麻豆传媒入口

Some of the first adorable patients to trickle into Dr. Nadine Burke Harris鈥檚 pediatric clinic when it opened in 2007鈥攍ong before she was named the first surgeon general of California鈥攚ere referred by teachers and principals.

Sitting in her examination rooms back then, in one of San Francisco鈥檚 poorest neighborhoods, Burke Harris knew almost immediately that something was amiss. Her young patients arrived with tentative diagnoses of oppositional defiant disorder or learning deficits, but routine exams uncovered a host of more serious physical ailments: asthma, autoimmune hepatitis, and even growth failure. Almost inevitably, the children鈥檚 caretakers鈥攁lso sick with advanced diabetes, heart disease, or cancer鈥攔elayed harrowing stories of family incarceration, sexual abuse, and even murder.

鈥淚鈥檇 have this snapshot of multigenerational adversity in one room,鈥� Burke Harris said, still looking worried decades later. How did the pieces fit together? What did a learning problem have to do with asthma, or with exposure to trauma? Could any of it be connected to terminal conditions like cancer?

An answer arrived 鈥渓ike a bolt of lightning鈥� in 2008, when Burke Harris read a from the Centers for Disease Control and Prevention (CDC) linking childhood trauma鈥攚hich the researchers called adverse childhood experiences (ACEs)鈥攖o dramatically higher rates of heart disease, stroke, cancer, and diabetes in middle-aged patients. Burke Harris鈥檚 own completed the picture, revealing an astonishing relationship between childhood trauma and the onset of learning and behavioral issues.

Today, the implications of those insights still feel revolutionary, blowing a hole in pious American myths about equity, social mobility, and financial success. Our good fortune, or rotten luck, is 鈥渨ritten into our biology,鈥� Burke Harris asserts in her 2018 book, The Deepest Well鈥攚ired into synapses and coiled within strands of DNA鈥攚here it exerts a stealthy and persistent influence on our bodies and minds, for better or worse.

For children with ACEs, the damage is reversible, and teachers can help, Burke Harris says鈥攂ut she鈥檚 adamant that they can鈥檛 do it alone. 鈥淲e all have to play our positions,鈥� she insists, emphasizing the need for broader coordination between medical, educational, and emergency systems. 鈥淚t鈥檚 unfair to ask teachers to be therapists or doctors. The role of educators is in delivering that daily dose of buffering care that鈥檚 so important for healing.鈥�

I sat down with Burke Harris recently to talk about how she came to her vocation, whether our traditional school disciplinary policies are supported by science, and how she overcame her skepticism about meditation.

STEPHEN MERRILL: In your book The Deepest Well, you say your father taught you that 鈥渢here is a molecular mechanism behind every natural phenomenon.鈥� There鈥檚 just such a deep curiosity about how the world works running through the book.

NADINE BURKE HARRIS: Yeah. That is just part of my DNA. It鈥檚 the way that I was raised鈥攎y dad is an organic chemist. When we were little kids鈥攚hen my four brothers and I were throwing paper airplanes at each other鈥攜our typical parent would be like, 鈥淪top that or else you鈥檒l put an eye out.鈥�

My dad would come in and he would say, 鈥淥K, let鈥檚 time your throws. Then let鈥檚 measure the distance so we can calculate the velocity. Then we know that gravity is 9.8 meters per second squared, so we can calculate the lift under the wings.鈥� It was science all day, every day in my house.

MERRILL: Right, and on one level the book reads like a scientific mystery. At your clinic, you鈥檙e surrounded by kids with really serious illnesses鈥攂ut for years the 鈥渕olecular mechanism鈥� beneath them eludes you. Can you take me back to that moment in 2008 when you were handed the CDC鈥檚 study on ACEs? What were you feeling when you read that?

BURKE HARRIS: It was like being hit with a bolt of lightning. You remember in that movie The Matrix, when all of a sudden Neo can see what the universe is really made out of? It was just such a validation鈥攁 coming together of all of these disparate pieces鈥攖hat I feel I had been seeing throughout my career.

Keep in mind, I had done research in college about the effects of stress hormones like cortisol and how they affect development. And I had been鈥攄ay in, day out鈥攃aring for patients at Bayview Hunters Point clinic, hearing their stories and seeing over and over again how they were impacted by the harms of poverty, trauma, and adversity.

Almost every cell in your body has a receptor for cortisol. When the stress response is triggered too frequently, or too severely, it can change the structure and function of children鈥檚 developing brains, their immune and hormonal systems鈥攁nd even the way their DNA is read and transcribed. Those changes are what we now refer to as a toxic stress response.

MERRILL: You鈥檝e said that school-aged children with ACEs often present with oppositional defiant disorder, impulse control issues, or difficulty focusing. What can teachers do? Does the science support social and emotional learning (SEL)?

BURKE HARRIS: Absolutely. Those are the tools to help kids understand how to recognize and regulate their emotions and their behaviors. One of the things that I think is really crucial: As a doctor, I may be the one who鈥檚 screening for ACEs, but I might see the child at the most a couple of times a year.

Educators can deliver the daily doses of healing interactions that truly are the antidote to toxic stress. And just as the science shows that it鈥檚 the cumulative dose of early adversity that鈥檚 most harmful, it also shows that the cumulative dose of healing nurturing interactions is most healing.

Giving children the tools to understand how to recognize what鈥檚 going on with them, then how to respond鈥攅specially to be able to calm their bodies down鈥攖ruly is healing.

MERRILL: I think our teachers will be glad to hear it.

BURKE HARRIS: I cannot tell you the number of kids that I have cared for who, when I say to them, 鈥淵ou know what? Because of what you鈥檝e experienced, your body might be making more stress hormones than it should. That can look and feel like being quick to anger, or having trouble controlling your impulses, or getting sick easily鈥濃�擨 can鈥檛 tell you the number of kids who have looked at me and literally said, 鈥淥h, you mean I鈥檓 not crazy?鈥�

Many of our kids have been told that they are the problem. Helping them to understand that what鈥檚 going on in their bodies is actually a normal response to the abnormal circumstance that they find themselves in, giving them tools to understand how to calm themselves down, how to keep themselves safe, how to connect with nurturing relationships鈥擨鈥檝e seen it be life-changing and life-saving.

MERRILL: Have you given thought to whether our discipline policies in schools are informed by science? Are punitive tactics like loss of recess, shaming, expulsion, suspension鈥攁re those going to work for kids with trauma?

BURKE HARRIS: I have a feeling that is a setup, but I鈥檓 grateful for it [laughs]. Because that鈥檚 really the whole point. If the science shows us that many of these behaviors are associated with a toxic stress response, then blaming and shaming that child is not going to improve that.

For example, if you have a child who is experiencing adversity at home and is being defiant, acting out, having a terrible time with impulse control, suspending them so that they can go home to be in that environment may be doing more harm than good.

We obviously need school safety policies and policies that support the orderly functioning of the school environment. But the science suggests that those should be things like in-school suspensions, restorative justice, opportunities to de-escalate and give a child the time and space to allow their adrenaline and cortisol levels to come down. It could be as simple as 15 minutes in a quiet area to get back to self-regulation. That鈥檚 a way to work with a child鈥檚 biology聽instead of working against the child鈥檚 biology.

MERRILL: That reminds me of this school in Nashville where I first saw a peace corner. Have you heard of these? Kids can go there just to calm down. There are even activities to get them to self-regulate.

BURKE HARRIS: Yes, I鈥檝e seen that! There鈥檚 one in California that has a similar space鈥攊t鈥檚 beautiful. I think it was in Fresno. When I saw it I was just like, 鈥淭his is awesome. This is science being implemented in our classrooms.鈥�

MERRILL: Can you talk to me about meditation? I know you were a little wary of the practice at first, but now you seem to prescribe it.

BURKE HARRIS: Yeah. That鈥檚 no joke鈥擨 really do prescribe it as part of my clinical practice. If you are experiencing an overactive stress response, there鈥檚 cortisol, adrenaline, all these stress hormones鈥攖hose are what leads to long-term harm.

So I went through the literature and said, 鈥淥K, well, what does the opposite?鈥� I was skeptical at first, but meditation helps to regulate the part of the brain that is associated with recovery post-provocation; it鈥檚 associated with reduced levels of cortisol and other stress hormones; and it also reduces the physiological indicators of an active stress response, like blood pressure and heart rate.

So I implemented a program in my clinical practice鈥攚e taught mindfulness as part of our treatment protocol for kids with toxic stress.

MERRILL: How young can the kids start?

BURKE HARRIS:聽Mindfulness practices can be done itty-bitty, for kids as young as 3 in my practice. The modality might change a little bit depending on the developmental stage. From 3 to 6, you might do one type. Then as kids get older, you can do more things, like downloading a mindfulness app on your phone and practicing聽10 or 20 minutes a day.

MERRILL: Is there anything else you want to say? Anything I missed?

BURKE HARRIS: The last thing that I want to say鈥攅specially in light of Covid聽and all of the anxiety around that issue鈥攊s for our educators. We know that educators are the backbone of our society. As we do this work, I want to encourage you to put your own oxygen mask on first. Because we need you in this fight. We need you in this struggle.

In order for any of us to provide that safe, stable, and nurturing environment for the children that we serve, we have to practice self-care so that we can be available. Please make sure to put your own oxygen mask on and practice real care for yourself so that you can be there for the next generation.聽