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

“[S]ince the brain is the part of us that allows us to think, feel, and act, whenever I’m trying to understand someone, I wonder about that person’s brain. Why did they do that? What would make them act that way? Something happened that influenced how their brain works.”

Perry, a child psychiatrist, discusses how he approaches his clients. Perry’s training and background is evident here: being a doctor, he has a grounding in biology and science, which leads him to apply this context in making sense of human behavior as well. Perry uses his clinical training and experience to draw understandable connections between biology and behavior throughout the book, particularly in the context of trauma. His expertise also helps explore one of the central themes of the book, The Biological Context of Trauma.

“As your brain starts to create the complex memories that store these connections, your personal catalog of experiences is being created. As we grow up, we are all trying to make sense of what’s happening around us. What does that sound mean? What does it mean when someone rubs my back? What does that expression on his face mean? What else happens when that scent is present?”

Perry explains how one’s early experiences and the memories they create can shape one’s entire worldview as they grow. Sensory inputs are the baby’s first window into the world, and as these sensory inputs—sounds, smells, sensations, and so on—are processed, feelings and experiences that are paired with these sensory inputs are registered, too. Thus, a child comes to learn that a particular scent is comforting, while a certain tone of voice or facial expression is dangerous or threatening. These associations affect how similar information is received, categorized, and reacted to later in life as well, making these associations the foundation of a child’s worldview.

“If our view of the world is that people are good, then we will anticipate good things from people. We project that expectation in our interactions with others and thereby actually elicit good from them. Our internal view of the world becomes a self-fulfilling prophecy; we project what we expect, and that helps elicit what we expect.”

Perry explains how one’s worldview regarding people can in fact evoke certain behavior from them, which will go on to confirm this worldview in a self-fulfilling prophecy. Thus, it becomes important to help a child create a worldview that paints people as good, caring, trustworthy, and deserving of respect, which is only possible when the child themselves shares this experience. Therein comes the vital role of love and caregiving in the early years of a child’s life, and points to the theme of Love and Relationships explored in the book.

“There’s always a pull to regulate, to seek comfort, to fill that reward bucket. But it turns out that the most powerful form of reward is relational. Positive interactions with people are rewarding and regulating. […] Connectedness counters the pull of addictive behaviors. It is the key.”

Early in the book, Perry offers one of its central ideas: that relationship and connectedness are key to the human experience, both in terms of regulation and healing. Positive interactions with people, particularly in the early years, are vital to the creation of foundational biology; later in life as well, these interactions remain rewarding and regulating. Furthermore, following an experience of trauma, these relationships can serve as a buffer against the worst effects of trauma, as well as actively help an individual heal from the experience.

“The more we face moderate challenges and succeed, the more capable we are of facing bigger challenges. This is something we see in sports, performing arts, clinical practice, firefighting, teaching—almost any human endeavor; experience can improve performance. This is why stress is not something to be afraid of or avoided. It is the controllability, pattern, and intensity of stress that can cause problems.”

Perry explains how stress by itself is not necessarily negative; the way in which one receives and processes it can make it something traumatic, or, in turn, resilience building. The former happens when the stress is too intense, prolonged, or experienced without any buffering factors or support to cope. However, stress presented in moderate, predictable, and controlled doses, and faced with the support of a network or community of caring and invested others, can, in fact, be resilience building.

“The hypervigilance of the Alert state is mistaken for ADHD; the resistance and defiance of Alarm and Fear get labeled as oppositional defiant disorder; flight behavior gets them suspended from school; fight behavior gets them charged with assault. The pervasive misunderstanding of trauma-related behavior has a profound effect on our educational, mental health, and juvenile justice systems.”

Perry explains how responses to trauma that are adaptive in the moment can carry over to other situations and become maladaptive. A lack of understanding of how trauma influences behavior leads to labeling and categorizing of these responses as problematic, and within the context of public and social systems and institutions, have far-reaching negative effects on the individual with trauma.

“Not every tall person is a good basketball player; and not all good basketball players are tall. But overall, a group of six-foot-five athletes is likely to be better at college basketball than a group of five-foot-five athletes. In the same way, having an ACE score of 5 merely means you will likely struggle more than someone with an ACE score of 1.”

Perry explains how the ACE score is only correlated to health and does not carry a causal relationship. Through the example of the relationship between height and basketball skills, Perry demonstrates that, while one may increase the likeliness or probability of the other, one does not ultimately guarantee the other. It is the same with the ACE study: Having experienced childhood adversity does increase the likeliness of developing health issues later in life but does not absolutely guarantee it.

“Our major finding is that your history of relational health—your connectedness to family, community, and culture—is more predictive of your mental health than your history of adversity […]. This is similar to the findings of other researchers looking at the power of positive relationships on health. Connectedness has the power to counterbalance adversity.”

Perry explains one of his findings based on the gaps in the ACE study, specifically that one’s relationships and connectedness are a greater predictor of mental health than one’s past adversity. This is in keeping with the idea presented earlier that love and caregiving in stable relationships helps create resilience, works as a buffer against stress, and can aid healing; it supports the book’s theme of Love and Relationships.

“As you consider your individual response patterns, know that by putting a small moment of space between the immediate feeling and your instinctive reaction, you are allowing yourself to stay present and ultimately regain control.”

Winfrey explains the importance of awareness of and insight into the underpinnings of one’s responses and behavior. By understanding what it is that causes one to respond or react in a certain way toward a trigger, one gains some sense of control over the situation. The awareness lends perspective, helping one view the situation in a new and non-reactionary way, which will eventually allow an appropriate response rather than a reaction from habit or maladaptive response patterns.

“Most important, you come to understand that belonging is biology, and disconnection destroys our health. Trauma is disconnecting, and that impacts every system in our body.”

Perry stresses the connection between The Biological Context of Trauma, explaining how a sense of belonging is essential to the human biology; this, in turn, means that feeling disconnected, isolated, or marginalized, is dysregulating, and can have a very real impact on an individual’s physiology. Prolonged dysregulation can be traumatic, and in turn negatively impacts all the body’s systems, from neural connections to endocrine functioning, as seen in Tyra’s case.

“In order to communicate rationally and successfully with anyone, you have to make sure they’re regulated, make sure they feel a relationship with you, and only then try to reason with them.”

Perry asserts the need for regulation for effective communication, by explaining the different states of arousal and their concurrent impact on cognitive functioning. In a state of dysregulation, or when a person experiences alarm, fear, or terror, higher-order thinking shuts down and the lower parts of the brain take over. One begins to react instinctually and based on past associations, rather than from logic or reason. To communicate effectively with someone, the listener needs to feel regulated and safe, which they will if they feel connected to the speaker. This state of regulation brings the cortex back into action, allowing the listener to effectively hear, process, understand, and respond to what the speaker is trying to say.

“The lesson for me was that a key aspect of What happened to you? Is What didn’t happen for you? What attention, nurturing touch, reassurance—basically, what love—didn’t you get? I realized that neglect is as toxic as trauma.”

Perry explains how he concluded that neglect is as toxic as trauma in the developmental scheme of things. By comparing Thomas and James, and observing that Thomas was able to progress with the help of the loving community while James never could, Perry concludes that the absence of love and caregiving in one’s formative years can leave those respective neural networks undeveloped. Akin to a mineral deficiency that can leave one’s bones fundamentally brittle, the absence of love, or neglect, can leave an individual lacking in the tools required to adapt and succeed later in life.

“I’ve worked with several emotionally neglected children of very wealthy parents who chose to ‘outsource’ parenting but did so in a way that was developmentally uninformed. They didn’t understand the importance of relational consistency early in life, so their infant was cared for by different shifts of hired caregivers.”

Perry stresses the importance of relational consistency in the early years of a child’s life. His definition of the same, and the emphasis on its importance, highlights how relational poverty can be experienced not just by those from difficult or less privileged backgrounds, but even by those inhabiting the upper strata of society. It recalls the fact that, in the early years of a child’s life, love and caregiving is rooted in action and touch rather than more abstract ideas of comfort and luxury. It is not enough to have material things and conveniences; to an infant, the soothing and familiar touch of a consistent and responsive caregiver is the need of the hour.

“The key point is that all of us tend to gravitate to the familiar, even when the familiar is unhealthy or destructive. We are drawn to what we were raised with.”

Perry explains why it is that individuals who have experienced abuse tend to gravitate toward similarly abusive relationships, even later in life. The associations formed in the early years are so strong and intense that these experiences are what constitute an individual’s idea of “familiar.” Even if what is familiar is unhealthy or destructive, it is what will make the individual feel safe. It takes a great deal of effort and restructuring for an individual to break out of these unhealthy patterns, further explaining why individuals in abusive relationships often find it difficult to break away.

“You are identifying such a central aspect of building resilience. Your connectedness to other people is so key to buffering any current stressor—and to healing from past trauma. Being with people who are present, supportive, and nurturing. Belonging.”

Perry reiterates the role of relationship and community in healing. In keeping with the theme of Love and Relationships, he asserts that one’s connectedness can serve as an effective buffer against a range of stressors. This is in line with his earlier explanation of how connection and belonging are foundational to human biology, and relationships are both regulating and rewarding.

“The journey from traumatized to typical to resilient helps create a unique strength and perspective. That journey can create post-traumatic wisdom. […] It is impossible to be truly wise without some real-life hardship. And we cannot develop post-traumatic wisdom without […] weathering together.”

Perry outlines the path forward from trauma, i.e., moving from a state of trauma to regulation to further wisdom, by understanding, processing, and gaining insight from one’s experiences. His assertion that it is impossible to be truly wise without hardship reiterates the idea that stress, by itself, is not a bad thing; bolstered by a network of loving and supportive others, stress in moderate and predictable doses can, indeed, be resilience-building.

“Your past is not an excuse. But it is an explanation—offering insight into the questions so many of us ask ourselves: Why do I behave the way I behave? Why do I feel the way I do? For me, there is no doubt that our strengths, vulnerabilities, and unique responses are an expression of what happened to us.”

Winfrey explains why she places such great importance on revisiting one’s past, and how it can help one gain a better understanding of oneself. While one’s past does not justify one’s present actions, it does offer a clearer picture of how current behavior and responses may have emerged. This idea allows one to look at an individual without judgment, but also without absolving them of the responsibility of their actions. However, rather than take punitive action toward those who transgress, it encourages society to chart a course of healing for the individual arising from a place of awareness and empathy.

“Our ancestors recognized the importance of connectedness and the toxicity of exclusion. The history of the ‘civilized’ world, on the other hand, is filled with policies and practices that favored disconnection and marginalization—that destroyed family, community, and culture.”

Perry explains how the modern world has moved away from the kind of connectedness present in the ancient world that naturally provided a buffer against stress and trauma. The inventions and practices of the modern world appear to be designed for disconnection and marginalization, both of which are experiences that can be stressful, even traumatic. This is heightened by the lack of opportunities to form and maintain lasting relationships in an urban setting, which leads to further dysregulation and trauma.

“The long-term solution is to minimize the development of implicit bias. We have to think about ways to raise our children with more opportunities to be exposed to the magnificence of human diversity earlier in their lives.”

Perry suggests that one way forward out of the disconnect and fragmentation experienced in the modern world is to minimize the formation of implicit biases by exposing young children to as much diversity as possible. If this happens, a young infant begins to form a worldview that is accommodating of a range of different attributes, beliefs, values, and practices, and is less susceptible to stereotyping, prejudice, discrimination, and further disconnection.

“The Māori concept of ‘disease’ explained these differences better than my medical model did; colonization intentionally fragments families, community cohesion, and cultures, and that disconnection is at the heart of trauma.”

Perry discusses one of his most important learnings from the Māori, i.e., the role of disconnection and fragmentation in heightening trauma. In keeping with this, the Māori do not separate their problems into categories related to education, healthcare, policy, and so on. They believe all pain springs from the same core issue of disconnection and emphasize the need for relationship and connectedness in the journey to healing. Perry’s experience with the Māori leads him to stress the need for Revisiting Ancient Wisdom.

“Our current challenge is that the rate of invention is now exceeding the rate at which we can problem-solve. […] As the writer and biochemist Isaac Asimov said, ‘The saddest aspect of life right now is that science gathers knowledge faster than society gathers wisdom.’”

Perry quotes Isaac Asimov as he explains how the structure and experience of the modern world is inherently dysregulating to the still-evolving human brain. The biology of the latter is still catching up with the kind of inventions present in the modern world, which, in turn, continue to stress and dysregulate the brain. Perry quotes examples of artificial lighting unbalancing natural circadian rhythms, and the consumption of processed food disrupting the gut microbiome, to illustrate his point.

“It really is never too late. Healing is possible. The key is knowing where to start the process. And matching the developmental needs of the person.”

Perry revisits the different states of arousal and emphasizes the importance in recognizing these, as well as the true developmental stage of the traumatized individual, to effectively help them heal. By recognizing both state and stage, one can divine where to start the process of healing, allowing for a more effective match of techniques and therapeutic interventions.

“How can our society move toward a more humane, socially just, creative, and productive future without confronting our collective historical trauma? Both trauma experienced and trauma inflicted.”

Perry emphasizes the importance of not just revisiting, but actively confronting past trauma, in order to heal. Only in confronting trauma will one be able to make sense of the experience, let go of the pain, and begin to convert the experience into insight. There is a need for this at not just the individual level, but at the societal one as well, if things are to change for the better at a social and institutional level.