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for those living or working with the impact of trauma

SAIA Book of the Month Jan 2016 - The Boy Who Was Raised as a Dog

28/1/2016

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​THIS REVIEW ORIGINALLY APPEARED IN THE SCOTTISH ATTACHMENT IN ACTION BULLETIN JAN 2016 AND IS REPRODUCED WITH PERMISSION

‘The Boy Who Was Raised as a Dog’ by Bruce Perry and Maia Szalavitz

Bruce Perry, founder of the Child Trauma Academy based in Houston, Texas has co-written ’The Boy Who Was Raised as a Dog’ with Maia Szalavitz. He describes it as ‘What Traumatised Children can Teach Us about Loss, Love and Healing’.

He expresses his life-long interest in human development and strives to share the stories of some of the young people he has worked with.  He and Szalavitz assert that stress and psychological trauma have a lasting and permanent impact on the chemistry and architecture of the brain.

From the outset of the book, he outlines the conditions necessary for the development for empathy or indeed cruelty and indifference. The link between trauma and symptoms like depression and what he refers to as ‘attention problems’ are made explicit in a way that is intended to be helpful for anyone living with or working with young people. His aim appears for the reader to understand better the impact of threat or violence on the developing brain in order that a more nurturing approach can be utilised where appropriate.

Perry’s descriptions of his early days as a psychiatrist allow some insight into his way of thinking. He talks about the professionals who influenced his practice. Very quickly, he lets the reader know of some of the cases he worked on.  It is often an uncomfortable, yet compelling read as each chapter describes,  with a lot of detail, young people with whom he has worked. He takes the time to go into the background stories with reference to their early days and care afforded to them. 

In these depictions, he demonstrates his thought processes, how his thinking helped him to attain a level of rapport with his patients and how he used his increasing knowledge to analyse his patients and their development.  His questioning nature led him to be sceptical of, and challenge some of the protocols of the day in favour of what he thought was the ‘right thing’ to do in each, individual case. Be aware, reader, that he describes cases where some of his patients have endured horrific conditions.

There is a great deal of theoretical information in this book, which I found useful and informative and I can highlight only some of my understanding here.  As well as outlining his understanding of brain structure and what he refers to as the architecture of the brain, Perry goes into detail about neuropharmacology, how the developing brain organises itself and how regulatory functions develop. In particular, he talks about how stress responses are formed. 

In telling the stories of each of his cases, Perry weaves his theoretical knowledge in a way that helps the reader’s understanding. The process of how neurological pathways are created and the importance of the caregivers ‘attunement’ are elaborated on. He describes attachment as, “A memory template for human to human bonds”.

He describes the methods he used to get to know his patients. ‘Colouring’ seemed to be a favoured pastime to begin with. He ascertains that work can only take place once a young person has reached a position of relative safety.  In order to begin any therapeutic work, Perry recommends that the reduction of chaos is essential and that the child’s environment should become calmer and more predictable. Only once a regular routine is established, he maintains, can any benefit be gleaned.

One of Perry’s recommendations for helping traumatised or fearful young people is the use of experiences which are based on patterns, repetition and, where possible, activities which are  rhythmical. This, he asserts will help that person with physical and mental regulation. 

One of the key messages for me is about how we function as relational beings. Perry asserts that our physical responses and ability to survive depend on our associations with others. He says that,
“As children, we come to associate the presence of people we know with safety and comfort; in safe and familiar settings, our heart rates and blood pressure are lower, our stress response systems are quiet.”

There are many intended messages in this book. Perry makes the point that we all need to be aware of our own state of mind when dealing with others. He suggests that if we present as angry or stressed, that we might induce those feelings in people around us. They might then ‘mirror’ those responses. He says,
“To calm a frightened child, you must first calm yourself”.


No matter what the reader might think about Perry’s methodologies (as a teacher, the description of the use of clonidine in his clinic was not given much explanation and was a bit of a ‘whoa there’ moment for me as I don’t understand a great deal about the use of medication), the insights he has shared about attachment, relationships and brain development have helped me in my work with young people and in life in general. This book has encouraged me to see things from a different perspective and to reflect on my practice. As Perry puts it, “People, not programmes, help people”.

This quote from the book sums up well how we have the potential to impact on others...
“Fire can warm or consume, water can quench or drown, wind can caress or cut. And so it is with human relationships; we can both create and destroy, nurture and terrorise, traumatise and heal each other.”

Throughout my adult life, I have recognised that there is a link between stress, trauma and fear and how people conduct themselves. Messages conveyed (often hidden) by people’s actions have been of enormous personal and professional interest. Theories put forward in this book have provided confirmation of this belief and increased my understanding, for which I am grateful.

Denise Feasby
Principal Teacher

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Book of the Month - January 2016 [The Body Keeps the Score]

1/1/2016

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​The Body keeps the Score – Brain, Mind and Body in the Healing of Trauma by Bessel van der Kolk, M.D      £21
 
What a wonderful book – authoritative, erudite, compassionate and beautifully written.

Dr Bessel van der Kolk combines the curiosity and analytical mind of the scientist with what Judith Herman calls, “the passion of the truth teller”, and the refreshingly humble outlook of a man in awe of his patients.

But a word of caution, this book is a challenge. Think twice if you are easily shocked, offended, or likely to wallow in guilt for doing what you believed to be best practice at the time. All we can ever do is our best and our best changes all the time, as van der Kolk himself has also had to acknowledge in his 30-year career.
 
To summarise the content I’m going to start in the middle of the book because it is here that van der Kolk makes the bold statement that developmental trauma is “the hidden epidemic” in society. As a trainer I talk to parents and teachers about attachment and trauma, many of whom think trauma is a fringe topic affecting a minority of children.  Van der Kolk would argue otherwise. He compares the (US) public health budget devoted to both heart health education and smoking cessation with the barely mentioned topic of childhood abuse, the cost of which exceeds cancer and heart disease in the USA.  To halve the rate of depression, drastically reduce alcoholism, IV drug use, domestic violence, suicide, prison admissions and improve workplace performance he believes we need to eradicate child abuse.
 
Even obesity comes in for a radical rethink. Diets, bariatric surgery even a sugar tax may look like a solution to a major health crisis, but for the trauma survivor society’s problem may actually be their solution, eg, being big may be a health risk in the long term, but for now being the biggest boy in class may be a way to feel safe from bullies, or being an overweight girl may stop unwanted sexual attention. Brace yourself for the research from one chief of medicine that most of his morbidly obese patients were survivors of child sexual abuse. Van der Kolk wants to get this “hidden epidemic” out in the open. When he asks, “how do you turn a newborn baby with all its promise and infinite capacities into a thirty-year-old homeless drunk?  He gets us to acknowledge how much relationship rather than genetics shapes development. So, while there may be a gene for alcoholism, for example, stressful experiences impact on genetic expression both in the womb and after birth.
 
Throughout the text van der Kolk gives us a glimpse of his own childhood and family traumas. He also tours the many dubious practices of the psychiatry profession over the course of his career, from the brutal to the inspired, focusing frequently on the profession’s more recent obsession with pharmaceuticals. Drugs such as Prozac transformed the lives of many depressed patients from the late 1980s onward, but in van der Kolk’s experience they did not work for war veterans with PTSD. The difficulty arose when medication was seen as the go to “fix it” for mental health problems rather than being part of a holistic treatment package. Drug benefits lay in their ability to dampen reactions not heal the illness. In the case of the half a million US children on antipsychotic drugs, medication has improved things for adults by making the children easier to control! Van der Kolk reports huge over prescribing in the children of low-income families and children in foster care. Shockingly, even thousands of under fives have been prescribed antipsychotics, reducing their aggression but also their motivation, playfulness, curiosity, general functioning and socialization.
 
Thankfully, amid the horror stories are accounts of the author’s inspirational teachers, such as the psychiatrist Elvin Semrad who discouraged him from relying too heavily on psychiatry text books and diagnostic labels which obscured his perceptions of real patients. Instead, he urged getting to know and respect the person while acknowledging that, “most human suffering is related to love and loss”. Teachers have also appeared in the form of patients such as Marilyn who told him his reassuring platitudes only made her more lonely and isolated because, “it confirms that nobody in the whole world will ever understand what it feels like to be me.”
 
Through his experience of working with patients Van der Kolk has  concluded that “all trauma is preverbal” whether it happens in infancy or adulthood. This doesn’t mean that it can’t be talked about but that talking rarely gets to the truth because it reactivates the experience of trauma in the body. Experiments with fMRI scans show that trauma activation stops the brain’s speech centre (Broca’s area in the cortex) from functioning. Consequently, the traumatised continue to live in isolated “speechless horror”. He questions accepted therapeutic practices in the light of what we now know from brain scans, research and experience and advocates alternatives such as yoga, EMDR, mindfulness and others that put trauma survivors back in touch with themselves.
  
There is so much in this book that cannot be summarised. I have only selected morsels to tempt and tantalise. In doing so, I feel that I have done it an injustice by missing out so much of the content on attachment, traumatic memory, the anatomy of survival, neuroscience and the numerous and varied paths to recovery. There is a huge focus on relationship and connectedness and our innate drive to be part of a tribe, which goes against the cultural norm of being an individual, competitive and self made. You have to read it to begin to grasp the breadth and depth of its reach but I’ll leave you with this summary by the author himself, “Trauma results in a fundamental reorganisation of the way the mind and brain manage perceptions… For real change to take place, the body needs to learn that the danger has passed and to live in the reality of the present. [We need] to think differently not only about the structure of the mind but also the processes by which it heals.”
 
Happy reading!
 
Reviewed by Sheila Lavery

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Scottish Adoption Book of the Month Jan 2016 - The Huge Bag of Worries 

1/1/2016

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THESE REVIEWS ORIGINALLY APPEARED ON THE SCOTTISH ADOPTION WEBSITE AND ARE REPRODUCED WITH PERMISSION

The Huge Bag of Worries tells the story of Jenny and her struggles with her increasing number of worries. Big worries, small worries, worries about all manner of things. No matter what Jenny tries to do, the worries just won’t go away and worse still, they keep growing...

Thankfully, help is at hand, in the shape of a kindly neighbour, who knows a thing or two about tackling a worry. Her words of wisdom and range of strategies soon help Jenny to lighten her load and finish up with a smile on her face!

This is a lovely children’s book, which would appeal particularly to those in the early years of primary school. It is enhanced by lively and witty illustrations, which help bring the story to life. The depiction of worries as furry creatures living in a bag also offers great creative options for working with children in a similar vein, to conceptualise and manage their own personal worries. The story has a reassuring message and the strategies offered by the neighbour are widely transferable and could be used by children again and again.

As a story, it stands alone as enjoyable read. For children struggling with worries on a range of levels, it is a terrific resource for supporting them to understand and manage these.

This months review comes from Naomi Head, a Senior Practitioner in the Placement Team.

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