The Boy Who Was Raised as a Dog: And Other Stories from a Child Psychiatrist's Notebook

by Bruce D. Perry

Children were believed to be naturally “resilient,” with an innate ability to “bounce back.”

the diagnosis of PTSD was only itself introduced into psychiatry in 1980.

same kinds of symptoms—intrusive thoughts about the traumatic event, flashbacks, disrupted sleep, a sense of unreality, a heightened startle response, extreme anxiety—began

Now the condition is believed to affect at least 7 percent of all Americans

the impact is actually far greater on children than it is on adults.

it is rare for a child to escape trauma entirely.

most cases are never reported

responses to children during and after traumatic events can make an enormous difference in these eventual outcomes—both for good and for ill.

human relationships: we can both create and destroy, nurture and terrorize, traumatize and heal each other.

Not all humans are humane.

conditions necessary for the development of empathy—and those that are likely, instead, to produce cruelty and indifference.

in order to understand trauma we need to understand memory.

TINA WAS MY FIRST CHILD PATIENT, just seven years old when I met her.

the three-foot-tall African-American girl with meticulously neat braids

Tina had been “aggressive and inappropriate” with her classmates.

exposed herself, attacked other children, used sexual language, and tried to get them to engage in sex play.

abused for a two-year period

four and ended when she was six.

perpetrator was a sixteen-ye...

He had molested both Tina and her younger brother, Michael, while the...

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no longer on public a...

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My behavior didn’t fit with her internal catalog of previous experiences with men.

Wasn’t labeling Tina “defiant” misleading, given that her “noncompliance” was likely a result of her victimization?

What about her speech and language delays?

“No, no. Tell me about her. Not about her symptoms.”

“Spend some time getting to know her—not her symptoms.

they often respond with “If I grow up,”

there were often several hours between the time Tina and her younger brother came home and the time Sara got off from work.

she didn’t want to risk more caregiver abuse. So the children stayed home alone, usually watching TV.

I slowly introduced new concepts, like waiting and thinking before deciding what to do next.

“You must interpret the resistance.”

I sensed her trying to understand if this was kindness or something sinister.

“Great! We should do a home visit with all of our patients.” He smiled and sat back. “Tell me all about it.”

But this very brief stressful experience, at a key time in the development of the brain, resulted in alterations in stress hormone systems that lasted into adulthood.

Why these particular problems in this particular child?

poorly regulated, underdeveloped, or disorganized,

glia.

all of these complicated cells (and there are many different types) must be organized into specialized networks.

lower and most central regions of the brainstem and the diencephalon are the simplest. They evolved first, and they develop first as a child grows.

emotional responses that guide our behavior, like fear, hatred, love, and joy.

Tina’s problems could be related to one key set of neural systems, the ones involved in helping humans cope with stress and threat.

myriad studies in humans and animals had documented the role these systems play in arousal, sleep, attention, appetite, mood, impulse regulation—basically all of the areas in which Tina had major problems.

They are capable of integrating and orchestrating signals and information from all of our senses and throughout the brain.

If I had to give Tina a label now, it wouldn’t be ADD, but rather post-traumatic stress disorder, PTSD.

We initially learn impulse control and decision making from those around us, sometimes from explicit lessons, sometimes by example.

On the surface she could make others think she was behaving appropriately, but inside, she had not overcome her trauma.

yet that would not erase her memory. I began to think that memory was what I needed to understand before I could do better.

Memory is the capacity to carry forward in time some element of an experience.