by Bruce Perry with Maia Szalavitz
Review by Christian Perring on May 13th 2008
Bruce Perry is a compassionate, insightful and thoughtful child psychiatrist who works in Texas. This collection of clinical cases focuses on the effects of trauma and abuse on children. He explains why they react as they do to their experiences, and when he can, he finds ways to help them. His approach is distinctive because of its emphasis on neuroscience and the ways in which extreme experiences affect the growth of a child's brain.
Perry starts off with the case of 7 year old Tina, who had suffered repeated sexual abuse, and now believed that she should act sexually with all men to win their approval. Her early experiences also caused her terrible stress, and affected her whole body, including her heart rate, her attention, her sleep, her fine motor control, and in her language development. Perry finds that he has only partial success in treating such profound damage caused by abuse. Other cases include a three year old girl who witnessed the murder of her mother and was alone with her mother's body for an extended period of time, children from the Branch Davidian ranch, a boy who was raised in a cage like a dog, a murderer who had been abused as a child, and children who claimed that they had abused by Satan worshippers. Through these cases, Perry sets out a great deal of scientific understanding of brain development and the importance of nurturing young children. He also points out some of the dangers of faddish theories about curing disorders in young children and of using treatments that haven't been shown to be effective. For example, he explains the enthusiasm for diagnosing Reactive Attachment Disorder and he argues that "Holding Therapy" that has been proposed and used as a cure can in fact be coercive and abusive.
Child psychiatry gets into the news with increasing frequency these days, and it is clear to all that in order to understand a child's problems you have to look not just at the child, but also his or her family. Perry makes this clear early on in his book. At the same time, neuroscience is considered as increasingly important to psychiatry, and Perry manages to explain how to make the link between the scientific knowledge and clinical treatment. There seems to be a tension between the contextualizing required by child psychiatry and the individualizing required by neuroscience. One approach sees the child as one member of a family unit, and the other sees the child as a developing brain. These two approaches are not necessarily in contradiction with each other -- the child is both these things -- but it can be hard to see how match the two of them together. Sometimes psychologists say that the answer is the biopsychosocial model which tells clinicians to consider the patient at many different levels of analysis: biological, psychological, and social. However, generally this is no more than a gesture, and there's no theory about how to combine these different levels of analysis. What makes The Boy Who Was Raised As a Dog especially interesting is that, while Perry doesn't present any such theory, he does show how he combine these different approaches in particular cases, which is at least a start. This comes out well in the title story, where Perry compares the case of Connor, a boy who suffered severe neglect, yet turned out quite well, with other children who experiences similarly negligent upbringing, yet turned out to be very antisocial. He shows how treatment can take many forms, including massage, a music and movement class, and advice about how to dress. He also argues that the genetic differences between children may also play a major role in explaining in how they respond differentially to their early experiences.
Perry's book avoids some controversies in child psychiatry. He says very little about debates over the safety of antidepressant medication and stimulant medication for children and adolescent, and he does not address questions as to whether ADHD, depression and bipolar disorder are over-diagnosed. We shouldn't expect him to cover these issues, since the book is about the effects of traumatic experiences. His emphasis on trauma show how important it is to understanding the mental health of children and the problems in development they undergo. The book does not promise miracle cures, but it does inspire hope that we starting to understand these issues more fully. Often psychiatrists herald the importance of neuroscience to their work with great fanfare, yet then only show a few generalizations and vague ideas about neurotransmitters, brain scans and "chemical imbalances" that, while interesting, tell us very little about how to help people or even the real source of their problems. In The Boy Who Was Raised As a Dog, we start to see how neuroscience can be helpful in guiding treatment in a psychiatric clinic.
Link: Child Trauma Academy
© 2008 Christian Perring
Christian Perring, Associate Professor of Philosophy, Dowling College, New York.
Comment on this review