Traumatologist on coping with tragedy: Let children feel how they feel

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When dealing with grief, especially in the case of a traumatic event, Clinical Traumatologist Hanif Benjamin says there are distinct differences between how children and adolescents process and interpret death as opposed to adults.

In a phone interview with Newsday on Friday, Benjamin, certified in child trauma, said when young people have experienced a traumatic death, it is important for the adults in the family to remember to allow the child to express their feelings.

“Let them feel how they feel,” he said. “It is ok (and) understandable that they feel the way they are feeling, including feeling overwhelmed.”

Benjamin said children and adolescents grieve differently and there are two main reasons why: their emotional capacity to process the situation and their understanding of the concept of death and dying.

“While an adult may have different coping mechanisms to treat with death and dying, children may not have those emotions.”

He said the age of the child also needs to be considered.

“Death is a magical thing. It is fantasised in the premise that whoever died will come back.”

Benjamin also said online video games have shaped and solidified this concept as many of the characters in games have the ability to come back to life.

“With children, you have to be concerned with what is real and what is perceived. Adolescents, however, don’t want to talk about it at all. They may just want to be quiet, or in their own world.”

He said young children can become very confused and take their cues from the adults in their environment. They may, for instance, piggyback on the emotions of these adults.

He said older children have more of a behavioural response to trauma. This can present as aggression and, depending on the circumstance, becoming withdrawn.

He also said death is still very taboo for children. “We still do not engage in family conversations about death.”

Don’t tell them how to feel

He said it is important for the family to respect the grieving process and understand that everyone, even children and adolescents, grieve differently.

“Respect how the child, and even the adult, grieve and don’t put perimeters or timelines on how they grieve, because no two people grieve the same way.”

Benjamin said people typically don’t know what to say in a tragedy which leads to inappropriate things being said.

“that’s a human flaw. Some say weird things because they feel like they have to say something. You don’t have to ask every 30 seconds if they are alright.

"You don’t have to say ‘God knows best,’ or ‘everything is going to be ok.’ You want to avoid the kind of statements that angers people. You don’t have to lay hands on them every day and pray.

"You don’t want to create that idea that something is wrong with them. They are going through grief and loss (and) it is normal.”

He said another critical point to note is to avoid saying things like, “It’s not your fault.”

“We’re not going to do this at this time. We’re going to allow them to feel how they feel, even if that feeling is irrational.”

He said the reason for this is because children may not, in the moment, be able to properly verbalise how they are feeling.

“For children, it comes out in their emotions or behaviour. They may become clingy to loved ones, or may not want to let them out of their sight because they may also be killed.”

Survivor’s guilt

“Survivor’s guilt is a very real thing for a lot of people, including children,” said Benjamin.

Survivor’s guilt is a mental condition that occurs when a person believes they have done something wrong by surviving a traumatic or tragic event when others did not.

He said survivor’s guilt is heightened in the first 72 hours of a tragedy.

“Monitor for suicidal thoughts, not just in children, but in adults. (Also monitor) risky behaviours as well because at this point, they really don’t care. They may be sleeping less or not taking care of their hygiene.”

He said there must be adults in the environment who can provide the emotional support they need. “

They may not be able to get it from their parents because (the parents) may be emotionally unavailable for children during this period. ”

He said children and adolescents need a “system of care” within the family unit to step in and provide care and attention.

He said children will have more questions than answers during this time.

“We can’t have this conversation without talking about God, spirituality, and religion.”

He said survivors may experience a crisis of faith, where they curse their God for allowing their loved ones to die.

“At this point, there is a lot of confusion. They will ask themselves, 'Why me and not them?’ They will replay every waking moment from the beginning to the end. In some instances, children may be blaming themselves.

“They question every moment in that tragedy and what is significant about that is they see every moment as a negative and think of all the things they could have done differently. They believe what happened is their fault and, for a while, no one can tell them differently.

Benjamin said it was natural for children to blame themselves in a tradgedy.

"And sometimes we push it on them as well because we’re not allowing them to ventilate how they feel.”

Dealing with grief is complex

He said children can experience constant flashbacks of every single detail of the event which leaves them with a sense of accountability, anger, hopelessness, fear and confusion. This, he said, inevitably leads to a lack of motivation which can present as sleeping problems, headaches, nausea, social isolation, and thoughts of suicide.

Benjamin recalled a case where a mother, who had just lost a child in a car accident but had three surviving children, began exhibiting suicidal tendencies.

“You know what that did to those three children? That was more traumatic for them than the initial accident.”

He said the surviving children felt at fault.

“We have to consider grief and loss in the context of someone who lived a long life as opposed to tragic grief and loss.”

He said type one trauma, or complex trauma, means it is happening in the present and so the response to that will be much different.

“This is not growing old and expecting to die at some point. There is something inherently complex in dealing with grief and loss because it is not something you (anticipate) or even think about.”

He also said children should not be forced to go to funerals.

“They may not be ready for that yet.”

Benjamin said children should be encouraged to find a natural outlet for their grief, such as drawing, colouring or, for older children, journaling.

“They will (still) relive the trauma, but they will have an outlet.”

It takes a village: The impact of tragedy on the community

“Everyone will go through survivor’s guilt, including rescuers,” he said.

He said trauma is like throwing a pebble into the water of a still pond which reverberates long after the tragedy has occurred.

“You have to look at the epicentre (which is) the family. Next is the people in the environment affected by this: the community, neighbourhood, school, church, etc. We also have to think about responders. They become a part of the circle of tragedy.”

He said in Trinidad and Tobago, there is not a proper system of care for those impacted by trauma. “The real work comes six months, two years later, when people realise their grief has changed.

“Trauma affects us all. We do not move from traumatic event to traumatic recovery. We stay in the trauma incident. We don’t move from that. The community does not move from that. There is nobody going to do a session with the community like when you have a mass shooting. I don’t see that happening here.”

He said those who are able to pay for private therapy can, but there is no crisis management centre available to take charge in the community and provide counselling.

“So, people go about their lives, but in reality, they are affected for years to come.”

He said in the early stages of grief, in the first few days, the family may not be ready for therapy. Instead, what the family will need is guidance through processing their raw emotions. He said the first few months would be a confusing time for the children especially.

“It is not uncommon for children to see, in a real way, their loved ones who have passed. That is normal at this point; to dream and have full conversations with people in your dreams.

Benjamin said, “Let us not make grieving a difficult process.”