Conn. Community Will Need Ongoing MH Vigilance, Say Experts

“I have seen trauma in many places but nothing ever struck me so hard as hearing about babies shot so many times,” said Syed Arshad Husain, M.D.

Husain, a professor emeritus of psychiatry and child health at the University of Missouri-Columbia School of Medicine, has cared for children after war in Bosnia, earthquakes in Pakistan, and tornados in Joplin, Mo., but all that paled next to the horrors of Newtown, Conn., on a Friday morning in December.

The shooting deaths of 20 children and seven adults in Newtown, Conn., was an especially terrible reminder of the need to help survivors, families of victims, and an entire community cope with overwhelming tragedy.

Hard as it might have seemed in the days immediately after the massacre, redeveloping a sense of safety was the key to reducing the risk of deeper psychological trauma in the surviving children, said child psychiatrist Louis Kraus, M.D., chair of APA’s Council on Children, Adolescents, and Their Families. Part of that effort means reestablishing the familiar routines of daily life.

“You have to get them back to school,” said Kraus in an interview. “The longer they don’t get back, the longer it will take them to recover.”

By the Tuesday following the shooting, in fact, the other schools in Newtown were back in operation. At press time, however, the Sandy Hook students were scheduled to remain out of school until after winter break.

Through the Connecticut Psychiatric Society, Husain, a member of APA’s Committee on the Psychiatric Dimensions of Disasters, volunteered to train Newtown teachers to recognize signs of psychiatric problems in students using a program developed by the International Center for Psychosocial Trauma, which he directs.

Parents also have to be aware of their own acute reactions to the event, said Kraus. “If they are not doing well, they can’t take care of their children.”

Caring for surviving classmates and siblings will be more complex because children respond to death differently depending on their developmental age, said Stephen Cozza, M.D., a professor of psychiatry at the Uniformed Services University of the Health Sciences. Cozza has studied and worked with children of military personnel who were killed or wounded.

Children younger than age 6 may reenact the event or complain of somatic symptoms, like headaches or stomachaches, he said in an interview.

“Others may exhibit magical thinking, believing they could have done something to prevent the event,” said Cozza. “We have to relieve the child of that misguided sense of responsibility.”

Some children may have symptoms of acute stress shortly after the event, but others may not exhibit serious psychopathology for a while, said Kraus. Still others may resolve initial symptoms only to have them reemerge months or years later.

Parents should also minimize their children’s exposure to media stories about the event. Younger children may perceive replays on television as evidence that the event is not over and the danger continues, making it hard to reestablish the needed sense of safety, said Cozza.

Parents of the child victims have the extraordinary burden of living with their own grief while trying to care for their other children, said Cozza. They may feel guilt at their “failure” to protect their child and anger at the perpetrator. The effects on a child’s body of fatal traumatic wounds, if seen by a parent, may add another excruciating level of emotional pain.

“Losing a child is one of the most horrific things someone can endure,” said Carol North, M.D., M.P.E., a professor of psychiatry and surgery in the Division of Emergency Medicine at the University of Texas Southwestern Medical Center and director of the Program in Trauma and Disaster at the VA North Texas Health Care System in Dallas.

“People are permanently changed, but the psychological damage has a specific course,” said North in an interview. “They may experience bereavement or traumatic grief or develop PTSD. Some may not develop psychiatric illness but can still be very distressed for a long time.”

In North’s studies of survivors of the 1995 Oklahoma City bombing seven years later, most people who had been diagnosed with PTSD, even if their cases remitted, still reported posttraumatic symptoms. However, one-third of those who had never been diagnosed with PTSD also reported symptoms.

Within bereaved families, brothers and sisters are sometimes shunted aside as parents grieve.

“We know less about the effects of these events on siblings,” said Cozza. “They can also feel survivors’ guilt and may feel responsible for continuing some tradition within the family that the victim once did.”

Parents may become overprotective with their surviving children, making it hard for the children to move on and grow up normally, he cautioned.

Most people recover from their traumatic experiences, but perhaps 10 percent to 15 percent will need some form of help at some time in the months and years to come.

“Eventually, the media lose interest, outside support begins to diminish, and the people on the scene are left to deal with their problems,” said North. “Suffering remains, and the need for support continues.” ■