| |
 |
Newsletter
Vol. II, No. VII.
Nineteenth Issue,
March 2005
LET’S GIVE A VOICE TO THE VOICELESS: AN OPEN LETTER FROM A CHILD PSYCHOLOGIST TO FELLOW MENTAL HEALTH PROFESSIONALS
by Mandy Fessenden Brauer, Ph.D.
February 2005
For several months I have watched as atrocity after atrocity is perpetuated on basically helpless civilian populations. I have felt paralyzed and helpless to do anything about it, as massive fire power and great numbers of soldiers and mercenaries march around the world wrecking havoc in areas that were once peaceful. Inside each of the atrocities we read about are individuals that we as mental health professionals know are traumatized. People help each other, of course, in times of havoc but atrocities leave long-lasting scars and emotional pain. It is up to us to help define what these events mean in terms of a people’s short and long term emotional health and how damaging they are to the people subjected to them. This is something we are eminently qualified to do. Thus, especially the psychologically damaging effects of war need to be spelled out clearly for those who don’t understand much about our field or the importance of the work we do.
This is an open letter to urge us, mental health professionals, to speak up in any forum we can find to stop the continued manufacturing of trauma. We can’t do anything to prevent natural disasters but we can speak out about the deliberate delivery of trauma! We, of all people, know the damage that even just one seemingly insignificant trauma does to an individual. We see examples of the effects of trauma every day in our clinical work. We have had to help our patients who were dysfunctional and in extreme emotional pain because of trauma and we have also had to help our patients who were functional but had deeply repressed and unresolved issues stemming from earlier trauma that affected many aspects of their daily lives. I am reminded of this when I read the newspapers about a horrendous act of child abuse and when I hear of people killed and injured, neighborhoods destroyed or fenced in with barbed wire and the daily difficulties of surviving in an area of conflict. In many cases, it seems that having a dictator or “bad” leader is far less devastating and psychologically damaging to the population at large than having a massive killing machine in the back yard.
Not long ago a ten year old Palestinian girl was deliberately killed by an Israeli soldier while at school: we understand how her family is traumatized as well as the children and teachers who witnessed the killing. We also know that friends, neighbors and others can be traumatized by such an incident. Those not in our field often can not understand how deeply trauma can affect so many. We know all too well from our own clinical work that a few sessions with a mental health worker does not erase the pain and the horror for the survivors. Countless children, as well as adults, have reactions to past traumatic events. Such unresolved trauma can result in pathogenic beliefs and interference or even paralysis of daily functioning that affects their relationships, their jobs, and how they interact with the world. Time alone does not “heal” as the saying goes. It merely provides a time to consider how to go on living and what to do with the terrible pain. Working through trauma seems to be a life-long process. Certainly mourning is.
Political conflict is, of course, not the only cause of trauma. People are affected by traumatic events every day on an individual level as a result of accidents, illnesses or dysfunctional families, for example. As professionals, we need to speak out about policies that hurt people because much more emotional damage is being perpetuated daily than those in our fields can deal with. And we, of all people, know the problems that trauma causes in the short and long term. We understand individual vulnerabilities and the propensity to other mental disorders after trauma, we understand that precipitous and harmful actions can reflect unbearable and overwhelmingly painful feelings being acted upon, and we understand, too, that not all people are able ever to recover from severe trauma. One noted psychiatrist refers to such victims of trauma as “shattered personalities,” in that they won’t be functional again. We simply do not have the tools to repair the damage from too much trauma nor can we predict with much certainty how much trauma is too much for any given individual.
For over 35 years I have worked with and listened to many traumatized people as a clinical psychologist in California and in other parts of the world including Gaza during the first intifada, in Armenia after a devastating earthquake and more recently in Egypt. I have done play therapy in California with a four year old girl whose father shot her mother while she was in the same room. And I have listened in the States to a teenage delinquent whose mother shot him because she was angry. A man in Egypt became psychotic after falling during an argument, taking him back when as a child of eight he was tied up and beaten by his father so hard he urinated and defecated all over himself. The three year old Palestinian survivor of an Israeli bombing, who lost her family and also had an arm severed at the shoulder, was functional until after her first child was born. She succumbed to a Major Depressive Episode when she couldn’t pick up her baby with only one arm. As professionals we would have expected her to have a reaction at some point, wouldn’t we? We don’t know how the symptomatology will manifest but we are not surprised when even a seemingly unrelated event serves as a trigger.
Think of all the dead and injured, think of all the traumas, big and small, in areas of trouble and conflict and think of the wider circle of people such trauma touches for the rest of their lives. In Gaza during the first intifada, 13 children who lived near a house that was demolished by occupying soldiers had to be hospitalized for emotional problems. These children did not lose their homes but they were petrified, read “traumatized”. What scars do these children carry with them now? And what other traumatic events related or unrelated might have scared and scarred them further?
The presence of trauma is more than just whether or not someone meets the criteria for Post Traumatic Stress Disorder or Acute Stress Disorder or some other differential diagnosis: it is also the pain that people go on living with. We can ease the suffering, hopefully, by helping to sort out erroneous ideas so often held by those who have been traumatized. We know, for example, from our clinical work that many children retrospectively blame themselves for a traumatic event. It is not uncommon for a child to believe he caused a parent’s death by misbehaving. The boy whose mother shot him believed he “deserved” such a punishment because he upset her. We can help a traumatized child get back on the path of normal development by sorting out those pathogenic beliefs and we can encourage children and adults alike to go on after being traumatized to have a full life. But traumas leave scars and scars are painful. We can ease but not eradicate the pain. That is not in our purview, at least it is not in mine.
How do we view the world through our various professional lenses? We seem to have more commonality in our diagnostic assessments than in other aspects of our separate professions. Certainly we have our different treatment modalities. However, it is critical that we all recognize trauma as trauma and not label it as something else. Why is it, for example, that mental health practitioners do not speak out more forcefully against the child abuse they hear about in their offices? We need to view the enuretic boy previously referred to who had numerous scars and described being hung from the ceiling and beaten as much more complex and damaged than a bed wetter in need of behavioral modification to stay dry. We need to understand he was a victim of physical child abuse and that severe abuse would have a profound and lasting effect on him both as a child and as an adult. While maintaining cultural awareness and sensitivity in all such cases, we need nonetheless, to recognize that a sexually acting out teenage girl, for example, may be reacting to having been sexually abused at an earlier time. Depending upon what we learn about earlier trauma from a thorough history-taking, we can then develop a helpful treatment plan. The need for us to explore and check for unresolved traumas requires us to use our clinical skills and to set aside our judgmental side in order to be clinically effective.
Recently in Gaza I met a group of children between the ages of five and twelve at the beach near an Israeli settlement. Some time before, they had been playing when one of their group reached into the sand, picked up something shiny and instantly there was an explosion. We, as professionals, can put ourselves there as one of those children: we are confused, scared, horrified, shocked and perhaps guilty. We feel relieved it wasn’t us. Maybe we want to scream but feel paralyzed, unable to move. The only thing the children knew was that all that remained of their little friend was a hand sticking out of the sand. Those closest had hot pieces of their friend’s body on them and it burned and it smelled. Imagine! Again, put ourselves there! It is like a horror film or our worst nightmare. What can we do, either as one of those children or as mental health professionals, what can we do? None of those children had mental health intervention: some said they wet the bed (regarded culturally as a big shame for their ages), had problems concentrating in school and had many thoughts that kept them awake about death, their friend, the Israelis, and so forth. All this is understandable, isn’t it? But the smell was what they couldn’t get out of their thoughts. Other children I’ve met in the West Bank who had burning body parts on them said the same thing: it is the smell that is so indelible, so haunting and troubling, so horrifying. Of course we can view the focus on odor as displacement or some other defense mechanism but the question still remains. How, I ask my fellow mental health professionals, do we help these children cope?
When scientists understood that the hole in the ozone layer was enlarging and threatening our health or that global warming could produce a major world-wide catastrophe, or even that cigarettes were bad for us, they spoke out. Why then, are we silent? Don’t we know the consequences? Of course we do! We know that without intervention the physically abused boy may likely abuse his own children. We know, too, that without intervention the girl who was raped as a prepubescent may act out sexually, may become depressed and in all likelihood will have problems having a normal marital relationship. So why are we so quiet whether about traumas inflicted in the privacy of homes or elsewhere? Maybe sometimes we do not understand initially that the patient has been the victim of trauma. Patients do not always tell us what we need to know to make an accurate diagnosis and memories of painful traumatic events can get repressed. In addition, we do not always have access to a patient’s full cluster of symptoms until weeks or even months have transpired.
And perhaps, since we are products of our cultures, we accept definitions and solutions that are culturally and not always clinically based regarding trauma. Some cultures are accepting of aberrant behavior after a trauma. There is a subculture where, after either an individual or group trauma, transient psychotic-like behavior is anticipated and dealt with by various dances and other cultural remedies. Other cultures may be accepting of histrionic symptoms after a traumatic event, not realizing that merely soothing or diverting and distracting may not always replace the need for mental health intervention. Both examples given suggest that cultures may seek ways to sooth members after traumatic events but we know that such solutions sometimes do not work. However, we, too, are products of our cultures. We, too, may sometimes wear cultural blinders. It is important for us to look at what we don’t always want to see, and to then admit what we have seen to ourselves and to accept our findings as challenges and opportunities to make positive changes within our own cultures based on clinical findings.
But I continue to wonder why we are so silent about trauma in the larger arenas? Perhaps we who are there to help others are overwhelmed when we realize the relative futility of our work in the larger scope of things. There is no possible way we can help all those traumatized around the world, whatever the causes of the traumas. Geographical distances, language differences and the scope of devastation and traumatization that is occurring in so many places make the job impossible.
Maybe we, too, are drugged by the media and television and begin to think of “us and them,” “them,” of course, not being like us and therefore not subject to the same reactions as “us,” and therefore not “worthy” of our speaking out. Maybe we, too, are afraid, realistically in some cases, of our own governments. Perhaps we rationalize that we are busy with other matters. So, are we just examining and identifying our own defense mechanisms like denial, rationalization, intellectualization or sublimation, to name only a few? Is that what it is? As an American, I am not talking only to others, but also to my fellow countrymen who are as guilty as any others for not speaking out.
Perhaps some of us have been silenced and are therefore unwilling to speak out about the devastating and long term negative effects of trauma by embarrassment or horror or complacency or something I have trouble describing, because of suicide bombers or contracted mercenaries, targeted assassins or those who behead. We need to see the trauma inherent in many different actions and we need to see actions in their contexts, setting aside our own biases to be effective. Perhaps we can’t help judging but using our clinical lenses, we set aside our personal feelings and realize that all who survive a traumatic event are in need of the help our mental health professions offer.
PREVENTION IS THE BEST CURE FOR POST TRAUMATIC STRESS DISORDER and for all the other mental disorders that occur to individuals in a dysfunctional environment and that war and political strife bring in their wake. We must speak out FOR people, to alert the rest of our societies that abuse of any sort, and war and arm conflicts and occupation are devastating for the human psyche and for the general good of mankind. So let us write about the psychological effects of what we are witnessing globally and let us tie it in with what we have learned in our offices by listening to traumatized people. Let us send letters and articles to our local newspapers and magazines. Let us speak out to educate our neighbors and politicians, those who are not as psychologically minded, that it is important to try to prevent traumatization of any and all kinds. Whether we talk about child abuse or other kinds of damage inflicted on others by hurt individuals or whether we are talking about armed conflict, both create long-lasting scars that effect individuals and also break down people’s capacity to function in a mentally healthy way, to raise mentally healthy children and to pursue the future constructively and with an element of hope.
Let us speak up from our positions of knowledge and give a voice to those whose voices cannot be heard. And let us do it NOW.
Dr. Mandy, a child psychologist, lives in Cairo, Egypt with her husband. She currently writes books for and about children everywhere and is an outspoken advocate for improving their lives. She welcomes your comments and can be reached at: [email protected].
|
 |
 |
About | Newsletter | Conferences | Press Releases | Publications
Home | Links | Contact |
 |
|
