The Boy Who Was Raised as a Dog (7 page)

At that time my laboratory was studying neurobiological mechanisms, which I knew were related to resilience and vulnerability to stress. We were examining a curious but very important effect of drugs that stimulate the systems I'd been studying in the brain. These effects are called sensitization and tolerance, and they have profound implications for understanding the human mind and its reaction to trauma.

In sensitization a pattern of stimulus leads to increased sensitivity to future similar stimulus. This is what is seen in the Vietnam veterans and the rats that were genetically oversensitive to stress or became that way because of early exposure to it. When the brain becomes sensitized, even small stressors can provoke large responses. Tolerance, on the contrary, mutes one's response to an experience over time. Both factors are important for the functioning of memory: if we didn't get tolerant to familiar experiences, they would always appear new and potentially overwhelming. The brain would probably run out of storage capacity, like an old computer. Similarly, if we didn't become increasingly sensitive to certain things, we would not be able to improve how we respond to them.

Curiously, both effects can be achieved with the same amount of the same drug, but you get completely opposite results if the pattern of drug use is different. For example, if a rat, or a human, is given small, frequent doses of drugs like cocaine or heroin that act on the dopamine and opioid systems, the drugs lose their “strength.” This is part of what happens during addiction: the addict becomes tolerant, and so more of the drug is needed to achieve the same “high.” In contrast, if you give an animal the exact same daily quantity of drug, but in large, infrequent doses, the drug actually “gains” strength. In two weeks a dose that caused a mild reaction on day one can actually cause a profound and prolonged overreaction on
day fourteen. Sensitization to a drug, in some cases, can lead to seizures and even death, a phenomenon that may be responsible for some otherwise inexplicable drug overdoses. Sadly for addicts, their drug craving tends to produce patterns of use that cause tolerance, not sensitization to the “high” that they desire, while simultaneously producing sensitization to certain undesirable effects, like the paranoia associated with cocaine use.

More importantly, for our purposes, resilience or vulnerability to stress depend upon a person's neural system's tolerance or sensitization following earlier experience. These effects can also help further explain the difference between stress and trauma, which is important to understand as we consider children like Tina and Sandy. For example, “use it or lose it” is something we hear at the gym with good reason. Inactive muscle gets weak, while active muscle gets stronger. This principle is referred to as “use-dependence.” Similarly, the more a system in the brain is activated, the more that system will build—or maintain—synaptic connections.

The changes—memory of sorts—in muscle occur because patterned, repetitive activity sends a signal to muscle cells that “you will be working at this level” so they make the molecular changes required to do that work easily. In order to change the muscle, however, the repetitions must be patterned. Curling twenty-five pounds thirty times in three closely timed sets of ten curls leads to stronger muscle. If you curl twenty-five pounds thirty times at random intervals during the day, however, the signal to the muscle is inconsistent, chaotic and insufficient to cause the muscle cells to become stronger. Without the pattern the very same repetitions and very same total weight will produce a far less effective result. To create an effective “memory” and increase strength, experience has to be patterned and repetitive.

And so it is with the neurons, neural systems and the brain. Patterns of experience matter. On a cell-by-cell basis, no other tissue is more suited to change in response to patterned repetitive signals. Indeed, neurons are designed to do just that. It is this molecular gift that allows memory. It produces the synaptic connections that allow us to eat, type, make love,
play basketball and do everything else a human being is capable of doing. It is these intricate webs of interconnection that make the brain work.

By forcing either your muscles or your brain to work, however, you do “stress” them. Biological systems exist in balance. In order to function they have to stay within a certain limited range appropriate to their current activity, and it is the brain that is charged with maintaining this essential equilibrium. The actual experience is a stressor; the impact on the system is stress. And so, if you get dehydrated during exercise, for example, that stress will make you thirsty because your brain is trying to drive you to replace the needed fluids. Similarly, when a child learns a new vocabulary word, there is a tiny stress applied to the cortex, which requires repetitive stimulation to create accurate recall. Without the stress, the system wouldn't know there is something new to attend to. In other words, stress is not always bad.

Indeed, if moderate, predictable and patterned, it is stress that makes a system stronger and more functionally capable. Hence, the stronger muscle in the present is the one that has endured moderate stress in the past. And the same is true for the brain's stress response systems. Through moderate, predictable challenges our stress response systems are activated moderately. This makes for a resilient, flexible stress response capacity. The stronger stress response system in the present is the one that has had moderate, patterned stress in the past.

However, that is not the whole story. If you try to bench press 200 pounds on your first trip to the gym, if you do manage to lift the weight at all, you're not likely to build muscle, but tear it and hurt yourself. The pattern and intensity of experience matter. If a system is overloaded—worked beyond capacity—the result can be profound deterioration, disorganization and dysfunction whether you are overworking your back muscles at the gym or your brain's stress networks when confronted with traumatic stress.

This also means that as a result of the strengthening effect of previous moderate and patterned experience, what may be traumatically stressful for one person may be trivial for another. Just as a body builder can
carry weights that untrained people cannot even move, so too can some brains deal with traumatic events that would cripple others. The context, timing and response of others matters profoundly. The death of a parent is far more traumatic for the two-year-old child of a single mother than it is for a fifty-year-old married man with children of his own.

In Tina's case and that of the boys at the center, their experience of stress was far beyond their young systems' capacities to carry it. Rather than moderate, predictable and strengthening activation of their stress systems, they had suffered unpredictable, prolonged and extreme experiences that had marked their young lives profoundly. I couldn't see any way that this would not be true for Sandy as well.

 

BEFORE I MET HER I tried to get as much background and history on Sandy as I could. I talked with her current foster family, her new caseworker and, ultimately, with members of her extended family. I learned that she had profound sleep problems and was pervasively anxious. I was told that she had an increased startle response. Just like the traumatized Vietnam vets I'd worked with, she would jump at the slightest unexpected noise. She also had episodic periods of daydreaming, during which it was extremely difficult to get her to “snap out of it.” A doctor who saw her without knowing her history might have diagnosed her with the “absence” or “petit mal” form of epilepsy: she was that hard to reach during these episodes.

I also learned that Sandy sometimes had aggressive, tantrum-like outbursts. Her foster family couldn't find any pattern to these behaviors, couldn't pinpoint what set them off. But they did report another set of “odd” behaviors: Sandy didn't want to use silverware. Unsurprisingly, she was especially afraid of knives; but she also refused to drink milk, or even look at milk bottles. When the doorbell rang, she would hide like a skittish cat, sometimes so effectively that it took twenty minutes for her foster parents to find her. She could also be found, on occasion, hiding underneath a bed, behind a couch, in a cabinet under the kitchen sink, rocking and crying.

So much for resilience. Sandy's startle reaction alone told me that her stress-response systems had become sensitized. Testifying would immerse her in painful reminders of that terrible night. I had to get some sense of whether or not she could tolerate it. Though I didn't want to, at some point in my initial visit I was going to have to probe her memory a little to see how she would react. But I comforted myself with the knowledge that a little pain now could help protect her from a lot of pain later, and might even help her begin the healing process.

 

I FIRST MET SANDY in a small room housed in a typical, sterile government building. It had been set up to be “child-friendly” with some child-size furniture, toys, crayons, coloring books and paper. A few cartoon figures had been painted on the walls, but “system” still screamed out from the tile floors and cinder-block construction. When I walked in, Sandy was sitting on the floor with some dolls around her. She was coloring. What first struck me, as it had when I first met Tina, was how small she was. I guessed she stood a bit less than four feet tall. She had huge, liquid brown eyes and long, thick, curly brown hair. On her neck were visible scars on both sides, from her ears to the middle of her throat. But they were much less noticeable than I had imagined they might be; the plastic surgeons had done a good job. As I walked in with Stan she stopped everything and stared at me, frozen.

Stan introduced me. “Sandy, this is the doctor I told you about. He is going to talk with you, ok?” he asked anxiously. She didn't move, not one millimeter. There was no change in her wary expression. In response Stan looked at me and back at her, gave a big smile and said in his best cheerful, kindergarten-teacher voice, “OK. Good. Well, I will leave you two together.” As he walked out I looked at him like he was nuts, surprised by how he'd dismissed Sandy's lack of response to his question. When I looked back at Sandy her face wore the same expression that mine did. I shook my head, shrugged my shoulders, and gave a little smile. As if in a mirror, Sandy did the same.

Aha! A connection! This was a good start, I thought. Don't let it slip away. I knew if I walked toward this tiny girl—I'm pretty big—her sensitized alarm response would go crazy. Her surroundings were already unfamiliar enough—new adults, new place, new situation—I needed her to stay as calm as possible.

“I want to color some too.” I said without looking at her. I wanted to be as predictable as possible and let her know what I was going to do step by step. No sudden moves. Make yourself smaller, I thought, get on the floor. Don't look at her, don't face her, use slow deliberate movements as you color. I sat down on the floor, a few feet away. I tried to make my voice as soothing and calm as possible.

“I really like red. This should be a red car,” I said, pointing at a picture in my coloring book.

Sandy studied my face, my hands, and my slow movements. She was only partly attentive to my words. This little girl was justifiably suspicious. For a long time I colored alone, chattering about my choices of colors, being as casual and friendly as possible without being overly “bright” as Stan had been when he tried to mask his anxiety. Eventually, Sandy broke the rhythm by moving a bit closer toward me and silently directing me to use a specific color. I complied. Once she came over to me, I stopped talking. For many minutes more we colored together in silence.

I had yet to ask her about what had happened, but I could sense that she knew that was why I was there—and that she knew that I knew she knew. All of the adults in her “new” life had sooner or later, in some way, returned her to that night.

“What happened to your neck?” I asked, pointing to her two scars. She acted as if she did not hear me. She did not change her expression. She did not change the pace of her coloring.

I repeated the question. Now, she froze. Coloring stopped. Her eyes stared off into space, unblinking. I asked again. She took her crayon and scribbled over her well-formed, disciplined picture but gave no response.

Again, I asked. I hated this. I knew I was pushing her toward her painful memories.

Sandy stood up, grabbed a stuffed rabbit, held it by the ears and slashed at the neck of the animal with the crayon. As she slashed, she repeated, “It's for your own good, dude.” Over and over—a stuck recording.

She threw the animal to the floor, ran to the radiator, and climbed up and jumped off again and again. She did not respond to my warnings to be careful. Worried that she would hurt herself, I rose and caught her on one of her jumps. She melted into my arms. We sat together for a few more minutes. Her frenzied breathing slowed and then almost stopped. And then, in a slow, robotic monotone she told me about that night.

An acquaintance of her mother had come to their apartment. He had rung the doorbell and her mother had let him in. “Mama was yelling, the bad guy was hurting her,” she said. “I should have killed him.”

“When I came out of my room and mama was asleep, then he cut me,” she continued, “He said, ‘It's for your own good, dude.'”

The assailant had cut her throat—twice. Sandy immediately collapsed. Later, she regained consciousness and attempted to “wake up” her mother. She took milk from the refrigerator and gagged when she tried to drink some. It oozed through the slit in her throat. She tried to give some to her mother, but “she was not thirsty,” Sandy told me. Sandy wandered that apartment for eleven hours before anyone came. A relative, worried that Sandy's mother had not answered the phone, had dropped by and discovered the horrifying crime scene.