Chapters 10 and 11

The final two chapters of The Boy who was Raised as a Dog seem to summarize the ideas that Dr. Perry believe are the key to helping disadvantaged children. Chapter ten is titled The Kindness of Children and it involves a little boy named Peter and his adoptive parents Amy and Jason. Amy and Jason adopted Peter from a Russian orphanage when he was three-years old. Peter was seven when his parents took him to see Dr. Perry. Peter had a history of speech and language problems as well as challenges with attention and impulsivity. Peter also had some social and academic challenges in school.

The orphanage that Peter lived in for the first three years of his life could be equated to a warehouse filled with children. The room he lived in had about sixty children in it with two caretakers on shift every eight hours. The children there received no individual attention from adults. They were essentially caged in cribs. The children in the orphanage turned to each other and somewhat became parents to each other. They would hold hands through the bars of their cribs they even created their own type of language to communicate with each other. It was probably the interaction that the children had with each other that helped limit the damage that occurred in Peter and the other children.

When Jason and Amy adopted Peter, they knew that they would have to provide extensive help for Peter. Once in the United States, Peter worked with speech and language therapists, occupational therapists, physical therapists, and mental health providers to help him develop more normally. Peter had improved dramatically over the four years he had lived with his parents but the progress was very slow. Amy and Jason took Peter to Dr. Perry after he seemed to plateau once he started school. Peter had a somewhat fragmented development. In some aspects Peter was a seven-year-old boy, but in other developmental aspects he was still a toddler. This fragmented development made it extremely difficult to parent Peter because Amy and Jason often had to shift their parenting strategies with Peter.

With this good foundation in place for Peter the subject of school needed to be broached. When Peter went to kindergarten, he had a very hard time because the other children did not understand Peter’s bizarre behavior. Peter didn’t understand the social cues that take place in a classroom and because of his behavior he was marginalized in school. This seemingly very difficult situation regarding school and Peter’s interactions with his peers actually wound up being the best treatment for him. Dr. Perry decided that he wanted to try to make Peter’s class into therapists for him. Dr. Perry and Peter went to Peter’s first grade class and taught the students a little bit about the brain and how it develops as you are growing. Dr. Perry then explained Peter’s situation to the class and explained that the beginning of Peter’s life was very different than the beginning of their lives. Dr. Perry explained that Peter’s brain didn’t start learning all the things it should have until he went to live with his parents and Perry asked them if they would just be Peter’s friend because Peter learns so much from playing and being around them.

This conversation with first graders was instrumental in changing the way that Peter was viewed by his classmates. The students essentially provided therapeutic experiences and helped Peter to catch up to them developmentally. All people fear something that they do not understand. With this new understanding of Peter’s unique situation, the students worked to help Peter instead of ostracizing him. From every situation expressed in this book, Dr. Perry found that “relationships are the agents of change and the most powerful therapy is human love.”

The final chapter of The Boy who was Raised as a Dog is titled Healing Communities. In this chapter, Dr. Perry doesn’t present a case that he had seen; he essentially summarizes everything that he has learned as a child psychiatrist. It is in this chapter that I find the most compelling argument about what needs to be done in our society to help these children who have dealt with such trauma. Ultimately, relationships with people matter. These relationships are the single most important tool that is needed for healing to take place. Unfortunately, so many of the children that are the most likely to experience trauma are the least likely to have a supportive family and community. People need healthy relationships in order to be mentally healthy. People need to be shown love in order to learn how to love themselves and others. The system in America for dealing with abused and traumatized children is far from perfect. In fact, this system is wholly inadequate for handling the problem and they often hurt the situation more than they help the situation.

This is where the church can come into play. The relationship between the church and modern culture is very difficult. In this situation, I believe that Christians and the church have the ability to transform our culture into something that is helpful for these children. There are so many opportunities to help. You can start at the beginning, in an attempt to help prevent trauma, neglect, and abuse by changing the treatment of new parents and infants. A little bit of knowledge about the development of children and how to support parents can go a long way. Christians should help create the community that can help families when they need it. People can learn what to look for during development. Something as simple as knowing that a baby not crying at all should be just as much of a concern as a child that cries all the time. Our society needs to not just focus on the intellectual development of children but also on the emotional needs of these children. We should want to have future generations that are not just intelligent, but children that are able to reach their full potential in all aspects of their life.

The church should have a major focus on building relationships, not just for adults but also for children. Relationships are one of the most important aspects of life. Our brain is use dependent, if we do not use the emotional, relational parts of our brain, they will not continue to develop and will eventually whither away leaving an underdeveloped brain. Christians can help teach parents about how to raise children in order to help them reach their full potential. Christians can help the children who have experienced trauma, abuse, or neglect and help them to heal from their injuries, both physically and emotionally. The call of Christians is to love your neighbor and these children need love more than anything else. I believe wholeheartedly that Christians can help create a loving and caring community in order to prevent abuse from happening and also to help those who experience it to recover most fully.

Chapters 8 and 9

Chapter eight of The Boy who was Raised as a Dog features a seventeen-year old girl named Amber. Dr. Perry met Amber after she was found unconscious at her school. She had shallow breathing, a slow heart rate, and extremely low blood pressure. After she was taken to the hospital, her heart even stopped. The doctors in the ER ran many tests on her and found nothing wrong. She was simply unarousable. Dr. Perry then stepped in and began to ask Amber’s mom Jill about her life. It was from this discussion that Dr. Perry learned that Jill was a single mother was in a relationship about eight years ago with a man named Duane. Duane raped Amber from the ages of seven to nine. Once Jill found out about the rape she left Duane. Dr. Perry determined that the previous night Amber had answered the phone and it was Duane. He suggested a visit. Jill quickly took the phone and firmly stated that neither she nor Amber would ever have anything to do with him again. Dr. Perry also saw that Amber had been cutting herself and figured that she had entered a dissociative state and was essentially overdosing on her own opiates and the results were similar to a heroin overdose. Dr. Perry then suggested treating Amber with naloxone, an antidote for opiate overdoses. The other doctors eventually agreed to give Amber that drug and within two minutes Amber woke up.

Dr. Perry then began to talk to Amber and eventually became her doctor to help her with overcoming the trauma from earlier in her life. During therapy Amber eventually began to explain what would happen when she experienced abuse, and now when she thought about the abuse that happened to her. Amber said that she had been able to find a safe place in her head where she wouldn’t feel the pain anymore. Amber described being a raven, even though she wanted to be a more majestic bird. She described herself as the “Black Death.” The dissociative state that Amber experienced is another possible response to trauma. Some people become hyper-vigilant in response to trauma while other dissociate. From Amber, Dr. Perry and his colleagues learned a lot about the dissociative response to trauma. Even now, when something reminded Amber of Duane and her trauma she would dissociate. This was something that she was unable to control.

From this new knowledge of dissociative responses to trauma, Dr. Perry was able to find some possible drugs to help with unwanted dissociation. The drug naltrexone was first tried on a sixteen- year old boy named Ted. Ted had unpredictable fainting episodes that had no discernable medical treatment. Ted had been a witness to continual domestic violence in his house from an early age. Ted’s mother was beaten by his stepfather on a regular basis. It was so bad that Ted’s mom had been hospitalized many times from the abuse. When Ted got older he would try to protect his mom and was able to redirect his stepfather’s rage onto himself. Eventually, seeing her son being hurt, Ted’s mom left his stepfather. Ted’s fainting was caused by a dissociative response to anxiety in his life. The medicine stopped Ted’s fainting but he still needed therapy to help deal with the anxiety he experienced on a regular basis when he was unable to dissociate. Dr. Perry was able to help Ted find more productive ways to handle stress in his life.  The combination of the drug and the therapy Ted experienced, he was able to better handle stress in his life without dissociating.

Dr. Perry continued to work with Amber as well to help her learn how to cope with stress without hurting herself or dissociating. Amber saw herself as a black raven and she even got tattoos to represent how she saw herself. Amber later moved with her mom to Austin because of a job and no longer saw Dr. Perry. She later emailed Dr. Perry to tell him about her new tattoo that had no black in it. She also began to see herself as a blue raven instead of a black one. Slowly but surely Amber was able to work on her stress management and became a “healthy, productive young woman,” she went to college and graduated in four years.

Chapter nine of Dr. Perry’s book deals with an issue of Munchausen’s by proxy syndrome (MBPS). James, a six-year old boy had an interesting, and complex situation through which a judge referred James to Dr. Perry. James was adopted by his parents before his first birthday. Merle, James’ mother, described him as “incorrigible and uncontrollable” he supposedly repeatedly ran away from home, attempted suicide, and wet his bed. James was hospitalized many times, once after he jumped from the second story of a house. According to Merle, James was so terrible that she called CPS on herself claiming to be a worried neighbor. The final incident was an overdose that Landed James in the ICU. Many caseworkers and therapists believed that James had Reactive Attachment Disorder (RAD), which is marked by a lack of empathy and the inability to connect with others. The descriptions of James’ behavior by his mother seemed to fit a RAD diagnosis. There was a problem though, when James was in the hospital or a treatment center, he was very well behaved and didn’t express any of the symptoms of RAD. Even in school he was relatively well behaved.

Dr. Perry found that the behavior of James’ adoptive parents was very strange as well. They would often show up for appointments when they had been told not to and when Merle was interviewed she seemed entirely focused on herself. Dr. Perry then met with James and really liked him. He seemed to behave appropriately and laughed and joked. Stephanie, James’ primary clinician, felt the same way about James. From these interactions with James, Dr. Perry determined that there was no way James could have a real case of RAD. They then started to look closer at James’ records and found many discrepancies. It turns out that almost every time that James was in the hospital, the staff there was suspicious of Merle. She continuously had strange reactions to what was going on with James and never expressed any real concern about his wellbeing.

With this information, Dr. Perry realized that many of the accidents were not initiated by James. He didn’t jump from the second floor; he was pushed. He didn’t try to swallow a bottle of antidepressants; he was forced to swallow them. The doctors determined that James was only sick because Merle was making him that way. Merle framed James as “difficult” with “behavior problems” and any attempt by James to escape his situation was seen as evidence those problem behaviors. It was through the discovery that James’ parents were deliberately deceptive. It was from this information that the doctors concluded that Merle had MBPS, a disease where a person attempts to make another person sick in a ploy for attention and support. Merle lived for the attention she received for having a “sick” child. If Merle had been let to continue with her behavior, James would have probably died.

From Dr. Perry and his teams’ recommendation, James and his siblings were removed from Merle’s home. A jury later agreed that the children had been abused by their parents and their rights were terminated. James’ continuous actions that had been viewed as disruptive behavior were actually cries for help from other people. This case taught Dr. Perry the importance of listening to the child he is working with regardless of what other adults say about the situation.

These two chapters reminded me about our class discussions about disability. Though they do not seem explicitly related. I have found that often people do not trust the word of a child when they are abused. It almost seems as if many adults think that these children somehow have less value than other adults. It seems easy for adults to try to diagnose children with diseases, to stigmatize them, simply because they may have different challenges in life or they have different opinions than their parents. No one thinks it’s all right for a child to be abused but often these children’s voices are not heard. Their age makes their opinion matter less. This should not be the case. In Luke 18:15-17, Jesus states that the kingdom of God belongs to the children and that one must approach the kingdom of God like a child in order to be able to enter it. Jesus places so much value in children that I think is missed in society today. These chapters remind me that God’s ideas of value are often the opposite of what we believe them to be.