An interview with Bruce D. Perry, MD, PhD                                                             

                                                                                         by Lou Bank

The first time Andrew Vachss told me that he had no imagination, I chuckled. I thought it was a bit of self-deprecating humor. The second time he told me, I understood the horrible truth he was imparting. Everything he writes about, all the crimes against children, is real, and everyone he writes about, all the sex offenders, really exist. The other side to that coin is that the heroes in his books also exists.

One of those heroes is Dr. Bruce D. Perry, the director of ChildTrauma Programs at Baylor College of Medicine. For 15 years, Perry has been conducting research to help us better understand the neurobiology of trauma. Perry is hardly the first to look into the subject, but he is unique in the tact that he has taken. His predecessors all focused on the question of where the violence came from. By and large, the findings showed that violent behavior could be attributed to an abusive upbringing.

Perry took that answer and asked the more important question: "Why are most abuse victims, then, not violent?" And the answers he's come up with, through these years of research, are helping us understand what must be done to stem the tide of violence that is washing over society.

I had the privilege of exchanging correspondence with Dr. Perry recently, an edited version of which follows:

What is the basic goal of or underlying purpose of the ChildTrauma Programs?

The ChildTrauma Programs are a combination of clinical, research, and training activities that are focused on understanding and helping maltreated children. The overarching mission is to understand the impact of experiences (good and bad) on the development of children, and, with this understanding, to change the ways in which we, as a society, care for our children. By decreasing or preventing some of the neglectful and traumatic experiences and by increasing experiences that identify, protect, treat, and enrich high-risk children, we can dramatically influence the direction of millions of lives -- and, in important ways, the direction of our society.

Obviously, any caring human being can understand the purpose of protecting children. But is there a reason to protect children beyond the moral imperative to do so?

Maltreatment of a child will always result in some loss of that child's potential and often can result in such impaired development that the child will develop severe problems such as pervasive anxiety, depression, substance abuse and dependence, school failure, vulnerability to future abuse, violent sociopathy, or criminality. Abused children absorb the pain and either pass it on to others in a destructive way (e.g., violence) or keep it and let it eat at themselves like a cancer. These "social ills" rob the individual and, in the end, rob our society of the benefits these individuals could have made to us. Without understanding how maltreatment of children is related to the health and capacity of a society, we will never truly meet our potential -- as individuals, as families, as communities, and as a culture. If we can make these connections, change the ways we treat women and children, and provide enriched, predictable, nurturing environments for our growing children, we can experience, as a species, transformation of amazing proportions. The human species 20,000 years ago had the same potential as today, yet there were few "manifestations" of our true potential -- we were brutal, cruel, and devoid of complex abstract art or culture. The elements of "humanity" -- those things that we have created -- are not really genetic. They are creations of thousands of generations of experience. And during this time we have slowly moved to a more "humane" set of values -- we are trying to rid ourselves of racism, sexism, random predatory violence. Yet each generation, we have to re-create for our children an environment which can nurture those "humane" qualities -- and all too often we are failing to do so. We are raising children in an `incubator of terror,' and creating impulsive, aggressive, anxious, and fearful children who fall far short of their potential.

What form does your research take?

How prevalent is the problem of child abuse?

The pervasive nature of the neglect, abuse, and traumatization of children is hard to truly communicate. Conservative estimates indicate that over 4 million American children each year are exposed to some severe form of abuse or neglect. This means that by the time a child reaches age 20, over 20 percent of our population has experienced severe traumatic stress, often in a chronic way. This means that 16 to 20 million children and adolescents currently are at risk for developing trauma-related problems (such as post-traumatic stress disorder). To put this in perspective, during the entire ten- year Vietnam era, 3.14 million American soldiers served in a combat setting. Of these, over 1 million developed emotional, behavioral, and physical problems related to their one year exposure to traumatic stress. These soldiers rotated out of combat. These children can't. They stay on the front -- day in and day out -- for years. And they carry their wounds into adolescence and adulthood, all too often without the benefit of any medical, social, or political support for these wounds.

A number of people have asked me how they can participate in your work and in Andrew's work. What are the opportunities for those of us not in the industry itself?

I think the most important thing that anyone can do to help with 'my' work is for each individual to realize that this is 'our' work. These problems are pervasive and have impact on us all -- either in direct or indirect ways. My true work is, in part, to help our society understand that this is `our' battle. These problems must be attacked in a variety of ways by a variety of approaches. There are so many ways in which people can join in this battle. I would encourage anyone to look around their community to see if there are ways to volunteer, to become more aware and to contribute in a way that makes sense for them. In a very concrete fashion, individuals can participate in the work at the CIVITAS ChildTrauma Programs by writing to learn more about what we do -- and if it seems to be something worth investing in, give us financial support.

One of the most important facts about the development of the brain is that early in life -- say the first three years -- experiences organize the brain and determine how that individual will function, in large part, for the rest of their lives. Many capacities, while not completely lost, are tremendously difficult to grow after this window of opportunity is lost. One of the most important of these capacities is the ability to be attached to -- and to "love" -- others. The part of the brain that allows us to feel pleasure and positive emotional connection to others is dependent upon consistent, nurturing experiences during the first few years of life. The child left alone, inconsistently touched or smiled at, infrequently "cuddled," will have a brain with an undeveloped area. This is a biological, physical phenomenon. These parts of the brain grow just like a muscle. And without "exercise" the muscle atrophies. So it is with these parts of the brain. Without "love" at these critical times, that part of the brain atrophies. And, as stated before, it appears that this atrophy can be permanent and almost impossible to reverse. This leads to clear implications for public policy and for how we should target our intervention dollars. Currently, we are missing the windows of opportunity. There is a tremendous mismatch between where we spend most of our intervention dollars (adults) and when the brain is most easily changed (early childhood).

If a child feels no emotional attachment to any human being, then one cannot expect any more remorse from him after killing a human than one would expect from someone who ran over a squirrel." Some people, I suspect, would show greater grief after killing a squirrel than they would having killed a human. Why is that?

It is a sad reality that for many children, the most nurturing, predictable and unconditional experiences come from animals -- dogs or cats. Children with abusive and unpredictable adults caring for them, put their hopes and dreams and faith in relationships with non-humans. So when they see an animal die, they actually feel the loss. But when a human dies - they may not. It is, however, the rare individual who can kill a human without remorse and still have a connection to anything living. But it happens. And in these situations, the person has 're-directed' some elements of connection and meaning to an animal or to animals. Most frequently however, the person who is cruel to humans is also cruel to other animals.

Understanding and modifying our violent nature will determine, in large part, the degree to which we will successfully adapt to the challenges of the future -- the degree to which future generations of human beings can actually experience humanity." What do you mean by 'humanity' in this case?

By humanity, I mean those elements of our existence which we have `created' -- the by-products of culture -- our language, religious beliefs, political structures, arts and sciences. We are at great risk of losing these things - cultural devolution - can take place in a generation. This is seen in what happened to the Native Americans, it is seen in what is happening in Bosnia, it is seen in certain parts of our inner cities - the loss of cultural 'DNA' - beliefs, language, childrearing practices - elements of humanity. As Andrew says - each generation of children is "Another Chance to Get It Right" - but that depends on what we provide for our children - what structure, what education, what beliefs, what love, what pain.

The part of his brain which would have allowed him to feel connected to other human beings -- empathy -- simply did not develop." Is it too late for it to now develop? Is there an age at which the ability to develop empathy, or any other emotion, is lost? Or is it an action -- such as sexual abuse -- which stops that development, like a skyscraper falling across a freeway?

Animals raised in the wild have from 15 - 30% larger brain mass than their offspring who are domestically reared." I would have thought this would work the other way around, as, presumably, the domesticated animal would tend to be nurtured more by humans and would be less threatened by natural forces and by other animals. Does the animal model of brain development differ from the human model, then?

The animals raised in the wild have a much more diverse and rich set of sensory experiences - they see more things, smell more things, taste more things, touch more things, run further and have many more 'experiences' - more quality - more quantity. This includes more stressful experiences - but a stressor with the capability and opportunity to respond is not necessarily a bad thing. A stressor is bad if you have no control and the stressor is unpredictable )such as is most often the case with abused children). And as a result, the brains of animals in the wild are more complex, diverse and larger. The domesticated animals (especially animals in zoos) have a narrower set of experiences and, therefore, smaller brains.

Obviously, not all abuse victims choose a path of violence -- on the contrary, the greater majority do not become predators. Why is this the case? How do people choose these paths? Is it a choice?

This question is very important. While we don't understand completely, it is becoming increasingly clear that the children who can carry the abuse without becoming violent and predatory have had some element of "hope" in their lives. Hope is the internal representation of a better world -- "hope" that somewhere, sometime, things will be better. And with that hope, a choice can be made. Choice is certainly a key element of the path individuals take as they absorb and live with the pain of abuse and neglect. The key issue here is that choice implies the presence of an alternate path. If the child is neglected and abused within the family unit, then the alternate path cannot reside within the home. That is why it is critical that the community have some structure, predictability, and nurturance: to give the wounded child some hope, and, ultimately, the opportunity to choose to live with the pain rather than spread it around. Without some hope -- without a caring teacher, an encouraging coach, a stable aunt -- without a place and a person where there is some calm, some "safe haven" -- the child has no choice. This is why we all can help. We are all in this together. If we cannot structure our schools, our communities, and our social agencies in a manner that will identify, protect, and, at a minimum, provide hope to our children, we will be swept away by the inevitable decay of socio-cultural devolution. Similar deterioration of pre-existing cultural achievements was seen after the fall of the Roman Empire -- the Dark Ages -- where, for centuries, no new literature or significant art was produced. Abstract cognition disappeared in western Europe. The planet was populated by generation after generation of superstitious, brutal, racist, misogynist, and non-creative people. We are not as far from that as we like to think. Repression, oppression, superstition, racism, sexism, and reactionary and simplistic views of the world persist -- and, without smart and aggressive research and training, these anti-humane qualities may prevail. If we provide enriched, nurturing, predictable, and safe environments for our children, they will create an enriched, safe, and humane society. If we keep raising our children with ignorance, unpredictability, and fear, we will have a rigid and reactionary society. It is our choice -- our responsibility -- our opportunity.

I asked Dr. Perry how I could help in his work. He was quick to point out that this is not "his" work, but rather "our" work -- society's problems impact each of us, and therefore it would behoove each of us to aid in the correction of these problems. Dr. Perry suggested three courses of action one might take:

In your community, there are children who need the gift of attention, respect, instruction, comfort, and, from these things, hope. So many children from abusive settings have lost hope. Even brief interactions with respectful, honest, and nurturing adults can be helpful to the abused child, allowing them to know that some adults can be kind and honest and predictable. There are many ways to find children who need your time: Volunteer to be a foster parent; to rock the crack-addicted infant in the hospital; to teach a child to read; to be an aide in the local public school; to answer phones at a battered women's shelter. In all of these settings, you can enrich the life of a child. You can give a child hope.

You may not realize how your skills can benefit maltreated children. Desperately under-funded child-protective, child-welfare, and child-mental-health systems can always benefit from the innovative use of your skills. A residential treatment center may need help with accounting or computer programming. A local children's shelter may not have a library. If you're are a dancer, teach some foster children how to dance -- a computer programmer, teach these children computer skills -- a writer, write editorials/articles/books about these issues or help an agency make a newsletter. Your skills -- whatever they are -- can be used to fight abuse. You may be able to bring attention and awareness about abuse to your workplace -- you may be able to make your workplace focus on some aspect of abuse. If you look, you will find that your skills are desperately needed in one of the many agencies attempting to help maltreated children.

In the United States, we spend more money on studying and treating abusers than we do on their child victims. Research, clinical services, and specialized professional training in child abuse are dramatically under-funded. You can help support these critical activities by financially supporting effective and innovative programs such as the  ChildTrauma Programs.

For more information about Dr. Perry's work and the work of the ChildTrauma Academy, please visit www.ChildTrauma.org

* copyright info: (c) 1996 Bruce D. Perry M.D.,Ph.D.