Pages: 480 Price: $24.95 ISBN: 1556436300
Having worked as a disaster relief chaplain in the aftermath of hurricane Katrina, I was looking for information that would give me an understanding of the stressors and behaviors in the children who rode out the storm or who "went north" for the storm and came home to total devastation. This is the first book that I have read regarding trauma and I found some of the ideas very intriguing. It was written for parents, teachers, medical workers, therapists, and anyone who worked with children, and it is easy to read and understand. It includes activities for teachers as well as parents and care givers.
The premise of the book is that trauma is a physiological event rather than psychological. According to Levine and Kline trauma triggers the “fight-or-flight response” which causes adrenaline, hyper- arousal, changes in blood flow to shore up muscles for fight or flight and various other physical responses. Because children often can’t flee or fight, they freeze. The idea is that all the physical energy that was built up in the anticipation of fleeing or fighting is trapped, and if it is not released, it can cause emotional/behavioral problems in the individual. The authors state that trauma leaves an imprinting on the brain. Trapped energy can cause behaviors that are often mis-diagnosed as other disorders, such as phobias, ADHD, acting out, disruptive behaviors, and many others.
There are four sections in the book. The first gives the definition of trauma, its impact on the body and what is going on in the brain. It tells how to recognize the physical symptoms of trauma in children as well as the emotional. Physical symptoms may include headaches, stomach aches, bed wetting, repetitive play, avoidance behavior, low energy etc. Feelings of shame and guilt, etc. emerge on the emotional level. (This is by no means the total list of symptoms, there are many more.) It helps the caregiver recognize the signs of shock, whether immediate or delayed.
Section two deals with preventing trauma and shows how to give "emotional first aid." It provides exercises to teach the difference between sensation and emotion and how to help trauma victims identify sensations that may be the cause underlying emotional difficulties. Sensations are the actual physical stimuli the body feels such as cold, numb, tense, jittery etc. These sensation responses are connected to the seven senses, but are often thought of as an emotional response. The authors contend that emotions are physiological responses as well, and have their own energy. The premise is that if you can identify the emotions and the sensations, then you can track down the cognitive response as well.
For example, in writing this book review, I notice tenseness in my shoulders (sensation). I am afraid that I won't find an editor to take an unsolicited book review (emotion). If I don't submit the review, then it will lower my grade and I might not pass the course that assigned the review (thought). The authors present the idea that if I could first focus on the sensation of the tense shoulders and in their words "befriend" that sensation long enough the sensation would change. Then I would get to the origin of the sensation faster, which would be the thought that I might fail the class. As I linger with the sensation it will diminish and I will settle down and be able to move on to what I need to do and not be locked in to the emotions that are underlying the sensation.
The exercises in this section are geared to equip caretakers to help children who are stuck in frozen emotions, or mixed emotions (from shock and trauma) to identify the sensations that are caused by the underlying emotions, and then identify the emotions involved. This allows the trapped physical energy to be diminished. If it is not diminished, those underlying emotions can grow and get out of control, such as rage, terror, etc. The exercises can be done in an individual setting or a classroom setting if the trauma happened at school. They help care givers to recognize and use the resources readily available. The activities include using internal resources such as music, art, math, sports, spiritual beliefs etc. as well as external resources which include caregivers, the environment, or sensory comfort. This section also covers what is going on in the brain during trauma. It gives hope to the traumatized and their loved ones that trauma and its effects can become a thing of the past, not something that has to be lived with daily and forever: there is healing after a traumatic event.
Section three gets into helping the traumatized person heal. It talks about the language to prevent further trauma as well as the language to help deal with trauma. It gets into specifics in regards to accidents, and falls, divorce, death, loss, sexual molestations, and medical procedures. To give an example, it lists eight things a caretaker can do to in response to falls and accidents. Responders need to be aware of their own responses before they can help the child. If the child shows signs of shock, keep her still and quiet, hold her, and then as she quiets down, draw her attention to the sensations she is feeling, etc. This helps the child release the physical energy that flooded the body as a result of the survival mode triggered by the fall.
Section four is a mixed section involving the authors' agenda in changing behaviors and policies in parts of society (i.e. birthing practices, circumcision practices, classroom practices, etc.). It presents some food for thought about the way we handle trauma for first responders, mass traumas (such as 9/11, Katrina, Columbine, etc). It also provokes thought on current hospital care for children, with examples of hospitals that have successfully initiated family-centered care.
I found the authors' bias in this section a little unsettling. They believe childbirth is a traumatic experience and assert that over use of Cesarean births and inducing labor are issues that could lead to trauma in the newborn. They promote a similar bias on the issue of male circumcision (Female circumcision was not addressed. I assume because it is not an American practice.), and elucidated on the trauma circumcision could cause, landing on the side of ending circumcision all together. They do not address the spread of STD's, the risk of cervical cancer in partners and various other health issues related to the issue. In regards to school, I got the impression that the authors felt that schools were not adequately addressing the issue of trauma in children and that school violence, acting out, etc., were issues of unresolved trauma. In all of these discussions the book appears to over simplify the issues and put the burden of mental and emotional health on people who are not trained in mental health issues. This bias made me uneasy and could possibly cause me to use this book only as a secondary source.
Another problem with the book was the lack of adequate foundation for some of the concepts discussed.. The authors mention repetitive play, avoidance behavior, and low energy on Somatic Experiencing several times in the book, and assume the reader knows what is being referred to. No definition is ever given for Somatic Experiencing and the omission leaves the reader with no platform for understanding the basis of the authors' argument. Nevertheless, some of the ideas and exercises are worth considering, though I would recommend balancing it with more study on trauma and children.
Even though this is the first book I've read regarding trauma, and in some areas raises questions for me, it is a book that I will keep as a resource.
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