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

by Bruce D. Perry

By conservative estimates, about 40 percent of American children will have at least one potentially traumatizing experience by age eighteen:

at any given time, more than eight million American children suffer from serious, diagnosable, trauma-related psychiatric problems. Millions more experience less serious but still distressing consequences.

Surprisingly, it is often when wandering through the emotional carnage left by the worst of humankind that we find the best of humanity as well.

Ultimately, what determines how children survive trauma, physically, emotionally, or psychologically, is whether the people around them—particularly the adults they should be able to trust and rely upon—stand by them with love, support, and encouragement.

Fire can warm or consume, water can quench or drown, wind can caress or cut. And so it is with human relationships: we can both create and destroy, nurture an...

Guilty about the luck, the opportunities, the resources, and the gifts I had been given, guilty about all of the times I had complained about working too much, or not getting credit for something I had done.

the biology and function of these important systems could be altered dramatically by brief periods of stress during early life. Biology isn’t just genes playing out some unalterable script. It is sensitive to the world around it,

One of the few things I knew for sure by then about traumatized children was that they need predictability, routine, a sense of control and stable relationships with supportive people.

The same miraculous plasticity that allows young brains to quickly learn love and language, unfortunately, also makes them highly susceptible to negative experiences as well.

The major predators of human beings are other human beings.

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, and that parents will take on this seemingly thankless task with pleasure.

Attachment, then, is a memory template for human-to-human bonds. This template serves as your primary “world view” on human relationships. It is profoundly influenced by whether you experience kind, attuned parenting or whether you receive inconsistent, frequently disrupted, abusive, or neglectful “care.”

in which children are not allowed the chance to develop permanent relationships with one or two primary caregivers during their first three years of life have lasting effects on people’s ability to relate normally and affectionately to each other.

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.

Unfortunately, this meant that when she turned eighteen, the state was no longer legally “responsible” for Virginia. As a result she had to leave her foster home and the foster parents were told to have no further contact with her. Their future as foster parents for other children was linked to their compliance with the wishes of the caseworkers. 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.

Not pulled by her limbic, emotional systems and not pushed by her cognitive, information-carrying cortex, Virginia parented in an emotionally disconnected way.

the love a baby feels for his caregivers is every bit as profound as the deepest romantic connection. Indeed, it is the template memory of this primary attachment that will allow the baby to have healthy intimate relationships as an adult.

Without this grooming his own growth hormones turn off, so even if he does somehow get enough to eat, he still doesn’t grow properly.

young victims of abuse and neglect need physical stimulation, like being rocked and gently held, comfort seemingly appropriate to far younger children. She knew that you don’t interact with these children based on their age, but based on what they need, what they may have missed during “sensitive periods” of development.

Though we all “perform” for others to some extent, the mask slips easily for those who have suffered early neglect.

This split between verbal and performance scores is often seen in abused or traumatized children and can indicate that the developmental needs of certain brain regions, particularly those cortical areas involved in modulating the lower, more reactive regions have been not been met.

When they mutilate themselves, they can induce a dissociative state, similar to the adaptive response they’d had during the original trauma.

provides an escape from anxiety caused by revisiting traumatic memories or just the challenges of everyday life. In dissociative states, as we’ve discussed, people can become so disconnected from reality that they move into a dreamlike consciousness

These experiences are linked with the release of high levels of opioids, the brain’s natural heroin-like substances that kill pain and produce a calm...

Research on addicts and alcoholics finds dramatically increased numbers of early traumatic events, as compared to those who have not suffered addictions. The most severe addicts’ histories—especially amongst women—are filled with childhood sexual abuse, loss of parents through divorce or death, witnessing severe violence, physical abuse and neglect and other trauma.

He didn’t care if the attention for high grades was positive, since he found any attention stressful, even threatening.

when people suffer extreme traumatic stress, their brains can become “sensitized” to future stressors, and it takes smaller and smaller amounts of stress to set the system off and prompt a full-blown stress response.

This is a common problem with many drugs in psychiatry, and in general medicine. A drug may be excellent at eliminating a particular symptom, but does not treat the whole person and deal with the full complexity of his problem, and therefore it may exacerbate other symptoms.

it is exhausting to view the entire world as a potential threat.

She tended to twist positive comments from others into neutral remarks, neutral interactions into negative exchanges and any negative cues into catastrophic personal attacks.

They project their self-hate onto the world and become sensitized—indeed, hypersensitive—to any sign of rejection.

when infants don’t receive enough rocking, cuddling and other nurturing physical and emotional attention. The regions of their brains that help them form relationships and decode social cues do not develop properly, and they grow up with faulty relational neurobiology, including an inability to derive pleasure from healthy human interactions.

(This “gut feeling” is actually a low-level activation of the stress response system, which is acutely attuned to combinations of incoming signals that are out of context or novel.)

prefer the certainty of misery to the misery of uncertainty.

significant early life neglect such as that seen in formerly institutionalized children like Peter leads to smaller brain size over all, brain shrinkage in certain regions, and a host of brain-related functional problems.

the areas where he was doing better were related to brain regions that had received stimulation, and those where he had deficits represented brain regions that had either been more severely deprived or had not yet received enough stimulation to make up for the earlier neglect.

The more healthy relationships a child has, the more likely he will be to recover from trauma and thrive. Relationships are the agents of change and the most powerful therapy is human love.

The most traumatic aspects of all disasters involve the shattering of human connections.

Indeed, at heart it is the relationship with the therapist, not primarily his or her methods or words of wisdom, that allows therapy to work.

The truth is you cannot love yourself unless you have been loved and are loved. The capacity to love cannot be built in isolation.