The Boy Who Was Raised as a Dog

by Bruce Perry

  “No. That is the official name of the raven.”

  “You like ravens.”

  “I am a raven.”

  “You look like a girl.”

  “Funny. You know what I mean.”

  “Kind of.” She was quiet. I kept going. “You want to talk animals. Let’s talk about the animal world.”

  “OK.”

  “Many animals have ways to send signals to other animals—their own species and their predators.” As I spoke she settled deeper in the chair. She grew quiet. I could see that I was getting close to pushing her to shut down. “Sometimes those signals say don’t mess with me, I’ll hurt you,” I continued, “A bear rises on both feet and huffs; dogs growl and bare their teeth, the rattlesnake rattles.” I paused and let the silence fill the room. I was trying to get her to understand how she gave off such powerful “leave me alone” signals. I knew she was often creating the self-fulfilling prophecy that “people don’t like me.” She emitted negative signals—and elicited negative responses. Then, of course, those reactions further reinforced her perception that the world is full of people who didn’t like her. She blinked and looked at me. She wasn’t tuned out yet. “What does the raven do?” I asked. She smiled a little.

  “The raven does this.” She sat forward, leaned toward me and pulled her long sleeved shirt up. I expected to see fresh cuts. But all I saw was a new tattoo, entirely in black ink. It was a raven sitting with spread wings. She held her arm out for me to study it a bit.

  “Nice ink. Who did the work?” At least she knew by now that her dark clothes, piercings and new tattoo were sending signals.

  “Bubba, down on Montrose.” She rolled her sleeve back down.

  “So tattooing now. Does that have the same effect as cutting?”

  “Not really. It didn’t hurt that much though.”

  “Are you cutting?”

  “No. I’m trying to use those relaxation exercises. Sometimes they work OK.” I had taught her a form of self-hypnosis to use in situations when she felt the urge to cut. Hypnosis helps people access their own dissociative capacity in a controlled way. I wanted Amber to gain a healthier control over when and to what degree she would use this powerful adaptive response.

  I had taught her an induction technique that involved focusing on her breathing. After simply observing each breath she took for a moment or two, she would then take a number of deep, controlled breaths and count them down, from ten to one. With each inhalation she would imagine taking one step down a staircase. At the bottom of the staircase was a door, and when she opened that door she would be in her “safe” place, where no one could hurt her and where she was in total control. Once she had that technique down, we worked on helping her use it whenever she was distressed or overwhelmed, rather than cutting herself.

  LITTLE BY LITTLE she would open up and then close back down. She’d discuss a bit of the hurt and shame that she carried around and then, when it got too painful, she’d withdraw again. I didn’t push. I knew that her defenses were there for a reason and that, when she was ready, she’d tell me more. She kept getting more tattoos, most of them small, all of them black. There was a black rose. A black Gaelic knot. Another small raven. And still, she always dressed entirely in black.

  In a later visit we talked more about how people are designed to read and respond to others. We talked about the signals we send.

  “Did you know that the human brain has special neural systems that are designed to read and respond to the social cues from other people?” I held up a neuroscience journal I had been reading. I was trying, again, to get her to recognize the negative signals she was sending out to people, and that she might be misreading the social cues of others.

  “Are you saying my social cue neurons are fucked up?” She had immediately jumped way past the point I was trying to make; her response itself precisely illustrated the problem I was trying to get her to address. I needed to back off a bit.

  “Yikes. Where did that come from?”

  “I know it’s what you’re thinking.”

  “So now your powers extend to mind reading? Can you read everyone’s thoughts or just mine?” She didn’t see the humor in my comment. I decided that the safest way to move forward was to approach her at a cognitive, rather than emotional, level.

  “When these special neurons in the brain fire, they are almost a reflection of similar neurons firing in the brain of someone you are interacting with. They’re called mirror neurons, in fact. And they’re a part of the systems that our brain has to help us connect with and communicate to others. Pretty cool, right?”

  She was listening. I hoped that she was processing some of this, maybe thinking about what it might mean for her. I continued, “When a mother holds her newborn baby and smiles and coos, all of the primary sensory signals—the visual input from the mother’s smile, the auditory input from the cooing, the olfactory signals from the scent of the mother and the tactile information from the warmth and pressure of the mother’s touch—all get turned into patterns of neural activity that go up into the brain of the baby and actually stimulate the parts of the brain that match the parts of the brain that the mother uses to smile, coo, rock and so forth. The baby’s brain is being shaped by the patterned, repetitive stimulation of the interactions from the mother!”

  She was listening now. I could see that she was fully engaged, nodding her head. I said, “Pretty amazing. I love the brain.” I dropped the journal back on my desk and looked at her for a response.

  “You are a strange dude.” She smiled. But I was pretty sure that she recognized that she had misinterpreted my comment, that I’d never said nor implied that her brain was “fucked up.” She was beginning to see how her perception could differ from reality and how her reactions to people might be based on a skewed vision of the world.

  AND OVER TIME, Amber got better. Her resting heart rate was now above sixty beats per minute and was no longer frequently dipping dangerously low. She had not had any further spells of unconsciousness. All reports from home and school suggested that she was doing well. She became more animated in our sessions. Now she talked about a small group of friends, all of them a bit marginalized, but overall healthy.

  Then one day she came in, slouched down onto the chair and announced, “Well, we are moving again.” She tried to act nonchalant.

  “When did you find this out?”

  “Yesterday. Mom got a better job in Austin. So we’re moving.” She stared into space, her eyes filling with tears.

  “Do you know when you are going to move?”

  “In a few weeks. Mom starts on the first of the month.”

  “Well. Let’s talk about this some.”

  “Why?”

  “Because I would guess that this feels pretty bad to you.”

  “So who is reading minds now? You don’t know how I feel.”

  “Mmmm. I believe I said that I would guess that this feels pretty bad. Is my guess wrong?” She pulled her legs up underneath her and dipped her head to prevent me from seeing her tears. A tear dripped onto her black pants. I reached over and handed her a tissue. She took it from my hand.

  “I hate this.” She said quietly. I let silence fill the room. I pulled my chair closer to hers and put a hand on her shoulder, leaving it there for a few moments. We sat.

  “What part do you hate the most?”

  “All of it. New school, new kids, new freak in town. I hate starting over all the time.”

  “That must be hard.” I didn’t want to invalidate her feelings by trying to put a positive spin on it. I knew that we would have time later to talk through some of the potential positive aspects of a new start. I just let her spill out her frustration and sadness. I listened.

  The next week, she came in, announcing, “I can’t wait to get out of this town.” She had already flipped to the “who cares?” mode. It is easier to leave people places if you “don’t care” about them.

  “So I guess all those tears last
week were . . . ?” She looked at me, angry. I held her gaze and allowed her to read my face, my expression, which told her that I was sad and concerned about her, and her anger melted. We started the hard work of helping her with this transition.

  During those last few weeks she struggled with how to present herself to her new school. Was she ready to “start over?” Did she need to always project anger, darkness? Did she always have to wear black? She was beginning to think that she might be able to be softer, more open and more inviting to new relationships. Our discussions about the animal world and how the brain works had seeped into her understanding of herself.

  “I can’t decide what to do. I don’t know if I should try to start over and be myself, or to protect myself. I don’t know what to do. I don’t know how to be.”

  “When the time comes, you will make the right choice.”

  “What do you mean?”

  “If you make the choice it will be right. Just don’t let anyone else choose for you; don’t let your mom, or your friends, or me, or . . .” I paused and caught her eye, “the ghost of Duane make the choice for you.”

  “How does Duane have anything to do with this?”

  “I think that the darkness is not your own. I think those things that worked when you were being abused—the disengaging, the fantasizing, the darkness you projected to the world—were forced on you by Duane.”

  “No. I made that world.”

  “Remember when you told me that when you first retreated to that world you wanted to be a songbird? A bluebird or a robin. And it didn’t work?”

  “Yeah.”

  “Those beautiful, colorful songbirds were your first choice, Amber. Maybe they didn’t work then because they were too vulnerable; and you needed something more powerful, dark, menacing to protect you.”

  “Yeah.”

  “Maybe you don’t need that now, Amber. Maybe it would be ok to let the birds sing.”

  “I don’t know.”

  “Me neither. But when the time is right, you will know. And when the time is right you will make good choices.”

  Before the move, I tried to encourage her and her mother to see a new therapist in Austin. I gave Jill a list of names and reassured her that I often worked with colleagues from a distance. I told her that I would remain available by phone or for occasional consultation visits to track Amber’s progress. But ideally, I hoped that she would find a primary therapist in Austin where she could continue the work we had started. Amber didn’t like that idea.

  “I don’t need to see a shrink. I’m not crazy.”

  “Have I been treating you like you are crazy?”

  “No.” She was quiet. She knew her argument was ridiculous.

  “Listen, it’s up to you. My opinion is that it would help you if you take the time to find the right person. Meet with these folks and you can see who you might feel comfortable talking with.”

  “OK.” She looked at me knowing that I knew she wouldn’t really try.

  “Well. Just make sure that whatever choice you make, it’s truly yours.” And I reached my hand out to seal the deal. She shook my hand.

  “Sure thing, Doc.”

  WE DID HEAR from Amber’s mother a few times in the first six months after they moved. She had taken her daughter to the first therapist on the list of referrals we’d provided, but Amber didn’t like the woman. They hadn’t gotten around to trying again. All too often when things seem OK, parents aren’t motivated to follow through with the expense and inconvenience of therapy. Since Amber was “doing great” her mom didn’t push it when Amber resisted finding a new therapist.

  More than a year after Amber moved to Austin, I signed onto my email and saw a note from BlueRaven232. At first, I thought it was spam and almost deleted it. Then I saw the subject: “New Tattoo.” I read it:

  Dear Doc:

  Wanted you to be the first to know. I got a new tattoo; a bouquet of flowers—orange, red, purple and blue. Real girly girl. No black ink. Blue Raven

  I wrote back.

  Thanks for the note, sounds like a nice choice. Good work.

  One question: Sky Blue Raven?

  Dr. P.

  Later that day, she wrote back:

  No. Navy Blue Raven.

  Hey, it’s a start, right?

  I smiled as I typed back:

  It’s a good start, Amber.

  Every now and again, I get email from Blue Raven. She is now a young adult. She went to college and graduated in four years. Like all of us, she has had her ups and downs. But from what I can tell she is a healthy, productive and caring young woman. She works with young children now and can’t decide whether to go back to school to become a social worker, police officer or a teacher. I suspect, however, that she will make the right choice for her. And I know that because of what she’s been through and what she learned about how trauma can shape a child’s view of the world, in whatever capacity she works with children they will be very lucky to know her.

  chapter 9

  “Mom Is Lying. Mom Is Hurting Me. Please Call the Police.”

  ONE OF THE hazards of running a clinic for maltreated and traumatized children is success: if you develop a reputation for being able to help these young people, you will inevitably be unable to keep up with the demand. It can be hard to increase staff and services and still maintain the high-quality, individualized, and time-intensive care the children need. This was why our working group ultimately decided to maximize our ability to get the best care to the most children by focusing on research and training. Our educational efforts target all of the adults who live and work with maltreated children—from psychiatrists to policy makers to police officers and parents. We continue to do clinical work with multiple service partners across the country, but back in 1998 most of this work was based at our large clinic in Houston. James, a six-year-old boy became one of our patients. Our work in his case was not therapy; I had been asked to provide expert input on his complex situation. James taught me a great deal about courage and determination, and reminded me how important it is to listen, paying close attention to the children themselves.

  James was referred to us by a judge who had received so many different opinions about the boy’s situation that he hoped we could clarify what was going on. A children’s legal advocacy organization was worried that he was being abused by his adoptive parents. Numerous therapists and Child Protective Services, however, believed that he was such a troublemaker that his adoptive family had needed a break from him. Teachers reported unexplained bruises and scratches. The boy had been adopted before his first birthday by a couple who had also taken in three other children and had one biological child. James was the second oldest. When we met him, his oldest sibling was eight and the youngest, a girl, was an infant.

  According to his mother, Merle,* James was incorrigible and uncontrollable. He frequently ran away from home, he tried to jump out of moving cars, he attempted suicide and wet his bed. By age six he had been hospitalized numerous times, once after jumping from a second story balcony. He lied constantly, especially about his parents, and seemed to enjoy defying them. He was being prescribed antidepressants and other medications for impulsivity and attention problems. He’d seen numerous therapists, psychiatrists, counselors and social workers. His mother said he was so unmanageable that she called Child Protective Services on herself, pretending to be a neighbor concerned that his mother could not handle him and that he was a danger to himself and his siblings. The last straw was an overdose of medication he’d taken that had landed him in an intensive care unit. He was so close to death that he had to be flown to the hospital in a helicopter for rapid treatment. Now he’d been taken to a residential treatment center to give his mother a “respite.” The judge had been asked to determine what should happen next.

  CPS caseworkers and several therapists believed he had Reactive Attachment Disorder (RAD), a diagnosis frequently given to children who have suffered severe early neglect and/or trauma. Leon,
who ultimately killed two girls, may have had this disorder: it is marked by a lack of empathy and an inability to connect with others, often accompanied by manipulative and antisocial behavior. RAD can occur when infants don’t receive enough rocking, cuddling and other nurturing physical and emotional attention. The regions of their brains that help them form relationships and decode social cues do not develop properly, and they grow up with faulty relational neurobiology, including an inability to derive pleasure from healthy human interactions.

  RAD symptoms can include the “failure to thrive” and stunted growth we saw in Laura’s case. The disorder is often seen in people like Laura’s mother Virginia, who was moved to a new foster home every six months and not allowed to develop a lasting early attachment with one or two primary caregivers. Children raised in institutions like orphanages are also at risk, as are children like Justin and Connor. In addition to being unresponsive to people they know, many children with RAD are inappropriately affectionate with strangers: they seem to see people as interchangeable because they were not given the chance to make a primary, lasting connection with a parent or parent-substitute from birth. These indiscriminately affectionate behaviors are not really an attempt to connect with others, however, but rather they are more accurately understood as “submission” behaviors, which send signals to the dominant and powerful adults that you will be obedient, submissive and no threat. RAD children have learned that affectionate behaviors can neutralize potentially threatening adults, but they don’t seem to engage in them as a way to form lasting, emotional ties.

  Fortunately, RAD is rare. Unfortunately, many parents and mental health workers have latched onto it as an explanation for a wide range of misbehavior, especially in adopted and foster children. Treatments like “holding,” which were so harmful to the Gilmer, Texas, children, are pitched as “cures” for RAD, as are other coercive and potentially abusive treatments that involve emotional attacks and heavy-handed discipline. James’s therapist, for example, had recommended that his mother lock him in a closet when his behavior got too wild.