IT HAS BEEN AN EXTRAORDINARY privilege to work with the children whose stories I have shared here—and I have learned a tremendous amount from them. I have been consistently amazed by their courage, their strength, and their ability to cope with situations that most adults would find unbearable. But while emerging therapeutic models like the neurosequential approach hold great promise, my experience as well as the research suggests that the most important healing experiences in the lives of traumatized children do not occur in therapy itself.
Trauma and our responses to it cannot be understood outside the context of human relationships. Whether people have survived an earthquake or have been repeatedly sexually abused, what matters most is how those experiences affect their relationships—to their loved ones, to themselves, and to the world. The most traumatic aspects of all disasters involve the shattering of human connections. And this is especially true for children. Being harmed by the people who are supposed to love you, being abandoned by them, being robbed of the one-on-one relationships that allow you to feel safe and valued and to become humane—these are profoundly destructive experiences. Because humans are inescapably social beings, the worst catastrophes that can befall us inevitably involve relational loss.
As a result, recovery from trauma and neglect is also all about relationships—rebuilding trust, regaining confidence, returning to a sense of security and reconnecting to love. Of course, medications can help relieve symptoms and talking to a therapist can be incredibly useful. But healing and recovery are impossible—even with the best medications and therapy in the world—without lasting, caring connections to others. Indeed, at heart it is the relationship with the therapist, not primarily his or her methods or words of wisdom, that allows therapy to work. All the children who ultimately thrived following our treatment did so because of a strong social network that surrounded and supported them.
What healed children like Peter, Justin, Amber and Laura were the people around them, their families, their friends, the folks who respected them, who were tolerant of their weaknesses and vulnerabilities and who were patient in helping them slowly build new skills. Whether it was the coach who allowed Ted to keep team statistics, Mama P. who helped teach Virginia how to nurture Laura, the first graders who took Peter under their wing and protected him, or the incredible adoptive parents of so many of my patients—all of them provided the most important therapy that these children ever received. Because what they needed most was a rich social environment, one where they could belong and be loved.
What maltreated and traumatized children most need is a healthy community to buffer the pain, distress and loss caused by their earlier trauma. What works to heal them is anything that increases the number and quality of a child’s relationships. What helps is consistent, patient, repetitive loving care. And, I should add, what doesn’t work is well-intended but poorly trained mental health “professionals” rushing in after a traumatic event, or coercing children to “open up” or “get out their anger.”
However, because it is exactly those children who are most vulnerable to trauma who are least likely to have a healthy, supportive family and community, it is exceedingly difficult to provide effective help through the current systems we have in place. Because healthy communities themselves are often what prevents interpersonal traumatic events (like domestic violence and other violent crime) from occurring in the first place, the breakdown of social connection that is common in our highly mobile society increases everyone’s vulnerability.
If we are to successfully raise healthy children, children who will be resilient in the face of any traumatic experience they may encounter—and some 40 percent of children will experience at least one potentially traumatic event before they become adults—we need to build a healthier society. The wonderful thing about our species is that we can learn; our memories and our technologies allow us to benefit from the experience of those who came before us. But at the same time those technologies, even the ones that are presumably meant to bring us together, are increasingly keeping us apart. The modern world has disrupted and in many cases abandoned the fundamental biological unit of human social life: the extended family. There has been so much emphasis on the breakdown of the nuclear family, but I believe that in many cases the extended family, whose dissolution has been much less discussed, is at least as important. It certainly, as you may recall from Leon’s story, can make the difference between a young couple who are able to cope and raise a healthy child and one where one or both parents becomes overwhelmed and neglectful.
For countless generations humans lived in small groups, made up of 40 to 150 people, most of whom were closely related to each other and lived communally. As late as the year 1500, the average family group in Europe consisted of roughly twenty people whose lives were intimately connected on a daily basis. But by 1850 that number was down to ten living in close proximity, and in 1960 the number was just five. In the year 2000 the average size of a household was less than four, and a shocking 26 percent of Americans live alone.
As technology has advanced, we have gotten farther and farther away from the environment for which evolution shaped us. The world we live in now is biologically disrespectful; it does not take into account many of our most basic human needs and often pulls us away from healthy activities and toward those that are harmful. My field, unfortunately, has been part of this trend.
For years mental health professionals taught people that they could be psychologically healthy without social support, that “unless you love yourself, no one else will love you.” Women were told that they didn’t need men, and vice versa. People without any relationships were believed to be as healthy as those who had many. These ideas contradict the fundamental biology of human species: we are social mammals and could never have survived without deeply interconnected and interdependent human contact. The truth is you cannot love yourself unless you have been loved and are loved. The capacity to love cannot be built in isolation.
I believe we’re at a transitional point in history where people are recognizing that modern societies have abandoned many of the fundamental elements required for optimal human mental health. We can see the problem in the seemingly inexorable rise in depression rates around the world, which cannot be explained solely by better treatment and diagnosis. A person born in 1905 had only a 1 percent chance of suffering depression by age seventy-five, but by their twenty-fourth birthday, 6 percent of those born in 1955 had had an episode of serious depression. Other studies indicate that teen depression rates have increased by an incredible factor of ten in recent decades. We can also recognize this trend in changing patterns of marriage and divorce, in the difficulties people report in finding satisfying romantic relationships, in the constant struggle families across the economic spectrum have in attempting to find a balance between work and home life. The disconnect between what we need in order to be mentally healthy and what the modern world offers can also be seen in the constant unease felt by parents—about the Internet, the media, drugs, violent predators, pedophiles, economic inequality and above all, the values of our culture that shape our responses to these issues. From right to left, no one seems to believe that our current way of life is healthy, even as we disagree about exactly what’s wrong and what should be done about it.
It’s time for our leaders to step up and ask: “How do we build community in a modern world? How do you explore relationships in a world that is going to have television, that will include email, artificially extended days because of electric lights, and automobiles, airplanes, psychoactive drugs, plastic surgery and everything else that goes along with advancing technologies? How do we deal with the presence of all of those things and create a world that respects our biological needs, one that enhances our connections to others rather than ignores or disrupts them?”
I certainly don’t have all the answers, but I do know that many of our current childcare practices are hurting our children. For example, in California, at a large center serving three- to five-year-olds, staff members are not allowed to touch the children. If they want to be hugged or held, the adults are supposed to push them away! This is a classic example of how a seemingly good idea—wanting to protect children from sexual predators—can have serious negative consequences. Children need healthy touch. As we’ve seen, infants can literally die without it. It’s part of our biology.
Unfortunately, we’ve become so afraid of unhealthy touch that we may actually make it more likely by failing to meet the needs of children for healthy physical affection. This can make them more vulnerable to pedophiles, not less, as children will tend to seek out those who appear affectionate toward them. As we increase distrust of others by keeping children inside, by not allowing them to play spontaneously in their neighborhoods with their friends, by rigidly structuring their lives, we are also destroying the community bonds that keep all of us healthy.
I’ve seen the horrors that sexual molestation of children can cause. They are clear in the Gilmer case, in Tina’s story and so many others. I know better than most people that worries about sexual abuse are grounded in a genuine and terrifying reality. But I also know that predators thrive by picking off the most vulnerable, by getting in where the fabric of the community is weakest. Any predator looks for the weakest prey; it’s another aspect of biology. In order to keep our children safe, therefore, we need to form healthy relationships and connect with others; we need to hug our children. Protecting children needs to be done in ways that respect their needs by strengthening the community, not splintering it. To keep children safe in daycare, don’t let lone adults touch children unobserved but, at the same time, don’t ban physical affection and comfort. To create a safe neighborhood, get to know your neighbors. Don’t keep your children locked away or only engaged in structured activities. We know enough about human nature to shape policies in ways that reflect and respect biology rather than ignoring it and then failing to recognize the consequences of doing so.
WHAT ELSE CAN WE DO TO PROTECT children from trauma, neglect and abuse? And how can we best help those who do get hurt? For one, we need to recognize that our current policies and practices do not put relationships first and that the current systems in place to help children don’t work. We need to acknowledge that many of the “solutions” we currently have for social problems do not effectively address them and may exacerbate them in the long run. We need to understand what we evolved to need and then work on ways to provide those things in the modern world.
A good place to start is at the beginning, with the way we treat infants and new parents. As we’ve seen, in order to develop normally infants need the devoted attention of one or two primary, consistent caretakers, and those caretakers need the daily support of a loving community that recognizes and relieves the exhausting demands of new parenthood. When humans evolved they didn’t live in a world where one woman spent her day alone with her offspring while her partner spent his day at the office. Both men and women worked hard to ensure survival, but women worked together with young children close at hand and older boys often accompanied men and were trained by them. An overwhelmed mother could hand her infant off to an aunt or a sister or a grandmother: there were, on average, four adolescents and adults for every young child. Today we think that a daycare center has an excellent adult/child ratio when there is one caregiver for every five children!
As primatologist and evolutionary theorist Sarah Blaffer Hrdy put it in an interview with New Scientist magazine, “Policy makers imagine that nuclear families epitomize the ‘golden age’ but in terms of the deep history of the human family, it is unusual for children to be reared only by their mothers and fathers. Children accustomed to nurturing from others view their social world as a benign place and act accordingly.” Hrdy’s book, Mother Nature: Maternal Instincts and How They Shape the Human Species, stresses the importance of extended family, whom she calls “alloparents.” She notes, “For children at risk of neglect, it is amazing how much difference alloparental interventions, say, from a grandparent, can make.” We have seen that throughout this book.
Further, when humans evolved, infants didn’t have their own room—they didn’t even have their own bed. They were usually never more than a few feet away from an adult or sibling at any time and most often were being held. Many of the sleeping and crying problems seen in infancy today are likely caused by the fact that a human infant left alone and out of sight distance of adults for almost the entire evolutionary history of humankind would have been facing near-certain death. It’s hardly surprising that babies find being left alone to sleep distressing. In fact, what’s startling (and what reflects the adaptability of the human brain) is how quickly so many get used to it. Infants might ultimately evolve such that being left alone doesn’t so easily set off their stress systems, but evolution works over eons, not the timeline preferred by most parents.
We need to educate people about the needs of infants and create better ways of addressing them. We need to have an infant- and child-literate society, where everyone who has or works with children knows what to expect. For example, if an infant doesn’t cry at all, like Connor, it’s just as much of a cause for concern as if he cries too much. Becoming more aware of age-appropriate behavior will ensure that, when necessary, children can get help as soon as possible.
Further, we need to call an immediate cease-fire in the “Mommy wars” and recognize that everyone benefits when new parents have the choice to spend more time with their children and when they have community support and access to quality childcare. As Hrdy says, “We evolved in a context where mothers had much more social support. Infants need this social engagement to develop their full human potential.” Many European countries—particularly the Scandinavian countries—have managed to have both highly productive economies and provide high quality child care and lots of paid family leave. There’s no reason that we can’t develop similar policies.
TO HELP CREATE A BIOLOGICALLY respectful home environment, parents can also do simple things like setting boundaries on media and technology—for example, having regular family meals when all phones, televisions and computers are off. In addition they can model behaviors that emphasize the importance of relationships, empathy and kindness in their interactions with people, whether they be relatives, neighbors, shopkeepers or others they encounter in their daily lives.
Schools, too, need to change. Our educational system has focused nearly obsessively on cognitive development and almost completely ignored children’s emotional and physical needs. Only two decades ago elementary schools had both significant lunch periods and recess times, and gym class was mandatory several days a week. Homework rarely took more than an hour to complete each night and children were thought to be capable of remembering deadlines and meeting them on their own. Big projects that required parental assistance were undertaken only a few times each year.
All of those things were respectful to the biology of young children, particularly that of boys who mature more slowly than girls do. Schools recognized that a short attention span is characteristic of childhood, that children need free time to run and play and learn how to socialize with each other. My co-author Maia’s nine-year-old nephew once told his mom that he didn’t know who his friends were. His days in school were so structured that he didn’t have enough free time to build real relationships. There was no recess. This is insane. In our rush to be sure our children have an environment as “enriched” as that of the neighbors’ children, we are actually emotionally impoverishing them. A child’s brain needs more than words and lessons and organized activities: it needs love and friendship and the freedom to play and daydream. Knowing this might allow more parents to resist social pressures and begin to push schools back in a more sensible direction.
In addition, our educational system and our society’s general disrespect for the importance of relationships is undermining the development of empathy. Like language, empathy is a fundamental capacity of the human species, one that helps define what a human being is. But like language, empathy, too, must be learned. Ordinarily, we pick up both during early childhood, but as Connor and Leon’s stories illustrate, the development of empathy and the relational skills that rely upon it require critical input from the environment. While fortunately very few babies are left on their own for long periods of time the way those two boys were, all too many young children are spending more and more of their lives in environments so structured and regimented that there is little time to build friendships and get the practice and repetition needed to support empathetic caring. Worse yet, time spent with their parents is often limited as well, and what remains is rapidly filled up with hours of homework or, alternatively, hours of television, computers, and video games.
Brain development is use-dependent: you use it or you lose it. If we don’t give children time to learn how to be with others, to connect, to deal with conflict, and to negotiate complex social hierarchies, those areas of their brains will be underdeveloped. As Hrdy states: “One of the things we know about empathy is that the potential is expressed only under certain rearing conditions.” If you don’t provide these conditions through a caring, vibrant social network, it won’t fully emerge.
We also need to recognize that not all stress is bad, that children require challenges and risk as well as safety. It is natural to want to protect our children, but we need to ask ourselves when the desire for risk-free childhoods has gone too far. The safest playground, after all, would have no swings, no steep slides, no rough surfaces, no trees, no other children—and no fun. Children’s brains are shaped by what they do slowly and repeatedly over time. If they don’t have the chance to practice coping with small risks and dealing with the consequences of those choices, they won’t be well prepared for making larger and far more consequential decisions. In today’s safety culture we seem to swing from strictly monitoring and guiding our children from infancy through high school, and then releasing them to the absolute freedom of college (though some parents are trying to encroach there as well). We have to remember that for most of human history adolescents took on adult roles earlier and rose admirably to the challenge. Many of the problems we have with teenagers result from failing to adequately challenge their growing brains. While we now know that the brain’s decision-making areas aren’t completely wired until at least their early twenties, it is experience making decisions that wires them, and it can’t be done without taking some risks. We need to allow children to try and fail. And when they do make the stupid, shortsighted decisions that come from inexperience, we need to let them suffer the results. At the same time we also need to provide balance by not setting policies that will magnify one mistake, like drug use or fighting, into a life-derailing catastrophe. Unfortunately, this is exactly what our current “zero tolerance” policies—that expel children from school for just one rule violation—do.
We know that our biology predisposes us to mirror the actions of those we see around us. We know that what we repeat, we reinforce and ultimately incorporate. The more we do something, the stronger the system devoted to it becomes in our brain. These facts are wonderful when what we are considering repeating is loving and nurturing, but they are frankly terrifying when we think about violence and the increasing number of simulations of violence that surround us and our children.
Living in a pervasively violent community, being economically disadvantaged or witnessing or being victimized oneself by violent acts are far more important factors in determining which children will grow up violent than simple video game or television exposure. Reducing economic inequality and helping victims of domestic violence and child abuse are critical if we want to cut violence and crime. While most abused children do not grow up to become abusers themselves, the odds that a parent will be abusive or neglectful increase dramatically if he or she has had such experiences early in life. But this can be made even worse if such children live in frayed communities, are surrounded by simulations of violence and have few countervailing positive social interactions.
The American Psychiatric Association estimates that the average child views some 16,000 simulated murders and 200,000 acts of violence on television alone by the time she turns eighteen, although no research yet even documents the amount of exposure from violent video games or explores how it affects children’s behavior. To build a society that emphasizes “the better angels” of our nature, limiting children’s exposures to such violence is important. We’ve seen throughout this book how small influences and decisions can add up to big problems over time. As a result, changing many little negative influences could ultimately have a large effect.
FURTHER, HUMANS EVOLVED IN A situation in which cooperation was critical to survival. Although we have never been entirely peaceful, some societies have raised children and settled disputes in ways that tend to tone down our violent tendencies, while others have acted in ways that amp them up. One of the most difficult questions facing evolutionary theorists was understanding how cooperation evolved, because the “winners” in evolution are those animals that reproduce most successfully, and quite often selfish behavior maximizes the chances of survival and reproduction. Evolutionists had long emphasized “nature, red in tooth and claw,” but a view that focused on the competition of the fittest for survival missed one of the most fascinating and important characteristics of humans and quite a few other species: the propensity for altruism.
Over time researchers discovered that in certain, delicately balanced situations, cooperation will arise in nature because those animals that do cooperate in these conditions are more likely to survive than those that always act on their own. In order for cooperation to persist, however, these favorable circumstances must also continue. In humans, the requirements for the maintenance of cooperation include a sense that others are likely to treat you fairly and the recognition and punishment (whether through legal systems or social rejection) of those who violate trust and cheat to benefit themselves at the expense of others.
Unfortunately, that basic sense of fairness and goodwill toward others is under threat in a society like ours that increasingly enriches the richest and abandons the rest to the vagaries of global competition. More and more our media and our school systems emphasize material success and the importance of triumphing over others both athletically and in the classroom. More and more, in an atmosphere of increased competitiveness, middle- and upper-class parents seem driven to greater and greater extremes to give their offspring whatever perceived “edge” they can find. This constant emphasis on competition drowns out the lessons of cooperation, empathy and altruism that are critical for human mental health and social cohesion.
I have often been asked to help develop a mental health response following traumatic events that I believe are direct results of a fractured community and our unrelenting focus on competition. Some of the most distressing of these have been school shootings. What I’ve found time and again in these cases is a winner-takes-all school culture, where bullying is pervasive and accepted and where the “losers” are not considered people who need understanding and support, but utterly deserving of their alienation and exclusion. In these situations it is not only the teenagers who have built and enforced a strict social hierarchy that causes unmitigated misery for those on the bottom, but also the teachers, parents and school administrators. Humans have always been a hierarchical species, of course—that’s another part of our biology—but when you emphasize merciless competition at the expense of all else, in a culture that glorifies violence, an occasional violent uprising by those who feel left out is hardly surprising. I don’t believe we will be able to prevent these incidents unless we work much harder to ensure all students feel included in their school community.
THE BRAIN DEVELOPS OVER TIME, with a constant accretion of repetitions and exposures; each moment is a chance to reinforce either positive or negative patterns. Once a pattern is started, it becomes like a groove or a rut, making similar behavior easier, more likely to be repeated. The mirroring systems of our social brains make behaviors contagious. And again, this is wonderful when what you are practicing is sports or piano or kindness, but not so great when what’s being repeated is impulsive, aggressive responses to threat. I think again about Leon and how, after he began to be neglected, repeated thousands of, in themselves, unimportant and small decisions, that came together and made bad behavior increasingly easy for him to choose and put good choices further and further out of his reach.
As a result of this property of the brain, earlier intervention is almost always better than later. But it has to be the right intervention. In Leon’s case much of what was done to “help” him actually served to make things worse. When children start to misbehave our initial impulse to punish and deprive them often serves us poorly; we tend to see children who are whiny and demanding and aggressive as “spoiled” and “indulged,” rather than recognizing that these qualities usually arise from unmet needs and unexplored potential, not from having too much or feeling too good. In order for a child to become kind, giving and empathetic, he needs to be treated that way. Punishment can’t create or model those qualities. Although we do need to set limits, if we want our children to behave well, we have to treat them well. A child raised with love wants to make those around him happy because he sees that his happiness makes them happy, too; he doesn’t simply comply to avoid punishment. These positive feedback loops are every bit as powerful as the negative ones, but they rely upon the sometimes counterintuitive response of first figuring out what drives misbehavior, then dealing with it, rather than acting first. I fully believe that if Leon had been reached early in his childhood, even if he’d already experienced some neglect by his mother, he would not have become the coldhearted murderer I met.
However, working with children who have experienced the kind of early trauma that affected Connor, Peter, Justin, Leon and Laura requires two things that are often in short supply in our modern world: time and patience. Traumatized children tend to have overactive stress responses and, as we’ve seen, these can make them aggressive, impulsive and needy. These children are difficult, they are easy to upset and hard to calm, they may overreact to the slightest novelty or change and they often don’t know how to think before they act. Before they can make any kind of lasting change at all in their behavior, they need to feel safe and loved. Unfortunately, however, many of the treatment programs and other interventions aimed at them get it backwards: they take a punitive approach and hope to lure children into good behavior by restoring love and safety only if the children first start acting “better.” While such approaches may temporarily threaten children into doing what adults want, they can’t provide the long-term, internal motivation that will ultimately help them control themselves better and become more loving toward others.
Troubled children are in some kind of pain—and pain makes people irritable, anxious and aggressive. Only patient, loving, consistent care works; there are no short-term miracle cures. This is as true for a child of three or four as it is for a teenager. Just because a child is older does not mean a punitive approach is more appropriate or effective. Unfortunately, again, the system doesn’t tend to recognize this. It tends to provide “quick fixes,” and when those fail, then there are long punishments. We need programs and resources that acknowledge that punishment, deprivation and force merely re-traumatize these children and exacerbate their problems.
One of the greatest lessons I’ve learned in my work is the importance of simply taking the time, before doing anything else, to pay attention and listen. Because of the mirroring neurobiology of our brains, one of the best ways to help someone else become calm and centered is to calm and center ourselves first—and then just pay attention.
When you approach a child from this perspective, the response you get is far different from when you simply assume you know what is going on and how to fix it. When I first approached Justin in his crib/cage, for example, I got a very different response than previous visitors had because I calmly recognized that underneath his frightening behavior was his own fear and hunger. Obviously it is difficult to have this kind of detachment when it is your own child who is misbehaving—especially when he’s doing something that has made you angry or upset—but the more you try to see the world from the child’s point of view and the safer you make him feel, the better his behavior is likely to be and the more likely you are to find ways of further improving it.
Another important implication of our mirrored biology is that concentrating children with aggressive or impulsive tendencies together is a bad idea, as they will tend to reflect and magnify this, rather than calm each other. Although research demonstrates the negative results of such grouping, we have unfortunately gotten into the habit of organizing therapy groups and residential programs in ways that concentrate such children. As we saw in Leon’s case, it can actually serve to make problems worse.
I also cannot emphasize enough how important routine and repetition are to recovery. The brain changes in response to patterned, repetitive experiences: the more you repeat something, the more engrained it becomes. This means that, because it takes time to accumulate repetitions, recovery takes time and patience is called for as these repetitions continue. The longer the period of trauma, or the more extreme the trauma, the greater the number of repetitions required to regain balance. Also, because trauma at its core is an experience of utter powerlessness and loss of control, recovery requires that the patient be in charge of key aspects of the therapeutic interaction. Over and over again the research finds that if you use force, if you push people to open up when they aren’t ready, if you require participation in therapy, if you don’t respect individual differences, then your treatment can actually do serious harm. Because safety is critical to recovery and force creates fear, coercive therapies are dangerous and ineffective for victims of trauma. Trauma tends to drive other mental health problems like many teen behavior problems and an enormous percentage of addictions. Unfortunately, coercive forms of treatment are common in these areas, and this is yet another case in which our efforts to deal with a problem may actually exacerbate it. We need to educate both parents and professionals about these truths, and also work to ensure that the justice system, foster care system and child welfare and mental health care systems use evidence-based approaches that at the very least are informed by knowledge about trauma and reduce, rather than increase, harm.
OF COURSE MAKING OUR WORLD safer for children won’t be easy. Efforts to do so must address some of the largest political controversies of our time: globalization, the “mommy wars,” economic inequality, to name just a few. And the United States has historically done little more than give lip service to children’s issues, with both parties raising the banner of “family values” while doing little to actually address the day-to-day problems affecting most parents and children. I don’t have all the answers. But I do think that understanding ourselves as a social species, with a brain that evolved with certain unique capacities and weaknesses, a brain that becomes what it practices, will allow us at least to ask the right questions. And that is the best place to start when seeking to build a loving, caring community.