A pair of 6-year-old-boys busied themselves in the relative calm and security of a day care center. They rolled up a blanket and placed it atop a long, blue plastic rack, which they then covered with a sheet.
One boy stood on each end on the flat rack, which they then lifted and carried solemnly around a large room, filled with toys. When the director of the center asked the boys what they were doing, the children replied that they were rescue workers. The rolled-up blanket was a body. The blue rack was a stretcher.
"They said they were carrying the dead people ... just like on television," the director recalls. "They were serious; they were not laughing. I told them I'd rather we didn't play that game."
Several days later, the two boys were back to playing traditional games, minding stores and building houses.
In the wake of the Sept. 11 terrorist attacks, parents, teachers and other child care professionals are struggling to help kids cope with life in a world that has suddenly changed.
Television news reflects the increasing dangers: America threatens war against Afghanistan and other state sponsors of terrorism. Authorities search for more suicidal agents among us. State and local governments, once preoccupied with keeping a casino afloat, now find themselves pondering preparations for chemical warfare and biological attacks.
Meanwhile, law-abiding Arab Americans, Muslims and people of Middle Eastern descent live in fear of mistaken identity by authorities or retaliatory attacks by their neighbors. Women hesitate to leave their homes after someone tried to grab a hajib (religious headdress) in a supermarket. A vandal throws a large rock through the window of a mosque in Slidell.
How do you explain the unnerving events to your children, much less to yourself? It may take time. As one local psychiatrist cautions: "The definition of 'normal' is now being re-defined."
Once dubbed "therapy nation" by The New Yorker magazine, America's long quest for coping mechanisms is no longer a joke. The annual back-to-school Ritalin debate among parents, teachers and medical providers has been shunted aside since Sept. 11. However, if the goal of terrorism is, as one local expert put it -- "psychological disruption" -- then the terrorists may face a resilient foe in America.
Mental health care professionals, educators and clergy nationwide are responding with an unprecedented, media-fueled deluge of expert advice on how to help kids. "Terrorism tips" abound on Internet web sites, the media, and in school take-home notices. Free public seminars on how to talk to kids about war and terrorism are mushrooming nationwide. Conventional and alternative therapists are rushing to the ramparts. The relatively young professions of child psychiatry and child psychology are being put to the test.
Today, says one local expert, doctors are aided in their work with traumatized children by recent studies of Vietnam combat veterans who became psychological "casualties" of that war. "Post-traumatic Stress Disorder (PTSD) had not been clearly identified in its present form until after the Vietnam War ended in 1975," says Dr. Charles Zeanah, director of child psychiatry at the Tulane University Medical School and an expert on exposure of young children to violence.
Dr. Joy Osofsky, a psychologist at the Louisiana State University Health Sciences Center who directs the Violence Intervention Program for Children and Families, agrees. "We have learned a lot about PTSD since the Vietnam War," Osofsky says. "We didn't pay that much attention to it then for children. We started our violence intervention program in the early '90s, and what we were seeing was signs of PTSD in children who were being exposed to lots of violence in New Orleans neighborhoods. But also, there has been much more focus on the effect of domestic violence on children."
In November, Osofsky will travel to New York City to help train professionals who are counseling children traumatized by the World Trade Center attacks. But she stresses that parents in New Orleans should be alert to their children's fears, as well.
"That is one of the reasons I have been encouraging parents to explain to children what really happened, because planes going into buildings looks like scary movies, not real life. It's important to emphasize that this is very rare and these are terrible people who have done this horrible thing, but we will keep you safe."
Like other experts, Osofsky urges parents to help their children "get back to the normal routines of life," and resume enjoyable activities such as a trip to a park or a movie. However, she and other experts candidly admit they do not know what advice they would give in the event of a second major terrorist strike.
Meanwhile, parents seeking the latest "how-to" book may be out of luck. "I think those books are going to have to be written," says Dr. Zeanah. "This is far different from anything we have ever experienced."
Last week, the Rothschild/Ochsner Pediatric Center presented a free seminar for local parents. In it, Dr. Patricia Blackwell, a developmental psychologist and mother of a 7-year-old daughter, deplored the lack of literature on how to talk to children about war.
Said Blackwell candidly: "I think we have all been living in la-la land."
But one local psychiatrist has been at Ground Zero for much of his career. Dr. Elmore Rigamer, owner-operator of a private clinic in Metairie, has been counseling American children fearful of terrorism since before the Soviet invasion of Afghanistan in 1979. The former medical director of the U.S. State Department in Washington was the first psychiatrist sent abroad to counsel American diplomats and their families in Central Asia.
He was stationed for two years in Kabul, beginning in 1977. Assigned to develop mental health and drug abuse programs for diplomat families, Rigamer became a reluctant expert on the traumatic effects of terrorism sweeping the region. He treated numerous U.S. citizens who survived terrorism, including some of the 51 hostages from the U.S. Embassy take-over in Iran, eight Americans who survived the burning of the U.S. embassy in Pakistan, and others who survived airline hijackings and bombings. In Europe, Rigamer counseled U.S. citizens who were already checking under the cars for bombs before driving off to work and school. In 1986, he developed a video program addressing fears of terrorism in American children in Germany.
Rigamer says parents need to delay reassuring children. First, he says, the child must have the opportunity to experience the catharsis of talking about what he or she has seen and feels. "If you just don't block the kid, the kid will do it, through drawings and through some play-acting," he says.
Also, accuracy is not as important with kids as expression. Don't interrupt, even to correct them. For example, he recalls listening to a young girl describe how she saw the murdered body of the U.S. ambassador. "Well, she didn't see that. But the idea is, let her talk about it."
The younger the child, the more blatant you have to come across as omnipotent, he adds. Adolescents, on the other hand, can understand probabilities. "With them, you can say, 'Chances are nothing is going to happen.'"
It's also important for adults to admit their fears. "Kids are much worried if you say 'I am not afraid' and they can see you trembling. It belies their perception. And they are much more afraid if you tell them you don't know what to do."
Children under seven should not be allowed to watch televised images of the attacks, because they might innocently mistake televised reruns for additional attacks, Rigamer points out. He adds that parents should not currently take vacations away from their young children unless it's absolutely necessary.
Rigamer predicts that if the terrorists strike again, it will not be symbolic targets such as the World Trade Center. Rather, he says, they might aim to disrupt the lives of everyday citizens by engaging in smaller, multiple attacks at shopping malls and supermarkets. Studies with recurring cancer patients and injury victims have shown that a second "attack" is psychologically more traumatic.
"Right now, we're feeling like it's not going to happen again. We're preparing, but we don't think it's going to happen," he says. If it does, he advises, you must think like a counter-terrorist. "You come back. You find new ways to respond. This new response means new ways of attacking helplessness. You can't give in to it."
Americans, he says, can learn much from reading the works of Viktor E. Frankl and other Holocaust survivors, he says (see sidebar).
Practically, if a second wave of terrorist attacks occurs, parents may have to restrict where their children go. While it is uncertain how society would respond, Rigamer emphasizes the mindset parents should adopt: "I'm keeping informed. I'm going to do everything I can to protect you. I'm not going to be separated from you, but I may not be able to let you go some places that you want to go."
He adds: "That is going to be a tough one for American teenagers to handle."
But some local teenagers are already preparing.
Five days after the attacks, a local forum on terrorism drew a crowd of about 20 youths, ages 10 to 19. All were Japanese Buddhists.
Their Sept. 16 meeting ended with plans to reach out to local Arab American and Muslim youths, says Lisa Lincoln, spokesperson for Soka Gakkai International (SGI) -- USA, a Buddhist lay organization. Soka Gakkai literally means "value-creating society."
A majority of the Buddhist youths said they did not feel safe after the events of Sept. 11. Some still had trouble sleeping and felt overwhelmed. "They discussed rumors they had heard about Nostradamus and the end of the world," she says.
Jean Saito, a 16-year-old student from Benjamin Franklin High, says she and her friends have witnessed verbal and physical abuse of Arab American children in some area schools. "Some of the children in the group are Japanese or half-Japanese and we discussed how 60 years ago, during World War II, this type of behavior was directed toward children like themselves," Lincoln says.
Sean Lewis, a 14-year-old student at McMain Magnet School, told the group he did not understand why the U.S. would bomb Afghanistan "if the terrorists are already here." A Buddhist student at Pontchatoula High on the Northshore expressed concern about being drafted for war. He said he did not want to kill anyone, but still wanted to be able to stand up for the United States.
The Buddhist concept of "bad karma vs. good karma" came up. Did the innocent people who died in the World Trade Center have "bad" karma, one youth asked. "The answer of course was things like this and accidents happen to good people just as well," Lincoln says. "The best that we can do is find positive things to pull from it."
Elsewhere, the Baptist-based McFarland Institute is offering the free services of its counselors and ministers to local schools.
"The McFarland Institute wants to do its part to alleviate the stress and pain New Orleans is experiencing," says Rev. E.W. Huffstutler Jr., executive director of the Institute.
Local Muslims and Arabs have been distributing a tip sheet from the American-Arab Anti-Discrimination Committee in Washington D.C. (email@example.com). The group offers advice to help Arab and Muslim children cope with heckling and even physical assault at schools, in addition to the trauma of witnessing the televised attacks.
Dr. Zeanah of Tulane says Arab Americans should do whatever they can to make clear their own feelings and reactions since Sept. 11. "In some ways, the more visible they are with those reactions, the more it will do to quiet people's fears about what they are thinking."
Meanwhile, one national expert is offering therapeutic help for kids in New Orleans and New York City alike. Elissa Faye, a Florida-based clinical psychologist and art therapist, is offering free assistance to local parents and teachers in interpreting children's post-attack artwork.
Faye, first profiled in Gambit Weekly following the devastation of Hurricane Mitch ("Home Fires," Nov. 23, 1998), has previously collected and analyzed art work from torture victims from Afghanistan. She has also used the sounds of dolphins to help alleviate symptoms of PTSD in child survivors of Hurricane Mitch and the Armenian Earthquakes -- two disasters that profoundly affected ethnic populations in New Orleans. Her nonprofit organization has also proposed helping family members of the victims of the terrorist acts.
"Children do not have the same level of cognitive development that adults do," says Faye. "That means they communicate in a different language, principally play and art and non-verbal behavior.
"In lay terms, children speak to us in different ways. Drawing is an immediate and cost-effective intervention: paper, markers and Crayons for drawing, and clay -- for aggression. We need to intervene immediately."
Prior to Sept. 11, says Tulane's Dr. Zeanah, a typical week might include "children who witnessed one parent being murdered by the other, children who witnessed parental suicide, children who witnessed serious ongoing violence between their parents, children who have been involved in serious accidents, or children who have been attacked by dogs."
His inventory of patient concerns now includes parental responses to children's fears of war and terrorism. Like other experts, he says the terrorist acts have especially revived fears of children who have experienced previous traumas.
"Kids remind us of the preciousness of life," he says. "The [attacks] remind us of life's fragility. And those two together shake us out of being preoccupied with things that don't really matter. It reminds us to keep the more important things in the forefront and let the other things take care of themselves."
Early last week, at the same day care center where two boys carried out a re-enactment of New York City rescue workers, three other children -- two boys and one girl, ages seven to eight -- began separate Lego projects.
One of the boys began building a tower. His playmates suddenly told him they would "not play blow up the tower."
"No, no. I'm just building a tower," the boy replied.
Made with red, white and blue bricks, the boy's skyscraper stood over a foot tall by the time he was finished. -->
In the wake of the Sept. 11 attacks, numerous experts have produced tip sheets and resources for parents and other caregivers. Web sites with information about talking with children include the American Academy of Pediatrics (www.aap.org), the American Academy of Child & Adolescent Psychiatry (www.aacap.org), Parenting Press (www.parentingpress.com), the National Association of School Psychologists (www.nasponline.org) and Mr. Rogers/Family Communications (www.misterrogers.org/families). The National Association for the Education of Young has posted an article on discussing the news with young children (www.naeyc.org/resources/eyly/1998/22). For local resources, call the Christus Health Clinic (836-7375), The Parenting Center at Children's Hospital (896-9591 or www.chnola.org), or the Violence Intervention Program, LSU Health Sciences Center (568-3997). To reach art therapist Elissa Faye, visit her Web site at www.DolphinTherapyInnovations.org or call (786) 274-8006.