This recorded book joins my growing list of titles dealing with trauma, and in particular childhood trauma. Dr. Perry's pioneering work as a psychiatrist serving children—those who lived through the horrors of Waco, Texas, a little girl who witnessed the murder of her mother, the title story, and a variety of others—left me hopeful for this field of care and thankful for those who pursue it with such compassion and diligence.

Learning the basics of the brain's developmental stages and how trauma impacts these is one of my take-aways. Perry also emphasizes the healing found in accessible practices such as predictable patterned routine, patience, and value in the number and quality of relationships a child establishes.

I found the reader's voice slightly distracting with occasional problematic pronunciation, but the overall content made it worthwhile listening. ( )

I've read this twice, years apart, in two different editions. As part of an undergrad psych course I read the original book, and more recently for a graduate counseling course I read the new, expanded edition. I've also had the opportunitiy to hear Dr. Perry lecture in person and talk to him a bit. Both editions are excellent, with the more recent one literally just containing updates to the individual cases to account for the large span of time between editions, so pick up the new one.
Dr. Perry is one of the greatest living therapists/psychiatrists working with highly traumatized children. For those familiar with his work overall, a lot of the discourse here is going to be familiar to the point of repetitiveness, but if you're just getting into the field there's a really low barrier to entry here as its written to be accessible to a lay audience. Think of it as something between anecdotal stories and case studies involving the application of his theories and techniques across his career.
While written to be accessible to the lay person, this is really looking at highly traumatized individuals mostly from backgrounds of unbelievable abuse. Unless you or a loved one is struggling with a traumatic background, or you work with those who have/work in education or human services, it feels a little exploitive/distasteful to read this just for 'fun'. Though I can definitely see some material here for those interested in or working in fields related to True Crime or cults, as there are stories involving children from groups such as the Branch Dividians. Similarly, those who may have had a very violent/traumatic childhood may want to just assume the whole book has a big trigger warning label on it.
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Child psychiatrist Perry educates readers about how early-life stress and violence affects the developing brain. He offers simple yet vivid illustrations of the stress response and the brain's mechanisms with facts and images that crystallize in the mind without being too detailed or confusing. The stories exhibit compassion, understanding and hope as Perry paints detailed, humane pictures of patients who have experienced violence, sexual abuse or neglect, and Perry invites the reader on his own journey to understanding how the developing child's brain works. Selected Reading Questionnaire.

Intriguing dive into traumatic childhood. Posits that human development requires extensive touch, modeling, and acceptance, yet our societies police touch, encourage individual action, and apply punishment. Child DXs like ADD, addiction, self harm are rooted in trauma. Wished author connected car real ( )

This is not a review, these are the things I highlighted. This is a handy place to keep them.


"I felt guilty watching them from my warm car. I thought I should give them a ride. But the field of psychiatry is very attentive to boundaries. There are supposed to be unbreachable walls between patient and doctor, strict borderlines that clearly define the relationship in lives that often otherwise lack such structure. The rule usually made sense to me, but like many therapeutic notions that had been developed in work with neurotic middle-class adults, it didn’t seem to fit here." [he was sitting in his car watching a child client and their mother waiting in the freezing cold and snow for a bus, trying to decide if it would be ok to give them a lift]


"About 27 percent of women and 16 percent of men report as adults having been sexually victimized during childhood."

“I made the mistake of mentioning this to Dr. Stine during an update on the case. He raised his eyebrows and stared at me. He seemed disappointed.
“What do you think is going on here?”
“I’m not sure. I think the mom seems pretty overwhelmed.”
“You must interpret the resistance.
The mother left these children in harm’s way. She may be resentful that this child is getting your attention. She may want her to remain damaged,” he said.
“Oh,” I responded, not sure what to think. I knew that analysts often interpreted lateness to therapy as a sign of “resistance” to change, but that was beginning to seem absurd, especially in this case. The idea left no room for genuine happenstance and seemed to go out of its way to blame people like Tina’s mom, who, as far as I could tell, did everything possible to get help for Tina. It was clearly difficult for her to get to the clinic. To get to the medical center, she had to take three different buses, which often ran late during the brutal Chicago winter; she had no childcare so she had to bring all her children; sometimes she had to borrow money for the bus fare. It seemed to me she was doing the best she could in an extremely difficult situation." [An example of Psychoanalysis being crappy and distorted]

"But as we discussed specifics of these various goals, it took some time before I was able to help her recognize that the future can be something you plan for, something you can predict and even change, rather than a series of unforeseen events that just happen to you."

"If the experience is familiar and known as safe, the brain’s stress system will not be activated. However, if the incoming information is initially unfamiliar, new or strange, the brain instantly begins a stress response. How extensively these stress systems are activated is related to how threatening the situation appears. It’s important to understand that our default is set at suspicion, not acceptance. At a minimum, when faced with a new and unknown pattern of activity, we become more alert. The brain’s goal at this point is to get more information, to examine the situation and determine just how dangerous it might be. Since humans have always been the deadliest animal encountered by other humans, we closely monitor nonverbal signals of human menace, such as tone of voice, facial expression and body language."

He said somewhere else something along the lines of "Kids are accepting by default and have to be taught prejudices" but now I can't find it


"As one family therapist famously put it, we tend to prefer the “certainty of misery to the misery of uncertainty.”" I looked it up and the net says it was Virginia Satir... Why did he not name her?



"Some of my work with Dr. U’Prichard involved two different strains of rats, which are animals of the same species that had some slight genetic differences. These rats looked and acted exactly the same in ordinary situations, but even the most moderate stress would cause one type to break down. Under calm conditions, these rats could learn mazes, but give them the tiniest stress, and they would unravel and forget everything. The other rats were unaffected. When we examined their brains, we found that early in the development of the stress-reactive rats, there was over-activity in their adrenaline and noradrenaline systems. This small change led to a great cascade of abnormalities in receptor number, sensitivity and function across many brain areas, and ultimately altered their ability to respond properly to stress for a lifetime." [This is one of the differences between a counsellor and a psychiatrist and a psychologist, psychiatrists and psychologists have occasion to say things like "when I studied rats" and "when I dissected the rat's brain". I'm not saying that's the only difference I'm just saying it's a difference.]


"Frequently, while at the lab, my thoughts would turn to Tina and the other children with whom I was working. I would force myself to work the problem: What do I know? What information is missing? Can I see any connections between what was known and what was not known? Was seeing me making any difference in the lives of these children? As I thought about my patients, I also considered their symptoms: Why these particular problems in this particular child? What could help change them? Could their behavior be explained by anything that I and other scientists in my field were learning about how the brain works? For example, could studying the neurobiology of attachment—the connection between parent and child—help solve problems between a mother and her son? Could Freudian ideas like transference—where a patient projects his feelings about his parents into other relationships, particularly the one he has with his therapist—be explained by examining the function of the brain?"

"Research increasingly links the risk of depression to the number of uncontrollable stressful events people experience during their childhood. Unsurprisingly, PTSD is frequently accompanied by depression."

"Like the hyper-arousal response, the dissociative response is graded and occurs on a continuum. Ordinary states like daydreaming and transitions between sleep and wakefulness are mild forms of dissociation. Hypnotic trance is another example. In extreme dissociative experiences, however, the person becomes completely focused inward and disconnected from reality. Brain regions that dominate thinking shift from planning action to concerning themselves with brute survival. There is a sense that time has slowed and what’s happening isn’t “real.” Breathing slows. Pain and even fear shut down. People often report feeling emotionless and numb, as though they are watching what’s happening to them affect a character in a movie." [collecting references pointing out the similarities between meditation, hypnosis, and dissociation]


"“I want to color some too.” I said without looking at her. I wanted to be as predictable as possible and let her know what I was going to do step by step. "

"Patterned, repetitive stimuli lead to tolerance, while chaotic, infrequent signals produce sensitization.
To restore its equilibrium, the brain tries to quiet our sensitized, trauma-related memories by pushing us to have repetitive, small “doses” of recall. It seeks to make a sensitized system develop tolerance. And, in many cases, this works. In the immediate aftermath of a distressing or traumatic event we have intrusive thoughts: we keep thinking about what happened, we dream about it, we find ourselves thinking about it when we don’t want to, we often tell and retell the event to trusted friends or loved ones. Children will reenact the events in play, drawings and their daily interactions. The more intense and overwhelming the experience, however, the harder it becomes to “desensitize” all of the trauma-related memories." [I remember a bit in the Mandarins where the narrator is doing therapy with a child and can't for love nor money get him to stop drawing pictures of his trauma and it's one of the few bits of the book that stuck with me because I couldn't figure out why she was trying to do that]

"The brain alterations that result from lingering terror, especially early in life, may cause an enduring shift to a more impulsive, more aggressive, less thoughtful and less compassionate way of responding to the world."

"In fact, the research on the most effective treatments to help child trauma victims might be accurately summed up this way: what works best is anything that increases the quality and number of relationships in the child’s life."

"There was no schedule to their daily life and no regularity to the people that they would see. One of the few things I knew for sure by then about traumatized children was that they need predictability, routine, a sense of control and stable relationships with supportive people."

"Virginia had grown up at a time when it was common for the child welfare system to move infants and toddlers to a new foster home every six months, the rationale was that this way they wouldn’t become too attached to any particular caregiver."

"As I began talking I tried to engage Mama and make her feel comfortable. I knew that people can “hear” and process information much more effectively if they feel calm. I wanted her to feel safe and respected. Thinking back now, I must have seemed very patronizing to her. I was too confident; I thought I knew what was going on with her foster child and the implicit message was, “I understand this child, and you don’t.” She looked at me defiantly, her face unsmiling, her arms folded. I went into long-winded and very likely unintelligible explanation of the biology of the stress response and how it could account for the boy’s aggression and hyper-vigilance symptoms. I had not yet learned how to clearly explain the impact of trauma on a child."

"Like Leon and others who have suffered early neglect, Connor couldn’t stand to be touched. At birth human touch is a novel and, initially, stressful stimulus. Loving touch has yet to be connected to pleasure. It is in the arms of a present, loving caregiver that the hours upon hours of touch become familiar and associated with safety and comfort. It seems that when a baby’s need for this nurturing touch isn’t satisfied, the connection between human contact and pleasure isn’t made and being touched can become actively unpleasant. In order to overcome this and help provide the missing stimuli, we referred Connor to a massage therapist. We would focus first on meeting his needs for skin-to-skin contact; then, we hoped, we could further address his asynchronous bodily rhythms."
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