Chapter 7 - Satanic Panic

This case was interesting and highly complex. I was very surprised that I had never heard of Jesse incidents before or the panic that spread throughout parts of Texas. Although, I have heard of the “memory wars” and feel like there is still a lot of confusion about memory today. I loved Perry’s explanation of a Microsoft Word file because I don’t think I had ever plainly realized how our memories are altered slightly every time they are retrieved. The incremental changes can make a difference overall of how we perceive the memory. It's somewhat comical. The concept of whether people have negative memories buried beneath their self-conscious has been talked about before. Is it possible to learn in your mid-thirties that you were abused as a child? Or is that your psyche now creating a story for other reasons? I'm glad that Perry mentioned that the norm is problems arising from the intrusion of traumatic memories into the present and not an inability to recall them. 

The idea that horrendous abuse was masked as "therapy" is disgusting. I found it very strange that some scientific concepts such as attachment were in small ways implemented to perpetuate further abuse. Holding sessions sound highly counterproductive. I hadn't previously considered how a little bit of knowledge can be harmful. Also, the emphasis on the importance of environmental and systems can be considered since Gilmer County had one of the nation's highest illiteracy rates. Given how complicated this entire case was and how it's not necessarily easy to follow, would the abuse have been discovered earlier on in an area with higher levels of achieved education?

It appears like a theme in our Perry readings involves how CPS or other forces have failed children in different ways. This shows how difficult it can be to know current and upcoming research findings and apply safety precautions that are uniform in all areas of the state. My impression is that there are a lot of ways to fall through the cracks and that there is not enough attention placed on the rate of failed interventions. But I do understand the difficult position they were in when they had to decide afterward. Could and should they place them back in a home where there were accusations against?

My biggest takeaway from this chapter is to take into consideration the differences in coping strategies utilized by each child. Therapy is not a one size fits all application and the discussion of past traumas may not be useful for everyone. Perry surprised me yet again when he came up with the idea to implement a heart rate monitoring device to further explore the children's reactions to stress and their reports. I don't think I would have ever thought of that. A device similar to a lie-detector on the go but while acknowledging that the children are not lying, simply continuing to do what was asked of them previously by ill caregivers. It was a genius move to uncover the truth. 

This chapter was fascinating and heartwrenching. Who knew that groupthink could be this harmful?

Chapter 6 - The Boy Who Was Raised As A Dog

I was very excited to finally reach the chapter the book was named after. Learning of Justin's initial presentation and the way he was being treated in the hospital's PICU was horrifying. I'm not sure what decade this was but an impromptu crib-jail made my stomach hurt and raised so many ethical red flags. One of the largest learning components that I've taken away from this book is how child abuse and neglect isn't always as intentional as I imagined. With Leon's, Justin's, and Conner's cases, I've realized that the parents don't always have to be the extremely malicious person we see in movies. In the case of Arthur, he tried to care for Justin and even sought him medical assistance. He wasn't hiding Justin's home condition and was genuinely seeking help and guidance. Dr. Perry always amazes me in the techniques he utilizes to introduce himself and also how he builds therapeutic rapport.

It was astounding to read of how QUICKLY Justin progressed. I understood Dr. Perry's initial question and concern of: "Does Justin have unexpressed potential or is there no capacity for further development?" This chapter gave me so much hope. When Perry described the letter and photo he received in the mail after years of saying goodbye to Justin, I cried and felt great and relieved when he admitted that he cried too. Learning that Justin's progress was most likely due to the first year of his life in which he had a loving caregiver was amazing. This helped me better understand the relationship between the brain and development and how crucial timing really is. I could now better understand why every case is different and how Leon was possibly set at a higher disadvantage.

With the previous hypothesis that listed the differences between Leon and Justin, I found myself trying to concretely decipher what this meant for Connor. Did he initially have a gene set for someone with not as high intelligence? Is the reason he didn't become angry and violent, like Leon, because he had healthy caregiver relationships on week evenings and weekends? The number of vast possibilities emphasizes how complicated the combination of genes and environment really is. I find myself wishing there was a hard equation that could really predict how a child may end up so that we could aid them before they experienced hardships and developmental delays.

The treatment plan set forward for Connor was very interesting to read. The rhythmic classes and massage therapy were methods that I found very strange at first but did wonders for Connor. If I, as a current social worker, didn't exactly know how these not-so-common methods could be useful, I can't imagine the reactions of others who were immediately involved in that case.

I really like that Perry mentioned that many parents in our country do not greatly understand childhood development and how parenting can best be achieved. There are probably more initiatives set in place today compared to the time period this chapter took place but it still is not enough. Parents need to know how to best prepare for their child, how to prepare, how important social supports can be, and what developmental, social, and verbal milestones their children should be hitting at certain ages.

Chapter 5 - The Coldest Heart

With each new chapter, I am astounded by the level of intensity and difficulty of the cases that Perry takes on. I appreciate Perry's distinction of the consequences that can come from early childhood neglect and abandonment and that not every outcome will result in such violent acts. The fact that Laura and Virginia did not experience similar emotional indifference highlighted to me that the combination of nature and nurture can be expressed in extremely interesting ways that are difficult to identify.

Not too long ago, I worked with my first patient who I believed to have antisocial personality disorder. I don't believe it was actually diagnosed but I knew immediately that I had never encountered a similar person before. This patient had a history of substance use issues and violence against his family. Something was different about him- an inability to connect or empathize with the harm he had instigated against his own blood. His demeanor stuck with me for days after his discharge. Reading of the heinous acts that Leon committed was difficult and I cannot imagine having as much composure or gracefulness sitting in a room with him like how Perry did. I was very surprised to learn that Leon's family was seemingly entirely different and had no past indications of violence or abuse. I imagine that this made Leon's acts even more difficult for his hardworking family.

I appreciated learning that Leon was not unintelligent but instead wasn't capable of taking into account others feeling in any other way than to manipulate. On the surface, I feel like the general public would slap a label of "stupid" when learning about crimes that occur. It's an easy way to dissociate from other people as a way to distance them and believe that there aren't similarities between themselves.

I liked that this chapter and Leon's story showed how powerful an individual's environment can be. As Perry said, there were no other signs of similar traits or behavior in his family history. I was very surprised to learn of the neglect that Leon's mother caused and it's heartbreaking to imagine all of the different systems, checkpoints, and agencies that should have helped that from occurring. While it seems like common sense, I had not thought much about the negative consequences that could arise from forming a group of children with behavior difficulties. Perry's explanation of the snowball effect and how risk factors seem to build upon themself strikes true to almost every patient I have worked with. It feels like Leon and Maria didn't stand a chance.

It's important that information of how people can develop in this manner and for the general public to understand the severity of what neglect can do to children. This case is tricky because I believe that most people would feel like Leon is guilty and therefore should be held accountable for his actions by being inprisoned. What is often less thought about is if treatment or interventions can actually "undo" the personality and lack of connection and empathy that has already been formed.

Chapter 4 - Skin Hunger

In this brief chapter, Perry tells a fascinating story about Laura and how a lack of nurture deeply impacted her health. From the onset, I was excited to learn about what Perry would discover in his work with her since many medical professionals were unaware of the underlying cause. I had never heard of a similar story so it was somewhat difficult for me to believe that this story was true.

Perry doesn't specify the exact year that this case occurred but I found it interesting that the possibility of infantile anorexia was even considered. Infantile anorexia feels unnatural and counterproductive to a human's survival instincts that I never considered that this could occur.

I greatly appreciated Perry's exploration of Larua's mom, Virginia. It can be too easy to blame or not empathize with parents when their children are experiencing health or psychological consequences but Perry shows readers that attachment and bonding can extend beyond a first glance. I was completely SHOCKED to learn of the different child welfare policies that were in place during Virginia's upbringing. For example, the fact that infants and toddlers were often moved to a new foster home every six months so that they wouldn't become "too" attached or that foster parents were not allowed to have any contact once the foster child became 18 years old. My goodness. What an awful set of policies that most likely affected too many children and their future children.

I have read before of how a baby's cuteness is an evolutionary adaptation but Perry's explanation served as a good reminder of the astounding ways that mankind has taken care of itself in hopes of prospering. I agree with Perry in that society tends to view mothers who do not "overwhelmingly tend to devote themselves to comforting, feeding and protecting their young" (pg. 84) as pathological. This widespread view is difficult to navigate, harmful, and obtuse since there are many reasons or contributing factors as to why this may be. Also, I found the comparison of a kitten's eye to be quite interesting. My initial assumption was that the unused functioning eye would have maintained its capabilities or would at least be able to regain its functioning with work and time. But in recognition of the "use it or lose it" philosophy and how development occurs, the opportunity being lost makes sense.

"Failure to thrive" is a new concept for me but the comparison of this theme with an animal "runt" of the family really helped me understand. The outcome of Virginia and Laura's story made me happy and it was encouraging to read of Mama P's fearlessness and relentless. Perry does a great job of pointing out the downfalls in the child welfare system but it was refreshing to read that the clinic/program had means to assist two mothers in such a hands-on way such as placing them in the same home. This chapter shows that there is hope and possibility even when early years are marked by trauma, distance, and a lack of caregivers.

Chapter 2 - For Your Own Good

Perry did a great job of thinking holistically of Sandy's care and being critical of how the system's actions, or inactions, can do further harm. It felt easy to me to be significantly displeased with Stan Walker, but then I reminded myself of the limitations he was also facing. 100 cases per worker with a high turnover and increasing demand is a systemic misfortune. These form of issues still occur today and it's important to be cognizant and critical of how these systems currently impact our clients as well as the efforts we can take on to help alleviate any further damage.

In my community, children were never debriefed about the traumatic things they experienced or witnessed. Children were a backdrop and were ever rarely referred to mental health treatment. These types of things were things that no one really spoke about and that everyone pretended didn't happen. I had never heard of the misbelief "children are resilient" but reflecting back on my upbring and widespread cultural feelings towards children and trauma, it fit right in. Therefore, it was refreshing to read of Perry's scientific explanation of how children are even more vulnerable to trauma due to their developing brain.

I am glad that the study and acceptance of PTSD have grown. It's difficult for me to truly grasp the concept that at one point, this diagnosis was only reserved for veterans. Perry's acknowledgment that any individual who has experienced trauma should have that trauma recognized in various domains of their life rang true to me. It's unfair and doing a disservice to dissociate the two when the individual is in school. In a school or criminal justice setting, I believe these negative past experiences are often overlooked and that these individuals are given automatic labels, are less likely to receive adequate treatment, and are likely to never process their trauma and develop negative coping skills.

In the following statement on page 36, I realized that I had not truly thought about the relation between the actual trauma event and the effects that followed. "Although the experiences that had scarred adults with PTSD were often relatively brief (usually lasting a few hours at most), their impact could still be seen in their behavior years - even decades- later." Like in the rat and stress example, that brief exposure could create a lot of symptoms for long periods of time. The fact that ONE HOUR of someone's life could change their entire behavior is astonishing. The more one thinks about it, the crazier the concept gets.

Perry's decription of the purpose of dissociation during the trumatic exposure was new information for me. Without dissociation, the heart rate would increase and people could bleed out due to their wounds. I always conceptualized dissociation as purely a psychological self-defense mechanism, so learning about how it has physical and innate benefits makes sense and emphasizes how our body has captivating systems to protect us. Perry tuaght me a lot in this chapter by effectively breaking down concepts and using basic examples to help foster deeper understanding.

Chapter 1 - Tina's World

Learning of Tina was a sobering reality check of the difficult reality of working in the specialization of children with trauma. I became very sad when her reaction upon meeting Dr. Perry was one marked by misunderstanding and sexual behavior. I don't know how I would have reacted if I were the narrator- should the mother or others have been notified? Is a male psychiatrist the best option for a young girl who has been hurt repeatedly by older males?

My personal reaction was that it was shocking to learn of young children exhibiting sexual behavior or advances due to trauma. It was difficult for me to remove the lingering thoughts from my mind because it just struck me as so unnatural. I feel these are things that most people subconsciously choose to never consider or think about for too long because the reality of these situations is painful and uncomfortable. 

I appreciated Perry's description of what it was like to work in this sector in the 1980's. I realized that I take for granted how far research has come and how now there are many areas of science that are proven to be related. The idea that the developing brain and the effects of trauma were not connected is strange to me. It feels wrong and harmful that children would be criticized or given a label due to their presenting behaviors without their previous trauma being taken into consideration. In relation to ethical dilemmas, it is possible that there most likely weren't as many stringent or defined rules concerning ethics then as there are now. Perry raised a great question that is still often debated now regarding where the line between professionalism and suffering should be. Tina's family endured hardship waiting in the cold, and to some people, it may feel inconsiderate, inhuman, and not conducive to the therapeutic relationship that the professional should have to ignore some factors entirely in fear of blurring boundaries. Ultimately, I felt happy that Perry made the decision to help Tina's family and that he also staffed the occurrence in supervision. In my opinion, this kind of work can be more difficult if one feels like they are not supported or have to make large decisions alone.

Perry's honesty of potentially not abiding by ethical standards, questioning one of his supervisor's, and feeling like he failed as his patient continued engaging in sexual behaviors added a genuine approach to his difficult work. It's important to be aware that people who are supervisors aren't always going to be correct or even adequate clinicians. If I were in Perry's position, I most likely would have also felt like I failed at providing treatment to Tina but his willingness to later identify how the resources were limited and how he could have improved was encouraging because even the "best of the best" have difficulty at times. Overall, it's important to remember that Perry does not have training in social work and that we are held to certain standards. With this in mind, readers should be aware that Perry's actions aren't necessarily the exact things we should be doing but we still have a lot to learn from his experiences.