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

by Bruce D. Perry

animals that have been placed in a situation without control for long enough become too frightened to explore the cage to figure out how to help themselves.

Like a doctor balancing desired effects and side effects of a drug by choosing the right dose, Sandy regulated her exposure to the stress of her reenactment play.

Her brain was trying, through reenactment, to make the trauma into something predictable,

Patterned, repetitive stimuli lead to tolerance, while chaotic, infrequent signals produce sensitization.

repetitive, small “doses” of recall.

Finally she would come and lay on my back. She would start to hum quietly and rock. I knew better by then not to talk or change position. I let her have the total control she needed. It was heartbreaking.

we tend to prefer the “certainty of misery to the misery of uncertainty.”

She would still hold my head to try to feed me.

She did less muttering and exploring and spent more time rocking and humming.

She walked over to the bookcase, pulled down a book, and crawled into my lap. “Read me a story,” she said. And as I started she said, “Rock.”

the members of the Mount Carmel religious community were called, became exquisitely sensitive to his moods as they attempted to curry his favor and tried, often in vain, to stave off his vengeance.

He separated husband from wife, child from parent, friend from friend, undermining any relationship that could challenge his position as the most dominant,

Children (and sometimes even adults) were in constant fear of the physical attacks and public humiliation that could result from the tiniest error, like spilling milk.

for the girls, there was knowledge that they would ultimately become a “Bride of David.”

fear of the “Babylonians”: outsiders, government agents, nonbelievers.

They were instructed in the most lethal suicide techniques with firearms, being told to aim for the “soft spot” in the back of the mouth if they faced capture by the “Babylonians.”

Government agencies—especially the chronically underfunded and overburdened Child Protective Service (CPS) systems—rarely have concrete plans to deal with sudden influxes of large groups of children.

Keeping them together turned out to be one of the most therapeutic decisions made in their case: these children would need each other.

they need predictability, routine, a sense of control and stable relationships with supportive people.

The fact that the brain develops sequentially—and also so rapidly in the first years of life—explains why extremely young children are at such great risk of suffering lasting effects of trauma: their brains are still developing.

observed that the nature of a child’s relationships—both before and after trauma—seemed to play a critical role in shaping their response to it.

To calm a frightened child, you must first calm yourself.

it is far more difficult for them to hide their true thoughts and feelings in their artwork.

islands of talent, knowledge, and connection surrounded by vast empty spaces of neglect.

She redrew the same compound building with flames everywhere. Atop it was a stairway to heaven. I knew then—just days after the first raid—that the siege was headed for a potentially cataclysmic conclusion.

I felt it was more important at this time to restore order and be available to support, interact with, nurture, respect, listen to, play with, and generally “be present.”

how the human brain cannot really be understood outside of its context

what works best is anything that increases the quality and number of relationships in the child’s life.

the mind and body cannot be treated separately,

Mother and daughter were not interacting.

all I could see here was a despondent, skinny little girl and a disengaged mother.

Since much of the brain develops early in life, the way we are parented has a dramatic influence on brain development.

a good “brain” history of a child begins with a history of the caregiver’s childhood and early experience. To understand Laura I would need to know about her family, which in her case consisted of her mom.

What we call “cuteness” is actually an evolutionary adaptation that helps ensure that parents will care for their children, that babies will get their needs met,

The first is the complex set of sensory perceptions associated with human relational interactions: the caregiver’s face, smile, voice, touch, and scent.

the neural networks mediating “pleasure.” This “reward system” can be activated in a number of ways, one of which is the relief of distress.

Consequently, the most powerful rewards we can receive are the attention, approval, and affection of people we love and respect.

As your brain develops these loving caregivers provide the template that you use for human relationships.

Similarly, if a child is not exposed to language during his early life, he may never be able to speak or understand speech normally.

Children who don’t get consistent, physical affection or the chance to build loving bonds simply don’t receive the patterned, repetitive stimulation necessary to properly build the systems in the brain that connect reward, pleasure, and human-to-human interactions.

Because of yet another inhumane child welfare policy—one aimed at reducing the system’s legal liabilities, not protecting children—Virginia lost the only parents she’d ever really known.

Virginia parented in an emotionally disconnected way. She didn’t spend much time holding her baby; she fed the little one propped up with a bottle, not nuzzled close to her bosom. She didn’t rock her, didn’t sing to her, didn’t coo or stare into her eyes or count her perfect tiny toes over and over or do any of the other silly but hugely important things that people with ordinary childhoods instinctively do when caring for a baby.

“failure to thrive.”

For most of us, including adults, the mere presence of familiar people, the sound of a loved one’s voice, or the sight of their figure approaching can actually modulate the activity of the stress-response neural systems, shut off the flood of stress hormones, and reduce our sense of distress.

the positive associations between human contact and safety, predictability, and pleasure may not develop.

but is abandoned as soon as she feels comfortable with her particular smell, rhythm, and smile, and then abandoned again once she acclimates to a new caregiver, these associations may never gel.

The price of love is the agony of loss, from ...

However, because she did live in a stable, loving home when the higher, cognitive regions of her brain were most actively developing, she was able to learn what she “should” do as a parent. Still, she didn’t have the emotional underpinnings that would make those nurturing behaviors feel natural.

Her body responded with a hormonal dysregulation that impeded normal growth, despite receiving more than adequate nutrition. The

“runt syndrome.”