The Boy Who Was Raised as a Dog (13 page)

We learned that some of the most therapeutic experiences do not take place in “therapy,” but in naturally occurring healthy relationships, whether between a professional like myself and a child, between an aunt and a scared little girl, or between a calm Texas Ranger and an excitable boy. The children who did best after the Davidian apocalypse were not those who experienced the least stress or those who participated most enthusiastically in talking with us at the cottage. They were the ones who were released afterwards into the healthiest and most loving worlds,
whether it was with family who still believed in the Davidian ways or with loved ones who rejected Koresh entirely. 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.

I also saw how bringing disparate groups together—even those with conflicting missions—could often be effective. Dozens of state, federal and local agencies had worked together to care for these children. The power of proximity—spending time side-by-side—had pulled us all to compromise in our efforts to help these children. Relationships matter: the currency for systemic change was trust, and trust comes through forming healthy working relationships. People, not programs, change people. The cooperation, respect and collaboration we experienced gave us hope that we could make a difference, even though the raids themselves had ended in such catastrophe. The seeds of a new way of working with traumatized children were sown in the ashes of Waco.

chapter 4

Skin Hunger

LIKE EVERYONE ELSE, doctors enjoy being recognized for their achievements. One sure way of attaining medical fame is to discover a new disease or to solve a particularly daunting medical puzzle. And the physicians at one Texas hospital where I consulted saw the little girl in room 723E as such a challenge. At four years old Laura weighed just twenty-six pounds, despite having been fed a high-calorie diet via a tube inserted through her nose for weeks. The stack of her medical files that confronted me at the nurses' station was about four feet high, taller than the shrunken little girl herself. Laura's story, like that of the children of Waco, helped us learn more about how children respond to early experience. It illustrates how the mind and body cannot be treated separately, reveals what infants and young children need for healthy brain development and demonstrates how neglecting those needs can have a profound impact on every aspect of a child's growth.

Laura's files contained literally thousands of pages of documents, detailing visits with endocrinologists, gastroenterologists, nutritionists and other medical specialists. There were endless lab reports of blood work, chromosome tests, hormone levels, biopsies. The documents included results from even more invasive tests, which had used scopes inserted into her throat to examine her stomach, and scopes inserted rectally to examine her bowels. There were dozens of reports from consulting
physicians. The poor girl had even had an exploratory laparoscopy, in which doctors inserted a tube into her abdomen to scrutinize her internal organs; a snippet of her small intestine had been clipped off and sent to the National Institutes of Health for analysis.

Finally, after being on the special gastrointestinal research unit for a month, a social worker pressured Laura's physicians to get a psychiatry consult. Just as the gastroenterology fellows thought they'd discovered a case of “intestinal epilepsy” when they first saw Laura years before, the shrinks, too, had a novel theory about Laura's case. The psychologist who came for the initial consultation specialized in eating disorders, and he believed he was seeing the first documented instance of “infantile anorexia.” Fascinated and excited, he discussed the case with his mental health colleagues. Ultimately, he requested a consultation from me because I had more experience with academic publishing and he was sure that this would be a reportable case. He told me that the child had to be purging secretly, or perhaps getting up at night to exercise furiously. Otherwise, how could she be fed so many calories but still not grow? He wanted my insight on this disturbing new problem, seen for the first time in a young child.

I was curious. I had never heard of infantile anorexia. I went to the hospital planning to start the consult like I always do, by reviewing the chart to learn as much about the child's history as possible. But when I discovered the four-year, twenty-previous-admission, six-specialty-clinic, four-foot-tall pile of documents, I just scanned the admission intake report and went in to introduce myself to the patient and her mother.

In the girl's hospital room I found a distressing scene. Laura's twenty-two year-old mom, Virginia*, was watching television, seated about five feet away from her child. Mother and daughter were not interacting. Tiny, emaciated Laura was sitting quietly, her eyes big, staring at a plate of food. She also had a feeding tube, which pumped nutrients into her stomach. I would later learn that Virginia had been discouraged from interacting with Laura during mealtimes by the eating disorders psychologist. This was supposed to stop Laura—the alleged cunning, infantile
anorectic—from manipulating her mother around food and meals. The theory then was that people with anorexia enjoy the attention they get when they don't eat, and use it to control other family members; denying them this “reward” was supposed to aid recovery. But all I could see here was a despondent, skinny little girl and a disengaged mother.

The brain is an historical organ. It stores our personal narrative. Our life experiences shape who we become by creating our brain's catalog of template memories, which guide our behavior, sometimes in ways we can consciously recognize, more often via processes beyond our awareness. A crucial element in figuring out any brain-related clinical problem, therefore, is getting an accurate history of the patient's experiences. Since much of the brain develops early in life, the way we are parented has a dramatic influence on brain development. And so, since we tend to care for our children the way we were cared for ourselves during our own childhoods, a good “brain” history of a child begins with a history of the caregiver's childhood and early experience. To understand Laura I would need to know about her family, which in her case consisted of her mom.

I started by asking Virginia innocuous, basic questions. Almost immediately I began to suspect that the source of Laura's problems lay in her young, well-intentioned, but inexperienced mother's past.

“Where are you from?” I asked her.

“I guess, Austin,” she said.

“Where are your parents from?”

“I don't know.”

Within minutes I discovered that Virginia was a child of the foster care system. Abandoned at birth by a drug-addicted mother, father unknown, 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. Now, of course, we know that an infant's early attachment to a small number of consistent caregivers is critical to emotional health and even to physical development. But at
that time this knowledge hadn't even begun to penetrate the child welfare bureaucracy.

More than in any other species, human young are born vulnerable and dependent. Pregnancy and early childhood are tremendous energy drains on the mother and, indirectly, on the larger family group. But despite the severe pain of childbirth, the numerous discomforts of pregnancy and breast-feeding, and the loud, continuous demands of a newborn, human mothers overwhelmingly tend to devote themselves to comforting, feeding and protecting their young. Indeed, most do so happily; we find it pathological when one does not.

To a Martian—or even to many nonparents—this behavior might seem like a mystery. What could prompt parents to give up sleep, sex, friends, personal time and virtually every other pleasure in life to meet the demands of a small, often irritatingly noisy, incontinent, needy being? The secret is that caring for children is, in many ways, indescribably pleasurable. Our brains reward us for interacting with our children, especially infants: their scent, the cooing sounds they make when they are calm, their smooth skin and especially, their faces are designed to fill us with joy. What we call “cuteness” is actually an evolutionary adaptation that helps ensure that parents will care for their children, that babies will get their needs met, and parents will take on this seemingly thankless task with pleasure.

So during our development, in the ordinary course of things we will receive attentive, attuned and loving care. When we are cold, hungry, thirsty, frightened or distressed in any way, our cries will bring the comforting caregivers who meet our needs and dissolve our distress in their loving attention. With this loving care two major neural networks are stimulated simultaneously in our developing brains. The first is the complex set of sensory perceptions associated with human relational interactions: the caregiver's face, smile, voice, touch and scent. The second is stimulation of the neural networks mediating “pleasure.” This “reward system” can be activated in a number of ways, one of which is the relief of distress. Quenching thirst, satisfying hunger, calming anxiety—all result
in a sense of pleasure and comfort. And as we have discussed earlier, when two patterns of neural activity occur simultaneously with sufficient repetition, an association is made between the two patterns.

In the case of responsive parenting, pleasure and human interactions become inextricably woven together. This interconnection, the association of pleasure with human interaction, is the important neurobiological “glue” that bonds and creates healthy relationships. Consequently, the most powerful rewards we can receive are the attention, approval and affection of people we love and respect. Similarly, the most powerful pain we experience is the loss of that attention, approval and affection—the most obvious example being, of course, the death of a loved one. This is why even our greatest intellectual, athletic or professional triumphs seem empty if we have no one with whom to share them.

If you are one of the majority of infants born to a loving home, a consistent, nurturing caregiver—say a mother or father—will be present and repeatedly meet your needs. Time and again, one or both parents will come when you cry and soothe you when you are hungry, cold, or scared. As your brain develops these loving caregivers provide the template that you use for human relationships. Attachment, then, is a memory template for human-to-human bonds. This template serves as your primary “world view” on human relationships. It is profoundly influenced by whether you experience kind, attuned parenting or whether you receive inconsistent, frequently disrupted, abusive, or neglectful “care.”

As noted earlier, the brain develops in a use-dependent manner. Neural systems that are used become more dominant, those that are not grow less so. As a child grows, many systems of the brain require stimulation if they are to develop. Furthermore, this use-dependent development must occur at specific times in order for these systems to function at their best. If this “sensitive period” is missed, some systems may never be able to reach their full potential. In some cases the neglect-related deficit may be permanent. For example, if one of a kitten's eyes is kept closed during the first few weeks of its life, it will be blind in that eye, even though the eye is completely normal. The visual circuitry of the
brain requires normal experience of sight in order to wire itself; lacking visual stimuli, the neurons in the closed eye fail to make crucial connections and the opportunity for sight and depth perception is lost. Similarly, if a child is not exposed to language during his early life, he may never be able to speak or understand speech normally. If a child doesn't become fluent in a second language before puberty, he will almost always speak any new language he does learn with an accent.

While we don't know whether there is a fixed “sensitive period” for the development of normal attachment the way there appears to be for language and sight, research does suggest that experiences like Virginia's, in which children are not allowed the chance to develop permanent relationships with one or two primary caregivers during their first three years of life have lasting effects on people's ability to relate normally and affectionately to each other. Children who don't get consistent, physical affection or the chance to build loving bonds simply don't receive the patterned, repetitive stimulation necessary to properly build the systems in the brain that connect reward, pleasure and human-to-human interactions. This is what had happened to Virginia. As a result of transient and fragmented caregiving during childhood she just didn't get the same degree of reward—pleasure, if you will—from holding, smelling and interacting with her baby that most mothers would.

At the age of five Virginia had finally settled into what would be her most permanent childhood home. Her foster parents were loving, highly moral. Christian people, and good parents. They taught her manners. They taught her to “do unto others.” They provided a basic, humane, script for normal behavior. They taught her that stealing was wrong, so she didn't take things from others without permission. They taught her that drugs were bad for you, so she didn't use drugs. They taught her to work hard and go to school, so she did that, too. They wanted to adopt her and she wanted to be adopted by them, but the state never terminated the parental rights of her biological parents and there was occasional talk by her caseworkers of the potential for reuniting her with her biological mother, so the adoption never went through. Unfortunately,
this meant that when she turned eighteen, the state was no longer legally “responsible” for Virginia. As a result she had to leave her foster home and the foster parents were told to have no further contact with her. Their future as foster parents for other children was linked to their compliance with the wishes of the caseworkers. Because of yet another inhumane child welfare policy—one aimed at reducing the system's legal liabilities, not protecting children—Virginia lost the only parents she'd ever really known.