A s a child I was growing up in a country that was at war with its neighbours, and even though I was lucky enough to live in the capital city that was not in immediate danger of an armed conflict, I do remember feeling scared at times trying to make sense of things that everyone was talking about and that was happening around me. I remember watching TV with my grandmother while they were showing black screen with endless lists of names of those who died or went missing. My grandmother was only 17 when she joined the army in the Second World War which meant that she knew exactly what war was about, so she watched these lists with a concerned face every day. At that time, I was going to school and my life was not jeopardised by bombs or arms, but the psychological consequences of those times came later for me and for many children of my generation.
Children are greatly affected by wars, armed conflicts and terrorism in various ways, as these situations destroy basic necessities of life (health care, schools, adequate shelter, food, water, etc.). The lack of food as an existential need can result in developing an eating disorder later in life (“staffing” with food to feel safe and alive, for instance). Furthermore, family relationships can be severely disrupted by death , injury or exile which translate into separation anxiety, stress and complex loss for the remaining family members. Wessells (in Smith, 2001) suggested that “When parents are emotionally affected by war, that alters their ability to care for their children properly. War stresses increase family violence, creating a pattern that then gets passed on when the children become parents.” This reminds us that children are dependent on adults offering them empathy, care and attention which in extreme situations like armed conflicts do not become the priority for adults. In addition, the same author reported that children exposed to acts of violence during formative years normalize violence in their life and relationships as adults but also hold a pessimistic view of the future which can lead to depression, post-traumatic stress disorder, phobias and anxieties.
Many children get killed, injured or end up with a disability or an illness during the wars, but can equally be victims of rape or be forced into being soldiers. As a result, children may suffer social and cultural losses if they have had to refuge or feel indifference to the surrounding world or themselves and reverse to a change of the moral construction of self which could lead them to lie, steal or kill to survive.
Even for those children who did not suffer such overt consequences of war, psychological impact can be significant. Sanderson (2013) defines trauma as an exposure to actual or threatened death, serious injury or sexual violation in which intense fear, horror or helplessness predominate. This definition includes witnessing such events which indicates that children may suffer from trauma on various levels and even complex trauma which comes from prolonged trauma of an exceptionally threatening or catastrophic nature likely to cause pervasive distress. Posttraumatic stress disorder which can occur at any time after a traumatic event(s) includes intrusive symptoms (flashbacks, recurrent nightmares, intrusive distressing thoughts), avoidance symptoms (avoidance of feelings, memories, use of drugs etc.), alterations in cognition (disassociation, lack of concentration, detachment or mood alterations (hypervigilance, aggression, sleep disturbance).
In order to understand how our body responds to trauma, it is important to know that adrenaline is strongly secreted when a person experiences trauma and it helps a memory become imprinted in the part of the limbic system called amygdala. The amygdala then stores the traumatic images of trauma as sensory fragments or the way the person experienced trauma with the five senses (image, smell, sound, taste or touch). This is why the brain can get triggered by a similar image or a smell which can lead into a panic attack, increased secretion of adrenaline and response to stress in a fight, flight or freeze mode.
Healing and hope
It is encouraging to know that the psychological research on trauma is extensive and there are numerous ways to help people who have experienced trauma as children (or later in life) to overcome their traumatic experiences or learn to live with them. Mental health professionals often work with trauma with a goal to restore control over trauma reactions in the future and validate existing coping mechanisms while reconnecting to others, self and the world. While in a particular circumstance of war-related trauma it is not always ideal to probe into traumatic events, as it can cause a re-traumatisation, modern therapists also use the advantages of technology, virtual reality and the use of avatars in therapy to restore reality and change perceptions. Therapy can help traumatized children to make sense of traumatic experiences as well as to grieve losses and encourage post-traumatic growth.
Loss can be observed as a larger term that does not only apply to an actual loss of a close person, but also as a loss of home, culture, identity, part of life, etc. Closely related to loss are bereavement and grief and we can grieve the loss of our identity in the same way as we can grieve the loss of a parent. Elisabeth Kubler Ross (2014) developed a model which provided a great understanding how grief develops called The Five-stage model which includes: Denial (how will we continue, going numb), Anger (giving structure to the loss), Bargaining (what if I did something differently, if only),Depression (appropriate response), Acceptance(new normality). The idea is that people who are grieving a loss can go back and forth throughout these stages and presenting this kind of model in working with trauma and loss can provide acceptance and normalization of their processes. Children who suffered war trauma and aggression can rightfully feel angry with many related factors, but it is important to acknowledge that depression is a legitimate response too. Bargaining or wondering if things could have been different or experiences rewritten can also trigger feelings of guilt and shame in relation to the traumatic events.
Finally, David Kessler (2019) added the sixth stage he called Meaning(purpose). This is a particularly important stage for war-affected children and adults as making sense of war is not a straight-forward task and finding a meaning or a purpose to continue living is individual and can be a personal journey on a road full of thorns and spikes. However, it is an incredibly important and even existential journey they must take using every available support and help they can find including that of mental health professionals.
Smith, D. (2001). Children in the heat of war. (Vol.32, No 8)
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Santa Barbara, J. (2006) Impact of War on Children and Imperative to End War. Croat Med J. 2006 Dec; 47(6): 891–894
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Kessler, D., (2019). The five stages of grief
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