Changing the questions we ask on trauma

'What is wrong with you?' – possibly one of the most common questions we hear on a daily basis. So common that a quick Google search for it produces countless results in the form of promptly shareable GIFs of celebrities who have famously uttered those words. This is perhaps not surprising, since the question arguably represents one of the most relatable ways to highlight or joke about the absurdity of one's behaviour. Less readily apparent, however, is how much asking 'what is wrong with you' has also affected the original formulation of mental health and psychological difficulties in the Western world.

For the best part of its history, the focus of psychiatry has been on understanding what made people with mental disorders wrong (or different, abnormal, etc) and finding ways to right it. This way of thinking ultimately led to the widespread blaming and victimisation of people with psychological difficulties, and their social marginalisation in asylums. Thanks to the research and progress made during the late 20th and early 21st century, today's perspective on mental health is far less victimising and more focused on each individual's story and experiences – what happened to them.

Yet we rarely ask someone who shows signs of psychological distress 'what happened to you?'. In fact, intrinsic references to wrong and right still persist. Not only do we use 'what is wrong with you?' as a joke, but we often tend to ask people who are upset 'what's wrong?' as a synonym of 'what happened?'.

It is on this need for a switch from asking 'what is wrong with you?' to 'what happened to you?' that Oprah Winfrey's latest written work begins. Titled after the latter question and co-authored with Dr Bruce Perry, a child psychiatrist and neuroscientist, the book is structured as a long conversation between the two authors on trauma and its effects on people's lives.

Far from being one of Oprah's admirers myself – particularly due to her past endorsement of scientifically controversial figures such as Dr Phil and Dr Oz – it was with a good dose of scepticism that I approached this read. However, I was pleasantly surprised to see that Dr Perry and his research provide an essential evidence-based foundation upon which the exchange between the authors develops.

In fact, the book's structure proves itself to be its biggest strength. Born at the intersection between Oprah's own experiences with trauma (both personal and as a TV host) and Dr Perry's decades-long clinical career, the conversation takes the reader on a journey across the scientific fundamentals of psychological trauma and resilience. These include not only the basic neuroanatomy of the brain along with the role of essential constructs such as attachment, regulation, and connectedness, but also the need for increased general awareness around trauma as well as specific psychoeducation and trauma-informed models of care (e.g. the neurosequential model).

Perhaps most importantly, the book does so in a detailed yet digestible and never overly technical fashion, which keeps itself grounded on the need to speak to lay audiences rather than specialists in the field. This is an often-hard feat to achieve, particularly on the topic of trauma, where a bestseller such as Dr Bessel van der Kolk's The Body Keeps the Score – albeit extraordinary for professionals – may fail to appeal to the wider public due to the density of its language and content.

Ultimately, the combination of Dr Perry's scientific clarity with Oprah's popularity and media outreach appears to be a surprisingly successful recipe that may help the general public increase its awareness and understanding of the impact of trauma on people's lives. As for clinicians, while it might offer limited specialist interest, What Happened to You? shows the potential to represent a valuable self-directed psychoeducation tool to offer patients during their psychotherapeutic journey.  

• Reviewed by Dr Nicolò Zarotti, Clinical Psychologist, Manchester Centre for Clinical Neurosciences (MCCN)