Burke Harris starts with an anecdote about Evan, a fit and apparently healthy father who had a stroke one morning (Burke Harris later reveals that Evan is her brother). While Evan lacked the usual risk factors for a stroke, he had a hidden one—a traumatic childhood experience. Burke Harris argues that we too often ignore the enduring health costs that come from the much-celebrated story of overcoming childhood poverty and adversity. Her book is an effort to show the effect of adverse childhood experiences (ACEs) on the lives of the adults who survive them. Her work is the result of what she learned running a pediatric community clinic in an under-resourced community in San Francisco.

Burke Harris opened her practice, Bayview Childhood Health Center, because she hoped to reduce disproportionately high rates of illness (health disparities) in the community. One of her early patients was a seven-year-old boy named Diego, whose growth chart and bones looked like those of a four-year old. After Diego’s mother revealed that the little boy experienced sexual abuse at four, Burke Harris began to wonder if such events might have a measurable biological effect that drove