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

Content Warning: This section of the guide contains discussion of mental illness and illness.

Gather initial thoughts and broad opinions about the book.

1. Burke Harris uses storytelling techniques to make complex medical science accessible to lay readers. Have you encountered other health or science books that employ similar narrative approaches—for example, works by Atul Gawande (Being Mortal) or Siddhartha Mukherjee (The Emperor of All Maladies)? What distinguishes Burke Harris’s approach to explaining the science of Adverse Childhood Experiences (ACEs) from other medical narratives you’ve read?

2. Burke Harris’s transformation from practicing pediatrician to national advocate unfolds over a decade of setbacks and breakthroughs. Which aspects of her journey struck you as most compelling or unexpected?

3. How effectively did Burke Harris’s framing of her investigation around John Snow’s discovery of the contaminated well help you understand her approach to identifying the “source” behind health disparities in communities like Bayview?

Encourage readers to connect the book’s themes and characters with their personal experiences.

1. Burke Harris emphasizes that storytelling is crucial, both in science and in helping trauma survivors process their experiences. How do you see storytelling functioning in your own life as a way to make sense of difficult experiences or complex information?

2. What insights about stress and its physical effects resonated most with your own understanding of how your body responds to challenging situations?

3. Burke Harris argues that medical education often overlooks the connection between childhood experiences and adult health outcomes. How does this gap between research findings and practical healthcare training compare to your own experiences with medical professionals?

4. Charlene’s relationship with her daughter Nia transforms through therapy and support systems that help her become a “buffering caretaker.” What examples of buffering relationships have you observed in your own community or family systems? How do these relationships seem to help people navigate stress and adversity?

5. How did learning about Burke Harris’s personal stake in this research—including her own childhood experiences and her brother’s stroke—affect your understanding of her professional motivations?

6. Burke Harris describes how even accomplished women in her elite social circles, like Caroline, dealt with the effects of ACEs in their families. What surprised you about the universality of childhood adversity across different socioeconomic backgrounds?

Examine the book’s relevance to societal issues, historical events, or cultural themes.

1. Burke Harris encounters resistance from community activists who worry that focusing on ACEs medicalizes social problems rather than addressing systemic inequities. How do you think medical interventions and social justice approaches can work together to address health disparities?

2. What does the gap between Felitti’s groundbreaking 1998 ACE study and its eventual integration into medical practice suggest about how new scientific insights reach professional training and public awareness?

3. How do you think communities should balance welcoming outside expertise with maintaining local control over resources and services, considering the tensions Burke Harris faced in Bayview?

Dive into the book’s structure, characters, themes, and symbolism.

1. How did Burke Harris’s multi-layered approach—weaving together patient stories, scientific explanations, and her personal journey—affect your engagement with the complex medical and social issues she presents?

2. Burke Harris returns to Diego’s story at both the beginning and end of the book, showing his progress from age seven to seventeen. This narrative framing reveals her evolving understanding of how to treat toxic stress responses over time. What does Diego’s continued need for support, despite his successes, suggest about the long-term nature of ACE-related interventions?

3. Burke Harris describes her evolution from a naive young doctor to a nationally recognized advocate through various setbacks and learning experiences. Which specific moments in her journey revealed the most about the challenges of changing entrenched medical practices?

4. How effectively do Burke Harris’s metaphors—such as comparing the stress response to a symphony conductor or to living with a bear in the house—help translate complex biological processes into accessible terms?

5. The book shifts between clinical explanations, personal anecdotes, and policy discussions throughout its four main sections. Which narrative approach did you find most persuasive in making Burke Harris’s case about the importance of addressing ACEs?

6. How does Burke Harris’s disclosure of her own family’s experiences with ACEs—including her mother’s mental illness and her brother Evan’s stroke—change the authority and credibility of her professional arguments?

Encourage imaginative and creative connections to the book.

1. Design your own intervention program for a community you know well that could help children and families affected by ACEs. What services would you prioritize and how would you gain community trust?

2. How might key chapters of this book read if reimagined from the perspective of one of Burke Harris’s patients, such as Diego at age 17, reflecting on his decade of treatment, or Charlene as she learns to become a better parent to Nia?

3. Burke Harris describes how different communities might respond to ACE-informed interventions based on their unique cultural contexts and resources. If you were tasked with adapting her approach for a completely different setting—such as a rural community or a different country—what modifications would you make to ensure cultural relevance? How would you address potential resistance or skepticism from community members?