One of the most challenging clinical issues that psychotherapists face in practice is treating individuals who have suffered from parental neglect. Unfortunately this is a much more common occurrence than most people realize. When treating the spectrum of those who suffered physical, sexual, or emotional abuse there is usually a narrative that is told and can be deciphered by careful listening to developmental history and examining symptom formation, as well as explicit memory where there is often clear recall of abuse. On the other hand, neglect, which results in a “silent scream” in many patients is much more difficult to decode. I call the effects of neglect the silent scream because if the psychotherapist listens closely you can hear the scream in the bound up symptom formation. The scream is often expressed in a rebellion by the body and is in a sense narrated by the soma as opposed to the psyche. Many patients I have treated with severe neglect have been previously seen for a spectrum of somatic disorders including chronic fatigue, fibromyalgia, depression, and severe GI tract disturbances. The are in a sense screaming in the only way they can for someone to orient to them. There is a failure of what I call the “protest-orient” system which is a central part of the early attachment system. Infants naturally protest when they have a need that requires an adult to orient to them. In neglect there is an extinction of the protest response to a state similar to Seligman’s learned helplessness where the dog stops moving and doesn’t try to escape the shock. The protest response has been squelched, and the the squelched response is expressed in the silent scream. One of the most challenging aspects of treating these patients is create an awareness of the impact of neglect on self-other schema. In successful treatment a narrative is co-constructed that allows for metabolization of affects related to the neglect. Cognitive schemata and beliefs about the self need to be identified. These are often related to beliefs of being insignificant, unlovable, worthless and even that survival is threatened. Roy Kiessling an EMDR trainer has been helping outline these survival beliefs that are fundamental to self-structure. If you are neglected you may not survive when you are an infant. There is much converging evidence that shows the basic attachment if not sufficient can result in failure to thrive and potential death. Spitz showed this a half century ago in his studies of infants in foundling homes, Harlow showed it with a primate model, and Beatrice Beebe shows it in her early infant attachment tapes and research. When I am evaluating patients I try to get as clear a developmental history as possible and then if symptoms are not related to current issues in the persons life I begin to look at the diffuse psychopathology as an adaptive response to unbearable loss of never experienced attachments. We know that when severe this neglect can result in reactive attachment disorders but at a lower threshold listen for the silent scream.