The Boy Who Was Raised as a Dog (8 page)

 

BY THE END of that interview I was certain that testifying would be devastating for Sandy. She needed help and, if she did have to testify, more time to prepare. Stan would work successfully, as it turned out, to postpone the trial. “Could you do the therapy?” he asked me. Of course. I couldn't say no.

 

THE I MAGES OF SANDY burned into my mind during that interview were staggering: a three-year-old child, her throat cut, weeping, trying to
comfort and also seeking comfort from her naked mother's hog-tied, bloody, and ultimately cold body. How helpless, confused and terrified she must have felt! Her symptoms—her “absences,” her avoidant responses to my questions, her hiding, her specific fears—were defenses constructed by her brain to keep the trauma at bay. Understanding those defenses would be critical to helping her and other children like her.

Even
in utero
and after birth, for every moment of every day, our brain is processing the nonstop set of incoming signals from our senses. Sight, sound, touch, smell, taste—all of the raw sensory data that will result in these sensations enter the lower parts of the brain and begin a multistage process of being categorized, compared to previously stored patterns, and ultimately, if necessary, acted upon.

In many cases the pattern of incoming signals is so repetitive, so familiar, so safe and the memory template that this pattern matches is so deeply engrained, that your brain essentially ignores them. This is a form of tolerance called habituation.

We ignore familiar patterns in ordinary contexts, so much so that we forget large portions of our days, which are spent doing routine things like brushing our teeth or getting dressed.

We'll remember if a familiar pattern occurs out of context, however. For example, you might be on a camping trip, brushing your teeth as the sun comes up. The beauty of the moment is so powerful that you will remember this one time as unique. Emotions are powerful markers of context. The pleasure and joy of the sunrise in this instance is unusual in the “brushing teeth” memory template, so it makes it more vivid and memorable.

Similarly, if you happen to be brushing your teeth when an earthquake destroys your home, those events may become forever connected in your mind and recalled together. Negative emotions often make things even more memorable than positive ones because recalling things that are threatening—and avoiding those situations in the future if possible—is often critical to survival. A mouse that didn't learn to avoid the scent of cats after one bad experience, for example, would not be a mouse likely to produce many offspring. As a result, however, such associations
can become the source of trauma-related symptoms. For an earthquake survivor who was brushing her teeth when the house collapsed around her, simply seeing a toothbrush might be enough to provoke a full-fledged fear response.

In Sandy's case, milk, once associated with nurturing and nutrition, now became the stuff that spilled from her throat, that her mother “refused” as she lay dead. Silverware was now no longer something used to eat your food, but rather something that killed and maimed and horrified. And doorbells—well, that was what had started the whole thing: the ringing of the doorbell had announced the arrival of the killer.

For her these mundane and ordinary things had become evocative cues that kept her in a state of continual fear. This, of course, confused her foster parents and her teachers, who didn't know the details of what had happened to her and therefore often couldn't recognize what might be prompting her strange behavior. They couldn't understand why she would be so sweet one moment and then impulsive, defiant and aggressive the next. The outbursts seemed disconnected from any event or interaction that the adults could identify. But both the seeming unpredictability and the nature of her behaviors made complete sense. Her brain was trying to protect her based upon what it had previously learned about the world.

The brain is always comparing current incoming patterns with previously stored templates and associations. This matching process takes place initially in the lowest, simplest parts of the brain, where, as you may recall, the neural systems involved in responding to threat originate. As the information moves upward from this first stage of processing, the brain has opportunities to take a second look at the data for more complex consideration and integration. But at first all it wants to know is: Does this incoming data potentially suggest danger?

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.

Upon further evaluation, our brain may recognize that the new pattern of activation has been caused by something familiar, but out of context. For example, if you are in the library reading and someone drops a heavy book on a table, the loud noise will immediately make you stop reading. You will activate your arousal response, focus on the source of the noise, categorize it as a safe, familiar accident—perhaps annoying, but nothing to worry about. If, on the other hand, you hear a loud noise in the library, turn and discover that other people around you seem alarmed, then look up and see a man with a gun, your brain would move from arousal to alarm and probably then into full-blown fear. If in a few minutes, you learn that this was a bad student prank, your brain would slowly move back down this arousal continuum toward a state of calm.

The fear response is graded, calibrated by the brain's perceived level of threat (see
Figure 3
, Appendix). As you become increasingly frightened, the threat systems in your brain continue to integrate incoming information and orchestrate a total body response aimed at keeping you alive. To that end an impressive set of interacting neural and hormonal systems work together to make sure your brain and the rest of your body do the right things. First, your brain makes you stop thinking about irrelevant things by shutting down the chatter of the frontal cortex. Then, it focuses on cues from others around you to help you determine who might protect or threaten you, by letting the limbic system's “social cue reading” systems take over. Your heart rate increases to get blood to your muscles in case you need to fight or flee. Your muscle tone also increases and sensations like hunger are put aside. In thousands of different ways your brain prepares to protect you.

When we are calm it is easy to live in our cortex, using the highest capacities of our brains to contemplate abstractions, make plans, dream of the future, read. But if something attracts our attention and intrudes on our thoughts, we become more vigilant and concrete, shifting the balance of our brain activity to subcortical areas to heighten our senses in order to detect threats. As we move up the arousal continuum toward fear, then, we necessarily rely on lower and faster brain regions. In complete panic, for example, our responses are reflexive and under virtually no conscious control. Fear quite literally makes us dumber, a property that allows faster reactions in short periods of time and helps immediate survival. But fear can become maladaptive if it is sustained; the threat system becomes sensitized to keep us in this state constantly. This “hyper-arousal” response accounted for many of Sandy's symptoms.

But not all of them. The brain doesn't have just one set of adaptations for threat. In the situation Sandy faced she was so small and so powerless and the threat she experienced so overwhelming, that she was unable to fight or flee. If her brain had responded by raising her heart rate and preparing her muscles for action, that would only have made her more likely to bleed to death when she was injured. Amazingly, our brains have a set of adaptations for these kinds of situations as well, which accounts for another important set of trauma-related symptoms, known as “dissociative” responses.

Dissociation is a very primitive reaction: the earliest life forms (and the youngest members of higher species) can rarely escape dire situations under their own steam. Their only possible response to being attacked or hurt, then, is essentially to curl up, to make themselves as small as possible, to cry for help and hope for a miracle. This response appears to be driven by the most primitive brain systems, located in the brainstem and immediately surrounding it. For infants and young children, incapable of or ineffective at fighting or fleeing, a dissociative response to extreme stressors is common. It is also more common in females than males and, if prolonged, dissociation is connected with increased odds for post-traumatic stress symptoms.

During dissociation, the brain prepares the body for injury. Blood is shunted away from the limbs and the heart rate slows to reduce blood loss from wounds. A flood of endogenous opioids—the brain's natural heroin-like substances—is released, killing pain, producing calm and a sense of psychological distance from what is happening.

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.

In most traumatic experiences, however, not one but a combination of these two major responses occurs. Indeed, in many cases a moderate dissociation during a traumatic event can modulate the intensity and duration of the hyper-arousal response. The capacity to become “numb” and partially robotic during combat, for example, allows the soldier to continue to function effectively without panic. But in some cases one pattern or the other predominates. And if these patterns are activated repeatedly long enough, due to the intensity, duration or pattern of the trauma, there will be “use-dependent” changes in the neural systems that mediate these responses. The result is that these systems can become overactive and sensitized, leading to a host of emotional, behavioral and cognitive problems long after the traumatic event is over.

We have come to understand that many post-traumatic psychiatric symptoms, in fact, are related to either dissociative or hyper-arousal responses to memories of the trauma. These responses can help people survive immediate trauma, but if they persist, they can cause serious problems in other areas of life down the road.

There are few better examples of trauma-related problems than what I saw in those boys at the residential center. The impact of trauma—and the frequent misinterpretation of its symptoms—revealed itself in the fact that nearly every one of them had some kind of diagnosis related to attention and conduct problems. In a classroom setting, unfortunately, both dissociation and hyper-arousal responses look remarkably like attention deficit disorder, hyperactivity or oppositional-defiant disorder. Dissociated children quite obviously are not paying attention: they seem to be daydreaming or “spacing out,” rather than focusing on schoolwork, and indeed, they have tuned out the world around them. Hyper-aroused youth can look hyperactive or inattentive because what they are attending to is the teacher's tone of voice or the other children's body language, not the content of their lessons.

The aggression and impulsivity that the fight or flight response provokes can also appear as defiance or opposition, when in fact it is the remnants of a response to some prior traumatic situation that the child has somehow been prompted to recall. The “freezing” response that the body makes when stressed—sudden immobility, like a deer caught in the headlights—is also often misinterpreted as defiant refusal by teachers because, when it occurs, the child literally cannot respond to commands. While not all ADD, hyperactivity and oppositional-defiant disorder are trauma-related, it is likely that the symptoms that lead to these diagnoses are trauma-related more often than anyone has begun to suspect.

 

THE FIRST TIME I met Sandy for therapy it was in the foyer of a church. Still in a form of witness protection, she had to be protected from the killer's fellow gang members, who could not be arrested because they hadn't directly taken part in the crime. So we met in unusual places at atypical times. Often, this turned out to be Sundays at a church. She was there with her foster parents. I greeted them. Sandy recognized me, but did not smile.

I brought her foster mother into the room where we were to hold the session, a preschool classroom. Then, I took some crayons and paper
and lay down on the carpet to color. In a minute or two Sandy came over and joined me on the floor. I looked over to the foster mother and said, “Sandy, Mrs. Sally* is going to go to church while we play. Is that OK?” She didn't look up, but said, “OK.”

We sat on the floor and colored in silence. For ten minutes our play was just like the initial visit in the court. Then, it changed. Sandy stopped coloring. She took the crayon from my hand, pulled at my arm and tugged at my shoulder to make me lay face down on the floor.