Nadine Burke Harris Quotes

Children are compelled to give meaning to what is happening to them. When there is no clear explanation, they make one up; the intersection of trauma and the developmentally appropriate egocentrism of childhood often leads a little kid to think, I made it happen.

struggling in school but being told that they had ADHD or a “behavior problem” when these problems were directly correlated with toxic doses of adversity.

understanding that exposure to early adversity affects the way dopamine functions in the brain is an absolute must.

The profound discovery was that our patients with four or more ACEs were twice as likely to be overweight or obese and 32.6 times as likely to have been diagnosed with learning and behavioral problems.

Once again, the science is new, but it suggests that even if you start out with shorter-than-normal telomeres, you can still slow decline by increasing your telomerase with things like meditation and exercise.

Researchers have found that infants of depressed moms have a harder time regulating their sleep; they sleep an average of ninety-seven fewer minutes a night than infants of nondepressed moms and have more nighttime awakenings.

This might sound simple, but I cannot overstate this: The single most important thing is recognizing what the problem is in the first place.

When you put a kid who had experienced adversity in an MRI machine, you could see measurable changes to the brain structures.

a person with an ACE score of two or more had twice the odds of hospitalization for autoimmune disease as someone with zero ACEs.

The licking and grooming behavior that occurred in the pups’ first ten days of life predicted changes to their stress response

What I hadn’t learned was how to break the intergenerational cycle of toxic stress.

Unfortunately, the fight-or-flight response is a destructive constant companion. As Dr. Nadine Burke Harris put it, the response is great “if you’re in a forest and there’s a bear. The problem is when that bear comes home from the bar every night.

And just like two siblings with the same parents might have different eye colors, they also might have different lengths of telomeres, which can lead to different outcomes even if they experience similar doses of adversity.

If we put the right protocols into place in pediatric offices across the city, country, and world, we could intervene in time to walk back epigenetic damage and change long-term health outcomes for the roughly 67 percent of the population with ACEs and their children. And, someday, their great-grandchildren.

The main issue is that when the stress response is activated too frequently or if the stressor is too intense, the body can lose the ability to shut down the HPA and SAM axes. The term for this is disruption of feedback inhibition, which is a science-y way of saying that the body’s stress thermostat is broken. Instead of shutting off the supply of “heat” when a certain point is reached, it just keeps on blasting cortisol through your system. This is exactly what Fisher and Bruce were seeing in the foster kids.

the difference between adaptive and maladaptive reactions is all about the when.

But to me, the most interesting part of what they found was that stress had a major impact on the length and health of telomeres, and that in turn had a major impact on the risk of disease.

Twenty years of medical research has shown that childhood adversity literally gets under our skin, changing people in ways that can endure in their bodies for decades. It can tip a child’s developmental trajectory and affect physiology. It can trigger chronic inflammation and hormonal changes that can last a lifetime. It can alter the way DNA is read and how cells replicate, and it can dramatically increase the risk for heart disease, stroke, cancer, diabetes—even Alzheimer’s.

Childhood adversity is a story we think we know. Children have faced trauma and stress in the form of abuse, neglect, violence, and fear since God was a boy. Parents have been getting trashed, getting arrested, and getting divorced for almost as long. The people who are smart and strong enough are able to rise above the past and triumph through the force of their own will and resilience. Or are they?

In the case of a human, it could be a dad hugging and listening. The buffer is hugely important, not just to attenuate the stress hormones but also to prevent the kind of epigenetic changes that lead to a dysregulated stress response and the major health issues that come with it.

These pups are not damaged goods; they are not defective. If they can get a safe, stable, and nurturing environment at an early age, the biology says that this sets them up to develop a healthy stress-response system in adulthood. As we’ve mentioned, the key to keeping a tolerable stress response from tipping over into the toxic stress zone is the presence of a buffering adult to adequately mitigate the impact of the stressor.

The licking and grooming behavior that occurred in the pups’ first ten days of life predicted changes to their stress response that lasted for the entire lifetime. Even more startling, the changes continued into the next generation, because female pups who had high-licker moms became high lickers themselves when they had their own kids.

Having an ACE score of two or more doubles someone’s likelihood of developing an autoimmune disease.

As a scientist, I couldn't accept these kinds of associations without some serious evidence.

In the case of the rat pups, it’s the mom’s licking and grooming. In the case of a human, it could be a dad hugging and listening.

Lots of kids wet the bed when they are little but grow out of it. An example of a tolerable stress response would be a child who reverts back to bedwetting after his parents’ divorce. The split isn’t acrimonious, and while the dad moved out, both adults are committed to co-parenting and understand that their child needs stability and extra support. As a result of that buffering of the child’s stress, he stops wetting the bed after a few months. Like my drive-by-induced stress, the effects are temporary if a solid support network is in place.

Toxic stress response can occur when a child experiences strong, frequent, and/or prolonged adversity—such as physical or emotional abuse, neglect, caregiver substance abuse or mental illness, exposure to violence, and/or the accumulated burdens of family economic hardship—without adequate adult support. This kind of prolonged activation of the stress-response systems can disrupt the development of brain architecture and other organ systems, and increase the risk for stress-related disease and cognitive impairment, well into the adult years.

Sleep, mental health, healthy relationships, exercise, nutrition, and mindfulness—we saw in our patients that these six things were critical for healing. As important, the literature provided evidence of why these things were effective. Fundamentally, they all targeted the underlying biological mechanism—a dysregulated stress-response system and the neurologic, endocrine, and immune disruptions that ensued.

Apart from these revelations, the profound discovery was that our patients with four or more ACEs were twice as likely to be overweight or obese and 32.6 times as likely to have been diagnosed with learning and behavioral problems.

Knowing that, it’s pretty obvious why this part of the brain is so critical to learning, and it’s easy to see how kids with quick-trigger amygdalae are behind the eight ball when it comes to everything from memorizing multiplication tables to spatial memory.

The body of research sparked by the ACE Study makes it clear that adverse childhood experiences in and of themselves are a risk factor for many of the most common and serious diseases in the United States (and worldwide), regardless of income or race or access to care.

Something scary is happening; you don’t want reason getting in the way of survival. The second is that the locus coeruleus is flooding the brain with noradrenaline, compromising the ability to override instincts and impulses. The PFC is the part of the kid’s brain that puts the brakes on impulses and helps him or her make smarter decisions. Telling a kid to sit still, concentrate, and ignore stimuli that are flooding his brain with the need to act is a lot to ask. This down-regulation of the PFC can have different consequences for different people. For some, it results in an inability to concentrate and solve problems, but in others it manifests as impulsive behavior and aggression.

It turns out that since 1825, researchers have known that Graves’ disease is often correlated with stressful life events, which Trinity had in spades. It was clear that her problems with emotional regulation were overlaid on the hyperthyroidism, making her time in the classroom that much more difficult. The crazy thing is that many busy physicians do their entire assessment of ADHD based on behavioral symptoms alone, without a stethoscope

ACEs instead of obesity, exercise and nutrition would still have been an important part of that. It wasn’t our initial intention to treat our patients’ toxic stress with dodgeball and cooking classes, but we were pleasantly surprised to see how much the kids improved when we added healthy diet and exercise incentives to therapy. I sat down to check in with the moms and grandmas each week, and they reported that when they changed their children’s diet and their levels of exercise went up, the kids slept better and felt healthier, and in many cases, their behavioral issues

And I did find it, in an impressive organization called the Mind Body Awareness (MBA) Project. MBA was doing mindfulness work (both meditation and yoga) with kids in juvenile hall and getting some solid results. I had seen the data on how many kids in juvie have their own fair share of ACEs (one study that came out later on looked at more than sixty thousand young people in the Florida juvenile justice system and found that 97 percent had experienced at least one ACE category and 52 percent four or more), so I figured it would be a good fit. After I met with MBA’s executive director, Gabriel Kram, and heard his story, I was even more

problems, if her ACE score had been zero, a standard ADHD workup would have been warranted. But now I knew that if a patient had four or more ACEs, she was thirty-two times as likely to have learning or behavior problems, which suggested that the underlying issue was probably not ordinary ADHD.

as a human being, I was brought to my knees by it. As a scientist and a doctor, I got up off those knees and began asking questions.

We have yet to develop fourth-generation antibiotics in the fight against toxic stress, but we can use the knowledge of how the stress response triggers health problems to institute some basic hygiene: Screening, trauma-informed care, and treatment. Sleep, exercise, nutrition, mindfulness, mental health, and healthy relationships—these are the equivalent of Lister dipping his instruments in carbolic acid and requiring his surgical students to wash their hands.

Instead, we often use guanfacine, a nonstimulant that was originally developed to treat high blood pressure but has also been used to treat ADHD. Guanfacine targets specific circuits in the prefrontal cortex where adrenaline and noradrenaline exert their action, improving impulsiveness and concentration, even in situations of high stress. While I felt good about taking a more systemic approach, like the doctors who first began to suspect that a compromised immune system was behind HIV/AIDS, I was working on a medical frontier. There wasn’t (and still isn’t) a clear set of diagnostic criteria or a blood test for toxic stress, and there is no drug cocktail to prescribe. My biggest guide for what symptoms might be toxic stress–related was the ACE Study itself, but I knew that the number of diseases and conditions it accounted for might just be the tip of the iceberg. After all,

Sleep, mental health, healthy relationships, exercise, nutrition, and mindfulness—we saw in our patients that these six things were critical for healing. As

In rural white communities, the story is about loss of living-wage work and the fallout from rampant drug use. In immigrant communities, it is about discrimination and the fear of forever being separated from loved ones at a moment’s notice. In African American communities, it’s about the legacy of centuries of inhuman treatment that persist to this day—it’s about boys being at risk when they are playing on a bench or walking home from the store wearing a hoodie. In Native American communities, it is about the obliteration of land and culture and the legacy of dislocation. But everyone is really saying the same thing: I am suffering. It is easy to get stuck on your own suffering because, naturally, it is what affects you most, but that’s exactly the mentality that is killing black people, white people, and all people. It perpetuates the problem by framing it in terms of us versus them. Either we get ahead or they get ahead. That leads quickly to a fight for resources that fragments efforts to solve the same damn problem.

The first was making sure the kids had the buffering care and love they needed. The second was getting the support and care that I needed. That knowledge made all the difference in the world.

Because early adversity increases inflammation, when you have higher numbers of troops roaming around the body, there is a greater likelihood that they’ll make a mistake.

The consequences of toxic stress are not just neurologic and hormonal; they are also immunologic, and those symptoms are much more difficult to spot.

prevent, screen, and heal the impacts of ACEs and toxic stress.

needed to focus on harnessing that strength instead of worrying about the opposition.

a community of people struggling with a legacy of ACEs, up against obstacles strengthened by historical cycles of marginalization and violence, but nonetheless coming

We explained to her later that we had a specialist who would teach her how to be a healthy buffer for her child’s stress.

While I knew all too well that poor communities experienced higher doses of adversity and had fewer resources to deal with it, I was worried that the issue was being framed as a “poor-people problem” or a “black-and-brown problem.

timing, sequencing, and dosage of these ingredients was critical.

Number one, reduce the dose of adversity; number two, strengthen the ability of the caregiver to be a healthy buffer.

Sleep, mental health, healthy relationships, exercise, nutrition, and mindfulness—we saw in our patients that these six things were critical for healing.

Fundamentally, they all targeted the underlying biological mechanism—a dysregulated stress-response system and the neurologic, endocrine, and immune disruptions that ensued.

problem was chronic dysregulation of the stress-response system, which inhibited the prefrontal cortex, overstimulated the amygdala, and short-circuited the stress thermostat—in other words, toxic stress. When I flipped through Trinity’s chart, I saw that she had an ACE score of six.

Chronic exposure to stress hormones can suppress the immune system in some ways and activate it in others, and unfortunately none of it’s good.

If their systems were flooded with stress hormones just like Sarah’s or the tadpoles’, it stood to reason that their bodies, including their blood pressure, blood sugar, and neurological functions, might react in similar ways; all could be seen as side effects of stress hormones. It made biological sense that a high dose of stress hormones at the wrong developmental stage could have an outsize impact on my patients’ downstream health.

The amygdala: the brain’s fear center Prefrontal cortex: the front part of the brain that regulates cognitive and executive function, including judgment and mood and emotions Hypothalamic-pituitary-adrenal (HPA) axis: initiates the production of cortisol (longer-acting stress hormone) by the adrenal glands Sympatho-adrenomedullary (SAM) axis: initiates the production of adrenaline and noradrenaline (short-acting stress hormones) by the adrenal glands and brain Hippocampus: processes emotional information, critical for consolidating memories Noradrenergic nucleus in the locus coeruleus: the within-the-brain stress-response system that regulates mood, irritability, locomotion, arousal, attention, and the startle response

The problem with PTSD is that it becomes entrenched; the stress response is caught in the past, stuck on repeat.

Because I understand now why I am this way. I understand why my siblings are this way. I understand why my mother raised us the way she did. I understand that I can break this cycle for my children and I understand that I’m not a victim, I’m a survivor.

It was clear that while ACEs might be a health crisis with a medical problem at its root, its effects ripple out far beyond our biology. Toxic stress affects how we learn, how we parent, how we react at home and at work, and what we create in our communities. It affects our children, our earning potential, and the very ideas we have about what we’re capable of. What starts out in the wiring of one brain cell to another ultimately affects all of the cells of our society, from our families to our schools to our workplaces to our jails.

Some of the effects of cortisol are similar to those of adrenaline—it raises blood pressure and blood sugar, inhibits cognition (clear thinking), and destabilizes mood. It also disrupts sleep, which makes a lot of sense if you are living in a forest full of bears—better to be a light sleeper.

Evan glances up and catches one of the medics watching him with an expression that makes him go cold. It’s a look of recognition and pity.

Physically, I would have the same responses: my heart would pick up its pace, my eyes would dart around, and I’d feel tightness in my stomach. I see now that my biology was reacting to an unusually high level of stress by temporarily linking red cars with danger. My body was remembering what happened and sending a flood of stress hormones

young children are the most vulnerable to adversity, but they also have the greatest capacity for healing when the interventions are begun early.

sleep, exercise, nutrition, mindfulness, mental health, and healthy relationships

integrative medicine, that is dedicated to looking at the whole person and using the latest science to improve health and well-being.

Her organization Turnaround for Children was leading the charge to bring the science of ACEs and toxic stress into schools.

The effects were maladaptive, meaning that instead of helping the tadpole thrive and survive, the response made things much, much worse. In fact, early exposure often led not only to irreversible developmental changes but, eventually, to death.

In the case of the hunter, the process was adaptive (good for survival) because it happened in adulthood; in the case of the tadpole, the process was maladaptive (bad for survival) because it happened in childhood (or tadpole-hood), too early in development.

e can’t treat what we refuse to see. By screening for ACEs, doctors are acknowledging that they exist. By being open about ACEs with friends and family, people are normalizing adversity as a part of the human story and toxic stress as a part of our biology that we can do something about.

Looking back, I can see now how I adapted to our mom’s illness by becoming more attuned to those around me. For me, quickly figuring out which mom I was coming home to was the key to navigating our household. Now it’s easy for me to tell when there’s something going on with people by reading a whole bunch of nonverbal cues. It’s kind of like a sixth sense. I would never want to repeat the distressing or unpredictable moments of my childhood, but I wouldn’t wish them away either. They are a big part of what has made me who I am. Sometimes I like to think of this ability to tune in to people as my own little superpower. As a doctor, it allows me to gently ask my patients the right follow-up questions and get to the heart of the matter quickly. This has been a huge gift for me in my practice.

My experience dealing with both sides of the ACEs coin is in part what drives my work. I know that the long-term impacts of childhood adversity are not all suffering. In some people, adversity can foster perseverance, deepen empathy, strengthen the resolve to protect, and spark mini-superpowers, but in all people, it gets under our skin and into our DNA, and it becomes an important part of who we are. I don’t think people who grew up with ACEs have to “overcome” their childhoods. I don’t think forgetting about adversity or blaming it is useful. The first step is taking its measure and looking clearly at the impact and risk as neither a tragedy nor a fairy tale but a meaningful reality in between. Once you understand how your body and brain are primed to react in certain situations, you can start to be proactive about how you approach things. You can identify triggers and know how to support yourself and those you love.

...the fight or flight response is a destructive constant companion. As Dr. Nadine Burke Harris put it, the response is great "If you're in a forest and there is a bear... When that happens, the Harvard researchers found, the sector of the brain that deals with highly stressful situations takes over. "Significant stress in early childhood, ' they write, "... result[s] in a hyperresponsive or chronically activated physiological stress response, along with increased potential for fear and anxiety" For kids like me, the part of the brain that deals with stress and conflict always activted- the switch flipped indefinitely. We are constantly ready to fight or flee, because there is constant exposure to the bear, whether that bear is an alcoholic dad or an unhinged mom. We become hard-wired for conflict. And that wiring remains, even when there's no more conflict to be had.

In late August 1854, there was a severe cholera outbreak in London. The Broad Street area in Soho was the epicenter, with a hundred and twenty-seven dead in the first three days and more than five hundred dead by the second week of September.

levels, regulate the HPA axis, balance the immune system, and improve cognitive functioning. Over and over again the research pointed to one treatment in particular—meditation. Though

It wasn’t until I stumbled into the wild world of telomeres that I saw there was more than one way to reprogram DNA.

telomeres protect DNA strands, making sure

所以，史前時代成年人撐過狩獵淡季和小蝌蚪被壓力害死，這兩者的差別在於暴露於壓力激素下的時機和時間。