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

by Bruce D. Perry

Yes, trauma at any age can cause a cluster of symptoms we call post-traumatic stress disorder (PTSD).

The first cluster is “intrusive” symptoms. These include recurring, unwanted images and thoughts of the traumatic event, and dreams or nightmares about it. One way to think about these symptoms is that they’re related to the brain’s efforts to make sense of the world. Often when a traumatic event takes place, it is so threatening and so far outside our usual experience that it doesn’t fit our working model of the world.

The mind wants to see what we believe, so it clings to things that support those beliefs—that worldview—and ignores things that don’t. But trauma shatters this inner landscape. Your worldviews are broken to pieces. People can’t be trusted. I’m terrified of my father, he hurts me. School is where my friends were shot.

Trauma leaves you shipwrecked. You are left to rebuild your inner world. Part of the rebuilding, the healing process, is revisiting the shattered hull of your old worldview; you sift through the wreckage looking for what remains, seeking your broken pieces. Dreams, intrusive images of the trauma, and reenactment play are your mind struggling to make sense of your new reality. As you revisit the shipwreck, piece by piece, you find a fragment and move it to your new, safer place in the now-altered landscape. You build a new worldview. That takes time. And many visits to the wreckage. And this process involves both unconscious and conscious repetitive “reenactment” behaviors, or writing, drawing, sculpting, or playing. Again and again, you revisit the site of the earthquake, look through the wreckage, take something, and move it to a safe haven. That’s part of the healing process.

The second cluster is “avoidant” symptoms. We believe that these symptoms arise when someone feels distressed after being reexposed to people, places, or other reminders of the original traumatic events.

avoided celebrations that involved them. In some ways, avoidant behaviors are an attempt to regain control over what feels like the uncontrollability of the traumatic experience. You may also recall that avoidance is part of a dissociative response to a threat (see Figure 6). When someone is in an unavoidable, distressing situation, avoidant behaviors can be protective.

We’ve discussed the first two symptom clusters, intrusive symptoms and avoidant symptoms, and now we get to the third: changes in mood and thinking. This can include depressive symptoms—sadness, loss of pleasure from anything, a sense of guilt, an overfocus on negative things, and basically a feeling of emotional and physical exhaustion. Finally, the fourth symptom cluster is an alteration in arousal and reactivity. These are symptoms related to the sensitized stress-response networks being overactive and overly reactive. They include anxiety, hypervigilance, increased startle response, high and variable heart rate, and sleep problems.

We absorb things from previous generations and pass them on to the next generation. Our genes, family, community, society, and culture are all part of this. So your question about fear being inherited is central to understanding trauma, especially “historical trauma.”

“Every family has patterns and pathologies of thought, belief, and behavior that are passed on from one generation to another in the same way that a physical characteristic is passed on.” And even though we like to celebrate the strengths and successes of those who came before us, Iyanla says, “Many of these conscious and unconscious characteristics are powerful and productive. Others are not.”

At our core, as we’ve said, we are relational beings—social creatures. And because of that, we are neurobiologically tuned in to other people. Part of our brain is continually monitoring others around us. We’re trying to understand other people’s intentions and feelings. This is part of our making sense of the world. We are sensing and absorbing the emotions of those around us.

Children, especially, are very contagious to the emotions of the people around them.

There are complex traits, such as altruism, that require genetic superstructure, but how we incorporate that into the complex beliefs and practices of Buddhism or Christianity or Islam is not genetic. There may be genetic elements to being wary or defensive when interacting with someone very different from your family or clan of origin, but racism is a learned set of beliefs about the superiority of a people, and racism in practice is about power, dominance, and oppression.

The language we speak, the beliefs we hold—both good and bad—are passed from generation to generation through experience.

Humankind, more than any other species, can take the accumulated, distilled experiences of previous generations and pass these inventions, beliefs, and skills to the next generation. This is sociocultural evolution. We learn from our elders, and we invent, and we pass what we’ve learned and invented to the next generations. And the organ that allows this is the human brain—specifically, the cortex.

As we’ve said before, the cortex is the most uniquely human part of our body, and, no surprise, it gives rise to the most uniquely human capabilities: speech, language, abstract thinking, reflecting on the past, planning for the future. Our hopes, dreams, and a major part of our worldview are mediated by our cortex.

The very same malleability of the brain—the spongelike quality that lets infants absorb and learn the language of their parents—also allows children to absorb the beliefs, good and bad, of influential adults.

Your own experiences and the echoes of your ancestors’ experiences influence the way you think, feel, and behave. They are major determinants of your health. And being aware of this can help us remember that everything we do right now is going to echo into the future. Our actions matter; we are impacting the next generations. So are we being as mindful as we could?

Every cell in your body has the same genes, but not every cell has the same genes “turned on.” This is because some genes are specific for bone, some for blood, some for neurons, and so forth. During development, the genes involved in, say, muscle-cell machinery are turned on in muscle cells, while the genes for blood, bone, and brain are turned off. As cells become “specialized,” many of their genes are shut off.

However, in some situations, for instance starvation, the body sends chemical messages to the genes that have been turned off, telling them to turn back on. Hey, we normally don’t need you, but since we are starving, we have to use sugar and fats more efficiently, so we’re turning you on to do that work. These are called epigenetic changes—“epi” meaning “above” in Greek, because the actual genes are not changing, but cellular mechanisms “above” the gene can turn key genes on and turn others off. These gene regulatory processes are continually at work in our body, trying to keep us “in balance”—well-regulated and as healthy as we can be.

In some cases, these epigenetic changes will be stored in the egg or sperm and passed to the next generation.

This young man’s children, and grandchildren, still enslaved and enduring other traumas, would benefit from these epigenetic, molecular adaptations. Yet as we’ve discussed, there is a cost to having a persistently sensitized stress-response network. It is likely that, over the generations, in different environments, once-adaptive changes would become maladaptive.

Picture an infant born with the stress-response apparatus already primed for trauma, ready for an unpredictable, chaotic, and threatening world. If the world is no longer as extremely chaotic, threatening, and unpredictable, the epigenetic changes that prime this infant for chaos may lead to a somewhat distorted process of creating his “worldview.”

As you might expect, the epigenetic mechanisms that regulate genes are reversible—they wouldn’t provide much adaptive advantage if they weren’t.

Just as threat and trauma can lead to epigenetic changes, so can nurturing interactions reverse those.

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.

As we’ve discussed, developmental adversity increases the risk for all kinds of health problems, including heart disease, asthma, gastrointestinal problems, and autoimmune disease. Understanding the correlations can change how we diagnose and treat these physical problems.

Diabetes is a great example. Worldwide there are 415 million people with the disease. In the United States, the figure is roughly 34 million—just over 1 in 10. Another 88 million American adults have prediabetic and cardiometabolic risk. If trauma has altered the CRNs (see Figure 2), there will be pervasive regulation problems, including regulation of blood sugar and insulin release. Both the risk for diabetes and the management of diabetes are related to a history of adversity.

And indeed, many trauma-related health problems are dismissed, missed, and misunderstood. But once you understand more about neuroscience, and how our senses and brain translate experience into “biological” activity, the artificial distinctions disappear.

You begin to see that a person’s “worldview” can change their immune system, and that a positive conversation with a friend can influence how a patient’s heart or lungs function that day.

Most important, you come to understand that belonging is biology, and disconnection destroys our health. Trauma is disconnecting, and that impacts every system in our body.

This means that before any new experience has a chance to be considered by the higher, “thinking” part of the brain, the lower brain has already interpreted and responded to it. It’s matched the sensory input from the new experience against the catalog of stored memories of past experiences—before the smart part of your brain even has a chance to get involved.

So the brain interprets two experiences similarly even though they may have happened decades apart. You might see them as separate events, but your brain categorizes them as the same.

And understanding that our brain processes every experience sequentially also helps explain miscommunication between brains—in other words, between people. Communication, after all, is about getting some idea, concept, or story from your cortex to another person’s cortex. From the smart part of your brain to the smart part of their brain. 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. Our facial expression, tone of voice, and words are turned into neural activity by the other person’s senses, and then the sequential process of matching, interpreting, and passing up to their cortex takes place. Along the way, there are many opportunities for the meaning of any communication to be distilled, distorted, magnified, minimized, or lost.

Let’s think about what happens when the stress response is activated. Frustration, anger, and fear can shut down parts of the cortex. When someone is dysregulated, they simply cannot use the smartest part of their brain. Look back at Figure 6, which illustrates state-dependent functioning; the further you move along the “arousal” continuum, the more the lower parts of the brain dominate your functioning.

In my work we talk about “getting to the cortex”—getting to the place where you can communicate rationally with someone. If the person is regulated, you can connect with them in ways that will facilitate rational communication. But if they’re dysregulated, nothing you say will really get to thei...

This is essential to understand if you’re a teacher, because while the regulated child can learn, the dysregulated child will not. But it’s the same for supervising people in a work setting or communicating with colleagues, your partner, your children—anyone. Regulation is the key to creating a safe connection. And being connected is the most efficient and effective way to get information up to the cortex. A...

The Still-Face paradigm shows viscerally that within seconds of a child perceiving their parent to be disengaged and emotionally absent, they start to feel distress and attempt to reengage the parent. But when these efforts fail, the infant disengages and emotionally withdraws. Imagine the impact on a developing child if that is a continuous experience. A cold, disengaged, partially attentive caregiver can have immediate, and potentially lifelong, toxic effects on the developing child. This child may grow up feeling inadequate, unlovable. Even with many gifts and skills, they will feel they are “not enough” as an adult, and that can lead to a host of maladaptive behaviors including unhealthy forms of attention seeking, self-sabotaging, or even self-destructive behavior.

This dissociative response is used when there is inescapable, unavoidable distress and pain. Your mind and body protect you. Because you cannot physically flee, and fighting is futile, you psychologically flee to your inner world. So going back to the infant with a disengaged parent; the infant’s fight-or-flight response is to cry. But if no one comes—or they come and are angry—the helpless infant will dissociate to survive this inescapable distressing situation. The same is true for children, youth, and adults faced with any inescapable, unavoidable pain and distress; they dissociate. And a whole set of neurophysiological changes helps you do that, including the release of your body’s own opiates.

I’m fascinated by what you’re saying because I’ve often wondered, for example, about the people who were on the airplanes on 9/11. They knew there was a terrorist and that they only had moments to call their families. In that moment of terror, there must have been some sense of dissociation because many were able to still function enough to call family, or write a note, or rush the cockpit. Dr. Perry: What you are pointing out is how adaptive it is to partially dissociate in many situations. If a soldier in combat simply went down the arousal continuum—and got to the flee and then fight stages—he would jump up and get shot. In order to maintain access to parts of his cortex—to think and behave in the ways he was trained to keep him alive in combat—he needs to dissociate to a certain degree. It’s critical to survival.

Being able to partially dissociate, to disengage from parts of the external threatening world and focus on trained behaviors, is key to success in competitive sport or high-pressure performances in the arts. The terms “flow” and “in the zone” are used to describe some of these partial dissociative states.

In reality, everyone uses dissociation every day. That’s what daydreaming is, right? And it can be a healthy coping mechanism. Dr. Perry: Exactly—mind-wandering. Reflective thinking and creativity require that we stop in the middle of a moment, reflect, and spend time “in our head.” We reflect on the past and imagine the future, making dissociative disengagement a key part of daily life. And it’s essential for relational interaction, as well.

We should understand that dissociation is not a bad thing, though it can happen in bad circumstances. Dissociating itself is a good thing. For example, a child daydreaming in class can indicate creativity. Our current public education system is good at producing workers, but it can be a miserable place for creators, artists, and future leaders.

Why can’t I stay in the game when things get challenging? It’s because your brain has been trained to dissociate when things become uncomfortable or feel like a threat to you. Even if a math test isn’t as big a threat as someone who wants to harm you, your dissociative response may be so overly reactive that your response to the math test is to shut down.

She’d go through the motions of being in the relationship—compliance—but as you say, it was a hollow compliance. She wasn’t really there. But after working with a therapist to create and maintain healthy relationships, she now actively practiced staying present. Gary Zukav validated her feelings by acknowledging that for many people, there is a “terror of being alive.”

One of the common behaviors seen with a sensitized dissociative response is cutting. And often someone who cuts will say, “It makes me feel alive—to see my blood. It is soothing.”

Remember that dissociation releases opioids (enkephalins and endorphins), your own painkillers. If a person without a sensitized dissociative response cuts themselves, their body releases a little bit of these opioids so that they can tolerate the cut; the amount released would be pretty small and proportional to the little cut. But when someone with a sensitized—overly reactive—dissociative response cuts themselves, they release a lot of opioid. It’s almost like taking a little hit of heroin or morphine.

That’s a really interesting question. If we start with early trauma, little children who have this sensitized response sometimes discover that when they pick at a scab or scratch a mosquito bite—wow, that feels good. They begin to learn that self-mutilating can be regulating.

People-pleasing is a classic coping mechanism that is part of the “compliant” behaviors seen with dissociation. But again, it’s important to remember that dissociation and self-regulating behaviors that are dissociative are not all bad.

The capacity to control your dissociative capabilities is very powerful. It allows people to be good at reflective cognition. It allows people to have intense focus on a specific task. Hypnosis, flow, being “in the zone”—all of these are examples of the trance state that dissociation allows. People who learn to control when and how they go into a trance state have a gift. I can guarantee you, Oprah, that you’re really good at dissociating. It’s one of your superpowers.

As we’ve said before, when we’re young and our brain is beginning to make sense of our experiences, it creates our “working model” of the world. The brain organizes around the tone and tension of our first experiences. So if, early on, you have safe, nurturing care, you think that people are inherently good. And, as we also talked about earlier, this worldview makes you project “goodness” onto the people you meet, and that projection of goodness elicits good things in return.