What Happened To You?: Conversations on Trauma, Resilience, and Healing

This chapter focuses on the role that early experiences, particularly love and caregiving, play in the formation and development of the human brain, attitudes, behavior, and personality.

Winfrey describes how, over all the interviews she has done, she has found one thing to be common among all her guests: “All of us want to know that what we do, what we say, and who we are matters” (75). Every single person she has interviewed, from presidents to pop stars to former convicts, always asked how they did at the end of the interview, displaying their longing to be accepted and affirmed. Winfrey believes this desire to be common to all people, and it comes down to how one is loved.

In keeping with this, Perry talks about a specific quality of the human brain: neuroplasticity. It is the capacity of the human brain to change and adapt to one’s individual world and is reflected in actual physical changes that take place in neural networks when they are stimulated. The brain changes in a “use dependent” way, meaning that neural networks form and adapt based on which skills are used. This relates to a key principle of specificity, in that for a particular part of the brain to change, that specific area needs to be activated by introducing corresponding stimuli or input. “This principle of ‘specificity’ applies to all brain-mediated functions, including the capacity to love” (74). If an individual has not received or experienced love, then the corresponding neural networks in their brain will remain underdeveloped. However, neuroplasticity makes it possible for these capabilities to emerge through exposure, even later in life.

Perry concurs with Winfrey’s opinion that the need to be loved is common to all humans and asserts that belonging and being loved are core to the human experience. Humans are a social species and are meant to be in community; the acts of loving and caregiving form the foundations of our biological development. For an infant, receiving love and caregiving manifests as the caregiver responding to the infant’s cry and arriving to meet its needs: “To the newborn, love is action; it is the attentive, responsive, nurturing care that adults provide” (76). Here is where the stress activation and response described by Perry plays out: When an infant is dysregulated owing to hunger, cold, pain, or tiredness, it cries out; a caregiver arrives and soothes this stress by providing the infant what it needs and offering co-regulation. When this response is consistent and predictable, resilience builds; in the opposite scenario, the infant is left sensitized and vulnerable.

The response to stress can take multiple forms, with the “fight or flight” response being a commonly used term. Upon the introduction of a threat, the brain narrows focus onto it, tuning out all other input from the external world and from within the body. In preparation to fight or flee, several neurochemical changes take place within the body, including an increased heart rate, the release of adrenaline and cortisol (stress hormones) and glucose (for energy), and the diversion of blood toward the muscles. However, Perry details how one does not switch immediately from a state of calm; being social beings, our first response is to “flock,” i.e., to look to others around us for emotional cues that tell us how to interpret the situation. These cues are mostly gleaned from nonverbal behavior, such as body language or facial expression. In a situation where others are not present, however, one may have a “freeze” response instead: pausing to assess the situation, such as a sound in a dark parking lot. As the level of threat increases, one finally arrives at a fight-or-flight state. If there is opportunity to escape, one flees; however, when one is cornered with no way out, then the survival instinct kicks in, and one fights.

The sequence of these four responses—flock, freeze, flee, fight—also correspond with the different stages of arousal that are present in one’s waking state: calm, alert, alarm, fear, and terror. When one is calm and relaxed, one’s mind can wander; one also has the most access to the cortex, the smartest part of the brain, and reflection is the key function. In the next stage of alertness, one still remains well-regulated and can access the cortex even while remaining focused on some aspect of the external world, such as engaging in a conversation; a “flock” response is seen in this state. The introduction of a sudden challenge, surprise, or setback can move an individual from alertness to alarm, from which point the lower layers of the brain begin to dominate. Logic takes a backseat as emotions take over, and the “freeze” response sets in; thus, arguments devolve into illogical or personalized attacks at this stage. If the threat persists or intensifies, one moves into a stage of fear, and further lower layers of the brain dominate, with the instinct to “flee” arousing. Finally, at its highest stage of terror and when one finds oneself backed up against the wall, the survival instinct of “fight” kicks in.

Perry reiterates how just as the brain processes information sequentially and bottom up, it also develops in the same sequence. The lowest networks that make up the CRNs are the ones that develop first, beginning in the womb. Thus, a healthy newborn displays numerous automatic, regulatory brain functions, such as body temperature regulation and respiration; however, it will not be capable of abstract reasoning for many years. Most of the brain’s growth and development takes place in the first five years of life, though owing to neuroplasticity, it still holds the capacity for change beyond this time. However, the early experiences of an individual’s life undoubtedly have incomparable impact on how they develop, biologically, and therefore, psychologically. Being at the receiving end of consistent love, care, and responsiveness, will lead to an individual’s CRNs being normally organized and regulated; this individual will, in turn, experience a healthy development of the higher areas of their brain, such as their limbic systems and their cortex. Unpredictable and prolonged stress leads to the disruption of the CRNs. The individual is sensitized to stress, their threshold being far lower than the normal; mild or moderate stress, which would only cause some alarm in a neurotypical individual, would send this person into a state of abject terror. The constant neurochemical changes that accompany such a high reactivity to stress eventually adversely affect all the brain and body systems that are connected to the CRNs, causing emotional, behavioral, and physical health issues.

In this way, Perry demonstrates how childhood experiences can literally impact the biology of the brain. He uses the analogy of a house that is beautifully decorated, but carries a weak foundation, faulty wiring, and shoddy plumbing; even if the core defects of the house are not visible at first glance, they will invariably become evident over time. Similarly, the early years of a child’s life are foundational with respect to brain development; the kind of interactions experienced at this point in the child’s life influence every aspect of their functioning as they grow, whether the interactions be positive or traumatic. This is in keeping with the human brain’s capacity to make associations between patterns of sensory input that occur simultaneously to create implicit memories: certain sounds, smells, facial features, expressions, gestures, and so on, come to be associated with positive or negative emotions. These implicit memories automatically work to categorize and interpret new experiences: Where a well-cared-for infant may automatically smile at a woman who shares facial features with its mother, an infant that has been neglected or abused may shy away from the person, in such a situation.

With respect to trauma specifically, Perry explains that individuals display specific trauma-related responses to different stressors or triggers, and these responses are dependent on the stage or stress response that was dominant in the initial experience. As illustrated earlier, stress responses move through stages of flock to fight; furthermore, especially in early stages in life when a fight-or-flight response is not viable to survival, children can respond to stress with dissociation. Thus, while some trauma-related cues can trigger a flight response (as seen earlier with Mike and loud sounds) or a fight response (as seen with Sam and the smell of Old Spice), other trauma-related cues can also trigger an avoidant response, causing an individual to shut down. Furthermore, the same individual can display these differing responses to different trauma-related cues.

Perry presents an example to illustrate this: some years ago, he was called in to a hospital to see a 13-year-old boy named Jesse, who was in a coma owing to a head injury that he sustained from a fight with his foster father. Jesse had been born into a family with a multigenerational history of sexual abuse and exploitation; upon discovering that a five-year-old Jesse was being prostituted by his biological parents, he had been removed by the police and eventually placed with a foster family. Jesse endured further abuse at the hands of his foster family, from starvation and forced exercise to physical abuse. Jesse sustained his head injury during one such incident, where he either fell or was thrown down the stairs after having refused to run up and down them any further.

As part of Perry’s assessment of Jesse, he was able to obtain unwashed clothing from Jesse’s biological and foster fathers, to which he was then exposed. Despite being unconscious, the smell from each of these articles of clothing triggered physiological responses in Jesse: in response to his foster father’s clothing, Jesse would thrash and moan, his heart rate rising from 90 to 120 beats per minute (bpm). However, in response to his biological father’s clothing, Jesse displayed a different response, with much less movement and an eventual decline of his heart rate to below 60 bpm.

These responses indicate two things. Firstly, there are powerful memories stored in the lower systems of the brain. Even when Jesse was unconscious, and his cortex was “offline” and unavailable, he still displayed physiological responses to evocative cues, owing to the presence of these implicit memories. Secondly, it demonstrates how Jesse had two, distinct sets of trauma memories. The abuse that he faced at the hands of his biological father was when he was very young, at a stage where a fight-or-flight response would not have been adaptive; thus, he would dissociate. The physiology of dislocation works differently than that of fight or flight—in the former, the objective is to help the body rest, replenish, survive injury, and tolerate pain. This is seen in his corresponding dissociative response of stillness and a reduced heart rate in response to the scent of his biological father. However, Jesse displayed a fight-or-flight response to the scent of his foster father—agitated movements and an increased heart rate. This is consistent with the kind of stress response he exhibited when he experienced abuse at his foster father’s hands—eventually, his response was to fight back.

In disseminating this aspect of the brain’s development and how the early years of love and caregiving, or the lack of it, can deeply impact human attitudes, behavior, and personality, Winfrey and Perry conclusively reiterate the need for trauma-informed systems in education, mental health, and juvenile justice institutions. They assert there is a need to “move away from ‘What is wrong with you?’ to ‘What happened to you?’” (91-94).