Scottish Attachment in Action BulletinÂ January 2016

He expresses his life-long interest in human development and strives to share the stories of some of the young people he has worked with. He and Szalavitz assert that stress and psychological trauma have a lasting and permanent impact on the chemistry and architecture of the brain.

From the outset of the book, he outlines the conditions necessary for the development for empathy or indeed cruelty and indifference. The link between trauma and symptoms like depression and what he refers to as â€˜attention problemsâ€™ are made explicit in a way that is intended to be helpful for anyone living with or working with young people. His aim appears for the reader to understand better the impact of threat or violence on the developing brain in order that a more nurturing approach can be utilised where appropriate.

Perryâ€™s descriptions of his early days as a psychiatrist allow some insight into his way of thinking. He talks about the professionals who influenced his practice. Very quickly, he lets the reader know of some of the cases he worked on. It is often an uncomfortable, yet compelling read as each chapter describes, with a lot of detail, young people with whom he has worked. He takes the time to go into the background stories with reference to their early days and care afforded to them.

In these depictions, he demonstrates his thought processes, how his thinking helped him to attain a level of rapport with his patients and how he used his increasing knowledge to analyse his patients and their development. His questioning nature led him to be sceptical of, and challenge some of the protocols of the day in favour of what he thought was the â€˜right thingâ€™ to do in each, individual case. Be aware, reader, that he describes cases where some of his patients have endured horrific conditions.

There is a great deal of theoretical information in this book, which I found useful and informative and I can highlight only some of my understanding here. As well as outlining his understanding of brain structure and what he refers to as the architecture of the brain, Perry goes into detail about neuropharmacology, how the developing brain organises itself and how regulatory functions develop. In particular, he talks about how stress responses are formed.

In telling the stories of each of his cases, Perry weaves his theoretical knowledge in a way that helps the readerâ€™s understanding. The process of how neurological pathways are created and the importance of the caregivers â€˜attunementâ€™ are elaborated on. He describes attachment as, â€œA memory template for human to human bondsâ€.

He describes the methods he used to get to know his patients. â€˜Colouringâ€™ seemed to be a favoured pastime to begin with. He ascertains that work can only take place once a young person has reached a position of relative safety. In order to begin any therapeutic work, Perry recommends that the reduction of chaos is essential and that the childâ€™s environment should become calmer and more predictable. Only once a regular routine is established, he maintains, can any benefit be gleaned.

One of Perryâ€™s recommendations for helping traumatised or fearful young people is the use of experiences which are based on patterns, repetition and, where possible, activities which are rhythmical. This, he asserts will help that person with physical and mental regulation.

One of the key messages for me is about how we function as relational beings. Perry asserts that our physical responses and ability to survive depend on our associations with others. He says that,
â€œAs children, we come to associate the presence of people we know with safety and comfort; in safe and familiar settings, our heart rates and blood pressure are lower, our stress response systems are quiet.â€
There are many intended messages in this book. Perry makes the point that we all need to be aware of our own state of mind when dealing with others. He suggests that if we present as angry or stressed, that we might induce those feelings in people around us. They might then â€˜mirrorâ€™ those responses. He says, â€œTo calm a frightened child, you must first calm yourselfâ€.

No matter what the reader might think about Perryâ€™s methodologies (as a teacher, the description of the use of clonidine in his clinic was not given much explanation and was a bit of a â€˜whoa thereâ€™ moment for me as I donâ€™t understand a great deal about the use of medication), the insights he has shared about attachment, relationships and brain development have helped me in my work with young people and in life in general. This book has encouraged me to see things from a different perspective and to reflect on my practice. As Perry puts it, â€œPeople, not programmes, help peopleâ€.

This quote from the book sums up well how we have the potential to impact on others...
â€œFire can warm or consume, water can quench or drown, wind can caress or cut. And so it is with human relationships; we can both create and destroy, nurture and terrorise, traumatise and heal each other.â€
Throughout my adult life, I have recognised that there is a link between stress, trauma and fear and how people conduct themselves. Messages conveyed (often hidden) by peopleâ€™s actions have been of enormous personal and professional interest. Theories put forward in this book have provided confirmation of this belief and increased my understanding, for which I am grateful.