Q&A With Bob Levey
Washington Post Columnist
Tuesday, April 1, 2003; Noon ET
"Levey Live" appears Tuesdays at noon ET. Your host is Washington Post columnist Bob Levey. This hour is your chance to talk directly to key Washington Post reporters and editors, local officials and people in the news.
Today, Bob's guest is Paramjit Joshi, M.D., chair of the Department of Psychiatry at Children’s Hospital.
| Paramjit Joshi |
Joshi shares advice on how to help children understand the war in Iraq. Over the past 25 years, she has developed an expertise in the study of psychological effects of violence, crisis and trauma in children. A Guide To Help Kids Cope With War is available on Children's web site.
"This fact sheet serves as a tool for parents, educators and childcare professionals so that they can understand the psychological impact of war on children and help determine the difference between what is normal behavior and when children might need help sorting through their feelings," Joshi said.
Joshi joined Children's National Medical Center in 1999, after serving as director of clinical services at the Office for Prevention of Violence at the Johns Hopkins Hospital Children's Center in Baltimore, Md. She earned a doctorate in pediatrics from Punjab University, Christian Medical College & Brown Memorial Hospital in Ludhiana, India, and remained at Hopkins for 22 years after completing her training there in general psychiatry and child and adolescent psychiatry.
Her focus over the last decade has been to chart local and international efforts to identify and treat children traumatized by violence–in wars abroad and closer to home in America: on its streets, in its schools, and through the media. A Fellow of the American Psychiatric Association (APA), Joshi is the recipient of the APA’s Award for outstanding contributions to disaster psychiatry. She has taught and published extensively on the issues of depression and childhood trauma, and in 1999 co-authored the book: “Empowering Children: Psychological Assistance Under Difficult Circumstances.”
Editor's Note: Washingtonpost.com moderators retain editorial control over Live Online discussions and choose the most relevant questions for guests and hosts; guests and hosts can decline to answer questions.
Bob Levey: Good afternoon, Dr. Joshi, and thanks for joining us today on "Levey Live." Let's begin with a question about the stress of war. Do you see more signs of children going "over the top" in the last ten days? Are you seeing more psychiatric patients at Children's Hospital?
Paramjit Joshi: Hello Mr. Levey. Thank you so very much for inviting me to participate on your web chat "Levey Live". In answer to your question , no we are not really seeing more patients because of the war but the ones that we are seeing are certainly expressing concern and worry about the war.
Bethesda, Md.: Hi
I'm the mom of a very bright 21-month-old boy. I've been insisting that we not watch war news/footage on television while he's in the room, and my husband thinks I'm insane -- he says there's no way my son could understand the images. I think the sight of bombs could be traumatic for him.
Am I being overly protective? Do you think a child his age should be insulated from these images?
Paramjit Joshi: This is a great question. Very young children also respond to what they are exposed to in their environment. So even though your child may not comprehend all of the content of what is on TV, the sounds can certainly be startling but more importantly how you may be responding to what you see on TV and the conversation that may follow.
Bob Levey: As you've pointed out in your research, television is a major problem at a time like this. Please discuss the difference between allowing a three-year-old to watch war coverage and allowing a 12-year-old to watch it.
Paramjit Joshi: There are developmental difference in how a 3 year old might respond and how a 12 year old will. Obviously the older children are able to better understand the nuances of what they see and may have questions and feelings related to that, while the younger child is more concrete and takes in what he sees literally.
Virginia: Are there any cultural differences? The black kids are my school won't talk to counselors (who are all whites).
Paramjit Joshi: Psychologically speaking there are really no cultural differences when it comes to being exposed to trauma or a war situation. However, different children might choose to deal with what they experience differently. Also the child needs to feel comfortable in the environment he/she finds himself in to be able to open up and ask questions.
Bob Levey: If a child is religious, does that help at a time like this?
Paramjit Joshi: There are four main factors that help children become more resilient during difficult times: family, school, community and spirituality/religion. I call them the four pillars of support that we all tend to lean on.
Bob Levey: Children often cry, suffer nightmares, lose their concentration. How do you tell if a child is exhibiting these symptoms because of the war, or because of the normal stresses of growth and adolescence?
Paramjit Joshi: If these behaviors are of new onset and are quite persistent it is more likely that it is in response to a current stress. However, if the child has always had trouble with nightmares etc. then there may be something long standing. However, it is best to try and talk to the child to find out what may be bothering him/her.
Washington, D.C.: Why do kids need to "understand" a war? Countries are fighting ... that's all they need to know. The Vietnam War certainly wasn't "explained" to me when I was a kid and I was fine.
Paramjit Joshi: We need to take the lead form our children, if they want to know more about what is going on we need to be able to communicate with them as openly and honestly as is possible. However, the child's emotional and developmental age needs to be taken into consideration as to the level of details that we go into. Children are curious and sometimes if we don't discuss certain topics it can actually increase their anxiety or they reach conclusions in their mind which may be incorrect.
St. Cloud, Minn.: My husband will be deploying to the Middle East though the military. Do you have some suggestions about how to talk with preschool aged children about their daddy being gone for 1-2 years? Also, are there any reading materials that you're aware of that you'd recommend? I feel comfortable creating a safe environment for them, no news coverage, sending letters to daddy etc. The military information really focuses on the children six years and older.
Paramjit Joshi: This is of course a very emotional time for families who have loved ones deployed overseas. For preschool children we need simple explanations for ex. "Your daddy is trained to be a soldier and his job requires that he go overseas for some time - we will miss him but he loves you very very much. We will write to him, make cards and try and stay in touch." Young children don't have a good sense of time so it is hard to know what 1-2 years mean. A long time could just be 2 weeks.
Bob Levey: Do you expect any increase in Columbine-style violence at American schools because of the war in Iraq?
Paramjit Joshi: There has been an interesting phenomenon that we have noted since 9/11 - that in fact there have hardly been any school shootings. The events of terrorism and war make youngsters have a different perspective. They start to think more about others than they do about themselves,. Often during these times they think about what they can do to make the world a better place.
Washington, D.C.: Where is the line between being scared "a normal amount" by things like the war and being overly scared and possibly needing help?
Paramjit Joshi: Being scared a normal amount is considered a "normal response to an abnormal situation". The time that this crosses the line is when it starts to interfere in our functioning ex. we are unable to go to school or work because we are so paralyzed by fear, we start to quell our anxieties by resorting to alcohol etc. or we start to exhibit behaviors which interfere with our inter-personal relationships. In children it would be starting to to become very withdrawn or the reverse one becomes very angry and agitated. Most human beings are by nature resilient and we tend to start to normalize after a while.
Bob Levey: Do children pick up on war-related stress that adults are feeling?
Paramjit Joshi: Children learn from watching their parents and other adults. In fact studies have shown that the best predictor of a good psychological outcome for children is directly related to how the primary care giver (usually the mother) is handling the situation. So children certainly know how the grown-ups around them are feeling.
Long Beach, Calif.: Is it counterproductive to be made to feel paranoid as a result of 9/11? Do children really need to know the threat level color for the day?
Paramjit Joshi: I agree that we don't need to be completely alarmed by every detail of terror threat that the government puts out. However, it may be worth your while to discuss what these color codes mean (Age of the child permitting) because if you don't the children are certainly hearing about it at school or from the news. We can put it in a constructive frame-work, but not micro-manage it.
Bob Levey: I can't cite the statistic exactly, but it's pretty shocking: By the time an American child reaches his 18th birthday, he will have seen 80-leven-zillion murders on TV. No, they won't have been real murders. Still, American kids are desensitized to the reality of violent death. Might that mean that real deaths in the real war in Iraq cause less trauma rather than more?
Paramjit Joshi: The issue of desensitization is a real one. For young children it may be so that when they see death on the battle field they don't think about the person as real. However, for older children who have been exposed to a lot of violence in the media or in their communities the desensitization works as a defense mechanism. They see so much of it that after a while it stops to both rthem as much. Sadly,it becomes an unconscious way to cope and so they are limited in their capacity to be empathic.
Bethesda, Md.: I am a teacher in Montgomery County schools. I find that the best way to help students understand the war is to explain that nobody wants war, but that sometimes it is necessary. I use the comparison that nobody wanted to have to fight the Nazis, but we had to to save the world. Most students, even my eight graders, have a rudimentary understanding of how evil Hitler and his henchmen were, and that Saddam Hussein and his rape-and-torture thugs act similarly. Have you tried making this comparison? Are you finding that it works?
Paramjit Joshi: Explaining why countries go to war is always a difficult one. On one hand we tell our children that we should resolve conflicts peacefully and by having dialogues, on the other hand governments decide to go to war. Different people have different ways of dealing with this. I usually try and ask the children why they think the US went to war. It helps brings out their views and a discussion. I personally try to stay away from previous examples as you have suggested. Children are wonderful in starting a constructive debate about the pros and cons of this war. They have their opinions which provide a wonderful way to share their ideas.
Bob Levey: Young boys have always been fascinated by guns and war games. Does this fascination make them better able to handle emotional stress when war is real?
Paramjit Joshi: Generally boys tend to externalize their feelings by playing with toy guns etc. and girls tend to internalize their feelings by playing with dolls etc. I don't think boys are better able to handle emotional stress when war is real, but they have learned growing up to keep their feelings in check. Girls tend to be more verbally and emotionally expressive.
Bob Levey: Early in your career, you treated children from East Baltimore whose lives were a disaster because of drugs, gang wars, high unemployment and high teenage maternity rates. How would "forgotten children" like those in East Baltimore handle the stress of a real war in Iraq?
Paramjit Joshi: Children who grow up in violent neighborhoods fall generally into three categories: those who are desensitized and hence are almost "unphased" with what is happening Iraq, those who become extremely fearful and depressed with a resurgence of post traumatic stress symptoms and a minority who become even more aggressive and violent since they perpetuate what they are seeing.
Bob Levey: Whenever there's a disaster at a school, officials rush in "grief counselors" to help the kids handle it. Do you think schools should use "stress counselors" during the war in Iraq?
Paramjit Joshi: I think it is far more helpful when schools integrate mental health as part of their physical health program. This integration allows these issues to be addressed on an going basis rather only "rushing in" when there is a crisis. Many school districts are recognizing this and implementing this. When we only respond in a crisis there are no on going efforts and the gains made are limited.
Bob Levey: You often use art as a way to analyze how a child is feeling. What would you look for in children's art that might indicate war anxiety?
Paramjit Joshi: Art is just a wonderful way to look into the child's mind. I have some of my patients drawing pictures of burning building, planes dropping bombs, sad faces. I had one child who actually knows some one who was killed draw a coffin draped in the American flag. Children's art work helps us explore the child's feelings and allows us to provide emotional help to them at their level of understanding.
Bob Levey: Should parents make a special effort during the war in Iraq to please their kids? Should they shop with them more than usual? Take them out to restaurants more than usual? Go to ball games with them more than usual? Or would kids see through this?
Paramjit Joshi: I think it is helpful for parents to spend more time with their children especially younger ones and latency aged - and just be more available in general. I would not necessarily focus so much on material things as I would in spending time together (simple things in life) and if you happen to watch the news together open a dialogue about what all this means. It helps with some of their anxieties and questions that they might have.
Bob Levey: About 40,000 Iraqi-Americans live in the Washington-Baltimore area. Clearly, they face special issues. What advice would you give Iraqi-American parents about spotting and coping with stress in their children?
Paramjit Joshi: Sometimes wars bring the worst out of all of us - we have a tendency as humans to cluster together towards what is familiar to us. Iraqi-American children unfortunately may feel ostracized by their peers, may feel conflicted about their loyalty towards being an Iraqi and an American. Who do they pledge their allegiance. I would suggest that parents have these conversations. Schools can help by having Iraqi children talk about their heritage and for children to be able to have these dialogues at home and school. As is said their is strength in diversity and we can't forget this during these difficult times.
Bob Levey: Many thanks to our guest, Dr. Paramjit Joshi. "Levey Live" takes next week off, but it returns with a vengeance on Tuesday, April 15, at the usual time--noon Eastern. See you then.
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