BOOK REVIEW

The Deepest Well: Healing the Long-Term

Effects of Childhood Adversity
by Nadine Burke Harris, MD
Review by Melvin Belsky, MD1 Perm J 2019;23:18-075
E-pub: 02/22/2019 https://doi.org/10.7812/TPP/18-075

and includes illustrative case descrip-

Not only will men of science have to grapple
tions and experiences, with creative
with the sciences that deal with man, but—and this is explanations of often complex medi-
a far more difficult matter—they will have to persuade cal concepts. The recounting of indi-
the world to listen to what they have discovered. vidual patient stories is powerful and
If they cannot succeed in this difficult enterprise, effective, and told with the kindness
man will destroy himself by his halfway cleverness. and gentleness they deserve. They are
— Bertrand Russell 1872-1970 revealing and instructive of the many
lessons to be learned.
Burke Harris is bright, well in-
Hungarian-born physician, Hans Selye (1907-1982), first formed, caring and authentically
“discovered” and described the necessity of physiologic stress for committed to using her newfound
maintenance of homeostasis.1 His studies led him to develop, understandings to minimize the de-
for the first time in medical literature, the concept of the Gen- structive, negative consequences of
eral Adaptation Syndrome as the first neurohormonal model of ACEs within her large community New York, NY: Houghton Mifflin
physiologic stress implicating pituitary and adrenal function in pediatric practice in San Francisco, Harcourt, 2018
the etiology of many chronic diseases, and the associated sickly CA. Her commitment to the broader ISBN-10: 0544828704
ISBN-13: 978-0544828704
appearance of those suffering from chronic illness. The concept community is evident. Her efforts at
Hardcover: 272 pages.
of General Adaptation Syndrome was more fully developed in forming the personal and institutional $27.00
his 1956 book, The Stress of Life.2 relationships needed to get others to
Selye, a prolific, pioneering neuroendocrinologist, claimed understand ACE, and use unfamiliar
the physiologic life is fundamentally a process of adaptation to clinical interventions for best outcomes, are admirable.
the totality of one’s experience, with real health and happiness Burke Harris’s descriptions of the “stress response,” immunol-
being the successful adjustment or adaptation to those ever- ogy, epigenetic regulation, neuroanatomy, and neurophysiology
changing conditions. Failure to adapt to the stress burden, in are imaginative and effective. The description of pathogenic
his view, resulted in disease and unhappiness. stress as “toxic” seemed off the mark, yet her acknowledgment
In 1985, Vincent Felitti, MD, Chief of Preventive Medicine of the reality of multiple end-organ pathology suffices. Beyond
at Southern California Permanente Medical Group, San Diego, Burke Harris’s obvious humanity, the strength of the book for
added mightily to Selye’s work with his findings of the profound, me lies in the creative, clever, and sometimes elegant descrip-
destructive, multi-organ system consequences of adverse child- tions of complex ideas in physiology, pathology, and treatment.
hood experiences (ACEs).3 I do not think this book would be compelling to the nonclini-
Nadine Burke Harris, MD, discovered Felitti’s pioneering cian without them.
work later, yet immediately understood the potential power Having said that, I also greatly appreciate the fact that Burke
of its lessons if implemented in her pediatric practice. She de- Harris insisted on re-emphasizing the principle that ACEs
scribes well her newfound understanding of the pathogenesis occur at similar rates across socioeconomic strata. She rightly
of ACEs and the excitement of potential, effective therapeutic avoids any urge to politicize this profoundly human problem.
interventions. For that, I am respectful and grateful.
It is in this historical context that The Deepest Well is best Finally, despite the minor criticisms of the book outlined, I do
understood as another admirable and effective attempt to “… believe The Deepest Well is a “must read” for clinicians (including
persuade the world to listen …” to the lessons of Selye, Felitti, physicians), as well as patients/laypersons unfamiliar with
and others. The Deepest Well is, in part, the story of how Burke
Harris transformed herself into a champion persuader of truths
difficult for others to hear, and a better clinician.
The language used is often colloquial, not formal, but the book Author Affiliations
reads well. It is both Burke Harris’s personal story of discovery 1
Private practice, Alamo, CA
of the pathogenic consequences of early childhood trauma/ACEs,
Corresponding Author
Melvin Belsky, MD (melbelsky@comcast.net)

Keywords: ACE study, adverse childhood experiences, childhood trauma

The Permanente Journal • https://doi.org/10.7812/TPP/18-075 1

The Permanente Journal • For personal use only. No other uses without permission. Copyright © 2019 The Permanente Press. All rights reserved.
BOOK REVIEW
The Deepest Well: Healing the Long-Term Effects of Childhood Adversity

the terrible and predictable consequences of early childhood How to Cite this Article
trauma/ACEs. The Deepest Well is an excellent introduction to Belsky M. The deepest well: Healing the long-term effects of childhood
anyone interested in understanding this “elephant” in our human adversity by Nadine Burke Harris, MD. Perm J 2019;23:18-075.
DOI: https://doi.org/10.1278/TPP/18-075
“room,” and is a formidable effort to “persuade the world” to
understand ACEs, and do something about them. For that, we
should all be thankful because helpful interventions do exist. References
1. Selye H. A syndrome produced by diverse nocuous agents. Nature
I encourage physicians, unaware of the profound implications 1936;138(3479):32. DOI: https://doi.org/10.1038/138032a0.
of ACEs/early childhood trauma in the treatment of their own 2. Selye H. The stress of life. New York, NY: McGraw-Hill; 1956.
adult patients, to read this book. Its content should motivate 3. Felitti VJ, Anda RF, Nordenberg D, et al. Relationship of childhood abuse and
physicians to assess ACEs in their own practices and direct household dysfunction to many of the leading causes of death in adults. The Adverse
Childhood Experiences (ACE) Study. Am J Prev Med 1998 May;14(4):245-58.
burdened patients to appropriate therapeutic resources. I
believe, as does Burke Harris, that once the pathogenesis and
implications of ACEs are understood, the physician’s point of
view and practice will change forever, and for the better, both
for the patient and for the physician. v

The2Permanente Journal • For personal use only. No other uses without permission. Copyright © 2019 The Permanente Press. All rights reserved. The Permanente Journal • https://doi.org/10.7812/TPP/18-075