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

by Bruce D. Perry

When it links coherent, consistently connected patterns together again, it tags them as “normal” or “expected” and stops paying conscious attention.

So, the systems in your brain that get repeatedly activated will change, and the systems in your brain that don’t get activated won’t change.

In Tina’s world, males larger than she was were frightening, demanding creatures who forced her or her mother into sex. The scent, sight, and sounds associated with them came together to compose a set of “memory templates” that she used to make sense of the world.

A three-year-old girl named Sandy had witnessed the murder of her own mother.

the girl’s hospitalization due to injuries she’d received during the crime, and her subsequent foster care placements.

“A three-year-old girl witnesses her mother being raped and murdered. She has her own throat cut, twice, and is left for dead. She is alone with her dead mother’s body for eleven hours in their apartment. Then, she’s taken to the hospital and has the wounds on her neck treated.

So, despite the doctors’ recommendations, he doesn’t get her any help. For nine months, this child is moved from foster home to foster home with no counseling or psychiatric care whatsoever. And the details of the child’s experiences are never shared with the foster families because she is in hiding. Right?”

Oddly enough, during my years of clinical training in child mental health I had little introduction to the child protective system or to the special education and juvenile justice systems,

The vast majority had had at least six major traumatic experiences.

(PTSD). PTSD did not even make it into the “differential diagnosis,” a list included in the case report of possible alternative diagnoses with similar symptoms that each clinician considers, then rules out.

these veterans’ stress response systems were overreactive, what scientists call “sensitized.”

As a result the brain’s capacity to regulate mood, social interactions, and abstract cognition was also compromised.

Consequently, we are also rapidly and easily transformed by trauma when we are young.

sensitization, a pattern of stimulus leads to increased sensitivity to future similar stimulus.

Tolerance, on the contrary, mutes one’s response to an experience over time.

To create an effective “memory” and increase strength, experience has to be patterned and repetitive.

The actual experience is a stressor; the impact on the system is stress.

Without the stress, the system wouldn’t know there is something new to attend to.

The stronger stress response system in the present is the one that has had moderate, patterned stress in the past.

If a system is overloaded—worked beyond capacity—the result can be profound deterioration, disorganization, and dysfunction

In Tina’s case and that of the boys at the center, their experience of stress was far beyond their young systems’ capacities to carry it.

I learned that she had profound sleep problems and was pervasively anxious. I was told that she had an increased startle response.

episodic periods of daydreaming,

Sandy sometimes had aggressive, tantrum-like outbursts.

Sandy didn’t want to use silverware. Unsurprisingly, she was especially afraid of knives;

refused to drink milk, or even look at milk bottles.

doorbell rang, she w...

As she slashed, she repeated, “It’s for your own good, dude.”

took milk from the refrigerator and gagged when she tried to drink some.

Emotions are powerful markers of context.

Negative emotions often make things even more memorable than positive ones because recalling things that are threatening—and avoiding those situations in the future if possible—is often critical to survival.

milk, once associated with nurturing and nutrition, now became the stuff that spilled from her throat, that her mother “refused” as she lay dead.

Her brain was trying to protect her based upon what it had previously learned about the world.

The fear response is graded, calibrated by the brain’s perceived level of threat

things. First, your brain makes you stop thinking about irrelevant things by shutting down the chatter of the frontal cortex.

Then, it focuses on cues from others around you to help you determine who might protect or threaten you, by letting the limbic system’s “social cue reading”

heart rate increases to get blood to your muscles in case you ne...

Fear quite literally makes us dumber, a property that allows faster reactions in short periods of time and helps immediate survival.

Dissociation is a very primitive reaction:

For infants and young children, incapable of or ineffective at fighting or fleeing, a dissociative response to extreme stressors is common.

During dissociation, the brain prepares the body for injury. Blood is shunted away from the limbs and the heart rate slows to reduce blood loss from wounds.

The capacity to become “numb” and partially robotic during combat, for example, allows the soldier to continue to function effectively without panic.

The result is that these systems can become overactive and sensitized, leading to a host of emotional, behavioral, and cognitive problems long after the traumatic event is over.

Hyperaroused youth can look hyperactive or inattentive because what they are attending to is the teacher’s tone of voice or the other children’s body language, not the content of their lessons.

She had me bend my knees and put my arms behind my back, as if I was hog-tied. And then, the reenactment took place. For the next forty minutes, she wandered the classroom, muttering things, only some of which I heard.

And that control, I began to recognize, would be critical to helping her heal.

AFTER ALL, ONE OF THE DEFINING elements of a traumatic experience—particularly one that is so traumatic that one dissociates because there is no other way to escape from it—is a complete loss of control and a sense of utter powerlessness.

regaining control is an important aspect of coping with...

“learned helple...

In both rats major changes can be seen in the stress systems of their brains: healthy changes in the case of the rats with control over the stress, and deterioration and dysregulation in the others.