By Dr Bruce Perry, adapted from the Foreword to the new book, Life Story Therapy with Traumatized Children, by Richard Rose.
A fundamental and permeating strength of humankind is the capacity to form and maintain relationships – the capacity to belong. It is in the context of our clan, community and culture that we are born and raised. The brain-mediated set of complex capacities that allow one human to connect to another form the very basis for survival and has led to the ‘success’ of our species on this planet. Without others or without belonging, no individual could survive or thrive. This need is so biologically powerful that when an infant is given signals from his caregivers that he is ‘not wanted’ and does not belong, the brain’s neural networks will activate a ‘shut down’ response and induce a ‘failure to thrive.’ And even with calories (but without the physical manifestations of ‘love’) this infant will lose weight and may die. This early life manifestation of the power of belonging has many related neurophysiological features later in life; the stress response and ‘reward’ networks in our brain are all interwoven with our ‘relational’ neurobiology. When familiar and welcoming human interactions are present, we feel pleasure and safety; we are regulated, we belong. When we are disconnected, when we are marginalized, we feel distressed, we literally feel pain.
This powerful, regulating, rewarding quality of belonging to a group, a family, a community and culture is not just focused on the present. We each feel a need to be connected to the people of our past; and without being able to draw on this connection – this narrative – it is almost impossible to envision hopes and dreams for a connected and safe future. It is the very part of our brain that is most uniquely human, the neocortex, that allows us to store, sort and recall our past as we construct the narrative that becomes the pathway from the past, and it is also the neocortex that envisions our pathways into the future. The neocortex allows humans to tell time; to create complex symbolic representations and associations that we have transformed into various forms of language; in music, art, writing (all inventions of our past) we are able to re-tell our story. The story of our people, where we come from and how we belong; our cortex helps us process, sort and sequence events and to store both our personal experience and the narrated experiences of others; the story of our parents; our parent’s story of our childhood before we could make narrative memory; the story of their parents; the history of how we belong.
Story telling is a unique and permeating quality present in all cultures across every era. The first and universal function of narrative in song, ceremony and story is how we have come to be, where we are connected, where we belong, where the connections were broken, lost, repaired. And in the cortically mediated narrative of storytelling of how we belong and how we have come to this point comes a powerful regulating, anchoring, reassuring and rewarding neurophysiological effect. It is no surprise that humans, the storytelling primates, are fascinated by narrative, poetry, novels and movies. The majority of our arts will portray personal narrative in some fashion.
This crucial aspect of the human condition – belonging, knowing your narrative – is damaged for many. And damaging the narrative of a people (cultural genocide) is at the core of a destructive, transgenerational process that has many negative manifestations; as odd as this may sound, the neurobiological consequences of stripping a community or culture of their language, customs, religious beliefs or child-rearing practices are devastating. The individual stress response systems and ‘reward’ neurobiology in a marginalized, disconnected and culturally fragmented group will be compromised and predisposes individuals of that group to a host of mental (e.g., depression, suicide), physical (e.g., diabetes) and social (e.g., increased substance abuse) problems. This is seen in Aboriginal communities in Australia, First Nations communities in Canada and Māori communities in New Zealand, among others. The neurobiological consequences of the destruction of narrative for a people are devastating.
It is the same with individual maltreated children. A fragmented, damaged, discontinuous personal narrative puts an individual child at risk. A child that is lost within her own family, community and culture is neurodevelopmentally vulnerable. Without a life story, a child is adrift, disconnected and vulnerable – their neurobiology of reward, stress regulation and relational interactions are all altered – in negative ways – without a cortically mediated coherent personal narrative. Our conventional efforts to ‘treat’ them will often be frustrated and ineffective. Sadly, most mental health interventions with maltreated children do not pay any attention to the child’s story. The focus is the manifestation of pathology – the symptoms. Make Billy stop swearing, hitting, running away – make Billy pay attention, be respectful, comply. We lose sight of how disconnected Billy is and often we actually contribute to the fragmentation and disconnection of his life story – a brief but telling story to illustrate how our efforts to ‘protect’ maltreated children can add to their confusion and disconnection. We often make these children worse.
At the beginning of an evaluation of a ten-year-old boy in foster care at our ChildTrauma Academy clinic, I asked him his name:
‘Which name do you want to know?’
‘What do you mean?’
‘Well, I don’t know my name, I guess. My new mum calls me Thomas. My last mum called me Leon. And when I visit my grandmother she calls me Robbie.’
‘What name do you tell your friends to call you?’
‘I don’t have any friends at this new house.’
‘Do you know what your biological mother named you?’
‘I think she named me Baby.’
As I looked through the records I could see that he was born a few weeks early. He had been in the Pediatric ICU and had never been named by his mother. His discharge records stated: ‘Baby Boy Jones’. Ten placements and four ‘names’ meant he was disconnected and adrift with no personal narrative. But ‘fix him’ if he acts out. He is inattentive, disrespectful, struggles in school and won’t do as he’s told. Fix him. Find the right label. Give him the right drug. Our current approach to these maltreated children has lost sight of the essential element of healing – and that is reconnection. Connect to the present and increase the number and quality of relational opportunities but, as important, reconstruct your past connections, lay out your disconnects and clarify your personal journey to the present.
A life story approach such as that described in Richard Rose’s new book Life Story Therapy with Traumatized Children helps children to reconnect by reconstructing their personal narratives, echoing the fundamental storytelling powers known to our ancestors who incorporated storytelling into all of their healing practices and rituals. In other words, storytelling therapy reflects not just knowledge of human healing; it is a manifestation of wisdom about humankind. The value and power of the life story approach, which is both developmentally sensitive and ‘trauma-informed’, cannot be underestimated. For any clinician working with our most disconnected children it is a wonderful way to help them reconnect – and heal.
Dr Bruce Perry, MD, PhD
Senior Fellow, The ChildTrauma Academy, Houston, TX
Adjunct Professor, Department of Psychiatry and Behavioral Sciences, Feinberg School of Medicine, Northwestern University , Chicago, IL
Copyright © Jessica Kingsley Publishers 2012.