Throughout the history of mankind, children have been facing wars. With the growing knowledge of trauma and the prolonged impact of exposure to stress, we now know much more of the psychological, social and developmental costs to both adults and children. The Community Stress Prevention Center (CSPC) was established in 1981, following massive attacks on the northern part of Israel from South Lebanon. The main aims of the center were:
To study the phenomena of civilians (mainly children) living under constant threat to their lives, to develop psychoeducational preventive programs aiming to help teachers to help children before, during and after an incident. To build a library of knowledge and information on these issues. To train educationalists, psychosocial and medical staff, community workers, community leaders and laymen in the field of stress prevention and stress inoculation, and to organize response teams to arrive at the scene and provide consultation support and, sometimes, direct intervention with affected children or adults.1

Childhood is devastated by war. For children who grow up in an environment of continuous or, even, intermittent stress, this colors their existence. They may assume that the world is not a safe place, and that parents - the primary source of children's security - cannot be relied upon for protection at all times, since they leave their children in times of danger (fathers are conscripted), allow separations from them (for example, for evacuation), and let horrific things happen.
The heaviest psychological price paid for war is the trauma of bereavement. Being orphaned, wounded, crippled or having one's house destroyed, cause mental suffering and, in many cases, irreversible mental damage. The concept of "bereft families" includes increasing numbers of children exposed to the traumatic experience of losing loved ones as a result of war or terrorist attacks.
While trauma is a direct injury, the stressful situations of war create indirect injuries. Children are influenced by the moods of their parents and absorb feelings of worry, pain, anger and frustration. Family functioning is disrupted by prolonged absences of fathers and sons serving in the army. When families live near the border, where frequent dangerous incidents occur, they are affected by the constant turmoil and lack of security. The necessity to take refuge in shelters from bombings destroys the daily routine and often disturbs the night's sleep. In emergencies, there is liable to be an evacuation. This means that children are separated from their parents: they are uprooted and taken to a strange place.
The intensity of the experienced stress is determined by additional factors:
• Proximity to the incident, enabling one to see or hear the incident and imposing a strong chance of personal injury.
• Identifying with the injured, because of the same age or sex, or similar
social status.
• Knowing the injured.
• Repeated incidents within a short period of time.
• Living in a border area or near a hostility zone.
Proximity to the place of the incident increases the stress, but geographical distance from the place of the incident does not always provide protection from stress and anxiety, since immediate reports on television and through other media narrow the psychological distance and increase the general feeling of insecurity. Thus, children living in different regions become directly or indirectly involved. This involvement can explain why psychological investigations have not identified any significant difference between the anxiety level of children in the center of the country and that of those living in border settlements (Ziv, Yisraeli & Verbenhaus, 1972).

"Circles of vulnerability," which become removed further from the point of the incident, can be compared to a pool full of frogs where someone throws a stone: the frogs in the middle will react with great fear whereas the others, feeling the shock waves, will develop reactions of anxiety (Ayalon, 1987).
Large groups of children throughout the country, exposed to the shock waves of enemy attacks, are in danger of developing stress reactions that are liable to affect normal functioning and to cause suffering to some of them, as well as to their families.
Once the battles subside, the stress does not completely disappear. Even in times of calm, there are elements of emergency. Living in a situation of "neither peace nor war," imposes a constant emotional burden and exposes both children and adults to messages rich in internal conflict on behavioral, emotional, and moral levels.
These contradictions are liable to bring about conflicts in the morals and values of the society and to challenge the norms of wartime, such as violence and depreciation of the value of human life and property in everyday life. All of these add up to the mental conflict caused by conflicting values (Kubovi, 1980).

Signs of Distress in Children

Under these conditions of threat, children tend to exhibit signs of distress, expressed in behavioral changes at home and with friend", in play, in drawings and in writing. Thus, one can detect signs of insecurity, anxiety, dependence, difficulty in concentration, frustration, anger, and aggression.
Stressful situations create two basic reactions: fight and flight. Flight reactions are accompanied by fear and anxiety and are frequently expressed through behavioral regression. Fight reactions are accompanied by anger, intensified by children's exposure to adults' violent way of settling international and regional conflicts. The functional disturbances arising from these two types of reactions are described below.
What are children frightened of in times of increased security tension, war, and terror? Are their fears different from those related to the normal process of growth and change? Through careful observation of children's signs of distress during tense security situations, six basic characteristics of fear can be identified:
Fear due to circumstances: Fear as a result of threat is called "healthy fear" and is common to both adults and children (Janis, 1975). It has the function of indicating the presence of danger and warns the person to be careful, thus ensuring survival. However, when circumstances interfere with taking the appropriate means of defense or inhibit flight reactions, then physical symptoms of confusion and psychological problems ensue, accompanied by regression in behavioral patterns.
Increased imaginary fears in young children: The fear of war is mixed with many other characteristic fears, and can cause difficulty in distinguishing between real and imaginary dangers. With growth and development, fears of war become more concrete. Even though the confusion caused by alarming incidents disappears once the threat is past, physical and behavioral symptoms can persist for some time.
Fear caused by the behavior of those around the child: Young children experience the world through the significant adults in their life. Overreaction on the part of adults will cause the children in their care to be afraid, whereas an atmosphere of peace and security in times of conflict will calm children. It is, however, difficult to request that parents remain calm in a dangerous situation. Some adults try, "for the child's sake," to pretend all is well, but their denial of fear can make coping all the more difficult. When these adults try to hide or deny their anxiety, they usually require that their children play the part of the hero, thus increasing a feeling of helplessness. Not only do children fail to receive support when they need it, but they are also denied the opportunity of verifying their perception of things - that their parents are worried or annoyed. Instead of being allowed to indulge in their emotions, children are likely to suffer shame or guilt and to feel confused and isolated. An open discussion of feelings and thoughts, combined with expectations of improvement and a better future, may counteract these fears.
Fear of separation from parents: Fear of separation or abandonment is normal during the first years of every child's life. It is heightened by the unavoidable separation from conscripted family members. These fears are intensified in times of war, when children suspect that following the departure of their fathers, they will also lose their maternal support.
Fear of death: Concerns about death preoccupy the child at various developmental stages. However, the issue still remains mysterious and unknown. In times of war, younger children are exposed to the experience of loss of life, without having the means of dealing with the information and the fear aroused by it. Cases of death around them may increase the feeling of their own vulnerability. The loss of loved ones forces many children to confront bereavement and increases their concern for children their age having a similar fate. Preparing children to cope with the subject of death, expressing feelings of distress and mourning, comforting those bereaved, and understanding the reactions of bereavement have become an urgent social-educational issue (Smilansky, 1978). However, frequent exposure to death can cause flattening of emotions, apathy and depreciation of the value of life.
Traumatic fears: In some extreme cases, exposure to life-threatening incidents or loss of loved ones is likely to cause post-traumatic stress disorder, which includes at least three of the following symptoms: remembering details of the disaster as if they were actually happening; phobic avoidance of places or activities arousing memories of the traumatic event; oversensitivity to sounds; nervousness; flattening of emotions; disruption in one's sense of identity; memory impairment or trouble concentrating; sleep disturbance; hyperalertness for repeated disaster; regrets and guilt about surviving when others have not; and suspicion and alienation with regard to society and its institutions. These symptoms are not likely to diminish or disappear without special treatment (Ayalon, 1989).

Long- Term Effects

Long-term mental damage is hard to gauge, since it is not always possible to distinguish between the effects of war and those of the various life events shaping children's personalities. Factors such as denial (conscious or subconscious) and social desirability decrease the hidden mental scars, unnamed and unclassified by conventional psychological measurements.
Studies from the time of World War II attest to long-term disorders in children to the occurrence of agitation and confusion in parents and other "significant adults" looking after them. Nervousness, bed-wetting, and other anxiety reactions that appeared in children after aerial bombings were related to reactions of overanxiety in their parents (Freud & Berlingham, 1942).
Follow-up studies with mentally affected children as a result of the civil war in Northern Ireland indicate that in only a few cases do the symptoms of fear and withdrawal persist and become chronic. In most of these cases, children were found to be oversensitive, to have previously exhibited signs of distress, and to have had some kind of developmental difficulty (Fraser, 1973). Most children with a normal ability to adapt calmed down with the passing of the storm and gradually returned to normal. Thus, the conclusion drawn is that special attention should be devoted to children defined as "high risk" (such as the physically weak or mentally handicapped; children who have suffered desertion, abuse or the loss of a parent; or those who have been uprooted from their homes). Preventive treatment can decrease the time required for rehabilitation.
War and incidents affecting security are particularly traumatic for children who have been directly exposed to death through loss of a parent or sibling, an attack by terrorists, a serious injury, the destruction of their home, or an attack on their settlement. These destructive events are likely to imprint themselves on the child's personality and to affect him or her for many years. Countless testimonies confirm that children suffering from direct injury carry their pain throughout their adult lives like a fire in their souls. The consequences of this pain permeate their lives and are transmitted to the next generation (Nathan, 1981).
The "survivor's syndrome" may appear after years of apparently normal adaptation, as a reaction to stimuli that arouse recollection of the original incident. This syndrome may become apparent in various behavioral, cognitive, and emotional expressions, such as nightmares, unrelenting ideations, fears associated with the place of the incident, expectation of reoccurrence of the incident, suspicion of others, feelings of guilt toward the victims, and various kinds of depression. Even when there are no immediate signs of suffering following a traumatic incident, one should not ignore the need for intervention, support, and rehabilitation among the victims and survivors.
A typical reaction of a society in constant conflict due to the security situation is denial of fear. "Playing the hero" receives widespread social applause. This happens at the cost of suppression and ignoring of emotions counter to this image, and of social disapproval of anyone showing signs of fear. The same expectation is also directed at the bereaved family. The long-term effects of such denial are evident in the decrease of emotional investment in relations, and the tendency to become hardened in order to prevent showing signs of weakness.
Despite the child's great sensitivity during the first developmental stages, most children display invulnerability to surrounding pressures, especially if they receive consistent support and calm from parents. There are additional factors enhancing the invulnerability of the child in emergency situations and in war.
Young children tend to take the environment for granted. They have nothing to compare it with, so they adapt to changes imposed upon them by the threatening environment as if these were everyday changes dictated by their parents. To determine adaptability, a distinction must be drawn between children who are objectively aware of the dangers and those who do not perceive the full extent of the situation, due to their age and personality, and whose feelings depend, to a large extent, on their parents' reactions.

Factors Enhancing Adaptation

Suppression and Denial: The use of these defense mechanisms helps children avoid confronting the stress. Ignoring it, diverting one's attention, or creating the illusion of immunity by saying, "It won't happen to me," are efficient mechanisms for decreasing anxiety whenever there is no possibility of controlling the threat.
Compensation: Staying in the shelter, in the permanent presence of adults, is likely to compensate the anxious child for his or her fears. Perceiving the shelter as a safe place enhances the feeling of security. Children enjoy the permanent presence of an adult (parent or teacher), as well as being together with others. The common worry about security is likely to cause some distortion of specific childhood problems, such as learning difficulties and overdependency.
Support Systems: The component of support in the stress equation plays a most positive role in coping. In border settlements - where there is a high degree of cohesiveness - inhabitants feel more secure, in spite of the security dangers, than do those in settlements where communal cohesiveness is low (Ayalon, 1983). The small and tightly-knit group allows expression of interpersonal distress and gives the individual a kind of "security net," offering a "soft fall" in hard times.
Active Cooperation in the Adult World: Children's reactions to war are not always connected with fear and withdrawal. Children who desire change and adventure often greet these novelties in their life with excitement and curiosity. Many children mature early, assume responsibilities, carry out family and community tasks, and become aware of and interested in political matters. To increase their own coping skills, therefore, children and young people should be directed toward helpful communal activities.

The BASIC Ph Model

We suggest a multimodal model to understand mental resilience in stressful situations. The model was developed through ongoing work with a population living in the shadow of constant threat on their lives. It was developed by observing and interviewing people under stress and it can be seen clearly that every individual has his or her own special combination of coping activities and resources.
In our research of coping mechanisms we found different coping styles. There are those whose preferred type of coping is cognitive-behavioral. The cognitive strategies include information-gathering, problem-solving, self-navigation, internal conversation or lists of activities. A second type will demonstrate an emotional or affective coping mode and will use expressions of emotion: crying, laughter or talking with someone about their experiences; or through non-verbal methods, such as drawing, reading or writing. A third type will opt for a social mode of coping, and receive support from belonging to a group, having a task, taking a role and being part of an organization. A fourth will use imagination to mask the brutal facts by day-dreaming, pleasant thoughts, or divert their attention using guided imagery; or try and imagine additional solutions to the problem that go beyond the fact - improvisation. Type five will rely on belief and values to guide them through times of stress or crises. Not only religious belief is meant here, political stances or feelings of "mission" are also intended, as well as the need for self-fulfillment and strong self-expressions. Ph-type people are those who mainly react and cope by using physical expressions together with body movement. Their methods for coping with stress are relaxation, desensitization, physical exercise and activity. Expending energy is an important component in many modes of coping.
The initials of the BASIC Ph model stand for:
Beliefs, attitudes, meaning;
Affect, verbal and non-verbal;
Social skills, roles and support;
Imagination in creative problem-solving and in the use of attention direction;
Cognition, information and problem-solving;
Ph, action and relaxation.
Our research has shown that it is possible to enhance coping skills. As it is the adults who make war, they should support the children of war.
Over the past 18 years, we have studied the impact of the security situation on children and adults living on Israel's northern border. Starting in 1979, we developed programs to assist teachers and parents help their children to cope with the security problems. The programs are geared to all age groups from kindergarten to adolescence.
These programs were implemented in most educational institutions and a follow-up study revealed a decrease in the level of fear, more openness towards sharing feelings, decrease in physical symptoms of anxiety and an increase in cooperative and coping behavior (Lahad, 1986).
In 1993, following an evacuation of children from northern settlements, in particular Kiryat Shmonah, we conducted a major study on the impact of this evacuation on children and their fears, coping and wishes to leave the region. The results of this study showed that children who were evacuated together with their parents coped better than those who left separately and, furthermore, even those who stayed under bombardment in town showed fewer signs of anxiety than those who left town without their parents, following the return to normal (Shacham, 1996). We were able to advise and work with the formal and non-formal educational systems after the operation and assist in full mental rehabilitation. We also found that the mobilization of coping resources is gradual. The cognitive resource is quite constant, whereas mobilization of the system of beliefs resources grows rapidly when stress escalates. After every incident along the northern border, both large and small, we implemented the principles of the BASIC Ph model, as discussed in this article, with very good results in maintaining the resilience of the children and, whenever necessary, facilitating their recovery.

1 Our organization is a nonprofit charitable organization assisting all the population of the North of Israel, regardless of religion, nationality or race. We are currently serving as advisers to UNICEF psychosocial projects throughout fonner Yugoslavia and training professionals worldwide.


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