{"id":116473,"date":"2023-11-01T10:23:00","date_gmt":"2023-11-01T14:23:00","guid":{"rendered":"https:\/\/www.shortform.com\/blog\/?p=116473"},"modified":"2023-11-01T13:55:57","modified_gmt":"2023-11-01T17:55:57","slug":"the-boy-who-was-raised-as-a-dog","status":"publish","type":"post","link":"https:\/\/www.shortform.com\/blog\/the-boy-who-was-raised-as-a-dog\/","title":{"rendered":"The Boy Who Was Raised as a Dog: Key Takeaways on Trauma"},"content":{"rendered":"\n

What key points can we take away from Dr. Bruce Perry\u2019s The Boy Who Was Raised as a Dog<\/em>? What does Perry teach about childhood trauma?<\/p>\n\n\n\n

In The Boy Who Was Raised as a Dog<\/em>, author Dr. Bruce Perry leverages his expertise as a child psychiatrist to teach the fundamentals of how trauma impacts children and how it can be treated. Understanding the key takeaways from this book gives you a foundational understanding of what trauma is<\/a> and how it works.<\/p>\n\n\n\n

Discover how trauma impacts the developing brain and how it can be treated.<\/p>\n\n\n\n\n\n\n\n

About The Boy Who Was Raised as a Dog<\/em><\/h2>\n\n\n\n

In The Boy Who Was Raised as a Dog<\/em><\/a>, child psychiatrist Bruce Perry describes a series of child abuse and neglect cases to illustrate how trauma impacts the developing brain and explain how he and his colleagues established an effective therapy model for traumatized children.<\/p>\n\n\n\n

Perry is a psychiatrist and the senior fellow of not-for-profit organization The ChildTrauma Academy<\/a>. He\u2019s also a professor at the Feinberg School of Medicine in Chicago and co-author (with Oprah Winfrey) of the bestselling book What Happened to You?<\/em><\/a>. Perry\u2019s co-author of The Boy Who Was Raised as a Dog<\/em>, Maia Szalavitz is an award-winning journalist and author of the books Unbroken Brain<\/em><\/a> and Help at Any Cost<\/em><\/a>. Perry and Szalavitz also co-wrote Born for Love<\/em><\/a> together.<\/p>\n\n\n\n

In this article, we\u2019ll explain the psychiatric principles that Perry discovered during his years of working with traumatized children, including the stress response<\/a>, the effects of trauma<\/a> in infancy versus trauma at a later age, dissociation in response to trauma<\/a>, and the role that relationships play in the treatment of traumatized children. We\u2019ll also look at specific case studies that contributed to Perry\u2019s Neurosequential Model<\/a> of Therapeutics. Our commentary explores research supporting and expanding on Perry\u2019s ideas, as well as scientific and social context<\/a> on how trauma can manifest and the nuances of treatment.<\/p>\n\n\n\n

Understanding Childhood Trauma<\/h2>\n\n\n\n

According to Perry, the general belief in the 1980s\u2014when he was first entering the field of child psychiatry\u2014was that trauma didn\u2019t impact children as heavily as it impacted adults. Children were seen as resilient; psychiatrists assumed they could recover from trauma<\/a> quickly and easily. However, Perry\u2019s and other researchers\u2019 work has since shown that trauma impacts children more strongly than it does adults, and that the earlier in life it occurs, the more likely it is to have severe and long-lasting consequences<\/strong>.<\/p>\n\n\n\n

The Developing Brain<\/h3>\n\n\n\n

To understand childhood trauma and its long-term impact, Perry says, we first need to understand how our brain develops in childhood. The brain develops sequentially, starting with the most simple regions, then grows more complex with age.<\/strong> The brainstem develops first, followed by the diencephalon, the limbic system<\/a>, and finally the cortex. <\/p>\n\n\n\n

However, this neural development doesn\u2019t happen automatically. The brain must be stimulated in certain ways and at certain times in order to trigger its growth.<\/strong> In infancy and early childhood, that stimulation comes primarily from caregivers. As we age, we also begin to receive neural stimulation from our interactions with peers and people outside our caregiving circle. Perry explains that neglect can leave the growing brain without this stimulation, while abuse and other traumatizing experiences can change the brain\u2019s responses to such stimulation. This is because this neural stimulation is what teaches us to regulate our brain and body\u2019s stress response, which, as we\u2019ll see in the next section, determines how we cope with traumatizing events. <\/p>\n\n\n\n

The Stress Response<\/h3>\n\n\n\n

Because of its critical role in the experience of trauma, understanding the body\u2019s natural stress response is essential to understanding all the other principles and cases Perry describes. According to Perry, the most primitive parts of our brain control the stress response, which is a physiological reaction that allows us to respond to threats in our environment.<\/strong> Perry describes two types of stress<\/a> responses: hyperarousal and dissociation. <\/p>\n\n\n\n

Hyperarousal prepares the body to flee or fight a threat by flooding it with chemicals like adrenaline and noradrenaline. Dissociation prepares the body to endure physical harm by slowing its major functions and releasing natural opioids to numb pain. Both of these responses also shut down higher-level brain functions, like abstract thinking<\/a> and impulse control<\/a>, in favor of functions that are likely to help us survive the current threat. <\/p>\n\n\n\n

The Stress Response in Infancy<\/h4>\n\n\n\n

The caregiver-infant interaction lays the neural foundations for coping with and regulating stress later in life<\/strong>. When we\u2019re infants, explains Perry, every new stimulus is stressful, including things as basic and essential as physical touch or hunger. A vital part of infant development is receiving care that teaches us how to respond to and process these new stimuli (or stressors). <\/p>\n\n\n\n

When an infant\u2019s stress response system<\/a> is activated, it cries\u2014a reaction that\u2019s designed to elicit a response from caregivers who attend to the infant\u2019s needs. For example, if the infant is hungry, the caregiver responds by feeding; if the infant is afraid or uncomfortable, the caregiver soothes them with holding, cooing, and rocking. These behaviors relieve the infant\u2019s stress response by determining the source of the distress and then eliminating it. <\/p>\n\n\n\n

According to Perry, this interaction creates an association in the infant\u2019s brain between social interaction with the caregiver and an activation of the reward centers in their brain, resulting in a feeling of pleasure. This association is what makes us enjoy and crave social interaction, and it\u2019s essential for developing empathy (as we\u2019ll discuss later). If the infant doesn\u2019t receive the proper caregiving response, they won\u2019t develop these associations. <\/strong>This can have both immediate and long-term consequences, such as the failure to attach to a caregiver or the inability to relate to others later in life. <\/p>\n\n\n\n

The Emotional Consequences of Deprivation in Infancy: Leon\u2019s Case<\/h4>\n\n\n\n

Because of the connection between the caregiver\u2019s mediation of the infant\u2019s stress response and the infant\u2019s later development, an infant deprived of vital caregiving in early life can have stunted social and emotional development, including a failure to acquire empathy<\/strong>.<\/p>\n\n\n\n

As an example of this process, Perry describes the case of a young man named Leon. At age 16, Leon murdered and violated the bodies of two girls. Leon had no remorse for his actions and blamed the girls for sexually tempting him. Perry talked with Leon\u2019s family about his early childhood and discovered that Leon had been severely neglected. His mother Maria, though loving and well-intentioned, had made a habit during Leon\u2019s infancy of leaving the house in the morning and not coming back until the evening, leaving him alone all day. <\/p>\n\n\n\n

As a result, his distress signals went unanswered: With no one to provide the care that would relieve his stress response, he never learned to associate human interaction with the relief of distress<\/strong>. He missed out on the neural stimulation that 1) teaches us on a subconscious level that we can rely on others, and 2) makes us feel good when we please others and bad when we\u2019re rejected by them. Thus, Perry says, he was unable to derive pleasure from (or even understand) interpersonal relationships, and he failed to develop social skills and empathy. <\/strong><\/p>\n\n\n\n

The Physical Consequences of Touch Deprivation in Infancy: Laura\u2019s Case<\/h4>\n\n\n\n

Deprivation of physical stimulation in infancy can also have a major impact on infants\u2019 physical development<\/a>.<\/strong> As mentioned earlier, physical touch is initially stressful for infants, as it\u2019s a sensation they\u2019re not used to. In order to properly develop their stress response systems and make touch less stressful and ultimately soothing, infants need a great deal of loving physical touch. The stress response has a direct impact on the body\u2019s hormone regulation, so a lack of touch can inhibit the release of growth hormone and stunt physical growth\u2014a condition called \u201cfailure to thrive,\u201d or the inability to develop physically despite receiving sufficient calories and nutrients. <\/p>\n\n\n\n

This was the case with Laura, a four-year-old who weighed just 26 pounds when Perry met her. (Shortform note: For context, the average weight for a healthy four-year-old is about 40 pounds<\/a>.) In talking with Laura\u2019s mother Virginia, Perry discovered that the woman had no knowledge or experience of loving, attentive care herself, and she simply didn\u2019t know that she needed to hold her baby during feeding, rock her when she cried, and so on. Laura\u2019s stress response systems weren\u2019t developing properly due to lack of physical touch, and as a result, her body wasn\u2019t producing enough growth hormone, so it couldn\u2019t develop or grow. Once Virginia learned to provide this vital stimulation, Laura began thriving.<\/strong><\/p>\n\n\n\n

Trauma at Later Ages: Associations and the Dissociative Response<\/h2>\n\n\n\n

These cases demonstrated that stress and trauma in infancy<\/em> could have long-lasting impacts. Some of Perry\u2019s other cases showed how trauma later in childhood could impact children\u2019s behavior differently. Below, we\u2019ll first explain how the brain stores information, including traumatic experiences. Then we\u2019ll look at the dissociative stress response and how it differs from the hyperarousal response described earlier.<\/p>\n\n\n\n

Traumatic Associations: Tina\u2019s Case<\/h3>\n\n\n\n

Perry explains that the brain stores information in the form of memories and associations<\/strong>. Associations, like those between caregiving and the brain\u2019s reward centers, occur when two neural patterns are activated at the same time again and again, eventually forming a new set of connections between areas of the brain<\/a>. <\/p>\n\n\n\n

To illustrate the role of associations in trauma, Perry describes the case of a young girl named Tina. At the age of seven, she was engaging in sexually inappropriate behaviors with peers and acting out in aggressive ways. She also behaved impulsively and had trouble paying attention<\/a> in school. Tina\u2019s mother explained her history, and Perry learned that Tina had been sexually abused by a neighbor\u2019s teenage son over the course of two years.<\/p>\n\n\n\n

The associations formed in Tina\u2019s brain from this experience caused an automatic stress response when she was around men<\/strong>, and the memory template she had developed based on the traumatic experiences taught her to try to appease them (and thus reduce the threat they posed) with sex. This association is what led her to behave inappropriately even with men who had never preyed on her. Additionally, the constant engagement of her stress response system led her to be on high alert for threats at all times, making it difficult for her to focus on schoolwork and control her impulses. <\/p>\n\n\n\n

Perry realized that the model of one hour per week of therapy wasn\u2019t sufficient to undo the ingrained associations that Tina had. <\/strong>In fact, as Perry amended later, therapy can\u2019t undo associations at all<\/strong>. Instead, you have to create new associations that will eventually replace the old ones in guiding the patient\u2019s behavior. You can do this by providing the patient with frequent, repeated experiences to form and strengthen new neural connections. In Tina\u2019s case, her experiences with sexual abuse by a man had formed a harmful association with males, so she needed repeated experiences with safe men in non-sexual contexts to help her form new templates and behave more appropriately.<\/p>\n\n\n\n

Dissociation as a Stress Response<\/h3>\n\n\n\n

In many of the cases Perry describes in which children\u2019s stress response systems become overactive due to excessive stimulation, physiological checks on the children showed that their heart rates were elevated, a sign of the fight or flight response<\/a>. <\/p>\n\n\n\n

However, the body has other ways to respond to stress depending on the situation. In cases where a threat is too great to escape or fight off, the brain may activate a dissociative response\u2014<\/strong>a response particularly common in children, who often lack the physical or mental means to fight or flee from a threat. Dissociation prepares the body to endure physical harm: It slows breathing and reduces blood flow and heart rate, which can help the body avoid bleeding to death, and the brain releases natural opioids that can alleviate pain and help the person detach psychologically from what\u2019s happening to them. <\/p>\n\n\n\n

Both hyperarousal and dissociative responses occur on a spectrum: Hyperarousal may look like a slightly elevated heart rate and nervousness or full-blown panic. Dissociation may take the form of daydreaming, or in extreme cases may cause the person to completely detach from reality and withdraw into their own mind. They become calm and numb, time seems to slow, and it feels as if what\u2019s happening to them isn\u2019t real and like they\u2019re watching it happen to someone else. Additionally, these responses rarely occur in complete isolation: Most trauma responses involve a combination of hyperarousal and dissociation.<\/strong><\/p>\n\n\n\n

Treating Childhood Trauma: Perry\u2019s Neurosequential Model of Therapeutics <\/h2>\n\n\n\n

The model that Perry developed for psychiatric treatment\u2014the Neurosequential Model of Therapeutics\u2014is founded on the premise that neural development must occur in order, and that if a child misses a developmental milestone due to the effects of their environment (such as abuse, neglect, or other trauma), that milestone can\u2019t be \u201cskipped over.\u201d For example, if a child is not spoken to during their early childhood years, they won\u2019t develop the language skills needed to speak or understand others at the same time other children do, and depending on the extent of the deprivation, they may never develop their language faculties at all. <\/p>\n\n\n\n

And, since brain development is cumulative, if a milestone is missed, the functions that build on that milestone won\u2019t develop properly either. The brain will still require a specific type of stimulation to develop that foundational function or region. This means that we can\u2019t treat traumatized children based on their chronological age; rather, we must treat them based on their developmental age<\/strong>. <\/p>\n\n\n\n

What Does Effective Therapy Look Like?<\/h3>\n\n\n\n

According to Perry, effective trauma therapy must have certain characteristics: It must involve regular, repeated experiences that build on the patient\u2019s existing skills and target their needs; it must take place in a predictable environment in which the patient feels safe; and it must be patient-directed and voluntary. <\/p>\n\n\n\n

Therapists drawing on the Neurosequential Model of Therapeutics progress through the following four steps: <\/em><\/p>\n\n\n\n

  1. Understand the patient\u2019s history, including the type of trauma they experienced and when they experienced it, as well as the patient\u2019s relationships with others<\/a>.<\/em><\/li>
  2. Understand the patient\u2019s current status, including their strengths, needs, and the quality of their relationships with others.<\/em><\/li>
  3. Create a treatment plan that builds on the patient\u2019s skills and targets their needs.<\/em><\/li>
  4. Implement the treatment plan and adjust it as needed. <\/em><\/li><\/ol>\n\n\n\n

    Children Helping Each Other: Peter\u2019s Case<\/h3>\n\n\n\n

    Perry also explains how children can help each other in their treatment, using the case of Peter, who was born in a Russian orphanage and only received a few minutes of basic interaction per day. As such, he missed out on vital caregiving responses like those described earlier. When he started school in America, he had severe deficits in language and social skills and was prone to long, frightening, and aggressive outbursts. <\/p>\n\n\n\n

    Peter\u2019s peers feared him and didn\u2019t interact with him, which made things worse. Once Perry visited Peter\u2019s class and explained Peter\u2019s background and why he behaved the way he did, the other children opened up to Peter. They invited him to play, sometimes even arguing over who got to be his partner in class activities. Peter improved rapidly as a result of these supportive relationships<\/a><\/strong>, and Perry explains that these children gave him more therapeutic treatment than the adults in his life ever could have. <\/p>\n\n\n\n

    The Importance of Community<\/h4>\n\n\n\n

    Many of these cases highlight another major point that Perry emphasizes: the importance of community in child-rearing. He explains that humans are extremely social creatures, and because of this, relationships are the most important factor in both facilitating healthy development and healing trauma<\/strong>.<\/p>\n","protected":false},"excerpt":{"rendered":"

    What key points can we take away from Dr. Bruce Perry\u2019s The Boy Who Was Raised as a Dog? What does Perry teach about childhood trauma? In The Boy Who Was Raised as a Dog, author Dr. Bruce Perry leverages his expertise as a child psychiatrist to teach the fundamentals of how trauma impacts children and how it can be treated. Understanding the key takeaways from this book gives you a foundational understanding of what trauma is and how it works. Discover how trauma impacts the developing brain and how it can be treated.<\/p>\n","protected":false},"author":24,"featured_media":15900,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_jetpack_memberships_contains_paid_content":false,"footnotes":""},"categories":[40,9],"tags":[1310],"class_list":["post-116473","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-books","category-psychology","tag-the-boy-who-was-raised-as-a-dog","","tg-column-two"],"yoast_head":"\nThe Boy Who Was Raised as a Dog: Key Takeaways on Trauma - Shortform Books<\/title>\n<meta name=\"description\" content=\"In The Boy Who Was Raised as a Dog, child psychiatrist Dr. Perry explains how trauma impacts a developing brain. 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