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

by Bruce D. Perry

effects of my treatment by those who were supposed to care for me weren’t strictly emotional. There was also a biological response.

although I experienced abuse and trauma as a child, my brain found ways to adapt.

understanding how the brain reacts to stress or early trauma helps clarify how what has happened to us in the past shapes who we are, how we behave, and why we do the things we do.

Despite the myriad circumstances into which we’re born, we come into the world with an innate sense of wholeness. We don’t begin our lives by asking: Am I enough? Am I worthy? Am I deserving or lovable?

Mike’s brain adapted to continuous threat—his body and brain became oversensitive and overreactive to any threat-related signals from the world. Back then, to stay alive, his brain made a connection—basically a specialized form of memory—between the sounds of gunfire and shelling and the need to activate an extreme survival response.”

At the top is the cortex, the most uniquely human part of our brain.”

“The systems at the top are responsible for speech and language, thinking, planning; our values and beliefs are stored there. And, very important for you, this is the part of the brain that can ‘tell time.’ When the cortex is ‘online’ and active, we can think about the past and look forward to the future. We know which things are in our past and which things are present, yes?”

“Okay. Now look at the bottom of the brain—the brainstem. This part of the brain controls less complex, mostly regulatory, functions like body-temperature regulation, breathing, heart rate, and so forth. But there are no networks in the bottom part that think or tell time. Sometimes we refer to this part of the brain as the reptilian brain, so think of what a lizard can do—they don’t plan much, or think; they mostly live in the moment and react. But we humans, thanks to the top part of our brain—the cortex—can invent, create, plan, and tell time.”

“Input from all of our senses—vision, hearing, touch, smell—first comes into our brain in the lower areas. None of our sensory input goes directly to the cortex; everything first connects to lower parts of the brain.”

“Once the signal comes into the brainstem”—here I directed their attention to the bottom of the triangle—“it is processed. Basically, the incoming signal is matched against previously stored experiences. In this case, the matching process connected the motorcycle backfire with gunfire—remember that combat-related memory? And since your brainstem can’t tell time, or know that many years have passed, it activates the stress response and you have a full-blown threat response. You feel and act as if you are under attack. Your brainstem can’t say, ‘Hey, don’t get so stirred up, Korea was thirty years ago. That sound was simply a motorcycle backfiring.’”

HIERARCHICAL ORGANIZATION OF THE HUMAN BRAIN The brain can be divided into four interconnected areas: brainstem, diencephalon, limbic, and cortex. The structural and functional complexity increases from the lower, simpler areas of the brainstem up to the cortex. The cortex mediates the most uniquely “human” functions such as speech and language, abstract cognition, and the capacity to reflect on the past and envision the future.

watched this sink in. “Now, when the signal finally gets up to the cortex, the cortex can figure out what’s really going on. But one of the first things that happens when you activate the stress response is that systems in the higher parts of the brain, including our ability to ‘tell time,’ get shut down.

But what was once adaptive has become maladaptive.

Each biological system in our body has some way to change in response to experience; in a sense, then, that change is a record of past experiences—or, basically, memory. Neurons are exquisitely sensitive to experience, and neural networks in every part of the brain can make memory. Remembering names, phone numbers, and where you left your keys is a function of the neural networks of the cortex. But we also have emotional memories: A song can elicit a feeling, an association with an experience that took place years ago. The smell of roasted turkey or freshly baked bread may elicit a warm sense of belonging, or a melancholy sense of a lost past. These feelings arise from associations stored in the neural networks of the limbic and other brain regions. And there are motor-vestibular memories—curling up in the fetal position is essentially an act of remembering—stored in even lower networks in the brain. But traumatic experience can create complex memory traces that involve all regions of the brain.

the brain develops sequentially, from the bottom up and the inside out, from the basic functions of the brainstem to the complex achievements of the cortex. Each brain area has the capacity to create memory—to change in response to experience and to store those changes in its particular neural networks.

In a young child, the cortex is not yet fully developed; in children younger than three, the neural networks are not mature enough to create what’s called linear narrative memory (in other words, a who, what, when, and where memory). However, in lower areas of the brain, other neural networks are processing—and changing as a result of—our earliest experiences. Associations, or memories, are being created in these lower networks, and this has a huge impact on how trauma is stored in the brains of the very young. If a child experiences abuse, their brain may make an association between the features of the abuser or the circumstances of the abuse—hair color, tone of voice, the music playing in the background—and a sense of fear. The complex and confusing associations can influence behaviors for years; later in life, for example, being served in a restaurant by a brown-haired man who hovers over you while h...

anything new will activate our stress-response systems. Our default response to novelty is “Uh-oh. What is this?” And until the new thing is proven safe and positive, it will be categorized as a potential threat. For most people, the unknown is one of the major causes of feeling anxious or overwhelmed.

But beyond the complex physical task of delivering essential nutrients to every cell, tissue, and organ, your heart’s pulse also regulates your emotional energy. A strong, even pace can bring a sense of calm. A rapid staccato can panic even the healthiest person.

From birth, your heart is constantly sending messages about the state of your well-being. It’s intimately attuned to the slightest shifts in your physical and emotional health, and when it sends out a warning, every part of you feels the effect.

Music, laughter, dancing (even a party for one), knitting, cooking—finding what naturally soothes you not only regulates your heart and mind, it helps you stay open to the goodness in you and in the world.

All life is rhythmic. The rhythms of the natural world are embedded in our biological systems. This begins in the womb, when the mother’s beating heart creates rhythmic sound, pressure, and vibrations that are sensed by the developing fetus and provide constant rhythmic input to the organizing brain. These experiences create powerful associations—essentially, memories—that connect rhythms of roughly sixty to eighty beats per minute (bpm) to regulation. Sixty to eighty bpm is the average resting heart rate for an adult; it’s the rhythm the fetus sensed, and it equates to being in balance, to being warm, full, quenched, safe.

Note: HPA = Hypothalamic-Pituitary-Adrenal Axis; ANS = Autonomic Nervous System; CRNs = Core Regulatory Networks The Tree of Regulation is comprised of a set of neural networks our body uses to help us process and respond to stress.

We have a set of core regulatory networks (CRNs), or neural systems, originating in the lower parts of the brain and spreading throughout the whole brain, that work together to keep us regulated in the face of various stressors. Collectively, the branches of this Tree of Regulation direct or influence all functions of the brain (like thinking and feeling) and the body (impacting your heart, stomach, lungs, pancreas, and more). They are trying to keep everything in equilibrium, everything regulated, everything in balance.

But what happens when a baby doesn’t get those positive, nurturing responses? Say, if a mom is on her own with no help, or depressed, or in a violent relationship? She may really want to be a loving, responsive parent, but is that possible under those circumstances? Dr. Perry: This is one of the central problems in our society; we have too many parents caring for children with inadequate supports. The result is what you would expect. An overwhelmed, exhausted, dysregulated parent will have a hard time regulating a child consistently and predictably. This can impact the child in two really important ways.

prolonged cases of trauma, the CRNs of the Tree of Regulation change and adapt so that they can better cope with the current challenge. The system works hard to keep you in balance, but it can be difficult and exhausting. And in these long-term cases, even when the challenge passes, the change in these systems persists.

We elicit from the world what we project into the world; but what you project is based upon what happened to you as a child.

The long-term effects of stress are determined by the pattern of stress activation. When the stress-response systems are activated in unpredictable or extreme or prolonged ways, the systems becomes overactive and overly reactive—in other words, sensitized. Over time, this can lead to functional vulnerability, and since the stress-response systems collectively reach all parts of the brain and body, a cascade of risk in emotional, social, mental, and physical health occurs. In contrast, predictable, moderate, and controllable activation of the stress-response systems, such as that seen with developmentally appropriate challenges in education, sport, music, and so forth, can lead to a stronger, more flexible stress-response capability—i.e., resilience.

If the parent is consistent, predictable, and nurturing, the stress-response systems become resilient. If the stress-response systems are activated in prolonged ways or chaotic ways, as in cases of abuse or neglect, they become sensitized and dysfunctional.

Even in the absence of major traumatic events, unpredictable stress and the lack of control that goes with it are enough to make our stress-response systems sensitized—overactive and overly reactive—creating the internal storm.

And also remember that humans are emotionally “contagious”; we sense the distress of others. Imagine a child in a home with a frustrated, angry father who has no job prospects, is disrespected in the community due to his status or skin color, and comes home feeling impotent, defeated. This parent’s internal storm becomes the home’s storm. His chaos becomes the home’s chaos. He may use alcohol or a drug to manage his distress. But a drug-using parent, a drunk, overwhelmed, frustrated parent is going to create a climate of fear for their children. As much as they may want to protect the children from their distress, and as much as they love their children, the mess is made. The children grow up internalizing this; they are incubated in terror.

Activation of key neural networks in the brain can produce the sense of pleasure or reward. These reward circuits can be activated in multiple ways, including relief of distress (e.g., using Alcohol to self-medicate or Rhythm to regulate the anxiety produced by a stress-response system that’s been altered by trauma); positive human interactions (Relational); direct activation of the reward systems using various drugs of abuse such as cocaine or heroin (Drugs); eating Sweet-Salty-Fatty Foods (SSF foods); and behaviors consistent with your values or beliefs (Beliefs). Each day we need to fill our “reward bucket.” The darker dashed line is a minimal level of reward that we need to feel adequately regulated and rewarded; if our daily set of rewards falls below this, we feel distressed. If we get above the upper, black-dotted line, we feel fulfilled and regulated. Each of us does this in a somewhat individualized way. Many of us have opportunities for healthy rewards: lots of positive human interactions through work, worship, or volunteering that are consistent with our values and beliefs, for example (A). But a lack of strong relationships and connection can make an individual more vulnerable to overuse of other, less healthy forms of reward (B). A healthy combination of rewards (e.g., lots of positive human interactions, doing work consistent with your values, integrating healthy rhythm and sexuality into your day, staying regulated in healthy ways) can help decrease the pull...

We need to understand that victims of trauma are more prone to all forms of addiction because their baseline of stress is different.

One of the most remarkable properties of our brain is its capacity to change and adapt to our individual world. Neurons and neural networks actually make physical changes when stimulated; this is called neuroplasticity.

A key principle of neuroplasticity is specificity. In order to change any part of the brain, that specific part of the brain must be activated. If you want to learn to play the piano, you can’t simply read about piano playing, or watch and listen to YouTube clips of other people playing piano. You must put your hands on the keys and play; you have to stimulate the parts of the brain involved in piano playing in order to change them.

the basic idea is that anything that can cause unpredictable, uncontrollable, or extreme and prolonged activations of the stress response will result in an overactive and overly reactive stress response

STATE-REACTIVITY CURVE When a challenge or stressor occurs, it will push us out of balance, and an internal stress response will be activated to get us back in balance. With no significant stressors—no internal needs (hunger, thirst, etc.) unmet and no external complexity or threat—we will be in a state of calm. As challenges and stress increase, our internal state will shift, from alert to terror (see Figure 6). In someone with neurotypical stress-response systems, there is a linear relationship between the degree of stress and the shift in internal state (straight diagonal line). For example, in the face of a moderate stressor (1), a proportional activation will put the individual in an active alert state. If an individual has a sensitized stress response (top curve) caused by their history of trauma, even the most basic daily challenges (2) will induce a state of fear. Someone with a sensitized stress response (3) will respond to even moderate stress with a terror response. This overreactivity contributes to their emotional, behavioral, and physical health problems.

neuroplasticity is basically the changeability of the brain. One of the key principles of neuroplasticity is that the pattern of activation makes a big difference in how a neural network changes. For example, moderate, predictable, and controllable activation of our stress-response systems leads to a more flexible, stronger stress-response capability (see Figure 3) that lets a person demonstrate resilience in the face of more extreme stressors.

In the arousal response, as we noted earlier, the brain will focus on the threat, tuning out any nonessential input from the body and the outside world. To prepare for fight or flight, our heart rate increases; adrenaline and related stress hormones like cortisol are released, as is sugar stored in our muscles; blood is diverted to our muscles. The general focus of the response is external.

STATE-DEPENDENT FUNCTIONING All functioning of the brain depends on the state we’re in. As we move from one internal state to another, there will be a shift in the parts of the brain that are in “control” (dominant); when you are calm, for example, you are able to use the “smartest” parts of your brain (the cortex) to reflect and create. When you feel threatened, those cortical systems become less dominant, and more reactive parts of your brain begin to take over. This continuum goes from calm to terror. State-dependent shifts result in corresponding changes in a host of brain-mediated functions, including problem-solving capacity, style of thinking (or cognition), and the sphere of concern. In general, the more threatened someone feels, the more control of functioning shifts from higher systems (cortex) to lower systems (diencephalon and brainstem). Fear shuts down many cortical systems. Adaptive behaviors seen during state-dependent shifts in functioning will differ depending upon which of the two major adaptive response patterns (Arousal and Dissociation) are dominant for any given individual during a stressful or traumatic event. Default Mode Network (DMN) is a term for a widely distributed network, mostly in the cortex, that is active when an individual is thinking about others, thinking about themselves, remembering the past, and planning for the future.

The hypervigilance of the Alert state is mistaken for ADHD; the resistance and defiance of Alarm and Fear get labeled as oppositional defiant disorder; flight behavior gets them suspended from school; fight behavior gets them charged with assault. The pervasive misunderstanding of trauma-related behavior has a profound effect on our educational, mental health, and juvenile justice systems.

There is a difference between thinking you deserve to be happy and knowing you are worthy of happiness. So often we block our blessings because we don’t, at our core, feel that we’re enough. Even if you’ve accumulated a house full of nice things and the picture of your life fits inside a beautiful frame, if you have experienced trauma but haven’t excavated it, the wounded parts of you will affect everything you’ve managed to build.

Our major finding is that your history of relational health—your connectedness to family, community, and culture—is more predictive of your mental health than your history of adversity (see Figure 8). This is similar to the findings of other researchers looking at the power of positive relationships on health. Connectedness has the power to counterbalance adversity.

THE IMPACT OF DEVELOPMENTAL EXPERIENCE THE BALANCE BETWEEN ADVERSITY AND CONNECTEDNESS With high connectedness and low adversity during development (blue dashed line), the balance of developmental risk is tipped in the direction of lower risk for mental, social, and physical health problems. In contrast, high adversity and minimal connectedness (black dashed line) increases developmental risk and the probability of significant problems in overall health.

The traumatic experience creates a set of trauma-related “memories”; these become “connected” to the type of stress response that played out in the specific traumatic event.

As you consider your individual response patterns, know that by putting a small moment of space between the immediate feeling and your instinctive reaction, you are allowing yourself to stay present and ultimately regain control.

Is fear transmissible from generation to generation? Can the fearfulness of a parent be transmitted to the child?—the answer is an emphatic yes.

there are genetic mechanisms that play a role in how our core regulatory networks (CRNs) function

One of the most important areas is the way we connect with others. Developmental trauma can disrupt our ability to form and maintain relationships. Whenever trauma or neglect takes place in the context of our caregiving relationships, there’s a high risk that the neural networks involved in reading and responding to other people will be altered. When these “attachment” capabilities are impaired, there will be difficulties with friendships, school, employment, intimacy, and family; there is even risk for repeating transgenerational patterns of abuse.

SEQUENCE OF ENGAGEMENT Our brain is continually getting input from our body (interoception) and the world (five senses). These incoming signals are processed in a sequential fashion, with the first sorting taking place in the lower brain (brainstem, diencephalon). To reason with another person, we need to effectively get through the lower areas of their brain and reach their cortex, the part responsible for thinking, including problem-solving and reflective cognition. But if someone is stressed, angry, frustrated, or otherwise dysregulated, the incoming input will be short-circuited, leading to inefficient, distorted input to the cortex. This is where the sequence of engagement comes in. Without some degree of regulation, it is difficult to connect with another person, and without connection, there is minimal reasoning. Regulate, relate, then reason. Trying to reason with someone before they are regulated won’t work and indeed will only increase frustration (dysregulation) for both of you. Effective communication, teaching, coaching, parenting, and therapeutic input require awareness of, and adherence to, the sequence of engagement.

The problem is that we don’t communicate directly from cortex to cortex. We have to go through the lower parts of the brain. All the rational thoughts from our cortex have to get through the emotional filters of the lower brain.