Samenvatting bij De jongen die opgroeide als hond - Perry - 1e druk
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Tina is a girl and she is seven years old. She lives with her younger brother, sister and her mother. According to her teachers, Tina behaves 'aggressively, improperly and exhibitionistically'. She is unable to keep her attention during class and refuses to follow instructions. She had been abused since she was four years old until the age of six by the son of her babysitter. This son tied up the children, raped them and penetrated them anally using objects. He threatened the children by saying that he would kill the children if they ever told someone about it. Eventually, the mother of the son (the babysitter) found out. This ended the abuse.
The men Tina met later in life were never loving or caring. They only taught her that men wanted sex, from her or her mother. When she had her first meeting with the psychiatrist, she immediately acted sexually. For example, she sat down on the lap of the psychiatrist, moved her hands to his crotch and tries to release his zipper. It is understandable that she exhibited this behavior, because she had learnt that men only want sex. This is what exists in Tina's memory. So, Tina's behaviour probably has to do with a disturbed functioning of her brain. The symptoms she exhibits suggest that there are abnormalities throughout her whole brain. She probably suffers from a post-traumatic stress disorder (PTS). She was probably also very sensitive to stress. Her stressful environment therefore was of higher impact. The early experiences one has as a child, have a great influence on the brain later in life. This is explained by the fact that the brain sees the world through patterns. Therefore, due to traumatic experiences in Tina's early years of life, she has developed a negative view on life, through the creation of associations (for example, men and sex). Therefore, later in life, she continues thinking this way about men.
Sandy is a four-year-old girl who witnessed the murder of her mother. Sandy herself also got hurt: her throat was cut twice and she was left for dead. She was alone with her mother's dead body for eleven hours. After Sandy was discharged from the hospital, she was jumping from one foster home to another for nine months. During these nine months, she did not receive any psychiatric help. Later, Sandy's case was brought to court. The prosecutor wanted Sandy to make a statement, a year after the murder had happened. However, it was said that this would be "quite overwhelming" for her. That is why, ten days before the trial's stars, a psychiater was called to help Sandy.
When Sandy went to court, the prevailing idea about children was that they are very resilient. However, this is not true. In contrast, children are more susceptible to trauma compared to adults. This is explained by the fact that in the early years of life, the brain's plasticity is high. This means that the brain is very sensitive to experiences (to the environment). This is true for both positive and negative experiences.
When children experience stimuli, there is a pattern of activation within the brain. This activation leads to an increased sensitivity for future, comparable stimuli. This is called sensitization. Resilience or susceptibility to stress depends on the tolerance or sensitization of a person's neural system, which is thus based on previous experiences. If the previous experienced stress is moderate, predictable and pattern-based, it makes the coping system stronger and leads to more competence in dealing with stress. However, in Sandy's case, the stress she experienced was not moderate; it was very extreme and she was unable to cope effectively with this stress. For instance, Sandy experienced insomnia, was very restless, and showed increased shock reaction. Sometimes, she also had aggressive tantrums and exhibited strange behaviors (such as an increased shock reaction when she would hear the doorbell). Ordinary things triggered fear in Sandy, which put her in a state of constant fear. This caused misunderstandings by foster parents and teachers, who did not know where certain reactions came from. If a new experience is familiar and known as safe, the brain's stress system will not be activated. If the incoming information is initially unknown, the brain unleashes a stress response. Anxiety can become maladaptive if the feeling does not disappear while the threat is gone. This is called hyperarousal, which may explain part of Sandy's symptoms.
Dissociation is a very primitive reaction. An example of a dissociative reaction is making oneself very small in the face of an attack. During dissociation, the brain prepares for injuries. Therefore, breathing slows down, pain and anxiety disappear and people often report feeling emotionless and numb. Dissociated children often do not pay attention to things that happen around them. One of the defining elements of a traumatic experience is a total loss of control. And, a predictable factor will cause less stress than non-controllable stress factors. To restore the balance, the brain tries to temper the hypersensitive memories related to the trauma by encouraging you to only have a few memories. This means that the brain strives to develop a sensitive tolerance system. Sandy received clonidine for her increased stress response. Eventually, Sandy's symptoms faded.
This story is about the Davidian community branch in Waco, Texas, where children lived in a world full of fear. The cult leader David Koresh separated children from their parents and friends. Koresh was seen as a servant of God. The community was prepared for the approaching end of the world, a final battle. In 1993 the FBI came to arrest Koresh, but that was not easy. 21 children were released during this arrest. The children were housed in a campus-like environment. There was no doubt that the children were traumatized by the raid on the ranch and also by the life they led. The children did not feel liberated, instead they felt like hostages. The only way to study the devastating symptoms of PTSD in such cases is to study children immediately after a traumatic event.
It was known that fear affects the brain and that it leads to changes in behavior. Thanks to this knowledge, the children could get adequate help. The two most important areas of the brain involved in anxiety are the locus coeruleus and the amygdala. Due to the same plasticity that allows young brains to learn languages quickly, they are also susceptible to negative experiences. In anxious situations, the brain will first close off the highest cortical areas located in the cerebral cortex. In the face of an acute threat, people often lose the ability to think or even the ability to speak. At the same time, the cortical areas, which usually control and temper stress, become smaller and weaker. Relationships are very important for the children's healing process. People interpret threat and learn to cope with stress by looking at people around them. Looking at drawings turned out to be a good method to find out information about and from the children. As people got to know the children, they learned that their talents were connected to the areas of the brain that were practiced and to the behavior that was rewarded.
A well-trained clinical team tried to put an end to the unstructured chaos in the house where the children were staying. It was not the intention to arrange a therapist immediately after the traumatic event, as this could be counterproductive. Children were able to find members of the clinical team that they could best deal with, creating a powerful therapeutic structure. Because the psychiatrist interviewed all the children and the staff members joined him, the children knew that this person was in charge. The idea of a dominant man gave them a sense of security. The children needed stability and with introducing routine in their lives, this need was fulfilled. What was remarkable, was that none of the children knew what to do, even when they were confronted with the easiest decisions! To teach the children usual things, the adults tried to set a good example (such as having men and women sit at one table) with the hope that the children would notice that there were no negative consequences to such things.
The FBI wanted to free the remaining part of the Branch. They saw Koresh as a scammer and not as a religious leader. Things got out of hand and most members of the group died, as Koresh had predicted. Fourteen years later, it turned out that it was not the children who had experienced the least stress, but the children who were placed in healthy and loving environments who did the best. So, what is most effective in fighting negative outcomes of stress experienced during childhood is a having relationships of a good quality.
At the age of four, Laura weighed only ten kilos and her files covered thousands of pages of documents with information about visits to medical specialists. Doctors in Texas saw her as an opportunity to gain medical fame. A psychiatrist was also involved to deal with Laura, because she may have anorexia. Laura's mother, Virginia, was a child of the foster care system.
As people tend to care for children the way they were cared for, a good history for a child begins with early caregiver experiences. Our brains make caring for children very enjoyable. A child has a cute appearance, which ensures that parents will take care of them. Loving and caring for children stimulates two large neural networks in our brains, namely a series of sensory perceptions that are linked to human relational actions and the stimulation of neural networks. The most powerful reward a person can receive is the attention, approval and affection of the people we love and respect. We also experience the most severe pain when we lose this (for example in the face of the death of a loved one). When a sensitive period is missed, some systems do not reach their full potential. The deficit caused by neglect can be permanent.
Because Virginia had always had temporary caregivers in her youth, she did not derive the same amount of reward from holding and dealing with her baby. At the age of five, Virginia had settled into what would be her most permanent foster home, but when she turned 18, she had to leave this family. Virginia became pregnant and sought help with a program for risk mothers. However, she was left to her own devices after childbirth, without knowing how to help her child emotionally. Without the physical and emotional signals from Virginia, Laura experienced a failure to thrive: she did not gain any weight. During the first visit to the doctor, Laura received the correct diagnosis, but this diagnosis was not explained to Virginia. She received nutritional advice, but did not go along with it. Months later she went to the doctor again and from that moment all examinations started. Babies experience being cherished, held, touched and rocked as comforting and enjoyable. Interactions with loved ones are our main stress-regulating mechanisms. The bond between a baby and its first most important caregiver is so strong that it feels like the deepest romantic bond. This also ensures that one can enter into good relationships as an adult. Lack of this stimulation was devastating for Laura. The lack of physical stimulation lead to that she was unable to gain weight. Mama P. was the solution to the mystery for psychiatrists and doctors. Mama P. knew that you had to give children love and fulfill their needs, not based on their age, but based on their needs (from what they missed). The proposal was to let Virginia and Laura live with Mama P. Virginia learned a lot from Mama P and Laura also made good progress and gained weight. After a year, Virginia and Laura went to live on their own, in the same street as Mama P.
Emotional deprivation in the early years can lead to malice and hatred. Leon was sixteen years old when he murdered two teenage girls and then raped their dead bodies. Leon had often come into contact with the judiciary, but nothing in his file had warned that he was capable of something this violent. His files did show that he was a master in manipulating others and was completely unable of emotional connection with others. When Leon told the therapist the story, it seemed that, as time passed by, he made the story less and less violent. Leon was totally unable to take into account the feelings of others: he could only abuse it. His verbal IQ was low, but his performal score (seeing through social situations and understanding other people's intentions) was high. This gap between the scores often occurs within abused and / or traumatized children. The strange thing about Leon's situation was that his brother Frank showed no problems while growing up in the same house and with the same parents. To find out what Leon's problem was, the therapist met Frank and his parents. The family had no idea why Leon was capable of something so evil. As history became known, it appeared that Mary (the mother) received a lot of support from family when she was pregnant with Frank. However, when Alan (the father) lost his job, the family had to move. Soon after Maria became pregnant with Leon. This pregnancy was very different from Frank's. Maria missed her old neighborhood and missed the group of experienced women who had helped her with her first pregnancy. She was now alone. It became clear that Maria resumed her walks with Frank, but that she left Leon at home. So, Maria unconsciously neglected her son systematically.
It soon became apparent that Leon showed no emotion when he received a scolding or punishment. Leon didn't seem to care about anything or anyone except himself. Like Laura and Virginia, Leon remained deprived of the most important stimuli needed to develop the brain areas that temper stress. For a child, an environment in which he is cared for one moment and left to his fate the next may be the worst imaginable world. Leon did not enjoy doing someone a favor or getting a compliment from someone else, nor did he suffer from rejection. For Leon, people were just objects that either stood in the way or came in handy for his needs. In order to function socially, people must develop a so-called theory of mind. This is disturbed in both autism and sociopathy, but people with autism do not tend to commit violence or crime. Autistic people can often be insensitive to the feelings and needs of others, but that is because they cannot perceive feelings properly, not because they want to hurt someone. Sociopaths' inability to empathize comes from it being difficult for them to mirror the feelings of others, this is coupled with a lack of compassion. They themselves do not enjoy relationships and therefore do not believe that others do feel that they do.
Young people with antisocial traits and hardened behavior often have abnormal amounts of the stress hormone cortisol. Different outcomes for a child who has been neglected may have to do with gender. Most of the boys treated by the psychiatrist grew up to be clumsy and lonely, but not to be malicious boys like Leon. Unfavorable heredity in combination with an anything but ideal environment was probably a determining factor for the formation of Leon's violent behavior. Often, there is a snowball effect. When things go wrong at the beginning, they keep going wrong and vice versa. Because his mother left him alone, Leon did not get the most important input he needed to calm and organize his somewhat disrupted stress system. This made Leon dependent and aggressive, which prevented his social skills to develop. Nowhere did Leon consciously make the choice to become wicked, but every little choice he or his family made pushed him further in the direction of sociopathy. What could the therapist tell the court? That Leon's brain has developed unbalanced because of what happened to him as a baby. That his emotional, social and cognitive problems were related to his mother's unintended neglect. And that Leon probably would not have committed the crime if he had not been drinking.
Justin was six years old when the psychiatrist met him at Intensive Care. Justin was a skinny and small child. There was a sort of cage around his bed, he was soiled with his own excrement and showed unmanageable behavior. Justin's mother was fifteen years old when he was born. At two months old, his mother left him with her own mother. When he was eleven months old, his grandmother died and her friend (Arthur) took care of Justin. Arthur was not mean, but he was totally unaware of the child's needs. Arthur was a dog breeder and applied that knowledge to the care of Justin. He gave him food and a clean diaper, but did not speak to him, did not play with him and did not comfort, reward or cherish him. Justin was diagnosed with static encephalopathy at the age of two, which means that he had serious brain damage due to an unknown cause, which would probably not be restored. Doctors did not know which deprivation the child was exposed to. A therapist and the writer of this book were the first to whom Arthur told something about his parenting practices, because the therapist was also the first to ask about it. To help Justin, it was necessary to see if his neural systems could be shaped by patterned, repeated experiences in a safe and predictable environment. The chaos and sensory overload in Justin's environment had to be reduced. Thanks to this intervention, Justin progressed remarkably quickly and seemed to feel safer every day. He also received physio-, ergo-, language- and speech therapy. After two weeks, Justin was placed in a foster home and six months later he was transferred to another family. Patterned, repeated experiences in a safe environment can have a great effect on the brain. Justin achieved milestones in development that no one had thought were possible. When he was eight, he could go to kindergarten.
Connor is fourteen when the psychiatrist meets him. Like Leon, Connor came from an intact family and his early childhood did not seem traumatic from the surface. Connor behaved strangely when it came to relationships, but he did not show the classic symptoms of autism or schizophrenia. Connor's peculiar symptoms and the fact that they did not match typical cases of autism made the therapist think that it may have to do with neglect during childhood. Connor's mother Jane was asked to describe Connor's history. The family business demanded so much attention that Jane returned to the office a few weeks after birth. They had arranged for a cousin of Jane to look after Connor, but what Connor's parents didn't know was that she left him alone and had another job during the day. Jane said that the first few weeks after she went to the office, Connor cried terribly. When Jane found out that her cousin was cheating them, she immediately fired her and stopped working to look after Connor. She thought there would be no lasting consequences.
In the previous example (Justin) there had been nurturing and love from his grandmother in the first years of his life and this had the result that the lowest and most centrally located brain areas got off to a good start. However, Connor had not received love in the first few months. Like others who suffered early neglect, Connor did not tolerate being touched. Connor's therapy was started with a massage. The involvement of the parents can be increased with this. The therapists wanted Jane to learn to express her love for her son with loving touches, which could compensate for the cherishing that Connor had to miss in his baby days. After 6 to 8 months of therapy, he slowly began to tolerate body contact with others and began to enjoy it. It was time for the next treatment phase, which was focused on his sense of rhythm. Disruptions in brain areas that have do with rhythm are often the consequences of depression and other psychiatric disorders. It is known that the maternal heartbeat provides the patterned repeated signals that are essential for the organization of the brainstem and its important stress-regulating neurotransmitter networks. Connor had missed the music (which is said to be the first human language) and the rhythm when he needed it most. Once Connor had learned how to keep the beat, the therapist started therapy. Connor did not understand body language and social signals. It turned out to be difficult to teach all the social signals that people use. Conversations have a certain rhythm, but Connor was unable to find this rhythm. Connor ended up well, he went to college and led his life without further outbursts. He suffered almost exactly the same kind of neglect as Leon, but never displayed malicious behavior. A number of genetically determined factors play a role in this. First, temperament and second, intelligence can protect against anger and sociopathy. Another factor is the timing of the trauma: the sooner the trauma, the more difficult it is to treat and the greater the damage. But the most important factor or predictor in determining the expected life course of neglected children is the social environment in which they grow up.
There is still little that can be done to change genes, temperament, and the processing speed of the brain, but it can help to determine how children are cared for at home and what their social environment is like. The treatment of traumatized children must begin by creating a safe environment for them.
A psychiatrist was asked to offer help in a complex case involving a group of children who were ritually abused by members of a satanic sect. For this story, is important to keep in mind that we shape memories, and memories also shape us. This is a constantly changing process. The memory is also subject to prejudices and influences from many sources. When a memory is retrieved, the memory is at risk at being distorted.
There was a story in Texas about a satanic sect in which children were being abused. But the question is: were the children actually abused or were the accusations false? In Texas, however, 'therapeutic foster homes' were chosen as a new place for the abused children, which had disastrous consequences.
None of the material related to Satanic Ritual Abuse had been scientifically investigated before it became widely known. The evidence was paper thin. In addition, the foster children also had to go through a form of quackery, namely 'holding therapy or attachment therapy'. During therapy, the adults held children firmly in their arms, forced them to look into the eyes of their caregivers, and open up to memories and fears. Holding therapy had to last for hours, without interruptions to eat or go to the toilet. Releasing anger in this way was to prevent future outbursts of anger.
Supporters of holding therapy believe that the problems of traumatized children are the result of poor attachment with their caregivers due to abuse and / or neglect in early childhood. This is probably true, but the danger lies in their solution to the problem. The ideology of holding was a good fit with the religious beliefs of the families, as the will of children had to be broken so that they would learn to resist sin and temptation. Holding can also be called the 'psychic pus' method. People spend hours on therapy to look for the cornerstone of their personal history, to find that one memory that makes their life meaningful and offers a solution. However, our memory just doesn't work that way. The problem with traumatic memories is that they force themselves on the present, not that they can be recalled. For people who are not experiencing any negative impact from their memories in the present, it can be harmful to be pressured to focus on those memories. The belief that you can only get better if you can remember the precise details of a trauma can become a self-fulfilling prophecy.
During the holding session, foster parents questioned children about their devil-worshiping parents. They asked long questions and hurt the child until they agreed with their version of the events. Children soon learned that the holding stopped when they admitted their parents' involvement in the cult. Even with questions about whether other children had been abused, children mentioned names in order to escape from the holding as quickly as possible, not because it was the truth.
Brian is an example of a boy who wrongly accused his parents. He ended up in a therapeutic foster home with 16 other children. His parents had already pointed out to him that their family would probably be the next family to be accused of satanic sexual abuse.
Forced admissions are problematic because they can lead to the conviction of innocent people, but also because facts that are not known to interrogators are revealed later. These affect the credibility of their witnesses and their own. How can you determine which charges regarding sexual abuse have been enforced and which are true? A heart rate monitor can be used to find out which signals are causing trauma symptoms in children.
The heartbeat method was tried by Brian. Brian indicated that he did not like that the foster family held and that he had to say that his parents did things they did not do to get out of it. He was very casual and said he had made up stories to prevent him from being hurt. The heart rate monitor helped see what things were doing to Brian.
A very disturbing aspect of this case was that the fear generated by this investigation spread, causing people who were otherwise rational, to behave in a bizarre way.
Amber is seventeen years old when she is found unconscious in the toilets of her high school. Despite the efforts of doctors, she could not be brought to consciousness. Her heart rate was very low and no doctor knew what was wrong with her. The psychiatrist started talking to her mother and he found out that Amber was cutting herself. People who self harm often have a traumatic past and this was also true for Amber. The unconsciousness could be an extreme dissociative response that had caused her brain to get an overdose of it's own opiates. Naloxone was administered and just like with an ordinary overdose of opiates, Amber quickly recovered. It was suggested that Amber talk to the psychiatrist. Amber finally agreed and she became more and more open and honest during therapy.
Amber's mother's ex-husband had abused Amber for years since she was seven years old. The sexual abuse Amber had experienced was violent and frightening. Amber was afraid to tell her mother what the man was doing. By ensuring that she knew when the abuse would take place, she was able to plan and isolate her fear of death so that it did not stand in her way for the rest of her life. She was able to handle her fear through the control she got over the situation. As a result, the consequences of the abuse for her daily life were minimal. When Amber was nine, her mother discovered the abuse and kicked the man out of the house. Amber was attracted to gothics and found that her fear diminished when she squeezed her arms or scratched them deeply. Self-mutilation is often considered an act of resistance or a way to attract attention, but in most cases it is probably an attempt at self-medication. Opiate antagonists such as naloxone and naltrexone could be tried to mitigate sensitized dissociation.
One of the first patients in whom naltrexone has been tested was the 16-year-old boy Ted. His only visible problem was that he suddenly fainted about twice a week. But there was more, he seemed to have a classical form of dissociation. Before he went to primary school, he had been a witness and victim of domestic violence. He lived with the daily threat of a very real occurrence of serious violence. Ted took the medicine, so he didn't faint anymore. But in addition to medication, help was needed for his stress response. The fainting of Ted was triggered by interactions with men and the display of masculinity. In the sessions he had to be exposed in a safe way to signals that had to do with masculinity. Ted became better and better at fully experiencing his own life.
Amber also made progress. She received cognitive therapy, one of the most effective treatments against depression. The key to recovery is to make the patient understand that his / her observations are not necessarily true and that the world is not as dark as it seems. Amber had to realize that she was sending negative signals to other people and that she might misinterpret the social signals of others. Amber's heartbeat became calmer. Later, Amber became a healthy, productive and caring young woman.
James is six years old when the psychiatrist is asked to make an expert judgment about his complex situation. James was sent to a therapist by a judge because there were so many different stories about the boy. According to his mother Merle, James was incorrigible and uncontrollable. He was temporarily in a psychiatric home and the judge had to decide what would happen to him afterwards. Social workers and therapists were convinced that he suffered from the reactive attachment disorder (RHS). The disorder is characterized by a lack of empathy and an inability to make contact with others. The disorder often occurs in people who are placed in many different families and therefore have difficulties with bonding. In addition to being cold, many children with reactive attachment disorders are inappropriate to strangers. Reactive attachment disorder is rare, but many parents, social workers, and therapists see it as an explanation for a wide range of misconduct, especially among adoptive and foster children. The descriptions of James' behavior that his therapist and mother gave seemed to be correct in the RHS diagnosis, but there was something strange about his records. When he was in a hospital, he behaved well. He was entertaining, made eye contact, and smiled. James could not have a reactive attachment disorder, because this and the fact that therapists were able to build such a good relationship with him did not fit the image of children with a reactive attachment disorder. It turned out that the medical staff had often been suspicious of James' mother, Merle. James even said once his mother lied and hurt him. This made it clear that James had run away because his mother was hurting him, not because he was seriously misbehaving. James' behavior resembled that of someone seeking help (which is not common with abused children), nore that of someone who has difficulty forming bonds and relationships. James, his brothers and sisters were in mortal danger and had to be evicted immediately.
This brought to light one of the most important conflicts in child psychiatry: the patient is the child, but he / she is not the person who can make the most decisions about his care and treatment. People who work with problem children must be alert at all times. One views a child as a "troublesome teenager" and the other as a "victim of sexual abuse". Although most parents want the best for their child, emotionally disturbed children often have emotionally disturbed parents. Heredity and biology play a leading role in the etiology of disorders. It is a challenge for child psychiatry to see the difference between disorders such as schizophrenia and autism and disorders that are caused by early abuse and neglect.
James' mother appeared to have the Munchausen by proxy condition. People with Munchausen syndrome deliberately make themselves sick to get medical attention and compassion from others. To develop persuasive symptoms, they do very extreme things. The cause of the syndrome is unknown, but it comes down to a matter of dependence. People with Munchausen by proxy syndrome try to make another person, usually a child, sick, to get attention and support. They cannot cope with it when a child develops and becomes more independent. James understood her behavior and was therefore in great danger. Fortunately, James and his brother and sisters were removed from the house by the judge and ended up well.
Unfortunately, increasing interest in this syndrome sometimes leads to unjustified persecution of women, for example in the case of cot death. Nine percent of the children whose mother has Munchhausen by proxy syndrome die and many more children suffer serious injuries.
Peter is seven years old when he comes to the psychiatrist's clinic for an evaluation with subsequent therapy. Amy and Jason had adopted him from a Russian orphanage when he was three years old. Although his caregivers at the time had boasted about how clean the orphanage was and how well fed the children were, Peter was seriously neglected, just like the other orphans. Each child received attention from the caregivers only fifteen minutes per eight hours when they were fed and changed. The only other contact was when they held the hand of the child in the next bed. They had also developed their own primitive language in the absence of a linguistic example. Peter has speech and language problems and problems with attention and impulsiveness. Furthermore, he sometimes has strange and very violent outbursts that can last for hours and in which he seems to have completely lost his self-control. At school he experiences social and learning difficulties. Cognitively, Peter is seven years old, but in other areas he is much younger. He is extremely caring in a remarkably immature way, because he responds just as a toddler responds to peers and adults. He also has some mathematical aptitude and in some linguistic aspects he scores above average. It turned out that the areas in which he did better were related to the brain areas that were stimulated. The areas in which he was lagging behind represented areas of the brain that were not sufficiently stimulated, leading to neglect with serious consequences. Peter's cortex was shriveled, his brain cavities were large and the structures of his deeper brain areas were very small for his age.
Peter's parents were advised to give him the attention that suits his level of development and not his age. The neurosequential approach helped to give him the specific stimuli that his brain should have missed. Massage offered him the physical affection he had not received and music and movement helped him restore his brain and body rhythms. Together with the love and affection of Amy and Jason and the patience and support of his classmates, this has caused Peter to be cured of his trauma. Both in terms of studies and in social terms, he has continued to do well since high school.
For children in particular, the most traumatic aspect of all disasters is the fragmentation of human relations. When the people who are supposed to love you, rob you of the safe and valued relationships that make you feel human, it is a very destructive experience. Because people are social beings, the worst disaster that can happen to us is always the loss of relationships. As a result, the recovery from trauma always has to do with rebuilding and having faith in relationships. In addition to medication and therapy, healing is impossible without lasting, caring and loving relationships with others. Abused and traumatized children need a healthy community around them. About forty percent of the children will experience at least one potentially traumatic event before they become adults. Dr Perry, the psychiatrist, believes that "we are at a transition point in history in which people come to see that modern society has lost many of the essential elements needed for optimal mental health". Children must be protected from poor childcare practices and other injustices. They have to grow up in a healthy and loving environment, where their needs are respected, by a strong and a non-fragmented community.
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