Asma: AI WHTY

Childhood Discipline: Regular corporal punishment, normalized in the rural South, caused significant physical and emotional harm.

Emotional Impact: Conditioned to suppress emotions and comply, leading to lifelong people-pleasing and difficulty setting boundaries.

Long-term Effects: Early trauma fostered independence but required healing to build confidence and healthy relationships.

Cultural Context: Reflects a broader pattern of normalized abuse among black children in that era.

Resilience: Overcame trauma through self-determination and connection, inspired by shared stories and professional insights.

Introduction to Oprah: In 1989, Dr. Perry was invited by Oprah to participate in discussions about child abuse, despite being an emerging researcher in trauma and brain development.

National Child Protection Act: Their collaboration helped draft the 1991 law creating a national database for convicted child abusers, signed into law in 1993.

Ongoing Collaboration: Conversations extended to The Oprah Winfrey Show and the Oprah Winfrey Leadership Academy for Girls (OWLAG), which models trauma-sensitive education.

Public Advocacy: A 2018 60 Minutes segment and Oprah’s public enthusiasm highlighted the importance of trauma-informed care, amplifying awareness globally.

Oprah’s Dedication: Her career-long focus on abuse, trauma, and healing has educated and inspired millions.

Oprah’s Work: Explored impacts of trauma, including abuse, violence, racism, and more, fostering awareness of healing, resilience, and post-traumatic growth.

The Oprah Winfrey Show: Addressed developmental adversity, brain development, neglect, and trauma for 25 years, paving the way for systemic awareness.

Collaboration: Oprah and Dr. Perry have discussed trauma, the brain, and resilience for over 30 years, culminating in this book.

Book’s Purpose: What Happened to You? shifts the focus from “What’s wrong with you?” to “What happened to you?” emphasizing how experiences shape us.

Goal: Through stories and science, the book aims to provide insights for understanding trauma and fostering healing.

Universal Beginnings: Every baby is born whole, not questioning their worth, but their early experiences shape their sense of self.

Oprah’s Childhood: She grew up feeling unwanted and lonely, shuffled between caregivers who lacked the time or capacity to nurture her.

Impact of Neglect: Traumatic or neglectful experiences in childhood can lead to deep emotional pain, leaving individuals longing for validation and prone to destructive patterns.

Healing Work: Recovery requires revisiting the roots of trauma, understanding how even brief sensory experiences can leave lasting imprints on the brain.

The Acorn Analogy: To comprehend who we become, we must examine the foundational experiences of our early lives.

Brain-Centric Perspective: Dr. Perry, both a neuroscientist and psychiatrist, views behavior through a brain-aware lens, seeking to understand how past experiences shape current actions.

Behavioral Questions: Common questions like “What’s wrong with them?” often stem from a lack of understanding about how experiences impact the brain.

Case Study - Mike:

• Mike, a Korean War veteran with PTSD, experienced anxiety, depression, flashbacks, and used alcohol to cope.

• Despite managing his drinking, triggers like a motorcycle backfire caused severe reactions, demonstrating the lingering effects of trauma.

The Role of Trauma in the Brain:

• Mike’s reaction—diving for cover—was his brain’s conditioned response to a perceived threat.

• Trauma often hijacks the brain’s stress response, creating automatic behaviors that can feel out of control.

Early Neuroscience Application: Despite limited knowledge of PTSD in 1985, Dr. Perry drew on his understanding of memory, stress, and the brain to begin explaining trauma’s impact.

Combat-Conditioned Brain: Mike's brain adapted to constant threats in Korea, becoming oversensitive to potential danger as a survival mechanism.

Memory and Stress Response:

• A connection formed between the sound of gunfire and the need for an extreme survival response.

• This "adaptive memory" persists even decades later, despite being unnecessary in his current environment.

Brain Organization:

• The brainstem (bottom layer):

  • Reacts to sensory input without the ability to analyze or “tell time.”

  • Processes sensory signals like sound and activates survival responses automatically based on stored memories.

• The cortex (top layer):

  • Handles advanced functions like thinking, planning, and distinguishing past from present.

  • However, during stress, the brainstem can override the cortex, leading to reflexive actions.

Sensory Signal Flow:

• Sensory inputs (e.g., sound) first pass through the brainstem, where they are compared to past experiences.

• A motorcycle backfire, matching memories of gunfire, triggered Mike’s stress response because his brainstem couldn't differentiate between past trauma and present reality.

Challenges in "Unlearning":

• Trauma-based memories are stored in the brainstem, which isn't directly under conscious control.

• These survival responses are automatic and difficult to change, even with conscious effort or reasoning.

Impact on Life: Mike experiences heightened vigilance and exaggerated responses (e.g., fear of fireworks) because his brainstem’s threat-processing system remains hyperactive.

Sequential Brain Processing:

• Sensory input travels bottom-up in the brain:

  • Starts at the brainstem (primitive, reactive area).

  • Moves through the diencephalon, limbic system, and finally to the cortex (the "smart" part of the brain).

• The brainstem processes signals first, often triggering instinctual, reflexive responses before the cortex can analyze or contextualize them.

• This explains why people often react and feel before they think.

Stress Response and Trauma:

• Stress shuts down higher brain functions (like the cortex) to prioritize survival.

• In Mike's case, his stress response triggered by the motorcycle backfire forced him into a reactive state before his cortex could recognize he wasn't in combat.

• This is why his traumatic memories from Korea overpowered his rational understanding of the situation.

The "What Happened to Me?" Shift:

• Oprah highlights a critical perspective shift:

  • Instead of asking "What's wrong with me?" (implying personal flaw), ask "What happened to me?" (acknowledging past experiences' influence).

• This approach fosters compassion and deeper understanding of how trauma affects behavior.

Developmental Impacts of Early Experiences:

• The brain develops sequentially—from the lower brain areas (action and feeling) to the higher ones (thinking and reasoning).

• Early life experiences, especially during rapid brain development, have a profound impact on how the brain organizes itself.

• Positive or negative experiences shape how a person processes emotions, interprets the world, and reacts to stress throughout life.

Trauma and Evocative Cues:

• Sensory inputs like sounds, sights, or smells can evoke traumatic memories.

• These "evocative cues" bypass rational thinking and trigger automatic responses linked to past trauma, as seen with Mike’s reaction to the backfire.

Early Experiences Shape Brain Development

• Trauma and Timing:

  • Even though traumatic events like Mr. Roseman’s occurred in adulthood, their impact was significant. Trauma in infancy or early childhood, when the brain is most malleable, has even more pervasive and lasting effects.

  • The developing brain of an infant or toddler is rapidly growing, forming neural connections that determine how they interpret and respond to the world.

• Developmental Sensitivity:

  • Starting in the womb, a child’s brain development is influenced by the mother's environment and actions, including stress levels, nutrition, and activity patterns.

  • At birth, the brain is inundated with sensory input that it must process and organize, a process that shapes long-term behaviors and worldviews.

2. Sensory Integration and Memory Formation

• External and Internal Sensory Systems:

  • The brain receives input from external senses (sight, sound, smell, taste, touch) and internal senses (interoception), which inform bodily states like hunger and thirst.

  • These inputs are continuously processed to maintain safety and well-being, creating an intricate feedback loop between the body and the brain.

• Making Sense of the World:

  • Sensory inputs from a single experience (e.g., a smell, a sound, a visual cue) are linked together to create a memory.

  • This process forms a “codebook” unique to each individual, helping them interpret the meaning of future experiences. For example:

    • A kind touch may evoke safety for one person but fear for another, depending on past experiences.

3. Early Life and Unique Worldviews

• Infant Sensory Overload:

  • The transition from the womb to the outside world introduces an overwhelming sensory environment. The brain must rapidly process these new inputs, forming connections that will later define how the child perceives their surroundings.

• Personal Codebook and Interpretation:

  • Life’s early moments play an outsized role in defining our understanding of relationships, emotions, and safety.

  • For example, eye contact could symbolize care or danger depending on what a child has experienced during critical developmental years.

4. Implications for Caregivers and Society

• Emotional Climate:

  • Oprah highlights the often-overlooked sensitivity of young children to their surroundings. Their brains are like sponges, absorbing emotional tones and behaviors even when they cannot fully articulate or understand them.

  • Negative or chaotic emotional climates can have lasting developmental repercussions, while supportive, nurturing environments promote healthy growth.

• Responsibility of Adults:

  • Adults play a pivotal role in shaping a child’s early experiences. What children see, hear, and feel in their early years fundamentally impacts how their brains are wired to interpret the world.

Childhood and Emotional Tone:

• Young children are highly sensitive to their environment’s emotional tone, even before they can understand language.

• Abusive environments, such as those with abusive fathers, teach children to associate certain figures (like men) with fear and danger.

• Nonverbal cues (e.g., tone of voice, tension) are crucial for children’s emotional development, even if they can’t articulate what they’re sensing.

Impact of Early Trauma:

• Trauma before age 2, when children lack the language to process events, has a deeper impact on the brain.

• Experiences without words get locked into the brain more powerfully than if they could be explained.

• Early trauma creates strong memory traces in various brain regions (emotional, sensory, motor) that shape how children perceive the world.

Memory and Trauma:

• Memory isn’t just cognitive; emotional and sensory memories also exist, stored in various brain regions.

• Traumatic experiences create complex memories that involve the brain’s emotional and sensory systems, making them more intense and lasting.

Development of Memory in Young Children:

• The brain develops from the bottom up, with basic functions handled by the brainstem and more complex processes in the cortex.

• Children under three cannot form linear narrative memories (who, what, when, where), but their lower brain areas form associations based on early experiences.

• Traumatic experiences can create strong associations (e.g., with an abuser’s features), which may later trigger unexpected reactions (e.g., panic attacks) due to the lack of a clear, cognitive memory.

Impact of Early Trauma:

• Trauma at a young age can lead to lifelong behavior patterns and beliefs, even if specific memories aren’t recalled (e.g., sexual abuse affecting intimacy).

• Victims of early trauma may have difficulty asserting boundaries, which can manifest in people-pleasing behaviors or sabotaging relationships.

Broader Definition of Trauma:

• Trauma is not limited to extreme experiences like abuse or war but can also include events like divorce.

• Children of divorce may experience deep emotional pain, such as Kris, who believed buying a ring could bring back his mother, and Daisy, who expressed anger at her mother's new relationship.

• Divorce can deeply impact a child’s sense of self-worth, especially if one parent becomes unavailable or introduces a new partner too soon.

Impact of Parental Relationship Changes:

• When a new person enters a child's life, the child will process this change and feel the shift in their parent's attention. Even healthy relationships can be destabilizing for children, as they interpret the new person as a potential threat until proven safe.

• The child’s stress-response system is activated by novelty, leading to anxiety and potential fear if the new person’s behavior is seen as threatening (e.g., if a new partner yells at the child).

Trauma and Stress Response:

• Traumatic experiences, such as verbal or physical abuse, are processed both in the brain's cortex (narrative memory) and deeper parts of the brain, which govern the body's stress responses (e.g., increased heart rate, muscle tension).

• Traumatic experiences alter a child’s regulatory systems, potentially causing dysregulation, where the child is in a constant state of stress.

Formation of Personal Codebook:

• Early-life traumatic associations (e.g., with an abuser) shape the lens through which the child perceives the world and relationships, creating a "personal catalog" that influences behavior and perceptions throughout life.

• Dr. Perry recounts working with children who had been removed from abusive homes, noting how early trauma influences their reactions and behavior, such as Samuel, a boy who had been caring for his siblings amidst neglect and violence from his father.

Sam’s Behavior in School:

• Sam, who had faced significant trauma, was making progress but started exhibiting aggressive behavior toward his new male teacher. Despite no obvious trigger, the teacher's proximity seemed to agitate Sam.

• This was puzzling for the staff, but the key to understanding Sam’s reactions lay in a deeper, subconscious association.

The Role of Associations and Triggers:

• During a supervised visit with Sam’s father, Dr. Perry noticed the scent of Old Spice on the father. This reminded him of his own positive memories with his father.

• However, Sam’s brain likely associated the scent of Old Spice with negative experiences involving his father, who had often been drunk during visits.

• Dr. Perry realized that the teacher’s use of Old Spice might be triggering Sam’s intense reactions, as his brain connected the scent to past trauma.

Solution and Explanation:

• Dr. Perry explained this to Sam and the teacher using a model of the brain, helping both understand how certain smells, sights, or sounds could trigger emotional responses based on past experiences.

• The teacher agreed to switch to a scentless deodorant, and Sam seemed to grasp the connection between the trigger (Old Spice) and his emotional responses.

Sam and the Teacher's Relationship:

• After identifying the trigger (the scent of Old Spice), Sam and his teacher were able to rebuild their relationship, leading to Sam becoming a model student. This illustrates how trauma-related triggers can affect behavior and how understanding these triggers can help resolve conflict.

The Brain and Memory:

• The story of Sam’s trauma emphasizes how the brain catalogs memories and makes associations based on experiences. For Sam, Old Spice evoked distress due to past trauma, while for Dr. Perry, it elicited positive memories. Our brains continuously process and categorize sensory input (like smells or sounds), forming associations that can shape our perceptions of the world.

• These associations influence how we form first impressions of people, whether positive or negative, and can contribute to implicit biases based on cultural and media influences.

Stress and the Heart:

• Dr. Perry introduces the idea that the heart is not only vital for physical health but also plays a role in emotional regulation. He shares a personal experience of heart palpitations, which he later learned were due to menopause, highlighting the connection between physical symptoms and emotional well-being.

• Constant stress, however, can have detrimental effects on both physical and emotional health. Dr. Perry points out that long-term stress is linked to anxiety, depression, and physical conditions such as heart disease and diabetes.

Dr. Perry discusses how trauma and stress led him to neglect his own well-being, relying on unhealthy coping mechanisms like food. Over time, he learned to regulate himself by setting boundaries, taking time for self-care, and finding soothing activities, like walking in nature.

Rhythm, such as walking or listening to music, is vital for emotional regulation. Babies are soothed by rhythmic motions like rocking, which helps them regain balance. As adults, we find our own rhythms—activities like knitting or dancing—that help us stay balanced.

Dr. Perry introduces regulation as the body’s system for maintaining balance and harmony, helping us stay safe and emotionally steady.

Stress occurs when external challenges push us out of balance, causing discomfort. Returning to balance activates the brain’s reward system, leading to feelings of relief and pleasure.

Regulation is key to health, not just biologically but in all areas of life, including relationships and community. Healthy self-regulation starts in infancy when babies rely on caregivers to help them return to balance. Responsive caregiving teaches the child to self-regulate over time.

Rhythm plays a significant role in this process. From the womb, rhythmic sounds from the mother’s heartbeat help the developing brain establish a connection between rhythm and safety. After birth, rhythmic movements, like rocking, comfort the baby by activating this memory of safety.

Caregivers who respond with nurturing care help the child’s brain develop strong regulation abilities, creating a foundation for healthy relationships and emotional balance. These early experiences are the roots of the brain’s “Tree of Regulation.”

Our neural networks work together in three key areas: regulation, relationships, and reward. These systems combine to form foundational memories that help us feel pleasure and balance when we experience warmth and acceptance from others. Our capacity to connect, regulate, and be rewarded is the glue that binds families and communities.

When a caregiver responds to a distressed infant, the baby experiences both regulation (relief from distress) and human interaction, associating the caregiver’s presence with pleasure. Over time, these experiences connect relationships to both regulation and reward, forming the “Tree of Regulation.” A nurturing caregiver helps the child develop a worldview that people are safe, supportive, and predictable.

This worldview creates a positive cycle where individuals expect good from others, often leading to self-fulfilling prophecies. A positive internal view can elicit good interactions and further reinforce the belief that people are caring and trustworthy.

The Tree of Regulation consists of core regulatory networks (CRNs) that help our body process and respond to stress. Stress is not inherently bad—it's a natural part of life and plays a role in learning, resilience, and personal growth. The key factor in determining whether stress is positive or destructive is the pattern of stress.

These CRNs, originating in the lower brain, regulate all aspects of our body and brain to maintain balance, keeping us functioning properly in the face of stressors.

A story illustrates this: a toddler, with a positive worldview that people are good, interacted with a frustrated man at an airport. Despite his rude behavior, she smiled and attempted to engage with him, turning his negative response into a positive one. Her belief in the goodness of people was contagious, and she ultimately drew out a smile from him. This story highlights how a positive worldview can influence others, creating positive interactions and reinforcing the idea that people are inherently good.

The toddler's positive interactions with the frustrated man were a result of her internalized worldview formed through loving, consistent care from her parents. This view allowed her to project goodness and elicit positive responses from others.

However, the situation is different for children who don't receive consistent, nurturing care. In cases where parents are overwhelmed, depressed, or in difficult relationships, the child may not receive predictable regulation. This inconsistency can lead to a sensitized stress-response system, where the child becomes hypervigilant or dysregulated, even in situations where it's no longer needed, like in the classroom. These changes in the child’s system can lead to issues like ADHD.

Moreover, the child’s worldview can become negative if caregivers are inconsistent or neglectful. For example, in a preschool project, a withdrawn girl, whose mother was overwhelmed and absent, began to internalize the belief that she wasn’t important. Despite the teacher's positive efforts, the girl’s lack of reciprocal social feedback led her to withdraw further, reinforcing her belief that she didn’t matter. This shows how early experiences shape a child's perceptions of themselves and others, creating self-fulfilling prophecies about their worth and relationships.

The long-term effects of stress depend on how stress-response systems are activated. When stress is activated in unpredictable, extreme, or prolonged ways, such as through neglect or abuse, the systems become sensitized. This leads to vulnerability across emotional, social, mental, and physical health. On the other hand, moderate and predictable stress, like challenges in education or sports, strengthens these systems and builds resilience.

In the case of the little girl, her mother’s overwhelmed, depressed state led to inconsistent caregiving, causing the child’s stress-response systems to be dysfunctional. If the pattern continues with neglect, where the child's fundamental needs are not met, this results in chronic distress and a state of imbalance.

The pattern of stress activation is key. Predictable, nurturing care strengthens resilience, while prolonged, chaotic activation from neglect or abuse leads to sensitized, dysfunctional systems. Stress-response systems, such as the "fight or flight" response, prepare the body to deal with threats. However, when fighting or fleeing isn’t possible, especially for babies and children, dissociation is an adaptive strategy. This involves mentally disconnecting from the external world, escaping into an inner world, to cope with overwhelming situations.

Over time, the ability to retreat into an inner world of control and safety increases for individuals who experience trauma. This coping mechanism can manifest in behaviors such as people-pleasing—doing things to avoid conflict and ensure others are happy—as well as seeking dissociative activities that regulate emotions. Unfortunately, this search for relief can lead to harmful methods of emotional regulation that ultimately have destructive consequences.

Russell Brand’s experience highlights the struggle to cope with an internal storm. Despite achieving sobriety, he continued to battle with feelings of alienation and loneliness from childhood, which led to harmful behaviors like compulsive eating, pornography addiction, and heroin use. For him, drugs were not about seeking pleasure, but rather a solution to avoid emotional pain. His story emphasizes how addiction often stems from dysregulation and trauma rather than indulgence or pleasure-seeking.

Dr. Perry points out that the link between trauma and addiction is well-documented. People who grow up in chaotic, unpredictable, and threatening environments often develop altered stress-response systems. This dysregulation is particularly severe when abuse or neglect comes from the very caregivers meant to provide safety and security. As a result, individuals may struggle with overactive, sensitized stress systems, leading to what Russell Brand called an “internal storm.”

This pattern of stress activation—unpredictable stress without control—can create emotional turmoil. The stress of a parent, such as a frustrated and overwhelmed father, can affect the whole family, leading to a climate of fear and insecurity. Despite efforts to shield children from their own distress, these environments breed internalized fear and dysregulation in children, perpetuating the cycle of trauma.

As children from traumatic environments grow older and are introduced to drugs or alcohol, they may experience relief from the distress that has defined much of their lives. For the first time, they might feel a sense of quiet and relaxation, something they have never known. This relief becomes a powerful source of reward, making the pull to use substances again irresistible. Relief from distress, as Dr. Perry emphasizes, is inherently pleasurable. This "reward" system is rooted in the brain's response to various forms of reward activation, including the relief of stress, positive interactions with others, or the direct stimulation of reward circuits by substances.

People naturally seek to "fill their reward bucket" every day. The reward bucket refers to the sources of pleasure or satisfaction we use to stay regulated. Healthy rewards come from relationships, values-driven activities, and fulfilling work. However, if these sources of reward are lacking, individuals may turn to less healthy methods, such as substance use or overeating, to fill the void. During times of increased stress, such as during the COVID-19 pandemic, many people reported feeling more anxiety and depression, which made them more vulnerable to using unhealthy coping mechanisms.

The challenge with reward systems is that the pleasure from them is often fleeting. The satisfaction gained from a single event—such as eating a snack, using nicotine, or even receiving affection—fades quickly, leading individuals to continually seek more. The healthiest way to fill the reward bucket is through human connection and relationships, but substance abuse can isolate people, making this approach harder to achieve. Substance abuse leads to relational disruptions, which, in turn, exacerbates the underlying dysregulation, pushing individuals deeper into unhealthy cycles of self-medication.

When people struggling with addiction are met with punitive measures, it often increases their distress rather than providing the support needed to break the cycle. Disconnection and marginalization make substance use even harder to overcome, creating a spiral where the need for external rewards grows stronger and more difficult to resist. In this cycle, disconnection and self-medication feed into each other, worsening the trauma and emotional imbalance that began earlier in life.

Impact of Drug Use on Well-Regulated Individuals:

• For individuals with well-regulated stress systems, meeting basic needs, and healthy reward systems, drug use may have some pleasurable effects, but it doesn’t create a strong pull to repeat the behavior or lead to addiction.

• Addiction is complex, and many individuals with substance abuse issues are often self-medicating to cope with past trauma or adversity.

Different Baselines for Drug Effects:

• People with an already high baseline of stress may need more medication to achieve the desired calming effect, whereas someone with a calmer baseline may experience drowsiness from the same amount of medication.

• People may appear calm, but biologically they are revved up and need more medication to soothe that heightened stress.

Addressing the Root Cause of Substance Abuse:

• To solve the problem of substance abuse, we must focus on understanding what happened to individuals in their past, especially regarding trauma and adversity.

• A developmentally informed, trauma-aware perspective is essential for addressing substance use and dependence in various systems (education, mental health, law enforcement, etc.).

Trauma and Vulnerability to Addiction:

• Trauma victims are more prone to addiction because their baseline stress response is already elevated, making it harder to regulate their emotions without relying on substances.

• Dysregulation plays a key role in the struggle with addiction, as there’s a constant pull to regulate distress.

The Importance of Relational Reward:

• Positive, healthy relationships are the most powerful form of reward and regulation for trauma survivors. Connection to caring individuals is critical for stepping away from unhealthy coping mechanisms like drugs, alcohol, overeating, or other addictive behaviors.

• Connectedness—spending time with people who care and support you—counteracts the pull of addictive behaviors and is key to recovery and emotional regulation.

Observation of Gloria and Tilly’s Visit:

• The author observes a positive visit between Gloria and her three-year-old daughter, Tilly. Over two years, there has been significant improvement in their relationship, and they appeared more comfortable and in sync with each other.

Background on Gloria’s Trauma:

• Gloria experienced significant trauma, starting with being removed from her family at age six and growing up in the child protective system. She faced multiple foster homes and schools and had complex emotional and physical health issues.

• Gloria’s trauma was not well understood by the adults in her life, including therapists, foster caretakers, and caseworkers.

• By the time Gloria aged out of the system at age eighteen, she was using drugs to cope with her pain. She became pregnant, homeless, and eventually had Tilly, who was later removed by CPS and placed in foster care with Mama P.

Mama P’s Role in Tilly and Gloria’s Lives:

• Mama P is a loving and experienced foster mother who helped Tilly thrive in a stable home. She also supported Gloria’s involvement in Tilly’s life, provided she wasn’t using substances.

• Mama P recognized that Gloria needed as much nurturing as Tilly and treated her as a young, unloved child in a woman’s body.

• After nine months, Gloria accepted clinical help for her trauma, leading to significant growth for both her and Tilly.

The Importance of Compassionate Support for Gloria:

• At the time of the observed visit, Gloria and Tilly were close to being reunited, with CPS considering the recommendation to the court. This visit was part of the reunification plan.

• During the session, Gloria pulled out candy for Tilly, which prompted a response from the CPS caseworker, who viewed it as inappropriate, given Tilly’s prediabetic condition. The caseworker labeled it as "abusive," but the author clarified that the candy was sugar-free.

• Gloria had used candy as a way to show love to Tilly, a behavior learned from her own childhood, where candy was used as a form of affection due to her lack of relationship tools.

• The author emphasized that Gloria’s use of candy was her best way of showing love, shaped by her own experiences growing up.

Controversial Views on How to Address Gloria’s Parenting:

• A clinical team member had suggested punishing Gloria if she brought candy to visits, but Mama P disagreed, arguing that punishing Gloria would not help her become a better parent. Instead, showing love and understanding to Gloria was more important.

• Mama P’s perspective was that to help Gloria become a more loving parent, the system needed to be more loving and supportive of her, rather than shaming or punishing her.

Gloria’s Parenting Approach:

• Instead of reprimanding Gloria for giving candy to Tilly, the team decided to switch to sugar-free candy and educate Gloria about nutrition and diabetes.

• Mama P continued to support both Gloria and Tilly with love and stability.

• A transitional reunification plan was created for Gloria and Tilly, which included significant support for both, allowing Gloria to regain custody of Tilly.

Gloria’s Personal Growth:

• Gloria achieved personal milestones, such as earning her GED and attending community college to study nursing.

• Mama P remained actively involved in their lives, offering support and fostering a loving environment.

Neuroplasticity and Change:

• The brain has the capacity to change and adapt, a process called neuroplasticity. Neural networks physically change when activated by specific experiences.

• Repetition of actions, such as practicing piano, can lead to improvement, as the brain’s neural networks involved in those activities are stimulated and strengthened.

• This principle of neuroplasticity, particularly the concept of specificity (activation of specific brain regions), applies to all brain functions, including emotional ones like the capacity to love.

• For someone who has not experienced love, like Gloria, the neural networks for loving may be underdeveloped. However, with practice and the experience of love, these capabilities can emerge and develop.

Oprah’s Reflection on Love and Human Connection:

• Oprah shared her insight from decades of interviews, stating that a common human desire is to know that what we do, say, and who we are, matters. People always seek validation, asking, “How did I do?” or “Was I okay?”

• Oprah connected this longing for affirmation to the experience of being loved, suggesting that the need for love and acceptance is fundamental to all humans.

Dr. Perry’s Thoughts on Belonging and Love:

• Dr. Perry emphasized that belonging and being loved are essential to the human experience, as humans are social and relational creatures.

• The brain is fundamentally designed to help us create, maintain, and manage social relationships. Our early relationships shape our capacity to love and be loved.

• The quality of care an infant receives, such as a caregiver responding to a baby’s need for food or comfort, profoundly influences their ability to form healthy relationships.

Love as Action for Infants:

• To a newborn, love is not just a feeling but is expressed through action—the responsive, nurturing care of the caregiver. A parent’s affection is not perceived by the infant unless it is shown through physical presence, attention, and care (e.g., meeting the infant’s hunger or discomfort).

• The quality of caregiving, like skin-to-skin contact, the caregiver’s scent, and their consistent responsiveness, shapes the infant's developing brain. These early interactions build the foundation for emotional and social functioning.

Building Resilience Through Responsive Care:

• When a baby experiences stress (e.g., hunger or cold), the responsive actions of the caregiver help the child return to balance. These interactions create resilience by reinforcing the idea that needs are met reliably and lovingly.

• The infant begins to associate the caregivers with comfort, warmth, and pleasure, which informs their view of the world as a safe place, fostering a resilient worldview.

Early Interactions and Child’s Capacity to Love:

• The pattern of caregiving interactions helps the child develop the capacity to love. When a child is loved and nurtured, the neural networks that support emotional connection and love are built.

• These positive caregiving interactions don’t only shape the child’s brain—they also influence the brain of the caregiver, creating a positive feedback loop where both the child and the caregiver are regulated and rewarded.

Humans Are Relational Creatures:

• Love and care are the foundations of human survival and success. Humans have thrived because we are capable of forming and maintaining relationships, which provide protection, cooperation, and support for the community.

• Love is essential to human connection and survival, acting as the "relational superglue" that binds people together in supportive and nurturing ways.

How Love Shapes Brain Development:

• Early care directly influences the development of critical regulatory networks (CRNs) in the brain. These networks are foundational for health and emotional functioning, helping the child manage stress, regulate body temperature, and respond to their environment.

• Brain development follows a bottom-up process: the most basic functions, such as bodily regulation and respiration, develop first in infancy, while more complex functions (like reasoning and abstract thought) develop later.

• Early experiences are particularly important in shaping the brain’s development. Although the brain continues to change throughout life, the early years are crucial for setting the stage for future growth and emotional well-being.

CRNs and Brain Development:

• The core regulatory networks (CRNs) play a crucial role in regulating and organizing the brain. Their signals help guide the development of higher brain areas such as the limbic system (emotions) and cortex (cognitive functions).

• If CRNs are well-organized and regulated, they support healthy brain development. If disrupted, they can have widespread negative effects on brain and body systems.

Types of Developmental Adversity:

• Prenatal Disruption: Exposure to drugs, alcohol, or extreme maternal distress (e.g., domestic violence) during pregnancy can disrupt CRNs and impact brain development.

• Early Caregiver Interactions: Disruptions in the infant-caregiver relationship—such as chaotic, inconsistent, rough, aggressive, or absent caregiving—can lead to abnormal development of stress-response systems.

• Sensitizing Stress: Exposure to unpredictable, uncontrollable, or extreme stress can lead to an overly reactive stress response system, affecting the child’s emotional and behavioral regulation.

The Stress Response and Neurotypical vs. Sensitized Systems:

• When stress occurs, the body activates a stress-response system to restore balance (homeostasis). In a healthy, neurotypical stress response, there is a proportional relationship between the level of stress and the body’s internal state.

  • For example, moderate stress (such as a small challenge) will activate a state of alertness, helping the individual respond appropriately.

• However, in individuals with a sensitized stress response (often due to trauma), even small stressors can induce an extreme reaction (such as fear or terror).

  • The stress response system becomes overactive, leading to difficulties in managing emotional and physical health.

  • This overreactivity can be harmful, contributing to emotional, behavioral, and physical health problems later in life.

The Complexity of Early Love:

• Oprah emphasizes that love is more complex than simply the absence of affection leading to sadness. The quality of caregiving, particularly during the early formative years, plays a critical role in shaping the stress-response systems and overall emotional health of an individual.

• How a child is loved and cared for impacts the development of the brain’s capacity for emotional regulation and resilience.

Impact of Early Experiences on Brain Development:

• Aggressive or neglectful caregiving or a lack of physical affection (such as being held as an infant) can biologically affect brain development.

• Early experiences—especially those involving touch, smell, and the way caregivers respond to an infant’s needs—help organize the brain. These interactions contribute to the infant’s "worldview" or internal codebook of understanding and responding to the world.

• Dr. Perry compares early brain development to building a house:

  • The brain’s foundation is laid in the womb, the framing happens in the first couple of months after birth, and by the first year, the brain's wiring and connections are being formed.

  • If the foundation is faulty, the child’s development may have issues, even if other aspects of life appear to be going well. These early developmental experiences are critical for future functioning.

The Role of Love in Early Development:

• Love is not just an abstract concept but something that is biologically and relationally built through consistent, loving, and responsive caregiving.

• Presence, attentiveness, and attunement—the caregiver being fully present and responsive to the child’s needs—are essential for the child’s ability to feel loved and develop healthily.

• A lack of love or chaotic, unpredictable caregiving can lead to developmental challenges, just as dysfunction often directly correlates with a lack of consistent and loving care in early life.

The Power of Small, Intimate Moments:

• Oprah reflects on a deeply emotional moment she had with a young girl, Kate, whose mother passed away. Kate shared that her most cherished memory of her mother was a simple, quiet moment when they had a bowl of cereal together late at night.

• These small, intimate moments of being fully present with a loved one—without grandeur or fame—create the most powerful and enduring emotional bonds. They exemplify the "glue of love" that holds human relationships together.

The Glue of Humanity:

• Dr. Perry emphasizes that the capacity to love and connect is essential for the survival and well-being of the individual and society. This ability is shaped by early childhood experiences.

• The way a child is loved during their early years plays a critical role in their emotional, social, and psychological health throughout their life.

• Love and Early Caregiving:

  • To a newborn, love is action: responsive, nurturing care (e.g., feeding, comforting).

  • Caregiver actions shape infant brain development, influencing resilience and worldview.

  • Predictable, loving interactions contribute to emotional regulation and building resilience.

  • Children’s sense of safety and trust is built through these early interactions, shaping their future responses to the world.

• Impact of Developmental Adversity:

  • Disruptions before birth (e.g., prenatal exposure to drugs, extreme stress) and inconsistent caregiving can disrupt the core regulatory networks (CRNs) of the brain.

  • Childhood adversity, such as neglect or chaotic caregiving, can lead to emotional and behavioral difficulties.

  • Sensitized stress responses from traumatic early experiences lead to heightened vulnerability in later life.

• Neuroplasticity and Stress Response:

  • Neuroplasticity: The brain’s ability to change based on experiences.

  • Predictable, moderate stress can strengthen resilience and stress-response systems.

  • Unpredictable, extreme, or prolonged stress leads to an overactive stress response, contributing to emotional and health issues.

• Example of Trauma (Jesse’s Story):

  • Jesse, a child from a multigenerational history of abuse, experienced severe trauma in his early years (e.g., sexual abuse, neglect, physical punishment).

  • His foster care placement involved further abuse, creating a deeply harmful stress-response pattern.

  • These adverse experiences severely disrupted his development and led to extreme stress responses, which impacted his mental health and behavior.

Jesse's Trauma:

• Jesse experienced ongoing abuse, including being told to lie about his treatment, forced to sleep in a chicken coop, and denied basic comfort and care. His painful emotional state was expressed in his diary: “Why does God hate me?”

• His history of trauma set him up for an overactive and dysfunctional stress response, furthering his emotional and physical health challenges.

Stress-Response Systems:

• Fight-or-Flight Response: Describes the body's acute reaction to perceived threats, increasing heart rate, releasing stress hormones (like adrenaline and cortisol), and preparing muscles for physical action. This response focuses on external threats.

• Arousal Response: The physiological changes when faced with a threat: increased heart rate, anxiety, nervousness, and physiological readiness to confront danger. Everyone experiences this in situations like exams, public speaking, or arguments.

Flock, Freeze, Fight or Flight:

• Flock: When under threat, humans often look to others for emotional cues and confirmation of the situation. This is the social response, relying on emotional expressions from others (e.g., facial cues).

• Freeze: The body may temporarily "freeze" when a threat is not immediately clear, pausing to process the situation (e.g., hearing a strange noise in a parking lot or in a tense argument).

• Fight or Flight: If the threat is confirmed, the body moves to fight or flee. Example: A deer in the woods exhibits flocking, freezing, and fleeing behavior when threatened.

Jesse’s Response to Abuse:

• Jesse’s dominant stress-response pattern was arousal—fleeing from abuse and eventually fighting back. This is seen when he refused to continue forced exercise and fought back against his foster father.

• His refusal to comply with the forced exercise led to a violent altercation, where he sustained a serious head injury, resulting in a coma and hospitalization.

Impact of Ongoing Trauma:

• Prolonged exposure to trauma, like Jesse's experience, triggers a heightened and maladaptive stress response. This ongoing cycle of stress and abuse can lead to serious emotional and physical health problems.

Brain's Memory and Stress Response Systems:

• Memory Formation: The brain makes associations between patterns of sensory input, creating memories based on past experiences. These memories help categorize and interpret new experiences.

• Jesse's Trauma: Jesse had two sets of trauma memories—one from his childhood abuse and another from his foster home abuse. His brain stored these memories to categorize new experiences similarly, leading to a trauma-based response to certain cues.

2. Dissociative Response:

• Definition: Dissociation is a mental capability where a person disengages from the external world to focus on the inner world, such as daydreaming. It acts as a protective response in highly stressful situations.

• Physiological Differences:

  • Arousal Response: Increases heart rate, directs blood to muscles, and prepares the body for fight or flight.

  • Dissociative Response: Decreases heart rate, keeps blood in the trunk to minimize injury, and releases painkillers (endorphins, enkephalins) to help tolerate pain and injury.

• Jesse's Use of Dissociation: As a young child, Jesse's only adaptive response to abuse was dissociation, emotionally fleeing to his inner world to survive.

3. Jesse's Physiological Reactions to Trauma Cues:

• Reactivity to Scent: When Jesse was in a coma, his body responded to scents linked to his trauma:

  • Foster Father's Scent: Triggered a strong arousal response, with a rise in heart rate and physical thrashing, linked to his abuse by his foster father.

  • Biological Father's Scent: Triggered a dissociative response, with his heart rate dropping significantly, indicating his brain's response to memories of abuse by his biological father.

• Memory Storage in Lower Brain Systems: These reactions occurred despite Jesse being unconscious, showing how trauma-related memories are stored in lower brain areas, outside of conscious awareness.

4. Impact of Trauma Responses:

• Varied Responses to Trauma Cues: People can have multiple, often conflicting responses to trauma-related cues, such as avoiding or shutting down, or becoming enraged and activated. Each person’s traumatic experience results in a unique "fingerprint" of responses based on the trauma's timing, nature, pattern, and intensity.

• Jesse's Story: His trauma responses, influenced by the abuse he faced, reflect how different trauma cues evoke different emotional and physiological reactions.

5. Jesse’s Recovery:

• Healing Through Connection: After coming out of his coma, Jesse suffered residual effects but eventually found healing through connection. His story highlights the malleability of the brain and the power of hope in recovery.

• Hope for Others: Jesse’s recovery journey is a reminder that despite severe trauma, there is hope, and healing is possible, especially when connection and support are part of the process.

Impact of Growing Up in Fear:

• Constant State of Fear: Children who grow up in fear, like Jesse, live in a constant state of stress. Their brain functions differently due to ongoing fear, affecting how they think, feel, and behave.

• State-Dependent Functioning: Our brain’s functioning is highly dependent on our current state. These states can change quickly, and our brain’s responses to these changes impact our behavior and cognitive abilities.

2. Brain States and Arousal:

• Calm State: When calm, the brain is relaxed, and we have access to our higher thinking abilities, specifically the cortex. This allows us to think critically, reflect, and make thoughtful decisions.

• Alert State: In this state, we are focused on something external, like a conversation. Our mind is still active, but our thinking is more focused.

• Alarm State: When surprised or threatened, we shift to an emotional state. Lower parts of the brain become more dominant, and our thinking becomes more reactive. This can cause conversations to become arguments, and our logic deteriorates.

• Fear State: In extreme stress or threat, the brain’s lower systems (such as the brainstem) dominate. Our cognitive functions like problem-solving and planning degrade as we focus solely on survival in the moment. In this state, the ability to think critically and reflect decreases.

• Sensitization to Fear: When trauma is prolonged, as in Jesse's case, the stress-response systems become sensitized, leading to a permanent state of fear. This constant state can impair functioning, even when the threat is no longer present.

3. State-Dependent Shifts in Brain Function:

• Adaptive vs. Maladaptive Responses: In a state of fear, brain activity shifts from higher-level brain functions (like the cortex) to more reactive, survival-oriented systems (such as the diencephalon and brainstem). These shifts help in situations of actual threat but become maladaptive in less-threatening environments, such as school or social settings.

• Default Mode Network (DMN): This network, primarily in the cortex, is active when we reflect on others, think about ourselves, recall past events, or plan for the future. Prolonged fear can suppress the DMN, reducing the ability to engage in these higher-order cognitive processes.

4. Trauma and Behavioral Impacts:

• Maladaptive Behavior in Non-Threatening Environments: Trauma-induced fear can result in behavior that is adaptive in a dangerous environment but maladaptive in a safe one. For instance, a child who grows up in a violent environment may struggle to function in school, where calm and thoughtful responses are required.

Misunderstanding Trauma and Its Impact:

• Trauma and Behavioral Labels: Children who have experienced trauma often display behaviors that are misinterpreted as mental health disorders:

  • Hypervigilance from the Alert state is mistaken for ADHD.

  • Resistance and defiance in the Alarm and Fear states are labeled as Oppositional Defiant Disorder (ODD).

  • Flight behaviors may lead to school suspensions.

  • Fight behaviors may result in assault charges.

• Impact on Systems: These misdiagnoses can have a profound impact on education, mental health, and the juvenile justice system, leading to inappropriate treatments and interventions.

2. Need for Trauma-Informed Systems:

• Trauma-Informed Care: Oprah emphasizes the importance of shifting from asking “What is wrong with you?” to asking “What happened to you?” This perspective can help recognize trauma-related behaviors and provide more compassionate, effective support.

3. Cynthia Bond’s Personal Journey:

• Prism of Pain: Cynthia Bond describes how she viewed the world through a "prism of pain" due to her traumatic experiences. She struggled with sleep, shame, and feelings of being broken.

• Self-Blame and Shame: Cynthia internalized a sense of inadequacy, feeling like there was something wrong with her character because she couldn’t “bounce back” from her trauma as others did. She believed she was flawed for not overcoming her struggles.

• Contemplating Suicide: At her lowest points, Cynthia even considered taking her own life, a common response for many dealing with untreated trauma.

• Diagnosis and Support: Cynthia was eventually diagnosed with depression and PTSD. While some people in her life were unsupportive or questioned her abilities, she eventually found the support she needed. This helped her learn that she wasn’t at fault for her trauma and that she could experience her feelings without being overwhelmed by them.

4. Recognizing the Link Between Early Trauma and Adult Patterns:

• Difficulty in Recognizing the Link: Many individuals have difficulty seeing how their early trauma influences their adult behaviors and decisions. This disconnection can make it challenging to heal and understand the depth of the impact trauma has on life choices.

Rationalizing and Avoiding Trauma:

• Rationalization and Avoidance: People often rationalize their behavior, thinking "that's just the way it is," or they attempt to quickly move past uncomfortable feelings through humor, unhealthy coping mechanisms, or by burying their emotions. Trauma is difficult to face and can remain unresolved for years.

2. Understanding Trauma:

• Definition of Trauma: Trauma refers to the lasting emotional shock from painful experiences. If left unexamined, it can have long-term physical, emotional, and social consequences.

• Impact on Decision-Making: Unresolved trauma can manifest in behaviors that appear to be poor decisions, bad habits, self-sabotage, or self-destruction. These behaviors are often misjudged by others but are deeply tied to the trauma experienced.

3. “What Happened to You?” vs. “What’s Wrong with You?”:

• Non-Judgmental Approach: Oprah and Dr. Perry emphasize the importance of asking “What happened to you?” instead of “What’s wrong with you?” to better understand and address trauma. This approach avoids blaming individuals for the outcomes of their trauma and focuses on understanding the root causes.

• Destructive Behaviors: Addiction, anxiety, depression, anger, job difficulties, and unhealthy relationships are often symptoms of unresolved trauma. At the core of many destructive behaviors is a deep sense of unworthiness.

4. The Perception of Unworthiness:

• Woundedness and Unworthiness: People who have experienced trauma may struggle with a core belief of being unworthy of happiness, even if they appear to have a successful or "perfect" life. This internalized sense of unworthiness affects everything they build in life.

• Healing and Hope: Despite these challenges, healing is possible. It requires recognizing trauma, understanding its impact, and taking gradual steps toward wellness.

5. The Prevalence of Trauma:

• Trauma Statistics: Dr. Perry discusses alarming statistics on trauma, noting that nearly 50% of children in the U.S. have experienced at least one significant traumatic event, and 60% of American adults report at least one adverse childhood experience (ACE). This is considered an underestimate by the CDC, highlighting the widespread nature of trauma.

6. Defining Trauma:

• Misuse of the Term “Trauma”: While the word "trauma" is frequently used, its true definition is not always understood. It is often thought of as a single bad event with lasting emotional consequences, but it can also refer to a pattern of emotional or behavioral changes resulting from significant distress.

• Historical Context of Trauma: The concept of trauma has existed for centuries. Early examples include Homer’s depiction of Ajax’s emotional deterioration in The Iliad, and later accounts of “shell shock” after World War I and other instances of combat-related trauma. These historical references show that the emotional impacts of trauma have been recognized for a long time.

7. Types of Adverse Experiences:

• Dr. Perry explains that adverse childhood experiences (ACEs) are a specific type of trauma, often involving neglect, abuse, or household dysfunction. ACEs can have significant, long-lasting effects on a person's health and behavior.

Trauma in Literature and Films:

• Many popular narratives, such as superhero origin stories, involve traumatic loss as a central theme.

• Trauma in Oprah’s Book Club: Oprah highlights that trauma is often a core element in her Book Club selections, citing Cynthia Bond’s Ruby and John Steinbeck’s East of Eden as examples of works exploring trauma, particularly transgenerational trauma.

2. Defining Trauma in Academia:

• Difficulty in Defining Trauma: Trauma is challenging to define academically due to the subjective nature of what constitutes a "bad event." The impact of trauma varies depending on individual experiences.

• Example of Trauma Response: The experience of trauma is subjective. For example, in a fire at an elementary school:

  • Veteran Firefighter: She may experience moderate stress, seeing the event as manageable and predictable.

  • Fifth-Grader: This child may feel temporarily stressed but returns to baseline after the event.

  • First-Grader: The child may experience prolonged stress, leading to trauma. The event triggers an intense, sustained stress response, affecting the child’s stress-response system.

• Different Reactions: The same event can lead to vastly different experiences and long-term effects for different people.

3. Key Factors in Trauma:

• The Stress Response: The nature and intensity of a person’s stress response, such as arousal (heightened alertness) or dissociation (emotional numbness), determines whether an experience becomes traumatic.

• Long-Term Effects: Whether an experience leads to long-term trauma depends on the individual’s stress-response system and how it is activated during the event.

4. The Challenge of Studying Trauma:

• Lack of Standard Definition: Studying trauma is challenging because it is difficult to define consistently. The three E’s of trauma—Event, Experience, and Effects—were developed to address this issue. Each of these components must be considered when studying trauma in research and clinical work.

5. Pandemic and Trauma:

• Pandemic as Trauma?: There’s debate over whether the global pandemic itself is traumatic for everyone. Some argue that experiences like not having a graduation ceremony or wearing a mask could be traumatic for some, while others, including Dr. Perry, suggest that these events may be difficult or tragic but aren't necessarily traumatic for everyone.

• Subjectivity of Trauma: The pandemic may not be inherently traumatic for everyone. The degree of trauma depends on individual experiences and perceptions.

Pandemic as a Shared Event, Unique Experience:

• Shared Event, Unique Experience: While the pandemic is a shared global event, it is experienced uniquely by each person. Not everyone will face the same challenges, such as illness, job loss, or the death of loved ones.

• Privilege and Vulnerability: Some will experience the pandemic with less hardship, revealing social privileges, while others, especially those with fewer resources, may be more vulnerable to trauma.

• Inequities and Magnification: The pandemic highlights existing inequalities, making the vulnerable more likely to face traumatic experiences. However, for many, the pandemic may be stressful but not traumatic.

2. Defining Trauma Beyond Obvious Events:

• Subtle Forms of Trauma: Trauma can stem not only from overtly harmful events like physical abuse but also from more subtle experiences, such as emotional abuse, humiliation, or the marginalization of minority children in majority communities.

• Stress-Response Systems: Such experiences can affect the brain and body over the long term, sensitizing the stress-response systems and leading to post-traumatic effects.

3. Factors Influencing Health Impact:

• Genetic and Environmental Factors: The long-term effects of trauma on health depend on factors like genetic vulnerability, the developmental stage at which the trauma occurred, prior experiences, family history, and the presence of supportive relationships and communities.

• Regulation and Balance: Understanding how stress impacts regulation and balance is crucial to understanding how trauma affects mental, physical, and social health.

4. Impact of Childhood Adversity on Mental Health:

• Childhood Adversity: Childhood adversity is linked to a significant portion of mental health disorders. Studies show that 45% of childhood mental health disorders and 30% of adult mental health disorders are related to early trauma or adverse childhood experiences (ACEs).

• Increased Risk: ACEs are associated with a higher risk for mental health problems such as depression, anxiety, schizophrenia, and other psychotic disorders.

5. Adverse Childhood Experiences (ACEs) Study:

• The ACE Study: The original ACE study, published in 1998, included a questionnaire on ten adversities experienced during childhood. The study showed that a higher ACE score correlated with a greater risk for physical, mental, and social health issues in adulthood.

• Health Risks: Individuals with higher ACE scores were found to have increased risks for major health problems, including suicide, mental health disorders, substance abuse, and other significant health issues.

• Replication and Importance: The study has been replicated multiple times, confirming its findings and making it one of the most important epidemiological studies. However, it faced initial pushback and has often been misunderstood.

6. Misunderstandings and Criticisms of the ACE Study:

• Sample Bias: The original study’s sample was predominantly white and middle-class, which led to criticisms regarding its applicability to other demographic groups.

• Limited Adversities: The ACE questionnaire focused on just ten adversities, which excluded many other potentially traumatic experiences.

• Correlation vs. Causation: A common misunderstanding is confusing correlation with causation. A higher ACE score increases the risk for certain health issues, but it does not guarantee they will occur.

• Analogy of Correlation: Dr. Perry uses the analogy that not all tall people are good basketball players, and not all good basketball players are tall, emphasizing that a higher ACE score increases risk but doesn’t ensure outcomes.

Correlation vs. Prediction:

• ACE Score as a Risk Indicator: Just like a group of six-foot-five athletes is likely to perform better in basketball, a higher ACE score indicates a higher likelihood of struggling with health or psychological issues. However, it does not guarantee these outcomes.

• Not Deterministic: A higher ACE score means greater risk, but many people with high ACE scores can still be healthy, productive, and successful. Conversely, some with lower ACE scores may face significant struggles.

2. Limitations of the ACE Score:

• Limited Predictive Power: The ACE score, while useful for understanding patterns at a population level, doesn’t predict individual outcomes. It gives a superficial glance at a person's past but lacks the depth needed for personal insight or clinical assessment.

• Personal Stories Matter: Understanding trauma and its effects requires a more nuanced and detailed exploration of a person’s unique experiences. The ACE score, a numerical value based on a questionnaire, does not capture the complexity of an individual’s personal journey or the deep impacts of their specific adversities.

3. Analogy to Interviews:

• Superficial Assessment: The passage draws an analogy with an interview process where handing out a form with ten questions (similar to the ACE questionnaire) and assigning a number would fail to tell the full story of the individual. In the same way, an ACE score doesn’t capture the nuanced, individual experiences that shape a person’s health and life trajectory.

What the ACE Score Misses:

• Timing, Pattern, and Intensity of Stress: The ACE score doesn’t account for when trauma occurs (timing), how it unfolds (pattern), or its intensity. These factors are critical in determining the long-term impact on an individual’s health.

• Buffering and Healing Factors: The ACE score also fails to include the presence of positive, supportive relationships or healing factors that can mitigate the effects of adversity. This makes the ACE score an incomplete tool for understanding the full impact of trauma.

2. Relational Health and Connectedness:

• Importance of Relationships: One of the findings from over seventy thousand cases in twenty-five countries is that the quality of relationships—how connected a person is to family, community, and culture—is more predictive of mental health than a history of adversity. Positive relational health can buffer the negative effects of adversity.

• Counterbalancing Adversity: Strong, supportive relationships can significantly counteract the harmful effects of trauma and adversity, offering resilience and recovery.

3. Timing of Adversity:

• Early Trauma is More Impactful: The timing of trauma is crucial. Experiencing trauma at an early age (e.g., age two) has a much greater impact on health and development than the same trauma occurring at a later stage (e.g., age seventeen). Early trauma can disrupt the foundational development of brain systems responsible for stress regulation.

• Impact of Early Childhood: The first two months of life are especially critical, as this period marks rapid brain development. If adversity is experienced early with minimal relational support, it can have disproportionately negative long-term effects compared to the same adversity occurring later in life.

4. Developmentally Informed Systems:

• The Role of Caregivers and Systems: Early adversity can lead to a sensitized stress response, causing long-term difficulties. Even if the child later enters a healthier environment, the early trauma can have lasting effects. It is essential for caregivers, educators, and healthcare providers to recognize the developmental context of trauma.

• The Danger of Misunderstanding: If caregivers and professionals fail to view the child’s struggles through a trauma-informed lens and focus instead on the child’s behavior with a "What is wrong with you?" mentality, it can hinder effective interventions. Without an understanding of the developmental and trauma-related factors, children may continue to face difficulties despite being in a safer environment.

5. Implication for Interventions:

• The Need for Trauma-Aware Systems: To help children who have experienced early adversity, systems need to be informed by developmental and trauma research. Interventions should focus on addressing the root causes of emotional reactivity and behavioral issues, rather than just treating the symptoms.

6. Encouraging Resilience:

• While the early experiences of trauma are critical, the passage emphasizes that poor outcomes are not inevitable. With developmentally informed, trauma-aware support systems, children who experience early trauma can still thrive and recover.

Connectedness vs. Adversity:

• High Connectedness, Low Adversity: Children with supportive relationships (connectedness) and low adversity are at a lower risk for mental, social, and physical health problems. This balanced environment fosters healthier developmental outcomes.

• High Adversity, Low Connectedness: On the other hand, children who experience high adversity with minimal relational support face an increased risk of significant problems in their overall health. The lack of support in the face of adversity exacerbates the impact of trauma.

2. The Importance of Reframing Perspectives on Trauma:

• The passage highlights the need to shift from asking “What is wrong with you?” to “What happened to you?” when dealing with children or individuals struggling with trauma. This change in perspective would help caregivers and professionals better understand the root causes of behaviors and struggles, rather than labeling children based on their symptoms.

• Systems such as homes, schools, healthcare, and mental health systems should focus on this more compassionate and insightful approach.

3. Early Childhood: A Critical Period:

• The text emphasizes the power of early childhood experiences, especially the first few months of life. Providing consistent, predictable support during this time can have a profound positive effect on a child’s development, laying the groundwork for resilient stress-response systems.

• These early positive interactions help regulate stress-response systems, which in turn promotes healthy brain development.

4. Brief but Positive Caregiving Interactions:

• Dr. Perry notes that even brief, positive caregiving interactions in early childhood can have long-lasting effects. For example, some children studied had only two months of attentive care at the start of their lives before their environment became chaotic and traumatic. Despite the subsequent years of instability, they performed better than children who initially suffered trauma and neglect but later experienced years of attentive care.

• Timing is key: early trauma followed by years of caregiving does not have the same developmental benefits as initial positive care followed by adversity.

5. The Power of Early Intervention Programs:

• Even short bursts of positive interaction can have a significant impact on a child’s development. Early intervention programs that provide brief doses of positive, supportive interaction can be highly effective in fostering resilience and mitigating the impact of trauma.

6. Healing from Trauma:

• A critical question arises: if a child doesn’t get the necessary support in the early years, can they still heal from trauma? Dr. Perry provides an optimistic answer: Yes, healing is possible. This is a theme that will be explored in more detail later, but the message here is that the brain's neural networks involved in relational connection and regulation can be responsive to therapeutic moments.

• For individuals with intense trauma, even small moments of meaningful therapeutic interaction can have a profound impact, challenging the idea that only long, structured sessions are effective.

7. The Intensity of Trauma and Healing:

• Dr. Perry notes that when dealing with trauma, particularly in young children, the "tolerable dose" of therapeutic interaction may be much shorter than expected—sometimes only a few seconds. This highlights how quickly the brain reacts to emotional intensity, and the importance of pacing therapeutic interventions to avoid overwhelming the individual.

8. The Case of a Three-Year-Old:

• Dr. Perry refers to a personal example of a three-year-old boy he worked with, suggesting that the behaviors exhibited by the child could provide further insight into the dynamics of healing and trauma.

The Story of the Boy’s Suicide Attempt:

• The three-year-old boy, after his mother was killed in a home invasion, expressed suicidal behavior by running into traffic shortly after being asked about his mother’s death by his father.

• The father had good intentions, trying to help his son process the trauma by encouraging him to talk about his mother. However, the timing and intensity of the emotional revisit were not controlled by the boy, leading to overwhelming distress.

2. Arousal and Emotional Regulation:

• When the boy’s trauma was evoked by his father’s questioning, his brain’s arousal systems were activated, leading to a shutdown of the higher thinking parts of his brain. This left the primitive parts of his brain in control, prompting the boy to rock himself, moan, and cover his ears—all attempts to self-regulate the overwhelming emotions.

• His behavior was not a deliberate choice to harm himself, but a fight-or-flight response triggered by the emotional overload.

3. The Power of Therapeutic Dosing:

• Dr. Perry emphasizes that therapeutic moments must be brief and controlled by the individual to help reset the brain’s response to trauma. In this case, the boy needed a brief, controlled interaction to revisit his mother’s death, not prolonged probing that could overwhelm him.

• The short, five-second interaction with the checkout clerk, where the boy briefly expressed his grief and received reassurance, was enough to manage the emotional impact at that moment. This brief, self-controlled interaction could serve as the start of emotional regulation.

4. Therapeutic Dosing in Everyday Life:

• Just like the boy, adults also benefit from small doses of emotional processing. Dr. Perry draws a parallel to how people handle difficult emotions—often by having brief, emotionally charged conversations, then stepping back to distract themselves, and returning to the topic later.

• Oprah shares her own experience with her close friend Gayle King, highlighting how their daily conversations provide a form of emotional dosing. They both support each other by briefly addressing difficult topics and circling back when ready, which is also an example of healing through brief, meaningful moments.

5. Healing Through Connection:

• The therapeutic process involves moments of deep connection, where people engage with each other in a supportive, present, and brief way, without overwhelming the emotional system.

• This approach to therapy isn’t about long, intense sessions, but about consistent, powerful moments of connection and understanding, much like how friends or loved ones provide support in everyday life.

The Role of Positive Human Interaction:

• Oprah and Dr. Perry explore how positive interactions—those that validate and reassure a person—are nurturing and help with emotional regulation. For the boy in the story, brief positive interactions helped him process the trauma and rebuild his emotional resilience over time.

• Oprah reflects on the value of having someone who reassures you that your feelings are valid and that your reactions are understandable given what you've experienced. This reinforces that emotional reactions to trauma are reasonable and part of a normal recovery process.

2. The Importance of Long-Term, Positive Interactions:

• While formal therapy lasted about a year, Dr. Perry emphasizes that the boy’s healing came primarily from thousands of small, positive interactions over the years—interactions with family, friends, teachers, and others in his life. These daily therapeutic moments helped him grow into a healthy, resilient young man, despite the early trauma of losing his mother.

• Dr. Perry uses the concept of “therapeutic moments”—brief, positive interactions that offer emotional regulation, healing, and bonding. These moments accumulate over time, providing consistent support that helps individuals recover from trauma.

3. Post-Traumatic Stress Disorder (PTSD):

• Oprah asks about PTSD, and Dr. Perry explains that trauma can cause PTSD at any age. PTSD involves intrusive and avoidant symptoms, which stem from the mind’s efforts to cope with traumatic experiences.

• Intrusive symptoms include recurring, unwanted thoughts, memories, and dreams about the trauma. This happens because the traumatic event is so overwhelming that it shatters the person’s worldview, leaving them to rebuild their inner sense of safety. The process of revisiting the trauma, whether through dreams, intrusive thoughts, or reenactment, is part of how the brain tries to make sense of the world after it has been disrupted by the trauma.

• Avoidant symptoms occur when someone avoids people, places, or reminders of the traumatic event because they are distressed by these cues. These symptoms are part of the brain’s defense mechanism to protect the individual from being reexposed to overwhelming emotional triggers.

4. Healing from Trauma:

• Dr. Perry emphasizes that healing is a process that requires time and multiple interactions—whether through therapy or the natural, supportive connections we have with others. The boy’s recovery wasn’t just about the formal therapy sessions but the ongoing, gentle, validating interactions that helped him rebuild a sense of safety and emotional balance.

• He likens the process of healing to sifting through the wreckage of a shattered worldview and rebuilding it piece by piece. This rebuilding involves revisiting painful memories in small doses, integrating them into a new, safer reality, and ultimately creating a new, healthier worldview.

5. Therapeutic Dosing in Everyday Life:

• Oprah’s relationship with Gayle King serves as an example of therapeutic dosing. Their daily conversations, which involve discussing difficult moments in small, manageable parts, mirror the healing process of revisiting trauma at a pace that’s tolerable and supportive.

• This illustrates that emotional regulation and healing don’t require long, intense therapy sessions, but rather a continuous series of small, meaningful interactions that allow a person to process their experiences in safe, nurturing ways.

Avoidant Behaviors as a Coping Mechanism:

• Dr. Perry discusses how avoidance of situations that remind a person of their trauma is an important coping mechanism. For example, Mike Roseman avoided Fourth of July celebrations due to his trauma being triggered by fireworks (a specific evocative cue). Avoidance helps regain a sense of control over the uncontrollability felt during the traumatic experience.

• Avoidant behaviors are often a dissociative response, where people attempt to protect themselves from emotional distress by disengaging from distressing situations. These behaviors can be protective but also limit emotional growth and connection.

• Avoidance can sometimes be unconscious, particularly in cases of trauma that occur during early caregiving relationships. Children who are abused by a caregiver may avoid intimacy later in life because closeness feels threatening, even if they long for connection. This is a common effect of developmental trauma, where emotional and physical closeness is associated with danger rather than safety.

2. Evocative Cues and Trauma Responses:

• Dr. Perry explains that evocative cues (like the sound of fireworks or gunfire) can trigger trauma responses. These cues are linked to specific stress responses that were activated during the trauma itself. The response to these cues can differ based on the nature of the trauma and the individual’s unique coping mechanisms.

• For example, Mike Roseman experienced an arousal response (heightened anxiety, increased heart rate) when hearing a motorcycle backfire because it reminded him of gunfire during combat. However, Bisa, a woman who survived brutal violence during the Rwandan Civil War, responded to gunfire with a dissociative shutdown—her heart rate slowed, and in extreme cases, she lost consciousness. This illustrates how different individuals process trauma in distinct ways.

3. Dissociative Response:

• Dr. Perry uses the example of a photojournalist at a refugee camp to describe how some trauma survivors, particularly those who experienced intense, inescapable pain, may react to loud noises with dissociative responses. Survivors of the Rwandan Civil War fainted when they heard gunfire because they had learned to shut down emotionally as a way to protect themselves from overwhelming trauma.

• Dissociative responses are one of the extreme reactions that can happen in PTSD, where individuals attempt to escape emotionally from an intolerable situation. This can involve fainting, feeling disconnected from the body, or becoming numb to painful emotions.

4. The Four Clusters of PTSD Symptoms:

• Dr. Perry reviews the four clusters of PTSD symptoms:

  • Intrusive Symptoms: Repeated, unwanted thoughts, memories, and dreams about the trauma, often linked to the mind’s efforts to make sense of the traumatic event.

  • Avoidant Symptoms: Efforts to avoid reminders of the trauma, such as certain places, people, or situations that bring the trauma to mind.

  • Changes in Mood and Thinking: Symptoms include depression, loss of interest in activities, excessive guilt, and a negative outlook on life. This also includes emotional and physical exhaustion, where the person feels drained from the emotional weight of the trauma.

  • Alteration in Arousal and Reactivity: This cluster involves hypervigilance, an exaggerated startle response, increased heart rate, anxiety, and trouble sleeping. These symptoms result from the stress-response systems being overactive due to the trauma.

5. Arousal and Reactivity in PTSD:

• The arousal and reactivity cluster is related to the sensitized stress-response networks in the brain. After trauma, the brain remains on high alert, leading to exaggerated reactions to even minor stressors. This can manifest as:

  • Anxiety or constant worry

  • Hypervigilance (always being on edge or alert)

  • Increased startle response (e.g., jumping at loud noises)

  • Variable heart rate and sleep disturbances, including nightmares or insomnia.

The Broader Effects of Trauma Beyond PTSD:

• Dr. Perry highlights that trauma doesn't always manifest as PTSD. While PTSD is a well-known mental health condition, trauma can affect individuals in many ways, and often, the long-term effects of trauma are not classified as PTSD. Other common impacts of trauma include depression, anxiety, and attachment disorders. These conditions may not be as directly linked to trauma as PTSD but are significant in terms of mental and physical health.

• Oprah reflects on the widespread nature of trauma, noting that if there are fifty million children who have experienced trauma, then countless millions of adults are also carrying that trauma, affecting their personal lives, relationships, and even their parenting. This trauma may be unrecognized by those who carry it, further compounding its impact.

2. The Generational Impact of Trauma:

• Dr. Perry emphasizes the intergenerational transmission of trauma, where the trauma experienced by one generation affects the subsequent generation. Parents who experienced trauma may unintentionally pass on its effects to their children through their caregiving behaviors. For example, caregivers who themselves were traumatized as children might not fully understand their actions or emotional responses, which can negatively impact their own children.

• The effects of trauma, therefore, stretch far and wide across generations and communities. Understanding this can help shift the perspective from blame to compassion—recognizing that trauma may be behind behaviors that seem inexplicable or difficult to understand. A central question in addressing trauma is: “What happened to you?”—rather than focusing on what’s wrong with the person.

3. The Personal Impact of Unresolved Trauma:

• Dr. Perry shares a personal story about his own struggles with trauma, specifically fear and anxiety. Despite living in a secure, high-rise building, he would feel intensely unsafe at night, to the point of leaving his home and checking into a hotel. These feelings seemed irrational to him, but he could not ignore them.

• The trauma he experienced was not linked to a specific event he could recall, but the feeling of fear remained unresolved. This situation reflects how unresolved trauma can manifest in irrational fears or emotional responses that don’t seem to make sense in the present moment but are rooted in past experiences.

4. A Triggering Memory from Childhood:

• While reading about the school shooting in Winnetka, Illinois, Dr. Perry unexpectedly began to cry, not only for the tragedy that occurred but because the words of a school principal triggered a long-forgotten childhood memory.

• The memory was of a traumatic event involving his grandfather, who had dementia and became violent one night. Dr. Perry’s grandmother was frightened, and the fear in her voice triggered a sense of anxiety in Dr. Perry. This story reveals how triggers (such as the mention of children being unsafe) can bring up memories of past trauma that had been buried for years, revealing the power of emotional triggers in healing and understanding trauma.

5. The Unpredictable Nature of Trauma and Triggers:

• Dr. Perry’s experience illustrates how trauma can lie dormant for years, only to be triggered unexpectedly by seemingly unrelated events. It also points to the complexity of trauma and its effects: the memory or trauma may not always be easily recalled, but the emotional response remains, sometimes surfacing years later when an evocative cue triggers it.

The Impact of Childhood Trauma:

• Dr. Perry recounts a deeply personal and formative experience from his childhood involving his grandfather’s violent behavior and the precautions his grandmother took to protect herself and Dr. Perry. After an incident where her husband attempted to choke her, she took drastic steps to ensure safety, including wedging a chair under the bedroom door and hanging cans around the door. The cans would alert her if the door was tampered with, symbolizing a constant state of alert.

• This experience traumatized Dr. Perry and left a lasting emotional scar. Even as an adult, he found himself living in a state of heightened arousal, constantly prepared for an attack, especially when he was alone at night. It wasn’t until he connected the dots—recognizing that the trauma he experienced in his grandmother’s bedroom was the cause of his ongoing fear—that he was able to start addressing it.

2. The Message of Fear:

• Dr. Perry connects this experience with a broader concept of how trauma shapes our responses and behaviors. He references the story of a school principal who resisted barricading doors after a school shooting, fearing that it would send a message of unsafety to the children. Similarly, the cans on the door in his grandmother’s bedroom reinforced a constant state of alert, making them always aware of potential danger, even though they were supposed to be in a place of safety (their bedroom).

• The key realization for Dr. Perry was that the trauma created by his grandfather’s attack conditioned his mind to remain in a constant state of hyper-alertness, a pattern that persisted into adulthood. Understanding the connection between the traumatic event and his ongoing fears allowed him to gain greater control over his emotional reactions.

3. Creating Space Between Reaction and Emotion:

• Dr. Perry explains that once we understand the root cause of our emotional responses, we can begin to create a space between our initial instinctive reactions and our actual response to a trigger. This space allows us to stay present and consciously choose how to navigate the fear or stress, rather than being driven by it.

• This concept is crucial in trauma recovery: by gaining awareness of the triggers and the origins of our emotional responses, we can break free from automatic reactions and regain a sense of control over how we deal with fear and anxiety.

4. Inherited Fear:

• Oprah asks whether a heightened sense of fear can be inherited, and Dr. Perry responds with a broader perspective. He explains that trauma can be passed down through generations, not just through direct experience but also through cultural and familial dynamics. He refers to this as transgenerational transmission.

• Fear of dogs is used as an example. While some people may have a fear of dogs because of a direct negative experience (e.g., being bitten), others may have no such experience yet still exhibit a strong fear of dogs. Dr. Perry suggests that this fear might stem from historical trauma, such as the use of slave hounds during slavery to control and terrorize Black people. The trauma of encountering these dogs during slavery was passed down through generations, creating a transgenerational fear.

• This type of fear can be further transmitted through emotional contagion, where children pick up on the fears or anxieties of their parents or grandparents. If a child sees their parent reacting with fear to a dog, the child may internalize that fear as well, even without a direct traumatic experience with dogs themselves.

5. The Role of Cultural and Familial Influence:

• Dr. Perry expands on the idea that fear, like other emotional responses, is influenced by more than just personal experience. It is shaped by family dynamics, community history, and societal events. In the case of fear of dogs, the historical trauma associated with dogs during slavery and later during the civil rights movement (when dogs were used to intimidate marchers) created a cultural memory of fear that was passed down through generations.

• As a result, fear can be not just an individual response to a personal event but a collective experience, influenced by the wider cultural context in which people live.

The Inheritance of Emotional Traits:

• Dr. Perry agrees with Iyanla Vanzant's perspective that emotional patterns, such as fear, can be passed down through generations in much the same way that physical traits are inherited. However, genetics plays a more complicated role here, and the transmission of emotional traits is not purely genetic.

• Fear, for example, is not directly encoded in our genes. But emotional traits such as fearfulness can be transmitted through behavioral and social channels. The experience of a parent, particularly how they react to stress or danger, can affect the child’s emotional responses.

2. Emotional Contagion:

• The concept of emotional contagion is crucial here. Humans are relational beings, constantly tuned into and affected by the emotions of others, especially those they are most closely connected with (like family members).

• Dr. Perry describes how children are particularly susceptible to picking up the emotions of the people around them. This means that if a parent or caregiver is fearful, that fear is likely to be “caught” by the child, shaping the child’s emotional responses and behaviors. For Oprah, the fear of her grandmother during the traumatic event with her grandfather was transmitted to her, changing her on a deep emotional and cellular level.

3. Generational Trauma and Cultural Impact:

• Oprah reflects on how the trauma experienced by the African American community, particularly stemming from slavery, has been internalized across generations. The trauma of racism, segregation, and brutality has left a deep imprint on the community, affecting individuals both personally and collectively. This transgenerational trauma has perpetuated cycles of pain and fear, not only on the individual level but also at the societal level.

• The Black Lives Matter movement in 2020 is highlighted as an example of this collective trauma reaching a boiling point, where both individuals and society as a whole were pushed to an apex of pain that demanded attention and change.

4. Transmission of Beliefs and Values:

• Dr. Perry elaborates on how beliefs and values are passed down, emphasizing that these are learned and absorbed through social interaction, not through genetic inheritance. For example, a child growing up in a household that speaks Spanish doesn’t inherit Spanish genetically. Instead, they learn the language through constant interaction with their family and community.

• Similarly, traits like altruism are not directly coded in our genes but are cultivated and passed on through cultural and social systems. Beliefs about religion, family values, and society are absorbed through these processes and can be intentionally transmitted from one generation to the next.

5. The Role of Early Life Experiences:

• Dr. Perry emphasizes that early life experiences are particularly formative. Children’s brains are incredibly malleable in early development, meaning that the emotions, behaviors, and beliefs they are exposed to in childhood shape the way their brains are wired. This underscores the importance of the environment and caregivers in shaping how children respond to the world and how these responses might later be passed down.

6. Intentional Change:

• Oprah and Dr. Perry suggest that if we can better understand how trauma, fear, and other emotional traits are passed down, we can make intentional changes both on an individual level (such as healing from personal trauma) and on a cultural level (such as challenging harmful societal structures or policies, like those that perpetuate racism). Understanding the pathways of emotional transmissibility is key to breaking these cycles of trauma and making real progress in healing and change.

Racism as a Learned Behavior:

• Dr. Perry begins by explaining that while certain traits, such as wariness or defensiveness in unfamiliar situations, may have genetic origins, racism itself is not innate. Racism is a learned set of beliefs that involves a belief in the superiority of one group over another.

• Racism in practice is about power, dominance, and oppression—elements that are culturally learned and reinforced, not biologically inherited. This highlights that societal structures and ideologies, including racism, are not natural or inevitable but rather socially constructed.

2. The Role of Human Brain in Sociocultural Evolution:

• The human brain, particularly the cortex, is central to sociocultural evolution. Dr. Perry highlights that the cortex enables uniquely human capabilities, including speech, language, abstract thinking, and the ability to reflect on the past and plan for the future.

• Humankind is capable of passing down accumulated knowledge, beliefs, and inventions to the next generation, allowing each generation to build on the experiences and innovations of previous ones. This transmission occurs through social learning, where children learn from their elders, incorporating both skills and values into their worldview.

3. Negative Beliefs and the Need for Intentional Change:

• Oprah asks how we can address negative worldviews that are passed down through generations. Dr. Perry responds that awareness of how our world influences us is the first step. Society, through media, institutions, and communities, often perpetuates biases, including superiority and oppression, in subtle but powerful ways.

• The brain's malleability plays a key role in this process: just as children can be taught to read through repetitive practice, they can also absorb beliefs—both positive and negative—through their exposure to influential adults and the environment around them.

4. Transmission of Beliefs:

• Dr. Perry emphasizes that beliefs, whether compassionate or hateful, are transmitted in the same way that skills are passed on. Through repeated exposure and social interaction, children’s brains absorb these beliefs, shaping their worldview.

• For example, if children grow up in an environment where diversity is celebrated, they are more likely to internalize inclusive and humane beliefs. Conversely, if they are raised in an environment that promotes fear or judgment of those who are different, they may absorb hateful or biased beliefs.

5. Intentional Disruption of Generational Bias:

• Dr. Perry suggests that generational transmission of bias can be disrupted if we are intentional about the values and beliefs we expose children to. We must consider every influence in a child's environment: from the media they consume, to the people they interact with, to how we treat others who are different.

• Making a conscious effort to expose children to diverse perspectives and celebrate differences can help reduce the transmission of destructive beliefs.

6. Everything Matters:

• Oprah concludes by emphasizing a profound realization she has had over time: everything matters. The way we live, the messages we send, and the environments we create for future generations all contribute to shaping their worldview. This insight underscores the responsibility each individual and society has in fostering a more inclusive and compassionate future.

Generational Influence:

• Dr. Perry emphasizes that everything experienced by an individual—whether it’s their own life experiences or the echoes of their ancestors’ experiences—shapes the way they think, feel, and behave. This intergenerational transmission influences health and well-being, and it’s important to recognize that our actions today will also affect future generations.

• Oprah underscores the ripple effect of our actions, stressing the importance of being mindful of how we influence not only our own lives but also the lives of those who will come after us.

2. Genetics and Stress Response:

• Dr. Perry responds to the question about whether heightened fear can be inherited by pointing out that genetic mechanisms play a significant role in shaping how an individual’s stress-response system functions. Some people are born with a genetically influenced capacity for hardiness, allowing them to withstand a wider range of stressors. These individuals are less easily dysregulated.

• On the other hand, some individuals are born with a sensitive stress response, making them more susceptible to being overwhelmed by relatively minor changes in their environment. This trait can manifest as a “difficult to soothe” temperament noticeable from birth.

3. Epigenetics: The Mechanism of Gene Expression:

• Dr. Perry introduces the concept of epigenetics, explaining that while every cell in the body has the same genetic material, not every gene is active in every cell. For example, muscle cells activate genes specific to muscle function, while other cells like blood or brain cells have different sets of active genes.

• Epigenetic changes occur when environmental factors, such as starvation, trigger the activation or deactivation of specific genes. This allows the body to adapt to the current situation—such as turning on genes that help the body process energy more efficiently during times of scarcity.

• Epigenetic changes are heritable, meaning they can be passed down from one generation to the next through egg or sperm cells, even though the underlying DNA itself remains unchanged. These molecular adaptations can persist through generations, allowing offspring to inherit traits that were advantageous in their ancestors’ environments.

4. Trauma and Epigenetic Adaptations:

• Dr. Perry offers an example of how extreme generational trauma, such as the brutalization experienced by enslaved Africans, could lead to epigenetic changes that alter how a person's stress-response system functions. These adaptive changes would have helped survivors of such traumatic experiences cope with their harsh, unpredictable environment.

• However, these epigenetic adaptations could come with a cost. Over generations, the sensitivity of the stress-response network may increase, making future generations more prone to heightened stress reactions. This adaptation, once beneficial, could become maladaptive in a different environment, where the trauma is no longer as immediate or pervasive.

• An infant born into such a lineage might have a stress-response system that is already primed for trauma, preparing the child for a world that feels chaotic and threatening, even if that world is not as perilous.

5. Impact of Generational Trauma:

• Dr. Perry concludes by highlighting the long-term effects of intergenerational trauma. Traumatized ancestors may undergo significant biological changes that prepare them for survival in harsh conditions, but this can carry forward to their descendants, even in contexts where the initial threat is no longer present. This creates a cycle where individuals remain overly sensitized to stress, even when their environment may no longer require such an acute response.

Epigenetic Influence on Worldview:

• Dr. Perry explains that if the world is no longer as chaotic or threatening, the epigenetic changes that primed a child for survival in a harsh environment could distort their worldview. For example, an infant born into a lineage of trauma might develop a perception of the world as unpredictable and threatening, even if their immediate environment doesn’t reflect this.

• However, this can be reversed. The brain remains changeable—epigenetic changes are reversible, so nurturing interactions can counteract the negative effects of past trauma and help the individual adapt to a new environment.

2. Understanding “What Happened” vs. “What’s Wrong”:

• Oprah highlights the importance of focusing on what happened to someone, rather than what’s wrong with them. Trauma, particularly developmental trauma, can deeply affect emotional and behavioral patterns, often without people realizing that their issues stem from experiences outside of their control.

• Many people have not had the opportunity to explore their past trauma and may not understand how it continues to influence their mental and physical health. Recognizing the impact of past trauma can help individuals gain a clearer understanding of their struggles and foster a more compassionate perspective.

3. Connection and Relationships:

• Dr. Perry points out that developmental trauma can disrupt the ability to form and maintain relationships. Attachment, or the ability to connect with others, is vital to our well-being, and trauma can alter the neural networks responsible for reading and responding to people. As a result, individuals who have experienced trauma may struggle with friendships, intimacy, family dynamics, and even work relationships.

• These difficulties in maintaining relationships often lead to isolation, disconnection, and loneliness, which can further contribute to mental health and physical health problems.

4. Physical Health and Trauma:

• Trauma can significantly affect physical health, increasing the risk for conditions such as heart disease, asthma, gastrointestinal problems, and autoimmune diseases. Dr. Perry emphasizes that the physical and emotional aspects of health are intertwined.

• A key example Dr. Perry discusses is diabetes, which has become a global health crisis. He explains that trauma can alter the regulation of the body’s core regulatory networks (CRNs), affecting how the body regulates blood sugar and insulin, both of which are critical in the management of diabetes. Trauma is therefore a significant factor in both the risk and management of diabetes.

5. Physical and Emotional Health Are Interconnected:

• Oprah notes the common misconception that conditions like diabetes are strictly biological. Dr. Perry argues that emotional health and physical health are deeply connected. Understanding this connection is vital for healthcare providers, including family physicians and doctors across all fields, to effectively treat patients. By considering emotional and developmental history, healthcare professionals can make more accurate diagnoses and create treatment plans that address both physical and emotional health.

The Biological-Psychological Divide:

• Dr. Perry critiques the biological vs. psychological distinction commonly made in healthcare, particularly when it comes to trauma-related physical symptoms. For instance, conditions like recurrent abdominal pain in children are often dismissed as “non-organic” (or psychosomatic) by the medical community. This is a harmful view, as it implies the pain is "all in the patient's head."

• The reality, as Dr. Perry explains, is that trauma can cause biological abnormalities in the body. For example, sensitized dissociation can lead to physical pain, like abdominal discomfort, that is rooted in trauma. Understanding neurobiology reveals that emotional and psychological experiences can have a direct impact on physical health, thus dissolving the false separation between the two.

2. Belonging and Disconnection:

• Dr. Perry underscores that belonging is biologically essential. Connection with others is a core human need, and when trauma disrupts a person’s ability to connect, it destabilizes their health. The consequences of disconnection, often caused by trauma, can harm every system in the body, including the immune system, cardiovascular system, and hormonal regulation.

3. Case Study: Tyra’s Diabetes and Trauma:

• Dr. Perry shares the case of Tyra, a 16-year-old girl with Type 1 diabetes who was admitted to the hospital after a diabetic coma. Tyra’s blood sugar levels were erratic, and the medical team struggled to determine the correct insulin dose, suspecting her of manipulating her insulin or engaging in self-destructive behavior by secretly eating sweets.

• During the consultation, Dr. Perry realized that Tyra’s physical symptoms (e.g., the spikes in her blood sugar levels) were connected to emotional trauma rather than intentional mismanagement. Tyra became visibly distressed upon hearing a siren, which triggered an emotional response linked to a traumatic event she had experienced just weeks earlier.

4. The Siren Trigger and Emotional Response:

• Tyra, while appearing positive and cooperative, had an intense emotional reaction to the sound of the siren. Dr. Perry took her pulse, which was high—a physical indicator of her heightened emotional state. As the conversation unfolded, Tyra revealed that a traumatic event had occurred two weeks earlier, which involved witnessing an incident that triggered her anxiety.

• Tyra’s emotional response to the siren (a seemingly harmless sound) illustrates how trauma can be stored in the body and trigger physiological reactions long after the trauma has occurred. Her body’s response to the siren was not only psychological but also biological.

5. Trauma and Health Complications:

• The medical team’s inability to understand the emotional roots of Tyra’s physical symptoms led to confusion and misinterpretation of her condition. This highlights how trauma can complicate the treatment of physical illnesses, especially when healthcare providers fail to consider the psychosocial context of a patient's symptoms.

• Dr. Perry’s approach, focusing on the connection between emotional states and physical health, helped Tyra’s medical team understand the underlying causes of her physical symptoms. By addressing the trauma, they could begin to better understand and manage her diabetes.

Tyra’s Traumatic Experience:

• Tyra describes witnessing a violent event where her friend, Nina, was shot. Tyra's account of the sudden shock of the moment and her physical reaction to hearing the sirens highlights the lasting impact trauma can have on the body.

• Tyra’s heart rate was 160 bpm, indicating she was in a state of fear. The physiological response to trauma, such as rapid heart rate, is part of the fight-or-flight stress response, which can remain activated long after the trauma has occurred.

2. Connection Between Trauma and Blood Sugar Regulation:

• Dr. Perry explains that stress and fear activate the sympathetic nervous system, releasing adrenaline. Adrenaline triggers the release of stored sugar (glucose) in the blood to prepare the body for fight or flight. However, this can disrupt the regulation of blood sugar, particularly for someone with diabetes like Tyra.

• The stress response from Tyra's trauma caused episodic blood-sugar spikes every time she heard sirens or encountered any reminder of the traumatic event. These emotional triggers led to fluctuating insulin requirements, which the medical team couldn’t initially explain.

3. Medical Misunderstanding:

• The medical team misunderstood Tyra’s symptoms as intentional manipulation or neglect of her insulin regimen. They didn’t consider that trauma and the stress response could be influencing her insulin management.

• Dr. Perry’s approach was to ask what happened to Tyra rather than assuming she was “doing something wrong.” Once Tyra’s trauma history was understood, the treatment plan was adjusted, including moving her to a quieter area of the hospital where she wouldn’t hear sirens, and therapy to help her heal.

4. The Dismissal of Trauma’s Impact:

• Dr. Perry points out that trauma has historically been underappreciated in medicine. Trauma-informed care was almost nonexistent twenty years ago, and the role of developmental adversity in mental and physical health is still not widely acknowledged today.

• When patients with a history of trauma present with chronic pain (e.g., abdominal pain, headaches, chest pain), doctors often label these symptoms as "functional" or "psychological", dismissing the underlying trauma. This leads to misunderstanding and mistreatment, exacerbating the patient’s suffering.

5. The Concept of Sequential Processing in the Brain:

• Dr. Perry explains how the brain processes sensory input in a sequential manner. The brain’s lower regions, which are responsible for basic survival functions, process sensory information first. These regions then compare the incoming data to stored memories of past experiences, before the higher cognitive functions (such as thinking or reasoning) in the prefrontal cortex get involved.

• This means that the brain responds to sensory input (like a siren) based on previous experiences and the emotional memory of past trauma, even before the conscious mind has time to process the information.

• Trauma can thus sensitize the brain to certain triggers, leading to exaggerated physiological reactions (like elevated heart rate or blood sugar levels) even when the trigger seems harmless.

6. Sequential Processing and Trauma:

• The sequential processing of sensory input helps explain why people who have experienced trauma can have automatic, emotional reactions to stimuli (e.g., sirens, sounds, or sights) that are linked to their past experiences. These responses are hard-wired into the brain and can lead to physical reactions like anxiety, heightened stress, or physical pain that are difficult to control.

The Lower Brain and Time:

• The lower parts of the brain, such as the brainstem and diencephalon, are responsible for processing incoming sensory information quickly. However, these regions don’t understand time. They process sensory input as if it’s happening in the present, even if the input matches a past experience.

• This becomes problematic when the past experience is a trauma. The brain can react as though the trauma is happening again in the present, even if the context has changed. For example:

  • Mike’s brain matched the sound of a motorcycle backfire to the trauma of war.

  • Tyra’s brain matched the sound of sirens to the trauma of witnessing her friend’s death.

  • For Oprah, being alone at night triggered memories of the traumatic experience of her grandfather’s attack.

2. Miscommunication Between the Brain’s Parts:

• Because the lower brain reacts to sensory input first, it may distort or misinterpret incoming signals before they reach the cortex (the thinking part of the brain). This can lead to miscommunication between people, as emotions (fear, anger, etc.) can distort the intended meaning of words or nonverbal cues (facial expressions, tone of voice).

• When someone is in a dysregulated state (such as when they are stressed, angry, or fearful), the lower brain dominates their response. The cortex (responsible for rational thought) becomes less involved, making effective communication difficult.

3. The Sequence of Engagement:

• Effective communication requires a sequential process:

  • Regulate: First, the person needs to calm down or regulate their emotional state.

  • Relate: Once regulated, a person can relate emotionally and connect.

  • Reason: Only after these first two steps can the person effectively use reasoning and engage in thoughtful communication.

• Trying to reason with someone before they are regulated can be counterproductive. It leads to frustration and can make the dysregulation worse.

4. State-Dependent Functioning:

• The further a person moves along the arousal continuum (from calm to heightened states of stress or anger), the more the lower brain takes control of their functioning.

• When someone is dysregulated, they can’t access the smart part of their brain. This is why people who are experiencing stress or trauma are often unable to engage in rational thinking or problem-solving effectively.

5. Impact of Stress on Communication:

• When the stress response is activated, it affects how we communicate. The lower brain filters incoming information and can distort or exaggerate it. The emotional tone of the message (through facial expression, body language, and tone of voice) can be interpreted through an emotional filter, causing the receiver to perceive the message in a way that may not align with the speaker’s intent.

• This is why miscommunication happens so often, especially when one person is dysregulated. The receiver’s emotional state can heavily influence how they process the message.

6. The Role of Trauma in Communication:

• Trauma impacts how people perceive and process sensory input. Even if the situation in the present doesn’t match the past traumatic experience, the brain may still react in the same way, leading to an overactive stress response.

• This is why people who have experienced trauma may respond disproportionately to triggers in their environment, making communication difficult, as their reactions are influenced by the lower brain's perception of danger or threat.

Regulation and the Cortex:

• To communicate rationally with someone, it’s crucial to get them to a regulated state. The regulated brain can engage the cortex, the thinking part of the brain, allowing for effective problem-solving and learning.

• If someone is dysregulated (e.g., stressed, anxious, or frightened), their brain’s lower regions dominate, making it difficult to access the cortex. In this state, they cannot reason or process information effectively.

• This principle applies to various settings, such as:

  • Teaching: A regulated child can learn, but a dysregulated child cannot.

  • Work: Employees or colleagues need to be regulated for productive communication and problem-solving.

  • Parenting: Children need to feel regulated and connected to learn or process information.

• Connection is key. Once someone feels safe and connected, they can use the cortex to engage in rational communication.

2. Sequence of Engagement:

• Dr. Perry uses the term sequence of engagement to describe the steps to reach the cortex:

  1. Regulate: The person needs to be emotionally regulated first.

  2. Relate: Establish a connection through positive, reassuring interactions.

  3. Reason: Once regulation and connection are achieved, rational thought and problem-solving can occur.

• Regulation is the foundation for connection, and connection is the bridge to rational communication.

3. Real-Life Example: Interviewing a Traumatized Child:

• Dr. Perry describes his experience working with the FBI’s Child Abduction and Serial Killer Task Force, where he interviewed a three-year-old boy named Joseph, who had witnessed his sister’s abduction and death.

• Joseph was overwhelmed with fear, and his brain’s ability to recall and verbalize the traumatic event was hindered by his fear and dysregulation. To access narrative memory (the memory of the event), Joseph needed to feel safe and regulated.

• Fear inhibits cortical functions, including those involved in memory, making it impossible for Joseph to provide useful information unless he felt safe.

• Joseph's mother played a crucial role in this process. Dr. Perry reasoned that if Joseph felt safe with his mother, he would begin to feel safe with him, leveraging the social contagion effect (the idea that a person will trust someone who is connected to a trusted individual).

• Building safety in a short time was challenging. In therapy, it typically takes ten to twenty sessions to build trust, but this wasn’t possible in an investigation. Instead, Dr. Perry used a method of brief, repeated interactions with Joseph (each lasting five minutes). These short, positive interactions helped Joseph’s brain categorize Dr. Perry as safe and familiar, making it easier to access his memory and process the trauma.

4. Overcoming Power Differential:

• Dr. Perry acknowledges the natural power differential between an adult and a child, which can make the child feel unsafe or threatened. He had to be mindful of this and minimize any dysregulating elements in his interactions.

• The goal was to maximize regulation and connection in a brief time to facilitate access to narrative memory and allow Joseph to eventually share his traumatic experience.

Relational Calculus:

• In every interaction, the brain constantly assesses:

  • Safety: Is this person a threat or an ally?

  • Power: Who holds the power in this situation?

  • Intentions: What does the other person want? Are they trying to help or hurt me?

• This relational calculus defines the power differential and can significantly impact how we feel, think, and react. It helps to assess whether we are in a position of dominance (feeling safe) or vulnerability (feeling threatened).

• If we feel vulnerable (e.g., due to a power differential), our brain's stress-response systems are activated, which impacts our emotional state, thinking, and behavior.

2. State Dependence and Memory:

• State-dependent memory refers to how our emotional and physiological state affects our ability to recall past experiences. In a fear state (when someone is dysregulated), the cortex (which is responsible for narrative memory) is less accessible, making it difficult to retrieve specific memories.

• A dysregulated person will struggle to recall details or process new information effectively. For example, someone experiencing test anxiety may know the material, but under stress, they can't access it.

• When a person is regulated and feels safe, their ability to retrieve stored memories becomes much easier. This is why safety and emotional regulation are crucial for effective communication, especially when dealing with trauma.

3. Power Differential and the Impact of Presence:

• Power differentials are not only about physical size but also about social influence. Dr. Perry notes that a person who holds a position of power (like Oprah) may not always recognize the full impact their presence has on others.

• In a situation with a great power differential (e.g., an adult interviewing a child about a traumatic event), it’s crucial to decrease that differential to make the person feel safe and to reach the cortex. If the child feels threatened or overwhelmed, they may be unable to access the memories necessary for recalling what happened.

4. The Interview with Joseph:

• Dr. Perry shares an example of how he worked with Joseph, a three-year-old boy who had witnessed his sister’s abduction and death. Joseph was understandably terrified and overwhelmed by fear.

• Contextualizing safety: Dr. Perry knew that to help Joseph feel safe, he needed to minimize the power differential between them. This involved physically positioning himself to be on the child’s level. By kneeling down and getting eye-to-eye, Dr. Perry tried to make himself less intimidating and more approachable.

• Explaining the purpose: Dr. Perry also took care to explain who he was and why he was there, addressing the fear of the unknown that can trigger the stress-response system.

• Establishing safety through connection: Dr. Perry spent several minutes interacting with Joseph's mother and Joseph, gradually building trust. He used brief interactions to help Joseph feel safe and regulated before attempting to engage him further about the traumatic event.

• The goal was to allow Joseph to feel connected and safe before delving into any difficult memories. The process involved short, positive interactions that would create an environment conducive to accessing narrative memory.

5. The Power of Presence:

• Dr. Perry’s example of Joseph highlights the significance of the relational calculus in trauma-informed interactions. By creating a safe space and decreasing the power differential, Dr. Perry made it easier for Joseph to access his memories and share his experiences when he was ready.

• This approach illustrates how the dynamics of power and the state of regulation can shape how people process and communicate trauma. When people feel safe and regulated, they are better able to engage in rational thinking and communication, which is essential for understanding and addressing traumatic experiences.

Building Safety through Play:

• Dr. Perry starts by engaging in play with Joseph, who is initially distant. By allowing Joseph to take control (e.g., pulling the truck away), Dr. Perry demonstrates respect for Joseph's space, reducing the power differential. This non-threatening interaction helps build trust.

• Over time, through brief and repetitive sessions of engagement, Joseph becomes more comfortable and starts interacting more openly with Dr. Perry.

2. Minimizing Fear with Familiarity:

• Joseph begins to view Dr. Perry as familiar and safe as a result of the repeated, brief interactions. The brain's facial recognition systems categorize Dr. Perry as someone he can trust, making it easier for him to process memories and engage in conversation.

3. Allowing Control:

• Dr. Perry offers Joseph control over the situation, telling him that they don’t have to talk about his sister if he doesn’t want to. This empowers Joseph, reduces his anxiety, and helps him feel safe.

• Control is a crucial part of regulation; when people feel they have a choice, they feel less vulnerable.

4. Accessing Narrative Memory:

• When Joseph is ready, Dr. Perry asks him to recall specific details about the abduction. By showing Joseph pictures and gently prompting him for more details, Dr. Perry helps him reconstruct the event.

• Joseph’s emotional state (being regulated) enables him to retrieve specific memories, like the appearance of the man who abducted his sister. He is able to identify the suspect from a lineup, and later, he guides Dr. Perry to the exact location where the abduction occurred.

5. Emotional Regulation and Trauma Processing:

• Dr. Perry understands that Joseph needs to be emotionally regulated before he can access and process memories of the traumatic event. The sequence of engagement (play, connection, and safety) allowed Joseph to stay regulated long enough to share critical details.

• As Joseph relives the event, he becomes visibly upset, but by this point, he has already identified the abductor and provided valuable information. Dr. Perry respects Joseph's emotional limits by stopping the process when it becomes too much for him.

6. The Importance of Safe Connection:

• Dr. Perry’s method exemplifies how building a safe, regulated connection is essential before attempting to engage rationally or reason with someone, especially in a traumatic context. Safety, trust, and familiarity are the prerequisites for effective communication, particularly with children who have experienced trauma.

7. Success of the Sequence:

• By following this sequence of engagement, Dr. Perry was able to access Joseph’s cortex—the area of the brain responsible for narrative memory. This allowed Joseph to recall specific details that were crucial for solving the case, demonstrating the power of regulated connection in facilitating communication and memory retrieval.

Impact of Trauma on Families:

• Joseph's case highlights the ongoing pain and emotional toll after trauma. The family struggles with loss, especially during milestones (e.g., birthdays, holidays, Mother's Day).

• The trauma's effects remain long after the event, and emotional healing was not yet fully understood.

Understanding Trauma and Stress:

• Dr. Perry had a strong grasp of how trauma affects the brain but lacked a full understanding of how to heal it.

• While early research focused on extreme trauma events, a deeper understanding of trauma's broad impact on the brain was necessary.

Case Study: Thomas and His Struggles:

• Thomas and another boy both had similar mental health diagnoses (ADHD, major depression, conduct disorder) and disruptive behaviors.

• Despite shared labels, they created different emotional climates in their interactions.

• Thomas had endured multiple foster homes and extreme physical abuse, leading to hypervigilance, mood swings, and restlessness.

• Despite his struggles, Thomas remained interactive, trying to engage with others and connect.

Thomas's Case:

• Resting heart rate of 128 bpm, indicative of an overactive, reactive arousal response (chronic fear).

• Diagnosed with ADHD, major depression, and conduct disorder, but his behaviors stemmed from PTSD.

• Extreme emotional reactivity: hypervigilant, restless, and prone to mood swings.

• Early physical abuse, multiple foster homes, and hospitalizations led to trauma-related behaviors.

James's Case:

• Resting heart rate of 60 bpm, showing disengagement rather than hyperarousal.

• No clear history of physical or sexual abuse, but a history of emotional neglect by his grandmother.

• Diagnosed with ADHD and conduct disorder, but his behaviors were rooted in relational trauma and emotional detachment.

• Stealing, lying, and threats were signs of detachment, not overt aggression.

• Grandma's abandonment led to further trauma and placement in the child protection system.

Trauma and Behavior:

• Thomas's symptoms arose from reactive arousal, while James’s behaviors stemmed from emotional disengagement.

• Early trauma in infancy (e.g., inconsistent caregiving) led to James’s dissociation and withdrawal from emotional connection.

• Inconsistent caregiving and lack of stable attachment resulted in James's inability to trust or connect with others.

• Trauma-induced dissociation in animals and humans involves an immobilizing, defeat-like response to inescapable threats.

Thomas’s Family Background:

• Thomas had a supportive and affectionate family, including his mother, aunt, and maternal grandmother.

• His father’s struggles with PTSD after Vietnam led to alcohol and drug abuse, causing family instability.

• Thomas’s father’s abuse began when Thomas tried to protect his mother, making him the target of the father’s rage.

• Despite the abuse, Thomas had early loving caregiving that helped buffer the effects of trauma.

• Healthy relational neurobiology allowed Thomas to respond positively to treatment, improving significantly over 12 months.

James’s Case:

• James's emotional neglect and lack of stable attachment led to disengagement in therapy and worsening behaviors.

• James’s history showed a lack of nurturing relationships, contributing to his inability to trust others.

• His behaviors became more predatory, and all therapeutic attempts to build relationships or modify behavior failed.

Key Insight: The Importance of Relational Support:

• Thomas’s improvement highlights the importance of healthy relationships in healing from trauma.

• James’s worsening condition illustrates how neglect (lack of relational care) is as harmful as direct trauma.

• The concept of What didn’t happen for you? is crucial in understanding trauma’s impact: a lack of attention, nurturing, and love is as toxic as direct abuse.

Neglect vs. Trauma:

• Neglect and trauma often co-occur but affect the brain differently, leading to distinct biological responses.

• Neglect during development causes disruption in the normal brain development process, especially if key experiences are absent or delayed.

The Impact of Neglect:

• Early neglect (especially in the first few years of life) can severely disrupt brain development, preventing necessary stimulation for normal growth.

• Romanian Orphans Example: Thousands of children grew up in state-run orphanages with minimal caregiver interaction, resulting in severe deficits in IQ, physical abilities, and social skills.

• Long-term consequences for these children included unemployment, health issues, and difficulties with relationships.

Neglect in Extreme Cases:

• Severe neglect can result in children being undersocialized, with issues like lack of toilet training, minimal language skills, and inability to form connections.

• Feral children: In extreme neglect cases, children may develop behaviors that are similar to animals, lacking basic social and communicative skills.

• Example: Dani, a child who was locked away and neglected, had significant struggles with communication and social interactions, even after being placed in a loving home.

Time Matters:

• Critical Period: The first six years are crucial for brain development. If essential neural networks are not formed during this time, some capabilities may not develop.

• Recovery from neglect is harder the longer the deprivation lasts. Shorter periods of neglect, such as a few months or specific incidents, may not have the same impact as extended early neglect.

Teenage Neglect:

• Grounding a teenager is not considered neglect, as their brain systems are already developed by that point.

Questions to Assess Neglect:

• When during development did neglect occur?

• What was the pattern and severity of neglect?

• How long did it last?

• What "buffering" factors (like other positive experiences) were present?

Types of Neglect:

• Chaotic Neglect: This happens when caregiving is inconsistent or unpredictable, leading to fragmented brain development. The child might receive care some days but experience neglect or abuse on others, which confuses and dysregulates the developing brain.

• Splinter Neglect: Occurs when some areas of development (like cognitive or social skills) are nurtured, but one critical area (like motor development or emotional growth) is neglected. For example, a child may have advanced cognitive abilities but underdeveloped motor skills due to lack of movement opportunities.

  • Example: A mother kept her children in car seats all day, which prevented them from developing motor skills. Despite being advanced academically, the children had severely underdeveloped legs and neuromotor capabilities.

Emotional Neglect:

• Some children grow up emotionally neglected, even in households with ample material resources, when parents are emotionally distant or fail to provide relational consistency.

• Example: Wealthy parents who outsource parenting to caregivers may fail to provide the consistent, relational care necessary for the child’s emotional development.

Relational Consistency:

• It is not just about how many caregivers a child has, but about the consistency of care. The brain requires consistent, patterned experiences to develop properly, especially in the early years.

• Language Development Example: If a child is exposed to multiple languages without enough repetition in any one language, they may fail to develop language skills properly. Changing languages too often prevents the brain from organizing speech and language abilities effectively.

Language and Relational Development:

• Just as a child needs repetitions with one language to develop language skills, they also need consistent relationships with a few stable, safe, and nurturing caregivers to develop healthy relational neurobiology.

• If a child is exposed to multiple caregivers without enough stability or repetition, their brain struggles to form the necessary connections for healthy emotional development, resulting in "splinter neglect" where key relational capabilities remain undeveloped.

Impact of Outsourcing Care:

• With increasing dependence on technology, parents may be physically present but emotionally disengaged, often distracted by phones or other devices. This lack of full attention and engagement can have a toxic impact on a child’s development.

• Children can sense when caregivers are not fully present. They need eye contact, direct engagement, and a feeling of safety and importance from their caregivers.

The Need for Full Engagement:

• Babies and young children need full, undivided attention to feel safe, valued, and part of their family or community. Partial attention, such as checking a phone during a conversation, conveys to the child that they are not important.

• A child who consistently receives this message may struggle with feelings of unimportance and develop difficulties in forming secure, loving relationships in the future.

Consequences of Dismissive Caregiving:

• If caregivers are disengaged, it can lead to emotional hunger in the child, who will crave connection and belonging but may lack the emotional tools to foster healthy relationships.

• The foundation for a loving, empathetic person is built on loving and nurturing interactions. Without these, the child’s neurobiological capability to love and form relationships may be compromised.

The Still-Face Paradigm:

• Dr. Tronick’s Still-Face experiment demonstrates how quickly infants can become distressed when their caregiver disengages emotionally. Within seconds, the baby attempts to reengage, and if unsuccessful, becomes distressed and withdraws. This highlights how critical consistent emotional engagement is for infants.

• If a child experiences this pattern repeatedly—feeling abandoned or neglected by disengaged caregivers—it can lead to long-term emotional challenges. The child may grow up feeling inadequate, unlovable, or "not enough," leading to maladaptive behaviors like unhealthy attention-seeking or self-destructive tendencies.

Impact of Caregiver Disengagement:

• A disengaged or emotionally absent caregiver leaves the child feeling unregulated and uncertain, creating a stressful and unpredictable environment. For an infant who depends on their caregiver for emotional regulation, this can cause the stress response system to become sensitized, meaning they may respond with heightened stress even to minor challenges as they grow older.

Stress Response System:

• The body has various levels of stress response: calm (when stress is low), alert (when there's mild stress, like a work presentation), alarm (a more intense stress, like a car accident), and fear (extreme stress, like facing a threatening situation).

• In severe stress responses, the body can enter dissociation, where the person feels detached or disconnected from the situation, almost as if watching it from outside their own body. This helps the brain cope with overwhelming experiences by distancing the person from the threat. Physiologically, dissociation reduces blood flow to the periphery, preparing the body for potential injury by protecting vital organs.

Dissociation is a response to inescapable distress, helping individuals psychologically distance themselves from pain.

Endogenous opioids (endorphins, enkephalin) are released during dissociation, reducing pain and creating an out-of-body experience.

Example: In a traumatic event, like an FBI agent describing a shooting, time may seem distorted—what happened in seconds feels like minutes.

Dissociation is adaptive, helping people cope in high-pressure situations, such as combat or sports, where a person can still function while feeling fear.

In grief, people may feel numb or robotic, as dissociation allows them to function through pain.

On 9/11, passengers on planes used dissociation to take action (e.g., calling family, rushing the cockpit) despite extreme terror.

Survival mechanism: Dissociation helps soldiers, athletes, or performers stay focused, disengaging from external threats and accessing learned behaviors.

Daydreaming is a form of healthy dissociation—allowing creative reflection or problem-solving.

In conversations, people can only stay focused for about 15 seconds before their mind wanders, which is normal and adaptive for processing information.

Public education: The system often prioritizes producing workers over nurturing creators and leaders.

Daydreaming: It is sometimes punished, but in trauma-aware schools, it's understood as essential for memory consolidation and reflection.

Dissociation: Encouraged in environments where children face chaos and trauma, allowing them to regulate and survive.

Coping mechanism: Children in dysfunctional homes dissociate to escape inescapable situations, as they can't fight or flee.

Dissociative disorder: Prolonged, unpredictable stress can make dissociation a habitual response, leading to an overactive, overly reactive dissociative response.

Example: Some young women at OWLAG dissociated when faced with any challenge, due to growing up in chaos.

Dissociation and challenge: The brain is trained to dissociate when discomfort or threat arises, even in low-stress situations like a math test.

Dissociative response continuum:

• Avoidance: Individuals avoid conflict, becoming invisible, staying quiet.

• Compliance: If confronted, they respond to please others but remain disengaged.

Dissociation in adults: Adults, like those who experienced trauma, may dissociate emotionally in relationships despite caring deeply, sabotaging connections.

Hollow compliance: A woman in a relationship might go through the motions but not be fully present, a result of dissociation.

Therapy and recovery: Through therapy, the woman learned to stay present in relationships and build healthy connections.

Terror of being alive: A phrase by Gary Zukav, acknowledging the fear many people feel about being truly alive.

Cutting as self-regulation: Cutting can feel soothing for those with a sensitized dissociative response, as it releases opioids like enkephalins and endorphins.

Opioid release: For someone without a sensitized dissociative response, cutting releases a small amount of opioids, tolerable for minor cuts.

Sensitized dissociation: For those with a sensitized response, cutting releases a large amount of opioids, similar to a drug effect, making it feel rewarding and soothing.

Dysregulated state: Cutting provides relief in a dysregulated state; in a regulated state, it would hurt.

Origins of sensitized dissociation: Often linked to chronic abuse (e.g., sexual abuse) in early childhood, leading to a sensitized dissociative response.

Peer influence: People often learn about cutting from peers or media, like popular TV shows, not just from personal trauma or experiences.

Cutting experiment: Some children experiment with cutting and find it painful, while others find it soothing, similar to drug use.

Drugs and trauma: A higher percentage of children with developmental adversities are more likely to engage in recurrent drug use or self-harming behaviors.

Maladaptive self-regulation: Behaviors like head-banging or hair-pulling offer an opioid burst, providing temporary relief.

Eating disorders: Can be a form of self-soothing, not related to body image, but to the need to regulate emotions.

Common coping behaviors: Can lead to personality traits that affect how people handle conflict or interact with others.

People-pleasing: A coping mechanism learned from abuse, where speaking up led to punishment. It becomes a personality trait, affecting relationships and health.

Dissociation as a tool: Dissociative behaviors are not always negative. They can enhance reflective cognition and focus, as seen in hypnosis or being "in the zone."

Oprah's superpower: Oprah’s ability to dissociate and reflect deeply, especially when reading, is seen as a positive skill. It allowed her to escape and find freedom in books at a young age.

Dissociation as a strength: Dissociation, while often seen negatively, can be a strength if managed. It allows for deep focus and reflective cognition.

People-pleasing as a coping mechanism: Oprah's compliance and people-pleasing were survival tactics learned in response to trauma.

Intentional living: Oprah learned the power of intention, which helps her make decisions based on what feels authentic to her, not on external pressure. This shift helped her create boundaries and heal.

The power of intention: Setting intentions has guided Oprah’s life, making her decisions more deliberate and aligned with her values, leading to healing and resilience.

Attraction to abusive relationships: Trauma victims may be drawn to abusive relationships because they are familiar. The brain organizes itself based on early experiences, so if chaos or trauma was experienced in childhood, a person may feel most comfortable with relationships that align with that worldview.

Familiarity over discomfort: People often prefer familiar misery over uncertain change. Even if abuse is painful, it can feel validating and predictable, reinforcing the person’s worldview. This makes it difficult to break free from abusive patterns.

Pattern recognition in trauma: Oprah discusses how many of the young women at her school were raised in abusive environments where they didn’t know what real love felt like. They had internalized dysfunction, so when faced with healthy relationships, they may sabotage them. The key to healing is recognizing these patterns of behavior.

The brain’s malleability: Dr. Perry explains that the brain can change throughout life, but intentional change requires recognizing the harmful patterns that stem from childhood experiences. The goal is to break these patterns and change the behavior.

Comfort in chaos: Children from chaotic backgrounds often feel more comfortable in chaos than calm. This discomfort with consistency leads them to provoke conflict to confirm their belief that the world is unpredictable and unsafe.

Predictable behaviors: Trauma survivors may act out or seek negative attention because it’s familiar, even though it’s harmful. Teaching adults to recognize these patterns can help prevent the reenactment of trauma.

The discomfort of change: Oprah recalls how some of the girls at her South African school acted out despite the new environment being loving and supportive. Dr. Perry explains that change, even when positive, can feel unsettling for those with trauma, and they may act out as a result.

Trauma and discomfort with stability: Dr. Perry explains that children from traumatic backgrounds often resist stability and nurturing because it challenges their worldview. They may act out to create the familiar chaos they grew up with, seeking comfort in what they know.

Healing through experience: Dr. Perry emphasizes that healing takes time, new experiences, and a lot of patience. The brain needs repeated positive experiences to build new, healthier associations and neural pathways. Therapy helps by building new, better default pathways, not by erasing the past.

Resilience and trauma: Dr. Perry critiques the common belief that children are inherently resilient, which can often be used as a way for others to avoid confronting the pain of trauma. The reality is that trauma leaves lasting impacts, and while some may heal, others struggle for years, never fully recovering.

Isolation after trauma: After a traumatic event, support often diminishes over time. As people move on, the traumatized person may feel isolated, and the emotional impact deepens. This process is true for both individuals and communities affected by large-scale trauma like war or systemic racism.

Avoidance of collective trauma: Dr. Perry also discusses how privileged groups tend to avoid confronting the trauma of marginalized communities, rationalizing it with phrases like “look how far they’ve come” or “they’re resilient,” which can further invalidate the trauma.

Us-and-them mentality: Dr. Perry explains that humans are biologically inclined to form an "us-and-them" mentality, which is rooted in competition for limited resources. Trauma often impacts a specific group, drawing initial attention and support, but as time passes, this support fades, and people move on, leaving the affected community feeling isolated.

Misguided attempts to help: In the aftermath of trauma, people often try to help with well-intentioned but misguided gestures—such as slogans or gifts—which fail to address the deep pain. These actions are more about easing the discomfort of those offering help than effectively supporting the affected individuals.

Resilience myth: Dr. Perry critiques the belief that children are born "resilient." Instead, children are malleable and shaped by their experiences. While resilience can be built, it's not an automatic trait, and trauma changes a person. The brain is malleable, and experiences—whether positive or negative—change us.

Irreversibility of trauma: Dr. Perry clarifies that no one emerges from trauma unscathed. The notion that one can return to the "same" state after trauma is unrealistic. Instead, trauma reshapes a person, and healing involves understanding and navigating these changes over time. The capacity to recover is influenced by the level of connectedness and support received during and after trauma.

Dissociation as a Coping Mechanism

• Definition: Dissociation is a mental process where individuals disconnect from their immediate environment or emotions.

• Purpose: Acts as a survival strategy in situations of inescapable chaos or trauma.

• Examples:

  • A child daydreaming to escape conflict.

  • Traumatized individuals mentally “checking out” to shield themselves from emotional intensity.

Dissociation and Childhood Development

• Trauma and Dissociation:

  • Occurs more commonly when children face uncontrollable, prolonged stress.

  • Young children, unable to fight or flee, rely on dissociation as their only adaptive response.

• Long-Term Impact:

  • If dissociation becomes habitual, the brain's stress-response system becomes overly sensitized, leading to an overactive dissociative reaction even in non-threatening situations.

  • Example: Reacting to a math test as if it were a serious threat.

Continuum of Dissociation

• Stages of Response:

  • Avoidance: Staying invisible, avoiding eye contact, not engaging voluntarily.

  • Compliance: Offering hollow or disengaged responses to avoid confrontation.

• Progression: Chronic use of these behaviors may evolve into a dissociative disorder, where the individual increasingly retreats into their inner world.

Dissociation in Adults

• Adult Behaviors:

  • Similar patterns observed, especially in relationships.

  • Example: An adult survivor of early abuse emotionally disengaging in relationships despite caring deeply.

  • Sabotaging relationships by dissociating or "checking out."

Developmentally Informed and Trauma-Aware Practices

• Understanding Daydreaming:

  • In trauma-aware environments, daydreaming is recognized as a necessary tool for memory consolidation and self-regulation.

  • Teachers in schools like OWLAG are trained to understand and encourage dissociative reflection as a coping strategy for students from challenging backgrounds.

Awareness and Growth

• Awareness of Patterns:

  • Recognizing dissociation as a learned survival strategy can help individuals understand why they "check out" during challenges.

• Reframing Stress Responses:

  • Supportive interventions can help individuals develop healthier coping mechanisms and engage more fully in relationships, education, and personal growth.

Connection Between Trauma, Dissociation, and Cutting

• Trauma's Role:

  • Cutting is often seen in individuals with a history of prolonged or extreme trauma, especially abuse (e.g., physical, emotional, or sexual abuse).

  • These experiences lead to a sensitized dissociative neurobiology, where the stress-response systems become overly reactive.

• Dissociation and Opioids:

  • Dissociation triggers the release of natural opioids like enkephalins and endorphins, which help numb physical and emotional pain.

  • For individuals with a sensitized dissociative system, cutting releases a large burst of these opioids, creating a soothing, even pleasurable, sensation.

The Psychology of Cutting

• Why Cutting Feels "Good":

  • Cutting doesn’t register as pain but as a form of self-soothing or regulation for those in a dysregulated state.

  • The release of opioids acts like a drug, similar to a small dose of heroin or morphine.

• Regulation Through Cutting:

  • Cutting becomes a learned method of self-regulation, especially for those who experience chronic dysregulation due to their trauma history.

  • The behavior is addictive because of the reinforcing calming effect.

Origins of Cutting Behavior

• Initial Discovery:

  • Some individuals discover cutting accidentally through behaviors like picking at scabs or scratching mosquito bites, noticing the soothing effect.

• Social Influence:

  • Many learn about cutting from peers or media.

  • Trends in cutting can often be traced to depictions in popular culture or TV shows, highlighting its social and observational learning components.

Broader Questions About Cutting

• Cultural and Environmental Factors:

  • Oprah raises the question of whether cutting occurs in different cultural contexts, such as villages or townships, or whether its prevalence is higher in certain environments (e.g., schools).

  • Dr. Perry notes that cutting may emerge from a combination of personal discovery and peer influence, suggesting it is not exclusively a cultural phenomenon.

Regulation vs. Dysregulation

• State Dependency:

  • Cutting primarily provides relief for those in a dysregulated state.

  • For individuals in a regulated state, cutting would be painful and not soothing.

Implications for Support and Understanding

• Therapeutic Interventions:

  • Therapists often work to help individuals replace cutting with healthier coping mechanisms for self-regulation.

  • Awareness of the neurobiological basis of cutting can guide trauma-informed care and interventions.

• Educational Settings:

  • Schools like OWLAG, designed to support traumatized individuals, must address cutting as part of their holistic approach to care, considering both the neurobiology and social influences behind the behavior.

Maladaptive Coping Mechanisms as Self-Regulation

• Cutting as Self-Soothing:

  • Similar to drug use, not all who experiment with cutting will continue; those who persist often have a history of developmental adversities.

  • Trauma increases susceptibility to using harmful coping mechanisms repeatedly.

• Other Maladaptive Behaviors:

  • Examples include rocking, headbanging, pulling out hair (trichotillomania), and making oneself throw up.

  • These behaviors, like cutting, are tied to the same neurobiology of stress and reward, releasing opioids to self-soothe.

  • Eating disorders can arise not from body image issues but as a form of maladaptive soothing.

Common Coping Behaviors and Personality Characteristics

• People-Pleasing:

  • A common coping mechanism stemming from abuse or trauma.

  • Often develops as a compliant dissociative behavior to avoid punishment or conflict.

  • Affects various aspects of life, including health, relationships, and self-advocacy (e.g., inability to say no).

• Subtle, Everyday Behaviors:

  • Some coping mechanisms may evolve into personality traits, influencing how individuals handle challenges or interact with others.

The Dual Nature of Dissociation

• Maladaptive vs. Adaptive Dissociation:

  • Dissociation isn’t inherently harmful; it can also be a source of strength when controlled.

  • Maladaptive dissociation (e.g., cutting) arises from trauma and dysregulation.

  • Adaptive dissociation enables focus, creativity, and problem-solving.

• Positive Examples of Dissociation:

  • Reflective Cognition: Ability to think deeply and process emotions.

  • Intense Focus and Creativity: Experiencing “flow” or being “in the zone.”

  • Escapism Through Reading: Oprah shares how books were her escape and a tool for imagining a broader world.

  • Imagination and Future Planning: Healthy dissociation allows for visualization and planning, key traits for personal and professional growth.

Trauma and Neurobiology:

• Connection Between Stress and Reward Systems:

  • All coping behaviors, whether adaptive or maladaptive, leverage the brain’s neurobiology for regulation.

  • Trauma sensitizes these systems, increasing reliance on dissociative responses for comfort.

Empowerment Through Controlled Dissociation

• Harnessing Dissociation:

  • The ability to regulate and use dissociation effectively can become a personal strength, or even a “superpower.”

  • Skills like focused reading, reflective thinking, and creative visualization are rooted in controlled dissociation.

Reframing Dissociation

• Not Always Pathological:

  • Dissociation is not inherently negative; it can be a powerful strength when harnessed.

  • Adaptive dissociation enables focus, reflection, and problem-solving (e.g., Oprah's ability to use books as an escape and her reflective nature).

• Maladaptive Patterns:

  • Dissociation can lead to behaviors like compliance or people-pleasing, especially in traumatic contexts.

  • Oprah’s early tendency to “stay under the radar” and avoid conflict by giving people what they wanted is a common dissociative coping mechanism.

The Power of Intention and Boundaries

• Transformation Through Intention:

  • Oprah credits Gary Zukav with teaching her to approach every decision with intention, asking, What is my intention in doing this?

  • This mindset helped her break free from people-pleasing, establish boundaries, and focus on what felt authentic to her.

  • Intention helped Oprah moderate her stress, making it more predictable and controllable, which is key to healing and resilience-building.

• Healing Through Boundaries:

  • Learning to say no empowered Oprah to prioritize her needs over external pressures or past patterns of compliance.

  • Intention provided a framework for authenticity and self-preservation.

Trauma and Attraction to Abusive Relationships

• Gravitating Toward the Familiar:

  • People are often drawn to environments or relationships that reflect their early experiences, even when these are unhealthy or destructive.

  • The brain organizes around early experiences to form a “working model” of the world:

    • Safe, nurturing care → Trusting, positive worldview.

    • Chaotic, traumatic care → Distrustful, negative worldview.

• Familiarity as Comfort:

  • Even when unhealthy, familiar dynamics (e.g., rejection or abuse) feel validating because they align with one’s internalized worldview.

  • As Virginia Satir stated: “We feel better with the certainty of misery than the misery of uncertainty.”

Unconscious Reinforcement of Trauma Dynamics

• Seeking Familiar Patterns:

  • In healthy relationships, individuals from traumatic backgrounds may feel discomfort because the safety challenges their worldview.

  • They might unconsciously provoke behaviors that restore familiar dynamics (e.g., chaos, conflict), reinforcing their internalized belief that the world is unsafe.

• Example of James:

  • Intimacy felt threatening to James because it clashed with his worldview that people and relationships are unsafe.

  • Rejection and mistreatment felt more validating, reinforcing his belief system.

Breaking the Cycle

• Awareness and Healing:

  • Recognizing the pull toward familiar patterns is the first step in breaking free from trauma-driven relationships.

  • Developing intentional behaviors, healthy boundaries, and new coping strategies can help reshape the worldview.

Recognizing Patterns of Dysfunction

• Familiarity with Chaos as Comfort:

  • Many trauma survivors equate chaos, unpredictability, or mistreatment with "normal." In a stable and loving environment, this unfamiliar calmness can feel unsettling or unsafe.

  • As Dr. Perry notes, children or adults used to chaotic environments often provoke situations that affirm their worldview, seeking punishment or rejection to confirm their internal belief: The world is unsafe. People cannot be trusted.

• Generational Patterns:

  • These cycles of trauma often extend across generations. Without conscious awareness of these dynamics, the same patterns repeat in relationships, workplaces, and social circles.

  • Oprah’s observation about her girls at OWLAG reflects this: they interpret stability and respect in relationships as unfamiliar, even wrong, sabotaging those connections.

The Role of Predictability and Safety

• Transitioning to Stability:

  • For individuals conditioned by trauma, sudden immersion in a supportive, loving environment can feel disorienting, even threatening.

  • The girls at OWLAG, for example, experienced a complete shift—from overcrowded, chaotic homes to orderly, nurturing spaces. Initially, this triggered homesickness and even acting out as they adjusted.

• Building Trust Over Time:

  • To heal, these individuals need environments where predictability and consistency are sustained long enough for their brains to begin re-organizing around safety.

Tools for Healing and Change

• Intentional Awareness:

  • Oprah’s advice to her girls to "connect the dots" is key. Identifying patterns in relationships and feelings can illuminate recurring dynamics.

  • Reflecting on repeated emotions—e.g., frustration or distrust—can reveal how current triggers are rooted in past trauma.

• Rewriting the Narrative:

  • Recognizing and breaking the cycle involves challenging ingrained beliefs:

    • "Not everyone is untrustworthy."

    • "I deserve respect and love without chaos."

• Guidance from Supportive Adults:

  • Teachers, foster parents, and mentors play a crucial role. By reframing children’s disruptive behaviors (e.g., acting out to provoke punishment), they can respond with patience rather than reenacting harmful cycles.

The Brain’s Capacity to Change

• Malleability Across Life:

  • The brain's neuroplasticity allows healing and growth at any age, but change is intentional, not random.

  • Progress begins with recognizing patterns and understanding their origins. Oprah’s emphasis on intention aligns with this process: using purpose-driven thought to disrupt old patterns and establish healthier ones.

• Gradual Healing:

  • Transitioning from a trauma-driven worldview to one of safety and trust requires time and consistent exposure to positive, stable experiences.

The Importance of Patience in Healing

• Understanding Resistance:

  • Resistance to change (e.g., sabotaging stable relationships) isn’t a conscious choice but a survival mechanism rooted in the brain’s learned response to trauma.

  • Adults working with trauma survivors must recognize this behavior as a sign of deeper wounds, not as willful defiance.

• Sustained Support Systems:

  • Environments like OWLAG provide the consistency needed to challenge old patterns. Over time, love and stability can rewire the brain to recognize these as safe and familiar.

Why Familiarity Often Overrides Stability

• Trauma’s Grip on the Brain:
  When children grow up in chaotic or abusive environments, their brains adapt to expect disorder. Chaos becomes their "normal."

  • In stable environments, like OWLAG, this deeply ingrained expectation of chaos clashes with the calm, nurturing surroundings.

  • This dissonance can feel unsettling, prompting behaviors that reintroduce the chaos they find familiar.

• "I Want What is Familiar":

  • Acting out is a way for these children to make their environment align with their internal worldview.

  • The challenge lies in helping them feel safe within stability, teaching their brains to recognize predictability and kindness as normal.

2. Creating New Neural Pathways

• Therapy as Construction, Not Deletion:

  • The brain retains all its past associations—those pathways don’t disappear.

  • Effective therapy doesn’t aim to erase trauma but to build new "default" pathways—stronger, healthier alternatives that can be chosen over the old, dysfunctional ones.

• "A Four-Lane Freeway Beside a Dirt Road":

  • The old road remains, representing trauma-driven responses.

  • Over time, with repetition and support, the newly built freeway becomes the primary route. The dirt road is used less and less.

3. The Role of Repetition and Time

• Repetition Shapes Change:

  • New associations require consistent, repeated exposure to positive, stable experiences.

  • At OWLAG, girls are immersed in years of nurturing relationships, structured expectations, and opportunities for growth. This creates the foundation for new pathways.

• Patience is Essential:

  • Healing is a gradual process. It takes time for the brain to adjust and build strong neural networks around safety and trust.

  • Patience and understanding from caregivers, educators, and therapists are critical to maintaining the stability these children need.

4. The Right Kind of Therapy

• Beyond Traditional Talk Therapy:

  • Trauma lives not only in memories but also in the body and brain’s automatic responses. Effective therapy acknowledges this.

  • Approaches like somatic therapy, EMDR (Eye Movement Desensitization and Reprocessing), or relational therapies focus on creating new, embodied experiences of safety and regulation.

• Relational Healing:

  • Relationships are at the core of creating new patterns. Positive, consistent interactions help rewire the brain’s response to connection and trust.

  • The structure and relationships at OWLAG exemplify how consistent support reshapes worldviews.

5. Changing Worldviews with Experience

• Expanding Possibilities:

  • Over time, the girls at OWLAG learn that love, stability, and safety are possible. This reshapes their internal model of the world, expanding their understanding of what relationships can be.

• Sculpting the Brain:

  • Each new positive experience adds to their neural repertoire, building a broader, healthier worldview.

  • Through repetition and new relationships, their brains gradually shift toward expecting safety and trust.

Resilience as a Misunderstood Concept

• Not an Inherent Shield:
  Resilience is not a magical trait that allows individuals, especially children, to "bounce back" unscathed. It requires nurturing, support, and resources to develop.

  • Children may dissociate or appear to “cope,” but these responses often mask underlying struggles.

• Used to Avoid Discomfort:
  By labeling others as “resilient,” people distance themselves from the trauma and pain of others. This allows them to protect their worldview and avoid the emotional labor of truly empathizing and helping.

2. Trauma’s Long-Term Impact

• The Emotional Bottom:

  • While support often peaks in the weeks following a traumatic event, it wanes over time. Six months in, individuals often hit their emotional lowest point as initial attention fades.

  • Without sustained support, the pain becomes isolating, deepening feelings of despair and abandonment.

• Trauma as a Community Challenge:

  • In large-scale tragedies, attention quickly shifts away from the epicenter of trauma. Communities rally briefly, then retreat, leaving individuals to grapple with the aftermath.

  • Efforts to "move on" often prioritize outward appearances over meaningful healing.

3. The Role of Privilege and Avoidance

• Privileged Narratives:

  • Statements like “Look how far they’ve come” or “They’re resilient” trivialize the ongoing impact of trauma, whether personal or systemic (e.g., slavery, racism, cultural genocide).

  • These narratives shift focus away from addressing systemic inequities and the real, enduring pain of marginalized groups.

• Emotional Distance Through "Othering":

  • Us-and-them thinking allows people to rationalize inaction. It’s easier to see trauma as “their” problem rather than ours.

  • This neurobiological tendency to prioritize one’s “clan” over others exacerbates isolation and inequity.

4. Misguided Responses to Trauma

• Symbolic Gestures Without Substance:

  • While well-intentioned, efforts like distributing T-shirts or organizing ceremonies often fail to address the core needs of those impacted by trauma.

  • Such actions can feel performative, more about easing the discomfort of outsiders than offering genuine help.

• The Struggle with Helplessness:

  • Witnessing pain triggers emotional contagion. In an effort to self-regulate, people may avoid or minimize the suffering of others, rather than sitting with the discomfort and offering sustained, meaningful support.

5. Moving Beyond Assumptions of Resilience

• Resilience Requires Community:

  • Healing is a collective process. Individuals need consistent, long-term support to rebuild their lives and create new patterns of strength.

  • Communities must address not just the immediate aftermath of trauma but its enduring effects over months and years.

• The Path to Wisdom:

  • True healing doesn’t erase pain; it integrates it into a new, wiser understanding of life.

  • This process demands time, patience, and the willingness to walk alongside those who are suffering, even when it’s uncomfortable.

The Myth of Resilience as Unaffected Recovery

• Nerf Ball Resilience:

  • The idea that children (or adults) can return unchanged to their pre-trauma state is wishful thinking.

  • Trauma, like any significant experience, leaves a mark. It reshapes our brains, emotions, and worldviews, sometimes subtly and sometimes profoundly.

• The Reality of Change:

  • Humans are malleable, not impervious. The experiences we go through—whether joyous or painful—shape us over time.

  • Trauma doesn’t just disappear; its impact is woven into the brain’s evolving structure and our patterns of behavior.

2. Malleability: The Metal Hanger Metaphor

• How the Brain Changes:

  • Like a metal hanger, the human brain can adapt and be reshaped.

  • After trauma, attempts to return to the “original shape” may help, but the brain will always carry traces of the experience.

• The Risk of Repeated Strain:

  • Chronic or repeated trauma can weaken the brain’s “structure,” making it more vulnerable over time—just as repeatedly bending a hanger can cause it to break.

3. Resilience as a Process, Not an Innate Trait

• Demonstrating Resilience:

  • Resilience is not a fixed quality. It’s an ability to adapt, recover, and grow in response to adversity, but it requires certain conditions to thrive.

  • Protective factors like connectedness, supportive relationships, and stable environments are critical in fostering resilience.

• Building Resilience:

  • It’s possible to cultivate resilience through intentional efforts, such as fostering strong social connections, creating safe spaces, and providing therapeutic interventions.

4. The Permanence of Trauma’s Impact

• Trauma Leaves a Mark:

  • No one, regardless of age, emerges from trauma entirely unchanged. While healing is possible, the person we become afterward is always shaped by the experience.

  • This doesn’t mean we are “broken” forever, but that we integrate the experience into our evolving sense of self.

• Growth Amid Change:

  • Healing can lead to growth, wisdom, and new strengths, but it requires time, effort, and a supportive network.

Resilience vs. Trauma: The Biological Impact

• Resilience Defined:
  Resilience doesn’t mean returning to “normal” or being unaffected. Trauma changes the brain, body, and overall development in some way. Even if a child “appears fine,” the biological changes are still present—sometimes showing up later in life.

• Examples of Impact:

  • A child who seems to do well in school may still experience heightened neuroendocrine responses, like an increased risk for health issues such as diabetes.

  • Children may show resilience in their emotional functioning but still exhibit subtle but enduring neurological impacts, such as changes in their stress-response systems.

• The ACE Studies:
  These studies underline that adversity during childhood, particularly trauma, alters development. The full impact may not be immediately apparent but always leaves a mark.

2. How Trauma Affects the Brain: Neuroimaging and Functionality

• Brain Imaging and Trauma:
  While brain scans show differences between children who have experienced trauma versus those who haven't, these differences aren’t always clear or easily interpreted. Imaging can show structural differences in brain areas, but it’s difficult to definitively link these changes to trauma alone due to the brain’s complexity and individual variation.

• Functional Indicators:
  Instead of relying solely on imaging, behavioral and functional signs of trauma are often the best indicators:

  • Impulsivity, inattention, learning difficulties, and speech or motor problems can all point to brain changes due to trauma.

  • Issues like depression, anxiety, or difficulty in forming relationships are more direct signs of how the trauma is affecting the brain.

3. The Role of Social Connection in Resilience

• Connectedness and Belonging:
  Oprah’s mention of “weathering” reflects the deeply important role of community in resilience. The support from groups like the church was critical to enduring trauma. Dr. Perry highlights that connectedness to supportive, nurturing people helps buffer against the effects of stress and trauma.

• The Buffering Effect of Support:
  The presence of others—people who are present, supportive, and stable—can be a central factor in building resilience, healing from trauma, and regulating stress responses.

4. Sensitivity of Stress-Response Systems

• Genetic and Early-Life Factors:
  Some people are more vulnerable to the effects of trauma due to genetics, early exposure to stress, or attachment issues. These factors can make an individual’s stress-response systems more reactive, making them more sensitive to future stressors.

• Resilience as a Malleable Skill:
  The ability to cope with stress and trauma is not fixed. Resilience is something that can be nurtured and strengthened over time, especially through supportive relationships and therapeutic intervention.

5. Healing and Growth: Moving Beyond Trauma

• Building Coping Mechanisms:
  It’s not just about "bouncing back" from trauma. Instead, resilience involves building new ways to cope with stress and distress. Therapy, social support, and even lifestyle changes can strengthen our resilience machinery, allowing us to handle challenges more effectively.

• CRNs Overview:
  The Core Regulatory Networks (CRNs) are neural systems that regulate stress and coping mechanisms. When these networks are well-organized and strong, they provide the flexibility to cope with a wide variety of stressors. Predictable, moderate challenges—those that are manageable and within reach—serve to strengthen these networks.

• The Impact of Practice:
  Just as physical muscles grow stronger with exercise, the brain's stress-response systems strengthen through practice. Children who experience moderate, predictable stress as they grow up will develop stronger coping capabilities, allowing them to handle bigger challenges later in life.

2. The Early Development of Resilience

• Foundations in Early Life:
  The process begins early in a child’s life. For example, a newborn feels hunger, thirst, or discomfort, and a caregiver responds by meeting their needs. This interaction teaches the child that their needs can be met in a predictable, safe environment. As the child grows, the stress response is activated by novel experiences, like crawling away from a caregiver and exploring, but the child always returns to safety when overwhelmed. This back-and-forth—leave, explore, return to safety—builds the foundation for resilience.

• Repeated Exposure to Predictable Stress:
  Throughout childhood, this cycle repeats with moderate challenges: starting school, making new friends, learning new skills, and participating in activities like sports or drama. These events are all predictable stressors that are important for the child’s stress-response development.

3. The Importance of Relationships

• Relational Foundations of Resilience:
  Dr. Perry emphasizes that relationships are at the heart of resilience development. For a child, the primary caregiver plays a critical role in modeling behavior, offering encouragement, and providing a helping hand through challenges. This relational support acts as the scaffolding around the child, allowing them to engage in challenges and eventually master them.

• The Power of Feedback:
  Positive feedback—such as praise, encouragement, or a comforting presence—motivates the child to keep trying and to tackle new challenges, building their self-confidence and resilience.

4. The Goldilocks Principle: Finding the Right Level of Challenge

• Moderate Challenges:
  Resilience-building challenges should not be too easy or too difficult. They should be just right—novel enough to stretch the child’s abilities but not so overwhelming that they result in failure. This "Goldilocks" principle is key for resilience. Too little challenge leads to stagnation, while too much challenge causes stress overload.

• Challenges Should Be Developmentally Appropriate:
  Dr. Perry illustrates that developmental challenges should align with a child’s stage. For instance, a child learning to write should not be expected to compose essays right away. Similarly, a child who struggles with basic arithmetic should not be pushed into algebra before they are ready. This ensures the child has the skills and support necessary to meet the challenge.

5. The Special Case of Traumatised Children

• Sensitivity to Stress in Trauma:
  Children who have experienced trauma often live in a constant state of heightened fear. This heightened sensitivity to stress can impair their thinking brain (the cortex), making what seems like a moderate challenge to others feel overwhelming to them. In these cases, even small challenges can trigger a dysregulated stress response. This highlights the need for careful support and understanding in providing challenges for traumatized children.

• Risk of Erosion of Self-Esteem:
  Without the right level of challenge and support, children who are pushed too hard may fail repeatedly, leading to frustration, anxiety, and a damaged sense of self-esteem. It’s crucial that challenges are manageable to avoid these negative outcomes.

6. The Role of Failure in Building Resilience

• Failure as Part of Growth:
  Dr. Perry stresses that failure is a normal and necessary part of development. Trying, failing, and trying again teaches children important lessons in perseverance and problem-solving, which are crucial aspects of resilience. Children need to experience discomfort and failure in order to learn how to bounce back and develop coping skills.

• Healthy Development Involves Challenges:
  Healthy development, both physical and emotional, involves gradually increasing challenges that help children build resilience and empathy. Just as physical exercise strengthens muscles, exposure to manageable emotional and cognitive challenges strengthens the stress-response system.

Failure and Success: A Key Cycle in Development

• Failure as a Path to Mastery:
  Development is built on the foundation of failure. Many failures typically precede success. Children need to encounter challenges that are close to their current abilities, with the support of encouragement, practice, and repetition to eventually master new skills.

• The Role of Safety in Exploration:
  A child who feels loved and safe will be more inclined to venture out of their comfort zone to explore new things. This sense of safety and stability is crucial for curiosity and healthy development. Without it, children may feel too insecure to face new challenges and might shy away from growth.

2. The Impact of Chaos and Lack of Stability

• Sensitized Stress Response:
  For children growing up in environments of chaos or instability, particularly early in life, their stress-response system may become sensitized. These individuals are more likely to react impulsively, acting before thinking. Their lower brain regions, responsible for immediate reactions, dominate, while the cortex, which is responsible for reasoning and thoughtful responses, is underactive.

• Dysregulation and the Difficulty of Connection:
  This heightened reactivity makes it difficult to meaningfully connect with someone who is emotionally dysregulated. Reasoning or offering advice during moments of intense emotion—like telling someone to “calm down”—is unlikely to be effective and often makes the situation worse. Instead, the key is staying regulated yourself and offering emotional presence.

3. The Importance of Being Present and Reflective Listening

• Being Present with Dysregulated Individuals:
  When someone is upset, particularly in a state of dysregulation, it’s crucial to stay present. Reflective listening is an effective tool: restating what they are saying, even if the words don’t have the immediate power to calm them. You cannot simply talk someone out of their emotions, but empathizing and absorbing their emotional intensity can help them regulate over time.

• Rhythmic Activities for Regulation:
  Engaging in rhythmic activities—such as walking, playing ball, or even coloring together—can be incredibly helpful for maintaining regulation. These activities promote a sense of connectedness and help both parties stay calm.

4. The Power of Rhythm in Communication

• The Role of Rhythm in Regulation:
  Rhythm plays an essential but often overlooked role in emotional regulation. Dr. Perry shares a personal experience with Mike Roseman, a Korean War veteran. Through their conversation, he notices that Mike’s routine of dancing each weekend helps him process and regulate his emotions. The physical rhythm of dancing seems to support Mike’s emotional well-being, demonstrating the value of activities that incorporate movement and rhythm for emotional regulation.

• Dancing as a Therapeutic Tool:
  Dancing, especially styles like swing, which involve rhythmic movement, can have a therapeutic effect on the brain. These movements help balance the body’s stress-response system and promote emotional stability.

The Role of Physical Therapy and Rhythmic Activities in Healing

• Mike Roseman’s Recovery:
  Mike Roseman, a PTSD survivor, had a highly sensitized stress-response system that caused significant sleep disturbances. After integrating regular physical therapy, including massage and dancing, Mike began experiencing longer, deeper sleep and reduced post-traumatic symptoms. These rhythmic activities helped regulate his body and stress-response system, supporting his emotional recovery.

• Walking and Nature:
  Dr. Perry emphasizes that walking, especially in nature, is particularly regulating because the sensory elements of nature (such as sounds, sights, and rhythms) help soothe and stabilize the body and mind. The repetitive and calming nature of walking, combined with the natural environment, fosters emotional balance and regulation.

2. The Importance of Control and Safety in Healing

• Giving Control in Conversations:
  For individuals who are dysregulated or traumatized, it’s essential to allow them control over when and how much they talk about their trauma. By giving them autonomy, they feel safer and more in control of their healing process. Forcing someone to talk too soon or too much can retraumatize them rather than promote recovery.

• Elizabeth Smart’s Parents:
  Oprah shares an example from her interview with Elizabeth Smart’s parents, whose daughter was kidnapped and held captive for over nine months. Elizabeth had not yet spoken about her experience at the time Oprah interviewed her family, and her parents were waiting for her to open up in her own time. This aligns with Dr. Perry's view that revisiting trauma must be done gradually and in manageable doses, at a pace set by the person experiencing it.

3. Healing Through Patterns of Stress Activation

• Moderate, Predictable Stressors:
  Healing from trauma involves revisiting traumatic memories and activating the stress-response system in moderate, predictable, and controllable ways. By doing so, individuals can rework and reprocess their trauma, helping to heal a sensitized system. This is not about overwhelming the person, but about offering small, manageable doses of challenge that can help the body and brain re-establish a regulated stress-response curve.

• The Healing Power of Community:
  Dr. Perry stresses the importance of community support in the healing process. Healing occurs most effectively in relationships with supportive, healthy people. A strong social network or community offers a natural healing environment where the person can revisit trauma in a safe, controlled manner. This community acts as a buffer for the stress response, promoting healing through connection and moderate stress activation.

4. The Path from Trauma to Resilience

• From Traumatized to Resilient:
  By experiencing trauma and learning to manage the subsequent stress responses, a person can journey from being traumatized to neurotypical—less reactive and vulnerable. Over time, they may even develop the capacity to demonstrate resilience, drawing strength and perspective from their experiences. This transformation can lead to post-traumatic wisdom, a unique strength gained through overcoming adversity.

• Intergenerational Healing:
  Dr. Perry notes that throughout human history, people lived in small intergenerational groups. These groups provided a natural support system for managing trauma, even in the absence of formal mental health services. The ability to revisit and process trauma within the context of community, over time, allowed for the healing and regulation of the stress response.

Post-traumatic wisdom: Healing and growth can emerge from trauma. Our ancestors likely had post-traumatic challenges but survived through community and ritual.

Traditional healing pillars:

1. Connection to clan and nature: The foundation of support and belonging.

2. Regulating rhythm: Activities like dance, drumming, and song that help regulate the body’s stress response.

3. Beliefs and stories: Offering meaning to trauma and life’s challenges.

4. Plant-derived substances: Occasionally used in healing rituals with guidance from elders or healers.

Modern trauma treatment: Best practices often reflect these traditional healing methods, though they tend to overemphasize psychopharmacology and cognitive behavioral therapy, while undervaluing connectedness and rhythm.

Ally’s story:

• Ally, a 4-year-old girl, witnessed her mother’s death and father’s suicide.

• Raised in a supportive community with family, school, and church involvement.

• Trauma-sensitive teachers and family helped her process the tragedy.

• Ally showed resilience due to stable, loving relationships—not innate resilience.

• She healed through ongoing relational support and understanding, despite occasional sadness.

Resilience: It’s not a fixed trait; it depends on the support and relational resources around a person.

Oprah’s experience: Growing up with a church as a supportive community, emphasizing the importance of connection in healing, not just worship.

Therapeutic value of community: Oprah emphasizes the importance of having a supportive community, akin to a "church home," for healing from trauma.

Social connection: Community helps build resilience, which contributes to post-traumatic wisdom, creating hope for both individuals and their community.

Post-traumatic wisdom: Dr. Perry highlights the importance of hardship and weathering challenges together to gain wisdom.

The role of healing in community: True healing often occurs outside formal therapy, within supportive social groups.

Waco case study (1993): Dr. Perry led a clinical team to support children traumatized by the Waco siege, where children witnessed violence and experienced chaotic, unpredictable environments.

Trauma symptoms: The children exhibited high resting heart rates (132 bpm on average) due to trauma.

Healing approach: Dr. Perry focused on providing structure, predictability, and control over their environment to help the children feel safer.

• Limited adult interactions and gave children opportunities to ask questions.

• Organized daily routines with group meetings, play, quiet time, and meals at consistent times.

• Allowed children to make choices about food, play, and quiet time.

Lesson: Dr. Perry’s approach demonstrates how stabilizing, predictable routines in a supportive community can help heal trauma, particularly when direct therapy isn’t immediately effective.

Team interactions at Waco: Dr. Perry’s team tracked each child’s daily interactions, which included brief therapeutic moments, like reassurance or activities such as drawing or swinging.

Children's control: The children controlled when and how they talked about their trauma, seeking safe, stable, and regulating interactions, often through simple activities.

Therapeutic impact: Despite no formal therapy, children received over two hours of therapeutic interactions daily, leading to a drop in group heart rates (below 100) and improved regulation and communication after three weeks.

Diverse therapeutic needs: Children sought different types of therapeutic interactions based on their needs at any given time—quiet nurturing, playful engagement, or authority figure reassurance. Different staff members fulfilled these roles based on their unique strengths.

Importance of developmental diversity: This approach reflected the concept of a multifamily, multigenerational clan, where various adults contribute to a child’s needs, ensuring a balanced caregiving system.

Modern caregiving challenges: Dr. Perry critiques the unrealistic societal expectation that a single caregiver, like a working mother, must fulfill all roles (emotional, social, physical) for multiple children, leading to overwhelming stress.

Need for communal support: Oprah and Dr. Perry stress the importance of community in caregiving. In hunter-gatherer societies, a 4:1 caregiver-to-child ratio existed for children under six, which contrasts with modern expectations (1:4).

Relational poverty: A lack of sufficient adult support and the burden placed on single caregivers is seen as a form of relational poverty, which harms children’s developmental and emotional well-being.

Single parents and societal pressure: Dr. Perry acknowledges that single parents, like Oprah's mother, often feel inadequate due to the overwhelming demands of modern life, which makes it harder for them to do more, even when they try their best.

Importance of community: A strong connection to community remains crucial for well-being, just as it was in ancient times. Modern life makes this harder to achieve, with fewer people feeling they belong or being active in supportive communities, like faith groups.

Social isolation and health: Dr. Perry links a person’s degree of social isolation to increased physical and mental health problems, highlighting the importance of relational support in buffering stress.

The power of relational regulation: Dr. Perry illustrates how relational support (like discussing a stressful work review with colleagues and a partner) helps regulate emotions. By revisiting distress in manageable doses, a person can reflect and reframe their reaction, leading to better emotional regulation.

Challenges of relational poverty: For those lacking a supportive community, distressing experiences are amplified by isolation, making stress harder to manage and leading to mental and physical effects akin to trauma.

Modern disconnection: The modern world’s mobility, technology, and disconnection pose challenges for creating the kind of community that facilitates healing, regulation, and resilience. The challenge is how to foster connectedness, safety, and belonging for everyone.

Shaka Senghor's transformation: Shaka Senghor, convicted of second-degree murder at 19, served 19 years in prison, including 7 years in solitary confinement. Initially angry and violent, he began transforming after six years, turning to meditation, reading, journaling, and writing his memoir Writing My Wrongs.

Skepticism turned understanding: Oprah initially felt skeptical about Shaka's story, based on his appearance and past. However, their conversation deeply impacted her understanding of what it means to be shaped by one’s environment and experience.

Early life and trauma: Born James White in Detroit, Shaka grew up in a seemingly ideal middle-class family. His mother, however, had an explosive temper and abused him physically. Despite excelling academically, his mother’s constant anger and unpredictable violence overshadowed his childhood.

Emotional neglect and fear: Shaka recalls being physically punished even when trying to share positive experiences, like getting an A+ on a test. This emotional neglect and fear led him to internalize the belief that the abuse was a form of love.

Impact of family instability: Shaka’s parents’ unstable marriage, followed by their divorce, left him emotionally devastated. He built an emotional wall and turned to the streets for acceptance, leading to delinquency and crime by age fourteen.

Lack of support and understanding: Despite Shaka’s descent into criminal behavior, no adults questioned why he was acting out. His trauma and need for support went unnoticed.

Seeking validation: Shaka’s dream of becoming a doctor was rooted in his desire for validation from his mother, who was only kind when taking him to the doctor. This moment of realization showed his deep emotional need for love and acceptance.

Turning point: At 19, Shaka’s life took a fatal turn when he shot and killed a man during an argument. In prison, he continued to spiral into violence and spent much of his time in solitary confinement.

Breakthrough moment: A letter from his son changed everything. The letter urged him not to murder anymore and encouraged him to pray for forgiveness. This moment was pivotal, inspiring Shaka to find his "light" and refuse to let that violence define his legacy.

Post-prison redemption: Since his release in 2010, Shaka has become an advocate for criminal justice reform, speaking to young people, teaching at the University of Michigan, and working with the MIT Media Lab. His core message is that people should not be defined by their past mistakes, and redemption is possible.

Understanding trauma: Shaka’s journey shows how understanding the past helps explain, though not excuse, behaviors. Acknowledging trauma is vital to healing, as confronting one’s past requires courage but is essential for recovery.

Impact of trauma on systems: Oprah and Dr. Perry discuss how trauma continues to affect individuals within systems like healthcare, schools, and the criminal justice system, which often misunderstand or retraumatize those affected.

Trauma-informed care: Dr. Perry expresses reservations about the term “trauma-informed care.” While there has been progress in recognizing trauma’s impact across systems, he believes more comprehensive changes are needed. Systems have historically lacked an understanding of trauma, implicit bias, racism, and other interrelated issues, which must be addressed to truly support healing.

Confusion over TIC: The term “trauma-informed care” (TIC) emerged in 2001 to address trauma in mental health and child welfare systems, but it quickly became confusing due to inconsistent definitions and implementation. Organizations and cities adopted the term with little clarity or concrete action, and TIC training became inconsistent and commercialized.

Lack of clear definition: Despite years of work, there is no universally accepted definition of TIC. Various organizations and committees have proposed different principles, elements, and guidelines, resulting in confusion about what TIC actually entails. The field is still evolving, and definitions continue to shift.

Growing awareness and progress: While the understanding of trauma has grown over time, with organizations like the National Center for PTSD and the CDC/SAMHSA establishing principles in recent years, there’s still much work to be done in addressing trauma across systems and societies.

Importance of perspective: Trauma’s impact is complex and pervasive, affecting not just individual behavior but also family dynamics, communities, and even genes. How we understand trauma depends on our worldview and personal experiences with it.

Essence of TIC: In simple terms, trauma-informed care means recognizing that people’s experiences of trauma influence their behavior and health. This understanding should shape how we respond to others—whether as parents, teachers, doctors, or in other roles. This awareness should guide us to act with empathy and support.

The Importance of Action: Awareness of trauma’s impact is critical, but the key question is: What can we do to help? Systems must provide opportunities for healing, avoid exacerbating trauma through recurring stressors, and ensure that marginalized groups are not retraumatized through dehumanizing practices.

Recognizing Bias: To be truly trauma-informed, it’s essential to recognize biases—both personal and structural. Marginalization (based on race, gender, sexual orientation) causes prolonged, uncontrollable stress that compounds trauma. Discriminatory systems need to be challenged, as they contribute to the trauma people experience.

The Anti-Racist Component: Trauma-informed systems must also be anti-racist. Racial marginalization disproportionately affects Black, brown, and Indigenous children in areas like mental health diagnoses, child welfare, education, and the juvenile justice system. These children often experience additional trauma from the very systems meant to support them.

The Role of Trauma in Behavioral Misunderstanding: Trauma affects a child’s ability to learn and manage feedback, often resulting in behavior problems that are misunderstood. Well-intentioned systems may inadvertently cause more harm by not recognizing the trauma behind the behavior.

Addressing Root Causes: Many programs focus on surface-level issues without addressing the underlying trauma that causes problems. For instance, after-school or employment programs that don’t understand why a child struggles with health or behavior won’t achieve lasting change.

Childhood Trauma and Development: Early-life trauma disrupts normal development. Children exposed to poverty, domestic violence, or neglect often have underdeveloped language, self-regulation, and coping skills. When these children enter environments that expect typical behavior, they struggle, leading to frustration, disruptive behavior, and academic setbacks.

Disproportionate Discipline: Children, especially children of color, are disproportionately expelled from preschool, which worsens the cycle of exclusion and academic disadvantage. This is a clear example of how trauma in early life can lead to marginalization in systems.

Mismatch Between Child’s Needs and Educational Expectations: Trauma-impacted children often face a mismatch between their developmental needs and the expectations of the education system, which is often underfunded and lacks trauma-informed practices. As a result, these children fall further behind each year, with their developmental delays and trauma-related symptoms leading to labels like ADHD.

Labeling and Punishment: Behaviors related to trauma, such as hypervigilance or self-regulation strategies (e.g., rocking, tapping), are often misinterpreted and punished. Children may be labeled, medicated, excluded, or expelled, eventually entering the criminal justice system. This is the essence of the school-to-prison pipeline.

Self-Blame and Cycle of Failure: Children struggling in school often internalize failure, believing they are “dumb” or “lazy,” which erodes their self-esteem. This cycle of frustration and shame can lead them to give up on school entirely.

Trauma’s Impact on Learning: Between 30–50% of public school children have experienced multiple Adverse Childhood Experiences (ACEs), which affect their ability to learn and behave. Many of these children are experiencing trauma-related memories that can be triggered by seemingly benign events in the classroom.

Unconscious Trauma Responses: Trauma can lead to subconscious associations that influence a child’s behavior without their awareness. For example, a child who witnessed domestic violence may feel discomfort around male figures who resemble their abuser, even if they don’t consciously recognize the connection. This can lead to sabotaged relationships with potential positive role models.

Behavior Shaped by Trauma: Children’s behaviors often stem from emotional triggers they don’t understand. The brain works to make sense of the world, and trauma-induced reactions may lead to negative patterns, such as avoiding teachers or perceiving them as threats, without any conscious understanding of why.

Trauma-Triggered Reactions: When the teacher tries to help the student with a writing assignment and touches his shoulder, the student reacts aggressively. This response is due to the brain’s trauma memories being triggered. The boy’s brain, associating touch with danger (due to past trauma), activates the stress response, which shuts down the rational brain, preventing a reasoned response.

Unpredictable Outbursts: The teacher might perceive the outburst as unprovoked and baffling. However, the behavior is a trauma-induced response, not an irrational act. These kinds of reactions often seem “out of the blue” because they are linked to past trauma that is unconsciously activated.

Misinterpretation of Behavior: The teacher, unable to understand the true cause of the outburst, may label the child as a “problem.” This misunderstanding leads to ineffective interventions, like suspension, referral to a counselor, or mental health services, which do not address the underlying trauma.

The Importance of Understanding Trauma: Schools that are informed about trauma and childhood adversity are better equipped to help. Rather than punishing or labeling the child, they can implement strategies to create a safe, regulated environment. The focus should shift from “What’s wrong with this child?” to “What happened to this child?”

Positive Outcomes from Trauma-Informed Practices: Schools that adopt trauma-informed practices see significant improvements in academic performance and reductions in behavioral issues. Strategies that support teachers and address students' needs and strengths can create a more supportive learning environment. The Neurosequential Model in Education (NME) is one such approach that has shown promising results.

Systemic Change: If schools change how they evaluate, support, and teach students with trauma, they can create better outcomes. Simple changes that support regulation and understanding of trauma can have profound effects.

Common Elements in Trauma-Informed Models: Successful trauma-informed models emphasize two main principles: regulation and connection. These models help individuals manage their stress responses and build healthy relationships before moving on to cognitive processing or reasoning.

Regulate, Relate, Reason: The sequence of engagement in trauma-aware settings is crucial. First, help individuals regulate their emotions, then establish connections with others, and only after that is cognitive reasoning and learning most effective. This is a foundational concept in trauma-informed care in schools.

Regulatory Activities in Schools: Schools often prohibit activities that promote regulation, such as walking, rocking, or listening to music while working. However, somatosensory regulation (e.g., rhythmic activities like music, sports, and art) helps activate the brain’s cortex and supports learning. These activities balance the stress response system and foster both cognitive and relational growth.

The Role of Arts and Sports: Activities like music, sports, and dance are more than just enrichment; they are integral to academic learning. These activities engage the whole brain, promote regulation, and foster social connections. This type of engagement helps students learn more efficiently than passive listening in traditional classroom settings.

Inadequate Mental Health Services: When a child’s behavior is misunderstood and they are referred to mental health services without trauma-informed care, the outcome is often worse. Misdiagnosis and overmedication are common, as current mental health systems are underfunded and overwhelmed. Treatment often focuses on crisis management, with minimal support or personalized care.

Ideal Trauma-Focused Mental Health Care: In a well-informed system, children receive a comprehensive assessment that looks at their developmental history to understand “what happened to you?”. Treatment should be individualized, recognizing that different children need different approaches, and should incorporate their strengths and needs for effective support.

Personalized Trauma Care: A "one-size-fits-all" approach in mental health care is ineffective. Like treating every chest pain patient with the same antibiotic, trauma care requires tailored interventions. Trauma-focused therapies like TF-CBT are helpful for some but may not work for all. Proper assessment and individualized care are essential for successful outcomes.

Trauma-Aware Clinical Teams: Effective clinical teams for trauma-informed care use a range of tools, including occupational therapy, physical therapy, speech and language supports, school liaisons, psychoeducation, and therapeutic techniques like TF-CBT, EMDR, and somatosensory interventions. These tools work best when applied in the right sequence, starting with regulation before moving to relational and cognitive therapies.

Neurosequential Model of Therapeutics (NMT): Dr. Perry’s NMT emphasizes the importance of a sequence of engagement in therapy, beginning with regulating the stress-response systems before addressing relational or cognitive issues. Healing involves revisiting and reworking traumatic experiences with the support of a safe, stable therapeutic relationship. This connection is crucial for rewiring the brain and reducing trauma symptoms over time.

Therapeutic Web: Access to a network of caring, invested people—what Dr. Perry calls the "therapeutic web"—is often more important than access to a single therapist. This network can include family, community, and cultural connections. Having positive relational opportunities throughout the day significantly enhances healing outcomes.

Indigenous and Traditional Healing Practices: Many traditional healing practices, such as those in Indigenous cultures, incorporate a holistic approach to mind-body healing. These practices are relational, repetitive, rhythmic, and sensory-based—such as storytelling, dancing, singing, and reconnecting with community. They target multiple brain systems and have been effective in altering neural systems involved in the stress response.

The Destructive Effects of Disconnection: Historical practices like colonization, slavery, and forced assimilation intentionally disrupted family and cultural bonds, leading to long-term trauma. These systems of exclusion and marginalization created disconnection and contributed to the dissociation of individuals, making them more vulnerable to exploitation and dehumanization. Connectedness, in contrast, is essential for healing and well-being.

Systemic Impact on Families and Communities: Dr. Perry argues that many societal systems, including child welfare, education, mental health, and juvenile justice, inadvertently fragment families and communities. These systems often employ practices that marginalize, shame, and punish individuals, which can perpetuate cycles of trauma and disconnection rather than supporting healing and connection.

Implicit Bias and Racism: In discussing the challenges at the Oprah Winfrey Leadership Academy for Girls, Dr. Perry explains how implicit bias and systemic racism can manifest through brain development. The brain forms unconscious associations based on sensory input from early life, creating deep-rooted memories of what feels familiar and safe. This can cause people to feel threatened or dysregulated when encountering those who are different, triggering a stress response.

Infant Stress Response to the Unfamiliar: Dr. Perry uses the example of an infant reacting to being passed around by unfamiliar people as a way of illustrating how the brain’s stress response is activated by novelty and unfamiliarity. This basic mechanism of survival is rooted in our evolutionary need to be cautious of unfamiliar experiences, especially when they involve differences from what we know.

Adult Stress Response and Regression: For adults, encountering individuals with attributes different from their “clan” can also trigger a stress response. In extreme cases, this may cause individuals to regress to a more primitive, reactive state, losing access to rational thinking and their higher values. This can contribute to behaviors driven by fear or bias rather than conscious thought.

Example of Cultural Differences: Dr. Perry gives an example of a young woman from Minnesota joining the Peace Corps and encountering children in rural Africa who had never seen a white person. The children’s reactions—fear, crying, and running away—weren’t directed at her personally but were due to their brains’ lack of positive associations with "whiteness," highlighting how unfamiliarity triggers a stress response. This underscores the importance of understanding the brain's natural reaction to difference and novelty.

Shifting Responses Over Time: Dr. Perry explains that while the initial stress response to unfamiliarity or difference (like encountering a white person for the first time) is based on survival instincts, over time, repeated positive experiences can reshape this response. For example, if the children in rural Africa repeatedly experience nurturing and care from a white Peace Corps worker, they will eventually associate “whiteness” with safety and kindness. These positive associations become deeply embedded in the brain and can influence their reactions to new encounters with people who share those same characteristics.

Building New Associations: The brain’s initial reaction to someone new is to categorize them based on observable traits. Over time, as more positive interactions occur, these categories become more nuanced, incorporating the individual’s unique qualities beyond their group membership (e.g., skin color, age, or gender). However, the brain also relies on shortcuts that may lead to stereotyping or biased responses, especially when the first experiences form strong associations that persist long into adulthood.

Example of a Child’s Early Negative Experience: Dr. Perry contrasts the previous example with a young Black child who had a traumatic first encounter with a white person. The child witnessed his father being violently arrested by a white police officer, leading to a deeply negative association with white people. As a result, when this child later encountered Dr. Perry, a white therapist, he initially felt fear and distrust, influenced by his past trauma. It took a long time to overcome these associations, illustrating how early experiences shape how people process future encounters.

Power of First Experiences: Dr. Perry emphasizes that the brain processes new encounters through the lens of prior experiences. In the case of the boy with negative experiences with white people, any new encounter with a white person would first activate his fear response, which would influence his emotional and behavioral reaction before he could engage his rational thinking (cortex). Even if he had a positive experience with a white person later on, the initial trauma response remains influential and automatic.

Cultural and Historical Context: In the case of South Africa, the historical legacy of apartheid and systemic racism has deeply influenced how people of color, particularly Black teachers at the Oprah Winfrey Leadership Academy for Girls, interact with white people. For many, the default association with whiteness is one of fear, distrust, or resistance due to the oppressive history. The adaptive survival strategies (such as compliance or dissociation) formed during this period are deeply ingrained and continue to influence behavior and interactions.

• Implicit Bias & Historical Context: Even after the end of apartheid, old patterns of behavior persisted unconsciously in interactions between Black and white teachers. The brain’s deep-rooted associations continue to influence behavior, despite conscious beliefs or values.

• Behavior vs. Beliefs: Implicit bias can lead to racist actions even in people who consciously reject racism. The brain's lower parts make unconscious associations, which can conflict with conscious values stored in the cortex.

• Parental Influence: Early childhood experiences, especially how parents treat people of different races, shape implicit biases. It’s not just what’s said, but the actions and emotional tones that influence how children perceive others.

• Media’s Role: Media portrayals significantly impact the brain’s associations. Historically, negative stereotypes of Black people in the media shaped white people's perceptions, contributing to implicit bias.

• Universal Bias: Everyone carries some form of implicit bias, shaped by early life experiences and cultural exposure. It's unrealistic to expect complete neutrality, given the complexities of early influences.

Media & Bias: Media disproportionately portrays Black people as criminals, reinforcing implicit bias. Crimes involving a Black suspect and white victim make up only 10% of crimes, but they account for 42% of news reports.

State-Dependent Functioning: In high-stress situations, the brain’s reactive parts override reasoning. For example, a white cop might feel threatened by a Black teen due to a mental catalog associating Black men with criminality, escalating the situation.

Importance of Trauma Training: Police officers and first responders need extensive training in trauma, brain function, and stress to prevent fear-driven reactions in critical situations.

Implicit Bias vs. Racism: Implicit bias refers to unconscious bias based on the brain’s lower regions; racism involves overt beliefs of racial superiority, rooted in systemic oppression.

Changing Racism: Compassion can lead to change. Oprah shares the story of Anthony Ray Hinton, a man wrongfully imprisoned, who formed a bond with a KKK member on death row. This relationship helped the KKK member change his racist beliefs before his death.

Implicit Bias vs. Beliefs: Implicit bias is harder to change than overt beliefs. While someone may believe in equality, their subconscious biases (in the lower brain) can still influence behavior.

Black Lives Matter & Bias: The Black Lives Matter movement has exposed structural racism and implicit bias, especially after George Floyd's murder. Many people react defensively, saying they aren’t racist, but everyone has ingrained biases.

Changing Implicit Bias: To address bias, recognize it, reflect on when it appears, and engage with diverse people. Building relationships with those from different backgrounds creates new, positive associations.

Cultural Sensitivity: Cultural-sensitivity training alone isn’t enough. True change comes from real-life experiences and relationships, not just seminars. Experiencing other cultures first-hand, like Anthony Bourdain did, is key to deep cultural understanding.

Long-Term Solutions: We need to raise children with diverse experiences to minimize implicit bias and change biased systems.

Humanity & Trauma: Despite the challenges, Dr. Perry is optimistic about humanity’s progress. Although there’s polarization and fear in society, overall health, social justice, and creativity are improving.

Māori Welcoming Ceremony: Dr. Perry describes his arrival at a Māori marae, where he experiences the pōwhiri, a traditional welcoming ceremony involving singing and ritual performed by community members.

Learning about Māori Healing: Invited by Dr. Robin Fancourt, Perry was introduced to Māori healing practices. He had previously learned from various Indigenous cultures, noting common elements like rhythm and nature’s harmony.

Immersive Learning: The elders taught him not through formal lectures but by immersing him in the community. This approach allowed him to experience the teachings firsthand rather than seeing them as mere academic concepts.

Holistic Approach: The Māori community viewed problems and solutions as interconnected, rejecting the Western separation of issues into categories like education, mental health, or justice. They emphasized a holistic view of life and healing.

Holistic Thinking: Dr. Perry draws parallels between Māori healing practices and the worldview shared by Cree and Métis elders, emphasizing the importance of understanding our history and ancestral experiences to truly grasp the present.

Ancestral Heritage: When speaking, individuals introduced themselves by tracing their family lineage, fostering a sense of cross-generational connection. Storytelling was a key tool for communicating lessons.

Community and Healing: The community came together for shared meals, conversations, games, and storytelling, creating a familial atmosphere. Dr. Perry also joined elders for walks, where they shared the medicinal uses of plants.

Māori Views on Trauma: Māori healers explained that issues like depression, trauma, and addiction were interconnected, stemming from fragmentation, disconnection, and dyssynchrony—concepts absent in Western medicine's symptom-focused approach.

Historical Trauma: The Māori, like many Indigenous peoples, have been deeply impacted by colonization, leading to high rates of mental health and social issues. The key to healing, according to the Māori, was reconnecting to family, community, and nature (whanaungatanga).

Western Medicine Limitations: The Māori healers collaborated with Western doctors but believed that health needed a more holistic approach—treating the person as a whole, not as separate parts. Addressing connectedness was crucial for healing.

Final Moment: Before leaving, an elder placed her hand on Dr. Perry’s heart and said, “We are healers,” which he initially misunderstood, thinking she meant both of them.

Healing Through Connection: Dr. Perry reflects on the Māori elder’s message that the collective community heals—“We are all healers.” This insight led him to reconsider the importance of relational health in children.

Shift in Focus: Upon returning from New Zealand, Dr. Perry shifted his approach with patients. Instead of just focusing on symptoms or problems, he began to ask about children’s relationships, friendships, and where they felt safe, aiming to understand their connectedness.

Timothy’s Story: Timothy, a ten-year-old boy with behavioral issues (diagnosed with ADHD and oppositional defiant disorder), was referred to Dr. Perry’s clinic after his medication didn’t help. Dr. Perry reviewed Timothy’s history, uncovering clues about his trauma—physical abuse, poverty, frequent moves, and social instability.

Timothy’s Trauma and Struggles: Timothy’s behaviors (hypervigilance, sleep problems, social immaturity) were symptoms of trauma, not ADHD. His social development was delayed due to constant upheaval and a lack of stable social environments.

The Importance of Friendship: During their session, Dr. Perry asked Timothy about his friends. Timothy’s answer revealed that his only close friend, Raymond, lived far away in Kansas, and they only met once a year. Despite this limited connection, Timothy lit up when talking about him, highlighting the significance of relationships for healing.

Timothy’s Struggles: Timothy, a 10-year-old boy with trauma-related symptoms, had no real friends and was socially isolated. His family lived in poverty, and his mother struggled with depression while raising him alone.

Contrast with Māori Community: Dr. Perry contrasts Timothy’s loneliness with the rich, interconnected community life of the Māori people, who have a strong sense of relational health, with all generations engaging together in activities.

Need for Connection: Timothy and his mother were experiencing a “poverty of relationships” due to their isolation, which hindered their healing. They lacked the social web needed for recovery, a concept central to Māori healing (whanaungatanga).

Treatment Approach: Dr. Perry changed his approach, focusing on connecting Timothy and his mother to supportive relationships. This included enrolling the mother in the clinic, finding Timothy a mentor, enrolling him in after-school activities, and encouraging his mother to join a single-parent group.

Positive Changes: Six months later, Timothy was thriving—his behavior problems were resolved, and he had a close friend. His mother also found support through the group and was healthier. The healing power of relationships and belonging helped transform their lives.