Children, Fear, Terrorism: Paths to Recovery

By Nancy Stiefel, CSW, writer, psychoanalyst, and a faculty member of the Mid-Manhattan Institute for Psychoanalysis. She is co-director of the Center for Aware Parenting.

(September 2002)

September 11 has provided those of us who work with children and families a sad opportunity to see the damage that fear can wreak on our most vulnerable patients - the young. Since that day, many clinicians have faced the challenges of helping these clients regain a feeling of safety in their daily lives. With the anniversary of September ll, we are on the alert for a resurfacing of feelings of panic, anxiety and grief among our patients.

In treating children these past months, I was reminded of a phrase spoken by a child analyst during my training years ago: "You must always remember," she said, "that the child is afraid." Recalling these words has been particularly helpful since jet planes permanently altered our external and internal worlds one year ago.

What are we to do when a child is affected by a disaster of such magnitude? In treating children who experience continuing and intense anxiety from September 11, I know that whether the child acts withdrawn, depressed or indifferent, or is talkative and outgoing in my office, he or she is terribly afraid. Getting a history from parents about the child's behavior at home and at school is invaluable in assessing his or her emotional state.

Creative Expressions

Frequently, the child is not able, or is unwilling, to talk. I encourage expression through play, in any way the child finds comfortable. For children suffering from the trauma of the September 11 devastation, drawing is the most often chosen activity. Through drawing, children repeat their experience with themselves as the creator and interpreter of it. Drawing can be extremely empowering for the child who so often feels powerless in the world.

Children often experience questions as assaultive, and they will simply not answer. They prefer to reveal their thoughts at their own pace. When a parent is in the room (I always allow the child to decide whether they want a parent with them) the parent often becomes impatient and will order their child to tell me what they are afraid of. I then explain that children protect themselves by not talking until they feel enough trust and comfort; until they are ready. It never fails to amaze me how a child, after drawing or playing games with me for several, sometimes many sessions, will suddenly, out of the blue, directly and openly talk about their most deep-seated fears.

One six-year-old girl whose school was near the World Trade Center witnessed people falling from the towers. She drew them with parachutes. This is an example of the ingenious ways that children find to spare their fragile egos from knowledge that they are not strong enough to integrate, in this case, the knowledge that so many people died horribly. The ability to translate unspeakably frightening experiences into pictures aids in the recovery of child trauma sufferers. This girl's drawings may have protected her from later psychosis.

Many children who lived near the World Trade Center or went to school in the area not only witnessed the events first hand, but also suffered from being moved from their homes and schools. But children who were not direct witnesses responded strongly to the palpable danger in the atmosphere, which was constantly fueled by the 24/7 media coverage. In treating children of both categories, I found that their symptoms depended more on their individual constitutions and their families' ability to provide insulation for them, rather than whether they were direct or indirect witnesses to the event.

The Role of the Family

The following anecdote sheds light upon parents' crucial role in providing insulation for the child. I saw a nine-year-old boy who had been having terrifying nightmares. In speaking with his mother, I saw immediately that she herself was terrified and unable to regain her equilibrium months after September 11. This brings up an important question: how can adults offer children a feeling of safety when their own security has been invaded? Since the parent is the child's insulation from an often terrifying world, a parent who is frightened out of her wits cannot protect her child from feeling endangered. In this case it was the mother who needed counseling. When she recovered so did her son, without treatment.

In treating children these past months, I was reminded of a phrase spoken by a child analyst during my training years ago: "You must always remember," she said, "that the child is afraid."

I did not work with any children who lost parents or close relatives, but from what I have gleaned from colleagues who did, it seems that some of these children may have experienced feelings similar to losing a parent who fought in a war. There is a local and national community that regards the victims of September 11 as heroes, and that openly grieves with their surviving family members. I hope and believe that along with their feelings of terrible loss, some of these children feel held by their community, and honored, and less alone.

I have witnessed in recent months the amazing buoyancy of the human spirit. Most children-and adults-can recover from trauma to experience happiness and comfort once again. But it is important for us to remember that the child who does not recover after a reasonable period may be suffering from an incipient emotional illness that predates September 11, or that he or she may be reacting to earlier trauma that have been reactivated by recent events. It is vital to identify these children, for they are particularly at risk, and may need extended treatment to recover.