Helping Kids in Japan: A Trauma Guide for Caregivers and Volunteers Working With Children Compassionate response for friends in Japan from all over the world has brought much attention to the needs of children affected by the earthquake in Japan and subsequent tsunami. Years of work in other areas hit by natural disasters has led my mental health colleagues and me to develop a simple guide to support those already in the field or planning to visit Japan soon. It is my intention in this article to provide an overview and helpful guidelines for use during the important second phase of this disaster, the Recovery Phase, as the Emergency Phase will hopefully begin to wind down and badly needed psychological support can begin. There is an enormous need to help children in the second Recovery Phase of this disaster before rushing too quickly to rebuild the external world. Governments and agencies too often rush to enter the third or Reconstruction Phase that follows a disaster of this magnitude without understanding the consequences of ignoring the deeply held emotional traumas of the local population. It is not a given that children will suffer adverse consequences following the tsunami; therefore, it is our intention to provide support to caregivers who wish to address the specific needs of children during the three- to six-month period following the earthquake and tsunami so the number of people who actually develop PTSD (Post-Traumatic Stress Disorder) can be substantially minimized. Much more can be said, and certainly much more has been written about trauma and children than is mentioned here. Many resources are available to families and professionals, but few take into consideration the underlying cultural needs of an area like Japan that was devastated. After much discussion with community leaders, local teachers, parents and caregivers, as well as considering the traditions that must be honored and respected, this guide has been assembled to support the Japanese communities affected in the months ahead. What is important is that body-centered therapies and approaches are every bit as important as any other efforts, and such interventions could conceivably be even more valuable than we can measure. It is my sincere hope that this guide will be of value to every child and caregiver now and in future generations.
Trauma is a wound to the energy of the body, either in physical or psychological terms. It is used to define an event that has caused harm or injury to the psyche, as in a "traumatic" event, disaster, disease or accident. Most traumatic events are totally uncontrollable; their results shatter people's personal sense of safety and security. Present in every episode that might be labeled traumatic are two components: • Extreme fear and helplessness • A possibility or threat of serious harm or death Basic human nature makes it possible for most people to recover from a traumatic event with little or no counseling or support. Every individual knows instinctively how to protect his or her life and acts accordingly; moreover, the sensing and feeling nature inside each child has a remarkable capacity to reorient life after tragic events if given loving support. A very small percentage of children will need more intensive interventions as a result of many factors -- the nature of personal loss, the history of family and social interaction, the degree of personal bodily harm, etc. These special cases, too, can most often be returned to a happy childhood over time. Normal coping mechanisms are available to children as well as to adults. While there is a reasonable concern for each child's well being, most of them will recover from this event and go on to lead happy, productive lives.
Helping All Children
Five key points to keep in mind when working with children:
1. Reaffirm safety, protection and your own concern for the child's overall well being
2. Monitor your own real emotions and feelings as they relate to the event, and take care of yourself so you can take care of others who need you.
3. Return to and maintain a steady routine of activities upon which a child can come to depend.
4. Watch for small problems that might develop which an early intervention (a gentle, caring chat or hug) can resolve; validate children's emotions and do not shut them down.
5. Allow more time that usual for simple activities, keeping in mind a slowed pace is easier to facilitate recovery.
Hope and meaning are the two essential components of resilience, the quality needed to recover a sense of purpose in our lives and move forward. No one can speak the absolute truth and give meaning to these events, but surely all of us share a sincere and genuine hope for the future of this nation and its most precious asset -- the children. Add to that a profound faith, abundant humor, remarkable sensitivity, perseverance in the presence of hardship, amazing adaptability and enormous caring and support from others, and this revered culture will undoubtedly recover its exquisite beauty and charm. Its people and children will return to a new life with our support.
• Infants and toddlers (up to 5 years old) may react with crying and clinging behavior, aware of the distress in their caregivers. Episodes of bedwetting, rocking, regressive thumb sucking or new fears are normal. Continual reassurances, physical contact and nurturing love are usually all that is needed for children of this age group in order to overcome the symptoms of trauma.
• Those in middle childhood (up to 12 years old) often act out more symptoms, exhibiting aggressive behaviors or anger, avoidances, and some challenges in returning to everyday routines such as school. Slowing down the processes and taking more frequent fun breaks than would otherwise be scheduled helps children of this age to work through their stresses. Physical movement -- like playing sports, martial arts or simple running games -- are excellent releases of stagnant energies.
• Adolescents' responses vary greatly and can more quickly accelerate into serious avoidant behaviors, like substance abuse. Some extreme risk-taking can also be observed, as children of this age group may harbor deep feelings of abandonment and thus carry a distorted value of life. Soliciting help from these children to create their future is a perfect response to this groups needs. Building projects that directly contribute to their future -- creating new curtains, painting, developing carpentry skills and other things which allow them to be an accepted part of the adult community -- dramatically reduces symptoms. Extreme Cases The most common diagnosis of those who suffer ongoing problems of trauma is known as Post-Traumatic Stress Disorder, or PTSD. This diagnosis is often misapplied to those experiencing normal coping symptoms, and as a result exaggerated expectations will frequently exceed actual psychosocial need. In effect, PTSD will not usually occur unless during the period of 90 to 120 days following the event nothing is done to help victims release repressed emotions.
In the fourth month, three symptoms may appear leading to a diagnosis of PTSD:
• Reliving the experience of the event through haunting pictures, memories, flashbacks, nightmares or a sense that the event is not over; reliving the stress caused by the event when placed near settings where the event took place (e.g. near an area where serious damage occurred, close to the shoreline or power plants)
• Avoiding behaviors in an attempt not to be reminded or exposed to the associated stress. These include disinterest in things that are normally fun, introversion or shyness beyond normal cultural mannerism, no interest in planning the future and feelings of abandonment or isolation.
• Physical hyper-arousal leading to loss of sleep, outbursts, startling, hyper-vigilance or "jumpy" over alertness.
Often, these three symptoms are also accompanied by:
• Obsessive behaviors that recreate the context of the trauma. • Dissociation and feelings of "disconnect" from others.
• A burden of guilt for surviving the event itself. The second group of three symptoms may or may not be present in a diagnosed PTSD, whereas the former three are thought to be necessary to confirm a diagnosis.
Helping Children Deal With Loss
Certain very simple skills are needed to help children deal with loss:
• Patience. Don't rush expressions of mourning or grief. Children may vacillate between outbursts of crying and ecstatic laughter. This is a normal coping mechanism and caregivers need to follow the lead of the child.
• Listen. Let children know you care by engaging them in simple conversations, and then be prepared to truly listen. Sharing your own feelings briefly might open up a dialogue with a child.
• Remember. Support children in recalling their deceased parents or siblings. Talk about what they loved, what they miss, and what they might not miss. It is unnecessary to react in any other way than your presence.
• Remove all blame. Some children take responsibility for the death of a parent or sibling, thinking they could have acted in a different way to warn or protect, or done something more to help. This guilt requires your sensitivity. Do everything you can to reassure the child that he or she did the best they could.
• Include. Many children can benefit from hearing other children express their feelings. Work in small groups of three, four or five children that create safe spaces to open up. Sometimes, the silent child will gain a great deal through this mechanism.
• Play. Remember, we are helping children, and children love to play games. Too much talking does little to help them deal with loss. Dance, play games, draw, sing -- do anything to express feelings or process energy in the body helps in a nonverbal way as well as any talking.
A Reality Check For all children, it is important to keep in mind that their world is now completely different than before. Their sense of personal safety, both physical and emotional, has been forever altered. Each caregiver must convey a new growing safety in his or her mannerisms, behaviors, language and unconditional presence. Children are also dealing with feelings of abandonment. Having lost one or both parents, many friends and siblings, together with their neighborhoods, possessions and communities having been swept away causes enormous stress. Keep your word and rebuild trust. If you say, "I'll be back tomorrow," you must come back. If you say, "I'll call you Friday," call. Children need to reconstruct their world by renewed trust in caregivers' actions. Make no promises you cannot keep. Religious beliefs have been forever challenged. Whether discussions of the laws of karma or the will of God are offered as an explanation, children have great difficulty placing their experiences into a reliable context. Help children to regain meaning in life by talking openly about what has happened -- not why it happened. Trust that they can develop their own sense of why at an appropriate time later in their lives. Give them hope, and talk about the future. Set a Good Example It is easy for caregivers to forget their own needs, but essential for them to take care of themselves. The degree to which you can truly be of value helping children is directly proportional to your own mental health. Take time out when necessary. Don't push. Relax, and trust the process of life to slow repair the damage of trauma. Talk with your own family and friends to process your own feelings. You are having a real experience yourself; don't disconnect from your emotions. Find safe spaces to release and process your emotions. Eat well and try to maintain your health. Exercise and keep moving; don't be too sedentary. Do something to relax and "escape"; read a book, listen to music or meditate to recompose your energy. Let go of judgments and resentments. Ultimately, everyone is doing the best they can. Appreciate each individual and his or her own offer of support. Trust the process. Life goes on; every day can improve. Breathe. Breathe again. Keep mindful of your breath. Over the next two months, our foundation will assemble an experienced team of mental health care professional who have an expertise in the area of trauma. We intend to travel to Japan to train caregivers there in a series of five carefully designed, very specific play exercises that anyone can use in Japan. If you know someone in or near the affected areas or are in touch with groups who plan to go there, please share the resources here and feel free to put them in touch with us. All methodologies that support children to release trauma held in their body can be among the most valuable of all.
by William Spear