Chapter 1 - Tina's World

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 behaviors and what he might do to understand and treat them, it is truly remarkable – and ultimately clearer, given that Perry recounts this story from 1987 – to me how far we have advanced in the fields of neurobiology, psychopharmacology, endocrinology, and human behavioral sciences more generally in recent decades. This account puts into perspective for me just how advanced the education I've received at the masters level really is by comparison, being that the core theme of my social work education has been trauma and its effects on behavior and development. In reading this chapter, I was able to see how I take my modern understanding of trauma practically for granted, as an obvious aspect of the case – all thanks to the research of Perry and those like him. Additionally, in reading this chapter, I glimpsed how radically different psychotherapy has become in light of that new, substantially more advanced understanding.

As for my second observation, regarding the anecdote Perry tells of deciding to give Tina and her mother a ride to the store and helping them with groceries, I was struck by something that Perry wrote that I myself have thought many, many times: “A sincere, kind act, it seemed to me, could have more therapeutic impact than any artificial, emotionally regulated stance that so often characterizes 'therapy.'” I've been told in a number of my classes during my graduate education that the most significant aspect of therapy, beyond any and all methods or techniques or perspectives – the aspect of therapy which is considered far and away to be the most therapeutic – is the actual relationship itself, the brain-to-brain dyad. In social work traditionally there has been an aspect of being on the front lines with our clients in ways that other helping professions aren't quite. The home visit, for example, is in the earliest roots of our profession, and I was glad to see it praised in the book when Perry brings up this somewhat unorthodox event during supervision. But what struck me most about this anecdote and the fact that Perry chose to tell it in the context of this particular chapter is that, for a social worker, this type of sociological consideration is fundamental to our practice, not an afterthought of assessment but central to it. It felt to me, reading this chapter as a social worker rather than as a physician, that in this respect our profession seems to have something of a leg up when it comes to broader diagnostic capability – the biopsychosocial, or person-in-environment perspective – and it makes me wonder how a social worker would have approached Tina's case...