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

by Bruce D. Perry

“Let’s look at the basic organization of the brain. It’s like a four-layered cake. At the top is the cortex, the most uniquely human part of our brain.” I started labeling my drawing with different brain-mediated functions, as in the illustration, opposite. As I did, I explained: “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?” Mike and Sally nodded. “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.” I looked at them to make sure they were tracking with me before continuing. “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 conn...

All experience is processed from the bottom up, meaning, to get to the top, “smart” part of our brain, we have to go through the lower, not-so-smart part. This sequential processing means that the most primitive, reactive part of our brain is the first part to interpret and act on the information coming in from our senses. Bottom line: Our brain is organized to act and feel before we think.

Not only is “What happened to you?” the key question if you want to understand someone, it is the key question if you want to understand the brain. In other words, your personal history—the people and places in your life—influences your brain’s development. The result is that each of our brains is unique. Our life experiences shape the way key systems in our brain organize and function. So each of us sees and understands the world in a unique way.

Our external senses—sight, sound, smell, taste, and touch—monitor what is going on outside of our body. To do this, they rely on the sensory organs—eyes, ears, nose, and skin. When these are stimulated by light, sound, smell, or touch, specialized neurons send a signal into the brain.

We also have sensory systems that tell us what is going on inside our body. This is called interoception, and it creates our sense of, for instance, being thirsty, hungry, or short of breath. All the sensory inputs from the outside world and our inside world give continuous feedback to the brain so that the proper systems can be activated to keep us healthy and safe. If we’re thirsty, we seek water; if we’re hungry, we seek food; if we sense danger, we mobilize our stress-response systems.

As your brain starts to create the complex memories that store these connections, your personal catalog of experiences is being created. As we grow up, we are all trying to make sense of what’s happening around us. What does that sound mean? What does it mean when someone rubs my back? What does that expression on his face mean? What else happens when that scent is present? For one child, eye contact means, “I care for you; I’m interested in you.” For another it may mean, “I’m about to yell at you.” Moment by moment in early life, our developing brain sorts and stores our personal experiences, making our personal “codebook” that helps us interpret the world. Each of us creates a unique worldview shaped by our life’s experiences.

Imagine, for a moment, the dramatic changes in the sensory world of a newborn. Their world, once warm, rhythmic, and dark, becomes, at the moment of birth, an overwhelming sensory bath of images, sounds, temperature shifts, and exposure to air. The brain is bombarded by new patterns of sensory input. And because so much of the world is new when you’re a baby, that’s when your brain is most rapidly and actively making these new connections. The experiences in the first years of life are disproportionately powerful in shaping how your brain organizes.

There are parts of our brain that are very, very sensitive to nonverbal relational cues. And in our society, this is an underappreciated aspect of the way human beings work. We tend to be a very verbal society—written and spoken words are important—but the majority of communication is actually nonverbal.

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.

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 he takes your order may elicit a panic attack. But because there is no firmly embedded cognitive recollection—no linear narrative memory—the panic is often experienced and interpreted as random, independent of any previous experience.

When you’ve been groomed to be compliant, confrontation in any form is uncomfortable because you were never taught that you have the right to say no; in fact, you were taught that you can’t say no.

On the show, rabbi and family therapist M. Gary Neuman told me that for most children, divorce is really like a death. He explained that children don’t see their parents as separate people who came together. They see one parent unit within one family unit. So even if divorce is what’s best for the family overall, the children feel pieces of themselves being torn away.

The sense of self informs every relationship or decision we make as we move through life. And when children don’t feel respected by the decisions of their parents, their beliefs about how they are valued are crushed.

Our brain catalogs vast amounts of input from our family, community, and culture, along with what is presented to us in the media. As it makes sense of what it’s stored, it begins to form a worldview. If we later meet someone with characteristics unlike what we’ve cataloged, our default response is to be wary, defensive. In turn, if our brains are filled with associations based upon media-driven biases about ideal body type, or racial or cultural stereotypes, for example, we will exhibit implicit biases (and maybe overt bias).

Rhythm is essential to a healthy body and a healthy mind. Every person in the world can probably think of something rhythmic that makes them feel better: walking, swimming, music, dance, the sound of waves breaking on a beach.

We have many different systems that are continuously monitoring our body and the outside world to make sure we’re safe and in balance—that we have enough food, water, oxygen. When we’re regulated, these systems have what they need. Stress is what occurs when a demand or challenge takes us out of balance—away from our regulated “set points.” When we get out of balance, we become dysregulated and feel discomfort or distress. When we get back into balance, we feel better. Relief of distress—getting back into balance—activates the reward networks in the brain. We feel pleasure when we get back into balance—from cold to warm, thirsty to quenched, hungry to satiated.

And regulation is more than a biological concept. In all areas of our lives, we are seeking what we need to be stabilized, balanced, and regulated.

Balance is the core of health. We feel and function best when our body’s systems are in balance, and when we’re in balance with friends, family, community, and nature.

And what’s really important for parents to realize is what you just said—that learning healthy self-regulation actually begins in infancy. When babies cry, they’re either hungry or thirsty or tired, or their diaper needs changing or they need to be touched. And since they can’t feed themselves or change their own diaper, crying is their way to get themselves back into balance—to get their caregiver to do what has to be done in order for them to get back into balance.

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. After birth, rhythms at these frequencies can comfort and soothe, whereas the loss of rhythm, or high, variable, and unpredictable patterns of sensory input, becomes associated with threat.

So, when you are raised in a nurturing, supportive, caring environment and you cry and someone responds to your needs, you are being regulated. Ultimately, as you grow up with this loving attention, what you describe as the Tree of Regulation grows—and these networks in your brain allow you to regulate yourself and connect to people in healthy relationships.

First, as we’ve been discussing, we have important neural networks involved in regulation—including our stress-response systems. Second, we have neural networks that are involved in forming and maintaining relationships. Finally, we have neural networks that are involved in “reward”; when these are activated, they give us pleasure. When these three systems begin to wire together, they create our foundational memories; these are the reason that we feel regulated and rewarded when we get signals of acceptance or warmth from another person. A person’s capacity to connect, to be regulating and regulated, to reward and be rewarded, is the glue that keeps families and communities together.

When the attentive and responsive adult comes to the crying infant, two very important things happen. The baby feels the pleasure of being regulated after being distressed—and also experiences the sight, smell, touch, sound, and movement of human interaction. The loving sensations provided by the adult caregiver start to become associated with pleasure. In thousands of moments, when the caregivers respond to the needs of the infant, the brain is connecting relationship to reward and regulation. And so, when you are an attentive, attuned, and responsive caregiver to these little ones, you’re literally weaving together this powerful three-part association—you’re building a healthy root system for the Tree of Regulation.

Furthermore, as we talked about earlier, these bonding experiences create the infant’s worldview about humans. A consistent, nurturing caregiver builds an internal view that people are safe, predictable, and caring.

The brain is a meaning-making machine, always trying to make sense of the world. If our view of the world is that people are good, then we will anticipate good things from people. We project that expectation in our interactions with others and thereby actually elicit good from them. Our internal view of the world becomes a self-fulfilling prophecy; we project what we expect, and that helps elicit what we expect.

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.

First, it affects the development of the child’s stress-response systems (see Figure 3). If the hungry, cold, scared infant is inconsistently responded to—and regulated—by the overwhelmed caregiver, this creates an inconsistent, prolonged, and unpredictable activation of the child’s stress-response systems. The result is a sensitization of these important systems.

In 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. The hypervigilance of a boy living with domestic violence scanning his home for any sign of threat is very adaptive; in a classroom, this can prevent the child from pay...

The second major problem has to do with that process of creating connections about relationships. If, while the infant is creating her working model of the world, the caregiver responds in unpredictable ways, or is episodically rough, frustrated, cold, ...

We had a project working with a preschool where we were observing student-teacher interactions. In one of the classrooms, there was a young, enthusiastic, and very nurturing teacher. At the beginning of the year, this teacher warmly greeted each child, gave them a hug and a big smile. All during the day, this teacher interacted with the children in very attentive ways. We noticed that one little girl avoided this teacher’s physical affection and never made eye contact. When the teacher hugged her, she simply stood still and didn’t reciprocate. Eventually we learned that this child had a very overwhelmed, depressed mother and that no other adults were in the household. As time went by, the teacher continued to be warm and effusive with the other children, but week by week, the positive overtures to this withdrawn, sad girl decreased. You can imagine that this girl’s worldview was I’m not that important; you can’t really trust people. About a month into the school year, the class was doing an activity when the little girl raised her hand for help; it was the first time she’d ever reached out that way. She held her hand high. Waved it. But the teacher was fully engaged with a group...

We elicit from the world what we project into the world; but what you project is based upon what...

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.

Though we’re generally not aware of it, we are continually sensing and processing information from the outside world; based upon this input, our brain and body respond in ways that help keep us connected, alive, and thriving. When we are pushed out of equilibrium—out of balance—we have a set of stress-response systems that will be activated to help us.

Most people are familiar with the term “fight or flight.” This refers to a set of responses that can kick in when we are afraid. Your brain will focus your attention on the potential threat, shutting down unnecessary mental processes (like reflecting on the meaning of life or daydreaming about an upcoming vacation). Your sense of time collapses to the moment. Your heart rate goes up, sending blood to your muscles in preparation, ...

Imagine a situation where you are too small to win a fight and unable to run away. In this case, the brain and the rest of the body prepare for injury. Your heart rate goes down. You release your body’s own painkiller—opioids. You disengage from the external world and psychologically flee into your inner world. Time seems to slow. You may feel like you are in a movie, or floating and watching things happen to you. This is all part of another adaptive capability, called dissociation. For babies and very young children, dissociation is a very common adaptive strategy; fighting or fleeing won’t protect you, but “disappearing” might. You learn to escape into your inner world. You dissociate. And over time, your capacity to retreat to that inner world—safe, free, in control—increases.

A key part of that sensitized ability to dissociate is to be a people pleaser. You comply with what others want. You find yourself doing things to avoid conflict, to ensure that the other person in the interaction is pleased, as well as gravitating toward various regulating, but dissociative, activities.

Most people with “developmental adversity” are chronically dysregulated—they tend to be wound up, anxious. Sometimes they feel like they are jumping out of their skin—or, as Russell Brand described it so well, the internal storm. As we will talk more about in a bit, their CRNs are sensitized.

Whereas the physiology of the arousal response is to optimize fight or flight, the physiology of dissociation is to help us rest, replenish, survive injury, and tolerate pain. Where arousal increases heart rate, dissociation decreases it. Where arousal sends blood to the muscles, dissociation keeps blood in the trunk, to minimize blood loss in case of injury. Arousal releases adrenaline; dissociation releases the body’s own pain killers, enkephalins and endorphins.

Now, as we’ve suggested before, what is adaptive for children living in chaotic, violent, trauma-permeated environments becomes maladaptive in other environments—especially school. 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.

In its essence, trauma is the lasting effects of emotional shock.

Even more recently, a study from 2019 by the U.S. Centers for Disease Control and Prevention (CDC) found that 60 percent of American adults report having had at least one adverse childhood experience (ACE), and almost a quarter reported three or more ACEs.

This illustrates one of the key issues in understanding a potentially traumatic event: How does the individual experience the event? What is going on inside the person; is the stress response activated in extreme or prolonged ways?

In other words, because the internal experience of a given event varies from person to person, so does the long-term impact.

This is the challenge of studying “traumatic stress.” How can we study the impact of trauma if we can’t come up with a more standard definition? In response to this challenge, the Substance Abuse and Mental Health Services Administration (SAMHSA) convened a group of academics and clinicians. They came up with the “three E’s” definition of trauma, which articulates what we just talked about: that a trauma has three key aspects—the event, the experience, and the effects.

What the ACE score does not tell you is the timing, pattern, and intensity of stress and distress or the presence of buffering or healing factors. It leaves out some of the most important variables involved in predicting health and risk.

The basic finding is that the experiences of the first two months of life have a disproportionately important impact on your long-term health and development. This has to do with the remarkably rapid growth of the brain early in life, and the organization of those all-important core regulatory networks

If, in the first two months of life, a child experienced high adversity with minimal relational buffering but was then put into a healthier environment for the next twelve years, their outcomes were worse than the outcomes of children who had low adversity and healthy relational connection in the first two months but then spent the next twelve years with high adversity. Think of that: The child who has only two months of really bad experiences does worse than the child with almost twelve years of bad experiences, all because of the timing of the experiences.

And we recognize the power and potential of very early childhood. Think of the impact just a few months of consistent, predictable support for a young parent could make. For the child, it could create a positive jump start in life that would lead to the development of more resilient stress-response systems. And in turn, these regulated stress-response systems would help ensure healthy development in higher parts of the brain.

The father had good intentions, but it wasn’t the right dose for a therapeutic moment. So, back to the issue of time. When the little boy looks up at the clerk and sees a woman about the age of his mother, with the same hair color, it’s an evocative cue. For a moment he is back to the memory of Mom, the murder. He looks at the clerk, makes one brief comment—five seconds, tops—and gets reassurance. That was enough.

One little fragment in the wreckage—a dose of therapeutic revisiting that he controlled. Because it is through controllable, brief revisits that the sensitized system can slowly, painfully be “reset.” Ideally, thousands of such therapeutic moments can be provided by the therapeutic web of loving, sensitive people in your life.