Chapter 7: Satanic Panic

Chapter 7: Satanic Panic

This was the most difficult chapter to get through for me. I found myself regularly having to go back and reread sentences and whole paragraphs because I had checked out or the information I had just looked over had initially left me in total disbelief. Perry’s descriptions of “holding”/”attachment” therapy, the role of social contagion in America in the early 90s around “Satanic Ritual Abuse,” the fad of “recovering” traumatic memories, and the firm adherence to these beliefs and therapeutic models by many professionals in various and relatively socially powerful positions were painful and infuriating to read about. I was most horrified by how the children in Gilmer who had been sexually abused by their family members were tortured further by being transported across the state, subjected to coercive and physically assaultive methods of treatment that were unsupported by any kind of evidence, and manipulated by caregivers, caseworkers, and the judicial system to confirm these adults’ own beliefs about the events in the small east Texas town.

Although horrifying, the history of this mass hysteria and the coercive methods used by the caseworkers, foster families, and prosecutors in the Gilmer cases are not particularly surprising. Perry described adults in therapy who look for the “Rosetta stones of their personal histories” and attempt to find solutions to their current issues in daily functioning by searching for the one traumatic memory that with explain and “resolve” their problems. Instead of learning to cope in the present and validate for oneself that life can be stressful, isolating, and overwhelming in and of itself (even in the absence of a history of childhood trauma/abuse/neglect), some adults will seek out alternative explanations to validate their daily experiences and feelings of already-justified fear, anxiety, sadness, etc. I drew a parallel from Perry’s commentary here to how the adults in this chapter acted and may have perceived the children in Gilmer who had been subjected to horrific abuse. Instead of working through their own feelings of disbelief, sadness, and anger around the cases, they sought out a “better” explanation (e.g. Satanic Ritual Abuse) for why the abuse occurred, perhaps to help themselves feel more at ease. However, just as daily life can be inherently overwhelming for an adult with a severe mental illness that has no roots in childhood trauma, the sexual abuse experienced by children in Gilmer was inherently horrific and required no kind of outside justification or explanation in order to effectively care for them. Providing empathy, understanding, and appropriate care and allowing a client to determine what exactly it is that they might need is almost always more important than intrusively digging into their past (in this case, via coercive interrogation and holding therapy), and it would have only served to benefit the children in this case.

By the end of the chapter I wondered what, if any, care was offered to these children after the criminal and custody cases had ended, and if they would even be able to trust another mental health professional in the future. I think Perry effectively modeled how building a safe, strong alliance with them might look if they or their caregivers sought out care again.

Chapter 6: The Boy Who Was Raised as a Dog

I consistently find myself anticipating maliciousness in the caregivers for the children Perry describes in each case. The chapter’s titular phrase evokes mental imagery of a child locked away in a basement for years, avoided, chained, fed scraps, and intentionally abused and neglected by a psychopathic or sociopathic adult figure. A horrific crime that would have made the news and may have been depicted on a late-night television show. Certainly, these atrocities happen and the victims hopefully find the support and care they need. However, Perry’s book offers a potentially more unsettling perspective: that many well-meaning, driven adults have children or unexpectedly become caregivers and do their absolute relative best to raise them without protective factors like sufficient parent education, knowledge of child developmental needs and milestones, or help from an attuned community of peers and extended family. I braced myself for the worst, expecting to feel anger toward Connor’s nanny and Justin’s caregiver, Arthur. Instead, my heart broke for these adults and I considered the kind of care and attention that they needed as caregivers and likely missed out on as young children.

This being said, it is immensely more difficult to find forgiveness within myself for the medical professionals who worked with the young children and caregivers in each of the cases (even with the knowledge that these cases are decades old). Between the lack of consideration for a young patient’s essential developmental needs, doctors who failed to consult with mental health professionals immediately after a young and clearly traumatized patient like Justin was admitted, and these professionals’ unwillingness to overcome their own inherent biases toward “difficult-to-treat” patients, it was almost impossible to empathize with their struggles. The disdain that the PICU system as a whole held for Justin was exemplified in one nurse’s words: “Just wait a minute and he’ll be screaming and throwing things again.” After Perry’s differential approach to interacting with Justin succeeded, this professional invalidated Justin’s clear potential to heal. I may not have been able to keep my cool as effectively as Perry was in this moment. For me, these feelings and thoughts signal a need to overcome the biases I have within myself about doctors and various components of the medical system. It is clearly just as important to simultaneously intervene in and treat this larger “caregiving” system as it is to work directly with the smaller systems of community, caregivers, and the child.

I appreciated Perry’s explanation of how the neurosequential approach to therapy evolved from the growing understanding of how the brain develops and is impacted at a young age by trauma and neglect. Utilizing treatment approaches that meet a young client’s developmental needs that were initially neglected in infancy and early childhood greatly appeals to me. However, I am unsure of how to effectively meet a young client who has experienced trauma where they are in this particular way without conducting the extensive kinds of assessments Perry models in each chapter. Experimenting with different therapeutic activities, games, play, and art when working with youth may currently be the best approach when lacking detailed information about a client’s childhood or a specific neurosequential assessment tool to determine areas of functioning that a client may need most help with.   

Chapter 5: The Coldest Heart

“The Coldest Heart” offered a great deal of helpful insight into Leon’s sociopathy. Reading the vivid and horrifying description of his crime followed by the details of his relatively normal family and childhood at first left me confused and consequently with certainty that Leon was fully responsible for his actions. I felt angry and disgusted, possibly the same way Perry did in his first interview with Leon. However, his decision to remain neutral, listen intently, and eventually meet with Leon’s brother and parents left me feeling impressed and with greater certainty that something was behind the brutal murder of the two adolescent girls.

A common theme in The Boy Who was Raised as a Dog is Perry’s innate drive to complete a thorough assessment of each of the children he works with. This assessment is consistently tailored to clients’ needs (and therefore looks different in each case), is driven by a desire to understand, and typically involves strategically gathering invaluable information from a child’s caregivers within the context of a focused, compassionate conversation. Assessment has always seemed like a nebulous, complex, and at times impossible task to tackle for me, but Perry’s approach leaves me with hope and has helped me plant small seeds of confidence within myself around this task. There sometimes seems to be no single uniform way to accomplish anything in this field, which is a large part of why I’m drawn to social work. It inspires creativity and greater compassion and asks us to constantly adapt and evolve.

Reading about Leon’s mother’s “routine” after moving to the city and giving birth to Leon left me with a feeling of deep sadness. I considered what it may have felt like to live in the dark, alone, detached, and trying to learn how to self-soothe at such an infantile stage. Leon had to adapt in such a terrifying way, in such a terrifying emptiness, that it left parts of his brain withered, underdeveloped, and unable to function properly. “So that’s an important piece of info,” I consistently think to myself as we read about the various possible causes of why the children in these chapters respond and behave the way they do. Furthermore, Leon’s history of being placed in “reformatory” environments to help him learn how to cope with stressors and interact positively with peers and adults only pushed him further down a path that was quickly leading to sociopathy.

I thought of the young, impressionable children I worked with at an RTC as a mental health technician. These children had histories of trauma, were incapable of living at home with their families for various reasons, and often entered the RTC with a specific diagnosis or comorbid diagnoses. After only a few weeks, I witnessed them “pick up on” the behaviors and response patterns of their peers on the unit and integrate these into their own patterns of interacting and responding to events and stimuli. It was certainly a systemic issue, and an intense and heartbreaking process to observe and attempt to intervene in: every young patient on the unit deserved and needed consistency, and in larger part, peers who could model appropriate behavior, who could interact with them in healthier ways, and who could simultaneously learn something from them. While intervening as a technician by attending interdisciplinary team meetings, integrating the advice offered to me by various hospital clinicians and nurses, and helping individual patients resolve interpersonal conflicts were short-term solutions to this pervasive issue, I still don’t have adequate answers to this problem. I hope to be a part of the solution, however, and know that improved community care, parent and teacher education, and developing my own skills as an aspiring clinician are steps in the right direction. I would love to hear your thoughts on this, fellow bloggers.

Chapter 4: Skin Hunger

One of the most powerful parts of this chapter for me was Dr. Perry’s initial interpretations of Virginia, Laura’s mother. I was so impressed with how he honored Virginia and her undeniably important role in Laura’s life and recovery. The stark contrast between the two pages that described the various invasive medical procedures performed on Laura, her doctors’ resistance to searching for any psychological explanations for her poor health, and her overwhelming medical history and the single sentence that portrayed Perry’s approach to Laura’s case—reading the intake report and deciding to simply introduce himself to Laura and her mother—left a smile on my face. While he was clearly interested in Laura’s medical history, he did not burden himself with a preliminary analysis of the ins and outs of the seemingly endless hospital records and chose instead to focus on Laura and her mother as humans deserving of a compassionate introduction. This set him apart from every other medical professional Laura and Virginia had interacted with and laid the foundation for an empowering therapeutic alliance.

I considered our readings from the week of the 20^th on engaging parents as partners in the therapeutic process (Cates, Packman, Paone, & Margolis, 2006; Kottman, 2003). Instead of actively including (or even making basic attempts to engage) Virginia in her daughter’s treatment, the various professionals that worked with Laura pathologized Virginia as an inadequate mother, ignored her, and even discouraged her from interacting with her daughter. Simple attempts to demonstrate basic compassion, engage Virginia as an expert on her life, or identify her strengths as a mother early on may have put both her and her daughter on a completely different and smoother path to recovery. Perry demonstrated these essential skills from his first interactions with Virginia and Laura and went above and beyond to understand Virginia’s background and tailor treatment to her unique needs.

This is the first chapter in which Perry extensively highlighted the importance of caregivers in a traumatized child’s development and journey to healing. His focus on helping Virginia process through her own experiences of childhood trauma and neglect and learn to facilitate nurturing, loving interactions between herself and her daughter resonated with me. I thought about the parents who want nothing more than to provide their children with a different childhood experience than the one they had growing up and are dead set on not repeating the patterns of maladaptive caregiving behavior, abuse, or neglect that they experienced at the hands of their own caregivers. While this is an admirable perspective and many parents are able to raise their children differently than they were raised, the past often remains stored in the deepest, most unconscious parts of our psyche. Logically deciding to be a different kind of parent is simply not enough, which was illustrated clearly and empathically in this chapter with Virginia. Reading about Perry’s referral of Virginia and Laura to Mama P was a deeply emotional experience: this treatment approach was restorative for both Laura and her mother, who needed the same nurturing, curative love and care that her daughter did.

Chapter 2: For Your Own Good

I found Perry's explanations of the "use-dependence" function of our brains and his arguments against children being wholly "resilient" to trauma quite helpful. The way he explained that young children are often more deeply affected by persistent and intense traumatic experiences than are adults because they are relatively powerless and vulnerable reframed the “resiliency” argument nicely for readers. Even though CPS, the court, and Sandy’s guardian-at-litem did not have this information about trauma’s impact on the brain at the time, I was deeply shocked at their hope for Sandy to testify against the man who raped and murdered her mother and slit her throat. No one appeared to have this young girl’s psychological or physical health in mind, nor did they consider the devastating impact that testifying in front of her attacker would have on her in both the short- and long-term. I was relieved that Perry decided to take her case and once again was thoroughly impressed with how he established a strong alliance with her by allowing her to guide their play and her own treatment and how he advocated for her within multiple systems.

It was surprising that Perry had chosen to prescribe Clonidine to the boys at the residential treatment facility, especially after his decision to not medicate Tina after his supervisor's suggestion in the first chapter. While it seemed that this medication was helpful for these young patients who were exhibiting symptoms of PTSD, I wondered about the impact that the long-term and possibly unsupervised use of this medication would have on these boys’ developing brains. I thought about our brief discussion in class about the use of medication with children. While Perry seemed to have thoroughly contemplated the potential consequences of Clonidine, I wondered about the quality of therapeutic care/follow-up at this RTC and whether the staff working with these patients were using trauma-informed practices and interventions to supplement the use of this medication. While this medication seemed to “level the playing field” for these young residents to benefit from any treatment that was being provided, I wish Perry had given us more information about any of the long-term therapeutic outcomes for these patients.

Even though I was skeptical of this decision, Perry’s discussion of the absence of differential diagnoses for these young patients is a timely one, even decades later. Children and adolescents are often still diagnosed with ODD, ADHD, and conduct disorder based on their behavior in school settings, with peers, and at home, without consideration of other external dimensions that may help explain their behaviors and responses to stimuli (i.e. violence at home, essential needs for shelter, sleep, food, care, or consistency not being met, exposure to traumatic events, etc.). Clinicians and doctors who work directly with children may still be hesitant to include PTSD in their differential diagnosis list possibly due to the stigmatizing nature of this diagnosis and the complexity that comes with treating and managing PTSD symptoms (although a diagnosis of ADHD or ODD can be just as stigmatizing and can follow a child throughout their young life). While I think a paradigm shift is occurring around the importance of identifying the symptoms of PTSD and providing trauma-informed care, this shift may take longer than Perry initially expected.

Chapter 1: Tina's World

Reading Chapter 1 of The Boy Who was Raised as a Dog was a validating and refreshing experience. I think I had some minor concerns about the book being inaccessible or overly clinical. I instead found Perry’s discussion of his early supervisory experiences, uncertainty about the diagnostic processes characteristic of the time, internal conflict over how to approach Tina and develop a treatment plan, and his desire to create a therapeutic environment that would provide Tina with an emotionally and psychologically safe space honest and written with great humility. Perry was easy to relate to as an emerging professional, and I repeatedly thought about my own experiences as a first-field intern with CIS in a middle school setting. My initial experiences in this setting were filled with uncertainty and doubt in my capabilities as a growing social work clinician, as well as concern about the traumas many of my students faced on a daily basis, how I could facilitate emotionally safe and enriching interactions with students, and how I could most effectively approach supervision to improve the care I was providing and the relationships I was attempting to establish. Ultimately, I resonated with Perry’s struggles and found his perseverance and focus in Tina’s case inspiring. This chapter also offered a great foundation for the rest of the book with its accessible explanations of the impact of traumatic experiences on the brain and the neurological symptoms of trauma.

Perry offered a strong commentary on the importance of sociocultural and economic factors and their impact on treatment and the client. Having a glimpse into “Tina’s World” helped me better understand the challenges she had been facing as a young child living in poverty and hearing about a young professional navigating potential boundary issues and treating Tina with cultural sensitivity resonated with me. Sharing his first encounter with an impromptu home visit was such an important start to the book. The way in which he worried about having driven Tina’s family home one night after a session painted a picture of the real anxiety that comes with navigating boundaries in unique and complex therapist-client situations, and Perry handled it well. I found myself thinking about my own internal conflict around therapeutic boundaries and only having 45 minutes a week with each of the students on my caseload at the middle school. I constantly questioned whether I was doing enough for them or was having an impact as an intern. While I was able to reframe this after several months working at the school, this conflict arose from witnessing some of the disheartening and difficult issues so many of my students were dealing with on a daily basis and really wanting to provide them with as many positive interactions with a trusted adult as possible and a place of emotional safety and understanding.

I thought about Maslow’s Hierarchy as Perry described Tina’s daily experiences with living in impoverished conditions and the sexual abuse she experienced at the hands of her caregiver’s son. Although Tina’s mother worked hard to provide Tina and her younger siblings with shelter, care, and love, Tina’s basic “physiological” and “safety” needs had been compromised by her early traumatic experiences (Maslow, 1958). I appreciated Perry’s work to meet these in the therapeutic milieu by allowing Tina to guide their play and direct her own therapy, modeling patience, and demonstrating unconditional positive regard and true empathy for Tina. Perry’s compassion for Tina was clear, and this chapter gave me additional insight into how I might improve my own approach to trauma work with youth.

Maslow, A. H. (1958). A Dynamic Theory of Human Motivation. In C. L. Stacey, M. DeMartino, C.L., Stacey, M. (Eds.), Understanding human motivation (pp. 26-47). Cleveland, OH: Howard Allen Publishers.