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

by Bruce D. Perry

Even less consideration was given to how trauma might harm children. It wasn’t considered relevant. Children were believed to be naturally “resilient,” with an innate ability to “bounce back.”

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 and terrorize, traumatize and heal each other.

Not all humans are humane. A human being has to learn how to become humane. That process—and how it can sometimes go terribly wrong—is another aspect of what this book is about.

They also expose how ignorance, poverty, violence, sexual abuse, chaos, and neglect can wreak havoc upon growing brains and nascent personalities.

interaction. My behavior didn’t fit with her internal catalog of previous experiences with men. She had only known men as sexual predators: no loving father, no supportive grandfather, no kind uncle or protective older brother had touched her life. The only adult males she’d met were her mother’s often inappropriate boyfriends and her own abuser.

Experience had taught her that men wanted sex, either from her or her mother. So quite logically from her perspective, she assumed that’s what I wanted as well.

All of them work in concert, like a symphony orchestra, so while there are individualized capacities, no one system is wholly responsible for the sound of the “music” you actually hear.

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

for her to assume that sex was what I wanted as well. When she went to school and exposed herself or tried to engage in sex play with other children, she was modeling what she knew about how to behave. She didn’t consciously think about it. It was just a set of behaviors that were part of her toxic associations, her twisted template for sexuality.

The vast majority had had at least six major traumatic experiences. All of these children had been born into and raised with chaos, threat, and trauma. They were incubated in terror.

If anything, children are more vulnerable to trauma than adults; I knew this from Seymour Levine’s work and the work of dozens of others by then. Resilient children are made, not born.

Children become resilient as a result of the patterns of stress and of nurturing that they experience early on in life,

if a rat, or a human, is given small, frequent doses of drugs like cocaine or heroin that act on the dopamine and opioid systems, the drugs lose their “strength.” This is part of what happens during addiction: the addict becomes tolerant, and so more of the drug is needed to achieve the same “high.”

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

Through moderate, predictable challenges our stress response systems are activated moderately. This makes for a resilient, flexible stress response capacity. The stronger stress response system in the present is the one that has had moderate, patterned stress in the past.

The pattern and intensity of experience matter. If a system is overloaded—worked beyond capacity—the result can be profound deterioration, disorganization, and dysfunction

Just as a body builder can carry weights that untrained people cannot even move, so too can some brains deal with traumatic events that would cripple others. The context, timing and response of others matters profoundly. The death of a parent is far more traumatic for the two-year-old child of a single mother than it is for a fifty-year-old married man with children of his own.

Similarly, if you happen to be brushing your teeth when an earthquake destroys your home, those events may become forever connected in your mind and recalled together.

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.

For an earthquake survivor who was brushing her teeth when the house collapsed around her, simply seeing a toothbrush might be enough to provoke a full-fledged fear response.

The fear response is graded, calibrated by the brain’s perceived level of threat (see Figure 3, Appendix). As you become increasingly frightened, the threat systems in your brain continue to integrate incoming information and orchestrate a total body response aimed at keeping you alive.

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. A flood of endogenous opioids—the brain’s natural heroin-like substances—is released, killing pain, producing calm and a sense of psychological distance from what is happening.

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. As a result, regaining control is an important aspect of coping with traumatic stress.

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

A former member said Koresh once excitedly compared the heartbeats of the prepubescent girls he violated to those of hunted animals.

and put them up around the cottage. But none of the children knew what to do when faced with the simplest of choices: when offered a plain peanut butter sandwich as opposed to one with jelly, they became confused, even angry.

Inside the compound almost every decision had been made for them. Having never been allowed the basic choices that most children get to make as they begin to discover what they like and who they are, they had no sense of self.

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

Relationships matter: the currency for systemic change was trust, and trust comes through forming healthy working relationships. People, not programs, change people. The cooperation, respect and collaboration we experienced gave us hope that we could make a difference, even though the raids themselves had ended in such catastrophe.

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.

blurred. One reason some autistic children may not talk is that they don’t recognize the need to communicate; they aren’t aware that other people don’t know what they know.

Autistic people can be insensitive to the feelings and needs of others, but this usually occurs when they cannot fully perceive these feelings, not because they wish to cause harm or to be unkind. They have every capacity to love and feel emotional pain, but not the wiring that allows them to easily understand how to interact and have relationships. They may have difficulty imagining what it’s like to be in someone else’s shoes—sometimes called “mind-blindness”—but they do not lack sympathy for those people’s experiences when they become aware of them.

them. In other words, they not only don’t completely recognize what other people feel, but they don’t care if they hurt them or they even actively desire to do so. They can imagine walking in someone else’s shoes, and they can predict how other people will behave based upon this ability to put themselves in someone else’s place, but they don’t care what it’s like there. Their only concern is how others will affect them.

But what about Leon’s inability to give and receive love? Can we blame him for having a childhood that wilted the part of his brain that allows him to feel the greatest joys most of us have in life: the pain and pleasure of human connection? Of course not.

This might also be called a “snowball effect”: when things go right early on, they will tend to continue to go right and even to self-correct if there are minor problems. But when they go wrong at first, they will tend to continue to go wrong.

Because trauma—including that caused by neglect, whether deliberate or inadvertent—causes an overload of the stress response systems, which is marked by a loss of control, treatment for traumatized children must start by creating an atmosphere of safety.

This should go without saying, but holding a child down and hurting him until he says what you want to hear does not create bonds of affection but, rather, induces obedience through fear.

healthy social support system. Believing that you cannot recover unless you remember the precise details of a past trauma can also become a self-fulfilling prophecy. It can keep you focused on the past rather than dealing with the present.

For example, some studies have found that depression can be exacerbated by ruminating on past negative events. Because of how memory works, such rumination can also lead you to recall old, ambiguous memories in a new light, one that, over time, becomes darker and darker until it eventually becomes a trauma that never actually occurred.

anything to do with him. Many “cutters”—as I would soon find out Amber was—have a history of trauma. When they mutilate themselves, they can induce a dissociative state, similar to the adaptive response they’d had during the original trauma. Cutting can be soothing to them because it 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 where nothing seems real and they feel little emotional or physical pain.

“I know that when you feel anxious, you feel pulled to cut yourself. And that when you first put the razor to your skin and feel that first cut, you feel relief.” She looked at me as though I was revealing a deep secret. “I know that sometimes in school, you feel the tension build inside you and you can’t wait to get to the bathroom and cut yourself, even just a tiny bit. And I know that even on warm days, you will wear long-sleeved shirts to hide the scars.”

place in my head.” As she described it, she seemed to change. “Little by little, I made that place my special retreat. Whenever I thought about going there and being there, I felt safe. Nobody knew where it was. Nobody could come in there with me. Nobody could hurt me there.” She paused. She was now speaking in a low tone of voice, in a monotone, almost robotically. She was staring off into space as she spoke. She hardly blinked. We sat in silence for a moment and then she continued.

I tried being a beautiful bird, a bluebird or a robin but I couldn’t be beautiful there. I tried being a majestic bird, like an eagle or a hawk, but that didn’t work either. My mind kept making me something dark. Like a raven. But I was powerful. I could control other animals. I was wise and I was kind, but I was absolutely ruthless in hunting down and using my power to kill evil. To those creatures, the bad ones, I was the Black Death.”

The same is true of people who use drugs like heroin or OxyContin. Contrary to popular belief, most people who try these drugs do not find them overwhelmingly blissful. In fact, most people don’t like the numbing sensation they produce. But those who suffer the after-effects of severe stress and trauma are likely to find the substances soothing and comforting, not deadening.

given to the child often determines how he is treated. A child seen as “bad” will be treated differently from one viewed as “mad,” and both will have their behavior seen in a very different light depending on whether the clinician sees a “victim” or a “perpetrator.” Further, depending upon one’s point of view, the exact same behavior can be framed as “running away” or “seeking help” and the perspective will profoundly affect decisions about what to do for and to the child.

video games. Brain development is use-dependent: you use it or you lose it. If we don’t give children time to learn how to be with others, to connect, to deal with conflict, and to negotiate complex social hierarchies, those areas of their brains will be underdeveloped.

Indeed, I have often speculated that many of the studies of ADHD and conduct disorder are complicated by the fact that more than 30 percent of study participants are actually manifesting trauma-related symptoms, not just some sort of genetically-based problem with the development of the brain’s attentional and executive control systems.