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Report from the Disaster Area Part 7: Emotional Care for Children: What Can We Do Now, Several Months Later?

Summary:
I participated in a seminar by Ryoko Honda, a psychologist with Japan Association for Play Therapy, who obtained her master's degree in psychology in the U.S. She talked about practical psychological care, particularly for pre-school children. The seminar was very educational. The association called "Let's study pediatric care! Let's protect children!" sponsored a lecture titled "Psychological Care for Children." The speaker was Katsura Sugihara, the Director of Pediatric Department of Tama Garden Clinic. According to Dr. Sugihara, "The energy of trauma is neither positive nor negative. In other words, positive and negative effects are determined not by the trauma itself from earthquake disaster, but depending on whether the energy is used productively and constructively or is used to attack others and to give in to despair." His words truly impressed me.

Keywords:
PFA, psychological first aid, play therapy, mental care, activities for the disaster area
Japanese Chinese

From the standpoint of Child Life Specialist

On June 17, I was asked by Dr. Shoko Yamada of Nagoya University to participate in the seminar by Ryoko Honda, who obtained her master's degree in psychology in the U.S. and currently works as a psychologist of Japan Association for Play Therapy. The seminar introduced the efforts of psychological healing through children's play. With student participants from all over the world, it was conducted in English and proved to be a good learning opportunity for all of us. It was very educational to learn about practical psychological care for pre-school children. School-aged children are able to express their feelings verbally, because school counseling is available for them. However, young children who cannot verbalize their feelings need the age-based care. One example of the age-based care is Play Therapy.

How should we, who are involved in reconstruction support, deal with people and children who are suffering from the disaster and have lost their family? We are so concerned that we tend to choose our words carefully and interpret their feelings from facial expressions. When trying to learn about mental care for children, we need to ask their parents some questions. The following are the examples of recommended and unrecommended questions.

A:Are there any concerns regarding your child?
B:Could you tell me about your child's attitude?

People tend not to feel like they are "interrogated" or "surveyed" if they are asked in a general way, as in the question "A" above.

When losing someone close...Children may think, "He/she (or the family member) passed away because of me. What a bad child I am!" Children tend to associate their behavior with the person's death, particularly if the child has quarreled with or rebelled against that person. It is necessary to teach them it was a natural disaster and nobody's fault.

Some adults do not want to let a child know that the person close to him/her passed away, so they sometimes pass the absence off, saying that the person has not come home yet or it is not known where the person went. Actually, adults also feel sad losing someone close and cannot talk about it. Since children instinctively notice that something is hidden from them and feel that something bad has happened and it must be a taboo subject. Then, children tend to repress their desire to know about someone they love, their memory of the loved ones, and their lonely feelings without the ones they love. As a result, the healing process is delayed.

In such a situation, let us be open and honest with children. It is OK to cry and grieve. Adults do not have to be tough. When a child asks where his or her mother (or another family member) is, please tell the truth. Tell the child, "Your mother was a truly wonderful person. We all loved her." That helps the child to move on to the recovery process. It is much better for children to follow such recovery process, rather than grow up confused and distorted with the feeling of being disguised.

After the disaster, we should respect the healing process of children and let them express their feelings by using toys to lessen their agony and trauma. It is sometimes necessary to repeat the same story or to destroy their toys and dolls, so that they can express their psychological damage and release stress. In this way, children can find their own feelings inside. Children, who simulate the memory of their father or lost friends by playing with two fish swimming together, can understand after a while that each fish has its own place to return. Children, who have their monsters and dinosaurs fight with each other or who pretend to be suffering from the earthquake and tsunami, can regain a sense of equilibrium after they express their own anger and aggressiveness. Those are the ways for children to get over their past trauma. However, repeating the same behavior over and over with no facial expressions; trying to hurt others or themselves; not enjoying what they used to do; and becoming withdrawn; are the signs that the child needs to see a psychological specialist.

From the perspective of a pediatrician

On July 10, I listened to the talk by Katsura Sugihara, the Director of Pediatric Department of Tama Garden Clinic. The event was titled "Psychological care for children" sponsored by the association called "Let's study pediatric care; Let's protect children." It was held on Sunday and they provided free on-site day care, so I was able to bring my four children with me to the venue. The audience was mainly composed of parents who were anxious and distressed regarding the influences of earthquake disaster and radiation on children. As advice, parents were told that it is OK to express their anxiety to children. They were advised to tell their children that "I am also anxious, but I want to make you feel safe and I want to do my best," rather than forcing themselves to say, "Everything is going to be all right!" to ease their anxiety. All of the audiences seemed to be relieved to hear that it was OK to be honest.

One of the participating mothers commented that she could not help searching for information to reassure her. The speaker responded that, "Information can be the source of confusion and does not help to turn off your anxiety. The important things for you to consider are: what kind of relationship you want to establish with your children; what you should do to stabilize yourself and trust your children, so that they can grow soundly; and what you should do to leave a better future to your children." "For example, when thinking about the influence of radiation, the probability is not zero or one. The probability of dying from radiation exposure is lower than from a traffic accident on the way home. If that is the case, is the information realistic?" These words grabbed my attention.

Recently, the world around us is filled with the words such as "anxiety" and "despair." However, what we have to think about by returning to the starting point is simple: "What should we do for the future that we want?" and "How should we prompt a smile from as many people as possible?" We must choose, think and act by ourselves, not just act without thinking.

When strongly shocked, we tend not to think what to do. However, Dr. Sugihara mentioned in his talk, "We cannot erase the fact that the earthquake occurred. Let's focus on what we can do from now." "Let's make a move to cooperate with others by extending a helping hand. Explore what you can do and find someone to work with." "Let's learn from the people who had overcome their fearful experiences such as disasters or accidents." Then, we can take a step forward.

Dr. Sugihara mentioned, "The energy of trauma is nether positive nor negative. In other words, positive and negative effects are determined not by the trauma itself from earthquake disaster, but depending on whether the energy is used productively and constructively or is used to attack others and to give in to despair." This message supports my long-held idea that "People can choose the way to perceive things by themselves." I truly wanted to carry this idea to parents all over Japan who live their lives with anxiety and ambivalence.

For those who wish to learn more about psychological care

Psychological First Aid (PFA) is considered to be the universal standard of psychological care, and has also been translated in Japanese. Hyogo Institute for Traumatic Stress presents Japanese version of PFA on their website. IASC Guidelines on Mental Health and Psychosocial Support in Emergency Setting (2007) of Inter-Agency Guidelines recommends the PFA training to those providing support to disaster victims (physicians, disaster support staff members, volunteers. The content of the training is verified by the World Health Organization (WHO) and by other international guidelines. It is also used in practical setting. PFA is not clinical/professional intervention, but an approach that focus on the role of the individual as a supporter in an emergency setting. It trains supporters to facilitate recovery of a safe and positive environment without harming disaster victims.

Many people hope to get involved in disaster support and help people at the disaster area on site. However, some supporters do not fully understand how to deal with disaster victims who are caught up in the emergency situation and having a difficult time. Supporters may need to think about how they should speak to disaster victims, as well as the words and behavior they should NOT use or show. At times, supporters could be hurt by spending some time with disaster victims. Other supporters might overlook the issue of personal information protection and take pictures of the disaster victims or pass the private information to the third person. PFA trains supporters so that they provide safe support and not further cause the disaster victims any further pain or distress.

How to apply for taking the PFA training

International Medical Corps (IMC) and Tokyo English Life Line (TELL) collaboratively provide training in Psychological First Aid to various organizations that support the disaster area. The training is not only for international and domestic organizations, but also for supporters at the disaster area, "life line" operators, and staff of other organizations.

As a method of psychological care, PFA places importance on care recipients and helps them receive necessary services. Training introduces how to respond to stressful situations, active listening skills, and how parents should support their children. It also teaches how to connect disaster victims to necessary services, and identification of disaster victims with serious stress in emergency settings as well as referral to a specialist. Furthermore, it includes supporters' self care.

Let's focus on what you can do from now

It is important for you to be stable as a mother, so that you will not burn out. Please try to be calm to avoid any negative consequences to your mental health from the disaster. For all mother who are eager to do their best to their children, it is the only way that you can do - support your children. Your children will leave the nest under your arm someday, to be independent and to overcome various experiences and difficulties in the future. Your perspective might change if you think about the future by considering your current experience as training until your children leave the nest someday. Since the disaster, we hear the words "safety" and "security" here and there. Now that we have learned those values, we can sufficiently prepare, helping others, and place importance on our ties with one another. Shall we try to meet people directly and ask them "How can I help you?" so that we can find the way to help people as much as possible.

Profile

Dr. Yoshida completed residency in obstetrics and gynecology (OB/GYN) at St. Luke's International Hospital in 1998, and entered the Graduate School of Nagoya University in 2001. After receiving her doctoral degree, she gave birth to her first child in 2004 (at the age of 31) while undergoing clinical training in Germany. After returning to Japan in 2005, she began working to open a women's health care clinic. She gave birth to her second and the third child in 2006 (at the age of 36) and in 2008 (at the age of 38), respectively. She started studying in the U.S from August 2008, and completed a master's degree in public health (MPH) at Harvard School of Public Health in 2010. She gave birth to her fourth child in Boston in July 2010, one month after her commencement ceremony. At Harvard School of Public Health, she is now working on a study of medical services in OB/GYN and measures to counter the declining birthrate, while working as an OB/GYN in Japan and raising her four children.
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