What Happened to You?

Hannah Milton is a GP, a mum, and a runner.

Dr Bruce Perry is a leading American neuroscientist and child psychiatrist who researches the impacts of childhood trauma on children and adults. He wrote the best-selling book “The boy who was raised as a dog”, also about the effects of childhood trauma.

Here he teams up with Oprah Winfrey and the book is presented as a conversation between the authors, which makes it feel accessible to take on the emotional and, at times, technical content. I think Dr Perry’s science and evidence-based approach will engage doctors, whilst Oprah’s curiosity and storytelling helps to lighten the subject matter. I listened to the audiobook read by the authors.

The main purpose of the book is to shift conversations away from “what is wrong with you?” to “what happened to you?” By understanding people’s pasts, we can understand why some behaviours develop in adulthood. Children who have grown up in emotionally or physically neglectful environments have to adapt to cope and get their needs met. These behaviours can become maladaptive in later life, and negatively affect adult relationships and wellbeing. The book helps the reader to make the connection between current thinking / feeling / behaving, and experiences in the past. As GPs we see the impact of these maladaptive behaviours, for example patients struggling with difficult relationships, low self-esteem, anxiety, depression, addiction, low health motivation… the list goes on.

In the book Dr Perry explains the limitations of focusing on Adverse Childhood Experience (ACE) tools. These tools were designed for population level research and they are valid and useful in this context only. He explains that defining an event as traumatic depends on many variables including the timing, the specific event, the experience and the effects, rather than an incomplete tick sheet of ‘adversities’. We shouldn’t give individuals a ‘score’ on the ACE tool even if a high ‘score’ increases the risk of many conditions in adulthood at a population level. It is more helpful to focus on the individual’s experiences of adversity. Dr Perry also shares his cynicism about labelling people, services or even countries as “trauma-informed”. It is impossible to become truly trauma-informed from a workshop alone!

This book also helped me think about racism and how implicit bias can develop. How being from a minority group within a majority group is a traumatising experience in itself. Feeling ‘other’ can have lasting effects. I have certainly read and heard about this from black authors and presenters (e.g. David Harewood’s “Maybe I don’t belong here”).

Dr Perry talks about how trauma can pass through generations, even if this isn’t a genetic change. He gives the example of black Americans ‘inheriting’ a fear of dogs from when they were used aggressively to attack civil rights marchers. Their children would detect the fright and develop their own fear, which they too can pass on to their children.

There is an explanation of self-harm, which I have always found very difficult to understand. People with a sensitive dissociative response to stress, due to previous trauma, can experience an opioid release when they cut themselves. It can even become addictive for this reason. Most people have developed their own ways of dissociating from stress e.g. exercise, reading, eating, alcohol… obviously some ways are healthier than others.

The book features a discussion about resilience: how this can develop and be nurtured in children through small manageable episodes of psychological challenge. There is plenty of hope, with an explanation of post-traumatic wisdom and how people can have the capacity to heal from huge trauma.

So many of the concepts within this book are relevant to the patients we see every day and they are presented sensitively and accessibly.

 

Featured book

Bruce D. Perry and Oprah Winfrey. What Happened to You? Pub: Bluebird, 2021. ISBN-13: ‎ 978-1529068467

 

Featured image by Caleb Woods at Unsplash