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Tackling Trauma

kgould's picture

 Kathryn Gould

Professor Grobstein


14 May 2010

Tackling Trauma

In the book, “The Boy Who Was Raised as a Dog,” Dr. Bruce D. Perry works as a detective and a healer, taking on tragic cases of child abuse and post traumatic stress disorder, working with children that others have given up on. More often than not, the children that Dr. Perry works with are thought to be irreparably broken, physically, with brain damage. Others are just viewed as “bad” or “violent” kids, ones that cannot be fixed, ones that are punished as any other child their age acting out would be punished.

But Dr. Perry, through a process of trail-and-error, finds that the best way to help these kids is not to treat them as delinquents or broken children, but as humans who were, mistakenly or deliberately, withheld the basic care and time that is needed to help develop a well-rounded, healthy individual.

It seems, to the reader, that the treatment of these kids after their horrible experiences borders on reckless indifference. Children who witnessed horrible acts of murder, who were attacked themselves, children who were ignored and neglected for years, children who sexually abused—they are all expected to grow, develop, and behave like “normal” children. They, as children, whose minds are still growing, are expected to be resilient. They’re supposed to “bounce back” from adversity, like pieces of rubber. But Dr. Perry shows us through a series of cases and anecdotes that these young minds cannot just “reset” to where they began. Their minds have been molded and shaped by their experiences, good or bad, and their behaviors have developed and been affected accordingly.

By using his past experience as a neuroscientist, a researcher working in a lab, Dr. Perry is able to observe that stressful experiences –especially in young minds—can change the brains of those affected in a big way. Minor stressors, things as small as not being held enough, or made to breastfeed, can permanently, and negatively, impact brain chemistry and, therefore, behavior. Mind you, most of the stories that he tells are not of “minor stressors.” Dr. Perry worked with the kids that were affected by the Waco Massacre, in Waco, Texas. He works with a young boy adopted from Russia who, at age seven, interacts with the people and the world around him as an infant would. A boy who had been raised in a “mass orphanage,” given minutes a day to be fed and changed, and then left in his crib until it was time to be fed and changed again. And Dr. Perry works with the boy who was raised as a dog.

The boy’s name was Justin. At the age of two, he had been diagnosed with severe brain damage of unknown origin, causing him to stop developing as a child his age should. He was unable to speak or walk; when Dr. Perry encounters the child for the first time in the hospital, Justin was being held in a “cage,” a crib with a lid, because he would fling himself out of it and bite and attack people. Justin could only shriek, knew no words, rocking himself in a mess of food and feces. He was being treated for pneumonia, which had been an issue since staff had been unable to maintain IV lines for fluid and antibiotics without him pulling them out or clawing at the hands meant to help him. When Justin began to throw food, feces, and anything he could get his hands on at the doctors and nurses, they called for psychiatry.

But rather than dismiss the boy out of hand as a brain-damaged mess, Dr. Perry delves into Justin’s history and finds clues as to why the 6-year-old cannot walk or speak, or behave like anything other than an animal. Born to a 15-year-old mother who abandoned him at two months, Justin was raised by his morbidly obese grandmother until he was 11 months old, when she was hospitalized and died. While the grandmother had been very kind-hearted and caring, and had done her best to take care of Justin, the child was only left to her boyfriend, a 60-year-old man who was not physically or mentally prepared to take care of a child not yet a year old. The man, Arthur, had mild mental retardation and only knew how to take care of the child as he took care of the others in his profession… as a dog breeder. He kept Justin in a cage for about 5 years, after trying to contact Child Protective Services, which did not act because the child was not immediately in crisis. Arthur did his best to take care of the boy, feeding him and caring for him with the dogs that he raised. Justin was only socialized with these dogs; he didn’t speak because he was rarely spoken to, didn’t walk because he had never had the space or the motivation to walk upright, on two legs. The brain is a historical organ, shaped and made from experiences. Without those experiences, how was this boy expected to live as anything other than the animals he had been caged in with?

With a careful and deliberate approach, one with lots of compassion and patience, Dr. Perry and the staff help Justin to socialize with other people, to sit in a chair on his own; within weeks, the child has taken his first steps. By showing Justin how to interact with people (i.e. not throwing poop), how to speak by speaking to him, how to behave like other children by behaving as he was expected, the animal that had once been caged up in the Pediatric Intensive Care Unit in the hospital grew into a child. Speech therapy, physical therapy, occupational therapy—Justin’s brain was given the experiences that he needed to develop the links and connections that he needed to be a child. He continued to rapidly improve, so much so that within about six months he was placed in an understanding foster home farther from the hospital…

Two years later, Dr. Perry received a letter from a clinic in a small town, a note from the foster family taking care of Justin. At eight years old, he was ready to start kindergarten. The child who had been pushed to the side of the PICU for attacking staff and throwing feces, the one who had been raised as a dog, was going to go to school. On the back of the note, written in crayon, “Thank you Dr. Perry. Justin.”

And this case is only one of the few that Dr. Perry recounts in his book, which not only talks about the history, experiences, and progress of the children he deals with, but also with the brain chemistry, the neuroscience, hidden behind the curtain.

It just goes to show you how malleable, how “resilient” the brain can be with the proper care, compassion, and understanding of neurobiology.

Perry, Bruce D., and Maia Szalavitz. The Boy Who Was Raised As a Dog: And Other Stories from a Child Psychiatrist's Notebook Child Psychiatrist's Notebook--what Traumatized Children Can Teach Us About Loss, Love, and Hea. New York: Basic Books, 2007. Print. 


Wilson's picture

Paediatric case management

Well, if you have child section in your clinic, you must be proficient in paediatric case management, as it becomes a per-requisite to be handling the young kids that are brought to the doctors in a critical condition.