February is a milestone for me. It marks the eleventh consecutive month that I haven’t watched an adult television program. As much as anything in my life, this wasn’t planned. But it transpired nonetheless. I began reading heavily, which became such a habit that the lure of my television faded. I was so behind on my shows, it was a bear to think I’d ever catch up. The longer time went by, the less I cared about the shows and their characters. For the few hours a day a single working mother gets to herself, I preferred talking to my friends and staring at my Kindle. (I used to be a proponent of reading books – you know the actual paper and binding. But you can’t read a book in the dark while rubbing your sleeping child’s back – and sometimes a girl has got to multitask.)

In late July – four months into my bibliophilia – I came across a title that intrigued me: The Deepest Well: Healing the Long Term Effects of Childhood Adversity by Nadine Burke Harris (the first surgeon general of California.) Amazon’s algorithms were onto me – even reading isn’t safe these days. I “came across” her book after reading The Body Keeps the Score: Brain, Mind, and Body in the Healing of Trauma by Bessel Van der Kolk.

Clearly Amazon knew this title would hook me in for another purchase. But what the algorithms didn’t know is that they’d help me uncover and understand humanity – mine and that of others – a little bit better.

With certain knowledge comes compassion and confidence. And having the knowledge Dr. Burke Harris exhaustively analyzed, lived with, and healed others from isn’t something I took lightly. And it wasn’t something I wanted to keep to myself.

The ACE Study

As most scientific breakthroughs go, the Adverse Childhood Experiences (ACE) Study didn’t start out because doctors were curious about the relationship between childhood experiences and chronic disease in adults, but that’s what it uncovered, nevertheless. It started in the late ‘80s when Dr. Vincent Felitti discovered a pattern in some of his most successful weight-loss patients. After sticking to the program and shedding significant amounts of weight, they’d end up quitting the program and gaining the weight back. He had conversations with two of these abruptly non-compliant patients and uncovered their link of childhood sexual abuse. After screening hundreds of patients and finding the pattern consistent, he knew the link was significant enough to share with his peers. And as with the early days of most breakthroughs, he was taunted and ridiculed.

Luckily, one of his peers – who worked for the CDC – believed the link suggested something meaningful. So, in 1995, after years of preparation, the ACE Study was born. Information was gathered from more than 17,000 participants around the U.S. After the data was compiled, they knew they’d uncovered something important:

According to the United States’ Substance Abuse and Mental Health Services Administration, the study found that ACE’s are common, often occur together and have a dose-response relationship with many health problems. The number of ACEs was strongly associated with adulthood high-risk health behaviors such as smoking, alcohol and drug abuse, promiscuity, and severe obesity, and correlated with ill-health including depression, heart disease, cancer, chronic lung disease, and shortened lifespan. See also: Adverse Childhood Experiences Study

Knowing this information is one thing, but applying it to your life and people you treat is another.

Dr. Burke Harris did just that. She wasn’t the first doctor to read the ACE Study, but she was one of the first to apply the screening processes in her clinic in the Bayview Hunters Point section of San Francisco — and one of the first to find a solution to the problem.

Recovery Is Possible

Dr. Burke wasn’t the product of a zero ACE score upbringing. And with the knowledge she now had, she was committed to finding a way to help people recover before an adulthood riddled with health issues arrived. She explains her own personal history and the history of her close family members. She also explains several patients’ stories and their experiences. It all comes to a head when she shares a vulnerable moment in her life – the loss of a child. Initially, she did what her body told her do … run. She left her family behind and tried to find a place where she didn’t feel the pain anymore. It wasn’t until someone asked, “Are you okay?” that she realized she wasn’t.

Her training kicked in. She knew she had to recover from her tragedy before it affected her remaining three sons. Her first step was making sure her boys had the love and support they needed while she looked for the care and support she needed.

Step one in any recovery is realizing there’s a problem to overcome. Ignoring it will only make it more difficult to process later on.

In order to recognize there’s a problem, you need the knowledge of what that problem stems from. Dr. Burke-Harris was able to overcome a tragedy in a way her ancestors never could because she had the knowledge of the problem and the confidence in its remedy.

Four ACEs

In the game of poker, having four aces is a powerful hand. Only a straight flush beats it. But if you don’t know how to play poker and look at your cards, you may not realize the strength of your hand. If you understand the rules of the game of poker, you become more confident. The confidence doesn’t come from having four aces, it comes from knowing and understanding what that brings to the table.

Do you have an ACE score? What will you do with that knowledge?


JoAnna Bennett
JoAnna Bennett
Mother, Marketer, Writer, and Reader. I’m a mother of two wonderful little humans. I’m also an avid reader, an insatiable learner, and a self-acknowledged survivor. I’m grateful to work at O’Brien Communications Group (OCG) because I’ve learned the self-soothing and restorative craft of writing. I used to resist calling myself a writer because I have a finance degree. I naively thought I needed an English degree to effectively express myself in writing. But now, writer is a title I proudly wear, and writing is something I’ll practice for the rest of my life.

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    • You can’t know what you don’t know! I too was amazed when I read Dr. Burke Harris’s book. I am also amazed that when I bring the study up with my doctors and my children’s doctors, most of them are ignorant on the subject too.

  1. Joanna – Thank you for bringing the ACE score to light – and I appreciate my friends’ comments here back to you – but I have to confess that I was still sitting with this: “It marks the eleventh consecutive month that I haven’t watched an adult television program.” My wife and I have fallen into the pattern of series watching, and while I relish our closeness on the couch, your piece reminded me of the hours of enjoyment I used to spend every morning before HS – after finishing my before dawn paper route – just reading quietly by myself. I actually mourned finishing Michener’s Hawaii and Nordhoff’s The Bounty Trilogy. They were like old friends. Now, it literally takes me months to finish a book, and when I start up late at night before bed, I always have to go back a page or two to remember where I was. I also used to write screenplays at night, and I no longer do that. That’s it; we’re selling the couch!

    • Don’t sell the couch!!! 🙂 We are human. Forming habits is normal. We just have to be conscious of the habits we create and form better ones when our current habits aren’t serving us. You guys should read together on the couch. That way you still get the closeness, but not the brain rot.

  2. Thank you for sharing this incredible piece, Joanna. It’s such an important conversation to have. I work with kids who have faced all kinds of trauma (i.e., abuse, neglect). What so many people don’t realize is that these kids carry a lot of baggage with them throughout life. At some point, the impact of that baggage shows up in all kinds of ways. I just had a conversation with someone about a kid who had experienced a terrible sexual assault. This person’s comment was, “She can decide if she wants to be a victim or a survivor. The choice is hers.” My response was, “She doesn’t get to decide whether to be a victim. She IS a victim. She CAN be a survivor but she needs our help to do that.”

    Pretending something didn’t happen doesn’t negate the impact of the event. It will show up some how some way sooner or later.

    • Thank you for your comment and thank you for working with the children that desperately need someone who understands their plight. Our bodies hold on to trauma and keep it inside. When what we need is for it to be felt, transformed and understood. During my healing journey, my therapist said one phrase that really got to me. When I blame myself for some of the situations I’ve been in, she’d say “You can’t know what you don’t know.”

      When you grow up thinking bad situations are normal, how can it be your fault that you don’t know how to recognize red flags? It can’t.

      Have you read the book Educated by Tara Westover? It is such a lovely depiction of one person’s struggle and triumph.

  3. Thank you, Joanna, for this! As a therapist who used to treat victims of sexual abuse, I have frequently witnessed the correlation between chronic or autoimmune diseases to childhood trauma, especially but not exclusively sexual abuse. Bessel Van de Kolk speaks about his. Being the end of National Human Trafficking Awareness month, sadly, the disempowerment of our most vulnerable will continue. 💖

  4. I learned about ACE scores through our local YWCA and am so glad to have been exposed to this important piece of the humanity / community puzzle. Thank you for sharing, JoAnna, and exposing more people to this powerful assessment.

  5. Excellent article, JoAnna on a very important topic! Thank you so much for bringing ACEs to this platform as many people continue to learn, understand, and create healing pathways for adults who endured many childhood traumas (including abuse but not excluding other types of traumas such as abandonment, medical procedures, developmental disruptions to healthy attachment). I’m excited to be living during a time period of willingness to look in places that previous generations were unwilling or unable to look. Not only are many people looking, they are being curious and making useful and profound connections and positive contributions to healing, health, and hopefully disrupting the ancestral cycles of abuse and trauma-then patterns of ill health in adulthood.

    • Thank you for your comment Laura. I couldn’t agree more. When I hear people say they are scared for the future, I laugh. They are much more equipped than we ever were!