July 21, 2024
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When sirens blare, Israeli children in Sderot chant in Hebrew: “Tzeva Adom Tze­va Adom: Red color, red color. Hurry, hurry to a safe area because now it is dangerous. My heart beats boom, boom, boom. My body is shaking doom, doom, doom. We are falling down (children go under desks) and now it is okay. Now we stand up and shake, shake, shake our legs. Breathe in deep, breathe out far, and now we can laugh. It is all gone, and now I feel better.” The children pose like Her­cules and continue to chant: “But I am over­coming because I am different. And now it is okay.” Hands are clapped and everyone gives a sigh of relief, “Yes!”

Israeli youngsters are taught this song as soon as they can talk to reduce the anx­iety created by sirens signaling rocket at­tacks. For 12 long years, this has been the re­ality for Israeli children in southern Israel near the Gazan border. Some of them have never known a life sans sirens.

Children exposed to war and violence are at high risk for post-traumatic consequenc­es that may negatively impact their personal, relational, and academic futures. This is true for preschoolers, toddlers, and infants, as well as older children. Old theories about young children being immune to war- and violence-exposure are upended by more recent as­sessments and research. Experts in the field of psychotraumatology found that safety be­gets expectations of further safety, and dan­ger begets expectations of more danger. The children’s fight-or-flight response is not a one-time event—it puts children into per­manent “survival mode.” Staying “on guard” replaces spontaneity and exploration. For children living in Israel and Gaza, basic as­sumptions about the safety of the world they know, while at home, at school, or at play, are overwritten by sirens and/or bombs.

For those who can find safe shelter, pro­tective routines can be created. A degree of psychic protection can build upon literal pro­tection, as in the songs and routinized be­haviors Israeli children are taught through shelter-drills and real-life attacks. For those without available turns-to-safety, such psy­chic protection (partial at best) is not availa­ble.

Professor Danny Brom, director of the Herzog Israel Center for the Treatment of Psy­chotrauma, has been leading mother–child groups to strengthen children’s emotional regulation for the last nine years. During this war, crisis intervention is the priority over tra­ditional therapy. Resilience workbooks have been distributed to young children in the south. There is a 24-hour hotline to help par­ents cope: A mother wants to know what to do when her 7-year-old vomits and collapses every time he hears a siren.

Says Brom: “The real work with trauma victims starts when the war is over. Restora­tion and recovery will take a long time. Those who have severe symptoms Post-Traumatic Stress Disorder (PTSD)—10-15%—have not had the opportunity to recover because chil­dren and adults are in and out of stress all the time.”

Brom believes PTSD is just one of the ef­fects of massive psychic trauma. The major­ity of victims are not necessarily suffering from PTSD. Children in Sderot and in south­ern Israel have not had a respite since the first rockets fell in 2002, and now more pow­erful missiles are aimed at them. Children under 14 have lived under threat of annihi­lation their entire life. How will these chil­dren feel about living in Israel when they grow up? What kind of faith will they have in God? How will this sense of insecurity in­fluence their intimate relations and ability to commit to a relationship and having a fami­ly? What kind of a world view will they devel­op? How will their aggression manifest itself when they become adults? How will they be able to regulate their emotions?

Children growing up in contexts of pro­tracted and recurring warfare and terror­ism, experiencing their days interspersed with preparations, protective maneu­vers, and their aftermath accrue massive strains and stresses. Add direct exposure to bloodshed and/or the anguish of loss or personal injury, and children directly learn of the limitations of adult capacities to safeguard them. They develop psycho­logical armor that may be adaptive in the moment, but maladaptive in the long-run. Waiting for PTSD to emerge before offer­ing intervention is imprudent, as accumu­lated violence underscores the benefits of “prevention.” This includes offering facili­tated play where the child creates a more coherent narrative through “pretending.” Helping parents and caregivers appreci­ate children’s symbolization in play, es­pecially when they are highly stressed themselves (which itself diminishes sym­bolic activities) becomes a key element in such prevention, exemplified by the Na­mal Program implemented in Sderot (de­veloped by Esther Cohen, and expanded and applied by the Israeli Center for the Treatment of Psychotrauma).

Operating efficiently in group thera­py focusing on caregiver-child relations, the program highlights themes of attach­ment, self-reliance, playfulness, and the importance of make-believe, a positive view of the child, child-expressivity of emotions, self-care for the adult caregiv­ers, the use of soothing interactions, and an increased appreciation for the com­plexity of child-thought. This is all de­signed to help the child feel that his or her inner experiences are understood. Countering feelings of helplessness and associated anxiety, active construction in play promotes a developmental ability for the child to distinguish what is real and what is imagined, to differentiate one’s own perspective from what is another’s, and resilience itself.

Moran BenDov, a resident and social worker in Sderot works with Hosen, a center for trauma treatment. She is with traumatized children and their parents 24/7. The schools in Sderot are now day camps, yet each after­noon, 200-300 children are in shelters with 50 to 70 volunteers from Sderot and elsewhere. The children are entertained with clowns, music, and movement among other activi­ties. There is a psychologist in every shelter; parents are taught to care for their children and understand their behavior during this traumatic time. BenDov’s center teaches par­ents to be aware of children’s symptoms like excessive clinginess, wanting to sleep in the parents’ bed nightly, bed-wetting, and night­mares. Parents are encouraged not to allow their children to watch news, to explain the truth but in age-appropriate ways, and not to expand on details. Children learn to cope from their parents, so parents need to stay calm in front of the children. But of course, this is not always possible.

Parents and caregivers in war-torn en­vironments are challenged to provide in­fants and young children with the basic ingredients of pleasure, security, safety, and trust, and the tools that children need to manage emotions in their lives, espe­cially negative emotions. This is true even when the child is not directly hurt and has not witnessed death or injury to others, though such experiences exacerbate re­actions. Young children, even infants and toddlers, are remarkably skilled at reading the emotions of those around them. The nonverbal communications are every bit as powerful as the verbal ones. Hence the adult who is terrified lends a feeling of ter­ror to the child via body tension, a slightly opened mouth, raised brows, and opened eyes locked in narrowed attention. Per­haps later the caregiver is angry or highly distracted. Young children tend to person­alize such behavior, attributing it to some­thing they did. Children at different levels of cognitive maturity, based upon age and distinct trajectories, may come to differ­ent conclusions, but the caregiver’s abili­ty to attend to the child’s experience and meaning-making is invariably crucial. But that becomes difficult when the parent is stressed and is not reading the child’s cues as sensitively as he or she would in a saf­er context.

BenDov went to a home of a woman who had a panic attack when a Kassam fell near her house. The 37-year-old had diffi­culty breathing, heart palpitations, noises in her ears, and heaviness in her legs. BenDov showed the mother a few breathing exercis­es while her 7-year-old daughter watched. After a few exercises, the daughter tried to get the mother to continue and told BenD­ov she wants to be a doctor when she grows up, showing amazing strength. In situations of life and death, children sometimes exhibit more resilience than the parents. Roles are re­versed and children end up taking on greater responsibility. Sderot has many single moth­ers from the former Soviet Union who don’t speak Hebrew very well. They rely on their young children to let them know what is go­ing on in the outside world.

The discovery of the tunnels has cre­ated new fears. Therapists are creating new ways to help people cope with this new threat of annihilation. Children are moved to safer areas for brief periods, sing the “Red Color” song, and play rock­et games.

All traumatic stressors, including nat­ural disasters, trigger concerns regarding injury or death to oneself or loved ones. Human brains are pre-wired to respond to such threat by entering a survival mode. Fear-arousal is a biological response that is given psychological meaning in con­text. One of the major factors in war and terrorism is that people are behind it. Chil­dren know that the danger comes from people with malevolent intent. Thus, mis­trust and hatred are fueled by their trau­ma. Even very young children remem­ber these traumas in meaningful ways. Enough knowledge has accumulated from Holocaust child studies and trauma research to recognize that there are long-term consequences to trauma-exposure during the earliest days of life. In fact, the fetus absorbs stress (e.g., through higher cortisol levels), proving that war-exposure has negative pre-natal consequences.

Danny Brom strongly believes that during war, children and adults don’t need traditional psychological care as much as they need human connection and to feel as part of a community. But pre-war psychologically-informed preven­tion is necessary to lessen the disruptive and frightening impact of the recurring threat. Later, psychological intervention will be needed for those with symptoms. Moran BenDov says creating a sense of community with those on the “outside” is vital. “We need to feel that Jews all over the world are giving us a big hug.”

Drs. Eva Fogelman and Mark Sossin are officers and therapists for the International Study of the Organ­ized Persecution of Children/Child Development Re­search, which works with child survivors of the Hol­ocaust since the 1970s. They apply the knowledge gained from Holocaust survivors to help children everywhere from suffering from the trauma of war. www.holocaustchildren.org

EvaFogelman, Ph.D. andMarkSossin, Ph.D. (exclusivetoJLBCfrom TheInternationalStudy of Organized Persecution of Children)

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