快猫短视频

When psychiatrist Bruce Perry was called in by staff at a paediatric hospital in Houston, Texas, the first thing he heard was an eerie,animal-like shriek. Turning around, he saw a bony 6-year-old boy in an iron crib with plywood wired to the top, throwing faeces, then whimpering a primitive lullaby as he rocked back and forth, soaked in urine. Unable to cope with the child鈥檚 violent outbursts, staff at the hospital had built a cage to restrain him. So who was the boy, and how had he ended up like this? In a new book, Perry tells the story of 鈥淛ustin鈥� and other traumatised children whose lives, he believes, hold important lessons as we try to integrate psychiatry with the cutting edge of neurology. Liz Else caught up with him.

How did Justin end up crouching in a cage?

He鈥檇 been brought in for an evaluation with a developmental paediatric clinic and was found to have pneumonia. So they put him on a normal hospital floor, where he was completely overwhelmed, terrified and out of control. In turn, he terrified the staff, so they decided to cage him. I called the book The Boy Who Was Raised As a Dog because he seemed more like a dog than a child at that time.

How did you try to make contact?

I approached him very gradually and cautiously, trying not to establish eye contact or use any of the non-verbal signals that I knew were associated with power and authority. I was very non-threatening and talked very slowly. I offered him a bit of food that I nibbled to show him it was safe.

How on earth had he got like this?

His mother was a 15-year-old who had left the two-month-old Justin with her mother. This grandmother had cared very well for him for the first 11 months, then she died, leaving him with her boyfriend Arthur, a man in his late 60s who knew nothing about children but a lot about dogs.

Arthur asked the child protection services for help, but they evidently felt the child was safe enough where he was. So Arthur started to raise him in the only way he knew how 鈥� as a dog. He put Justin in a dog cage, fed and watered him, changed him but rarely spoke to him or played with him. Justin鈥檚 only real companions were dogs. Arthur wasn鈥檛 cruel, just ignorant and possibly a bit retarded.

鈥淎rthur raised him in the only way he knew how 鈥� as a dog鈥�

Did you make any progress at all?

Other doctors had told Arthur that Justin was brain-damaged 鈥� by the age of 5, he still couldn鈥檛 walk or talk. These doctors hadn鈥檛 known how he was being brought up, however.

The first thing I did was decrease the chaos in Justin鈥檚 life by moving him to a private room, minimising his interactions and bringing in physical, occupational and speech therapists. The improvement was remarkable. As Justin started to feel safer, he smiled. He even showed signs of a sense of humour: he knew how much everyone hated having faeces thrown at them, so when someone gave him a chocolate bar he let it melt in his hand and pretended he was going to throw it. Over the next few weeks he took his first steps and was taught the basics of self-care.

Surely all the textbooks say that a child like Justin who has missed developmental milestones can never be helped later?

That had generally been our experience. But Justin had received some pretty solid nurturing from his grandmother in the first few months of his life. We think these early basic human interactions laid down some of the neurological structures in his brain necessary for further development.

Does that challenge conventional wisdom about development in areas such as speech?

The thing people forget is that the most malleable part of the brain, and the last to develop, is the cortex, where speech and language are centred. Conversely, the most difficult parts of the brain to change are those that develop earlier, in the midbrain and brain stem. When children have been deprived in their early years, it鈥檚 a lot easier to build up their cognitive capabilities than it is to develop their ability to relate to others.

What happened next?

After some more weeks of amazing progress he went to live with a foster family, where he continued to make what I think was the most rapid recovery from such severe neglect I鈥檝e ever seen. It challenged my thinking about the potential for recovery. We still get reports on him, and he鈥檚 doing pretty well in school, he鈥檚 passing his classes, he has friends and has learned to speak properly.

How many children like Justin do you believe there are?

In the US alone, we know that every year there are at least half a million new cases of children found to have suffered from severe trauma or neglect. So at any one time, there are going to be between 8 and 10 million children with some kind of profound trauma or neglect-related dysfunction. That鈥檚 a huge burden on any society. If you look at a society that鈥檚 been badly affected by famine or war, then those numbers climb still higher. You can imagine the experiences of children in some parts of Africa. These things have a significant impact on the way a culture develops.

In your book, you also draw some strong political conclusions from your work.

If you have an ill-educated and half-starved population, the chances are they will rear children who will suffer some kind of trauma. Some of these children then grow up to become leaders, but their ability to be creative is compromised by their early traumas.

These concepts are fundamental to truly understanding and developing policy. I believe that if you understand how the brain works, how people function under stress and the way that this can carry across generations, then you realise that some of the attempts of the west to bring peace to the Middle East are neurologically doomed to fail.

Why?

Because the people are traumatised to the point where they literally can鈥檛 hear what you say and take it in.

Have you ever tried to explain any of this to the people attempting to negotiate peace?

Increasingly at our unit we are being asked to communicate these ideas to state legislators, governors and other people in policy-making positions. I am part of a group that鈥檚 doing this on a small scale through a UK-based charity called Worldwide Alternatives to Violence. The charity is trying to help people understand that there really is a relationship between childhood traumas such as exposure to violence, and criminality. There is a way to divert people from risky and unhealthy futures by paying attention to the way they are treated when they are young.

You鈥檙e against drug therapies, aren鈥檛 you?

We need to learn how to use psychotropic drugs in a way that is responsible and is a true adjunct to treatment, as opposed to a cop-out. There are physicians in the US who will see 35 children in a day, each one for only 15 minutes. And every one of these children is put on medication. It鈥檚 stunning but it happens all over the country.

What kind of therapies would you prefer to see?

Everything from speech, physical, play and art therapies to massage, to desensitising techniques, to cognitive behaviour therapy. We鈥檙e thinking a lot about how we can reinvent the way human beings can live together and raise children.