We are now preparing to bring a Second Response team to Ormoc and Cebu in the Philippines where tens of thousands of traumatized children and adults struggle after what may have been the strongest typhoon on record. We will train mental health professionals in Manila and then travel to impacted areas. A member of our trauma team was on the ground on November 20th to assess the need, make contact with mental health officials and begin the process of collaboration with local groups for us to train and support.
Emergency care continues but now is the time for psycho-social interventions to begin. We are addressing children whose emotional needs in 4-6 weeks will be painfully evident without our interventions.
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Since the collective American trauma of 9/11, we are witnessing an even greater need for mental health interventions that can prevent PTSD, not merely wait for it to arise to treat it. A decade of two wars focused our conversation on safety and terror while an increase in violent conflicts on the other side of the globe became daily news. Earthquakes, tsunamis, hurricanes and climate related interruptions to everyday life become more frequent and talk shows cover gun control, suicide and aberrant behaviors. Post-traumatic stress is a reality, but the Disorder is not always inevitable.
We've clearly entered a new era of concern about mental health, so Big Brother is on the march, too. It won't be long before health screening of school children will begin to determine what is "normal" as the pharmaceutical companies gear up for even bigger sales of psychotropic drugs. This is not the way to deal with these issues when body-centered therapies like those we deliver through our effective PLAYshops can make such a huge impact without pumping even more chemicals into our already tired brains.
Following traumatic events, how can we best help future generations and those who care for our children?
Two things define a traumatic event: loss of control and an overwhelming fear of imminent physical harm or death. In the days and weeks that follow a trauma like a natural disaster or a terrifying event, children commonly experience a variety of stressors before they return to their regular routine. Studies have shown that merely the support of family, friends and community allows 90% of children to find resilience and normal coping skills within themselves; however, as many as 1 out of every 10 children will be unable to overcome this "loss of safety" and suffer a variety of what can become crippling mental and physical disorders.
In the case of natural disasters such as earthquakes, tsunamis, hurricanes and wildfires, large relief groups and governmental agencies act as "first responders" in the first, "Emergency Phase" to provide the most basic human needs: food, water and shelter. Virtually every member of the general public is aware of the essential services provided by these organizations; in fact, these groups are perceived as so important that 90% of funds donated after a major disaster arrive in the first week and go to these first responders. People cannot bear to imagine children without food or a place to sleep and trust these institutions to deliver the goods. What most donors do not consider is that after their mission is accomplished, many of these agencies do not provide effective interventions in the "Recovery Phase" that help children to further restore their inner landscapes, their sense of emotional stability and inner peace.
Second Response was created specifically to help children recover their original ability to have fun by providing facilitated safe, joyful and respectful "PLAYshops" of 30-45 minutes with groups of children who have been impacted by a natural disaster. Depending on the number of children, each PLAYshop is led by 2-5 facilitators who guide the group through a series of carefully crafted non-verbal exercises designed to help kids effortlessly release fear, grief and anger from their bodies. The entire time occurs to children as pure fun, including periods of wonderful improvisation, call and response, laughter and silly wiggling that enhances improved circulation and respiration, revitalizes muscle tone and restores flexibility to joints all of which alleviates physical stress and stagnated blood supply. Participants universally report feelings of deep relaxation in the days that follow, better more restful sleep, greater attention to schoolwork and an overall sense of well-being, safety and security.
"You can discover more about a person in an hour of play than in a year of conversation." - Plato
Ironically, educators, teachers and parents often pay more attention at home and in school to proper decorum, good behavior and "following the rules" than to the inherent benefit of impromptu fun, creative play and outright zaniness. As a result of the increase of natural disasters, traumatic events and an ever-widening culture of violence, we risk nursing a generation of either drugged humanoids or marginalized loners. Our current approach to children's mental health has become more reactive and dangerously shortsighted without realizing the importance of physical activity and play.
Brain scans confirm that in the presence of fear, grief or anger, certain chemicals are released in the body as coping mechanisms. Body-centered therapies that replicate these emotions in play, when "pretending" to be afraid or sad, result in the same physiological response; however, when a child becomes frightened by a traumatic event and is unable to scream, there is no "release" of the energy that results from the impact of the event and the emotion (together with the physical response) is repressed. Similarly, when loss occurs and a child is unable to shed tears, moan, wail or sob, the chemicals related to this natural way the body expresses loss are trapped inside.
PLAYshop games that include "pretend" sadness and fear are accompanied by lots of noise making what imitates screams and sobs without re-traumatizing participants in any way. Since the brain does not distinguish real from pretend fear, grief or anger, it reacts physically in the same manner in either case. What is present in a PLAYshop that is missing at the time of the traumatic event is a nonverbal, safe way to express emotion rather than repressing that emotion in the body.
For a period of 60-120 days following a natural disaster or major trauma, these energies of "unfinished" emotions remain more superficial in the body itself. Even in the presence of a few lingering symptoms of hyper-arousal in which heart rate and respiration increases and secretions of ACTH and cortisol spike, participants in PLAYshops effectively externalize the repressed emotions through the exercises thereby avoiding the onset of the "D" in P (Post) T (Traumatic) S (Stress) D (Disorder).
Following a trauma, it is completely normal to exhibit signs of PTS; when the "D" occurs and takes root in the body, physical symptoms like skin rashes, digestive problems, respiratory conditions and sleep issues emerge together with the already present emotional challenges like avoidance behaviors and hyper vigilance. Three to four months later, a child may be properly diagnosed with PTSD that becomes an issue for the entire family and community who are all burdened with the care of individuals with this disorder. School and workdays are lost, and health care costs rise exponentially.
What we must acknowledge, as is the case for so many degenerative illnesses present in our culture today, is that the overwhelming majority of cases of PTSD are preventable provided that there is appropriate, timely interventions in the window immediately after safety is restored to the community and before these symptoms sink into the body and become systemic. This is truly the second "Recovery Phase" that follows disaster.
Second Response works with adults who've been exposed to these traumas in smaller groups called Care for the Caregivers. The very real needs of first responders, like teachers, parents, police officers, firefighters and school personnel are often overlooked in the period following traumatic events. Our Care for the Caregivers workshop first reviews the phenomenology of trauma and then engages the group in similar exercises to those in children's PLAYshops. The entire workshop lasts only three hours; the result for adult participants is quickly evident, empowering resilience and enabling them to address their own individual needs as they arise.
Second Response teams also train caregivers, parent groups, teachers and first responders how to lead these exercises and pass them on to their communities. In past disaster regions, it has been typical for medical schools to host Second Response facilitators when they arrive. Medical students, interns and residents then spend 3-4 hours in training with Second Response staff who then return to outlying regions where they can repeat the process, training local caregivers in the same way. Eventually, small groups participate in PLAYshops spread across a wide area. In Sri Lanka, Samoa and Japan following natural disasters in each of these countries, tens of thousands of children were served in a very short period of time with an extremely low service cost to child ratio.
Proactively and preemptively teaching these skills in local areas throughout regions that are likely to suffer future disasters, such as in the Indonesian "Ring of Fire" or throughout areas of South America, India and other areas prone to earthquakes and tsunamis, will result in building capacity on the ground in advance of need. The same can be done in any community or school settings where disasters or episodes of violence will impact local populations. Teaching these skills in advance will further reduce costs of sending trained staff into an area every time a traumatic event occurs.
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