats parent and child as a team: child-parent psychotherapy (CPP). This treatment has tremendous effect, as did other interventions Harris explains: in mindfulness, sleep, exercise, nutrition and healthy relationships. Because of her success, the book is joyful: scientific detectives can make enormous improvements in peoples’ lives, especially those who need it most.
But she also tells painful stories, her personal experiences and those of her patients. She pleads for a conversation on ACEs and the courage to implement change. Harris is not only brilliant and heroic, but grounded in reality: the daughter of a Jamaican doctor and mother of four boys. She contributes a splendid voice towards efforts for a more just and healthy world.