WAR, TRANSGENERATIONAL TRAUMA AND PREVENTION:
Reflections for our daily clinical practice
Enza Gidaro, Cogntivie Behavioral Psychotherapist, EMDR Consultant
Simona Vecli, Systemic Relational Psychotherapist, EMDR Practitioner
Most adults today, have a vivid emotional memory of past warfares. As international terrorism has become a permanent force in our modern world, the last three generations, foremost the youngest, have been exposed directly or indirectly to such violent tactics. Adult patients living in today’s modern society, constantly live with the media headlines highlighting these incidents of terrors serving as a model for scenarios of a Third World War. Exploring if any experiences of similar traumatic events might have happened within the family of origin of our patients, as well as in their extended family, may help understand a patient’s personal sense of vulnerability.
In reactions to the Paris terror attacks in November 2015, not suprisingly, many patients asked for support for their strong emotional reactions to these dramatic events, which exacerbated the effects of traumatic memories linked to their parents’, grandparents’ or uncles’ warfare experiences.
This made us think about how important it is to explore these issues during history taking and when outlining a therapeutic planning.
The ACE questionaire presented by Carol Forgash at the EMDR European Conference in Milan (2015), can be a useful tool for everyday clinical practice. As a complement, clinicians can collect information about any traumatic events (Phase 1) by asking the following questions:
- Have you ever been a combat soldier?
- Have you ever lived in a war zone?
- Have you ever assisted to any war violence?
- Have you ever been victim of war violence?
- Have you ever been a victim of attacks?
- Have you ever provided assistance to victims of war or attacks?
- Has anyone in your family ever been a combat soldier, lived in a war zone or directly experienced war violence?
- Has anyone in your family survived terrorist attacks?
- Has anyone from your family ever provided assistance to any victims of war or terror attacks?
Genograms can also be useful: this tool allows to quickly identify and understand various patterns in the patient’s family history, which may influence the patient’s current state of mind. The genogram maps out relationships and traits that may outline historical trauma, extending across many generations, caused by traumatic experiences linked to historical social political unrest and armed conflicts. Each member’s traumatic experience, even if a distant family line, can function as a trigger. From a biosocial perspective, the family system is an individual’s primary rearing environment, from which the oldest and most meaningful trauma can stem from disrupting events which have affected other members.
Every family has at least one member who has experienced a:
- direct traumatization: usally grandparents, great-grandparents, uncles and sometimes fathers – experienced firsthand exposure to war-related events. Also, relatively young people may have survived more recent conflicts at the turn of the 21st century, such as military soldiers, or survivors of a terrorist attack since 2001;
- Indirect traumatization: this can be caused by a second hand interaction, like hearing about a traumatic event. It is common for patients to have heard about battles, imprisonment, torture, violence, hardship, deprivation and exodus, or to have lived with someone who had a PTSD symptomatology. The transimission of trauma operates at a meta-level through dysfunctional behavior, myths built out of consesus, a projection process that operates toward the manifestation of patholocial symptoms within the family context.
Exposure to trauma stories of other family members can lead to secondary traumatization, as well as for children and adolescents being exposed to the most recent media coverage on terrorist attacks: the horror described in grandparents’ or parents warstories can be reactivated by these recent terror attacks, serving as targets and triggers. Studies conducted on subjects who were offsprings of holocaust survivors revealed that they did not manifest worse psychopathological signs compared to the general population, but tended to manifest a specific psychological profile including proneness to PTSD, difficulties in the separation-individuation process, as well as the juxtaposition of vulnerability and resilience, in the face of stressful circumstances (Lanius, Vermetten, Pain; 2012).
Negative cognitions often fall from one generation to the next through stories told, a handed down learning process through generations. War stories conjur lifeworlds inflected by uncertainty and precariousness, a life amid the preception of threat and loss of control. As EMDR therapists, we are aware of how significantly these existential insecurities afflict a person’s general health and self-preservation. These negative cognitions can turn into inherited life-scripts and easily lead to a repetition compulsion of the trauma. Psychic legacies such as not feeling safe or of non-belonging to a place or group, intermittent relationships, no access to education or pleasant activities, are passed on through unconscious cues or affective messages between the generations (Condor, Handout for EMDR, 2014). Transgenerational transmission of trauma more likely leads to symptoms and psychopathology, depending on the resilience of the family and their society. Today’s generation’s psychological vulnerability is highly challenged by the intensity of an original trauma and on what timely protective psychosocial factors are available within the family and the wider community.
Considering the global breadth terrorism entails, these guidelines are meant to serve the scientific community and laypeople, as a preventive tool for psychological trauma in children, as well as fostering resilience at a social level. All of us, therapists, parents, teachers, educators, members of the community, can contribute in creating safety, trust and establish solid ties by instilling hope for the future within societies.
By ameliorating attachment bonds, one further goal should be to foster tenderness, as well as increase empathy and generosity toward others. It is through these knowledges and humanity, that we can contribute in ensuring each day safety and peace among our children and the world.
¹ Forgash, C. (2015). The Adverse Childhood Experience (ACE) Poor Health Cycle with EMDR (Rompere il ciclo); Rivista di Psicoterapia EMDR, 30, 5-7.
C.Condor, EMDR with Women with Complicated Childhoods; Handout for EMDR, 2014.
Ruth A. Lanius, (a cura di), E. Vermetten, C. Pain; L’impatto del trauma infantile sulla salute e sulla malattia, Fioriti Ed., Roma, 2012; The Impact of Early Life Trauma on Health and disease: The Hidden Epidemic, (a cura di) Ruth A. Lanius, Eric Vermette e Claire Pain, Cambridge University Press, 2010.
Terrorism and PTSD
How to talk about terrorism and prevent PTSD in children and adolescents
Enza Gidaro, Cogntivie Behavioral Psychotherapist, EMDR Consultant
Simona Vecli, Systemic Relational Psychotherapist, EMDR Practitioner
Parents, teachers, caregivers, face many challenges in educating and supporting children while they are growing up. This task can be more or less daunting at times. When facing repeated acts of terrorism, that create an atmosphere of instability, uncertainty, prevention plays a vital role in promoting psychological and mental health in children. Choosing the right words, appropriate to a child’s emotional and cognitive universe to convey the harsh reality, as well as promptly recognize any signals of distress after such horrible events, is crucial. As therapists, we believe that the best way to provide a systematic guide on how to best approach children after such horryifing events, is by delivering messages which convey predictability and clarity (Charter of the Rights of the Child, ONU, 1989 ).
These guidelines have been developed by the Italian EMDR National Association and are meant to help adults in explaining to children what terrorism is.
GUIDELINES FOR TEACHERS AND PARENTS:
Terrorist acts and war actions are exceptional manmade events, taking their toll on many aspects of the life of a community and can significantly interfere with a sense of safety in children, giving the message that the world is an unsafe place to be in.
The child looks to the way the adult handles the news to determine their own approach. If the adult is reassuring and calm, they will be so, too. Physical comfort, vicinity and snuggling up can make the difference, if the child cries or is tense.
Carefully consider your child’s maturity and temperament when observing or intervening with the child. The younger the child, the more he needs to have information in a way that makes sense to him and has to be provided by a nearby, accessible attachment figure.
Children at school may show signs of distress through change of behavior, such as increased irritability and expression of tension and conflicts within the class. This can be a sign of unsufficiently processed material.
What can teachers, parents and caregivers do to help children? Here are 5 helpful strategies to help you to carry out a prevention plan:
Families and teachers need to observe the child’s behavior, emotional expression and cognitive performance during their play, social and school experiences, to detect any changes in their expressed attitude and emotions. Schools, families and local communities must work together in partnership, in order to tap into more information, since manifestations of distress may vary greatly according to the different contexts and situations.
It is best to quickly identify students who manifest anxiety or fear and tell their parents right away; school psychologist or counselors should partner up with family and school staff, and assess if any students may have experienced a recent personal tragedy, or might have a direct connection to victims of the terror acts, providing them with support, as well as to other school-employed professionals.
Parents need to monitor how much school-aged kids are exposed to images related to the terror attack. Preschool children should be kept away from images or news. Pay attention to what they hear from others: it is not uncommon that children may talk to each other about what they have heard on the news and have misconceptions that may even create a situation in their mind that is scarier, causing worry and anguish.
Find a place where you can talk with the child without being interrupted. Children need an invitation from an adult to talk about what happend. Having the right understanding of what has happened, can actually help take away the confusion, and help kids feel better. Find out what they know, where they heard it from, what their opinion is and have them ventilate their emotions, especially starting from 6 years of age. This can help the adult understand what the child needs to know, and how they feel toward themsevels and their loved ones
Encourage them to express how they feel by saying “It looks like you are worried/scared/sad…”
Ask them if at times they are likely to think about the images or the event more often, than in other moments. Asking questions teaches children to focus on themselves and increase their level of personal awareness in relation to their emotions and cognitions. This also enables their critical thinking and teaches the value of pursuing the search for answers.
Keep it simple. The first thing to do is to clear out any confusion: it is important for adults to keep talking to children, because they may be mislead by misconceptions coming from their peers. Parents should remember, that if they will not talk to their children about what happened, someone else will: this will increase their risk of being exposed to traumatic material. Parents need to take some time and decide what they want to tell them and the meanings they want to convey to their children. Since adults are at risk of being traumatized by such horrifying events, the contents of their explanations should not be alarming, nor stir up racial hatred.
The second aim is to always tell the truth in a clear way and according to the child’s age and level of understanding: use a simple language and a calm tone; do not downplay the seriousness of the event, nor say something humourous about it.
Children have difficulties in storing explanations within their memory system. Assess what they have understood and be prepared to repeat things if necessary. Discrepant information will confuse them. Children want and deserve to receive the best and most honest explanations. Identify all the people who are working to keep the country safe, working hard in rescue interventions and stepping up the efforts to prevent this from happening again. This is very important with preschool and school age children, who have been exposed to the news.
- REASSURE THEM
Adults and children alike will be rattled by such events. Nevertheless, adults should try to convey confidence and calmness, as children watch us to determine how they should feel about things. By using a simple language, children need to be told that they are not alone, that they are loved and safe: “…we are right here and we will protect you”. Reassure them that all their loved ones are safe.
In the event of such random and extreme displays of delibrate violence toward a community, make a list of all people who are dealing with the consequences of these events and ensuring everyone’s safety: “…the police, all law enforcment bodies and governments are working together in keeping the situation under control and making the city a safer place”. Bring them to the present moment: “We are here together now and we are talking about it: we are at school/home and we have many things to get done.” Engage children in positive activities and help them focus on other things.
- Keep the lines of communication open
The operational aspects and consequences of a terrorist attack require that adults keep the lines of communication with their children always open: “… we can still talk about it” , “…if there is anything you don’t understand, we can explain it to you”.
A relationship of trust helps a child feel supported for how they feel emotionally and physically. Never cut them off by telling them not to cry, or laugh at them or reprimand them for any bizzarre questions, but underline all appropriate contents in a respectful way. Let them feel, that what they are bringing to you is important and worthy of consideration.
Children need to resume their daily educational programms and activites. Stress can wear them down, therefore make sure your child gets enough rest, accumulates physical activity and leads a healthy diet. Routine and everyday priorities help children re-establish the “safe place” they belong to.
HOW TO TALK TO CHILDREN
Be sure not to bring up the subject, unless prompted by one or more children. Families and educators should establish a collaborative approach in reassuring children, by providing consistent and congruent messages when discussing what happened.
“… there are some people who think that in this world different men and women cannot stay together, either because they believe in a different God or because they are from a different ethnicity; we and the rest of the world believe in peace….” Should the children directly refer to the terrorist attacks (e.g. “men who are shooting”), the adult can say:
“…it did happen. But now, in most parts of the world, the governments are dealing with it, because no one wants people to fight and hurt each other and everyone wants peace”.
Promote exchanges between their peers and how each individual differs in what they experience: focus on their small group and foster cohesion among them. This will help them resume a sense of safety within their environment and not feel threatened (e.g. play group, songs, workshops on cooperation and friendship).
School-aged children (age 8 to 10) are ready to understand events in the news and begin to think more logically about events. They have a clear notion of what a nation is, of Europe and of all other continents. Children at this age begin to think more logically about terror events and of what a terrorist really is. Explain that terror attacks by Muslim extremist have nothing in common with the mainstream muslim community, to avoid rifts bewteen groups with different backgrounds: “…religion is neither fear nor violence”. Multi-ethnic classes are the best social context for gearing improvement in racial and ethnic relations toward the prevention of prejudism.
“Ever since the terror attack and many days later, the news will keep talking about these terrible acts, describing what is going on and the manhunt underway. All special forces are working to protect the population and activate more efficient security measures.
Paris is the capital of France and France is a European nation. We live in Europe and we are people who love life and freedom.
What has happened, at the hands of some men, is an attack to freedom and to our way of being and of living. We hear that these horrifying acts are done in the name of religion, but that is not true.
Europe and the rest of the world is actively ensuring safety and protection to all the people in these countries.
As parents and teachers, we are sad and very much upset by the news. We are glad though, that we are here all togeher and are able to talk about this.
If you are thinking about what has happened or seen on tv and cannot get rid of these images, please know that we are here for you, we can talk about it and we can help you understand what happened.
Talking to others about what worries or scares you, will help you feel much better. This way, worries go away or at least you will stop worrying as much.”
At this age kids are more easily exposed to media coverage and developmentally they are able to engage in more sophisticated information. Their questions raised during class will bring up more complex topics like war, economic interests and will focus on religion and spirituality. Remember to pinpoint their need for knowledge by asking questions such as “what exactly do you want to know?”, “what is your personal opinion about this?”, “what would you suggest doing?”.
They can be more vocal about the events and the adult can use discussions as an opportunity for growth and understanding of the true facts underpinning these horrific events.
When extremely stressed by being exposed to traumatic material in the news, older kids often revert to younger kid behaviors and may get sillier and downplay what happened. These are clear reactions to fear and concern about the future. Carefully observe their behavior and refer to the emotional stress markers checklist below.
EMOTIONAL STRESS MARKERS
Psycholgical development in children and adolescent can be altered by direct or indirect exposure to a dramatic event; just like adults, children face greater risk to develop a psychological disorder, the more severe a trauma is. PTSD, depression and separation anxiety are just a few of the most common disorders that can occurr in developmental age.
This is a list of “emotional stress markers”, after exposure to a traumatic event:
- Emotional numbness, separation anxiety
- Changes in their play
- Loss of skills they had already learnt
- Distress triggered by event-related stimulus
- Increased aggression
- Excessive vigilance, difficulties in concentrating.
- Nightmares, trouble getting to sleep, night wakings
- Increased somatic complaints
- Fear, crying, generalized psychological distress.
- Intrusive thoughts related to the traumatic event or traumatic images.
- Separation anxiety
- Trouble getting to sleep, nightmares, fear of the dark
- Irritability or anger
- Hypervigilance and exaggerated alarm responses
- Communication problems
- Decreased concentration or attention span
- Survivor’s guilt
- No hope toward the future, questions about death and dying
- Panic attacks
- Fabulating and telling lies
In case of one or more symptoms, see a qualified therapist for Acute Stress Syndrome/PTSD. For further information please visit www.emdeurope.org