What Happened to You? Conversations on Trauma, Resilience, and Healing (2021) is a best-selling book written in collaboration between Oprah Winfrey and Dr. Bruce D. Perry. It examines how individuals can understand themselves and others better through the lens of childhood adversity and trauma, offering scientific insights on the impact of traumatic experiences on human behavior.

Oprah Winfrey is an American talk show host, author, and philanthropist, best known for her television show The Oprah Winfrey Show. The recipient of multiple accolades and awards for her work in media, including Emmy, Tony, and Peabody nominations and wins, she has also co-authored multiple books on aspects of her own life. What Happened to You? similarly contains several personal anecdotes reflecting Winfrey’s own experiences with and insight from trauma.

Bruce D. Perry is an American psychiatrist and renowned brain and trauma expert. He has worked as both clinician and academic in hospital and education settings, in addition to serving as a consultant in high-profile incidents involving children with trauma. Perry has authored hundreds of journal articles, book chapters, and scientific proceedings, and co-authored several full-length books. What Happened to You? is his third such collaboration.

This guide is based on the Pan Macmillan Kindle edition.

Content Warning: This book contains mentions and descriptions of self-harm and physical and emotional abuse, violence, and trauma.

Plot Summary

In the introduction of the book, Oprah Winfrey recalls being “whupped” by her grandmother, and how other such forms of discipline had a profound impact on her, growing up. She credits these experiences with developing in her a need to explore and understand her own and others’ stories of trauma so that she might recalibrate, heal, and move forward with her life. Dr. Bruce D. Perry, in turn, recounts the beginning of his association with Winfrey, and the more than three decades that he has spent in conversation with her about topics like developmental adversity, stress, resilience, and healing. Subsequent chapters of the book each begin with an anecdote, offered by either Winfrey and/or Perry, followed by a conversation between the two. Perry disseminates information about the biological and psychological underpinnings of the experience of trauma, its impact, and the path to healing, while Winfrey’s questions and input guide the trajectory of the conversation.

The first chapter explores the structure and function of the human brain with respect to how it develops from infancy to adulthood, and how it receives and processes information in these years. Perry explains how early memories play a disproportionate role in shaping an individual’s behavior and personality in a very real, tangible, and physical way. An explanation of brain structure and its four segments given through the examples of Mike Rosenman, a war veteran with post-traumatic stress disorder (PTSD), and a young boy named Samuel with a history of physical abuse, illustrates how sensory memories influence the way one receives, categorizes, and reacts to information about people and environment.

The second chapter examines the idea of seeking balance, and how humans achieve this in their lives. Perry explains the importance of rhythm and relationships in the process of regulation, and how these intertwine with the sense of reward, especially in a young infant’s experience. The lack of healthy and predictable caregiving interactions in one’s early life can lead to dissociation as a response to escape the pain of neglect or trauma; this can lead one to seek out unhealthy regulatory behaviors in keeping with the feeling of dissociation or escape, such as addiction. Perry emphasizes that ultimately, the most powerful form of reward is relational, and that connection and relationship have the most power to restore balance in an individual’s life.

The third chapter focuses on how love and caregiving, particularly in the early years, have a profound impact on the formation and development of the human brain. This influences attitudes, behaviors, and even personality, as one progresses through life. In this context, Perry explains the neuroplasticity of the human brain, and how experiences such as receiving love can shape neural networks. He also tracks the sequential development of the human brain and the various stages of response to stress. With the example of Jesse, a young boy with a history of physical abuse and a resultant brain injury, Perry demonstrates how an individual can have multiple stress responses to different evocative cues based on the state they were in when they initially experienced the traumatic event.

The fourth chapter explores the spectrum of trauma with respect to several aspects of its experience and lasting effects. Winfrey and Perry provide a means for the reader to identify traumatic experiences in their own life, as well as key moments and experiences that have shaped who they are in the present. The authors also discuss healing from trauma, concluding that a survivor’s search for reinforcement and validation of their reactions and feelings will help the healing process.

The fifth chapter looks at the relationship between individual history and present physical and emotional states so readers may draw connections between their past experiences and their present way of functioning. Through explanation of concepts such as transmissibility and epigenetics, Perry demonstrates how fear, and its subsequent effects, is passed down across generations. He also establishes conclusive links between trauma and its effects on physiological health.

The sixth chapter examines how neglect can be as toxic and damaging to a developing brain as trauma. Perry explains the difference between neglect and trauma as the lack of essential experiences that help form basic neurobiology in case of the former, and the addition of a negative event or experience that stresses and damages existing neurobiology in the case of the latter. Winfrey and Perry also discuss some of the ways in which people attempt to cope with the impact of trauma or neglect, and the proper role of therapy in these instances.

The seventh chapter focuses on the idea of post-traumatic wisdom, and the factors that help an individual move from a state of traumatization to “typical,” and ultimately “resilient,” as they arrive at this wisdom. Perry discusses how certain aspects of the modern world can inhibit this process for individuals looking to heal from trauma.

The eighth chapter returns to the structure and function of the human brain with respect to how biases are formed and expressed in the brain, and how these biases impact social systems and institutions. In examining the human brain and implicit biases, Perry also touches upon the need for a trauma-informed approach at an individual and societal level in all kinds of human interaction.

The final two chapters discuss the experience of “relational poverty” in the modern world, as Perry recounts his learnings from spending time with the Māori community and their approach to connectedness in the context of healing. The authors discuss how increased connectedness and awareness in the world will help with healing and moving on from trauma. The book concludes with Perry’s update on Jesse, the young boy with the brain injury, and his journey of healing. Winfrey recounts her experience of forgiving her mother on the latter’s deathbed, and urges readers to both forgive and release past traumatic pain in order to truly heal and arrive at post-traumatic wisdom.