Isaac’s experiences of childhood mistreatment twist and stretch his body and his mind like a worm on a hook, even now, well into middle age. This is his story, as told by his psychiatrist of twenty years. They have worked together so closely that Isaac’s psychiatrist has lost his objectivity and distance. To be true to Isaac’s story, he must reveal himself and how their work has changed him. Indeed, the story of Isaac and his psychiatrist, Bob, is a story of relationships. About how deeply people can affect each other for better and for worse – including people who are ill and the professionals who care for them.

It is also the story of the relationship between two psychiatrists, Bob and Jon – us. We have been friends and collaborators for more than thirty years. Jon specializes in providing psychiatric care for people with cancer, often young adults with bone cancer and women with breast cancer. We are about the same age and share tastes in music and in jokes. We don’t make eye contact at funerals because we make each other laugh. We have taught together and worked together on the same projects for so long that people often confuse us. Neither knows who is responsible for our best ideas. The safety and honesty of our relationship helps us both be better doctors and sustains us in the face of relentless vicarious exposure to our patients’ traumas.

With Isaac as an example, we have written this book to start a revolution. No kidding. People whose early experiences have caused lifelong damage need a revolution of relationships, specifically a revolution of health care relationships. Millions of adults who share Isaac’s experience of disease and suffering caused by early adversity need a health care system that responds to their reality. The changes in health care relationships they need are also revolutionary – doctors and other health care professionals who see and understand their experience, conversations in which they have a voice, and safety from repeated harm.

Of course, Isaac has consented to his story being told and at times urged Bob to tell it. Nonetheless, he has been harmed in the past when others learned about his mistreatment. We have changed much to protect his anonymity. We are also mindful of our readers. Reading about Isaac’s experiences will cause uneasy feelings. We have left out details that were not required to make our points; it is not our intent to shock. But the story of what matters in Isaac’s childhood cannot be told without relating some of the particulars. For those who have lived a life that is free of the kinds of experience that Isaac has had, revolution requires unease. But for those who know similar experiences all too well, descriptions can be triggering. Isaac’s experience has much to teach us. If you have not had his experiences, you know someone who has. Childhood adversity that is severe enough to be harmful throughout life affects over sixty million American adults and about nine million Canadian adults. It is one of the biggest public health issues of our time, and yet health care systems are ill-equipped to even acknowledge the problem. Everyone looks away, but looking away makes things worse.

We can learn from Bob’s experience as well. It is rare to be allowed into a doctor's office to see and hear what happens there. We have opened the window as wide as we can for you. If you are a doctor or in counselling yourself, a “doctor's eye view” on a very challenging relationship may give you something new to work with. If you are managing on your own the kind of pain that Isaac has endured, we hope Isaac’s story will demonstrate how it can help to share that burden.

Stories of childhood mistreatment tend to resolve into simple narratives: villains and victims, good parents and bad ones, good doctors and bad ones, us and them. If we are going to change the world, everyone needs to realize that there is only us. Real stories are messy; we need you to see the whole mess. A note about we and I. We realized in the writing that the narrator of the story could only be Bob, and so it is told in the first-person singular. A switch to we when we reflect on the meaning and implications of that story was distracting. So, although we have collaborated equally on all parts of the book, we have told it from Bob’s perspective. Jon makes appearances throughout the book as its third main character.