The Child Who Became What the Adults Saw
When Neglect Is Misread as a Deficit in the Child
There are children who are described early with words that begin to stick.
Difficult.
Restless.
Delayed.
Aggressive.
Withdrawn.
Unwilling to learn.
Brain-damaged.
Words can be necessary. They help adults describe what they see, seek support, and find appropriate measures. But words also shape the gaze. Once a label has taken hold, we easily begin to see the child through it.
The child is no longer a child who is struggling.
The child becomes a difficult child.
Not a child who has learned that adults are dangerous.
But a child who lacks the capacity for attachment.
Not a child who has never been given the opportunity to develop language.
But a child with severe language difficulties.
Sometimes the words describe something real. Children may have congenital differences, developmental conditions, illness, or brain injury. It would be just as wrong to explain everything through upbringing and environment as it would be to explain everything through the child.
But sometimes the diagnosis becomes a full stop before the story has been heard.
We ask:
What is wrong with this child?
Before we have asked:
What has this child lived through?
There is a difference between these questions that can change an entire life.
The Boy in the Cage
The psychiatrist Bruce Perry was once called to a children’s ward to meet a six-year-old boy. The boy’s name was Justin.
The staff described him as uncontrollable. He was aggressive towards anyone who came near. He threw food and faeces. He wore only a nappy, could not speak, and rocked back and forth while making small sounds in his throat.
They said that he behaved like an animal.
On the ward, he had been placed in a cage.
There was no proper social history. No coherent account of where he had grown up, who had cared for him, or what his days had looked like.
It was as though the boy had arrived at the hospital without a past.
But no child arrives without a past.
Justin had been born to a fifteen-year-old mother who disappeared when he was two months old. He then lived with his grandmother. When she died, he was eleven months old. He was left in the care of her partner, Arthur.
Arthur does not appear to have been someone who consciously wished to be cruel. But he knew little about children. He did, however, have dogs and understood how to care for them.
So he treated Justin in the same way.
The boy was placed in a dog cage. He was fed with the dogs. His nappy was changed. His most basic bodily needs were, in a limited sense, attended to.
But a child needs more than food and a dry nappy.
A child needs faces that respond.
Hands that lift.
Voices that speak.
Floors on which to crawl.
People to imitate.
Play, touch, rhythm, eye contact, language, and repeated experiences of the world responding when the child makes a sound.
Justin lived in the cage for approximately five years.
When he was two years old, Arthur took him to a doctor because his development was slow. The doctor found that the boy’s head was small and arranged for brain imaging. The scans showed severe cerebral atrophy. His brain resembled that of a person with advanced dementia.
The conclusion was that the boy had a serious brain injury of unknown, perhaps congenital, origin.
No one investigated how he lived.
Several doctors saw him over the years. They saw the child who did not walk, did not speak, and did not develop as children were expected to develop.
But they did not see the cage.
The Visible Child and the Invisible World
This may be one of the most fateful features of work with children: the child is visible, while the conditions of the child’s life are often hidden.
The child sits before us with their behaviour.
The home is somewhere else.
The history exists in rooms we have never entered.
The relationships do not necessarily reveal themselves in the consulting room.
It therefore becomes tempting to place the explanation inside the child.
The child is restless.
The child is aggressive.
The child lacks language.
The child has poor impulse control.
All of this may be accurately described. But the description does not tell us why.
When the surroundings disappear from view, the child’s adaptation may be misread as the child’s nature.
A child who has learned to remain silent in order not to wake a violent adult may be described as withdrawn.
A child who attacks before anyone comes close may be described as aggressive.
A child who constantly monitors doors, faces, and sounds may be described as unable to concentrate.
A child who does not seek comfort may be described as emotionally cold.
A child who cannot learn may be described as intellectually limited.
But perhaps the child is using all their attention simply to survive.
The behaviour may be problematic in the world the child now inhabits. But it may have been meaningful in the world in which it developed.
This is not the same as romanticising symptoms.
Aggression can harm others.
Withdrawal can hinder development.
Lack of trust can make help difficult.
But if we merely try to remove the behaviour without understanding what it once protected the child from, we risk treating survival itself as illness.
What Is Wrong with You?
The question “What is wrong with you?” does not have to be spoken aloud in order to shape an encounter.
It may be present in the assessment.
In the form.
In the report.
In the gaze that first notices the deviation.
Children sense how adults understand them.
They notice whether the adult meets them as a problem to be corrected or as a human being trying to live with something difficult.
A child who is repeatedly treated as difficult may begin to see themselves in the same way.
I am the one who ruins things.
I am the one no one can bear.
I am the one who cannot learn.
I am the one who does not belong.
In this way, the adult’s description can become part of the child’s identity.
The child becomes what the adults see.
This does not mean that professionals should avoid describing difficulties. Children need precise assessments in order to receive appropriate support. But the description must never become the whole child.
We must be able to say:
This child hits.
Without saying:
This is a violent child.
We must be able to say:
The child has great difficulty forming trusting relationships with adults.
Without thinking:
The child is incapable of love.
Language can open understanding.
But language can also close it.
What Happened to You?
Another question opens another world:
What happened to you?
This does not mean that the child can necessarily answer.
Young children cannot tell their life stories. Some do not remember. Others lack the words. And some do not know that what they have lived with is different from what other children experience.
The question is therefore not only something we ask the child.
It is a stance we bring with us.
We investigate the history.
We ask who was there.
How the child was comforted.
What happened when the child cried.
Where the child slept.
How meals took place.
Whether anyone spoke to the child.
Whether the world was predictable or chaotic.
Whether the child lived with fear, loneliness, or pain.
Such questions do not make diagnoses unnecessary. But they place them within a context.
A brain does not develop in a vacuum.
Language develops between people.
Trust is formed through repeated experiences.
Self-regulation begins when someone else helps the child to regulate.
The child learns calmness by borrowing another person’s calm.
If this was absent, the child cannot simply be blamed for lacking the result.
When Perry Saw the Cage in the Boy
When Bruce Perry met Justin, he tried to imagine how the world must look from the boy’s position.
He approached slowly.
No sudden movements.
No forced eye contact.
A low, rhythmic voice.
Food offered without demands.
Perry did not treat the boy as an animal. But he understood that Justin had learned about the world through a life among dogs and behind the bars of a cage.
He had to begin where the boy was.
Not where a six-year-old ought to have been.
This is a crucial difference.
Adults often measure children against what is expected:
A six-year-old should be able to speak.
A six-year-old should be able to eat with a spoon.
A six-year-old should understand instructions.
A six-year-old should be able to sit still.
When the child cannot do these things, the distance between the child and the norm becomes the problem.
Perry began somewhere else:
What has this boy actually experienced?
What does he perceive as danger?
What can his body tolerate?
How can contact be built without frightening him?
He did not enter the room demanding normality.
He entered with a willingness to understand.
After a short time, Justin took food from his hand.
Then he began to show trust.
This was not a miracle in the sense that everything suddenly became well. But it was a sign that something within the boy could still respond when the world around him changed.
The Child Was Not Empty
Children who have experienced severe neglect may be described as though something fundamental is missing within them.
A lack of attachment.
A lack of empathy.
A lack of language.
A lack of social understanding.
Some of these descriptions may be professionally accurate. But they can also create the impression of emptiness.
Justin’s story shows something else.
He was not empty.
He had been shaped by the life he had been given.
He had learned smells, sounds, movements, and ways of obtaining food that suited his world. He had developed, but in the direction permitted by the experiences available to him.
When the environment changed, the boy also began to change.
He came out of the cage.
He began to smile.
He listened to human voices.
Within a relatively short time, he took his first steps. He learned to eat with a spoon, brush his teeth, and put on clothes.
Later, he began attending preschool and lived a life more like that of other children.
This does not mean that severe neglect can always be repaired quickly. Many children carry its effects throughout life, even after receiving good help. The story must not be used as a promise that love alone heals everything.
But it does show that what had been understood as a fixed deficit within the child was, to a significant degree, connected to a world without human stimulation.
The boy did not merely have a damaged brain.
He had a brain that had not received what it needed in order to develop.
The difference is decisive.
The first understanding points towards a child who is fixed and unreachable.
The second points towards a child who may still respond to new experiences.
The Brain as History
We sometimes like to think of the brain as an organ that either functions or does not function.
But the brain is also a history.
It is shaped through what the child experiences repeatedly.
Safe faces.
Calm voices.
Touch.
Play.
Fear.
Pain.
Unpredictability.
Absence.
What is repeated creates pathways.
A child who continually lives in danger develops a brain prepared for danger.
This may be a strength within a threatening environment. The child notices small signals, reacts quickly, and sleeps lightly.
But when the child later enters a safe place, the body may continue behaving as though danger is near.
The adult sees overreaction.
The child experiences readiness.
The adult sees poor impulse control.
The child’s body is trying to survive.
The adult sees resistance to closeness.
The child is protecting themselves from something that once caused pain.
This does not mean that everything can be explained by the brain. A human being is more than their nervous system.
But knowledge about the brain’s capacity to change can help us understand that experience settles in the body, and that new experiences can also create change.
The child does not only need to know that they are safe.
The body must experience safety, again and again.
When the Diagnosis Conceals the History
A diagnosis can bring relief.
At last, there is a name.
Parents, teachers, and helpers may understand more. The child may gain access to rights, support, and treatment.
Diagnoses are not the enemy.
But they can become dangerous when they are used as complete explanations.
A child receives a diagnosis related to attention difficulties.
Sleep problems, fear, and chaos at home may then disappear from view.
A child receives a developmental diagnosis.
A lack of stimulation or severe neglect may then be overlooked.
A child is described as having an attachment disorder.
We may then forget that the child’s mistrust could be an accurate response to adults who truly were not trustworthy.
The diagnosis describes the child.
The history explains how the child arrived there.
We often need both.
But if the diagnosis causes us to stop being curious about the child’s life, it becomes a lid.
The child is reduced to a category.
What is unique disappears.
The professional must therefore continue asking:
What does this diagnosis explain?
And what does it conceal?
The Moral Danger of Placing the Fault in the Child
When the problem is placed inside the child, the surroundings are more easily released from responsibility.
The school does not have to ask whether the child feels safe.
The family does not have to be examined.
The institution does not have to change.
The child must be treated, regulated, and adapted.
This can acquire moral significance.
The child becomes responsible for reactions created within relationships over which the child had no power.
A child who has learned violence is punished for hitting.
A child who was never met with language is criticised for lacking words.
A child who was ignored is described as attention-seeking.
A child who has experienced adults disappearing is blamed for clinging to or rejecting new caregivers.
Again, boundaries must be clear. Violent behaviour cannot be accepted simply because the child has been exposed to violence. Other children and adults must be protected.
But the boundary must be accompanied by understanding:
“I cannot allow you to hit.”
And at the same time:
“I know that your body reacts quickly when you become frightened. I will help you.”
This is different from:
“There is something wrong with you.”
The Adults Who Did Not See
It is easy to read Justin’s story and ask how the doctors could have failed to investigate his home.
How could a child come into contact with healthcare services several times without anyone asking where he lived?
How could a severely underdeveloped boy be sent back to a cage?
In retrospect, the failure seems obvious.
But perhaps the story should first make us cautious about our own gaze.
What are we overlooking now?
Which explanations do we take for granted?
Which children are returned to environments we have not investigated carefully enough?
Which symptoms do we treat without asking what they protect against?
Professionals always act on limited knowledge. No one sees everything. And it is easy to be wise afterwards.
That is precisely why we need ways of working that protect against our blind spots.
A social history.
Interdisciplinary collaboration.
Home visits.
Conversations with several caregivers.
Observation over time.
And the basic curiosity:
What does the child’s world look like when we are not there?
When Neglect Does Not Look Evil
Arthur may not have described himself as someone who abused a child.
He gave Justin food.
He changed his nappy.
He took him to a doctor when he became concerned about his development.
Perhaps he believed that he was doing the best he could.
This does not make the neglect less serious.
But it shows that harm does not always arise from conscious cruelty.
Children may be damaged by adults who lack knowledge, capacity, support, or understanding.
A person may mean well and still cause grave harm.
This matters because we often search for the evil person.
If no one appears cruel, we may underestimate the situation.
But the child’s needs are not determined by the adult’s intentions alone.
Care must be assessed according to what the child actually receives.
Does the child receive protection?
Contact?
Stimulation?
Comfort?
The opportunity to develop?
An adult may lack harmful intentions and still be incapable of providing adequate care.
This is painful to acknowledge.
But the child cannot wait for the adult one day to become better at meaning well.
Beginning Where the Child Is
A six-year-old who has lived in a cage cannot be treated as though he merely lacks discipline.
A child who has never learned safety cannot be commanded to trust.
A child who has not developed language cannot be punished for failing to explain.
Help must begin where the child is.
This sounds self-evident, but it is difficult in practice.
Adults often begin where the plan is.
The school begins with the curriculum.
The institution with its routines.
The therapist with the method.
The foster home with its expectations of family life.
The child is expected to enter a world that already exists.
But traumatised and severely neglected children often need the world to move slightly towards them first.
The pace must slow down.
Demands must be adjusted.
Contact must come before correction.
The adult must ask:
What can the child tolerate now?
What creates distress?
What may offer a small experience of mastery?
How can we repeat safety until the body begins to believe in it?
Beginning where the child is does not mean remaining there.
It means making further development possible.
Safety Before Learning
A child who lives in danger is preoccupied with danger.
The child watches faces.
Voices.
Doors.
Movements.
The child assesses who is angry, who will disappear, and when the next unpredictable event will come.
There is then little room for letters, numbers, and new concepts.
Adults may interpret this as lack of motivation.
“He does not want to learn.”
But perhaps he cannot learn at that moment.
Not because the ability is absent, but because the brain is using its resources for something more fundamental.
Am I safe?
Will someone hurt me?
Will I be abandoned?
Will I receive food?
The child does not first need stricter demands.
The child needs a world calm enough for attention to become available.
Safety is not a reward the child receives after behaving well.
Safety is the condition that makes regulation, learning, and participation possible.
The New Experience
A child who has lived with neglect does not change simply because they are moved.
The old world remains in the body.
The child expects the new adult to fail.
For food to disappear.
For love to be withdrawn.
For touch to cause pain.
For rules to change without warning.
The child may therefore test the new world.
Hide food.
Destroy things.
Reject care.
Lie.
Steal.
Attack anyone who comes close.
The adult may experience this as ingratitude.
“We give you everything, and this is how you respond.”
But perhaps the child is investigating:
Will the food truly be here tomorrow?
Will you remain when I am difficult?
Does care depend on my behaving well?
Can I trust that this world is different?
The answers are not given mainly through words.
They are given through repetition.
The meal comes.
The adult returns.
The boundary is set without humiliation.
The conflict ends without the relationship disappearing.
In this way, the child may slowly receive new experiences.
Hope in What Can Still Be Shaped
Justin’s story is dark.
But it also carries hope.
Not an easy hope that says all harm can be erased.
But a hope that human beings can continue to be shaped.
The brain is not finished.
Relationships can gain new meanings.
The body can learn different rhythms.
Trust can grow where once there was only fear.
This hope carries obligations.
If we believe that the child is simply like this, our efforts easily become management.
We limit the damage.
Endure.
Lower expectations.
But if we understand that the child has also become this way through experience, we must ask what new experiences we can offer.
Music.
Play.
Movement.
Rhythm.
Touch on the child’s terms.
Language.
Predictability.
Repeated care.
Not as random activities, but as building blocks in a new relationship with the world.
The Child Is Always More
Even the best historical understanding can become a new form of reduction.
We may move from saying:
“The child is difficult.”
to:
“The child is traumatised.”
That word too can begin to stick.
Suddenly everything is interpreted through trauma.
The laughter.
The anger.
The school difficulties.
The friendships.
The child becomes the trauma story.
But a child is always more.
The child has temperament.
Interests.
Humour.
Will.
Abilities.
Vulnerabilities.
Some things are shaped by experience, but not everything can be explained by it.
Seeing the history does not mean turning the child into a product of history.
It means understanding more without closing the child down.
The child is what has happened, what is happening now, and what may still become.
Seeing with Two Ways of Looking
Perhaps the professional needs two ways of looking at the same time.
One sees the difficulties clearly.
This child cannot speak.
This child hits.
This child cannot manage school.
This child needs extensive help.
The other sees the child behind the difficulties.
What is the behaviour trying to express?
What kind of world made this necessary?
What exists here that has not yet been given the opportunity to develop?
The first protects against naivety.
The second protects against reduction.
Together, they can make help both realistic and hopeful.
We should not pretend that the damage does not exist.
But neither should we turn it into the child’s final identity.
The Child Who Became What the Adults Saw
Justin was long seen as a child with congenital and irreversible brain damage.
The adults found what they expected to find.
A small brain.
A lack of language.
Atypical behaviour.
Minimal development.
Everything confirmed the image of a severely damaged child.
But no one saw the life that had shaped him.
When Perry changed his way of seeing, the question changed too.
Not:
What is this boy lacking?
But:
What has he never received?
Not:
Why does he behave like an animal?
But:
How would a child have to adapt when treated like an animal?
This did not remove the child’s need for treatment.
On the contrary, it made treatment possible.
If the problem lay only in a damaged boy, there was little to be done.
If the boy carried the marks of a damaged caregiving world, a new world might begin to leave different marks.
The Decisive Question
When we meet a child who is struggling, we still need to ask:
What is the child unable to do?
What must be assessed?
What treatment or support is needed?
But we must also ask:
What has the child experienced?
What has the child lacked?
What has the child had to learn in order to survive?
What is the behaviour trying to protect?
And what new experience can we offer?
This is not only a professional question.
It is an ethical question.
Because the way we understand the child determines how we meet the child.
If we see deficit, we will correct.
If we see wickedness, we will punish.
If we see weakness, we may lower every expectation.
If we see adaptation, we may become curious.
If we see pain, we may offer care.
If we see possibility, we may begin to build.
Children are not only affected by what adults do to them.
They are also affected by what adults believe about them.
A child who is met as hopeless learns something about the future.
A child who is met as dangerous learns something about their place among other people.
A child who is met as more than their symptoms is given another possibility.
That is why we must be careful with our gaze.
The child may become what the adults see.
But through new encounters, the child may also discover that they are more.
More than the diagnosis.
More than the behaviour.
More than the neglect.
More than the life that has so far brought these things into view.
And perhaps healing begins precisely there:
When an adult sees what the child has not yet been able to show.
And perhaps healing begins precisely there:
When an adult sees what the child has not yet been able to show.
Author’s Note
The story of Justin is drawn from Bruce D. Perry and Maia Szalavitz’s book The Boy Who Was Raised as a Dog: And Other Stories from a Child Psychiatrist’s Notebook—What Traumatized Children Can Teach Us About Loss, Love, and Healing. Through a series of clinical narratives, the book shows how early trauma, neglect, and the absence of safe relationships can shape a child’s development, but also how new and repeated experiences of safety, rhythm, and human closeness can make change possible. This essay also draws on my own experience from many years of work with vulnerable children and families, and on a fundamental conviction that a child’s behaviour must be understood in the light of the life the child has lived—without reducing the child either to their history or to a diagnosis.
Reference:
Perry, B. D., & Szalavitz, M. (2017). The boy who was raised as a dog: And other stories from a child psychiatrist’s notebook—What traumatized children can teach us about loss, love, and healing (Rev. and updated ed.). Basic Books.
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