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Child Abuse on the Brain

Child psychiatrist Bruce Perry believes that many kids diagnosed as being psychotic or hyperactive are actually suffering from posttraumatic stress disorder: they are shell-shocked veterans of the war against children.

Eddie can be a real pain.

The skinny 14-year-old blue-eyed blond lives at Saint Joseph's Carondelet Child Center, a home for boys with severe behavior disorders on East 35th Street.

Eddie* is the last in his dorm to fall asleep at night, and frequently has to be removed from the room for disturbing others with his loud talk. When he is disciplined, he whines and blames his conduct on others. If he is asked to leave one area and go to another, he often runs off wildly. He constantly seeks the attention of adults at the center, but when he gets it he becomes frenzied and usually ends up serving time-outs.

This is mild stuff compared with how Eddie acted before he came to Saint Joe's six years ago. In one foster home he would get out of bed at night, raid the refrigerator, throw food on the floor, and smear feces all over the bathroom. In another foster home he destroyed the toys and gifts his father sent him, and he urinated day and night on the furniture. When he was seven he tried to jump out of a window of a moving school bus, saying he wanted to kill himself. During a four-month stay at a psychiatric hospital after that suicide attempt he was placed in full leather restraints 19 times because of his violent tantrums and attempts to hurt himself.

Bruce Perry, a University of Chicago child and adolescent psychiatrist, first saw Eddie in 1989, when he started consulting at Saint Joe's. "He was bouncing off the walls," Perry says.

Most of the 30 boys who live at Saint Joe's have the jumpiness and irritability, the nightmares and sleep difficulties of a shell-shocked combat veteran. Which is what Perry says the boys are. Consider what Eddie has been through:

When he was three and a half, he was found wandering alone on a west-side street, naked and covered with feces. He was placed in foster care, but his mother soon regained custody. A year later, after someone called a Department of Children and Family Services hot line, a social worker took Eddie and his two siblings, both younger, to a doctor to be examined. The doctor found all three kids covered with bruises, scabs, and scars; Eddie had cigarette burns on his hands as well. Eddie said his mother and her boyfriend both beat him regularly with a belt and a stick; there were indications that the boyfriend had also used a baseball bat on Eddie. He was placed in another foster home.

While in foster care, Eddie was brought to his father's apartment twice a month for unsupervised visits. (Eddie's parents had separated earlier.) Before he left for one of these visits, Eddie, not quite five years old, told the social worker who picked him up that he had a stomachache and didn't want to see his father. The last time he had been at his father's home, he told the social worker, "a little bad boy put a big stick in my throat," and it had given him a stomachache. The stick was big and pink, Eddie said. His father had warned him not to tell anyone about the "bad boy," because then his father would be put in jail and there wouldn't be anyone to take care of Eddie. A DCFS worker apparently was informed of what Eddie had said, but the only action taken was to reduce Eddie's visits to his father from twice a month to once a month. Three years later Eddie's two younger brothers were removed from their father's care after they made it clear to a school therapist, verbally and with puppets, that their father had been forcing them to fellate him daily. They said their father had done the same thing with Eddie.

Eddie is suffering from posttraumatic stress disorder (PTSD), according to Perry, an expert in the disorder. PTSD symptoms include hypervigilance, exaggerated startle response, difficulty concentrating, difficulty falling or staying asleep, irritability, and "unpredictable explosions of aggressive behavior," according to the revised third edition of the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders. The symptoms develop following "a psychologically distressing event that is outside the range of usual human experience," the manual says, and are intensified "when the individual is exposed to events or activities that resemble or symbolize the original trauma." The stress leading to PTSD can be a natural disaster or an accident, according to the manual, but PTSD results more frequently, and the disorder tends to be more severe and longer lasting, when the precipitating event "is of human design"--torture or assault, for instance. While a serious threat to one's own life can lead to PTSD, so can the sudden death of one's spouse or children.

After World War I doctors who treated combat veterans for shell shock noted that when the veterans were exposed to loud noises they frequently developed upset stomachs, rapid heart rates, breathlessness, tightness in the chest, and sometimes loss of bladder and bowel control. By World War II the term "shell shock" had been replaced by "battle fatigue." In a 1945 book on the subject, R.R. Grinker and B.L. Smith wrote that the flight personnel they studied "seem to suffer from a chronic stimulation of the sympathetic nervous system. They perspire freely, are tremulous, restless and irritable, sleep poorly, and look very sick. At times these symptoms suddenly increase, especially in response to mild auditory or verbal stimuli, and the patients react as if they had received an injection of adrenalin."

But until the last dozen years or so, veterans who complained of such symptoms were frequently considered malingerers, whiners, and neurotics. When they described their flashbacks and hallucinations to psychiatrists, the psychiatrists sometimes decided they were schizophrenic and drugged them with antipsychotics.

Vietnam veterans have died at staggering rates from suicide, drug overdoses, car accidents, and police shoot-outs, and their rates of imprisonment, drug addiction, and alcoholism have also been vastly disproportionate to their numbers. But in the first several years after the war, assertions that these were the aftereffects of combat were met with great skepticism. Only as Vietnam veterans aged--and assumed positions of power in veterans' organizations, in Congress, and throughout society--did the idea that veterans' emotional and behavioral problems were often war related begin to win widespread acceptance, which culminated in the American Psychiatric Association's inclusion of posttraumatic stress disorder in its 1980 diagnostic manual.

Since then, the PTSD diagnosis has been extended to rape victims, burn victims, and survivors of floods and earthquakes. But the largest group of PTSD victims by far is children, maltreated kids like Eddie. Yet Perry says the idea that many of these kids are suffering from PTSD "is still not widely appreciated in our field." Psychiatrists and psychologists, he maintains, continue to diagnose kids "who have grown up in the equivalent of a war zone" as having conduct disorders, or attention-deficit hyperactivity disorder (ADHD), or schizophrenia.

Perry, a neuroscientist who has a PhD in pharmacology in addition to his psychiatry credentials, was among a group of Yale University researchers who five years ago found evidence of altered brain chemistry in combat veterans with PTSD. This study and others like it demonstrated that many veterans were suffering from a genuine disorder they could not overcome simply with greater discipline and willpower.

Now Perry hopes the understanding being accorded to veterans will be extended to kids like Eddie, "who so often are thought of just as little brats--or later on, little criminals."

It was physiologist Walter B. Cannon who in 1915 coined the phrase "fight or flight" to describe how the sympathetic nervous system reacts when the brain perceives a significant threat. The brain first focuses on what it sees as the threat, tuning everything else out. "If you're a cave baby," Perry says, "and you see a saber-toothed tiger and it roars, you immediately pay attention only to that. You quit hearing the birds in the background, the crackling of the fire." (Some scientists call this preliminary concentration of the "fight or flight" reaction the "freeze" stage.) The sympathetic nervous system orders the release of adrenaline from the adrenal glands; the adrenaline gets the heart pumping faster and harder. The pupils of the eyes dilate to improve sight. The liver pours sugar into the blood, and the blood carries it to the heart, the lungs, the central nervous system, and the limbs to increase strength and endurance. The sugar also makes the blood able to clot faster in case of injury. "It's an incredibly wonderful response that we've evolved," Perry says, "and it's been critical to our survival."

The adrenaline and other stress hormones released during "fight or flight" actually change receptors in the brain, Perry says, but the change is usually only temporary and quickly reversed. But when the threat is particularly long or intense or occurs too frequently, the changes may be long lasting; the receptors become overly sensitive, making them likely to overreact to smaller stresses--causing the jumpiness characteristic of PTSD. He says that when this overdose of stress hormones occurs in the developing brain of a young child, the changes in the brain may be permanent.

All children feel stress from time to time, during periods of being hungry, cold, or frightened. Perry says moderate doses of stress in childhood are healthy, training the sympathetic nervous system how and when to respond. Usually a parent or another adult feeds the crying baby or hugs and reassures the terrified toddler, keeping the event from being too traumatic. "But imagine what happens to a child with neglectful or abusive parents. When the child gets hungry, he or she may cry for two hours because the parents are out. And imagine if they wake the child up sometimes in the middle of the night and beat him. Or sexually abuse him. The child is going to be exposed to too much stress hormone--and that's going to change the way the brain develops, so that the child becomes more impulsive, more aggressive. They'll be physiologically tuned up--they'll look like they're in a popcorn popper."

The kids at Saint Joe's are "persistently at least halfway up the slope to the complete stress response," he says. "When anyone is moderately stressed for a long time, they get more irritable, harder to get along with. And that's the case with these kids.

"The brain develops in response to the environment it's in. I see these 13-year-old inner-city kids, and they've been exposed to beatings and shootings their whole lives, and all this other crap--and these kids are hostile, and doing gang signs, and don't trust adults. I think their brains are perfect. They've adapted perfectly to their environment. It's just that their environment hasn't done right by them."

Most child psychiatrists in this country do either clinical work or laboratory research. Perry, who's 37, is one of only a handful who spends a lot of his time doing both. He has seen the effects of child abuse both in therapy sessions and under microscopes. In the last few years he has published dozens of journal articles and textbook chapters on childhood PTSD. Lately he has been speaking on the subject more frequently to groups of nurses, doctors, social workers, and lawyers.

"I have become convinced that I have to be a much louder voice in educating my peers and everyone else about these issues," he says. "There are 1.5 million kids in the U.S. this year who will be physically or sexually abused. It's very ominous. But my friends in Oak Park [where he lives with his wife and five children] have a hard time hearing about the scope of this problem. When I tell them about the stuff I see at Saint Joe's, they can't believe it. People would rather not believe that things are that bad. When a celebrity says they've been sexually abused as a kid, people will say, 'They're doing it to get better ratings.'

"You can't talk about this problem without talking about poverty, drug abuse, teenage pregnancy. By the time you get done talking, you've got eight or ten huge public-policy problems. It's paralyzing--you don't know where to go, how to start, what to do. But our culture will only change when it begins to understand that the development of children is the most critical area of our lives."

Perry has been meeting with philanthropists in recent months, soliciting money for his brainchild, the Center for the Study of Childhood Trauma. The center would disseminate information about child abuse and neglect, and lobby for more research funds. He says that because research money goes to "who's screaming the loudest, who has the most powerful political lobby," and because kids can't vote, few federal dollars are spent on studies of childhood trauma. "We talk about ourselves as a culture that loves children. But there's more political advocacy for spotted owls in this country than for these kids."

When he consults at Saint Joe's two mornings a week, Perry spends most of his time advising staff members how to work with the residents. The counselors and teachers appreciate his laid-back style. They say it's easy to trust Perry's advice, given his lab and clinical experience. What they aren't aware of is that Perry also brings to his work firsthand knowledge of the power of a major emotional trauma.

Perry was born and raised in Bismarck, North Dakota. When he was in fifth grade the drifts from Bismarck's annual blizzard covered his family's one-story house. In North Dakota, he says, "nature is so incredibly overwhelming that you're always humbled. The dominant landscape feature out there is the sky. On clear nights there are places where you can look straight forward and see stars, and you just turn 360 degrees--you don't have to look up at all--and in every direction you see stars. I grew up with a real sense of man as a part of the food chain, as part of a greater whole."

He was the second of four children. His mother, a housewife, was "very expressive and always reinforced that in me, even though it often isn't reinforced in boys." His father, a dentist, is still practicing at 64 ("still plugging away--literally," Perry says). As a child, Perry watched the paying customers who were waiting in his father's anteroom wait longer when a poor Native American came in, because his father would treat the Native American next. "He would tell us that these people had not been treated well--that we stole their land and the least we can do is show them some kindness."

Though Bismarck is the capital of North Dakota, it has half the population of Oak Park. In his teens Perry would get together with friends and wonder what to do. "I ended up sitting around a lot of times, just thinking. I thought about typical adolescent stuff--girls, relationships. But I also thought about God and the meaning of life." When he was in high school, he and his father took an anthropology course at the local junior college. The accounts of life in different cultures fascinated him. So did his readings of works by primatologist Desmond Morris.

Today, in his office at the University of Chicago, a bust of Teddy Roosevelt sits on his desk. "He was kind of a wimpy little kid with asthma," Perry says. "He went out to North Dakota, worked on a ranch for about two years, became a great conservationist, and came back tough as nails. I was a skinny little asthmatic kid myself. I guess I was just real determined." He was especially determined to run track. He taught himself to concentrate on his breathing, to picture his lungs pumping efficiently, and thus to tune out the fears that can worsen asthma. He read a Sports Illustrated article in seventh grade about the self-hypnosis practices of East German swimmers, and incorporated some of their visualizing techniques in his preparation for races. At Bismarck High the skinny little asthmatic set state records in the 100-yard dash (9.6 seconds) and in the 220 (22.0).

Perry says he wasn't much of a student in high school. "I was smart and I loved to read. But I was just so oppositional--teachers would tell me to read something, and just because they told me to read it, sometimes I wouldn't."

He was recruited by Stanford University because of his running, not his grades. He didn't know Stanford was a prestigious academic institution. He just knew that its track coach, Payton Jordan, had been the Olympic track coach in 1968.

During his first days at the university he heard classmates bragging about their grades and test scores; one classmate had gotten a perfect score on his SATs. Perry's roommate described the all-nighters he had pulled studying for tests in high school. Perry couldn't conceive of spending so much time studying. Maybe I'm in over my head, he thought. When he reported to his first class--calculus--the other students looked not only smarter to him, but older. The professor arrived and commenced lecturing without even introducing himself. Perry had taken precalculus in high school but did not recognize the symbols the professor scribbled on the blackboard. Perry's sympathetic nervous system went on alert. He sat like a statue as the professor continued incomprehensibly. How am I going to tell my parents? Perry wondered. What's a good jock school I can go to? After a half hour the prof turned to the class and announced, "Oh, by the way--for anybody who didn't see the note on the door--this is a graduate class in linear algebra. They moved the calculus class down the hall." Perry soon learned that though he would have to work hard, he could cut it at Stanford.

He majored in human biology. His freshman year he participated in a seminar directed by Seymour Levine, a neuroendocrinologist renowned for his findings about the physiological effects of stress. Levine was doing studies that showed that the simple handling of rat pups by a human--for just a minute or two a day, for two weeks--caused changes in the rats' brain chemistry that lasted into adulthood. The handling by a human was stressful for the baby rats, Levine explained, and it was probably stress hormones that brought about the changes. Perry was amazed that stress could have such an enduring effect.

That summer, back in Bismarck, Perry married his hometown sweetheart, Arlis Dykema. In September they took an apartment in a residence for married students on the Stanford campus. On the evening of October 12, 1974, a Saturday, Bruce and Arlis went for a walk on campus. When he was ready to return home to resume studying, she said she wanted to walk some more.

Detectives knocked on Bruce's door near dawn. Arlis still hadn't returned, and Bruce was a wreck. He had searched the campus for her. He had called campus security and asked them to look for her. Now the police wanted him to accompany them to their station to fill out a missing-persons report.

The detectives didn't tell Bruce that Arlis's body had just been discovered by a security guard. The guard had found her under a pew in the Stanford Memorial Chapel, an ice pick rammed in her head. She had been beaten and choked as well, and she was naked from the waist down. The police took Perry to the station and grilled him for two hours: "We know your wife was having an affair and you found out." "She told you she was pregnant and you got angry." Perry was dazed, perplexed, terrified. When the police had picked him up it was chilly, but he had been wearing only shorts and a T-shirt. They hadn't let him pull on pants or even shoes, and he was freezing in the station. "You want a cigarette?" the detectives kept asking him, even though he kept telling them he didn't smoke. "Where's my wife?" he asked over and over, without getting a response. Finally the technician who was fingerprinting him told him what had happened to Arlis.

Perry was released after he passed a lie-detector test. Arlis's killer was never found.

Perry returned to Bismarck for the funeral. Then he left Stanford for several months. He hitchhiked around, staying with friends in Grand Forks, North Dakota, in Colorado, in Atlanta, and in Chicago, where he stayed with a former high school classmate who was attending the University of Chicago.

He spent a lot of time alone, wandering the streets with just a few dollars in his pocket. "I know what it's like to have to hunt for a warm place to sleep, to sleep in a ditch, and to count pennies to see if you have enough to buy a burger at McDonald's," he says.

Friends and relatives had urged him not to think about Arlis's murder. Get right back in school, they told him. Get your mind off of it. "I don't know if it was instinctual or what, but I didn't feel that was what I should do. I had to get in control of what had happened, instead of having the event control me. When anyone is traumatized, they've got to make that transition away from being a victim. Something had happened that was completely out of my control. I had to get away from feeling that because unpredictable, uncontrollable things happen, I might as well not do anything.

"Sometimes I felt like I was going through a movie--I'd have moments where I'd go, 'Jesus--I can't believe this is going on.' I had long periods of pain, and sadness, and of thinking how unfair it seemed. I tried to think about what it was that would make a human being do this. There was a lot of anger initially--but I didn't know where to direct it, since I didn't know what exactly had happened. You sort of had to make something up to get angry at. Then I just quit doing that--it was getting in the way of me being able to move on. When I accepted the fact that death was a part of life, it did not matter that much anymore what the person who killed her looked like or was like."

Perry didn't suffer a prolonged case of jitteriness; he wasn't haunted by hallucinations or flashbacks. He says he thinks he avoided PTSD partly because he dealt with the trauma head-on. Studies have indicated that when soldiers are persuaded to think about and discuss their feelings immediately after combat they develop PTSD symptoms less often. "I was lucky it happened at a point in my life when I could afford to take time off and just go sit in a park and think about what happened."

Unlike young children who are abused, "I had the power to do abstract reasoning," he says. He also had friends and family members he could talk to about what happened. The only people many maltreated kids have to talk to are the ones who are abusing them. "That's why kids end up working through these things behaviorally," he says.

Instead of embittering him, Perry thinks Arlis's slaying strengthened him. He had been "relatively timid, shy" before the murder. Afterward he was "much more self-confident. Because I couldn't imagine anything worse to experience, and I saw I could live through even this and be happy. I felt older. I felt free to be whatever I wanted to be.

"I thought about the external trappings of our culture, and the things we value and don't value. You get caught up in the fact that you're doing well in sports or you're getting good grades. I found that many of the things I cared about doing well at were really pretty empty. I felt freed up from the whole process of getting good grades, or going to a great school, or being the best at this or that. I put more effort into my relationships--because I knew that's what's really enduring. My work is important to me to the degree it has social impact, and a lot of it is focused on our culture acknowledging the importance of relationships."

The sudden loss of his wife ultimately made him a more empathic therapist as well, he says, especially in counseling people who were struggling with the impact of a sudden trauma. "In therapy I try to think very carefully about what the person who's talking to me is really experiencing. To do that, you have to draw upon your own experiences. I've had--unfortunately--a broader repertoire of experiences upon which to piece together this little reconstruction of what somebody else's life must be like."

On July 15, 1976, three masked men brandishing guns kidnapped 26 children and their school-bus driver in Chowchilla, California. The kidnappers drove the children and the driver around for 11 hours in two blackened vans, then buried them alive for 16 hours in a truck trailer. Two of the kidnapped children dug the group out.

Shortly afterward a mental-health-center physician reassured the parents of the children that hardly any of them were likely to be significantly affected emotionally by the experience. But when a San Francisco psychiatrist, Lenore Terr, talked with 23 of the children several months later, they described recurring nightmares and extreme and unusual fears. "They remained permanently on guard," Terr wrote later. "No matter what anyone told them, they seemed unable to trust again." The children were clearly suffering from "psychic trauma," Terr wrote.

Four years later, when Terr interviewed the children again, she found PTSD symptoms persisting in every one of them. Most continued to have nightmares; 12 of the kids reported dreams in which they died. The recurring stomachaches and bladder problems that had begun shortly after the kidnapping continued for some. All but two of the children voiced severe pessimism about their lives. "I think I'm going to die young," an 11-year-old girl told Terr. "I'm sure of this. Maybe 12 years old. Someone will come along and shoot me."

Terr concluded that "children are not more flexible than adults following a pure psychic trauma. Despite the popular wish among the public and the lay press that children will spontaneously outgrow or even improve themselves after such sudden, intense frights, the evidence from Chowchilla is to the contrary."

Perry was in a neuroscience program at Amherst College in Massachusetts at the time of the Chowchilla kidnapping. He had returned to Stanford for the spring quarter after Arlis was killed, but everyone there knew about his loss and gave him "a big sympathy vote" that made him uncomfortable. So he had decided to transfer.

One of Perry's professors at Amherst--a physiological psychologist--had a lab, and Perry started working in it. "He had a whole floor, with a behavioral lab, a neurochemistry lab--it was just great. You had opportunities as an undergrad that you don't get at bigger universities--you'd read the literature, and think of an idea, and order the rats, and do an experiment. It was pretty bad stuff, but it was interesting." His professor was studying how a certain toxin that killed dopamine neurons changed rats. Perry would pick up a rat pup, tip its head back, inject the toxin in the back of its head with a syringe, then compare the rat's behavior and brain chemistry with that of similar rats. "I've always been very, very curious," he says. "What I liked about research in a lab is how you could have a question, and you could think about the best way to answer that question, and you could get a result. Over time I've learned that the best research is research that ends up generating more questions and better questions." He laughs. "And that you really can't get answers like I thought you could."

At Amherst Perry simply studied what interested him; he didn't bother to fulfill requirements for a degree. Nonetheless he was accepted at Northwestern University's medical school in 1977.

One of his advisers at Northwestern had discovered alpha-2 adrenergic receptors, proteins in the membranes of various cells--muscle cells, nerve cells, platelets--that receive signals from, and are changed by, the neurotransmitters released during stress responses. (Neurotransmitters carry messages throughout the brain.) Another of Perry's advisers had invented a procedure for studying alpha-2 receptors directly, using a radioactive probe. Perry's doctoral dissertation in 1984 focused on these receptors.

During a residency in psychiatry at Yale from 1984 through '87, Perry studied the brain chemistry of veterans with major depression. Blood was drawn from them, the platelets were separated out, and the alpha-2 receptors in the platelets were measured. Researchers elsewhere had found more alpha-2 receptors in people with major depression; Perry found fewer. "At first I thought, 'Oh, I fucked up--this research is tough.'" Then he discovered that the depressed veterans in his study had been given secondary diagnoses of PTSD--a diagnosis no one had paid much attention to. Perry and fellow researchers compared the alpha-2 receptors of veterans with PTSD who were not diagnosed as depressed. These veterans too had fewer alpha-2s than the controls. Why was unclear. What was clear was that PTSD was a biologically distinct syndrome.

Researchers at the time wondered why some combat veterans developed PTSD and others didn't. Maybe there was a gene that predisposed certain people to PTSD, some researchers speculated. Perry, recalling animal studies by Stanford's Levine and others, thought the answer was in nurture and not nature. Levine had shown that rats shocked in infancy exhibited exaggerated responses to acute stress in adulthood. Perry reasoned that people who developed PTSD had also suffered acute stresses in childhood--typically physical or sexual abuse--that made them more vulnerable to traumas in adulthood.

In 1987 Perry accepted a fellowship in child and adolescent psychiatry at the University of Chicago. In the lab he continued to study the alpha-2 receptors of adults with PTSD or other mental illnesses. His interest in what predisposed people to PTSD led him in 1989 to his present consulting work at Saint Joe's.

Saint Joe's is across the street from the Douglas Tomb State Historical Site, in the 700 block of East 35th. The four-story stucco structure was built in 1858, and has seen more than its share of PTSD since. It served as a rehabilitation home for injured Union soldiers during the Civil War and for disabled veterans after the war. The Chicago archdiocese bought the building in 1871 and converted it into an orphanage; for a time it also provided temporary shelter for abused women and their children. In 1953 Saint Joe's began extending care to emotionally disturbed kids. That has been its sole function since 1965.

The 30 boys who live here, ages 5 to 15, were referred to Saint Joe's by the Chicago Board of Education and by DCFS because they proved unmanageable at home and even in specialized programs in the board's schools. Their social-history records, compiled by DCFS investigators, are laden with accounts of beatings and molestations by parents, grandparents, foster parents. The boys stay at Saint Joe's for three years on average, until a judge returns them to the custody of a relative or a suitable foster home becomes available. Given the boys' histories of fighting, vandalizing, and running away, foster homes rarely become available. Typically they stay at Saint Joe's until they're 15, and then move on to group homes for older boys.

The residents sleep on twin beds in three dorms, grouped by ages. On weekdays another 45 boys and girls join them in classes in a school on the premises. These children have also been booted out of regular schools, but most of them still live with their parents.

Perry had counseled maltreated children before, so he was not shocked by the case histories of the kids at Saint Joe's. What did surprise him were the social and legal systems responsible for the welfare of these children--how "incredibly ponderous and inefficient and misinformed" they were. What disturbed him most was how frequently psychiatrists in their diagnoses seemed to pin the blame for the kids' behavior on the kids themselves--focusing on their "psychosis" or "conduct disorder" rather than on their tumultuous upbringing. "They were looking at symptoms and not causes," he says. "The fact that a kid could go through evaluation after evaluation and nobody would think that their exposure to violence had something to do with their behavior--it just was astounding to me.

"Sometimes giving the diagnosis is a license to quit thinking about what's going on," he says. "The diagnosis to me isn't as important as getting a complete understanding of the child. But it's rare for someone to be thorough when they evaluate these kids. There are so many kids in the system and so few placements with access to good psychiatric care or good psychological testing. The people who do it for the Board of Education or for DCFS are swamped. It's not unusual for a psychiatrist to be thrown a whole stack of records and to be told that in 40 minutes he has to give the kid a diagnosis and come up with a treatment plan. It's absurd! It takes me months to get to know these kids." The result is kids don't get the kind of help they need, he says. "A kid will have a learning disability, and it won't get picked up for five years. He'll be feeling bad about himself because he can't keep up in school, and so he'll act out and end up in a behaviorally disordered class, where the goal is to keep the kids alive until the next day."

Since the stress response affects the functioning of the brain stem, and the brain stem regulates heart rate, Perry decided to study the heart rates of children with PTSD at Saint Joe's. All of the children in his study had been severely beaten or sexually abused in their early years. While a group of children of the same age had a resting heart rate of 84 beats per minute, 85 percent of the PTSD children had heart rates greater than 94 beats per minute. Forty percent of the PTSD group had heart rates above 100 beats per minute. The kids in the study were asked to lie down for nine minutes, then stand for ten. The heart rates of those with PTSD shot up higher and returned to the resting rate more slowly than the heart rates of the controls. The study shows "poorly integrated brain-stem functioning" in the PTSD kids, Perry says, caused by their overexposure to trauma in early childhood.

Perry then had an antihypertensive--clonidine--administered to 17 PTSD children at Saint Joe's. After four weeks the children's heart rates had dropped from an average of 110 beats per minute to 96. Teachers were asked to chart the children's behavior before, during, and after the four weeks; they found the kids less impulsive, less anxious, and concentrating better during the four-week trial.

Since then Perry has switched numerous residents at Saint Joe's from antipsychotics, or from the Ritalin typically prescribed for those diagnosed as having attention-deficit hyperactivity disorder, to clonidine, which has milder side effects. Of the 17 boys at Saint Joe's who receive medication, 13 take clonidine. "Every kid we have put on clonidine here has had some positive effect," he says. "It would be silly to call this a wonder drug. But for some kids, it is a wonder drug. It tunes them down a bit, so they can respond to stressful events without coming completely unwound." A small but growing number of psychiatrists around the country are now prescribing clonidine for kids with behavior problems, he says.

But while clonidine "makes it easier for a child to cope," Perry says, "lasting progress comes from the child being in a nurturant, predictable environment. That's much more important than any drug. We don't know that well how the brain works, but we know it develops as a mirror to what it's exposed to. It takes what's on the outside and puts it on the inside. If on the outside you have nurturance, structure, predictability, children can build good things inside themselves." At Saint Joe's he tries to help the staff foster such an environment.

"Willie is really a very beautiful child," his therapist, Margaret Eder, says. But "he sees himself as a defective person. He says he never wants to have children because they will be like him."

Ten staff members and Perry are sitting in a dining room in the basement of Saint Joe's around four round tables that are pushed together. It is a Thursday in late January. The teachers and counselors are discussing treatment plans for three residents. Treatment reviews like this one are conducted most Tuesday and Thursday mornings. Reports are given by a boy's therapist, one of his classroom teachers, and the counselor in his dorm. Perry asks and answers questions, assesses the child's progress, and makes recommendations.

You couldn't expect Willie to think much of himself, given his background, Perry tells the group. Thumbing through a fat green binder in front of him, he reminds the staff of Willie's background. (Perry does this routinely in staffings. "A kid may be driving staff nuts," he tells me later. "But when they're reminded how he was sodomized at age two or had a hypodermic needle injected in his penis at age three, it's easier for them to remember where his behavior is coming from.")

Willie, now 11, was 6 when DCFS took him and his two sisters away from their mother. She had been spending her welfare check on drugs and booze while her kids went hungry. She beat the kids too.

Willie was placed in the home of a relative, where a teenage cousin sexually abused him. He was moved to a foster home. After four months his foster parents said they could no longer deal with his constant fighting, his attempts to hurt himself, and his frequent running away. The residential treatment facility to which he was transferred didn't have any better luck. Along with his behavior problems there, Willie began to hear voices and have visions of his mother attacking him with a burning cross.

DCFS placed him in Saint Joe's in September 1989. Perry evaluated him the day after he came to the center. Willie might be schizophrenic, Perry wrote, noting the recent hallucinations. But he also thought Willie's problems might be due to the "chaotic, frightening, hostile and shifting world" in which he had been raised. If so, "we would expect him to begin to do much better in the highly structured and, dare I say 'loving,' environment present at Saint Joseph's."

But since Willie's closest relationships had been "unpredictable, unreliable, and harsh," Perry cautioned that "the more we make attempts to get close to him . . . the more deteriorated he will become." It would take years of nurturing for Willie to relax and trust people, he said.

In Willie's first 16 months at Saint Joe's, he bit, kicked, punched, and cursed teachers and fellow residents almost daily. Then in January '91 he tried to hang himself in a bathroom. He spent three weeks in a psychiatric hospital before returning to Saint Joe's, where he soon returned to his violent ways.

But at the staff meeting this morning, Larry Haskin, a residential counselor, tells the group that Willie has settled down in recent months. "Last night he got mad about something on TV and he had to be restrained--but that's the first time in a while."

Eder agrees that Willie's behavior has improved. When a situation seems overwhelming to him now, she says, he tends to withdraw and sometimes just goes to sleep. "But that's a lot different from what we used to see of Willie, flying into rages 25 times in half a day." She pauses. "Still, Willie is in a state of extreme hyperarousal, always scanning the environment to be sure everything is OK."

When Willie misbehaves now, adds one of his teachers, Sandy Krupa, he usually is able to serve his time-outs in the classroom instead of having to be escorted to another room. He does well in math and in reading comprehension, she says, but he has "extreme difficulty remembering sight words. He's seen the word 'the' for several years now, but he can't read it unless I remind him that it's that funny 'T H' word."

Perry taps the green binder and says, "It's a shame, because clearly he's a bright kid." On a test of nonverbal ability, Willie scored a 12 on a 20 scale, Perry says, "which is very, very bright." But he scored only a 3 on a 20 scale on a verbal test.

High nonverbal and low verbal scores are not unusual at Saint Joe's, Perry tells me later. "These kids learn how to pick up on nonverbal cues much better than the average kid. They see subtle changes in body posture, and they know what they mean--because that's been the only reliable predictor of what's going to happen to them. Mom comes home with alcohol on her breath and she walks a little funny, and those are the times they get hit. She may come home and say, 'Honey, I love you.' But what does the kid learn? You learn that "I love you' doesn't have meaning--that swaying and smelling of alcohol do."

Perry asks Krupa whether Willie has been tested for learning disabilities. Testing had been scheduled last year, Krupa says, but Willie missed it when he was hospitalized after his suicide attempt. Perry recommends the testing be rescheduled. He also suggests that Willie's teachers rely as much as possible on nonverbal mediums for teaching Willie--using computer games, for example. Someone else at the table suggests comic books.

"I'm happy with the way things are going with this kid," Perry tells the group. "When he came in here, he was a mess. And the question was, did he have some sort of endogenous psychotic disorder, or did he have adequate raw material and the capacity to develop normally, but it didn't have the chance to develop because of his early life experiences? And here we give kids the benefit of the doubt." Now it looks like Willie "has the raw material. With the nurturance and the structure and the stability that you all have provided, that raw material has continued to grow, and I think you all should feel proud. The bottom line--keep doing what you're doing."

Many PTSD kids appear psychotic at first, Perry tells me later. Under stress people "revert to the more comfortable, tried-and-true defense mechanisms. When I get really stressed out, I go back to sort of a preadolescent stage--stomping around and fuming. But many kids will regress to incredibly primitive mechanisms--they'll rock and they'll go back to primary-process thinking. Primary process is the way very young children view the world. They make odd associations because they haven't had much experience. A child sees a red fire truck for the first time and hears a siren, and the next time they see anything red they'll say, "Oh, siren."' Because PTSD kids are so easily stressed, they do a lot of this primary-process thinking, Perry explains, which is what leads to them being diagnosed as psychotic and put on antipsychotics.

Martin, age ten, is second on today's agenda. He was four when he was removed from his mother's home. His mother admitted to a DCFS investigator that she regularly beat her son. She also told the investigator that she had been beaten regularly as a child; she said her mother hated her because her complexion was darker than her siblings'. (Willie's mother had been abused by her mother, according to DCFS records. Anyone familiar with the histories of the boys at Saint Joe's, Perry says, knows too well how inevitably "violence begets violence, and sexual abuse begets sexual abusers.")

Martin was shuffled between foster homes for the next five years. In one of the homes some older boys tried to molest him, he later told a therapist; in another he was forced to look at pornography and to sleep with his foster mother; in another his foster parents whupped him regularly for wetting the bed.

In school he often refused to stay in his seat and he bullied other children. He was diagnosed as having attention-deficit hyperactivity disorder and put on Ritalin, but his behavior problems persisted.

Early in 1990 Martin visited several times with his father, who had recently been released from prison, and his father told Martin he might try to gain custody of him. A few months later his father was shot to death. Soon after Martin tried to stab himself with a syringe, then tried to hang himself in a closet. He was hospitalized, and last August was placed in Saint Joe's.

Martin "still has little hope for a happy future and anticipates rejection and abandonment in relationships," his therapist, Margo Tirado, reports to the group.

Such fatalism predominates among kids at Saint Joe's, Perry tells me later. "Kids here don't say 'When I grow up.' They say 'If I grow up."'

Arthur Walker, a residential counselor, says that Martin "has yet to form a relationship with anyone on the dorm. He instigates fights with peers by talking about their parents and giving the middle finger. He's always making sexual comments. He told me he uses the sexual comments and the profanity in place of being aggressive. I've told him, 'Martin, you got to find a different way of expressing yourself.'

"He gets up at six o'clock in the morning and causes people trouble, making sexual comments. I end up just sitting in the lounge with him for about an hour until it's time for everyone else to get up, so I can get ahead of him. You must get ahead of Martin. If Martin gets ahead of you, you're never going to catch him."

A teacher, Susan Staehle, tells how Martin punched her "with all his might" in the stomach a week ago. Since then he's shown nothing but remorse, she says. "He tells me he's so afraid I'm going to hate him. He's always trying to pat my head."

"That's how he often relates to people," says Eric Tomlinson, the director of residential services. "He'll force you into a situation where you have to restrain him or do something authoritative. Then it's like he bonds with you."

Perry says, "What you've all been saying is consistent with what happens when a child grows up with an abusive mother. See, most of these parents, they don't do these things because they're bad, but because they're overwhelmed. They're distracted by their social circumstances--they have no money, no support network. They hit their kid--the kid cries more. So they hit him again, and they end up beating him up. Then they realize they've just beaten the shit out of their child, whom they love--and they feel terrible about it. So they become overly nurturant, overly indulgent. They give them candy. They say, 'Let's go buy you something.'" Abuse and love get confused in the child's mind, Perry says, and the child learns to cause trouble because of the warmth he associates with its aftermath.

In class Martin is "extremely distractable," Staehle says. With his classmates, "he sometimes tries to be friendly but ends up being irritating."

"That's what they used to say about me," Perry says.

"Used to?" Tomlinson says.

Perry has on blue jeans and a beige cardigan sweater over a T-shirt. He is in stocking feet, having slipped out of his loafers, as he tends to do during meetings. He is not an intimidating presence at the staffings. "He's very casual and down-to-earth," Tom Eagan, Saint Joe's program director, says later. "People tend to revere psychiatrists, and some psychiatrists use their position to establish their authority. But Bruce isn't concerned about his 'authority.' His knowledge is commanding in itself."

The third boy being considered today, Jose, is 14. His mother handed him over to the state when he was 9, saying she couldn't manage him. He too was moved from foster home to foster home--sometimes because of problems with the home, sometimes because of Jose's violent behavior. He was placed in Saint Joe's three years ago.

Karlton Shaw, a residential counselor, begins the discussion. Shaw only recently began working at Saint Joe's, and this is his first staff meeting. "The first time you give a report you have to sing it," Perry tells him.

Shaw tells the group that after Jose visited a relative's home earlier this month, $30 was discovered missing from the home. That evening $30 turned up in Jose's pants. "But Jose refused to admit that he had taken the money," Shaw says.

Pam Garfinkel, director of social services, says that Jose recently stole $20 from her. "I know it's not good to label these kids with personality disorders," she says, "but his narcissism is unbelievable."

Jose's teacher, Kay Maurer, reports that "incidents of dishonesty, half-truths, and outrageous excuses continue to occur daily."

But Perry is upbeat in his assessment of the boy's progress, attributing his behavior largely to adolescent growing pains. Jose's insurgence is taking a deviant route because of his troubled childhood, Perry says, but it at least shows "he's continuing to develop in some line. He may take a real aberrant course for a while. But just like we're amazed this stuff is happening now, the good stuff will come out sometime too. I have no doubt that this kid will be healthier eventually because of what he is getting from all of you here."

The teachers and counselors at Saint Joe's need frequent reassurance, Perry says later, particularly the staff members who work with adolescents. "It's very frustrating for people to work hard with a kid for three or four years, do stuff above and beyond the call, and then have the kid treat them like dirt. Really what the kid is doing is acting out those earlier conflicts with their major adult relationships. That wasn't a big issue for them when they came here at [age] eight or nine; then they were working on their relationships with peers. So I need to remind them that the good stuff they've given a kid will reemerge once they've gotten through this rocky period.

"The people who do the front-line work at a place like Saint Joe's have extremely difficult jobs," he says. "They take an incredible amount of abuse from these kids. Anybody who's a parent who has a difficult child or a child who has a period when they're difficult--imagine that from eight kids all day long. By giving the staff some support, I think I make them more effective with the children."

But Perry says he isn't just blowing smoke when he tells staffers the kids here can do better one day despite their wretched upbringings. "People have strokes and they recover functioning," he tells me. "The brain is incredibly resilient."

After the treatment review ends and most staffers have left the dining room, a teenage boy carrying a small green Marshall Field's shopping bag approaches Perry. He pulls two packages in red gift wrap from the bag and hands them to Perry. Smiling shyly, he says something softly to Perry, then quickly leaves.

In December Perry had left boxes of Frango mints in staffers' mailboxes as holiday presents. A couple of the boxes disappeared before the staffers got them. Earlier this month the teen, who had stolen the mints, had left Saint Joe's to live with his grandmother. But he had felt guilty about the theft, and so had bought two replacement boxes out of his own money.

"You hear a lot about how these kids have no remorse," Perry says. "This kid could have gotten away with it. Or he could have just said, 'I did it, and I'm sorry.' But he chose to make it right by going out and replacing them. That's a good sign."

The amount of stress isn't the only factor in PTSD, Perry says, but also its consistency. Rats who are shocked and exposed to loud noises at erratic intervals as pups overreact dramatically to the same stresses as adults, he says. They also have more difficulty learning certain tasks as adults. Rats who aren't ever shocked as pups function adequately when stressed as adults. But the rats who handle stress best when they're grown are those who were stressed on a regular schedule as pups.

"If you're almost never stressed as a kid, you're not going to be able to handle stress later," Perry says. "We see this sometimes in kids who are completely overprotected. The best thing is a consistent, controlled exposure to novel events. A child who's just started to walk will go out and explore, and he'll get to the point where he can be out of the view of Mom. Then something will happen--he'll pull down a pot or pan and it'll make all this noise, and he'll run back to Mom and get soothed. He goes exploring again, gets stressed, gets soothed. The systems in the brain involved in the stress response are getting exercised but not overloaded."

The combat veterans he has counseled "hated worst sitting in camp between patrols, because sometimes they'd get shelled, sometimes they wouldn't. Predictability is interwoven with control. If you feel you have control over an event--even one that would ordinarily be traumatic--it's going to feel less stressful."

That's another reason kids with abusive parents often provoke their parents into hitting them--so at least they have control over when it will happen. One client Perry tells about--a woman in her 20s--had an alcoholic father who beat her frequently when she was a child. "Some nights it would happen, and some nights it wouldn't. She would be sitting upstairs when her father came home, and she wouldn't know whether it was going to happen or not--and she couldn't get anything done. So she would go downstairs and provoke him into hitting her, so that she could go back upstairs, knowing it was done for the night, and do her homework."

That's why Perry emphasizes the importance of a consistent, predictable environment to staff members at Saint Joe's. He also urges the staff not to be overly authoritarian. "A lot of the kids here were serially abused by adult males. So any interaction with a man they perceive as threatening in any way causes them to unravel. It's like how a veteran gets cold sweats from hearing a helicopter. The child will get more anxious and more oppositional.

"Let's say a male teacher tells a child, 'Get in line--it's time to go to class,'" Perry says. "Sometimes his body language or tone of voice will make the child feel threatened, and he'll say no because of that. If the staff member doesn't understand what's happening with the child, he'll say 'You have to get in line' in a more threatening way. So the child gets more defiant. Pretty soon the whole thing has escalated, and the child may end up in restraints. It looks like what the staff member did was totally appropriate, but what it looks like doesn't matter--it's how the child perceives things. The staff members here have been taught that when the child says no, they sometimes have to back off, say, 'OK, you have a choice--you can get in line, or why don't you go over to your area and take a few minutes to pull yourself together?'"

Program director Tom Eagan, who has worked at Saint Joe's for ten years, says Perry's ideas have helped the staff work more productively with the residents. "It makes a big difference if you understand that a kid may be reliving a past traumatic episode, as opposed to thinking he's just a bad egg or a budding sociopath. If you understand that the kid needs to settle down inside, and you're firm and calm, you tend to get much better responses than if you're confrontative.

"If you don't understand why a kid is acting a certain way, it's hard to temper your reactions to it," Eagan says. "Because they do provoke. They do degrading things to staff--call them names, spit on them, assault them. It's hard not to get angry about it. You tend to want to overpower the kids. When you understand why a kid is acting the way he is, you don't take it as personally. And you know how to help the kid get control over it. I might tell a kid who's being combative 'Pay attention to your breathing, your heart's racing'--try to make him aware of his internal state, so that he can get himself back under control instead of depending on me to do it for him."

While Perry believes the kids at Saint Joe's will benefit from their time here, he knows it won't completely offset the damage done in early childhood. "These kids may appear nonschizophrenic and nonpsychotic while they're here. But I would suspect that many of them as they get older, and they're no longer in such a nurturant, stable environment, will revert to more primitive ways of dealing with things. What you hope is that they'll find a niche: get work as a night watchman, find someone in their world who's really kind to them--someone in church or a social worker--who can provide the nurturance and stability they need. People who get a lot of nurturance and stability when they're younger don't need as much when they get older. But the people who didn't get it when they were small continue to need it."

Cross-cultural studies have shown that "people with emotional or mental illnesses do better when they have a network to fall back on," Perry says. "Schizophrenics tend to do much worse in Western cultures like ours than in primitive cultures, where there are tight-knit families and people are part of a small village. Most of these kids have been cut loose from families and friends and set adrift. The long-term outlook for them is not bright."

Perry says he is "very grateful" to be working at Saint Joe's. "I think most of us in academics are pigs. We spend our whole lives indulging ourselves--making ourselves smarter, publishing our papers, getting money for our labs. And we think we're doing a favor back when we teach people or do a little bit of clinical work. These kids at Saint Joe's--I help them a lot. I feel fortunate that there's an environment where I can do that without having to sacrifice my own piggish goals.

"It brings you back to earth to walk into one of those dorms, and be pissing and moaning about the fact that your car has a flat, or a paper got rejected, or a grant didn't get a fair reading--and see how these kids live, how profoundly difficult their lives are."

Some of Saint Joe's donors throw a Christmas party for the residents every year. At one of these parties Perry watched a nine-year-old boy approach one donor, a wealthy woman. Before this child had come to Saint Joe's, at age five, Perry says, he had "basically been a trash-can kid, dumped by everybody in his life." At the party the boy grabbed the woman's hand and walked her over to his cubicle. "He told her, 'I want to show you where I live.' He showed her his bed and his desk, with a few of his drawings on it. He told her, 'Look at this--see how special I am that I have this.' This lady had more on her ring finger than had been spent on this kid in the last five years--and he's telling her how wonderful he was to have this little space. Not all of the kids feel that way--a lot of them feel really alienated. But this kid was able to take those few shreds of material things, and the other elements of being at Saint Joe's, and build some self-esteem around it."

Researchers working for Perry at the U. of C. have been reviewing the histories of children at Saint Joe's and in similar facilities, studying the relationship between the age of the children when first traumatized and their subsequent symptoms. According to the early results, children abused in their first three years "look more psychotic," Perry says. "They'll have more thought disorders, and they're more likely to hallucinate. They'll also have more pervasive delays in physical growth, and social, emotional, and cognitive development." Kids who are abused mainly in middle childhood "tend to be anxious, to have more depressive symptoms and more aggressive-conduct disorders."

Kids who were physically assaulted tend to be physically assaultive, the study indicates, and kids who were sexually assaulted tend to be sexually assaultive.

The biology researchers in his lab have been taking "tiny brain balls you can barely see" from embryonic mice, and growing them in cultures. The brain balls are kept in beakers, in a liquid that helps support them. Then soluble cocaine is pipetted into the liquid of some of the beakers. The growth of neurons, receptors, and neurotransmitters in the brain balls exposed to cocaine is measured and compared with that of the brain balls not exposed to cocaine. That the drug changes brain development is already clear; exactly how is not. "It depends on when it's given and in what dose. There are times when you give it and you'll end up with more receptors, and other times when there'll be fewer. What we do know is anything that changes normal development of the brain typically leads to a less functional brain." Perry plans to some day expose embryonic mouse brains to stress hormone instead of cocaine, to further test his belief that an excess of stress hormone hampers normal brain development.

Perry says the cocaine study shows how complicated and difficult to fathom the brain is. Despite many advances in recent years, our knowledge of how the brain works is still primitive. "The brain has a hundred billion neurons, and ten times as many glial cells [small cells that provide nourishment and support for neurons], which play major roles in lots of regulatory functions of the brain. You're talking about billions and billions of cells. And they're continually communicating with each other--they're continually turning off certain genes and on other genes, making slight changes in their structure. When you study the brain, you may have very big goals. But you have to be satisfied with answering very small questions."

Perry won't be looking for answers in Chicago for long. He leaves the city in July for a position with the Baylor College of Medicine in Houston. He will be chief of psychiatry at Baylor's Texas Children's Hospital and associate chairman for research in the Baylor College of Medicine's psychiatry department. He will also direct a PTSD program out of the Veteran's Administration Medical Center. All these positions will allow him to do long-term studies of a variety of people with PTSD--combat veterans, rape victims, and, of course, kids. He also hopes to turn his attention to more positive subjects eventually--such as how a healthy mother-infant relationship leads to a healthier nervous system.

Perry thinks that doing clinical work and basic lab research makes him better at both. "There are many things you can study in the lab, all of them fascinating. But some of them don't have a lot of bearing on human existence. When you're also working clinically, you're more likely to focus on relevant questions in the lab. And the lab research I do makes me more cautious in my clinical work. I know that a lot of what we do clinically--like the way we prescribe medication for the brain--is more a product of heritage and tradition than fact."

Research "gives you the power to make better decisions about things," he says. "I think the weight of truth about the way things work ultimately drives the way things will be. Two hundred years ago there were concepts in the scientific literature that Africans were inferior. But over time the weight of scientific evidence has played a major role in making people understand that that's absurd. It's the same with what we're doing: the more we understand about how the brain develops, the better position we're in to know how to prevent maladaptive development. That will have impact on a wide array of public-policy issues.

"I think the more that the people in positions of power--teachers, physicians who work with these kids, social workers--understand what's going on, the more empathic they'll be with these kids," he says. "It's only through empathy that you can be sustained to do the work necessary to change things."

But it's a lot easier, he says, to get funding for other kinds of research--his cocaine studies, for example--than for a study on child abuse and neglect or childhood PTSD. "It makes me real angry, because the number of cocaine babies is dwarfed by the number of kids brought up in these violent, chaotic settings that are a product of poverty. But poverty isn't a sexy enough issue."

That's the main reason he's trying to start the Center for the Study of Childhood Trauma--to organize researchers in this area and pressure federal sources for money. The center, as he envisions it, would also improve communication between the different disciplines that work with abused kids. "There's a whole group of people who study sexual abuse--psychologists and social workers who have their own publications and organizations and books about how to treat the kids. But by and large they don't know much about biological aspects of this problem. And child psychiatrists or developmental neuroscientists who study these problems don't tend to communicate with the people who do a lot of the frontline work. Many of the people in the legal system don't know much about the problem either. Yet they're the ones who decide where a child should be placed and how a child should be treated.

"We have enough information where if we stopped research right now, we could still very drastically change the way we practice," he says. "But that information has to be disseminated much more quickly."

Even though he's leaving for Texas, Perry plans to have the center headquartered in Chicago at Saint Joe's. He would return to Chicago at least once every two months to consult with the center's advisory board.

Perry spends little time in the lab these days; the experiments he designs are carried out by subordinates. He says he misses seeing the results of an experiment registering in the lab, but not the actual lab work. "Quite honestly, I'm not interested anymore in mixing up buffers or measuring pH, or pipetting stuff into a test tube."

Most of his time is spent reading, speaking to groups, and writing proposals, journal articles, and book chapters. Sometimes he yearns for the days in North Dakota when he had time to sit around and just think. "You go from this appointment to that appointment. That's why everybody says, 'Oh, all these great thoughts come to me when I'm in the shower.' That's the only time you're by yourself and thinking."

Last October he ran in the Chicago Marathon for the third straight year, finishing in three hours and 47 minutes. One reason he runs is that it gives him time to be alone and think. He also frequently doesn't go to bed at all on Thursday nights. After his wife and kids retire, he'll catch up on some writing and reading, and enjoy the time he has to think about his research. Around dawn he'll go for a long run, then he'll shower and head for the office. If he gets sleepy early on Friday and the work he's doing is boring, he'll take advantage of the self-hypnosis training he received in medical school. "I'll put myself into a trance, tell myself, 'You're going to do this work, and you won't get distracted, and it's not going to be difficult, and you're going to enjoy it.' Then I'll just sit down and get it done.

"A lot of the stuff I do--it's not crap, but you gotta play the right game," he says. "You have to publish in the right journals and talk to all the right people just so you can get some leverage so you can do something good. Since I can do that, I'm doing it."

He seldom talks about Arlis's murder. Most of his peers don't even know about it. "When I was younger and the subject would come up with people who were getting to know me, it would blow them away. It was such an overwhelming thing that I would find it would change our relationship. Then, when I decided to get my PhD, I had friends who thought I was doing it because I had all these unresolved issues because of what had happened. People would interpret everything I did in the context of this event, which was really not fair. I mean, I was interested in the effects of stress on development, because of Stewart Levine, a whole year before this stuff happened.

"It was sort of a fluke that I got into PTSD," he says. "I probably would have even if it [the murder] hadn't happened. The reason I've stayed in it probably is not a fluke. I do think that the reason I'm sustained by this area, and work well clinically in it, is because I identify with these people."

Batman is one of Perry's favorite movies. "The film is all about PTSD--Batman's got PTSD," he says. In the movie young Bruce Wayne sees his parents shot to death by a robber in an alley, and he grows up to be Batman. "Kim Basinger asks him why he does his caped-avenger thing," Perry says. "And he tells her, 'Because I can.'"