#2 in my News Blog series; original post September 13, 2013
Dr. Bruce Perry just put out his latest on “How Your Brain Works 101,” in his September 5 webinar for the National Council on Behavioral Health. Perry’s revelations at Dr. Daniel Siegel’s March 8 (2013) UCLA Conference “How People Change” hit me in the solar plexus. Now you can hear him and download his slides, (Click here and scroll all the way down to September 2013). [FN1]
You know how your car works – don’t you want to know how your brain works? Click here for an introductory video on how Attachment Disorder causes brain trauma [FN2] Click for Dr. Perry’s YouTube channel with educational videos in depth: https://www.youtube.com/channel/UCf4ZUgIXyxRcUNLuhimA5mA?feature=watch
I first heard of Bruce Perry in August 2010; not his name, but his substance. I was commuting to another high-pressure defense job on the 91 freeway outside Anaheim, CA, worrying about how to pour concrete at Seal Beach Naval Base. It didn’t look to my clients, or to me, as though I had anything wrong with my high-performance business brain.
On the car stereo was a CD by psychologist Dr. Henry Cloud. “Humans are neurologically designed, physiologically designed, psychologically, spiritually, emotionally, and cognitively designed, to be in a relationship where you are loved,” Cloud said to my shock. “You are designed to take aspects of that relationship inside of you, and they actually become a part of who you are. My 17-month-old came into the world with nothing in her head. A lot of need, not a lot of words, didn’t read. Babies are all need and they cry. Adults must calm them, and the minute we put them down, they start crying again.
“But after we do that a million times, the gap for how long they can tolerate not being held gets wider and wider. They take our love from the outside, and it becomes part of them on the inside… Love becomes actual equipment that you take in and walk around with.” [FN3] I felt sad; I couldn’t identify.
But watch how my body reacts to the right research:
Cloud went on, “We can now do scans of the brain of older kids who were in institutions and were not held, comforted or soothed, and there are parts of the brain which are dark. There’s nothing growing in there — because nothing was planted; neurologically there’s literally no brain activity. But the kids who were held and loved, those parts of the brain are physiologically growing.”
I nearly drove off the 91 overpass at 70 MPH. It hit me in the gut the minute he said it. “Oh, S#$%”, I thought, “parts of my brain are dark!” (Go tell that to the Marines at Seal Beach.)
It wasn’t until 2 1/2 years later when some guy named Perry put up his slides at UCLA in March 2013, that I saw the pictures. It was brain scans of two children aged 3, a normal brain in grey, and one labeled “extreme neglect,” parts of which were black. In that moment, I knew Cloud had referred to Bruce Perry’s work. [FN4]
As I’ve shown in previous posts, maybe 50% of Americans have some degree of attachment disorder, neurological areas which didn’t get Dr. Cloud’s “love on the inside.” We don’t want to go around with parts of our brain dark.
Most Primitive Brain Develops First
He calls this the Neuro-sequential Model of Therapeutics (NMT). Dr. P’s “Four Part Brain” slide above shows the time sequence from the bottom up: first the brain stem develops (pink); then the diencephalon cerebellum (yellow); they make up our primitive reptilian “survival” brain. Next develop the emotional limbic brain which only mammals have (green), and finally the thinking cortex (blue).
Why time sequence? Our entire big Einstein brain is an outgrowth of its most primitive part: the brain stem (the knob at the top of the spinal chord), and its spin-off, the cerebellum.
This “reptilian brain” is in the back of your head at the level of the ears. It maintains rock bottom survival such as body temperature, heart rate, sleep, and breathing – all the functions you never think about which if they didn’t happen you’d be dead. Not only reptiles have the same apparatus but so do pre-bony fish like sharks. That’s humbling: our whole brain starts with something that primitive.
“During development, the brain organizes from bottom to top, with the lower parts of the brain developing earliest,” Dr. Perry says. Reptile brain better hit the ground running at birth or infants don’t breathe; the rest of the brain can and does grow in later. “The majority of brain organization takes place in the first four years of life,” he says. “Because this is the time when the brain makes the majority of its ‘primary’ associations and core neural networks organize as a reflection of early experience, early developmental trauma and neglect have disproportionate influence on brain organization and later brain functioning.” [FN4 Op cit]
What goes wrong from “conception to 36 months” can fry our reptilian brain and put it in permanent fight-flight or freeze (dissociation shutdown). Then the entire brain can be thrown out of whack starting from its first cell divisions.
As the ACE Study has shown, this results in heart, gut, and many other chronic physical diseases throughout adult life.
“The brain is an historical organ,” Perry said. “The NMT Core Assessment’s first step is a review of the key insults, stressors, and challenges during development. Intrauterine insults such as alcohol or perinatal care disruptions (such as an impaired inattentive primary caregiver) alter the norepinephrine, serotonin, and dopamine systems of the brain stem and diencephalon that are rapidly organizing. These early life disruptions result in a cascade of functional problems in brain areas these neural systems innervate.”
Think your thinking brain’s in charge? “Think” again – we’re arrogant about how much our thinking brain can do. Fact is, it’s the new kid on the block in the brain. It has a lot less influence than we imagine on the roiling instincts and feelings in the subconscious or “downstairs” brain, as Dan Siegel calls the rest of the brain below the cortex. Siegel says the “downstairs brain” also includes thick clusters of neurons associated with the brain stem that form around our viscera (heart, lungs, gut etc.). Development of all that can go wrong from the hour the sperm hits the egg. It did with me.
“When a child has experienced chronic threats, the brain exists in a persisting state of fear,” Perry says. This “makes the stress response oversensitive, over-reactive, and dysfunctional due to over-utilization of brain stem-driven reactions. Such reactions become entrenched over time, and the ‘lower’ parts of the brain house maladaptive, influential, and terrifying pre-conscious memories that function as a template for the child’s feelings, thoughts, and actions.” [FN4]
“Cognitive behavioral therapy (CBT) is great if you have a developed frontal cortex – but we’re talking about a five year old kid who’s so scared to death most of the time that it’s shut down his frontal cortex ’cause he just saw his mother get shot,” Perry told his UCLA therapist audience March 8. “You’re going to do 20 sessions of CBT and expect change? B#$$%&! (expletive) That’s a fantasy.” (Wild applause).
Listening to him talk, I can feel things inside me resonating, probably things that didn’t develop right in the womb, and I can feel it healing because, finally, here is compassion for my situation. It’s a remarkable experience.
When I hear Dr. Perry and his colleagues identifying these issues, it hits me in the solar plexus and the gut. I feel like someone is telling me “You’re not crazy, this actually happened deep inside you, you don’t have to conceal the pain anymore. You can be understood, you can be accepted as who you are.
“You can say exactly how you feel for the first time in your life and we are not going to run screaming from the room. We are going to accept you, because we can say scientifically that this is the way your cells developed in the environment you were in.”
Once I feel accepted in this profound way, I literally feel the problem begin to heal. Dan Siegel reports that it’s been proven by brain scans that this feeling of acceptance and belonging produces re-growth of damaged brain tissues. It simulates the missed environment of love, acceptance and “we’re glad you’re here” which the infant was designed to experience at birth.
“Born for Love”
Bruce Perry and his Attachment Theory and trauma specialist colleagues like Bessel Van der Kolk, Daniel Siegel, Allan Schore, and Mary Jo Barrett, are also overturning the American Psychiatric Association (APA) apple cart by calling this “developmental trauma.” It starts in the womb and is continuous from there, going on in the pre-conscious years.
It differs completely from incident-by-incident based trauma such as assault, rape, school violence, or combat stress, which can hit at any age. These later “PTSD” traumas have been assumed to what trauma is, yet horrible as they are, they are just not all there is.
Many (like me) take a lot of damage in wrong therapy which treats developmental trauma as if it were incident trauma. The APA’s latest “what’s my disease” bible, the “Diagnostic and Statistical Manual of Mental Disorders (DSM-5),” just out June 2013, doesn’t even recognize the existence of developmental trauma.
How to heal? Dr. Perry lays out the brain science behind Dr. Cloud’s idea of “getting love on the inside.”
“Attachment is when the baby learns by thousands of good experiences that stress is tolerable because it leads to reward opiates such as dopamine in our body, and that this pleasurable outcome is cathexsized to a person, Mom, who consistently attunes to it about this,” Perry said at UCLA. “When the baby feels distress, the attuned Mom feels distress and gets her own pleasure rewards by responding to the baby. So the infant brain weaves together the neurobiology of what interaction with another human being is, and connects it to stress relief, pleasure and safety, when this happens repeatedly. Ultimately, just seeing or hearing Mom makes you feel safe and pleasurable. Let a wounded combat soldier talk to his mom, and he’ll require 45% less pain meds.”
“Patterned, Repeated, Rhythmic Activity”
“Because the brain is organized in a hierarchical fashion, with symptoms of fear first arising in the brain stem and then moving all the way to the cortex, the first step in therapeutic success is brain stem regulation,” Perry said. “An example of a repetitive intervention is positive, nurturing interactions with trustworthy peers, teachers, and caregivers, especially for neglected children who have not had the neural stimulation to develop the capacity to bond with others.
“Others are dance, music, or massage, especially for children whose persisting fear state is so overwhelming that they cannot improve via increased positive relationships, or even therapeutic relationships, until their brain stem is regulated by safe, predictable, repetitive sensory input.” An hour here and there of even sensitive therapy is rarely enough, he says.
“Children with relational stability and multiple positive, healthy adults invested in their lives improve; children with multiple transitions, chaotic and unpredictable family relations, and relational poverty do not improve even when provided with the best ‘evidence-based’ therapies. The healing environment is a safe, relationally-enriched environment,” he says.
“The only way you can move from these super-high anxiety states, to calmer more cognitive states, is rhythm,” Perry emphasizes. “Patterned, repetitive rhythmic activity: walking, running, dancing, singing, repetitive meditative breathing. You use brain stem-related somato-sensory network regulation, which make your brain accessible to relational reward and cortical thinking.”
Dr. Perry’s ChildTrauma Academy in Houston offers courses such as “Somatosensory Regulation Plan for Dysregulated Children” and “The Power of Rhythm: Music, Movement & Language.” Somatosensory rhythmic programs at Dr. Bessel van der Kolk’s Trauma Center in Boston feature yoga, drama, drum circles, trampoline work, and more.
“If you want a person to use relational reward, or cortical thought,” he says, “they’ve got to be emotionally regulated first! We must regulate people, before we can possibly persuade them with a cognitive argument or compel them with an emotional affect. All our contingency-based models do nothing but merely escalate their negative arousal!”
Sound stupid, like your doctor saying “Scram and go cool off at the gym” ? I thought so – until I tried it. It works, big time. But what happened was so explosive, it’s another blog for another day.
The take-away is 1: Listen to Dr. Perry; figure out how your brain does work; see if anything he says resonates. Call up the ChildTrauma Academy and get their materials and training on Somatosensory Regulation and the power of rhythm.
Or if you can’t wait, as I’ve said before, find a really empathic, loving therapist who knows trauma inside out, and bring him that Peter Levine book. [FN5] That’s what I used to do somatosensory work before I heard of Bruce Perry. You’ll need professional supervision when you do the exercises on the CD in the back of Levine’s book, and look out world.
Even if we’re 92, we can grow parts of our brain. Daniel Siegel did it with a 92-year-old lawyer using mindfulness practice. [FN6]
Excerpts from Kathy’s forthcoming book DON’T TRY THIS AT HOME: The Silent Epidemic of Attachment Disorder – How I accidentally regressed myself back to infancy and healed it all and related research of attachment and brain science are posted here every Friday. Watch for the continuing series of excerpts from the rest of her book, in which she explores her journey of recovery and shares the people and tools that have helped her along the way.
FN1 Perry, Bruce D. MD, PhD, “Helping Children Recover from Trauma,” National Council LIVE, National Council on Behavioral Health, September 5, 2013; http://www.thenationalcouncil.org/events-and-training/webinars/webinar-archive/ Scroll down to September 2013.
FN2 Bruce Perry, Daniel Siegel, et.al, “Trauma, Brain & Relationship: Helping Children Heal,” (25 Minutes) www.youtube.com/watch?v=jYyEEMlMMb0 – an introductory video on Attachment Disorder. A new understanding of how trauma effects the development of the mind-body system, and how it affects children’s behaviors and social relationships. Copies at www.postinstitute.com/dvds.
FN3 Cloud, Henry, PhD, “Getting Love on the Inside,” Lecture, April 2002 (CD), Mariner’s Church, Newport Beach CA, www.Cloud-Townsend Resources.com, [Coauthor with Townsend, John, PhD, of “Boundaries,” Zondervan, 2004]
FN4 Perry, Bruce, MD, PhD, “Born for Love: The Effects of Empathy on the Developing Brain,” Annual Interpersonal Neurobiology Conference “How People Change: Relationship & Neuroplasticity in Psychotherapy,” UCLA, Los Angeles, March 8, 2013 (unpublished).
Dr. Perry’s latest research and key slides (otherwise hard to obtain) are in his National Council speech in FN1 above.
Key videos, articles on Interventions, Trauma, Brain Development/Neuroscience, etc. are at: https://childtrauma.org/cta-library/
“The Neurosequential Model of Therapeutics” by Perry, B.D. and Hambrick, E. (2008) is at: http://childtrauma.org/nmt-model/references/
FN5 Levine, Peter A., PhD, “Healing Trauma: A Pioneering Program for Restoring the Wisdom of Your Body,” Sounds True, Inc., Boulder CO, 2005; ISBN 1-159179-247-9
FN6 Siegel, Daniel J., MD, “How Mindfulness Can Change the Wiring of Our Brains,” National Institute for the Clinical Application of Behavioral Medicine, www.nicabm.com, March 2011. Check for the passage on a 92 year old lawyer code-named “Stewart.”
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