Book review of ‘What Happened to You?’ by Bruce Perry and Oprah Winfrey

More than a question turned into more than just a book!

That all-important phrase… ‘What happened to you?’ (as an inviting, compassionate alternative to ‘What is wrong with you?’) is gaining traction as the guiding question with regard to understanding health issues. In this seminal book, authors Bruce Perry and Oprah Winfrey engage in a long and fascinating dialogue, interspersed with illuminating monologues, in which they address the many faces of trauma. On one of the last pages of the book, Oprah refers to a guest from one of her shows: “She said that until you heal the wounds of your past, you will continue to bleed. The wounds will bleed through and stain your life, through alcohol, through drugs, through sex, through overworking.” In a nutshell, this is what lingering trauma is about and why dealing with it appropriately deserves more societal attention. Although there are many definitions, it is important to realise that trauma is much broader than, for example, being raped, witnessing murder, or fighting a war. The book is a treasure trove of real-life lessons of how things can go wrong in any human’s life. Fortunately, Perry and Winfrey also help us gain insight into what can be done towards healing, partly by diving into what is needed for healthy development.

In this review, the aim is not to do full justice to all the wisdom the authors share with the reader; that is too high an aspiration. Instead, we would like to give you an impression of what to expect and what can be gained from the book. We could hardly put our pencils down while indicating beautiful one-liners and catchphrases. Also, there are a myriad of concepts applicable to the work of raising awareness regarding the impact of childhood trauma and we will certainly return to those in due time. We noticed numerous valuable ideas with profound policy implications.

The book is published as a hard cover with a tender summer blue, mixed with soft tones of green. It has 10 main chapters, apart from the introduction and annexes, beautifully built up. Each chapter starts with an illustration, depicting the chapter’s theme in an abstract fashion on the left, followed by its title on the right, a meditative cloudy page on the left and a gripping story on the right again, the authors taking turns. After each introduction, the dialogue continues, with Winfrey’s words and questions in blue, Perry’s stories and answers in black. In total, there are 11 visuals explaining the basics of neurophysiology and stress regulation. Throughout the book, they are being referenced where applicable for the reader to return to and get a good grasp. What would have been helpful is a detailed index so one can easily find back certain concepts and terminology; maybe it can be added in a next print run.

Another merit of the book and something that makes it stand apart, is the fact that it is written in a conversational manner. Not only does that make for an interesting read, it also helps even the uninitiated reader understand how trauma occurs, how it can affect a person’s life even decades later, and what healing from trauma looks like. In the dialogue, after Perry explains a complex neurological concept, Winfrey responds by asking questions that a lay person may have, to which Perry responds with even more depth. Storytelling and sharing the lived experience of trauma is a means that can help readers understand trauma and its impact in an accessible way. The way these two authors handle this approach, gives the material profound and impressive authenticity and depth.

Image of Table of Contents used with permission from www.neurosequential.com

From the many noteworthy topics, we have made a selection of themes that we feel carry a world of insights underneath and are helpful in provoking paradigm shifts. These themes deserve to have those with the lived experience as their audience, as well as those in positions of professional expertise, policy making, and political power. The book aims to address ‘anyone with a mother, father, partner, or child who may have experienced trauma’ (p. 10). Of course, many of us will be in several categories at the same time, which makes this material all the more relevant.

Some theory

The core of Dr. Bruce Perry’s work is in the concept of neurosequential programming, meaning that the brain and its neurobiology get built from the bottom up, from simple to complex, from the brain stem up to the cortex: we feel before we think (p. 27-29). All those early experiences build our ‘world view’ and create setpoints for our stress regulation, with the first year of life having a disproportionately large impact. If, in that life stage, someone has too many experiences of being unseen and unloved, neglected or abused, their healthy development is at risk. If we experience too much toxic stress (as opposed to healthy stress and tolerable stress with buffering protection from stable adults), we become dysregulated. Our neurobiology gets sensitised and becomes ‘overactive and overly reactive’, which leads to dis-stress, dis-comfort and can result in dis-ease and dis-functioning on many levels. Also, it damages our view of others as safe, predictable and caring. This can have huge implications for how we approach relationships and life’s challenges. We may start seeing the world through a ‘prism of pain’ (p. 97) and develop a deep sense of unworthiness (p. 98). To soothe it, a flight into addictions may seem the solution. Marginalisation, humiliation, shaming, and emotional abuse are all part of ACEs, ‘adverse childhood experiences’ (p. 103). Dr. Perry righteously points out, however, that ACEs are not a diagnosis, not the ‘prolonged exploration required to truly understand [someone’s] personal journey’ (p. 108). They do increase the likelihood of struggle later in life, though, depending on their duration, intensity and timing: ‘Adversity impacts the developing child. Period’ (p. 191).

Importance of nurture and connection

Seeing that buffering protection is crucial to prevent stress from turning into toxic stress and trauma, the importance of nurture and connection becomes obvious, throughout life, but especially in the early years. If a child experiences coregulation and connection, it can build resilience, which is, contrary to the often held belief, not an innate quality. There is ‘neuroplasticity’ (brain malleability), but this can go either way. This means that resilience is a potential that requires healthy relationships. It cannot flourish in ‘relational and emotional starvation’ (p. 266). Therefore, caregiving and parenting quality really matters for the child’s wellbeing and there are a number of great concepts in the book further explaining and illustrating that. We mention three important ones:

  • regulate, relate, reason: first downregulate stress, so you can get the relationship right, and only then the cortex becomes accessible for reasoning and learning (p. 142);
  • relational poverty: not having enough adults around to take care of children’s needs (p. 201);
  • sociocultural evolution: learning from our elders and transmitting abstract (cortical, so very human) things like values, beliefs, skills, hopes and dreams to the next generation not through genetic inheritance, but by example and through intentional instruction, which means we can proactively influence what we hand down (p. 129-131).

Those who can create holding space for us (p. 114) and can apply ‘reflective listening’ (p. 197) and ‘empathic fluency’ (p. 259) help build safe spaces where we can experience a true sense of belonging.

From hurt to healing

If the pain is there, how do we soothe it? It all comes back to loving relationships: ‘Everything matters’ and ‘belonging is biology’ (p. 137): our sensory organs and brains translate experience into biological activity of the body (p. 137). Brain and body are always inextricably connected in these perceptions, so, Perry states, a dualistic approach of health fails to do justice to this connectedness and is dismissive, as it only addresses symptoms. If we understand that ‘the relationship is the superhighway to the cortex’ (p. 144) and that ‘if we don’t feel safe, we become dysregulated’ (p. 148), we know what we can do for ourselves and those around us: be there for one another, because ‘neglect is as toxic as trauma’ (p. 159). If we no longer ask ‘what is wrong with you’, but understand ‘what happened to you’ (and to us, for that matter), we can start learning to look at health in a different way. We can learn to see our own and other people’s behaviours and illnesses in a non-judgmental and compassionate way, as a result of our efforts to survive difficult circumstances. As Perry humbly explains about his own process of becoming more competent in supporting people: ‘[W]e kept listening and learning’ (p. 151), something all of us can do.

Perry does see an issue, however: ‘Science gathers knowledge faster than society gathers wisdom’ (p. 257) and ‘many policy recommendations are made with good intentions but with minimal understanding of the developmental needs of children’ (p. 267). This is an appeal to all those professionals working with young ones (or with the inner children of the older ones!), because ‘many people feel incredibly relieved when they understand how their brain works and why’ (p. 283). If we manage to heal from the trauma we experienced, we can develop ‘post-traumatic wisdom’ (p. 200), wisdom that comes from the hardship we endured and the healing we went through.

In summary, ‘What Happened to You?’ is an amazing read, a guaranteed page-turner. It is an impressive addition to the field of trauma studies. Published in English just in April of this year, it was already a New York Times best-seller in May and included in Amazon’s best science books for 2021 so far. It is translated in Dutch and published this month by Spectrum.
Our pasts, especially if we have experienced trauma, shape the way we interact with others, form relationships, and live our lives. This book helps trace and piece together all these experiences that formed us, while showing us many ways to healing. Whether you or a loved one have experienced adversity and you are trying to understand more about yourself and others, or whether you work in healthcare, educational, judicial, and other professional settings, this book is a must read. The idea of developing post-traumatic wisdom is a very hopeful and encouraging thought. We wish all readers great strides in that process with the help of this book!

Posted in Boek- en filmbesprekingen.