What Happened to You?: Conversations on Trauma, Resilience, and Healing

by Bruce D. Perry

What I could discover was profound, but what I would discover was on me.

In Western psychiatry we like to separate them, but that misses the true essence of the problem. We are chasing symptoms, not healing people.

Similar overrepresentation of Indigenous people and people of color in special-education, mental health, juvenile-justice, and criminal-justice systems is seen in Australia with Aboriginal and Torres Strait peoples, Canada with First Nations, and the United States with Black, Latinx, and Native American populations.

Our ability as a people to tolerate stressors is diminishing because our connectedness is diminishing.

The irony is that all human communication is characterized by moments of miscommunication and getting out of sync, but then repairing things.

Conversation, for example, promotes resilience; discussions and arguments over family dinners and mildly heated conversations with friends are—as long as there is repair—resilience-building and empathy-growing experiences.

Social media makes this difficult.

Mature human interactions involve efforts to understand people who are different from you.

Empathy is the ability to put yourself in somebody else’s shoes—both in an emotional sense, to feel a bit of what they may feel, but also in a cognitive sense, to see the situation from their perspective. If you approach an interaction from an empathic stance, you’re much less likely to have a negative perspective on whatever is going on.

human beings have been human beings—in this genetic form—for about 250,000 years. And for 99.9 percent of that time, we lived in hunter-gatherer bands of relatively small multifamily groups. So our brain is “suited” for the social attributes and complexities of these smaller groups.

Our current challenge is that the rate of invention is now exceeding the rate at which we can problem-solve.

As the writer and biochemist Isaac Asimov said, “The saddest aspect of life right now is that science gathers knowledge faster than society gathers wisdom.”

And the stress is far worse if you have to also worry about housing, food, or employment. The unpredictability and insecurities of poverty drain the stress-response system’s bandwidth in ways that make “opportunities” to escape poverty extremely difficult to take advantage of.

We are having far fewer family meals; our conversational skills are fading. The art of storytelling and the capacity to listen are on the decline. The result is a more self-absorbed, more anxious, more depressed—and less resilient—population.

Our society’s transgenerational social fabric is fraying. We’re disconnecting. I think that’s making us more vulnerable to adversity, and I think it’s a significant factor in the increases in anxiety, suicide, and depression we are seeing currently, even before the COVID-19 pandemic.

Disconnection is disease. I think the Māori elders were right, and that there is some correlation between rising suicide rates and the increased fraying of our social fabric.

True. But being on the bottom of any power differential makes life a lot harder. If you don’t belong to the “in” group, your marginalization can contribute to feelings of not belonging.

Many people have had the experience of feeling “exhausted” after a day of travel, even if all they did was stand in a few lines and sit on a plane. This happens because your brain was continuously monitoring thousands of new stimuli.

Remember: Activating your stress-response systems, even at a moderate level, for long periods of time is physically and emotionally exhausting.

One of the things we don’t appreciate in Western cultures is how powerful and important touch is to our physical and emotional growth.

But it’s simply unhealthy for a three-or four-year-old child to go eight hours without touching or hugging or playfully wrestling with another person.

We’re reactive; we prioritize convenient, short-term solutions; we’re risk-averse; and we use material things rather than relationships as rewards.

I think we need the same sort of universal “rules” for the standard use of our technologies. No-phone zones and no-phone times, proper “dosing” and spacing of screen time, and so forth. We know, for example, that nonstop screen time for a young child is not optimal for healthy development of language skills, attention, or concentration, so age and time limit recommendations have been made by the American Academy of Pediatrics.

An infant or toddler consumed by a screen is missing out on other critical forms of learning about the world. They should be exploring what things feel like, smell like, taste like. They should be making sense of their world using all their sensory tools.

When you actually look at children’s language acquisition, you see that fluency is related to the number of words spoken in a back-and-forth, interactive, conversational way. Not the number of words heard on a device.

El and Ryan’s podcast episode for CareU

My pain and the resolve that followed it became a cycle that would repeat itself many times. I believe it is, in a profound way, the very through line of my life. The struggles I endured as a child are what allowed me to recognize and care about pain in others. The validation I longed for as a child is what I see other people longing for just as intensely. Thousands of people had the courage to share their stories with me because their story was my story. Their pain was my pain. Because all pain is the same. — Oprah

It’s important to clarify that most people who are abused don’t go on to abuse others in the same way. On the other hand, it is becoming clear that it’s the very rare person who has been abused who doesn’t have some form of adaptation that impacts how they deal with people. It doesn’t have to be a “pathology,” but it can influence the ways in which you form and maintain relationships.

This goes back to our earlier talk about why some people seem to seek abusive relationships. Our brain, our mind, pulls us toward familiar patterns—even when those patterns are negative. People end up repeating previous maladaptive patterns and often don’t recognize it. A lot of times, the people around us will see it more clearly than we do.

But over the years, there were some very special teachers who took the time to nurture the potential they recognized in me.

The Neurosequential Model allows us to create a version of how the individual’s brain appears to be organized; it is basically like an inspection of a house. By asking about the “history” of the house’s construction—the “what happened to you?”—we are able to home in on the most likely problems.

Once we know the source of the problem, we can better understand how to fix it. In a sequence that replicates the original construction of the house—the brain—we put in place a “rebuilding/renovation” plan. With the problem areas in mind, we can provide experiences—both educational and therapeutic—that jump-start and reorganize the systems that were impacted by neglect, adversity, and trauma. We have a better idea about how to select and sequence therapeutic experiences—a better grasp of what we can do to help, and when.

When Susan was removed from her mother, she entered shelter care for two months. Then she was in a succession of three foster homes before she was finally adopted. One can only imagine her “worldview” about the safety and trustworthiness of adults. The process of building her house was continually interrupted; the wiring, plumbing, and framing were all impacted by a two-year span of unpredictable, uncontrollable, and extreme activation of her stress-response systems.

Now, part of the problem was that the educational and mental-health systems—not to mention her parents—viewed Susan as a seven-year-old child. But while she was chronologically seven, she wasn’t developmentally seven. She had the social skills of an infant, the regulatory skills of a two-year-old, the cognitive skills of a three-year-old. Parents, teachers, and therapists kept trying to reason with her. They explained the rules and tried to explore “why” she did all these “naughty” things. They were doing the best they could; they did not understand state-dependent functioning or the developmental challenges that were predictable considering Susan’s history.

We didn’t focus on Susan’s problems with peers, her inability to pay attention in class, her depressive symptoms, her explosive outbursts, or even her speech problems. We were going in sequence. We started with the lower systems, knowing we’d get to the other problems later in the treatment process.

A key part of a neurosequential approach is to help parents, teachers, and clinicians know the “stage” and watch the “state.” Meaning we want to help them learn what the child’s actual developmental capabilities are—their actual stage, as opposed to their age.

As we have discussed, if the child is too dysregulated, they will not be open to any new learning or experience. And if you continue to expect the child to pay attention, focus, and learn, you will be eroding the child’s sense of safety with you. You will be damaging the empathic bond between the two of you—the very thing on which all chance of change depends.

Your relationship lives to teach another day.

Neurosequential. It’s all about the sequence. The brain develops, processes incoming sensory input, and heals in sequence.

Exactly. It really is never too late. Healing is possible. The key is knowing where to start the process. And matching the developmental needs of the person.

But if the adults who live with, teach, and treat these children are not regulated, they will not be able to be fully present in a compassionate, regulated way.

Stephanie’s comment about if the teachers are ok, the kids will be ok.

As you point out, if you don’t give back to yourself, you simply will not be effective as a teacher, a leader, a supervisor, a parent, a coach, anything. Self-care is huge. Unfortunately, many people feel some guilt about taking care of themselves; they view self-care as selfish. It’s not selfish—it is essential.

Trauma and adversity, in a way, are gifts. What we do with these gifts will differ from person to person.

way. It is true, though, that the cost of wisdom can be very high. And for many people, the pain never goes away. The wise learn how to carry their burden with grace, often to protect others from the emotional intensity of their pain.

I can’t help thinking the same is true for a society, not just an individual. How can our society move toward a more humane, socially just, creative, and productive future without confronting our collective historical trauma? Both trauma experienced and trauma inflicted. If we truly want to understand ourselves, we need to understand our history—our true history. Because the emotional residue of our past follows us.

I agree, but we are so from this right now that it won’t happen anytime soon.

Dr. Perry: It is easy to be discouraged and overwhelmed by the many problems in our society, to be demoralized by the inequities, adversities, and trauma that are all too pervasive in our world. But if you study history, you will recognize that the overall trajectory for humankind is positive. Our world is filled