Dr Bharati Ankalgi

Kathmandu

Today we are facing trauma and violence in our day-to-day life. These regular incidents going around us have definitely some deep psychological impact on all of us. Whatever may be the reason for this violence and whoever might have committed it, it is very clear that we are all affected by this situation. To encounter such situation regarding regular checking, facing close contact with guns, seeing violent crime situation, disturb our minds and affect all ages.

Exposure to violence at home or surroundings can lead to emotional harm. Helping people, especially young, avoid or overcome emotional problems in the wake of disaster is one of the most important challenges facing a parent, teacher or mental health professional.

Impact of violence Both adults and children who experience catastrophic events show a wide range of reactions. Some suffer only worries and bad memories that fade with emotional support and passage of time. Others are more deeply affected and experience long term problems. Post-traumatic stress disorder shows some soldiers, survivors of criminal victimisation, torture and other violence, and the survivors of natural and man-made catastrophes suffer long-term effect from their experiences.

Children who have witnessed violence in their families, schools, or communities are also vulnerable to serious long-term problems. Their emotional reaction including fear, depression, withdrawal or anger, can occur immediately or sometime after the tragic event. Youngsters who have experienced a catastrophic event often need support from parents and teachers to avoid long-term emotional harm. Some may recover soon, some may suffer from post-traumatic stress disorder.

What is trauma?

Trauma has both medical and psychiatric definition. Medically, ‘trauma’ refers to a serious or critical bodily injury, wound or shock. Psychiatrically ‘trauma’ refers to an experience that is emotionally painful, distressful, or shocking, which often results in lasting mental and physical effects. Psychiatric trauma or emotional harm is essentially a normal response. It involves the creation of emotional memories about the event that are stored deep within the brain.

In general, it is believed that the more direct the exposure to the traumatic event, the higher the risk for emotional harm. For example, that student will be most severely affected emotionally who sees a classmate shot, even killed than the student who was in another part of the school when the violence occurred.

But even second-hand exposure to violence can be traumatic. All children and adolescents exposed to violence or a disaster, even if only through graphic media, reports, should be watched for signs of emotional distress.

Reactions

Reactions to trauma may appear immediately after the traumatic event or days and even weeks later. Loss of trust in adults and fear of the event occurring again are responses seen in many children and adolescents who have been exposed to traumatic events.

Typical reaction in different age groups:

• Five years and younger: Fear of being separated from parents, crying, screaming, immobility, aimless motion, trembling, frightened expressions and expressions and excessive clinging. Parents may also notice children returning to regressive behaviour such as thumb sucking, bedwetting and fear of darkness. Children at this age are affected by parents’ reactions to the traumatic events.

• Six- to 11-year-old: Extreme withdrawal, disruptive and regressive behaviour, inability to pay attention, nightmares, sleep problems, irrational fears, irritability, refusal to attend school, outbursts of anger and fighting are common. Complaints of stomach-ache or other bodily symptoms that have no medical basis, depression, anxiety, feelings of guilt and emotional numbing may occur.

• Adolescents: Twelve to 17-year-olds may exhibit responses similar to those of adults, including flashbacks, nightmares, emotional numbing, avoidance of any reminders of the traumatic event, depression, substance abuse, problems with peers, antisocial behaviour, withdrawal and isolation, physical complaints, suicidal thoughts, school avoidance, academic decline, sleep disturbances and confusion. The adolescent may feel extreme guilt over his/ her failure to prevent injury or loss of life, may harbour revenge fantasies that interfere with recovery from trauma.

When we find such problem we should try to help our child as much as possible and we should seek help from mental health professional.

Early intervention to help children and adolescents who have suffered trauma from violence or a disaster is critical.

What educators can do

• Give yourself a bit of time to come to terms with the event before you attempt to reassure the child. This may not be possible in the case of a violent episode in school. But sometimes in a natural disaster there will be several days before schools re-open and teachers can take the time to prepare emotionally.

• Don’t try to rush back to ordinary routines too soon. Give the children or adolescents time to talk over the traumatic event and express their feelings.

• Respect the preferences of children who do not want to participate in class discussions about the traumatic event. Do not force discussion or repeatedly bring up the event; doing so may re-traumatise children.

• Hold in-school sessions with entire classes, with smaller groups, or with individual students to tell that their fears and concerns are normal reactions.

• Offer art and play therapy for young children.

• Encourage children to develop

coping and problem-solving skills and age appropriate methods for managing anxiety.

• Hold meeting with parents to discuss the traumatic event, their children’s response to it, and how they and you can help.

If there are more problems one should consult a mental health professional.