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November 1, 2001
Vol. 59
No. 3

The Shrink in the Classroom / Coping with the Unthinkable

The events of September 11, 2001, are without precedent. The enormity of these terrorist attacks is disorienting and immensely anxiety-provoking. These feelings are especially visceral for all of us who endeavor to aid children and adolescents in their understanding of these awful events. In fact, even those clinicians who specialize in the treatment of grief and trauma are feeling overwhelmed and clumsy. It is no wonder that teachers and school administrators are struggling to discern the most helpful way to approach their students.
Nevertheless, teachers are ideally suited to help their students through this crisis. Children and adolescents think of their classrooms as a community, and community is invaluable right now, especially as a cohesive force.
Educators ask: What are the effects of trauma on students? Do different developmental stages affect both normal and abnormal responses to trauma? What treatments help those students who are experiencing post-traumatic syndromes? Perhaps most important, how can teachers intervene to ameliorate the climate of fear and discomfort that such horrible events as the terrorist attacks can create?

What is Post-Traumatic Stress Disorder?

Post-Traumatic Stress Disorder is the psychiatric diagnosis that describes specific psychological symptoms that occur after a severe and traumatic event. Symptoms, which persist for at least one month, include a state of increased arousal, avoidance or emotional numbness, and a constant reexperiencing of the traumatic event. More transient symptoms are characteristic instead of Acute Stress Disorder. Many individuals briefly experience severe psychological symptoms in the wake of significant trauma, which then substantially abate after a month.
Individuals may have genetic or other biological predispositions to developing Post-Traumatic Stress Disorder, but the cause of post-traumatic symptoms is always an external event. The severest traumas are usually serious threats to one's life or well-being, but what is traumatic clearly depends to a large extent on one's subjective experience. As psychiatrist Judy Herman points out, "Traumatic events are extraordinary, not because they occur rarely, but rather because they overwhelm the ordinary human adaptations to life" (1992, p. 33). Traumatic events threaten one's sense of bodily or psychological integrity, thus potentially setting in motion the need to avoid particular settings or situations, to be vigilant for future attacks, and to continually reexperience the event as one attempts to organize and understand a morass of emotionally charged and seemingly senseless information.

Developmental Considerations

Students at different ages experience severe trauma as a function of their developmental stage. For example, adolescents may reexperience traumatic events through intrusive memories and nightmares, whereas younger children might engage in repetitive imaginative play in which traumatic themes are prominent. Further, younger children may experience nightmares that are not immediately recognizable as related to a traumatic occurrence. Older children are much more likely to understand the content of their dreams and daydreams as stemming from post-traumatic symptoms. All age groups can experience such physical symptoms as stomach-aches and headaches in the wake of terrifying events. Young people experience these physical symptoms most often when they are exposed to cues that remind them of the trauma.
Avoidance symptoms include the tendency to avoid thoughts and feelings that are associated with the trauma. Younger children who are playing, for example, might abruptly change the plot of their fantasy to prevent any recollection or examination of the experience that they are exploring. Older children are often left with a sense of a foreshortened or unpleasant future. For example, following the space shuttle explosion in 1996, during which a class of elementary school students watched their teacher perish, many of the students subsequently stopped pretending to be astronauts and dropped their aspirations to venture into space.
Hypervigilance is characterized by increased states of arousal and increased startle responses. Some students will experience short tempers and angry outbursts, and older children may have difficulty focusing or concentrating.
For all cases of Post-Traumatic Stress Disorder, psychotherapy is a key component of treatment. Psycho-therapy can help young people decrease their level of arousal and arrange their traumatic events into a more coherent story. Medications can help treat both the heightened arousal and the symptoms of depression and anxiety that often accompany post-traumatic states.
As with all psychosocial problems experienced by students, symptoms occur along a spectrum. Even students whose symptoms do not meet the full criteria for Post-Traumatic Stress Disorder or Acute Stress Disorder may require attention. Severe states of hypervigilance, for example, can potentially affect a child's development, regardless of whether other symptoms of Post-Traumatic Stress Disorder are present. The same can be said of severely avoidant or reexperiencing behavior. Although only a small percentage of students who are exposed to significant trauma develop Post-Traumatic Stress Disorder, many traumatized students may experience a host of difficulties, including depression or social and academic problems. A traumatic event does not ensure that problems will develop, but the risk for problems increases among those students who are exposed to horrific occurrences.

Coping with September 11

The terrible events of September 11 have greater magnitude than previous traumatic events suffered and experienced by many people in the United States. Many clinicians and educators have expressed concern that their current level of expertise is not sufficient for present circumstances. The unfortunate reality, however, is that research on such tragic events as the Challenger explosion and the Oklahoma City bombing has taught us a great deal about the effects of trauma on large populations of children. In circumstances as disorienting as these, we need to extrapolate the ways in which our current knowledge can aid us with the present crisis.
In general, helping a student cope with recent events requires special consideration of his or her developmental capacity. We expect elementary students to think concretely. They are most concerned that rules be well known and properly followed. This preoccupation allows them to feel safe and to trust their own capacity to accomplish tasks. Adolescents, by contrast, begin to develop the capacity for abstraction. They, too, are concerned with safety, but they use their ability to view issues from multiple angles to better plan for and understand the world around them. In times of crisis, however, young people often regress. All age groups may be prone to fears that they are somehow to blame or could have prevented the tragedy from occurring. Teenagers may fall back to more concrete thinking, feeling, for example, that all people of Islamic faith are evil and malignant.
To this extent, teachers need to meet students where they are. This does not mean condoning panic or paranoia. Instead, teachers need to be aware of their students' moods and empathize with their fears. An unempathic lesson, especially when students genuinely feel that their lives are in danger, will serve only to further impress upon students that they must manage their terrible anxiety and intense emotions on their own. Helping students reach just beyond their current level of functioning will create in the student a sense of mastery and a heightened sense of well-being.
Never let your students worry alone. It is impossible to shield students from constant media coverage, but adults must let students know that they are safe and not alone with their fears. Many students will be overwhelmed with anxiety about recent events and may view as particularly insincere any attempt to move on with schoolwork in the face of the class's intense anxiety. Educators should directly address students' concern about safety, assuring students of the security of the classroom and of the ways to reach parents and other loved ones should the need arise. For elementary school students, make sure that an adult is present if they are watching media coverage of the disaster. Also, younger children may not be aware of geographic differences, and in communities that are lucky enough to be far from the trauma, making these distances clear is helpful. Elementary school students may also need an occasional break from the news. Once safety concerns have been met, it may be useful to move on to a different project more associated with normal routines.
Adolescents may require more careful discussions. Just as with younger children, we must explicitly tell teenagers that they are safe while in school. In addition, however, adolescents may benefit significantly from a careful and nonjudgmental discussion. One might begin with such questions as Where were you when you heard the news? and What was the most difficult thing for you? Discussion can help students explore their recent experiences with the support of their classmates and instructors. Helping students intellectually investigate the history of recent Middle East troubles, for example, allows the engagement of the abstract reasoning that the teenager is honing. Intellectualization is a powerful academic and developmentally appropriate tool for the adolescent during times of stress.
In spite of our best efforts, some students will not fare well in the classroom without outside help. Marked decreases in academic or emotional levels of functioning should prompt quick referrals to appropriate mental health officials within the school. In fact, studies of other tragedies, including school shootings, massive earthquakes, hurricanes, and other acts of terrorism have demonstrated the effectiveness of quick interventions for those students who develop significant problems. By being vigilant and empathic, teachers can make an enormous contribution to the well-being of students during these difficult times. At a time when a sense of community is essential, the classroom can become a potent force for healing.
End Notes

1 Herman, J. (1992). Trauma and recovery. New York: BasicBooks.

Steven C. Schlozman has contributed to Educational Leadership.

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