The Risk of Low-Magnitude Stressors for Children’s Mental Health
Two articles in the American Journal of Psychiatry struck me as pointing out a vital need in caring for children’s emotional health.
The first article was on a recently published study comparing stress in children over 3-7 years of their life, the number of both low-magnitude stressors and extreme stressors and the risk of developing post traumatic stress disorder. The findings affirmed what everyone expected that extreme stressors carry more risk, but what was surprising was that because low-magnitude stressors are four times as frequent as extreme stressors, they accounted for up to two-thirds of the cases of PTSD and half of the cases of sub-clinical PTSD.
“Relative to low-magnitude stressors, extreme stressors place children at greater risk for post traumatic stress symptoms. Nevertheless, a sizable proportion of children manifesting post traumatic stress disorder symptoms experienced only a low-magnitude stressor.” June 15, 2010 American Journal of Psychiatry
The second article I dug up was a 10 year old study of PTSD in quake victims in China. This study compared two villages in the same region. One was 10km and the other was less than one kilometer from the epicenter. All other factors being equal the two differences between the villages were the level of severity of damage from the quake and the level of care that the village received afterwards. Surprisingly, it was the village that had less damage but also received less care that showed the greatest number of cases of PTSD. The village with the greater stressor also received a large outpouring of support – homes were rebuilt, donations flowed in and there was a much greater sense of hope for the future. In comparison, in the village with less damage there was little help with repairing damaged homes and constant fear of aftershocks.
Earthquake damage in China
The connection between these two studies and the lesson that we need to learn is that even though extreme stressors require professional attention and have greater risk of developing into PTSD, even low-magnitude stressors can affect the emotional health of children. Indeed, because of the high visibility of some extreme stressors, care is almost guaranteed, while children who were not personally affected but were in the vicinity of the event might be at greater risk of developing emotional disorders (i.e. school violence, outlying areas in natural disasters, siblings and friends of abused children). Likewise, more common stressful events such as a move, divorce, loss of a pet, failure in sport or classwork, rejection by peer group, especially if concurrent require adequate care as well to prevent stress disorders.
Emotional Health – Five Lessons for Children
Operation Safe’s work with children after disaster in the developing world is aimed at reducing the risk of developing PTSD. Because of the short supply of professional psychologists in these countries and programs for these children we train volunteers and parents how to care for the emotional needs of their children. We have found that through the use of stories, games, crafts, songs and friendship we are able to help children who might not have received any care to be emotionally healthy. I am not a psychologist and recommend that if you have any suspicion that your child is at risk of PTSD that you consult with a licensed professional. But I strongly advocate for the mental health of children that the following five lessons be instilled in children even before trauma, but especially after either low-magnitude or extreme stressors are encountered.
Teaching Themes to Chinese Children
1. ”I am Not Alone”
- One of the most fundamental needs of a child is to know that they are safe. Usually this means that they are with an adult who cares for them. After trauma it is common for children to become isolated, to feel that no one else understands what they are feeling or are going through. In the OperationSAFE program we use the story of “Pete’s Adventure” to help children see that they are not the only one’s who go through emotions such as anger, loneliness, frustration and fear. We also help children who have lost their homes and normal surroundings find new friends and a new place where they can be safe.
2. ”Everyone is Important”
- On the second day of the OperationSAFE program we help the children to understand that their story is important. Many children are like flies on the wall, they listen to everyone else’s story (sometimes becoming more traumatized by the secondary accounts from adults than the original trauma) but are not given the chance to tell theirs. Children can easily blame themselves for things that happened or assign more importance to parts of the story that others overlook. As they tell their own story and listen to the stories of other children they are given a chance to heal and adults can help them process events with greater perspective.
Aurora the Whale
3. ”Follow and Believe”
- In the story of “Pete’s Adventure” just when things seem to be the darkest, Aurora the Whale shows up to encourage Pete and his friends. She teaches them to follow their heart and believe that things will get better. One of the biggest factors mitigating PTSD is hope. Children need to know that the people they depend on believe that things will get better and learn to take each day one at a time. Adults should speak the truth to children, but always at an age appropriate level and always sprinkled with a healthy measure of hope. No matter how bad the outlook might be, stress that they are safe now, that you are with them, and that things will get better.
4. ”Be Strong and Courageous”
- Some symptoms of PTSD are irrational fears and avoidance of things associated with the trauma. It can be too much to ask a child to just face their fears and be strong, so we focus on the courageous act of asking for help. All too often children face their fears on their own and never express them to an adult, who then interprets the child’s unwillingness to go to bed, or obey instructions as disobedience.
Colorful characters teach the themes.
5. ”You are Loved”
- The keystone to emotional health is that the child understands that whatever they might be going through emotionally, they are still loved unconditionally. Because trauma so often involves loss, it is natural that a child would assume that everything in their life is at risk. Adults need to make sure that children understand that whatever might happen in the future, and whatever they share with us, they can count on our love to never change.
Don’t wait until a disaster to strike to teach these lessons to your children. The world is a stressful place and children are exposed more and more to low-magnitude trauma and secondary stress. We might not be able to protect them from everything, but we can give them a strong mental capacity to handle stressful events in their lives.
This week I took a few days off and went to the Southern Alps of Japan, a beautiful area where rice fields are surrounded by majestic snow capped mountains. If you don’t look at the architecture or the agriculture, you would think that around the next corner you would run into Heidi. But of course it is the unique Japanese atmosphere that makes it all the more attractive.
Mt. Kaikomagatake in the Southern Alps of Japan
The Challenge
After one day of total relaxation, my dog Sammy and I started off to climb Mt. Kaikomagatake, one of the peaks towering behind us. My motivation was both to enjoy the mountains but also to prepare for our July 10th climb of Mt. Fuji to benefit earthquake children on the Tibetan plateau. You see although I adore climbing, it wasn’t until after we decided to challenge Mt. Fuji to get ourselves ready for the altitude in Tibet, that I realized how out of shape I am! I haven’t climbed a real mountain for years! Mt. Kaikomagatake is a real mountain with an elevation of 2966 meters (9829 feet) and I wanted to see how far Sammy and I could go before having to turn back.
Moving Mountains
It is funny how faith moves mountains. One action that is spurred by faith encourages other similar actions. It is the difference between hope and expectation. When you are only hoping for something you look longingly into the distance yearning for the situation to change, for something to fall into your lap, for someone to notice but there is no positive action. But when expectation enters into the equation, things start to happen. I have been hoping to lose weight and get into shape for quite a while now, but there is always something else to do and another project to start. My hope didn’t bring results. However, now I have a very large expectation in front of me because I have stepped out in faith to lead a team to help children on the Tibetan Plateau. I know that I will need more strength than I have, and cannot let my team down and so I took another step of faith and decided to climb Mt. Fuji to prepare. Since I live in Japan, Mt. Fuji is not as far off and unimaginable as Qinghai, but it still is a mountain sized expectation for which I need to prepare.
Milestones
Sammy, my labrador retriever and I started out early in the morning hiking through the forest. Posted repeatedly along the trail were warnings about black bears, so I fastened bells onto my belt-loop to alert the bears to our presence and kept Sammy on his lead until we were stopped to rest. Sammy wanted to pull me up the mountain, but I knew that he would need his stamina for later in the climb. I sure would need mine! Thankfully we never met any bears but we did come across a troop of nine Japanese monkeys. Things were a little tense as we passed through their clearing, but their leader shepherded his group off to the side and Sammy and I went through quickly without making eye contact.
More challenging than any wildlife, of course, was the mountain itself. Japan’s mountains are very steep and this trail was no different. The further we rose the more difficult each new section became. Along the way I found that those who had gone before me had left markers, small stone reminders that progress had been made and that another milestone had been achieved. If you only look at the summit, it is easy to lose hope. If you focus completely on the pain of each forward step, you are as likely to turn back as to go on. But by pressing forward to the next milestone we were able to keep going. Sometimes it seemed like forever before we found the next one, dropped the pack, burst out the water bottles and sat down. Sometimes we would come over the top of a ridge and find the next marker as a pleasant surprise.
As we neared 2000 meters, the terrain started to change and the weather began to shift as well. We were surrounded by mist as we entered the clouds and the rocks and boulders grew larger forcing me to use my hands and Sammy to make heroic jumps. The rewards were greater as well as it seemed that the whole mountainside was in bloom, like a well-tended park instead of a wilderness. Looking down on the clouds we could catch glimpses of the surrounding mountains and reaching the summit of the ridge, we could peer down massive walls of granite on either side. The way forward was up sheer rock with chains for hikers to pull themselves up with, but unfortunately my partner was unable to use them. Not for lack of heart, but due to concern for his safety, we had to turn back and head for home.
Mt. Yatsugatake seen from the trail.
Partners in Faith
Faith is not a solo endeavor. The reality is that faith is an adventure. With every adventure there are risks and rewards. If there are only rewards then it is not an adventure but a job, (and probably not a very fulfilling one). If there are only risks then it is just foolish thrill seeking. But because adventure demands both risk and reward, we must prepare for the risks and expect the reward. If you bring someone along with you, many of the risks can be overcome more easily. Sammy’s boundless enthusiasm kept me going through many torturous sections of the trail. His presence gave me a sense of security amongst the creatures of the wild. He isn’t much of a conversationist, but he is a very good listener. And despite having to turn back because of Sammy, he actually saved me from greater danger, as the moment we arrived safely home, torrential rain poured down for the rest of the night.
This time we reached 2000 meters, and came home safely after 8 hours of hiking. We didn’t make it all the way to the top, but we accomplished a lot. The next morning I was feeling it, and even Sammy slept in till eight. But I am already planning another marker along the way, recruiting more partners to join us, and expecting mountains to move.
I have thought quite a bit about whether or not blogging, facebook and twitter are really worth the effort, or rather what the correct balance should be between more traditional communication and the new social media. In typical business parlance I am worried about ROI, return on investment. Does it make more sense for me to spend my communication time writing e-mails, making phone calls and designing newsletters, or sending off tweets into the void, updating statuses and writing blog articles that might just well go unread?
To be honest I don’t really consider ROI that often, as I am not in the business world but the non-profit humanitarian sector. I do quite a lot of things that do not make much business-sense but in which there is a lot of common-sense. I give away much more money than I make. I often help people who can be of no use to me at all. I go out of my way to find the least and the lost that no one else is willing to spend the money to help because it is inefficient and unproductive. I do this because I believe in the brotherhood of all and the larger community, not to make money but because helping one another is our duty as human beings. Perhaps in this brave new world of connections and community online, common-sense has something to share with business-sense.
Cast Your Bread Upon the Waters
The business model is to track every effort made against the amount of return gained through that effort. Efficiency then requires that we maximize efforts that bring in greater returns and weed out useless exercises. This might work well in the corporate world where customers are reduced to numbers and bottom lines are everything, but in the connected world of community both online and for smaller non-profits there is more to consider. The old saying goes, “Cast your bread upon the waters, for you will find it after many days.”
- Goodwill – Communities have long memories. A specific action might not have any immediate result, but continued interaction within a community will build reputation, trust, and positive image that will influence decisions in the future.
- The Tip of the Iceberg – The network of connections that we can track are only the tip of the iceberg. For every person that we actually talk to, there are friends, neighbors, relatives and countless others who are influenced indirectly through them. They will never even show up on our radar until they have need of us.
- Relationship – Once goodwill has been established, people in your community, online or otherwise, will be willing to do things for you even though it brings them no immediate benefit either. People will step up in times of need simply because it is the neighborly thing to do.
So perhaps it is better for us to be less efficient in the short-run to become more effective in the long-run. I liken it to the constant dilemma of “the walk-in”. At times it seems that I can never accomplish anything because there is always someone at my door who just dropped by to chat. I might be frustrated but of course I put on a big smile, offer them a cup of coffee and prepare to “waste” the next half-hour or so chewing the fat. My productivity might suffer, but in reality I know that the personal visit always trumps whatever important project I might be working on, because it is these people who will be donors, volunteers, partners and advisors, they are the ones who will believe in what we are doing and move heaven and earth to see that it happens, all because I took the time to sit down with them, hear their concerns and share my heart. A half an hour not wasted but well spent, but with precious little data with which to track it.
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