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Steven Marans, Ph.D.:
Fourth and final speaker at Creation of a Self: Color and Trauma in the Life of a Child

"The boys, and increasingly girls, who shoot and stab one another have all to often been beaten and neglected for many years. Frightened victims becoming frightening assailants"

-- Steven Marans

In a series of vivid demonstrations, Dr. Marans demonstrated the powerful results that can accrue when psychoanalysts work as partners with other community resources. He showed how we need to bring psychoanalytic expertise to those places where it is needed, such as in a child's acute, immediate responses to exposure to violent trauma. Knowledge gained in the consulting room does belong in the community. It is necessary to understand the traumatization that grows from children's exposure to violence. Psychoanalysts are especially well-suited to address the convergence of inner and outer that gains expression in attempts to deal with the results of violent trauma.

Listening: "What do I do ... what do I do"

The very first call Dr. Marans received on the CDCP 24-hour call service came from an officer at the scene where an 11 year old boy had witnessed his father blow his brains out right in front of the child. He heard the relief in the officer's voice now that he had someone to call to help with this situation. The officer was not aware that as he drove to meet this boy and his mother at the police station, he was silently saying to himself, over and over like a mantra of sorts, "what do I do... what do I do?" The answer, of course, was to listen, which is not always easy to do. Once someone finds themselves passive in the face of potentially overwhelming and painful events a host of physiological and psychological processes result -- many of which make listening difficult.

One aspect of the response to exposure to violence is violence. Violence is itself a mode of adaptation to exposure to violence. Being a witness is connected to being a victim and eventually being a perpetrator. Unfortunately this is a natural progressional. Those children who shoot and stab one another have been victims of violence and neglect themselves.

Sooner Rather Than Later

There was a shared concern among several different groups in New Haven that something clearly needed to be done. The CDCP (Child Development Community Policing Program - for more information click here) was a collaboration between Yale Child Study Center and the New Haven Police department. The problem was that police officers have daily contact with victims, witnesses, and perpetrators of violence. However, they are typically not trained to deal effectively with the problems these children have during their acute response to trauma. Conversely, clinic-based mental health professionals are trained and professionally equipped to deal with the psychologically distressed child but have little opportunity for contact.

In part, the program trains police officers to optimize the developmental consequences of their contact with children and families exposed to violence. The officers are people who can provide both a needed level of security at a time of crisis and an opportunity for children to identify with benign authority figures. Traumatized children are rarely seen in clinics until well after the trauma, when chronic symptoms or maladaptive behaviors bring them to attention of parents, teachers, and juvenile courts. Valuable opportunities are lost for intervention in these delays. By working together, clinic and police, there is an increased chance for professional contact at the moment of exposure to violence that could provide both immediate stabilization and, where needed, ongoing clinical services.

The collaboration seems to be working. The CDCP provides a range of training and consultation services, including a 24 hour phone service. In the past four years New Haven police officers have referred over 1,000 children and their adult caregivers, along with hundreds who have themselves committed serious violent crimes. These childrens have often been seen within minutes of the violence in their homes, at school, at the Study Center, or at the police station.

The Convergence of Internal and External

In his 1926 paper "Inhibitions, Symptoms and Anxiety" Freud described the traumatic situation as "experience of helplessness on the part of the ego in the face of an accumulation of excitation whether external or internal in origin." The "trauma consists of the subject's estimation of his own strength compared to the magnitude of danger and his admission of helplessness in the face of it." Freud saw the roots of the traumatic situation in experiences from earlier developmental phases. In traumatic situations external and internal dangers, real-world dangers and the internal dangers of psychic reality -- all converge. Unlike Freud, and many who work only in the consulting room, CDCP child analysts have had the advantage of early, almost immediate, intervention. Dr. Marans noted that he and his colleagues get to follow a child's response to exposure to violence from minutes after the event through long-term follow-up. They have the chance to observe and address the convergence that Freud described.

"Exposure to violence may precipitate a host of responses that reflect the powerful convergence of internal and external dnagers that derive from past and present"

-- Steven Marans

The traumatic consequences of an event, the child's developmental phase, and the child's own psychological history all converge on defining the nature and extent of a trauma for that specific child. Overstimulation and excessive stress can threaten a child's developmental capacities. Regression leads the child to earlier configurations of needs, conflicts and anxieties. Of course, children whose development is already fragile to begin with are especially vulnerable when faced with violent trauma. However, clinical assumptions must not be based on the external facts alone. The trauma must always be seen as something experienced by this particular person at this particular moment in their life. Anna Freud noted that our assumptions may have little to do with a child's experience of an event or the meaning attached to it. In order to determine the best intervention, it is necessary to learn about the child's experience of an event in the context of their particular life. Once again, this requires listening.

Case #1 - Beverly and the Stray Bullet

Beverly, a 6 year old hispanic girl, and her classmates were caught in the midst of a random drug related shooting while riding on their school bus; the boy sitting across from her was shot in the head but survived. As a result of CDCP intervention, Beverly began psychotherapy twice a week when symptoms emerged. Her previous school performance had been good, her family was intact, including mother, father and 10 month old brother. But after the shooting Beverly had trouble sleeping and eating and developed multiple new fears, with a need to be close to her mother at all times.

Beverly returned to the scene of the shooting on many occasions in her therapy, through games and in drawings. Each narrative offered along with a drawing ended with her feeling both afraid and bad. As this was explored she said that she had been scared that the bullet might hit her and bad because because her friend had been hurt. In one drawing Beverly depicted herself and the boy who had been hit, with the bullet coming at her own head and then diverting to strike the boy's head. This prompted her to reveal a secret over a series of several sessions whose articulation led to a decrease in symptoms and a successful resolution of the presenting problems.

The first part of this secret was that several days before the shooting she had been reprimanded by the bus driver for teasing the same boy who had been shot. This led her to reveal that she had also repeatedly teased her baby brother and actually wished him to go away. This was all revealed with great anxiety over several sessions. Her anxiety and fear were based on her belief that her bad wishes about her brother had come true in the shooting of her class mate; she was punishing herself as though her magical thinking had been responsible for the shooting of her classmate. It is, of course, not unusual for a young girl to display hostile wishes directed towards a baby brother by displacing those wishes onto a classmate. What is unusual, and traumatic, is that his girl watched that boy get shot in the head and the realization of those displaced wishes caused her great anxiety and guilt. She was traumatized because of need to cope with anxiety, guilt, and feelings of responsibility for real and imagined events that converged for her on that bus.

Case #2 - Mike and the Loss of an Hero

Magical thinking, concerns about separation, bodily damage, competitive strivings, and Talionic justice are particularly prominent in young children. There is also a great threat for the school age child in the breakthrough of earlier infantile longings. These urges can undermine the school age child's sense of competence and autonomy. School age children often exhibit symptoms which at the same time give expression to and attempt to ward off infantile fears and helplessness that emerge in the face of violence.

Mike, 9 years old, witnessed the shooting death of a teenage boy whom he idolized; the shooting occurred as the result of a basketball game and Mike was the only witness. He was so distraught, the police decided to interview him later that day instead of immediately after the shooting. The CDCP therapist saw Mike after the police interview. Mike drew a series of pictures of the shooting event in which the gun and the shooter got increasingly larger than Mike and his friend shrank.

In the following weeks Mike had nightmares, was increasingly irritable, and picked fights at school and at home. His performance at school before the shooting had been mediocre. His father had left when he was 3 years old but his developmental history was unremarkable. His mother expressed concern that Mike spent too much time away from home doing things like watching the older boys play basketball. She was concerned that he would be drawn into the drug culture that was a part of their public housing environment.

In the course of twice weekly psychotherapy that went on for 8 months, Mike's drawings and narrative accounts became increasingly elaborate, revealing the important role that John had played in his inner life as a realization of his highly idealized father, whom he dimly remembered. Mike saw him as strong, competent, and, most important of all, interested in him. He would let him on the court and occasionally even teach him a move or two. Mike described how John's attention was so important to him, especially in contrast to his mother's nagging and concern for his safety. This maternal concern made him feel like a baby and he needed John to counter that.. In repeatedly depicting and describing the moment in which John was shot and fell, Mike was eventually able to express the source of his traumatic moment. He recalled the look of surprise and helplessness on John's face as he fell. In that moment, John became the helpless baby and Mike was once again feeling the loss of a strong idealized figure who left him. This, of course, is closely connected to his father who had also abandoned him.

With this link between the past and present losses and feelings of abandonment recognized, Mike and his therapist were then able to make sense of his aggression and fighting as attempts to reestablish power and defend against feelings of babyish vulnerability. He began to identify situations in which his confidence was threatened, by joking and teasing of friends or his brother, or by his mother's concern for him. As he recognized the source of his irritability and fighting, these symptoms gradually subsided and eventually stopped as did his nightmares. While his treatment ended in a good resolution of Mike's post-traumatic adaptation , his history and setting make him vulnerable to violence in the future. Only long-term follow-up will tell how the shooting event and its meanings may be reorganized in his development to come.

Case #3 - Sherise and the Lost Coat

Dr. Marans noted that adolescence is one of the most dramatic phases of development, characterized by intense biological, psychological, and social changes. An adolescent's attention is often focused on an awareness that he/she now possesses the equipment to act on sexual and aggressive urges that were previously purely fantasies. In addition to regressive symptoms described in the two previous cases, adolescents involved in violent episodes are also at risk because of their feelings of vulnerability and competing feelings of grandiosity, omnipotence, and sexual awakening. This can lead to risky reactions to the realities of violence, such as staying home from school to avoid violence, joining a gang, or arming themselves, to name just a few. These responses are often attempts to deal with or reverse feelings of overwhelming fear.

Sherise, a 15 year old african american girl living with her family, was robbed at gun point of her leather jacket. She was beaten, bruised and shaken. 3 months following the robbery she was referred to CPCD with symptoms of sleeplessness, missing school, and insisting on having her mother's company when moving throughout her own home. Prior to the robbery Sherise had been a good student and held a part time job, it was the job that got her the money to buy the jacket that was stolen. After the robbery she described feeling like a pathetic baby, unable to care for herself. She increasingly fought with her mother. Heightened feelings of dependance along with a simultaneous repudiation of these feelings caused conflicts with her mother that often escalated to shouting and physical aggression such as shoving.

In treatment, her mother was encouraged was to retreat during the conflicts and give Sherise some more room. Sherise revealed in her therapy that during the robbery she had been afraid of being raped. She connected this fear of rape to her avoiding going to school. She elaborated that there was a boy at school with whom she had begun to develop a romantic relationship, and that since the robbery, she felt ashamed and anxious when thinking of this potential first boyfriend. For Sherise, the normative adolescent anxiety over sexuality had gotten tied up with her intense vulnerability and loss of control associated with the robbery. By not going to school she was not merely avoiding the potential danger of the street, but avoiding her potentially romantic, sexual feelings towards this boy. As she became aware of these connections, she was able to return to school and to the budding relationship. For many adolescents this is not the outcome in the face of these conflicts over sexuality and power. Many inner city adolescents faced with what appear to be dead ends, build up their sense of strength with a gun or seeking safety and intimacy by joining up with a gang.

It Hurts When Fantasy Becomes Reality

Childrens' responses to violence are not simple. The responses we see in their symptoms, inhibitions, and anxieties result from the powerful convergence of internal and external dangers in the violent episode. Things which should stay in the realm of fantasy are no longer contained there. For too many children, primitive fears materialize on a regular basis and not just in one specific event. Continual exposure to violence can severely undermine a child's basic sense of security and safety, impairing their development and sense of mastery. Psychoanalytic interventions can help identify sources of danger and bring them under greater ego control, allowing the child to return to their optimal developmental course.

Maran closes by citing a favorite story of his, one from the depression era. Its called The Night of the Hunter and in it a father includes his children in a robbery by hiding the money in his daughter doll and telling his son to protect his sister and the money. The father is caught and executed, but not before inadvertently letting a preacher know about the money hidden in the doll. Soon the mother dies and the children are then pursued by this "psychopathic preacher." The childrens' saviour is a character named Rachel who protects children, taking the depression era wandering waifs off the street.Reflecting on the perils of childhood fears we see they often go unarticulated. It is our task to help children find the words for their fears, whether as children or adults, so they can put the past in its proper place and, like Rachel, protect them from those fears hunting them.

And finding words for fears is what psychoanalysis does. Without the consulting room, psychoanalysis would have little to offer. Without moving beyond the consulting room we would have little knowledge of the exigent circumstances that all too often undermines optimal development.

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