When the Gulf War broke out in January 1991, we were in the United States, planning our first annual follow-up visit to Israel after having spent a sabbatical year there (1990-91) working on issues of children in war. We had put on an international symposium under the auspices of the Freud Center of the Hebrew University on the topic of “Children in War,” bringing together mental health professionals, educators, and policymakers from all over the world.
A friend and colleague with a child in third grade in a Newton, Mass., public school told us that the children had many questions about the war and its effect on children in Israel. (Israel and the Territories were being subjected to Scud missile attacks.) Our colleague asked our help in addressing these questions.
At first we intended to collect the children's questions and send them to colleagues in Israel who might bring them to children there. After the first week or so of the war, it became possible to fly to Israel, and we were sufficiently concerned about our Israeli and Palestinian friends and colleagues to go there. We took with us (along with boxes of cake mixes for friends shut in during Scud attacks and various academic books that colleagues needed) the questions from the American third-graders. We soon found our way into an Israeli and a Palestinian school.
Some of the questions: “Could you have a birthday party during a SCUD attack? What would happen if the sirens went off in the middle of your birthday party?” “Has a Scud missile hit your neighborhood?” “How does a gas mask smell when it's on?” “Are you worried about coming home one day and finding your house wrecked?” “Do you worry about something happening to your parents while you are in school?” “Can you sleep?”
The initial set of interviews turned out to be the first in annual visits to several schools. We followed one Israeli group for seven years, one Palestinian group for two years, then a second Palestinian group for five years. After the first visits, we reported back to the third-grade class in Newton about Israeli and Palestinian children's answers to the questions they had sent. In later years we made other efforts to bring to children in America the concerns of Israeli and Palestinian children.
One result of the Gulf War in the United States was a sudden public demand for information on how to talk to children about war. This concern proved ephemeral, quickly subsiding with the formal end of hostilities. We and other colleagues — some of whom had a great deal of first-hand experience working with children who were exposed to violence — decided to organize a working group around issues of children in war and communal violence.
Together with Donald Cohen of the Yale Child Study Center and James Garbarino (then of the Erikson Center in Chicago and now at Cornell University's Family Study Center), we put together the Working Group on Children in War and Communal Violence. This group is now part of the International Association for Child Psychiatry and Allied Professions. We hold twice-yearly meetings in different cities, each day-long meeting devoted to a different aspect of the larger topic. Many analysts participate in this group. Recent topics have included “Talking to Children about the Holocaust,” “Talking to Children about Slavery and its Aftermath,” “Children in the Criminal Justice System,” “Programs Mobilizing Youth to Help Reduce Youth Violence,” and “Refugees and Immigrants: Current Policies and Their Impact on Children and Families.”
The group has served as a place for informal exchange of knowledge and help, contacts for colleagues overseas looking for consultation and advice, for example, on children in Rwanda and the former Yugoslavia. The group has also sponsored several projects, including a large bibliography on children and violence and a recent book, Minefields in Their Hearts: The Mental Health of Children in War and Communal Violence (Yale University Press, 1996), edited by R. Apfel and B. Simon. Currently, the group is compiling information about instruments for assessing trauma of different sorts and for assessing the effectiveness of interventions. Over the next few years, we will focus on the relationship between trauma and moral development.
Our own work with children has consisted primarily of the interview project outlined above, meetings with colleagues and children in the former Yugoslavia and in Jordan, and writing and lecturing on the impact of violence on children, both short-term and long-term. This year we began a seminar for trainees (open to staff) at the Cambridge Hospital on politically engendered violence and its impact. Part of the seminar is devoted to interviews with refugees seeking political asylum in the United States.
Our work in Israel and in the Palestinian Authority has consisted of annual interviews of two groups of children, one on a kibbutz in Israel, and one at a Palestinian private religious school. We have gotten to know the setting in which the children live and some of the adults who are their teachers and caretakers; we have had the opportunity to interview some of the families of the children. We have also visited classrooms, talked with groups of Israeli high school students in school settings, and met with Palestinian children informally in family settings. The interviews have been powerful experiences for us and, we believe, helpful to the children (who are now 14-15 years old). We have had unusual opportunities to watch the development of feelings and attitudes about war, peace, and conflict resolution; the interplay between the political and the personal in the lives of these children; ways in which both trauma and resiliency are transmitted intergenerationally; and the role of schools and teachers in helping children cope with war and violence.
The work is fascinating but taxing. We are often distraught at hearing many of the stories about the Israeli-Palestinian conflict. We are often personally conflicted and confused, immersed in Israeli-Palestinian discussions. Complicating things is that our role in these situations inevitably involves some ambiguity: We are researchers, we are outsiders, we are an audience for subtle and not-so-subtle political pleadings, we are people to whom one school faction can complain about another school faction, we are willy-nilly clinical consultants. We are asked to affirm how good things are, or how bad things are. We have been asked, more implicitly than explicitly, to critique people and help them with their concerns. It is not just that we are not playing a familiar and relatively comfortable psychoanalytic or clinical psychiatric role; at any given moment we are not sure which of several roles we are in, or want to be in. We do spend a fair amount of time discussing these role uncertainties with each other and with our clinical or research colleagues, and our activities often call for our clinical observational skills and our abilities to recognize and buffer (but not generally to interpret) transferences.
There are also real conflicts between pursuing this kind of work and doing clinical work. We have generally taken two to four weeks off each year in February to travel and work in the Middle East, disrupting our schedule of patient work. While patients come to expect this interruption, they (and we) do not always like it. We lose income, and not all patients can tolerate such a break (in addition to a summer vacation). Patients, friends, and family become anxious.
There are also problems in shifting frames of reference. In working with children in war, we hear people dealing with fundamental issues of survival, honor, deep devotion to causes, and chronic anxieties of a sort we ourselves do not live with in our everyday lives. We return to clinical settings where our patients (and our colleagues and ourselves) are concerned about politics on the job, Blue Cross reimbursements, should I marry Jill or Jane, should I take this high-powered job or that high-powered job — and we can find ourselves impatient. We have to remind ourselves that the people we know in situations of chronic violence yearn to have only these latter kinds of problems (which, incidentally, do not disappear under conditions of chronic threat of violence — sometimes they are aggravated).
As analysts, we cannot be interested in childhood or child development without seriously worrying about the fate of children in situations of great distress. We do what we do because it feels right, compelling, and deeply gratifying. We are working within a tradition established by some distinguished analytic forbears. We particularly follow the example of the late Susan van Amerongen, one of our analytic mentors. A Dutch resistance fighter in World War II, she taught us that one goal of analysis is to know the difference between right and wrong, and to know when to try to right what's wrong.
Roberta J. Apfel, M.D., M.P.H., and Bennett Simon, M.D., are both psychiatrists and psychoanalysts. Apfel, whose background is in maternal and child health, is on the faculty of the Boston Psychoanalytic Society and Institute and is a clinical associate professor of psychiatry at Harvard Medical School, Cambridge Hospital. Simon has written on tragic drama as a cultural representation of violence against children and is a training and supervising analyst for the Boston Psychoanalytic Society and Institute. He is also a clinical professor of psychiatry at Harvard Medical School, Cambridge Hospital.