The Boy Who Was Raised As A Dog - Reflections

In chapter six, we follow the stories of both Justin and Connor as Perry explores the particulars and nuances of the effects of trauma on human cognitive and social development. We first meet Justin, who we soon learn is himself the titular boy who was raised as a dog. Placed in a cage and raised alongside dogs from the time he was about a year old, Justin was nonverbal and significantly stunted in terms of his neurocognitive and social development when Perry first encounters him as a six-year-old on the PICU. In the case of Connor, whom we meet as a teenager, we learn that he was routinely left alone for hours and hours by a negligent babysitter while his mother was working, resulting in years of sensory deprivation and limited human interaction. For several chapters and cases in a row now - Laura, Leon, Justin, Connor - Perry has been painting a grim picture of what neglect and ignorance can do to a developing child, particularly in tandem. But what I keep seeing, the theme I ke

Another graphic and disturbing chapter, the titular "coldest heart" of chapter five is a reference to the case of Leon, a teenager whom Perry visits in a maximum security prison for an assessment pending the sentencing phase of his trial. When we are introduced to him, Leon stands accused of the murder and subsequent rape of two girls, ages 12 and 13. Perry's role is to interview him and to gather information on any "mitigating circumstances" that might be relevant to Leon's defense. Leon's case is a fascinating one, to me, because of the degree to which it is an outlier in terms of psychiatric prevalence. Leon is given a diagnosis of antisocial personality disorder (ASPD), known colloquially as psychopathy or sociopathy, a cluster B personality disorder characterized by "a pervasive pattern of disregard for and violation of the rights of others..." According to the DSM-5, the prevalence of ASPD in the general population ranges from 0.2% and

"Skin Hunger" was a short yet remarkable case study in human development. In chapter four we follow the case of young Laura, a child who cannot seem to grow and gain weight, weighing only 26 pounds at age four, despite having access to the full support of medical and nutritional science, as well as psychological and psychiatric disciplines. We also are introduced to, and spend much of the chapter discussing, Virginia, Laura's loving but physically and emotionally distant mother, and a character called Mama P, who is a zealously affectionate woman and from whom Perry gleans the insight of how the simplicity of love can affect the entire trajectory of a patient's outcome. This chapter put into perspective for me an entirely new aspect of human development, one that I was unaware could result in the kinds of inhibited physical growth that was seen in Laura's case. Laura, despite receiving the adequate nutrients and being hooked up to feeding tubes in all different

In the third chapter, Stairway to Heaven, Perry recounts working with some of the children who had been released from the Branch Davidian compound in Waco in the early 1990s. Having myself been born in 1991, this event is just outside the scope of my memory – though I do vaguely recall hearing news stories and conversations between the adults in my life, especially in the late 1990s when the incident was officially investigated, and piecing together some aspects of the story in the years after. I've never revisited this piece of history, until now. For those of you who, like me, would appreciate some additional background on the incident, please watch the following short clip.   It's interesting to watch this brief summary of the events of the Waco Siege from the perspective of a reporter or historian rather than reading about them from the perspective of a clinician. In watching this clip, and bearing in mind Perry's own perspective on the events and the work he w

In the second chapter of Perry's book we follow the case of Sandy, a four-year-old girl with an unfathomably tragic and traumatic story who is being asked to testify in the case of her mother's murder, to which she herself, at only three years old, was a witness – and very nearly a victim. Perry recounts being contacted by a lawyer, Sandy's guardian-ad-litem, in the hopes that he might be able to prepare Sandy for her testimony, and being unable to keep himself from intervening in this case. As I'm sure it did for many, if not all, readers, this chapter struck particularly hard for me but in a highly specific way. The case of Sandy is by every measure horrific and graphic; but it is maybe due in large part to that dark and sinister aspect of Sandy's story that drew me, as it did Perry, so deeply into her case. Had I been in Perry's place at the time, I too could not have restrained myself from taking up her case, no matter how much else I had going on in my

In the first chapter of Perry's book, Perry recounts his experiences with his first patient as a child psychiatrist, Tina, who we learn has been repeatedly and egregiously sexually abused between the ages of four and six, resulting in significant trauma and developmental disturbances. Considering the entire chapter, two things stood out to me overall: firstly, I was struck by the degree of uncertainty that Perry describes feeling with respect to Tina's symptomatology, being in hindsight an obvious case of trauma resulting in severe PTSD, among other things surely; secondly, I was fascinated by the aside that Perry tells of giving Sara and her family a ride to the grocery store and subsequently home on a freezing Chicago night in winter, rather than watch them wait for the bus in the snow, and the implications this has for me as a social worker rather than as a physician. To speak to my first observation, in light of Perry's research and uncertainty around Tina's