Tuesday, October 30, 2012
Helping Children (and Yourself) Cope and Understand the Storm and other Disasters
Eitan D. Schwarz, M.D., D.L.F.A.P.A., F.A.A.C.A.P.
FEINBERG SCHOOL OF MEDICINE, NORTHWESTERN UNIVERSITY
Based on http://mydigitalfamily.org/?page_id=476
Disasters raise hard questions for children (and grownups, too). Before, during and after the event, even kids far away ask "How can I be sure that this won't happen to me or to my parents? Why? What can I do?" When grownups live through or witness violent manmade or natural events, they often cannot come up with answers that put them entirely at ease. They may feel lost, helpless, and disoriented. They become even more uneasy when children ask for explanations or help in coping.
Individuals and communities may vary in how they react, but people everywhere are more similar than different. Under eight headings below, we provide information to orient people in the aftermath of violence and help them begin to cope:
--BEFORE, DURING, AND in the aftermath of an event, do your best to assure your own and the child's actual physical health and safety and include the children in preparations.
--Support others and let them support you.
--Begin coping: Crises bring out either the best or the worst in people. Challenge yourself to do your personal best.
--Restore your confidence as a parent or teacher.
--Discover and respond to the child's needs. Realize that children already believe in you and do not demand proof of unlimited powers to protect them.
---Cope actively to survive the stress of passive helplessness that the disruption brings.
--Teach, learn, and grow together.
--Appreciate that disasters can leave its troubling signature in the minds of normal people as malignant memories that can stubbornly persist for a lifetime.
FIRST, in the immediate aftermath of an event, do your best to assure your own and the child's actual physical health and safety.
In the initial hours and days, shield children from the violence by enclosing them in a cocoon of family safety and warmth. Relax usual routines and standards and offer children extra affection, protection, and time together.
Ask children repeatedly what you can do to help them feel safer. Let younger children sleep with parents, encourage them to find comfort with a favorite stuffed animal or blanket, and avoid difficult or long separations of family members. Assure children repeatedly you are doing everything you can to help them be and feel safe.
Gradually replace this initial approach with the reassurance that comes with restoring daily routines to normal.
It is normal to have some signs of stress for hours or days: An unfamiliar numbness, intense vulnerability, anger, and fear, nightmares, poor sleep, appetite, memory and concentration, and a sense of unreality, disorientation, or doom. Please realize that most things have a beginning, middle, and an end. Even bad things can eventually improve, especially if you resolve to do your best to make it so for yourself, loved ones, and your community.
Media coverage can make unwilling witnesses of us all, and can bring violence needlessly closer than is good for us. If you find yourself watching endlessly repetitive coverage, especially alone, ask yourself, "Am I really learning anything new?" Force yourself to step away from the TV to limit your exposure to disturbing images. Seek the company of other people.
SECOND, support others and let them support you.
Violence can test how well a family or community works. Stress can bring family or community members closer, but it can also widen pre-existing rifts and cause severe damage. Paying attention to this fact and deciding ahead of time how to deal with family and community during the crisis can give us more control over the outcome. Deliberately giving and gracefully receiving support, patience, understanding, kindness, and consideration can go along way to preserving or even strengthening family and community.
THIRD, begin coping: Crises bring out either the best or the worst in people. Challenge yourself to do your personal best.
Frame the event for yourself. Examine its direct personal relevance to you. Think through and form your own understanding of what happened. Set goals and make plans, even on an hour to hour basis.
How you decide to respond can make a big difference. For example, you can actively seek other adults regularly for mutual support and decide together as family and community how to cope with this difficult reality.
Clear plans and definitive actions that quickly restore civil order and safety are necessary to return security to a society. Responsible media can provide balanced facts and guidance. Talented political and spiritual leaders can channel frustration and anger by inspiring hope, affirming ideals, and modeling for all of us coping, grief, compassion, repair, healing, and growing.
FOURTH, restore your confidence as a parent or teacher.
As grownups, we have strong natural instincts to protect loved ones, and commonly pride ourselves on how well we do so. But disasters can shatter our confidence by reminding us how we may not be able to keep harm from our children. In the face of violence, we can all feel as helpless and vulnerable as children.
After a violent event, parents and teachers feel inadequate, and act as if they suddenly no longer know how to talk to children. When they ask experts, "What do I tell children about the violence of nature?" they may also be asking, "How do I reassure the vulnerable, frightened part of myself?" or "If I cannot protect us from the violence itself, tell me how to shield myself and my children from the terrifying reality of its existence and my frightening inability to protect us" They may be indirectly voicing their own painful vulnerability and helplessness.
However, they are not inadequate. The event has robbed them of their confidence. They still have plenty of common sense and competence left.
Realize that we worry about what or how to tell children about horrible events not mainly because we don't know our own children or what to say to them, but because we are struggling with our loss of confidence. Decide to regain confidence in yourself. Be confident that you will not harm a child by being sensible in what you say.
FIFTH, discover and respond to the child's needs. Realize that children already believe in us. They do not demand of us new skills or proof of unlimited powers to protect them.
Children mostly need to be reminded of our love and competence by seeing how well we cope and continue to take care of them and ourselves. It is usually good for children to see adults coping appropriately (not necessarily perfectly) with limitations imposed by adverse events. Children can learn a lot about stress, loss, grief, and renewal by watching how grownups do it. They are helped more by watching what we do than by hearing what we say.
Parents and teachers should strive to agree on one explanation. Because they are still developing, children of different ages differ from each other and adults in how they experience and cope with an event or grieve a loss. Children usually don't care as much about events far removed from their immediate vicinity — the younger the child the smaller the world, the more tied the reaction to the primary caretakers' and the more the need for shielding.
Wait for children to ask first, and then look for how distressed the child might actually be. Adjust your response to the child. Don't give more details than necessary. Limit exposure to media images – the younger the child, the less he should view any media violence. Watch the news together once daily with older children and discuss and interpret actively. Do more listening than talking. Talk with, not at the child. Talk in a manner appropriate to the child's ability to understand. Ask the younger child to draw.
SIXTH, cope actively to survive the stress of passive helplessness that violence brings.
Constructive, positive, goal-directed activities that promote family and community unity and values and mutual support are crucial for children and adults alike. Do something tangible (family, classroom, or community projects) to reach out and help survivors or just those less fortunate who must live with daily violence in their homes and neighborhoods. Advocate politically for anti-terror and public health causes. Work together to lessen violence and the suffering it brings wherever and whenever you can. Do your part and teach children to do the same.
Find strength and meaning in spiritual and religious activities. Mark anniversaries as opportunities for healing by grieving for loved ones, affirming values and unity, and celebrating survival and courage.
Children can be helped to actively remember and identify how much safety there is in their lives, and how much they know about their own parents' love and devotion to them. They can review good times, birthdays, and holidays such as Christmases and Thanksgivings (maybe by drawing or looking at photos and reminiscing.) They can be reminded of getting hugs when feeling down, ill or injured.
SEVENTH, teach, learn and grow together.
Lively discussion is an active process, and there is nothing like energetic goal-directed activity for coping with stress. This can be a chance to discuss the science of weather and all the resources we have as a society to cope with its violence
A discussion of faith and morality can include how evil can coexist with good in this world and how we make our choices. Try to find an approach that balances helping a child feel safe and hopeful while still acknowledging the existence of random violence and danger in the world. How to add to the goodness of the world, to respond with compassion to the survivors, victims, and families involved. , This can be an opportunity for spiritual growth for children and adults alike.
You may talk with children about how anger can be a normal feeling and explore appropriate ways of expressing it. There is a big difference between feeling angry and acting violently. Younger children can be assured that when a loving parent is angry, it is self-limiting and passes quickly. With older children, who can understand finer distinctions, you can discuss how a healthy relationship is one in which rifts do occur but can be repaired and healed by apology and forgiven
Finally, this is an important opportunity for adults to demonstrate their respect for children by affirming their beliefs that children have rights to affection, nurturing, safety and protection.
EIGHTH, appreciate that violence can leave its troubling signature in the minds of normal people as malignant memories that can stubbornly persist for a lifetime.
Psychological injury can persist long after the physical is healed. Generally, the nearer physically or emotionally a person or family is to the violence, the greater the dose of violence, the harder adjustment and healing could be and longer they might take. Expect that adjustment in the aftermath of a violent event may take months, and healing years.
Losses can be grave. But property can usually be replaced. Our lost illusion of invulnerability can be supplanted with a humbler and more realistic sense of mortality and with richer valuing of individual, family, and community life. Lost loved ones cannot be replaced but must be mourned, grieved, and remembered. Grief takes time, and we all need the support of people when we go through it initially and over time, especially during anniversaries.
Although they may make us uncomfortable because they remind us too poignantly of what we'd much rather put behind us, people who are more vulnerable and continue to suffer harder and longer deserve our inclusion and compassionate attention. Children and families directly involved, those near the violence physically or psychologically, those who suffered greater losses, those prone to anxieties, or those who had experienced other violence in the past are at greater risk. While most children are safe and have loving parents, there are many who have been hurt by adults or witnessed domestic or community violence.
Sadly, healing for such high-risk folks and families can be more complicated, difficult, and incomplete, especially for the minority that develops depression or Post-traumatic Stress Disorder. Doctors think that in such cases the brain itself may have been changed by the intense helplessness and terror experienced during the violence. See the scientific article THE POST-TRAUMATIC RESPONSE IN CHILDREN AND ADOLESCENTS (Schwarz, E and Perry, B D The post-traumatic response in children and adolescents. Psychiatric Clinics of North America, 17 (2): 311-326, 1994, http://tinyurl.com/8jdluzw fuller details.
Anyone who suffers symptoms that interfere with daily life for more than a few weeks may have a psychological injury that deserves an evaluation by a qualified professional. Sometimes symptoms can reappear after an initial improvement or may be delayed for some time and appear for the first time long after the event. Symptoms can include re-experiencing, avoidance, hyper-arousal, depression, anxiety, or substance or alcohol abuse.
If a child continues to be distressed beyond a few days and does not respond as usual to your efforts or shows persistent or intense signs of anxiety and/or depression, consider an evaluation by a qualified mental health professional who specializes in caring for children. Look for symptoms that include unusual changes in behavior such as persistent preoccupation or play with new themes or themes related to the violent event; increased aggression, anger, or irritability; poor sleep or nightmares; renewed or new fears; jumpiness; headaches, tummy aches, or other physical complaints; poor appetite; separation difficulties or refusal to go to school or be left alone; clinginess, shyness or withdrawal; or poorer concentration or memory, especially for the event itself.