Ladders of Love

Robert Saul, MD explains why adders of love are critical for children, providing support as children and families lift themselves from trauma to a pathway toward restoration, resilience and flourishing.

November 28, 2023

One of the joys of reading is that you never know what pleasure awaits on the next page in a book (visit our BOOKS section here, and/or support Dr. Saul’s book here).

As a physician, I regularly reviewed medical journals and really looked forward to reading about new discoveries or pertinent information to improve care.  I still continue to read a few journals since my job as a physician is never done, even though I am retired from clinical practice.

A few weeks ago I picked up the current issue of the Journal of the American Medical Association (JAMA) to read an article in the section titled A PIECE OF MY MIND. This section features articles about personal issues for health care professionals.  The article in question (Sreeramoju P. Hurting and healing (A Piece of My Mind). JAMA 330(4):319-320, 2023) detailed the intensely personal story of a female doctor’s story of infertility, the eventual adoption of a male child from another country and the sudden death of her husband during the process.1  This highly emotional journey is further punctuated by challenging behavioral outbursts from her son that were very difficult to deal with.

The story is very poignant for me.  In my retirement, I am currently working as a senior advisor to a local children’s home with residential care for children needing special assistance due to any of a number of circumstances.  We are looking at ways how we can use/enhance the approach of trauma-informed care for each child and family in our care.(See here for context from Dr. Saul’s blog)

The JAMA article provided further insight into the complex issues ahead.  Let me highlight some of the quotes from the article that speak to the multiple, interrelated issues at hand.


  • “Children who have experienced complex emotional trauma in early life have trouble accepting love and attaching securely to an adoptive parent.”

The author, several years after the adoption at 22 months, found herself the target of difficult-to-accept vitriol. “You are not my mommy…I hate you. I don’t love you” are difficult words to hear from any child.  While one might understand that her son was troubled, it was certainly very difficult to be the target of such anger.  Recognizing that his early nurturing was most likely less than optimal (given up for adoption), the author sought counseling help.  The counselor wisely noted that these outbursts are “his disorganized way of seeking connection.”  Indeed, experts in trauma-informed care have taught us the same and have emphasized our need to be careful of our responses (references 1-3 below).



  • “That’s when it struck me that my child knew what he lost but did not know what he gained. I recognized that my journey to motherhood was also marked by loss and grief.”

When traumatized children strike out, more often than not it is because of their own loss(es) and their inability to regulate, relate, and reason in their new or unfamiliar environment. They know what they have lost and what they don’t have, but they don’t know what they have gained.  We know what they have gained (a loving, supporting, nurturing relationship [adoptive parent]) but they don’t know this.  If you have never had such a relationship (the safe, stable nurturing relationship [SSNR] that I often refer to), it is very difficult, if not next to impossible, to just be told that everything will be ok.  When stress is encountered, they most often revert back to their previous “adaptive” response.  We consider these responses maladaptive because of their caustic nature, but that is what they learned and how their brain and its wiring grew to adapt to situations that were intolerable.

The author’s adoptive parenting journey was also marred by tragedy, the sudden loss of her husband. These compounded factors, childhood trauma and maternal grief, demonstrate the complexity of trying to deal with multiple issues at the same time.  Our approach to the children and families so affected must recognize that multiple factors are always present, and we must be open to dealing with them as these factors are revealed over the course of our care.

  • “’So you came and rescued me.’ Getting stuck among things and asking to be rescued is a big theme in his imaginative play.”

Eventually, the author’s son grew into an acceptance of this new SSNR and gained insight, even if it was unconscious in his imaginative play, into the dynamics of his new family. He could articulate that he was rescued.  He even grew to see that his mother was his rescuer and together they could tackle numerous stresses in their lives.  He openly related at times that “Mommy, I am so angry that my bones are breaking.”  This heart-breaking insight came with a toll but hopefully allows for positive growth in the years ahead.

  • “By what age is someone expected to heal from primal or other wounds that are not their fault and show up in school to celebrate valentine’s day, mother’s day, or father’s day, and successfully contain themselves in response to stressors?”

The author’s quote here shows the frustration that must be present in all care-giving folks at times but certainly those that are dealing with children that have suffered trauma. These latter children are likely to respond to unique situations and occasions in a very distinct manner at different times.  We must be willing to anticipate these responses and modify our reactions accordingly.  Expect the unexpected but respond in an even-handed loving, nurturing way.

  • “I realized that my days of naïvely thinking that we as a society simply need to provide food and shelter to the tens of millions of orphaned children in the world are long gone. Yes, they need food and shelter, but they need ladders of love and specialized behavioral health care too.”

This last quote that struck a chord with me is the meat-and-potatoes of trauma-informed care.

These children need their basic needs met but without love, nurturing AND specialized behavioral health care, we are serving an incomplete plate of services.

Our society has failed them if we cannot fulfill all of their needs.


Ladders of love are critical for our children.  They provide the support as the children and families lift themselves from the trauma to a pathway toward restoration, resilience and flourishing in the days and years ahead.


"Our society has failed them if we cannot fulfill all of their needs."
- Robert Saul, MD


“Climbing ladders” requires assistance for every rung along the way to prevent slipping back down the ladder.  This support for children and families alike is crucial to a society that seeks to raise good citizens – folks that care for each other and care about each other.

My thanks to Dr. Sreeramoju for her willingness to expose her heart and let each of us learn a little more on how to improve the lives of our families, the lives of others, and the life of our communities.  Building these ladders of love with the necessary supports should be the goal in our days ahead.


  1. Forkey HC, Griffin JL, Szilagyi M. Childhood Trauma and Resilience: A Practical Guide. American Academy of Pediatrics, 2021. 224 pp.
  2. Perry BD, Winfrey O. What Happened to You? Conversation on Trauma, Resilience, and Healing. Flatiron Books, 2021. 298 pp.
  3. Garner AS, Saul RA. Thinking Developmentally: Nurturing Wellness in Childhood to Promote Lifelong Health, American Academy of Pediatrics, 2018, 175 pages.

All opinions published on SomeDocs-Mag are the author’s and do not reflect the official position of SoMeDocs, its staff, editors. SoMeDocs is a magazine built with the safety of free expression and diverse perspectives in mind. For more information, or to submit your own opinion, please see our submission guidelines or email opmed@doximity.com. Do you have a compelling personal story you’d like to see published on SoMeDocs? Find out what we’re looking for here and submit your writing, or send us a pitch.

All opinions published on SomeDocs-Mag are the author’s and do not reflect the official position of SoMeDocs, its staff, editors. SoMeDocs is a magazine built with the safety of free expression and diverse perspectives in mind. Do you have a compelling personal story you’d like to see published on SoMeDocs? Submit your own article now here.


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