Healing the Invisible Wounds of Syrian Children

In March 2018, the Syrian conflict entered its eighth year with no end in sight. This war has stolen the right to childhood from millions of Syrian children. An entire generation is growing up with the ‘toxic stress’ caused by seven years of bombing, bloodshed and displacement.

In this interview, SOS Children’s Villages psychologist Dr. Teresa Ngigi explains the impact disasters and wars have on children and families, and tells us about the importance of the healing process.

Is there a difference between trauma from natural disaster and trauma caused by mass displacement or conflict?

“When you have continuous disaster – such as war, epidemic, or extreme poverty – children tend to develop resilience that sometimes makes them almost numb to the trauma. This isn’t good but it’s a coping mechanism. Those experiencing disaster for the first time have not previously had the need to create such defence mechanisms.”

How does treatment differ for one-off disasters compared to prolonged emergencies? 

“Developmental trauma and continuous trauma create a basis for serious health, mental and relationship problems or learning disabilities – even though externally the individual may appear resilient.

Event trauma – from an earthquake for example – may result in post-traumatic stress disorder (PTSD). The person becomes disorientated. They cannot put their life back together and this interferes with their wellbeing in different ways, including physical and mental health problems. 

In both instances, it is important to understand that there’s a difference between treatment and healing. Healing is a long-term process, but treatment can come in the form of medication to address symptoms without necessarily helping the healing process. We need to be able to assess the individual’s situation, identify their needs, create a treatment plan, and then evaluate whether we are able to achieve the appropriate objectives.” 

A drop-in center in Syria, providing unaccompanied and vulnerable children with shelter, food, health and hygiene services, and psychosocial support. Credit: SOS Children’s Villages

Does toxic stress impact girls & boys differently?

“The way the brain copes and processes toxic stress differs between boys and girls. The insula – the brain region that processes emotions and empathy – is smaller in girls and larger in boys who have experienced toxic stress. The functions controlled by this part of the brain include perception, motor control, self-awareness, cognitive functioning and interpersonal experiences. Girls who experience toxic stress may suffer from a faster than normal ageing of one of the part of the insula which puts them at higher risk of developing PTSD. High levels of stress could also contribute to early puberty in girls.

It’s important to put these findings into consideration when designing healing approaches. Girls may be more susceptible to PTSD than boys, hence they need specific interventions.”

How important is a long-term perspective in treating trauma like you see in Syria?

“Very important! If you start a process with a child who has been traumatized and you leave that process halfway, you are going to worsen the situation for that child. 

An assessment is extremely important to establish the needs of the child, as well as to assess whether we have the resources, time, and expertise to start and continue the healing process. Healing trauma is a demanding endeavor, and mental health specialists need to work diligently with a traumatized person to create a solid and reassuring relationship and guide them towards taking their power back.”

The initial phase of a humanitarian response typically involves reaching as many people in need as quickly as possible. Would you say that dealing with deeper mental health issues, especially of children, is more complex? 

“Yes, and this is why SOS Children’s Villages works with partner organizations to divide duties and responsibilities. There are organizations better able to address the immediate large-scale needs in a disaster zone. We use our expertise in caring for vulnerable children and helping their families to address their very specialized needs with a long-term perspective.

Through training local social workers and other specialists, SOS Children’s Villages can improve local capacity and strengthen the ability to respond to the needs of children and their families.”

Child Friendly Spaces (CFS) have been a central feature of SOS Children’s Villages’ work in emergency situations. How important are these facilities? 

“Child friendly spaces are a central part of our emergency response work. They offer a great environment to deal with trauma because you have caregivers who are trained, a secure and safe place, and an environment where children can express themselves. After trauma it is very important to be able to express yourself. Even without verbalizing experiences, children are involved in drawing, art therapy, singing, dancing and other activities.

It is also important that parents take part in activities so that they can participate in the healing process. Participating with their children is therapeutic for parents. We help address the needs of the parents through the children.” 

Children participating in educational and psychosocial activities at one of SOS Children’s Villages child friendly spaces in Aleppo, Syria. Credit: SOS Children’s Villages

How do Child Friendly Spaces help in providing ‘normalcy’? 

“Child Friendly Spaces offer a place for children to play, talk with other children, learn and tell stories. These activities help the children get in touch with themselves and feel a sense of belonging. When you bring them together, they feel they are a part of a community that is safe and protected.”

You can learn more and support SOS Children’s Villages Syria here!

Healing from Sexual Trauma: A Therapist’s Perspective

As a follow-up to Letter to Assault Survivors, Girls’ Globe contacted a therapist for professional insight into the psychological ramifications of sexual assault, and how survivors can heal. Michelene Wasil works with survivors of sexual assault, both men and women, many of whom were victimized in the military. Throughout her interview, Wasil repeatedly returns to a common theme regarding the struggles her clients face: “There’s a lot of shame involved.”

“Shame and guilt. That’s typically what happens.”

Paradigm of Pain

Victims of assault can have counter-intuitive reactions, which can in turn exacerbate their trauma and cripple recovery efforts. When we broached the question of maladaptive reactions, Wasil was unsurprised, having worked with clients who turn to chemical painkillers like drugs and alcohol, as well as those who develop internal ones, like sexual addiction or gambling.

She says that trauma can do more than alter a person’s behavior, it can also decimate their emotional capacity.

“There’s also a lot of emotional avoidance, unhealthy attachments, so they might get into abusive relationships. Numbness, emotional numbness, inability to really feel love.”

“Two [clients] can’t really have an intimate life, at least not very often, because it’s very painful…I’m not a doctor so I can’t tell you if it’s because of the rape, but I can guess that likely that’s a big thing. They can’t even enjoy sex anymore, or sex is cued with the trauma, so they are constantly reminded of what happened to them.”

Self-Blame

One of the most damaging tendencies, and one that acts as the biggest hurdle to recovery, is the tendency to pin blame on victims instead of perpetrators. 

“If you look at any typical rape case in a courtroom, women are interrogated about what they wore that day, they’re interrogated about their sexual history,” Wasil points out. “Someone defending a rapist will dig up the woman’s past, so there’s that whole idea of, ‘you shouldn’t have been wearing that short skirt,’ or ‘you shouldn’t be out past 2 AM,’ ‘you shouldn’t have had so much to drink.’”

A community’s willingness to blame victims can lead the victim themselves to shoulder responsibility, or tear apart every aspect of a situation, from what they said, to what they did, to how they felt.

“I have a client who was sexually assaulted in the military, so there’s that added layer of shame, as in, ‘I should have fought them off.'” explains Wasil, “And then if you…get really graphic, ‘I was aroused during this trauma, so I must have liked it somehow,’ so there’s all this self-doubt. It gets really murky and complicated.”

Wasil has also witnessed revictimization, where victims, either in childhood or adulthood, find themselves entangled in subsequent abusive relationships.

“I don’t think it’s that they choose dysfunctional relationships,” says Wasil.

“I think it’s that they’ve been so psychologically damaged from this horrendous trauma that I don’t know if they really know how to interact in a healthy way, and their unhealthy behaviors are attracting other unhealthy people.”

The Way Forward

The crucial thing for survivors of sexual assault to know is that recovery from an assault is possible, through the support of family, friends and professional help. However, survivors should start therapy with realistic expectations.

“It’s a long road to recovery,” advises Wasil. “It also depends; if you were raped as a child and raped as an adult, and haven’t talked about it, and it’s been 30 years or 20 years, whatever, that’s been festering for a really long time.” 

No matter what modality treatment takes, healing from sexual assault and breaking patterns of behavior – even painful ones – is not an easy process to undergo, although in some cases medication prescribed by a professional can help through the worst of it. “It can get worse the first month or two,” advises Wasil. “Just stick with it.” 

“I would say if you’re going to a therapist, and you don’t feel better in 8 – 10 sessions – if you don’t feel better at all – it might be time either find a new therapist or consider some medication.”

A Letter to Assault Survivors

‘Effects of sexual assault on future relationships’

‘Multiple sexual assaults’

‘Definition of rape’

‘Was I raped’

‘Can you be raped twice’

‘Can your boyfriend rape you’

‘Please help’

These were some of an endless list of phrases I typed into google search bars, coming through every results page to see if anything could explain the last few years of my life.

Five years ago, if you’d typed any of the above, you’d get a handful of articles (and one pdf document) that documented the phenomenon of repeated sexual assaults. Most were unhelpfully inconclusive as to why it happened, but they were my only comfort in that they at least confirmed that it did.

A victim of multiple sexual assaults challenges our comprehension, and our empathy. We imagine that the after-effects would be hypervigilance, an ingrained wariness of risky behaviors or situations. The human brain, however, does not always act logically when distorted by extreme pain or shame, both of which rape victims experience profoundly.

A devastating letter by the victim of Brock Turner shed light on struggles of recovering from an assault, but fewer of the less palatable effects of an assault are as widely discussed. People are generally willing to accept anguish, anger or fear. They’re less ready to believe that trauma can beget trauma.  If a woman has been so badly burned, some ask, why would she throw herself into another fire?

Smart, strong, reasonable women who have been victimized by sexual assault can still be vulnerable to abusive relationships, sexual situations they don’t know how to control, and unsure how or when to say ‘no’.

I’m one of them. One ten minute incident five years ago spurred me to spend the next 1,095 days unknowingly punishing myself for it. If a boy bought me a drink, I’d feel so guilty that he’d spent $5 on me that I’d close my eyes and bear it when he pushed me against a wall and put his hands up my shirt, even if I’d asked him not to. Was that assault? It couldn’t have been. I didn’t fight him off.

If I came home exhausted and someone I was dating didn’t listen when I said I was tired, then pulled me on the bed and unbuttoned my jeans while I protested, I’d try not to show them I was biting my tongue and crying because of course, this was how men were supposed to treat me and it was my job to put up with it. Also, I’d said yes before. So it couldn’t be rape.

If sex hurt, it was because it was supposed to. If I’d done something I didn’t want to, it was because ‘can we not do this’ was a favour I should be grateful for, not a fixed boundary. If I got hurt, it was my own fault because I should’ve known better. If I started talking about it, the confused looks while friends asked for clarification – “I mean, you said you were tired, but you didn’t insist, did you?” “If you didn’t want him to touch you, why didn’t you push him off?” – pummelled my definition of ‘consent’ to practically nothing.

The more confused I became, the more ashamed I became, the worse my decisions became, the longer my list of, ‘did I want that?’ became, the more my vicious cycle strengthened. Before I hit a breaking point and went into therapy, I would have had to be pulled into an alley kicking and screaming before I considered it rape (and even then I would have double checked what time I was walking home and asked myself what I was wearing).

The only things that would lend my story credence are that despite what happened, I have a good career, I have a stellar social media presence, I’m constantly projecting happiness, I’ve had successful relationships, and I’ve not spoken about it publicly before. The less we speak about it, the less we let it affect us, the more we blame ourselves, the more credible we are. As painful as it may be to lock ourselves into our patterns of behaviour, it is far more terrifying to admit what we’re doing, to admit what’s happening to us. It’s horrendous to be a rape victim. It’s intolerable to be a rape victim nobody believes.

I’m one of the luckier ones. After three years, I stumbled into therapy and a social circle of women I respected with similar experiences. For the last two years, I haven’t cared if someone buys me a drink, and my boyfriends know that even if it’s just because I want to read a book instead, they’ll have to wait until tomorrow.

Nonetheless, I’m still hesitant to talk about it. But recovering enough has left me with the gnawing guilt that comes with knowing that there are other women, right now, who are googling, wondering how much of what’s happening to them is their fault, desperately hoping it isn’t.

It took me five years to be able to say, being raped doesn’t mean you deserved to be raped. Being hurt once doesn’t make you damaged goods. You don’t have to spend your life repenting for something you didn’t do. If you didn’t want it, if you say you didn’t want it, that’s enough.

No matter how many times it happens, you should know, it isn’t your fault. You don’t have to live your life telling yourself it is.

Repairing the Mind-Body Connection After Trauma

 “Yoga can build back people’s ability to slow down in reacting to stress, to re-build the connection with their bodies, and engage in self-care.”
– Rebecca Epstein, Executive Director, Center on Poverty and Inequality

A recent report from Georgetown Law revealed a new avenue of trauma-informed treatment for adolescent girls. Rebecca Epstein, Executive Director of Georgetown Law’s Center on Poverty and Inequality and current yoga teacher, co-authored the report alongside Thalia González, Associate Professor at Occidental College. The report explores the potential of somatic interventions to improve the physical and psychological wellbeing of girls who have experienced trauma. Somatic interventions – meaning interventions that focus on the connection between the participant’s mind and body – are not new, but this research is showing new levels of promise for adolescent girls and young women.

“Trauma is part of many marginalized girls’ lives,” Epstein stated in a recent interview. “Across the board, girls have experienced every form of trauma studied at a higher rate than boys…yoga is one way to try to repair the mind-body connection.” Somatic interventions are made up of three core components: mindfulness, regulated breathing, and physical poses.

Epstein and González specify that, to be effective, somatic interventions targeting girls who have experienced trauma need to be trauma-informed, gender-responsive, and culturally competent. The teachers must pay attention to girls’ specific needs, provide options and choices, and acknowledge that different cultural experiences may affect a girl’s reaction to somatic interventions and the practices involved therein.

A stand-out participant named Rocsana exemplifies how somatic interventions, specifically yoga, can help girls heal. In a phone interview, she described how yoga taught her to be calm, to be more patient with her children, and how to think before she reacts. She practices yoga at home with her children, along with breathing and mindfulness exercises, and states that the techniques helped her leave an abusive relationship.

Now a yoga teacher herself in her own community, Rocsana aims to empower other girls through the methods she learned from the California-based Art of Yoga Project.

“The girls that I teach are young girls and they’re mostly Latina and African American. I want them to feel strong and powerful. I want them to feel good about themselves.”

A key element of somatic interventions is an appreciation of girls’ intersecting identities and individualized experiences. One of the report’s key recommendations reads, “Account for differences in types of trauma experienced by girls based on their intersectional identity.” Many holistic approaches to girl-centered programming acknowledge that girls’ experiences are directly related to the various, and often multiple, types of oppression and discrimination they face.

As Epstein describes, girls’ overlapping identities – be them race, gender, sexual identity, or others – affect how they experience trauma and how they are treated if they should choose to disclose or report their experience. “Women of color are responded to differently when they experience trauma…they are often ignored or blamed for their trauma.” Epstein underscores that girls of color are often seen as complicit in their trauma or are blamed for their experience.

Trauma-informed somatic interventions that acknowledge and address intersectionality allow girls to reclaim their agency, their sense of choice, and their ability to separate the trauma from their self-worth, dignity, and potential.

The use of somatic interventions signals an advanced appreciation for girls’ holistic wellbeing. As evinced by the Adverse Childhood Experiences (ACE) study, childhood trauma can lead to long-term mental and physical health effects. These include depression, suicidal tendencies, heart disease, and cancer.

Epstein and González see great potential in using somatic interventions to mitigate these effects and interrupt the inter-generational cycle of violence. “While there has not yet been a mainstream connection between the body and the mind and trauma and the body,” says González, “we see this report as a critical next step in advancing policies and practices aimed at providing system-involved girls with the foundation for a healthy and successful future.”

Perhaps this report will help those in the adolescent girl field make the connection and envision new, holistic ways to help girls improve their wellbeing.

Women's Mental Health in Post-Conflict Society: South Korea PART I

As the 2013 Miss Korea contestant photos made way through the Internet, my immersion into the Korean culture had also just begun.

Photo Credit: Jezebel.com

Korea is quickly earning global repute for a sense of superficiality, not to mention its rank as the country with the highest per capita rate of plastic surgery. It makes sense that a booming economy, growing cities, and our globalized world would spawn more westernization, but this doesn’t explain the uniqueness of South Korea’s plastic surgery habits.

During my first months living in South Korea, it has been difficult not to notice the phenomenon. Girls (and guys) walk down the street, sit in coffee shops and restaurants, while looking in mirrors, combing dyed blonde hairstyles, and re-applying makeup. “Before & After” photographs litter business entrance ways, and it is apparent that actors, news casters, teachers, and cellphone salesmen are sporting new eyelids.

To shed light on this issue, I spoke with Dr. Anne Hilty, a cultural health psychologist who has been living and working in South Korea for 8 years. She practiced psychology in New York prior to her move across the globe. One of her research areas is women’s empowerment. What I learned from her about Korea, is also one of the reasons she decided to move her life and work here. Korea is unique, and its uniqueness holds a special significance for the mental health status of Korean people. Dr. Hilty suggests that the preoccupation with beauty in South Korea has various roots, most notably in Korea’s long history of war and trauma.

Prior to 1400, Korean society was egalitarian. Afterward, in the 500-year long Joseon period and with the re-introduction of Confucianism, the belief system redefined gender roles, undermining the status of women. This historical rendering of women as “second class” citizens provided the impetus for the country’s traumatic history to affect women to a greater extent than men. 

After the fall of the Joseon dynasty in 1897, Japan occupied the country, during which time Koreans were made to conform to Japanese traditions, speak Japanese, and take Japanese names, a form of cultural violence.

Under a United States interim government set up after WWII, one tenth of the Korean population was massacred, in the name of fighting against communism, as the United States and Russia positioned themselves for control of the country.

In the years after the Korean War, President Park Chung-hee, father of the current president, Park Geun-hye, began the New Village Movement or Saemaul Undong, as a way to reestablish the economy. Saemaul Undong consolidated rural villages into large cities, emphasized modernization, and forced the population to change their customs. Tradition was labeled superstition. Dr. Hilty explained that too swift an economic development is also a type of cultural trauma, and that “Korea’s economic miracle is astounding. Their rate of development within a 30-year period was unprecedented in all the world. No one has developed from where they were to where they became within such a short period of time.”

By the 1970s the sense of economic stability allowed for a popular movement toward democracy. In response, the Korean government launched various massacres against its own people in the 1980s, including taking up arms against a student led protest, killing about 200 individuals, in my current city, Gwangju.

Dr. Hilty explained that it takes a society about 5 generations to fully recover from the trauma of major conflicts, and Korea has had “an entire century of multi-layered trauma.”

Dr. Hilty cited a recent survey that reported 70% of the workforce in South Korea having some version of depression. Additionally, Korea has the highest suicide rate in the world and increasing divorce rates. An Asia Society report on the status of women found that quality of life, education, and health rank very highly for South Korean women; however, the status of women in business and politics is relatively low. When nations develop, usually all four of the categories improve simultaneously, but there is a disparity in Korea based on its distinct culture and history.

Dr. Hilty confirms that there is an “emphasis on appearance (in Korea), and often it’s appearance over substance.” She explained that “part of that would be true of traumatized people…because if you go more deeply that’s where the pain lies…it’s a lot easier to stay on the surface and make the surface look pretty…you can pretend that the pain isn’t there”.

However, the preoccupation with beauty is compounded in South Korea. People were starving 40 years ago and now, Korea is generally wealthy. Dr. Hilty said “new money doesn’t bring with it the reassurance that it will stay.” People subconsciously “flash it around.”  The lack of a peace treaty with the North additionally removes confidence that peace and economic stability will last.

Finally, an important consideration is Korea’s 1600-year tradition of Confucianism. Confucius said, “the outer appearance reflects the state of the inner person”, a statement not meant in a superficial way, but might be translating into society that way today.

korean stars makeup and cosmetic wonder 07
Photo Credit: asiantown.net

All is not lost! Dr. Hilty explains that in the last six months a trend in marketing for various South Korean products has shifted from an emphasis on “well-being,” which “assumes a baseline of health,” to an emphasis on “healing,” which “implies something needs to be fixed.” She suggests that this is a subconscious change in ideology, a realization of pain has occurred, and that the healing process is beginning.

We can’t forget that what Dr. Hilty is describing is a population level and cultural effect of trauma. We know that this explanation does not hold for everyone. Most importantly, we need to recognize the opinion of the South Korean women who do get plastic surgery. It is a modern trend that is not viewed as shameful in Korea, and not necessarily used to look western. Many of the women say they want to enhance themselves because they can.

I hope understanding Korea’s past can help eradicate negative views about Korean women. Korea should be known for its resiliency, and the very many strong women who do characterize the country. Part II will explain the various ways Korean Women have and continue to empower themselves!