7

Baby, Get Your Gun
THE IMPACT OF TRAUMA
AND HEAD INJURY

There was an old woman
Who lived in a shoe.
She had so many children
She didn’t know what to do.
She gave them some broth
Without any bread.
She whipped them all soundly
And put them to bed.

—MOTHER GOOSE

Citizen reported that on the evening of 10-22-84 loud screaming was coming from within (S) [Jeffrey’s mother’s] apartment and sounded like a child was being hit. Citizen also stated that this type of action took place more than once. . . . Writer and Officer Johnson left (S) residence and went to [V’s] school to interview him and examine for abuse. . . . When [V’s] pants were pulled down, writer found that both buttocks had been bruised. The right side was very red and blue in color and it was quite obvious that (V) had been struck numerous times. . . . Writer left school and contacted CPS and said they should interview (V) and consider placement. Writer to issue CTA (citation) to (S) for Assault IV into District Court.

—POLICE INCIDENT REPORT

Mostly we were always really afraid. Sometimes if somebody was just coming up to give us a hug and they’d say our names loudly—and they were coming up to give us a hug—we would cower. We would actually throw our hands up and cower. And I did that all the time until I moved in with Richard, my [foster father]. And when he saw that, he just broke down and started bawling, and I didn’t understand why. I figured he was mad at me, and I thought he was gonna come hit me. So I just threw up my hands like, “You’re not gonna hit me so just get away!” And he just started crying. . . . And I didn’t understand why he was crying, why that was going on. . . . ’Cause after a while you don’t realize that it’s not wrong anymore. You see all this stuff and you don’t realize that it’s not wrong anymore to hit somebody. . . .

My mom beat my brother up. That one time she beat him with a braided belt, and she put bruises like from his knees all the way up to his neck. I mean, like, I don’t know. She had hit him a lot, I mean, and it was like colors you never thought that human people could actually make in their body. You know what I’m saying? I mean it was like all the colors on his back and on his backside and different places. I was totally amazed. I mean, I’d never seen anything ever quite like that. . . .

You could go home and watch Cops on TV and see every single thing on that has happened to us at one time or another. Every single thing! I mean, you name it. There’s been guns pulled. There’s been knives pulled. There’s been people cut open. You name it, it’s happened. To me, it’s not really—this is sad to say—but it’s not really anything new, and after a while you just kind of become callous to it. After a while you’re just sitting there looking at it, and it’s like, well, nothing new, I guess. And you hear your family, “Well, such and such deserved it.”

—JOHN, AUGUST 1996

Sometimes it’s more difficult than others. I think everybody has to deal with it, you know. Everybody has to deal with anger. It’s how we deal with it that’s important and how we learn to deal with it. What makes us decide to deal with it or what makes us not decide to deal with it—to just let it flow . . . and run into uncontrolled rage. There are different levels of anger from upset, to mad, to pissed off. Then there’s raw fear, you know, and uncontrolled rage. And I borderline up there. When I get mad, I borderline up there, then I follow my impulses. If I can’t control it up there, then I follow my impulses. If I can’t control my impulses, then I do things that I regret later. . . . I do follow my impulses . . . because that was the way I learned to survive when I was little. . . . Like, if I knew I wasn’t supposed to be running from an asswhupping, but I’d be running anyway. What I was doing was wrong, but I would follow the impulse rather than stop and think about the consequences of “He’s got to catch up to me sooner or later.” I didn’t care about that. I just wanted to get away.

—JEFFREY, AUGUST 1996

On a stifling hot and humid day on July 15, 1976, a school bus was hijacked as it rolled along a backcountry road near Chowchilla, California, a small, middle-class town in the San Joaquin Valley. The children, ranging in age from five to fourteen, were returning from a day of outdoor recreation and activities, including a performance by the sixth-grade class of Born to Be Free. The bus driver slowed on his route to pass a white van that was blocking the road. As the bus passed the van, suddenly two men, one with a stocking over his face and the other wearing a mask and carrying a gun, leaped from the van and forced their way on to the bus. They ordered the driver and the older children to the back of the bus.1

The kidnappers then drove the bus for some distance into a steep gully and at gunpoint ordered the children to get out. The older children went first. One by one they filed off the bus and disappeared from the view of the younger children into the white van, which had followed the bus. When the van was full, one of the men slammed the butt of his gun into the stomach of ten-year-old Terrie and ordered her to stop just before getting in. The white van pulled off, and a fourth man in a green van drove out of the slough and pulled alongside the bus. Terrie, the youngest children, and the bus driver filed into the second vehicle.

The children sat crammed in the vans on hard, wooden seats. The windows were boarded, and any communication with the kidnappers was blocked by a solid barrier erected behind the front seats. They were driven aimlessly in the heat on bumpy roads for eleven hours in total darkness without food, water, or an opportunity to go to the bathroom. At one point the vans stopped and then backed up. Some of the children thought they would be driven off a cliff; others smelled gas and thought they were going to be burned alive. None of them knew what had happened to the other half of the group.

Finally, about three in the morning, the vans stopped and the children were ordered outside at gunpoint. One by one they were interrogated beneath a tentlike canopy placed near a ladder that led down into a hole. Their inquisitor wore a mask and was eerily illuminated by a flashlight placed under his chin. He demanded that each child tell his or her full name, and he confiscated some personal possession—a toy, a bathing suit top, or the contents of a pocket—and then he ordered the child to get down into the hole. The rectangular space underground, which later turned out to be a large truck trailer buried several months before, was lit by flashlight and prepared in advance for the children’s arrival. There were stale cheerios, soggy potato chips, a jar of peanut butter, musty water stored in cans, and a pile of old mattresses.

The children timidly explored their environment and settled in. A few kids held up towels to shield other children as they went to the bathroom in two wheel wells with signs over them marked “boys” and “girls.” Suddenly, they heard the sounds of shovels above and rocks and dirt began hitting the top of the hole. Some of the children begged and shouted, while others whimpered as they were buried alive. The bus driver implored the kidnappers to have mercy and then fell to his knees praying as the shoveling continued. As the dirt and rocks continued to clunk relentlessly on top of the hole, he lay down and cried. They were all “goners,” he told the children.

As the hours dragged by, the children remained quiet and listless. Some of them slept. The rest sat doing nothing. This torpor continued until sometime during the day of July 16, when one of the younger children leaned too hard against a makeshift pole and the roof began to collapse. This new crisis galvanized the older children, who with great effort and ingenuity finally dug their way out and led the others to freedom. Jack Wynne, the bus driver, having lifted the littlest children out, took off on foot to find a telephone. As they emerged from their crypt, the children found themselves in a strange valley nearly one hundred miles from home with no idea of what had happened or why. (The four kidnappers were caught and convicted. At his parole hearing in 2012, the ringleader downplayed the reason for the kidnapping as simply greed; the children had just escaped before the ransom note could be delivered.)

The sheriff and his deputies took the children—by bus—to the Alameda County Prison for questioning. They received a fifteen-minute physical examination by a prison doctor and a pediatrician, who found them, much to the relief of the waiting world, to be in “good shape.” The medical team did not call any psychiatrists, psychologists, or social workers because the children seemed calm and normal. None of them was hysterical or crying, and none of them seemed to be acting strange, except for the smallest kids, who had repeatedly slipped off the bus and tried to hide when the sheriff and deputies came to rescue them.

After eating hamburgers and apple pie, the children spent the night in the prison and were then taken home in the morning—on a bus—with no warning of or protection from what they were to encounter: a town gone insane with FBI agents, news personalities and reporters from around the world, television cameras, microphones, sightseers, and frantic parents, siblings, and relatives, all waiting for the bus as it pulled into the parking lot next to the Chowchilla fire station.

No psychiatrist or psychologist even spoke with the children until five months after the incident, when Dr. Lenore Terr, a clinical professor of psychiatry at the University of California at San Francisco, approached one of the families. She had read a newspaper article published in the Fresno Bee reporting that the children were still suffering from terrible fears and nightmares. Terr undertook one of the first major studies of the long-term effects of trauma on children and found that at one-year, four-year, and five-year evaluations every single child of Chowchilla was still seriously affected.

As incredible as the blindness to the psychic injuries of the Chowchilla children may seem to us now, at the time of the incident in 1976, we believed that children were resilient and would weather most trauma given time. The two doctors who initially examined the children had no idea that anything serious was wrong. They didn’t even know what symptoms to look for, since the possibility of serious psychic injury, let alone any specific symptoms of trauma in children, was totally absent from medical literature.

As the story of the schoolchildren illustrates, the understanding that, for children of any age, long-term damage can occur from a single searing trauma or prolonged exposure to chronic stress or fear is relatively new. But we have yet to understand that when serious trauma occurs to babies and toddlers during their most explosive phase of brain development, the injury reverberates beyond anything we have ever imagined possible. Fear and anger produce changes in the levels of hormones that are associated with aggression and violence, including noradrenaline, which puts the brain on red alert, and serotonin, which has a calming effect when the perceived danger subsides. When stress is especially severe or prolonged, permanent changes may occur in hormone levels that alter the brain’s chemical profile and affect patterns of information processing. The result may be maladaptive behavior patterns, including both aggression and depression. Children so traumatized come to perceive the world as a dangerous place.

Jeffrey’s older brother, John, describes how he and Jeffrey cowered from the hugs proffered by foster parents who held out their arms spontaneously to receive the boys. For children who have associated adults’ sudden arm movements with being hit, this fear is a normal response. Children who are seriously traumatized stay watchful to anticipate and be prepared for the worst. They are apt to misread gestures and respond accordingly.

When the environment continues to teach a child to expect danger rather than comfort, the results can be disastrous. Such was the case of Robert “Yummy” Sandifer, who was shot through the back of his head at age eleven by two members of his gang.2 In commenting on Yummy after his death, Cook County public guardian Patrick Murphy said, “He was in trouble the moment he was conceived.”

Yummy was born to an eighteen-year-old mother on welfare. He was her third child. By the time she was twenty, she had five children. At the time of Yummy’s death, she had seven children by four different fathers. The court records show that she had a serious drug problem and had been arrested forty-one times. Yummy’s father, also a teenager, went to prison for theft three months after Yummy’s birth. At the time of Yummy’s death, his father was in prison again, for dealing drugs. The court records show that Yummy had a history of serious physical abuse and neglect. At twenty-two months, he was treated at a Chicago hospital for scratches and bruises on his arms and torso. His mother said he had been beaten by his father. When Yummy was three, the police found him at home alone with two other brothers under the age of five, apparently a routine occurrence. He was removed from his mother’s custody and placed with his grandmother when investigators found cigarette burns on his neck, back, and buttocks, scratches on his face and abdomen, and marks on his legs from beatings with an electrical cord.

Yummy’s criminal record began at age nine. Police believe that he committed more than two dozen felonies before his death two years later. He was prosecuted eight times for various felonies and convicted twice. The charges included attempted armed robbery, auto theft, arson, and burglary. He was kicked out of a group home for fighting and stealing. He was turned loose by a frustrated judge who could no longer detain him under state law after a dozen homes refused to take him.

In a story published in the Toronto Star on September 3, 1994, George Pappajohn reported on a psychological examination of Yummy conducted at a state-run shelter for children ten months prior to his death. During the testing he had to be reassured constantly that it wasn’t a police interrogation and that he wasn’t in trouble. At one point when he heard a walkie-talkie outside the door, he jumped to his feet to look for police. In writing of the incident, Pappajohn said:

He seemed to see the worse—even in himself—and to expect it from others. . . . Even though the troubled child in the lime-green jeans and food-stained sweatshirt was in the care of the Illinois Department of Children and Family Services, not in court or jail, he thought of himself as “servin’ time.” . . . Robert’s past was marked by abuse and chaos, but he made the transition from victim to victimizer by the age of 9. In language both clinical and heartbreaking, the psychological report fills in that picture. . . . “Robert is a child growing up without any encouragement and support,” the examiner wrote. . . . “Since he is so bound up in trying to manage negative feelings of inadequacy on the inside, and the pressure his environment is exerting from the outside, Robert is emotionally flooded. . . . His response to this flooding is to back away from demanding situations and act out impulsively and unpredictably. . . . He is caught up in a never-ending cycle of emotional overload and acting out. His anger is so great that his perception of the world is grossly distorted and inaccurate.”

What happens to children to turn them into vicious killers? How does a baby turn into a child who wants to hurt or even kill another baby? How can a child grow into an adult who enjoys torture and killing? The answers, which are just beginning to surface, are not simple. But neither are they impossible to understand once we reflect on how the brain works. It is the brain that mediates this metamorphosis from baby to killer. And it is the environment that shapes the entire process.

THE HOUSE THAT JACK BUILT

We humans have evolved and maintained our primacy on the planet because of our amazing ability to successfully adapt to the varying environments in which we find ourselves. The brain presents us with a microcosm in which we are able to see how biology shapes itself in response to individual experiences. Like the capacity of photographic paper to respond to varying patterns of light, our brain is constructed to respond to specific environmental needs and will adjust its chemistry to reflect environmental demands. In early childhood, or even in later life, responses such as extreme vigilance, chronic anxiety, and depression are adjustments that protect people in difficult settings when their survival is threatened. But when such responses are generated in the first years of life, they may be developed at the cost of other more constructive potentials such as trust, confidence, and curiosity, which atrophy when not reinforced by the environment.

Neurons, the basic cells of the brain, connect with one another to form networks; networks connect with one another to form systems; systems work together to facilitate specific functions such as vision. Every neuron in the human brain is geared and waiting for stimulation to call it into action. Experiences in the environment determine which of these cells will be called into use and for what purposes so that an internalized reflection of specific responses needed for survival in a particular environment is created in the brain of the developing child. The more a certain type of stimulation is experienced, the more the corresponding cells in the brain will be called upon or sensitized. Once sensitized, the same neural activation can be called forth by less and less intense stimulation.3

When the brain is first forming, both the quantity and quality of tissue and chemistry can be changed by sensitization to trauma. The same experiences can change the brain of an older child, also, but in the beginning, in infancy and toddlerhood, while it is at its most malleable, the brain actually organizes itself around these conditions. Hypersensitivity can become wired into basic brain chemistry and bodily functions. And attention and capacities in the brain originally available for learning other skills may be deflected to help defend against future trauma.

FROM STEM TO STERN

As discussed in chapter 2, the brain grows from the simpler or more basic functions to the more complex. So the brain stem, which regulates basic functions like heart rate, body temperature, and blood pressure, grows before the midbrain, which controls sleep, appetite, and arousal. This is followed by the limbic area, the center of emotional activity. And finally, the cortex, the seat of rational and analytical process.4 In the normal brain, there is a balancing system in which the “lower” or more primitive areas of the brain—the parts responsible for excitatory processes—are modulated or held in check by the “higher” or executive functions in the cortex.

Early developmental experiences that build cortical functions, such as exposure to language or music or a loving relationship with a parent, are investments that protect against the expression of violent or impulsive behavior. Conversely, experiences that increase reactivity of the lower areas of the brain, such as physical or sexual abuse by a parent, will increase the capacity for impulsive emotional responses and the likelihood of later violence.5 Dr. Bruce Perry, founder of the ChildTrauma Academy in Houston, Texas, has specialized in treating traumatized children and teaching how trauma in the environment alters the developing brain. Dr. Perry’s research is at the forefront of our evolving understanding of the impact of early trauma and its relationship to the early precursors of impulsive violence.6

Because development occurs in stages that build upon each other, that which occurs first tends to echo through subsequent development. For example, negative experiences such as chronic maternal stress or drug consumption that occur prenatally and affect the development of the brain stem or midbrain will subsequently affect the development of the limbic and cortical areas of the brain as they mature.7 This is not to say that all children, or even most, who are young victims of abuse or neglect will become victimizers. In fact, most will not. And all neglect, abuse, or trauma does not have an equal impact. Children are not affected equally; ameliorating factors vary greatly in the lives of individuals. Most of us have had some degree of negative childhood experience. But growing numbers of children across the world are victims of severe trauma ranging from sexual mutilation, to incest, to war and natural disasters. In this country alone, conservative estimates of the number of children exposed to trauma exceed five million each year.8 These are the children who are victims of or witness to physical, emotional, or sexual abuse, or to domestic or community violence such as gang murders. For American children, the gestation of violence takes root primarily in the home. When trauma or neglect happens early in life and is left untreated, the injuries sustained reverberate to all ensuing developmental stages. Adult and adolescent community violence begins with violence inflicted on the babies these individuals once were.9

ROUND AND ROUND IT GOES

In the late 1980s Cathy Spatz Widom of Indiana University conducted an extensive review of the literature to answer the question “Does violence beget violence?” Her conclusion was that, although it is not invariably the case, there is strong evidence that a history of maltreatment is associated with aggression and violence. Her review documented what those of us who are parents have often experienced in spite of our best efforts: that we tend to parent as we were parented.10 Widom reviewed several studies of intergenerational transmission of abuse and concluded that, overall, abuse tends to breed abuse. Dorothy Lewis, who also looked retrospectively at histories of violent criminals, reported that the more offenders were victimized by chronic violence in the home, the more violent crimes they committed.11

The cycle Widom documents is obviously generated by nurture, by the experiences the child has in the environment. But in addition to understanding the social and psychological imprinting of abuse, several researchers, including Perry, paint a brain-based picture of how being victimized in childhood can lead to becoming an adult victimizer. Again, this is not an either-or argument. While we tend to think of mind and body as separate domains with separate lines of influence, they are not separate at all. The mind is constructed in the brain, which is a physical entity with physical connections—in fact, controlling connections—to the entire body.12 Nature and nurture are united in the brain. All that we experience changes the brain, and the brain in turn changes physiological responses in the body. Heart rate, blood pressure, and muscle tension are all examples of changes that occur in response to experiences. Each relationship, each person, each situation we experience is reflected by responses in the brain, which is constantly adapting itself and the rest of the body in response to environmental input. So when we look at the transition of the baby from victim to victimizer, the first step is understanding the neurological as well as the psychological impact of chronic fear, pain, or terror in earliest life.

TOO LITTLE TO FIGHT OR FLEE

The phrase “fight or flight” was coined by W. B. Cannon in 1929 to describe the classical adult response to threat.13 But for the infant, neither of those options is available. Faced with overwhelming fear—such as parents yelling or hitting each other—or having cries signaling hunger or discomfort met by pain, the infant brain presents a different menu: becoming very alert or becoming numb—hyperarousal or dissociation.

According to Perry, in the initial stages of fear, an alarm reaction is triggered in young children, just as it is in adults. The sympathetic nervous system goes into full swing, increasing heart rate, blood pressure, respiration, and muscle tone and creating a release of stored sugar. The child becomes hyperalert so that all information irrelevant to the perceived danger is tuned out. Next, if the threat materializes, the autonomic nervous system, the immune system, the hypothalamic pituitary axis (HPA), and other stress systems in the brain come into play. Norepinephrine is released, and all the regions in the brain that regulate arousal within the brain stem and midbrain are turned on. If the threat is perceived frequently or is very intense, the systems contributing to hyperarousal will become sensitized, ready to flip on at the least provocation.

Following even one intense exposure, the systems involved in stress modulation will be reactivated by reminders or thoughts of the event, including dreams. If it occurs often, the response may generalize to more reminders of the event so that a loud noise will be enough to terrify a child traumatized by gunshots, or any man may terrify a child traumatized by rape. When chronic hyperarousal is elicited in the earliest weeks and months of life—for example, by physical or verbal abuse experienced directly, or by witnessing episodes of terrifying domestic violence—sensitization will cause the dysregulation of the stress response systems. Traumatized children will show sleep problems, anxiety, or impulsive responses. In extreme situations, the fear responses go into overdrive, resulting in overreactivity, oversensitization, and difficulty concentrating. Hyperaroused children may suffer from high blood pressure, rapid heart rate, a rapid and irregular heartbeat, slightly elevated temperature, and constant anxiety. The neural thermostat becomes stuck on high. The child becomes hypervigilant for signs predictive of the feared event, constantly on the watch for nonverbal cues that may signal threat in the environment and in a physiological state of preparedness to face the danger. According to Dr. Perry, when this process occurs in very young children while the brain is still at its most malleable and is just organizing, trauma that is originally experienced as a brief “state” of arousal can, after chronic intense experiences, become a “trait” in the child. The brain organizes around the overactivated systems to ensure the child’s survival.

Religious cults that deliberately employ physical, emotional, and social violence to condition their young to mindlessly follow directives have provided unfortunate natural experiments revealing how children respond to chronic trauma. Dr. Perry examined eleven of the children involved in the Waco, Texas, Branch Davidian crisis. He compared their noradrenaline levels after they were released from David Koresh’s compound with those of a group of inner-city Chicago children he had examined earlier. Perry characterized the abnormally high noradrenaline levels in both groups of children as the “chemical signature of post-traumatic stress disorder.” These children, while seated, had heart rates of 100–170 beats per minute; the average for their age is 84. Their brains were pumping noradrenaline and other stress hormones—their chemistry reset for survival in a dangerous setting.

Originally an adaptation to a threatening environment, these responses become maladaptive in a nonthreatening environment such as school. With noradrenaline keeping the body in a constant state of readiness, these children are quick to erupt. With this neurophysiological state hardwired into brain function and chemistry, IQ, school performance, and social relationships generally suffer. This is commonly the scenario when children have been physically or sexually abused.

By kindergarten, the world of nonabused children is expanding to include their focused learning of numbers, letters, and a kaleidoscope of interests. But children who have been unable to develop trust and security with a primary caregiver in the first two years show a depressed interest in the world—and in themselves. The playfulness we anticipate in very young children is often absent or dulled. Dr. Dante Cicchetti, of the University of Minnesota and the Institute of Child Development, has studied the self-image of abused children extensively. In one study, children at nineteen months of age were placed in front of a mirror after a spot of rouge was painted on their noses. The nonabused control children reacted with delight upon seeing their decorated faces, while the children who had been maltreated viewed their faces without expression or made negative faces at themselves.14 Cicchetti’s studies also show that abused children are more dependent and have less knowledge and ability to think effectively. Lacking security in the present, they are also less likely to seek to explore or to engage in new situations.15

Each of these factors creates additional barriers to success in school. By age thirty months, maltreated children use proportionately less descriptive language and are less likely to verbalize or describe their feelings than children who have not been maltreated. They also talk less about themselves, their activities, and other people.16 Numerous studies show that in early grade school abused children perform less well than nonabused children on various developmental measures, have attentional problems, lack impulse control, and perform less well on measures of verbal IQ.17 Instead of providing the foundation for self-control, for empathy, and for focused cognitive learning, abuse in earliest life undermines all three.

Because we each view the world through our own filter, based on our individual experiences, it is not surprising that abused children tend to suspect others of hostile intent. Even neutral behaviors may be viewed as arising from cruel motives. This negative expectation is associated with greater aggression in elementary school, which is in turn associated with peer rejection.18 The combination of aggression and peer rejection predict academic, social, and behavioral problems in middle school.19

When a traumatized child sits in a classroom next to a nontraumatized child, even if they are of equal intelligence, the traumatized child will not be available to focus on the cognitive information being presented by the teacher in the same way that the nontraumatized child will. The traumatized child will be hypervigilant, still on red alert for signs of impending threat. A margin of his or her focus will be on reading subtle cues in the nonverbal behaviors of those in the vicinity—constantly prepared to take quick protective action for survival. Cortical functions that would otherwise be available for the lesson presented by the teacher are deployed for self-protection. There is a jumpiness—a quickness to act—in response to often misperceived intentions of others. In grade school, such children may be diagnosed as ADHD or even ODD. Learning and relating are often drastically affected, resulting in learning disabilities and impaired self-image and confidence.

Dr. Perry explains that as they grow older, hyperaroused children become ostracized. Standing outside of the mainstream of nontraumatized children, they inevitably find each other. The violent cycle begins to intensify as disenfranchised preadolescent and adolescent children hang out with others like themselves. Lacking the healing effect of a nurturing home or normal environment, gangs or groups of children with in-common trauma and deprivation look to one another for social acceptance and appreciation of the very traits that first segregated them from their peers. Hypervigilance, impulsivity, pervasive expectations of threat, and quickness to be the first to act are the exact skills called for in gangs and illegal activities. That which has been a liability in school is an asset on the streets, where the environment is similar to the traumatic environment that first shaped the child’s adjustment. Like all children, these children migrate to a familiar setting where they feel acceptance and valuing of their abilities. In a chapter of his book Maltreated Children entitled “The Vortex of Violence,” Dr. Perry describes the too commonly heard retorts from young offenders that reflect this now deeply ingrained mind-set: “Listen, man, I just did him before he did me.” “I could tell he was going to jump me—he looked me in the eyes.” “If I didn’t shoot him, he would have shot me.”20 Alcohol further lowers the adolescent’s capacity to control fear-based thoughts and impulsive behavior. Such a child may permanently see the world as a hostile place where one has to be ready to defend oneself. Cradled in trauma, the adolescent is positioned to begin the cycle again.

Jeffrey fits this profile. Based on the testimony of family members, he was a baby terrified by chronic traumas ranging from multiple, often abusive caregivers, to violence between his parents, to drug-induced stabbings, to regular beatings, which he ultimately volunteered to take for both himself and his brother. After he was diagnosed with ADHD, stimulant medications had little effect on his hypervigilance, impulsivity, and inability to focus in school. Obviously a bright, verbal, and insightful young man at nineteen, when he was interviewed for this book, Jeffrey reflected that he learned in grade school that his only possible friends were “the little toughs.” Drugs and alcohol played a role in Jeffrey’s life from his earliest memories, compounded his school problems, and appear to have been a major contributor to his first and only serious crime. Although Jeffrey was only sixteen when he was imprisoned, he was clearly identified as one of the troubled kids on the fringes of his community, and he had already fathered one child.

Any child, regardless of gender, intelligence, or temperament, when exposed to repetitive terror, will develop a chronic fear response. The form the response takes will vary—commonly by gender. Boys, as they grow older, tend to develop an “externalized” or aggressive, impulsive set of symptoms: the “fight” response. Males are more likely to be violent. Girls will typically “internalize,” responding to such trauma by dissociation, or “freezing.” We can see how this works by observing traumatized babies.

The baby or young child will typically cry in response to threat, hoping to elicit the help of a caregiver. When the caregiver is neglectful or is the source of the trauma, and crying does not result in help or results in further pain, the child either moves further into arousal with more vocal and motoric efforts to engage help or will stop crying altogether or freeze. Lack of movement and sound in the face of increasing threat allows for the opportunity to camouflage, to scan for additional information, and to think how best to respond. In children who have been sensitized by previous trauma, freezing may be the first response to anxiety. Because sensitization means that events or people or fragments of memory that bear any resemblance to the original threat may elicit the same anxious response, such children may freeze or act defensively in situations that observers find puzzling. Thus, a child like Jeffrey’s brother, John, who has been hit by his parents, may throw up his hands to protect himself at the approach of a well-meaning foster father intending a hug. Or a child asked by a teacher to do a seemingly simple task may, fearing abuse, appear to be deaf and dumb, refusing to budge—appearing oppositional. If the terror continues, the child may move from freezing to complete dissociation, appearing to “go away” or to disengage mentally and emotionally from the immediate environment.21 The child is there in body but not in spirit, mind, or heart. Dissociative states vary along a continuum that ranges from short episodes of daydreaming to total loss of consciousness. Individual children (or adults) dissociate at varying points in their response to terror. Some will immediately faint at the first sign of arousal, while others will only dissociate late when reaching a state of complete terror.

Both hyperarousal and dissociation involve brain stem–controlled central nervous system activity that produces an increase in epinephrine and other neurochemicals. But unlike hyperarousal, dissociation results in decreased blood pressure and heart rate. In dissociation, there is an increase in dopamine-secreting systems, which work together with opioid systems in the brain to produce a calming effect, lowering pain perception, and altering one’s sense of time and space. The younger the child is at the time of experiencing terror, the more likely she or he is to respond with dissociation rather than hyperarousal. Freezing or dissociation is the most likely response to be employed if one is helpless, feels powerless, or is immobilized. When we are terrified and know there is nothing we can do to escape, dissociation is our only choice. This is why women and children, especially young children, are more likely to move to dissociation than arousal to survive violence perpetrated by men. Fight is futile. Numbness and compliance work. For self-protection as they grow older, many children employ a combination of hyperarousal and dissociation.22

The chronic overactivation of neurochemical responses to threat in the central nervous system, particularly in the earliest years of life, can result in lifelong states of either dissociation or hyperarousal. In the case of hyperarousal, overdevelopment of the stress response systems in the brain stem and midbrain alters the development of the higher cortical functions, creating a predisposition to behave in aggressive, impulsive, and reactive ways. The oversecretion of cortisol is believed to actually destroy synapses in some parts of the brain, particularly in the orbitofrontal system, an area involved in reading emotional responses in other people.23 As mentioned earlier, the overuse of the alarm response in young children can result in post-traumatic stress disorder or ongoing symptoms of fear characterized by intrusive memories or flashbacks, fear of vaguely similar occurrences, invasive dreams, interrupted sleep patterns, hypervigilant or avoidance behavior, numbing, detachment, or a decline in cognitive performance.24 PTSD, while frequently diagnosed in adult victims, is rarely diagnosed in very young children.

It is ironic that we continue to overlook the reality of the impact of serious trauma on babies. While we know PTSD is a common response to severe trauma in older children and adults, we fail to recognize the much more pervasive damage being done to a baby’s developing brain at a time when the impact of trauma can shape the entire organization of key brain functions.

Perhaps the most disturbing implication from the research on the brain’s adaptation to chronic fear and anger is the growing evidence that it may be altering the course of human evolution. Not only can the changes in hormone levels be permanent in an individual’s lifetime, but the altered chemical profile may actually become encoded in the genes and passed on to new generations, which may become successively more aggressive.25 Increased rates of child abuse and other forms of unpredictable and uncontrollable trauma in our culture mean that more and more children are having this experience. Dr. Perry calls this process, along with its growing social implications, “devolution.”26

There is some speculation that an increase in violent crimes committed by females may be an early sign of this accumulation of violence in our nation’s social fabric. Dr. Robert Cairns, a psychobiologist from the University of North Carolina at Chapel Hill, undertook a research project to breed increasingly aggressive male rats by successively breeding the most aggressive lines. In the course of the study, he observed that sisters of the aggressive males were also more aggressive. Based on his study results, Cairns believed that in rats, genes for increased aggression can be transmitted to offspring by parents who are exposed to stressful environments. Cairns speculated that this same dynamic also may be occurring in the human population. After looking at the arrest records of two populations of teenage girls from 1900 to 1960, Cairns concluded:

The pattern is emerging of girls, who are increasingly victims of child abuse, who grow up angry and have children with men who are likely to also be aggressive. As a result, succeeding generations of children are being born to aggressive parents and into aggression-producing environments. It really suggests that if there are red signals that our society has to be wary of [they] should be those temporal increases in female violence. This has been ignored, but is maybe the most important of all.27

WHEN JACK FALLS DOWN AND BREAKS HIS CROWN

It has long been an established fact that injury to the head, even a single blow, can cause subsequent recurring violent behavior. The medical literature is filled with anecdotal accounts of patients who suffered remarkable negative personality changes after a head injury. Raff Brinker, the father in the classic children’s story Hans Brinker; or, The Silver Skates, written in 1865 by Mary Mapes Dodge, is a fictional account of this phenomenon. At the time the story is told, Raff Brinker has changed literally overnight from a loving, cheerful father and husband to a silent and strange man who is subject to periodic episodes of murderous violence directed at his wife. This metamorphosis occurred in the story when he fell and hit his head and was taken home unconscious after trying to repair a dike in the middle of a storm.

While accidental injuries that lead to violent behavior are rare, they are clear evidence that the brain can be profoundly altered by a physical blow, which can cause small lesions at specific sites.28 A number of studies on adolescents and adults shows a correlation between head injuries and aggression and violence. Several retrospective studies on juvenile and older death row inmates show that a high percentage have a history of serious head injury. A 1986 study on a group of violent adult offenders who had been sentenced to death found that all of them had a history of head injury.29 A second study by the same group of researchers two years later on a group of fourteen violent juveniles on death row corroborated this earlier finding; all the juvenile offenders had a reported history of serious head injury.30 Males with problems of aggression in marital and dating relationships also often reflect this history, with correlations between head injury and wife battering ranging from 52 percent to 92 percent.31

While there is debate among some researchers as to whether the head injury causes violence or those who are prone to violence suffer an abnormally high degree of head injuries as a result of their lifestyle, a growing body of information demonstrates that head injury may play a much greater role than is currently understood in predisposing an individual to delinquency and crime. Head injury from either blows or the early shaking of an infant may diminish coping skills, judgment, and control.32 Generally, the studies on the links between head injury and violent behavior have been done on older children and adults. The role of early head injuries resulting from child abuse has been virtually overlooked. To an angry or frustrated parent whose patience has snapped, the head of the infant or toddler is the part that cries or is rebellious and talks back. As such, it is a primary target for hitting. Rough shaking or blows can cause shearing and multiple microscopic lesions throughout the brain. These early injuries are often cumulative from multiple incidents of abuse and, except in the most extreme cases, are hard to detect because they leave no external marks. The damage from such injuries often does not appear until later as the affected neurological system matures.

The extent of this problem is both insidious and serious—the majority of all infant head injuries and 95 percent of serious head injuries to children are due to child abuse.33 Even violent offenders who do not report a history of head injury may have suffered early neurological damage if they come from abusive homes. Many of the studies that report a high incidence of head injury in violent offenders from other accidental causes also report high rates of serious child abuse. Such individuals have had a double dose of damage to the brain and are more likely to become violent. Ultimately, it is likely that we will come to discover that the link between child abuse and violent behavior may be both biologically based through early damage to the brain and psychologically and socially based through the modeling of violent behavior.34

The majority of studies on the link between injury to the head and aggressive behavior focus on damage to either the frontal lobes or the temporal lobes. The frontal lobes are the seat of the capacities for planning, self-regulation, and sustained effort as well as of higher abstract thinking and judgment. The temporal lobes, by contrast, contain the limbic system structures important for regulating emotion and behavior. Individuals who have sustained injuries to their frontal lobes show impairment in their control of emotional expression and an absence of empathy or awareness of the impact of their behavior on other people. They are often highly egocentric and unable to appreciate pain to anyone but themselves.35 While impairment of the frontal lobes does not always lead to aggression or violence, it is particularly serious when the injury occurs early in life, before internal controls have developed.36 There is strong speculation by researchers, such as Dr. Charles Golden of Nova Southeastern University in Florida, that frontal lobe injury is a primary cause of sociopathy or cold-blooded criminal behavior. Dr. Golden believes that the apparent increase in violent behavior is linked to several aspects of modern living, including car accidents, child abuse (especially of youngest children), and the increased capacity of medical science to save the lives of premature and birth-injured infants.

Temporal lobe injuries, by contrast to frontal lobe injuries, are associated with “episodic dyscontrol,” in which violent behavior erupts seemingly out of nowhere, is unpatterned, and occurs without provocation or premeditation.37 As many as 30 percent to 50 percent of individuals with a criminal history may have sustained injuries to their frontal or temporal lobes.38 Although head injury is one way in which the human brain may be altered toward aggressive behavior, it cannot be assumed that all brain-injured individuals become aggressive, let alone violent. In most cases, brain damage creates only a greater likelihood of impulsive behavior. The larger environment plays a key role; with rare exceptions familial and social factors exacerbate or greatly lessen the likelihood of violence. Conversely, even in cases in which no acute brain injury has occurred, negative environmental factors, such as trauma, may produce neurological changes of such magnitude that violent behavior may be the result.

In grappling with the issue of violence, it is crucial to understand that both the physical structure and the chemical profile of the human brain may be adversely and permanently altered from prolonged stress or injury during the most rapid period of brain growth, which occurs during the first thirty-three months of life. When children have been traumatized or head-injured, the key to preventing such early experience from setting a course toward impulsive, aggressive, and violent behavior is the presence of a nurturing and responsive caregiver.39 One healthy individual willing to protect, teach, discipline, love, and play constructively with a child can greatly offset the adverse effects of trauma in a very young child. But when the child’s caregiver is equally affected by the threat or is the source of trauma, the risks to the child’s development are greatly magnified. When the caregiver is physically present but is emotionally unavailable or distant, the convergence of early chronic trauma or head injury with impaired attachment becomes the seedbed for impulsive violence. One person can make the difference.

POSTSCRIPT

In the years since Ghosts was first written, one of the most important understandings changing the world of medicine, as well as mental and behavioral health, is the recognition that what happens to us emotionally also happens to us physically and vice versa. All of our systems—nervous, endocrine, immune, digestive, respiratory—are connected. With increased understanding of common hormones and of pathways between the brain and all vital functions, we are recognizing that emotional trauma can take many physical and emotional forms, and that physical indicators—such as the use of certain muscles, gestures, and postures in the body—may be powerful ways of addressing and decreasing the effects of trauma. In recognition of this reality, the National Institutes of Health created the psychoendoneuroimmunology department, reflecting the merger of these once disparate specialties into a new area of study. And one of the most powerful forms of therapy for those of us suffering early trauma is sensorimotor therapy, which uses various bodily signals to recognize and provide a way to release long-stored traumatic memories. Pioneers like Pat Ogden (a leading sensorimotor therapist) and Stephen Porges (a researcher on the nervous system and its efforts to modulate trauma) are leading the way. The use of alternative therapies such as dance and drumming, yoga and martial arts (e.g., qigong and tai chi) are gaining recognition for their applicability to trauma reduction. This work is discussed in Scared Sick: The Role of Childhood Trauma in Adult Disease.

Dr. Vincent Felitti, who wrote the introduction to this book, adds an interesting update on the Chowchilla story that illustrates the developmentally toxic role of trauma in the lives of affected children. Several years ago, following a public presentation of the Adverse Childhood Experience Study, Felitti was greeted by a woman who said her husband would like to speak with him. Her husband turned out to be Larry Parks, who introduced himself as a person for whom the information on such experiences was particularly relevant, because he was one of the children who endured the horrific school bus kidnapping in Chowchilla. Larry explained in detail the psychosis that has infused and shaped his life following the incident. Larry’s story, which Dr. Felitti encouraged him to write, was subsequently published as an e-book (The Chowchilla Kidnapping: Why Me?, July 11, 2011) and gives a detailed description of the impact of trauma on an already vulnerable boy and his family. Larry was six years old when the kidnapping occurred. The impact on an even younger child is unimaginable.