This article is an excerpt from the Shortform book guide to "What Happened to You?" by Bruce Perry and Oprah Winfrey. Shortform has the world's best summaries and analyses of books you should be reading.
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What do Oprah and Bruce Perry say about childhood trauma in their book What Happened to You? In what ways can childhood trauma follow you to adult life? What can you do to ease your suffering?
In What Happened to You?, Oprah Winfrey and renowned psychiatrist Bruce D. Perry discuss how childhood trauma can have a severe and lasting impact on the brain—and thus our worldview, health, and behavior—sometimes without us even realizing it. They also describe how to begin the healing process with compassion for yourself and others.
Here’s an overview of Oprah and Bruce Perry’s discussions on childhood trauma.
What Happened to You? An Overview
In What Happened to You?, Oprah and Bruce Perry are particularly interested in childhood trauma—trauma experienced during the formative years of development. In this article, we’ll discuss this type of trauma, including how it impacts the brain and its consequences in the short and long term.
Childhood Trauma’s Impact on the Developing Brain
While experiencing trauma at any stage of life can impact our well-being and mental health, Perry and Winfrey explain that childhood trauma has especially severe and long-lasting effects. This is because so much of our brain development happens during the first few years of life. As a result, our childhood experiences are foundational to our worldview, personality, and behavior.
(Shortform note: Scientists disagree on whether our worldview, personality, and behavior depend more on nature (the genetic material in our DNA) or nurture (our childhood experiences), as Perry and Winfrey suggest. However, recent research suggests that personality comes from the interplay between your genes and your environment. You’re born with a certain temperament—for example, you may be quiet or loud, timid or outgoing. But your environment and upbringing also help determine your personality traits and can even change your basic temperament.)
When you’re born, Perry explains, your brain isn’t fully developed. As you grow up, it grows with you. It rapidly forms new synapses—connections between brain cells, or neurons. These synapses make up complex chains, called neural networks, that send information to each other through electrical signals. As this happens, you begin to use new areas of the brain that control language, rational thought, and motor skills.
(Shortform note: Research confirms Perry’s claim that the brain grows rapidly in the first few years of a child’s life. Brain size doubles in the first year alone, and the number of neural networks skyrockets. Recent estimates suggest that as infants and toddlers, we develop one million new synapses every second.)
However, when a child experiences trauma, it can disrupt the brain’s normal development. Think of the adult brain as a city—a complex system of interwoven parts. The early years of childhood development are like the ground that the city is built on. If it is sturdy ground, the city will be structurally sound. But if it is unstable or swampy, the city will develop problems: Its buildings and roads might begin to collapse. If it experiences a severe event like an earthquake, it’ll be more susceptible to damage.
Similarly, if a child experiences trauma, the brain’s foundation will be weaker. Perry and Winfrey explain that as the child grows up and the brain grows in complexity, this weak foundation can cause problems. For example, children who experience trauma often struggle with speech, motor-control issues, and problem-solving skills.
The Short-Term Effects of Childhood Trauma
The developmental issues we’ve just discussed can lead to both short-term and long-term problems for survivors of childhood trauma. According to Perry and Winfrey, two of the most common short-term effects of childhood trauma are 1) an inability to love and be loved, and 2) an overactive stress response, which can lead to increased anxiety and difficulty concentrating. Let’s explore both in detail.
1) An Inability to Love and Be Loved
Perry and Winfrey maintain that one of the most important skills we develop as infants is the ability to experience love. At this stage of development, we wholly rely on our caregivers to meet our needs (for example, food, soothing, or a diaper change). If caregivers consistently and lovingly respond to our needs and make us feel better, we begin to form positive associations between human contact and comfort. In other words, we learn that being around people and experiencing love makes us feel good.
However, if a child needs something and the caregiver isn’t there, is only there at certain times, or meets the need with an abusive reaction, the child doesn’t associate human contact with comfort and love. Instead, human contact is scary and unpredictable.
According to Perry and Winfrey, this negative view of human contact can hinder the child’s ability to form healthy relationships. Because she doesn’t experience love at home, she might have a harder time giving and receiving it in situations outside the home—for example, at daycare. She might not show affection to her classmates and teachers, or she might not know how to react when someone shows her love.
Perry and Winfrey suggest that this can create a vicious cycle. When the child doesn’t have a loving home, she struggles to connect with others and develop loving relationships. Without these relationships, she doesn’t experience love in other places and continues to drift further from others. She therefore becomes more isolated and never experiences the love needed to break the cycle.
2) An Overactive Stress Response
Childhood trauma can also overactivate a child’s stress response, making them hypervigilant and anxious. Perry and Winfrey explain that children who live in an abusive home must always be alert for signs of abuse. This means that their stress responses are very sensitive—more often than not, they’re in a fight-or-flight or dissociative state.
While this overly active stress response helps a child survive at home, in other settings, it isn’t so helpful. Perry and Winfrey suggest that a heightened stress response can make it hard for the child to focus in school, make friends, and trust adults. Children who experience trauma are often misdiagnosed with ADHD because they have trouble sitting still and concentrating.
Like the inability to love, a heightened stress response can create a vicious cycle. Perry and Winfrey suggest that if teachers, coaches, and other students aren’t aware of the child’s traumatic experiences, they’ll view the child’s behavior as disruptive. They’ll probably get frustrated, which will further isolate the child, making them less likely to reach out for help and less motivated to follow the rules.
The Long-Term Effects of Childhood Trauma
For children who suffer abuse, trauma’s impact on the developing brain tends to create long-term issues. Perry and Winfrey mention three broad ways that childhood trauma can impact people in the long-term: 1) mental and physical health issues, 2) flashbacks and triggers, and 3) unrecognized behavioral patterns.
Let’s take a look at each of these.
1) Mental and Physical Health Issues
According to Perry and Winfrey, suffering a traumatic event in childhood increases the risk of a range of mental and physical health issues later in life. People who experienced trauma as children often experience depression and anxiety, as well as physical symptoms such as chronic pain and increased risk of heart disease.
(Shortform note: Research confirms Perry and Winfrey’s assertion that trauma often causes long-lasting mental and physical health issues. Studies suggest that between 40% and 50% of trauma survivors experience anxiety and depression after a traumatic injury, and that these symptoms can last up to 20 years after the injury. In one study, 68% of trauma survivors reported experiencing physical health problems five years after the traumatic event.)
Perry and Winfrey note that doctors sometimes dismiss the physical manifestations of trauma. These doctors might tell patients that the pain is imagined or “psychological,” implying that it isn’t actually happening in the body. However, the authors maintain that the mind and body are connected. Physical pain from trauma is real, and addressing that pain is an important part of any care plan.
(Shortform note: The authors’ emphasis on the mind-body connection is part of a broader movement in Western medicine: In the past several decades, Western doctors and scientists have found direct links between mental health and physical health. However, this movement isn’t new—studying the mind and body together was a common practice in Western medicine until the 17th century. Furthermore, non-Western medical practices, such as Chinese medicine, have always been highly aware of the mind-body connection.)
2) Flashbacks and Triggers
Another common long-term effect of trauma is flashbacks, in which a trauma survivor relives a traumatic moment. Perry and Winfrey explain that flashbacks occur when the brain creates long-lasting associations between the circumstances surrounding a traumatic event and the stress response. For example, if a drunk father hits his child, the child’s brain may create an association between the smell of alcohol and a state of fear. The brain learns that when that smell is present, bad things happen.
Our brains create these associations to protect us from similar situations in the future. For example, the next time the child smells alcohol, his brain will recognize the situation and tell him to hide or run away. However, the brain can sometimes do its job too well, triggering our stress response even if we aren’t in danger.
For example, when the child grows up, he might suddenly experience a stress response when a middle-aged man smelling of alcohol approaches him. Even if he isn’t in any immediate danger, he might feel suddenly anxious and uneasy. As we discussed above, this type of sustained stress response can have negative impacts on our mental and physical health.
3) Unrecognized Behavioral Patterns
In addition to creating health problems and triggering flashbacks, trauma can influence behavior in more subtle ways. According to Perry and Winfrey, trauma survivors often develop negative habits and ways of seeing the world, sometimes without realizing it.
As we’ve mentioned, experiencing love and care as an infant allows us to develop healthy relationships later in life. Childhood trauma can create a vicious cycle in which the child doesn’t know how to receive love and becomes more and more isolated.
Perry and Winfrey explain that these behavioral patterns continue to influence us as adults, even though we might not be aware of them. When someone experiences trauma, they come to expect the same patterns of abuse that they suffered as children. This can inhibit our ability to form healthy relationships, especially if we’re unaware of how our childhood trauma is influencing us.
For example, if a person is abandoned by her parents when she’s young, she might later struggle to develop trust in intimate relationships. Because of her childhood trauma, she might mistakenly come to expect that anyone who says they love her will leave. However, if she isn’t aware of her childhood trauma or the effect that it has on her, she might think her feelings are based in reality. This could make it difficult for her to form a trusting relationship.
The Healing Process
In the previous section, we discussed how trauma can have short-term and long-term impacts on our worldview, behavior, and relationships. Fortunately, there are ways of addressing and working through trauma to help us heal and develop healthy relationships.
Perry and Winfrey maintain that every person going through trauma has a different background and different needs. There is no one-size-fits-all solution to trauma.
(Shortform note: While doctors agree that there is no one-size-fits-all care plan for trauma, there are common guidelines that care providers can follow. For example, the National Child Traumatic Stress Network uses the Psychological First Aid model, which outlines several “core actions” that doctors should perform. These include speaking to the patient with compassion and understanding, stabilizing symptoms, connecting the patient to support networks, and offering practical assistance to the patient and their family. While the details of each case will be different, these “core actions” help doctors make sure that they’re providing positive care.)
Still, the authors mention several important pieces of advice for anyone struggling with trauma: Lean on your community, ease your stress response in small doses, and have compassion for yourself and others. Let’s explore each strategy in detail.
1) Lean on Your Community
According to Perry and Winfrey, the most important factor in dealing with trauma is experiencing love and support from your community. They note that even for people without trauma, having meaningful social connections is an excellent indicator of mental health.
However, when healing from trauma, the authors maintain that these social connections become even more important. To process traumatic events, survivors need to share their thoughts and feelings with a supportive community. Trauma often makes its victims feel unloved and unworthy. But healthy, communicative relationships can help people feel listened to, cared for, and validated.
(Shortform note: While healthy, meaningful connections improve our mental health and can help trauma survivors heal, unhealthy relationships can make people feel unsafe and unloved. So, how can you tell whether your relationships are healthy? Mutual respect, trust, honesty, and compassion are just a few key elements of a healthy relationship. When developing a connection with someone, think about whether you feel safe with them and can be yourself.)
Perry and Winfrey suggest that ideally, a therapist can be a part of this community. But they also note that not everyone has access to a therapist, and Perry maintains that a supportive community of family and friends can be just as valuable.
2) Ease Your Stress Response in Small Doses
As we mentioned earlier, trauma creates associations in the brain that can retrigger the stress response even years after the event. When this happens, it becomes difficult or impossible to think rationally. According to Perry and Winfrey, this makes it hard to work through trauma.
(Shortform note: In The Body Keeps the Score, van der Kolk elaborates on the authors’ point that flashbacks make it hard to work through trauma by noting that flashbacks often shut down specific areas of the brain: in particular, those related to speech and language. This can make it impossible for the trauma survivor to speak about her experience. To combat this, van der Kolk suggests several strategies that can help the victim express and process their trauma, including free-association writing and developing bodily awareness through meditation.)
Therefore, according to the authors, the first step in working through trauma is to ease your stress response. This retrains the brain’s neural pathways to recognize that it isn’t actually in danger, allowing you to think rationally and process traumatic memories. Perry and Winfrey offer two concrete tips for beginning this process:
1) Use rhythm: Rhythmic activities such as walking, dancing, and coloring can help regulate the body and brain when processing traumatic memories. According to Perry and Winfrey, rhythmic motions have a therapeutic effect on us, a connection that goes back to the womb, when we hear our mother’s heartbeat and associate it with safety.
(Shortform note: While Perry and Winfrey claim that rhythm is therapeutic because it connects us to our time in the womb, another theory suggests that rhythm is beneficial because it can change our brainwaves. Scientists have found that listening to rhythmic music causes our brainwaves to resonate with the rhythm. This increases blood flow and activity in the brain, which can improve concentration and reduce anxiety.)
2) Address trauma little by little: Perry suggests that on a biological level, we can’t think or talk about a traumatic memory for more than a few seconds before our brain tries to protect us and our stress response kicks in. Because of this, Perry and Winfrey recommend addressing trauma in small doses. Thinking about a traumatic memory for only a few seconds (as opposed to forcing yourself to think about it for longer) will make it easier to regulate your stress response.
The need to process trauma bit by bit also helps explain why having a large, healthy, and robust community is so important. According to the authors, having a long conversation with one person won’t be as helpful as having many shorter conversations with different people.
3) Have Compassion for Yourself and Others
According to Perry and Winfrey, another important element of healing from trauma is having compassion. When a person experiences trauma, they can often feel like something is wrong with them. They might feel that it’s their fault that they can’t sustain a healthy relationship or that seemingly random triggers create anxiety or dissociation. However, Perry and Winfrey emphasize that having trauma doesn’t mean that something is wrong with you.
This is where the title of the book comes from. Instead of asking ourselves and others “What’s wrong with you?”, Perry and Winfrey say, we should ask, “What happened to you?” This question, which they borrow from the work of psychiatrist Sandra Bloom, shifts the focus from blaming the trauma survivor to understanding their past. It introduces compassion into the healing process and helps the survivor understand that it isn’t their fault.
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Here's what you'll find in our full What Happened to You? summary :
- How childhood trauma can have a severe and lasting impact on the brain
- Why it’s so important to address your trauma
- How to heal from trauma and develop healthy relationships
