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Oprah Winfrey and leading child psychiatrist and neuroscientist Bruce Perry, MD, PhD explore the impact of childhood trauma on who we become, the decisions we make, and how healing must start with one question ‘what happened to you?’
[0:08-1:32] Oprah: I am so delighted to be participating in South By Southwest Edu Online this year, and speaking to such an incredible community of teachers, of administrators, of university professors, business leaders, policy makers, students, all of you. You know as a lifelong learner, I applaud all of you for the work that you’re doing to impact education today and in the future. And I believe, and know for sure, the teachers have always been my heroes and I think a lot of people are actually appreciating teachers differently now than ever before. With children homeschooling and e-learning, parents have truly come to see and experience what you do, so I think that’s a good thing. This has been an extraordinary year, from the moment our lockdowns began last March. What’s really been on my mind is how do we process all of this and more importantly how do we help children process it. And so I am delighted today to be here with someone who I know can help answer those questions, Dr. Bruce Perry. I’m here in my garden. You’re joining me from Nashville, Tennessee my old stumping ground. Hi!
[1:33-1:34] Dr. Perry : Hi, how are you?
[1:35-1:56] Oprah: I’m so good. You know the truth is that you and I have been thinking about talking about for a long time working together for 25 years on issues surrounding what makes people behave the way they do specifically childhood trauma and I’m so excited right now because have you seen the book that we did together.
[1:57-:1:58] Dr. Perry : I have.
[1:59-3:41] Oprah: Well it’s a beautiful thing to see. Through deeply personal conversations Oprah Winfrey and Dr. Bruce Perry explore how what happens to us in early childhood influences the people we become. They challenge us to shift from focusing on what’s wrong with you or why is that guy behaving that way to asking what happened to you. This is such a critical question and the reason why I wanted you to do a book about it that. I get to sit and ask questions about it because several years ago, I think it was 2017 or 18, I was doing a story for 60 minutes on childhood trauma based on this place in Milwaukee called Saint Ann’s Clinic. I interviewed you for that and although I’ve been talking to you for over 30 years about the effect of trauma on children’s brain, it was in that moment that I had the biggest aha ever. It actually changed the way I see people. It changed the way I see myself. It changed the way I operate in business and it changed the way I operated my school. Because the question of not what’s wrong with you but what happened to you, allows us to look at a person from not a place of judgment but a place of trying to understand what went on before that is causing that behavior. So that’s a long intro into why does that shift matter.
[3:42-4:30] Dr. Perry: Well, one of the most important things about that shift in frame of reference is that we know that the experiences you have when you’re growing up both good and bad, shape the biology of your brain and that sets you up for the way you see the world, the way you process experience, the way you interact with other people, the way you manage the physiology of your heart, your gut, your lungs and so. These early experiences literally have a major impact on your physical health, your mental health, your social health. And really every aspect of our society is impacted by developmental experiences and particularly developmental experiences that are toxic, traumatic.
[4:31-4:52] Oprah: Okay, because a lot of people say you know what happened to you, you carry that into childhood. It’s what happened to you as a child shaped the way you actually viewed the world and your world view determined your personal view of yourself. And that is why you either grow up with a sense of worthiness or not based on what your surroundings are. That’s what I hear you saying.
[4:53-5:27] Dr. Perry: Exactly, exactly, you know and one of the things that I think just about anybody can sit back and think about influences on their life whether it’s a coach or a teacher or your parents. And I think people intuitively understand that your life experiences influence who you are. But what I don’t think they connect with is that those experiences literally change the biology of your body. Particularly the biology of your brain.
[5:28-6:14] Oprah: That’s what we did not realize until you came along to tell us. We know that those experiences influenced the way we see the world. We did not know that it changes or has the impact on your brain. So let’s start with the word trauma because I know it’s a term that’s thrown around a lot nowadays and you’d like to be very specific. So how do you define trauma because the book that we have uh co-authored, you did most of the authoring and I was the co-part, is Conversations on Trauma, Resilience, and Healing. And we’re going to talk specifically about those three things today. Because I know you have a different take on resilience than most people do that’s so fascinating. So let’s start with trauma.
[6:15-8:00] Dr. Perry: So everybody uses that term, right? They’ll talk about how oh my god I was traumatized by something that somebody said to me at lunch. When we are talking about trauma in this book and when I talk about trauma, I’m actually referring to an experience that can literally influence the way your stress response systems work and as a result have long-term impact on the person. So this is an important thing because the experience itself is not necessarily the trauma. Two people can go into the same event and one will be completely overwhelmed and have long-term problems with sleep, anxiety, impulsivity. In part, because both of them are going to have a slightly different ability to manage that event that they bring into it. So there may be somebody who has a history of inconsistent, unpredictable life experiences and they’re more fragile. So when they’re in a school fire, for example, they’re going to have a much harder time than a child who has come from a stable, consistent, predictable background. And they’ll both have some initial response but the child who has that stable background is going to have a higher probability of getting back to a healthy baseline. The other child’s more vulnerable.
[8:01-8:02] Oprah: So interesting. Also interesting that most people associate the word trauma with big dramatic events like fires or hurricanes or you know major disasters. But there are also um silent traumas or quiet traumas. Silent problems, I think you call them, that have also equally lasting impact.
[8:03-9:02] Dr. Perry: Exactly and I think that that this is an area that I hope the book will help people understand better. You know one of the things that we’ve been talking about in this last year, as in our society, is racism. And the inequities of poverty and the inappropriate maldistribution of wealth in our society. One of the things that we know is that the stress response systems in our body are very very malleable. They change in response to the pattern of stressor that you experience. If your experiences with stress are unpredictable and inconsistent and you have no control over them, you can have changes in the biology of that stress response system that looked just like a big capital T trauma. Even though you never had any big event.
[9:03-10:38]: Let’s say you are a minority child in a majority community. You’re continually getting these little, little doses of like why are you here. When those happen, your stress response activates slowly transform your stress response system to becoming what we refer to as sensitized. It’s overly active, it’s tuned up, and then it’s overly reactive. So what will happen is somebody who has a stress response system like that is going to have a predisposition for having hypertension, for having diabetes, for having asthma. And of course, if you look at children of color and youth of color in our society, their rates of asthma, heart disease, diabetes are higher than the general population. And it all goes back to that question of what happened to you, what your early childhood development was like.
[10:39-11:41] Oprah: So if I can get this message to the world I will be so satisfied. People may be surprised or even shocked to learn that our brain development and decision-making patterns are shaped by the first few years of our life experiences. And you know when I first started talking to you 30 years ago, we were talking about doing a program called zero to six, what happens in those zero to six years. What I have since learned from our discussions is that it’s not even zero to six but those first two months. Which makes sense because anybody who has ever had a baby, been around a baby in those first couple of months, they just take in everything, they’re like a sponge. You’re saying in this book that if in the first two months.. Go ahead, explain it. This is it. This is the bing, bing, bing moment. Attention everyone.
[11:42-13:07] Dr. Perry: First of all, I think you know there’s a lot of work that’s shown that adverse experiences or traumatic experiences during development change your biology and make you at increased risk for heart disease, you know mental health problems, substance abuse, all kinds of bad things. But if you actually start to look at when those adverse experiences take place, it turns out that the most important time appears to be the first start in life, the first couple of months. And so when we look at kids who have lots of adversity and few relational supports in the first two months of life and then they get into a healthy environment after only two bad months, they have worse outcomes than kids that have a good two months and then something bad happens.
[13:08-14:20] Oprah: That is why often when people adopt, a child is six months old say and that child went through a lot of trauma in the first couple of months. And it’s zero to two months and then that child is put in an environment where everything is wonderful and they’re being nurtured and supported. And you can’t figure out why they are having problems and why all the things that I’m doing aren’t really working. It’s because what happened to that child in the first couple of months. So does that mean that if you’re zero to two months, horrible things are happening like chaos, people are cursing around you, all kinds of manifestations of darkness are showing up around you and you don’t have the language to explain it, it’s more damaging than if it happens to you older and you at least can process it through language?
[14:21-16:28] Dr. Perry: You have more tools the older you get. The brain of an infant is not developed yet to the point where they can really understand what is happening. Furthermore, these key regulatory systems, these key stress response systems that we write about, they’re organizing very rapidly early in life. Like you said it’s a sponge-like sort of responsivity to what they’re experiencing and so if those stress response systems experience chaos, threat, and all kinds of extreme things, they’ll literally be these genetic changes in the way those systems organize. They’ll literally view the world as and walk around in a state of fear all the time. And so what that means is if even in a safe environment, if your brain is primed to respond to everything as if it’s a threat, a teacher who comes up to you and tries to be kind, your brain will go what do you want from me as opposed to let me listen to you. That leads to this cascade of problems that just magnifies as you get older. We write about this in the book, the key thing is that the older the child gets and the more they struggle with these things, the more the adult world misunderstands their behavior. So instead of saying your inattention and your aggressive behavior is because of what happened to you, it’s because you have some other problem and so we’re going to punish you and exclude you. And it literally leads to this this sort of vicious negative cycle of misunderstanding and then actions on the part of the adult world that further traumatize the child.
[16:29-16:53] Oprah : So you want us to imagine the brain as a four layer cake because you say the key question is not only is what happened to you, the key question is if you want to understand someone.
[16:54-17:38] Dr. Perry : Right, I think one of the reasons I wanted to write this book was that I believe that the more science literate our population becomes, not just about what we’re talking about but about a lot of other things, we’ll be better parents, we’ll be better teachers, we’ll be better in law enforcement. And one of the simple fundamental tools we do to to help teach people these things is have them envision the brain as this upside down triangle. And down on the bottom are these sort of regulatory systems that control heart rate, blood pressure, and so forth. As you get higher and higher in the brain you get to the cortex, the top part of your brain, that’s the most uniquely human part of our brain. So if you look at all of the capabilities that we have as a species, the most uniquely human capabilities arise from systems in our cortex.
[17:39-19:12] : Those capabilities are the things that we’re trying to basically encourage and build into the brain of a of a child when we teach them right from wrong, when we teach them language, we teach them geography, we teach them the story of our people. All of those things go into the cortex but the dilemma is down here in the lower part of the brain. We’ve got these regulatory networks involved in the stress response and when they’re activated and when you feel under threat, the first thing that happens is you shut down the top part of your brain. If you want to teach a child who has trauma-related dysregulation, you’re going to have to figure out how to regulate them before you talk to them about geography. You’re going to have to figure out how to regulate them before you talk to them about math. All of the things we’re trying to do in education, parenting, therapy that are intended to reach the top part of the brain, they’re never going to get there if we don’t first deal with the trauma altered stress response systems that originate in the lower part of the brain.
[19:13-20:19] Oprah : So it’s why if someone is angry, you can never reach them through more anger. And that’s just not philosophical or social, that’s actually the way your brain works. Our brains are exquisitely attuned to the relational cues that other people are giving. We’re contagious to the emotions of other people. So if you’re in an argument with your spouse, for example, and they’re escalating and you’re escalating and you’re trying to reason with them. There’s no reason that can actually be received because the brain won’t let it.
[20:20-21:21] Dr. Perry : Exactly, it is just simple biology and everybody can learn this. Once people do learn this, it really opens up a lot of doors for the way you understand the people around you and yourself. And so the key to this is that when I talk with you, Oprah, and when people hear us that information goes into the lower part of their brain first. It doesn’t go directly to the cortex, it has to get through this lower kind of reactive part of our brain and then it has to go through the emotional part of our brain. And then it finally gets up to the reasoning part of our brain. There’s a lot of places where you can get short-circuited and so that’s why we use this term we talk about. You know, the sequence of engagement if you really want to get to somebody’s cortex first of all, they have to be regulated.
[21:22-21:57] Oprah : The term regulated, I don’t think a lot of people are familiar with that term. I know in your world you all regulate all the time and now I teach this at my school. So I knew that it was getting through when I went back to school in 2019 (was the last time I’ve seen all the girls). And they’re all talking to me about their regulation practices. They’re all into being regulated, so explain what that means. What does being regulated mean?
[21:58-23:50] Dr. Perry : Well, broadly speaking, it means being in balance. Your body has all these systems to help you sort of manage and keep imbalance your oxygen levels. And so if your oxygen level gets low because you’re working really hard by walking up steps, you’ll take deeper breaths. You get a little dysregulated by getting short of breath and and your body will work to regulate you, get you back in balance. We have these all of the systems that have to do with sleep and wake. The oxygen and sugar in our blood, for example, they’re always trying to keep us in balance. And so these stress response systems, that I talked about that are in the lower part of the brain, they’re continually getting information from the outside world and from the inside world. One of the major sets of signals that your brain cues into is the relational milieu, which I basically mean the signals coming from the people around you. If you’re getting signals from the people in your classroom, for example, that you belong, you feel safe, you feel regulated. But going back to these microaggressions that I talked about earlier, if you’re getting signals that you don’t quite belong, you’re not one of us, you literally feel disregulated. It’s a stressor and so anything that makes you feel marginalized, minimized, degraded, not heard, activates your stress response.
[23:51-24:55] Oprah : Well since we are speaking to educators today, one of the concerns is so many children are experiencing major setbacks, not only in terms of their education but also in their social, emotional development and sense of isolation during the pandemic. The the CDC reported that from March to October 2020, the proportion of ER visits related to mental health increased 24% for children age 5 to 11 and 31% among adult adolescents age 12 to 17. So, is it possible to heal from the damage that’s been done?
[24:56-25:51] Dr. Perry : It’s going to take time. It is possible. Healing is always possible. The question is whether or not the educational community, and the the people who support that community, are going to be willing to do the things that we know will help these kids become better regulated, recover, and restore their resilience. Right now, what we know, is that that this last year has drained the reserves of all the educators. It’s drained the reserves of children. It’s drained the reserves of healthcare workers.
[25:52-26:09] Oprah : How do we make up for lost time? Should we think of it as making up for lost time or just starting where we are now? I think trying to catch up is going to cause people a lot more stress instead of this is where we are now and now here’s what we need to do.
[26:10-27:25] Dr. Perry : You are spot on! The most important thing is for people to remember what we talked about earlier. If you are dysregulated, that top part of your brain, the cortex, it’s shut down. No matter how much you teach, if you go to summer school, if you do twice as much educational instruction, you’re not going to get any more change in the cortex. So the first thing that we need to do with these kids and with the teachers is help them get regulated, get back into routines, get back into connecting with each other. Then, basically, adhere to regulate. If we do this the right way, if coming back into school focuses on play, physical hygiene, how’s your sleep, how’s your nutrition, are you getting enough exercise, then once the cortex is open.. learning can go very, very, very fast. But if you try to teach kids or push teachers when they’re dysregulated, you’re going to make it worse. We’ll fall further behind.
[27:26-27:35] Oprah : And what are ways to regulate ourselves as adults and ways to regulate children if you’re working with children?
[27:36-29:06] Dr. Perry : They’re kind of two go-to things that help people get regulated. One is being with other people. When you’re in the presence of people who you belong with, who you feel connected to you, feel safer, you feel regulated. These kids need to play with each other. Teachers like having their class full when everybody can be safe and healthy. And so that’s one thing, reconnect and encourage relational interactions. The second thing is to take advantage of rhythm. Rhythm is sort of this fundamental regulatory gift that our brain has that comes from our earliest experiences in utero, where our brain made associations between maternal heart rate and not being hungry, not being cold, not being thirsty. We were talking about these memories we have in the lower parts of our brain, one of the first primal sets of memories have to do with the power of pattern, repetitive, rhythmic activity and being regulated. Like let’s let kids run, know dance, music. There’s a whole range of activities.
[29:07-30:45] Oprah : I want all of the educators who are listening to us right now to hear what you’re saying. It is, regulate first before you can have any kind of reasoning happening, period. You know, several years ago I interviewed Shaka Senghor, who as a teenager got involved with gangs and drugs and ended up spending 19 years in prison. He’s now out and doing remarkable things. But at one point, he was a straight-A student. He wanted to be a doctor and came home one day and his mother threw a pot of something at him and broke the tiles in the kitchen. When he came in to tell her that he had gotten an A. He said his mom was always having these kinds of episodes and after that moment his grades started to fail. He started hanging out with the wrong crowd. And during that entire time from this kid going from straight-A’s, wanting to be a doctor, life then starts to fall apart, nobody ever asked what happened to him, what’s going on in his family. I wonder what are some of the signs of trauma educators should be looking for in a child to tip them off that something isn’t right? How do educators begin asking that question?
[30:46-32:37] Dr. Perry : Exactly, you know one of the things that is a very, very common manifestation of trauma, that’s seen in classrooms, is inattention. And a lot of times these kids that are inattentive are actually either hyper vigilant, they’re kind of scanning every little noise because of their trauma related changes, or they’re tuning out because they’re dissociating. Both of those adaptive responses get labeled as attention deficit disorder. They’re mislabeled and mischaracterized. These kids frequently end up on medications which don’t help very much. One of the other things that people see a lot in educational settings is what I would call passivity and compliance on the part of students. Teachers misinterpret as them being quiet, little learners, they follow good directions, but if you look carefully, what you find is that these kids are doing all of these compliant behaviors just because they want to get the teacher to leave them alone and back off. So it’s great if a teacher has a kid who wants to please you, but if it feels excessive that can sometimes be a manifestation of trauma.
[32:38-33:57] Oprah : You mentioned disassociation and I think this is one of the great learning experiences I had to go through at my school in South Africa because we’re only taking in girls who’ve been traumatized. And what we learned is that disassociation was a part of their coping mechanism, and a lot of teachers before we were attuned to your way of teaching thought that what’s wrong with this kid. People who have been through traumatic situations tend to disassociate in order to protect themselves because if you’re raised in an environment where people are screaming and yelling and there’s noise all the time, you’ve got to disassociate just to keep yourself centered and and regulated. So it’s important to understand the disassociation usually is the first thing that shows up with people who’ve been traumatized.
[33:58-35:13] Dr. Perry : That’s exactly right and you know the interesting thing about it is that it’s sort of this confusing presentation for educators because one of the things that happens is a lot of kids that dissociate come to love reading. So they’ll read really well and they’ll do well on their reading assignments because reading is kind of a dissociative experience. You can go to a different world. It’s a very positive form of dissociation. But what happens is these very same kids who do well with reading when they try to do math, they can’t do it. Part of it’s because math requires this linear, sequential focus and these kids are like dipping in and out of attention. And so the teachers see a kid who gets all A’s in reading and they get D’s in their math, and they’re thinking that’s because you’re not trying. Very few of them understand that that’s really dissociation.
[35:14-35:22] Oprah : How does understanding what happened to a child bring clarity to why a child purposely acts out?
[35:23-36:50] Dr. Perry : A lot of times when a when a teacher has a child who acts out in the class, they feel as if it’s personalized. As if the misbehavior is directed towards them. And in fact, it it very rarely is. If a child has a history of trauma, it’s because the behavior is kind of a manifestation at times of the fight-or-flight response. Whether it’s physical proximity becomes an evocative cue, every time any other adult got close One of the things that we’ve been able to do with educators is if we teach them about trauma, and about these responses, they begin to shift the way they understand the child. They no longer take it personally, they ask what happened to you. Sometimes they may not know what happened, but they realized something did something happen. So they can then change the way they treat them. They don’t kick them out of class, they don’t punish them, and make it worse. They actually try to make some kind of accommodation.
[36:51-37:35] Oprah : Over the years, when that happens, children have been punished, they’ve been ostracized, they’ve been condescended to, they’ve been made to feel shamed by the behavior, which only makes it worse. Tell me this, if you know traumatic things that happen to you, from zero to two months are embedded there in the brain. If those first six years have a major impact on how you see the world and view the world and in the formation of your personality, how then can you even begin to change things that happened to you at a time when you had no control over it?
[37:36-38:30] Dr. Perry : That’s a very important question. All parts of the brain are malleable, changeable. The key is actually reaching the parts of the brain with sufficient repetition to cause change. And so children who have these early life insults that result in these profound abnormalities during development, if you end up getting opportunities for consistent, predictable, stable relationships over time, you will, over time, get better even if you had a bad start. You can get better.
[38:31-39:51] Oprah : It just takes time. All it takes is one person who believes in you. It’s why every time I see the picture of Mrs. Duncan or a tape of Mrs. Duncan, from when we had her on the show, I break into tears because I was saved by Mrs. duncan, my fourth grade teacher, and other teachers around me. That’s why I love teachers so much because all it takes is one person who believes in you. And for a lot of children in this world, all they have are the people who are in their churches or communities or, you know, schools. Thank you so much Dr. Bruce Perry for writing this book, for enlightening me, and hopefully now we’ll be able to bring that enlightenment to a lot of other people. To understand themselves and particularly understanding how what happened to you shaped the way you see the world and what you can do now if you want to change that view of the world. What Happened To You is available april 27th, wherever books are sold. Thank you everybody at South by Southwest edu for joining us
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