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Eitan Schwarz, MD FAACAP DLFAPA
Eitan Schwarz, MD FAACAP DLFAPA
Board-certified general and child and adolescent psychiatry. Education: Cornell, Johns Hopkins, and trained at the U of Chcgo, now Northwestern U med
 

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Terror in Boston: National and Individual Trauma and Healing

Apr. 20, 2013 3:46 pm

IN THE WAKE OF THE BOSTON MARATHON TERRORIST ATTACK: NATIONAL AND INDIVIDUAL PSYCHIC TRAUMA AND HEALING

Since a school shooting in 1988, the author has studied and written on the causes and effects of terror and violence. Here are some pieces relevant today, the end of another traumatic and healing week in America. For more please visit here.

HEALING A NATION

9-11 NATIONAL TRAUMA (2002) [What America is going through now illustrates a phase in recovery from violent trauma. We offer below an approach to understanding this process and an example of a prescription for coping and healing that can be generalized to all survivors of violence.]

Like individual men and women, families, communities and nations injured by violent traumatic events commonly evolve patterns of recovery that can lead to resolution and healing. America, recovering from 9-11, is in the midst of such a process. This national response is an aggregate of the reactions of the many individuals who have been impacted so personally by the violence of 9-11. A process has been unfolding: Initial shock and disbelief was first followed by an outpouring of community unity and support, then a series of strong steps that seemed to promise restoration of safety and eliminate threat, and then a period of seeming complacency.

Now America is experiencing another common, necessary, but very risky phase. It is struggling to come to terms with vulnerability while also searching for causes and fixes. With the grandiose power of hindsight, Americans are wondering how their trauma could have been prevented and are agonizing over how they might have failed themselves or had been let down by officials who should protected them.

But Americans must be cautious. This can be a destructive time. We already know from school shootings and other violence how this phase of recovery can bring out the worst in people, destroy their self confidence and faith in family and community, sow divisiveness, and strain or even wreck relationships, communities and families. America must understand that it is precisely the intent of terrorists to destroy by terrifying, disrupting, shaking confidence and sowing divisiveness. Americans must realize that their recovery is necessarily going to be incomplete and imperfect. The very real ongoing threat of more terrorism to come will keep the US vigilant and worried. Americans must realize that they will never recover the illusion of invulnerability that had blessed them for so long.

Americans are now challenged to get to the next phase of recovery — accepting vulnerability without succumbing to excesses of cockiness, cynicism, passivity, helplessness, complacency, self doubt or scapegoating. Now more than ever, Americans must strengthen and actively affirm and practice their belief in the goodness of their nation, its communities, and its families and offer support to free people elsewhere struggling with similar violence. Americans must support each other and their leaders. Leaders must act wisely, firmly, and with a clear, unwavering vision at home and abroad.

Most importantly, Americans must not allow violence or the threat of it to destroy their faith and confidence in what makes them unique. Especially as national holidays commemorating American war dead and independence approach, Americans should unite to treasure, celebrate, and take pride in their nation as history’s noblest and most successful, truly the best hope of mankind.

THE BRAIN AND TRAUMA

CHECHNIAN ATTACK ON RUSSIAN SCHOOL (2004)

Q: BESLAN, FSU: Is there any special information you can give us?

A: We hope that this information helps.

By nature and as part of our resiliency, we must all live our daily lives in an illusory ‘bubble of invincibility’ which enables us to carry on normal moment to moment activities by focusing our direct awareness away from each of the myriad improbable threats that can befall us. Terror shatters our ‘bubble,’ and psychologically injures us when we live through or witness intense fear and helplessness.

Most of us are resilient and restore our lives to normal. Depending on its intensity and our physical and emotional nearness to the violence, each of us tries to ‘decide’ somewhere in his mind to what extent terror would damage or shatter his ‘bubble.’ But actually, crucial brain circuits that maintain this ‘bubble’ and monitor and react to danger are activated by such an experience, so this ‘decision’ is not mainly conscious or volitional. Some people cannot restore their ‘bubble’ within a few weeks after the event because their brains have been permanently reset in an activated state. They are haunted for a life time by ‘malignant memories’ from the violence, While human history is replete with violence, the rise of terrorism as a political tool in our current historical time also makes it harder for us all to maintain this ‘bubble.’

Beginning with attacks long ago in northern Israel, brutalities targeting school children speak to the barbarism of some terrorists and inhumanity of their ideologies. Children especially need families to help maintain, strengthen, and restore their ‘bubble.’ Civilized humane societies, governments, communities, schools, and families must do whatever it takes to protect their defenseless children and identify and treat those unfortunates who carry ‘malignant memories’ and can remain tragically injured by such attacks.

The children and families of Beslan are in our hearts and prayers, as are those of Darfur, Sudan, and all peoples who suffer brutal violence. Please see our other articles in these pages for further details.

RADICALIZATION IN SOME CULTURES

RAISING CHILDREN TO HATE, MURDER, AND SUICIDE AND POLITICAL RADICAL INCITEMENT (2007)

Imagine this: You are snuggling with your four year old, watching The Wizard of Oz.

This is what you see:

Near the end of the movie, the Wizard emerges. He gives the Lion courage and says, “Lion, you now have the courage to sneak into a school of little Munchkins and murder as many as you can and kill yourself in the process. Do it soon, and you will be a hero.” He tells the Scarecrow as he hands him brains, “Scarecrow, now you can figure out the best way to make a bomb full of nails and other sharp metal pieces to strap to your friend so that he can blow himself up into bits in a restaurant full of women and children Munchkins, killing as many of these pigs as he can along with himself.” And he also advises the Tin Man, “Tin Man, now you can have a heart that can contain so much hatred that you will want to kill and kill and kill as many Munchkins as you can and even yourself.”

The Wizard then says to all, “You know, guys, Munchkins are not like us. Don’t worry. They are pigs and killers. And it is better that you die so that you can come back to Emerald City and have anything you want. Oh, and your surviving family on Earth will receive many gifts from me.” And then he turns to Dorothy, “As for you, young lady, here are your Ruby Slippers. Click them and go back home to Kansas and raise your children to become a cell of martyrs who hate and murder as many Americans as possible, and in the process die violently and gloriously themselves.”

After the movie, you gently stroke your son’s hair, and tell him softly how proud of him you will be when he grows up to have the courage, intelligence, and heart to hate and murder and die, and be a hero just like the girl next door.

Surreal and unthinkable as this illustration may seem to most readers, a quick search of YouTube yields examples that this type of incitement to hate is widespread in certain cultures. Can children this young truly decide for themselves to become killers? Is it better to encourage young kids to value their own lives and their culture and build their society, allowing them to decide later about the use of violence to promote spiritual and political goals?

In America’s and other societies’ inner cities, where families are especially undermined by poverty and poor resources, children are frequently desensitized early and initiated later into violent alternative street gang cultures by committing rape and murder. Voices in such communities loudly condemn these practices, and mainstream culture is in constant conflict with these criminals, yet tragically kids keep dying. In contrast, in some cultures, parents are actually encouraged to raise children who hate and commit mayhem, murder, and suicide with more fervor than ever used to promote their children’s healthy living, or used to advance their academic, moral, social, and athletic success.

We must make our own society violence-, abuse-, and exploitation-free as we affirm the value of every human life, strengthen our own values, and pass these on to our children (With gratitude to Anita Rosenfield, Ph.D., Yavapai College, Sedona, Arizona, for her generous help.)

RAISING, HELPING, AND HEALING KIDS

RAISING NONVIOLENT KIDS (2002)

Q: How can I help my son learn social responsibility and alternatives to violence as he grows up? As a brand new parent, I am alarmed by what he might learn AND NOT LEARN from so many popular TV shows, movies, magazines, music, professional sports, and computer games — the ever present popular culture that will engulf him.

A: Learning social responsibility and how to resolve conflict without violence is a life-long undertaking. Parents should give children sound groundings in the essential basics by teaching and practicing these attitudes and values.

Start by deciding (together with your partner if appropriate) on the values that matter to you and that you want to convey to your child. Your child will always look to you for clarity, so be clear in your own mind about where you stand about violence and how you practice your attitudes in daily life.

Your baby is already learning essential core attitudes of trust and security that will last his lifetime directly from how well he has been treated from early infancy onward. Make sure you understand thoroughly your baby’s unique developing physical and emotional needs and meet them as fully as you can. Never direct violence — verbal or physical — at your child and always shield the child from witnessing violence. If you show him that the world is an unpredictable or dangerous place and that violence is acceptable, he will have a hard time unlearning these lessons later on and may never succeed.

Early in the preschool years you can begin teaching your child kindness, personal responsibility, compassion, positive problem solving, respect for himself and others, the Golden Rule, the value of individual life and community, and the balance between self assertion and social responsibility. It is better for parents to be proactive than reactive. Teach and model such values throughout your child’s life.

Children welcome help as they struggle to figure out what is right and what is wrong and the gray areas in between. Always ask the child for his opinions as a starting point. Keep the conversation short and simple with younger children and use examples from fairy tales and stories and play with dolls and pets. As he gets older and begins school, engage your son in active conversations about moral and ethical matters whenever opportunities present themselves in the child’s daily life. Review moral matters with the child daily.

Children benefit from learning that anger is a common and normal human feeling. But they must learn the difference between feeling or thinking angry and acting violently, a lesson that should be repeated often. Learning to label the feeling and to resist the impulse to act on it takes much practice. It is also important to teach children to accept and expect that conflicts and differences will normally occur between well-meaning people and must be resolved without violence. Teach children skills to achieve this goal. Competitiveness and assertiveness based on respect for self and others are healthy, while bullying or being bullied are not. Non-violent ways of expressing and channeling anger and frustration should be taught to children daily.

Older children and pre-teens should be taught that impaired judgment caused by alcohol and other drugs often leads to violence. However, mental illness is not a cause of violence, and violent people are not necessarily ‘crazy’ or mentally ill. Older children and teens can also be taught that there may be times when violence can be an acceptable solution (e.g. war, self defense, preventing terrorism), but always with restraint and only as a last resort and never when driven only by impulse or personal anger. Help the teen channel aggressiveness and energy away from violence and high risk behaviors and into positive and constructive activities.

When a child is aggressive or violent, understand the cause and then give guidance and appropriate discipline or punishment. Ask the child to think about what problem his violence was supposed to address and help him think through alternative solutions. If he does not respond to your efforts, obtain professional help rather than getting into an endless spiral of negative interactions. Some children, like those with Attention Deficit Disorder, find it hard to learn from experience.

Involve your family in community service projects and encourage each family member to perform at least one good deed daily. Review these together as a family at dinner. These are other ways to inculcate values and enrich and strengthen your personal, family, and community life.

Most importantly, your own actions — “Do as I do, not as I say” — really matter. Try to put into practice non-violent values in your own life (with help from your religion if part of your life.) Refrain from directing physical or verbal violence at others. Our handouts APOLOGIZING and IS IT PUNISHMENT OR ABUSE? provide some insights. Your own behavior — personal responsibility, compassion, positive problem solving, respect for yourself and others, practice of the Golden Rule, respect for the value of individual life, and a striving for balance between self assertion and social compliance — especially as practiced towards all in the household (including the child, siblings, grandparents, and even pets) is your main means of teaching such attitudes. Indeed often, “The acorn does not fall far from the tree.”

WHAT TO TELL CHILDREN ABOUT TERRORIST BOMBINGS (1992)

Recent news stories may raise these questions for children (and grownups, too): How can anyone hurt little children? How can I be sure that this won’t happen to me or my parents? Who would do such a thing? Why? Can I do something? When grownups hear about such an event, they cannot find an easy explanation that will put themselves at ease. Yet, children will also want an explanation from parents and teachers. A complete explanation may not be entirely possible or easy, but we must try.

We must find a balance on the one hand between helping a child feel safe and on the other acknowledging the existence of violence, evil, and danger in the world. This must be done in a manner appropriate to the child’s ability to understand. First, don’t bring this topic up or discuss it in front of children. Wait for them to ask first. Then look for how distressed the child might actually be. Adjust your response to the child’s needs. Don’t give more details than necessary.

Second, a parent or teacher should think through their own understanding of what happened, as difficult as that might be. Could it have been anger? Idealism? Human frailty? Fanaticism? Evil? Part of a worldwide struggle between religious fundamentalism and Western secularism? It is important to say that we really don’t know the people involved or their circumstances. We only know a few oversimplified images selected by media.

This is a chance to discuss with children how to evaluate what they see in the media and how important it is to know a lot more before making judgments. It is also a chance to discuss politics, prejudice, and the use of violence to solve problems or resolve disputes. A discussion of faith and morality can include how evil can coexist with good in this world and how we make our choices. How to respond to the survivors, victims, and families involved on a tangible human level (class projects, etc.) and how we feel about what should happen to the perpetrators are other discussion topics.

Third, in contrast, children can be then helped to remember and identify how much safety there is in their lives, how much they know about their own parents’ love and devotion to them. They can review good times, birthdays, Christmases and Thanksgivings. They can be reminded of getting hugs when feeling down, ill or injured. Focussing on the first responders and caregivers and gratitude to them is essential.

Fourth, they can be assured that when a loving parent is angry, it is self-limiting and passes quickly without destructiveness. This is a chance to discuss with children how anger can be a normal feeling and describe appropriate ways of expressing it. With older children who can understand finer distinctions you can discuss how a healthy relationship is strengthened when rifts are repaired and healed through apology and forgiveness.

Fifth, this is also an opportunity for adults to demonstrate their respect for children by affirming their beliefs that children have rights to affection, nurturing, safety and protection from adults.

Sixth, children and families directly involved in such events benefit from individual approaches that include intensive reassurance of safety and nurturing in the short run, and ongoing expert assessment and treatment in the long run.

If a child continues to be distressed or shows persistent signs of anxiety such as changes in behavior, increased aggression, nightmares, clinginess, headaches, tummy aches, or shyness, poorer concentration, sleep, or appetite, consider an evaluation by a mental health professional who specializes in caring for children. While the majority of children are safe and have loving families, there are children who have been hurt by adults or witnessed domestic violence. The approach to them would be more complicated and requires an expert professional.

[This one pager was distributed widely in the wake of the first World Trade Center terror attack.]

 
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