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Listening to children's voices: literature and the arts as means of responding to the effects of war, terrorism, and disaster.

Since the United Nations set up its office of the High Commissioner for Refugees (UNHCR) in 11951, the number of refugees has escalated from one million (Wilkes, 1994) to almost 33 million (UNHCR, 2008). Since the Holocaust, in which six million Jews, as well as millions of Roma, homosexuals, and others were killed, close to five million more people have been victims of genocide; many of those victims have been children (Springer, 2006). During World War I, 20% of the casualties were civilians; in World War II, 50% were civilians; now, 90% of wartime casualties are civilians (Ellis, 2004b; Warren, 2004)--again, many of the victims are children. Children also have been the direct targets in genocidal wars (Pearn, 2003). Millions more children endure and witness atrocities. In the last decade, some 10 million children have been traumatized by war and civil unrest (Hamilton & Moore, 2004). There are 70 million landmines worldwide; close to 40% of those detonated maim or kill children (Mankell, 2003). In sub-Saharan Africa alone, 11.5 million children are orphans because of AIDS; by 2010, that number is expected to almost double (Ellis, 2005).

Clearly, more and more children are forced to deal with crushing hardships. The responsibilities of adults worldwide to attend to the affected children have never been greater. In this article, we first give an overview of the psychological risks for children who experience war, terrorism, and disaster. We then listen to the voices of children through their literature.

Psychological Risks

The impact of genocidal war, armed conflict, and civil strife is measured not only by physical damage, but also by persistent emotional trauma. While physical injury resulting from armed conflict is not to be minimized, children are even more devastatingly affected by the emotional trials of attack and injury, and by the disappearance of their parents, friends, and loved ones. The helplessness of neither knowing whether their family is alive nor having a body to bury fosters an irreconcilable despair in children, as do their subsequent attempts to flee to safety. Thus, children suffer not only from the impact of violence but also from the loss of a secure and predictable environment (Yule, 2000).

Unable to provide for their own safety, children depend heavily upon adults to ensure their survival. Under pervasively threatening conditions, children become emotionally vulnerable (Veenema & Schroeder-Bruce, 2002). When family and community structures break down, children often struggle to re-establish a sense of order. They become prey to the manipulation of authority figures who offer the appearance of rescue and security. This vulnerability, paired with poverty and lost community resources, makes these children more likely targets for recruitment as child soldiers (Uppard, 2003).

The emotional response to violence trauma does not end with the armed conflict, but rather continues through the often prolonged relocation process. Adjustments to accompanying stressors must be addressed at various stages, such as "(1) while in their country of origin; (2) during the flight to safety; and (3) when having to settle in a country of refuge" (Fazel & Stein, 2002, p. 366). This journey from direct target of violence to passage through the gauntlet of asylum-seeking protocol has been shown to leave its mark on children. Traumatic experiences consistently and frequently result in mental health disorders (Barenbaum, Ruchkin, & Schwab-Stone, 2004), including posttraumatic stress disorder (Berman, 2001; Kinzie, Cheng, Tsai, & Riley, 2006; Morgos, Worden, & Gupta, 2007-2008), depression (Thabet, Abed, & Vostanis, 2004), somatization responses (Hinton, Chhean, Fama, Pollack, & McNally, 2007; Mollica, Poole, Son, Murray, & Tor, 1997), anxiety disorders (Al-Jawadi & Abdul-Rhman, 2007), and behavioral acting-out, as well as other internalizing behaviors, such as elective mutism. Behaviors associated with these disorders have been observed many years after "successful" relocation has been completed and prevailing violence has ceased to be a threat (Cohen, Dekel, Solomon, & Lavie, 2003; Durst, 2003; Kaplow, Saxe, Putnam, Pynoos, & Lieberman, 2006; Schaal & Elbert, 2006). Accompanying this apparent emotional and behavioral dysfunction are neurobiological changes that endure for many years after the physical threat has subsided (Bevans, Carbone, & Overstreet, 2005; Tucker et al., 2007).

Intervention Strategies

Both the immediate and the long-term effects of traumatic experiences have been well-documented. What remains unclear, however, is what constitutes effective interventions for reducing their impact, emotionally and cognitively (Onyut et al., 2005). Simply attempting to gloss over problems that have threatened children's very existence, and attempting to impose more adaptive behaviors, is similar to painting over rust. Despite the shiny covering of what appears to be a fresh coat of abilities, the underlying abrasion of emotional injury will ultimately break through.

Developmental factors that influence the child's response to stress (Allen, Heston, Durbin, & Pruitt, 1998; Spates, Samaraweera, Plaisier, Souza, & Otsui, 2007) must be considered in approaching treatment (Brown, Pearlman, & Goodman, 2004). Coping strategies and an ability to respond to adverse circumstances are a function of cognitive and emotional maturation. Strategies used to treat emotional trauma in adults often include psychodynamic, cognitive, and cognitive behavioral approaches. These approaches rely heavily upon the adults' abilities to identify their feelings and verbally express the contingencies between events that have occurred and the feelings that they elicit. They further rely upon the ability to cope with the re-presentation of traumatizing events. The differences in adult and child strategies largely lie in the child's inability to symbolize, recount, and process the experiences; thus, applying strategies that have been effective with adults to children is both inappropriate and ineffective (Angel, Hjern, & Ingleby, 2001).

Limited success for treatment of traumatic disorders has been reported with the use of eye movement desensitization and reprocessing (EMDR), cognitive behavior therapy (CBT), psychotherapy, desensitization training, testimonial therapy, and narrative exposure therapy (Ehntholt & Yule, 2006). These techniques rely upon the victims reporting flashbacks, nightmares, and any associations or intrusions of stimuli they encounter in their daily experiences that are associated with a prior troubling insult--and thus relies upon confrontation with the events eliciting the emotionally traumatic response. Often, reliving the traumatizing episodes is met with avoidance and often re-traumatizes the child, making access to emotionally provocative experiences more difficult and resistant to treatment.

This was demonstrated by Goldie in 1999 with her effective use of nonverbal play therapy, whereby verbal interpretation of the child's trauma further exacerbated symptoms with physical acting out. Simon, the subject of Goldie's study, was a deeply troubled and sometimes violent 6-year-old boy who, along with his family, had experienced missile attacks and the threat of poison gas (Goldie, 1999). Through interviews with his parents, the author provides an anecdotal account describing the family donning gas masks. Simon was too small for a mask and therefore was placed in a protective chamber, which Simon later called a "cage." Initial contacts in psychodynamic-based therapy involved toy play and direct verbal interaction by the therapist. Simon responded to verbal confrontation regarding his trauma experience by attacking the therapist and using toys in an aggressive manner, often breaking them. Initial efforts to elicit the sources of Simon's extreme emotional and behavioral responses through verbal channels were apparently too threatening. They resulted in Simon's retreat as well as greater submersion of the pervasive emotional threats that, to the victim, seemed irresolvable. Reviewing the relationship between current psychological problems and war stress of 99 Bosnian refugee children of school age, Angel et al. (2001) concluded that talking about their experiences only exacerbated their emotional problems. Nonverbal approaches, however, may allow individuals to maintain an affective distance from their trauma until they are psychologically able to make the connection.

Returning a sense of control to the victim appears to facilitate a "willingness" to address prior traumatizing experiences. It is important to remember that the adult treatment provider represents authority to children. In the child's limited life experiences, authority is identified as a threat to his safety and is to be feared. Fostering empowerment, vital to the child's self-esteem, can be accomplished through activities in which self-direction is a key component. Harris (2007) found that dance and movement represented a "culture of origin" ritual that had restorative capacities for adolescent torture victims from Somalia and Sierra Leone. After involvement in a dance and movement therapy program, former child combatants reported a reduction in symptoms of anxiety, depression, hyperarousal, intrusive recollections, and aggression. The activity also restored community reintegration and social support, often lost during war and civil strife.

Additional modalities, such as art and music, have allowed individuals to represent their conflicts and reduce their stresses when verbal expression was not available to them for a variety of reasons. These methods have been successful with younger children, who often do not have sufficient vocabulary to verbalize their feelings (Thong, 2007). According to Lev-Wiesel and Liraz (2007),

Trauma survivors find it hard to find words to describe the traumatic event itself and the emotions that accompany the event. Looking at one's own drawings might enable the drawer to become a spectator to his or her negative experiences. This might facilitate the later verbalization of their experience. (p. 72)

This approach has been effective in treating bereaved children and those who have experienced incest and torture (Krakow & Zadra, 2006).

Victims of warfare and refugees represent different cultures, socioeconomic groups, and experiences. Thus, one form of treatment does not meet the needs of all trauma victims. In many cases, trauma-focused therapy itself may not be effective (Kinzie et al., 2006). In addition, the early egocentricity of children, which leads them to believe that they are the cause of their tortuous experiences, must be addressed. Additional means of effective catharsis must be sought to free the young victims from their experience of an enveloping and heretofore hostile world. Providing a means of making contact with others having similar experiences may reduce their isolation and once again make them feel connected to the nurturing contributions of humanity. The broad-based approach of shared literature and the arts may facilitate such efforts.

The Arts and Literature

The arts, which do not rely entirely on verbal communication, have been effective in addressing children's emotional needs (Hamilton & Moore, 2004). Due to their dynamic and complex nature, literature and the arts offer multiple venues for children to express and cope with traumatic experiences. Children in distress throughout the world have found solace through aesthetic experiences, which open possibilities for them to make sense of their lives and recapture lost hope. Hamilton and Moore (2004) write that the arts "in the framework of the child's cultural heritage are expressive therapeutic tools for traumatized children, and help to integrate the past, present, and future in a way that restores a sense of identity, meaning, continuity, and belonging" (p. 33). Children's and young adult literature show how writing, storytelling, theater, radio, poetry, music, the visual arts, and reading can be helpful. Film and video are mentioned less, perhaps because the technology to carry out such creative projects is not available in many parts of the world. In the following sections, we offer examples of how children express and cope with their traumatic experience through different forms of arts and literature.

Writing. For some children, the process of writing in journals and diaries helps them deal with their trauma by facilitating exploration of a range of emotions, which can eventually give purpose to their lives. During the Bosnian genocide, in which 300,000 Bosnians were killed, Zlata Filipovic kept a journal about the hardships of living in Sarajevo, subsequently published in 1994 as Zlata's Diary: A Child's Life in Sarajevo. She recorded her daily joys and sorrows, and found in her diary a safe haven from the relentless assaults of the outside world. As an adult, Filipovic (2006) wrote Stolen Voices, co-authored by Melanie Challenger. Thebookis a selection of young people's writings in times of war, from World War I to the current war in Iraq. Filipovic, having experienced war and witnessed genocide herself as a child, demonstrates her acute sensitivity to children now in need, as she once was herself. She describes what writing meant to her and others:

[W]riting arises as a countermeasure. On scraps of paper in the dimness of cells, on old exercise books in candlelit cellars, in notebooks on a battle field, young men and women gaze inwardly to observe the effects of their horrific circumstances upon their personalities and outwardly to record the transformations of the world around them under the burden of wartime. (Introduction, p. xix)

Filipovic describes how reading children's and young adults' poetry from Terezin, a Nazi concentration camp, affected her 50 years later in Bosnia. She writes,

These poems stand as testament to the extraordinary value of writing as an instrument for human expression in the most prohibitive and dire of circumstances. By the defiance of their writing, the voices of those young individuals survived long after the Nazis sent the authors to an early and anonymous grave. (Introduction, p. xix)

Like Filipovic, Halilbegovich (2006) kept a diary during the same time period in Sarajevo. She has revisited her childhood diary and, in a unique format, responds as an adult to her childhood entries in My Childhood Under Fire: A Sarajevo Diary. In the introduction, she tells of the shocking events that transpired on April 6, 1992, which set off a war and genocide in her beloved homeland. Forced to live in basements with about 300 other tenants to avoid bombs, Halilbegovich began to keep a diary: "It was my only place of peace amidst the chaos," she writes (p. 9).

Filipovic and Halilbegovich finding solace in writing is not unusual. Marx, in One Boy From Kosovo (2000), records day-to-day living as seen through the eyes of a 12-year-old, Edi, in the Macedonian refugee camp of Brazda, set up for Kosovars. "Boredom was one of the worst problems at Brazda," writes Marx, "and people fought it in different ways" (p. 20). A photograph shows Edi and his siblings writing in their journals, which Marx reports was a daily event.

Thura Al-Windawi (2004), in Thura's Diary: My Life in Wartime Iraq, gives a firsthand account of the early months of the Iraq invasion in 2003. While the diary conveys relief at Saddam Hussein's downfall, it is clear that Al-Windawi observed consequences of war that were as disturbing as circumstances of the previous regime.

Oral Storytelling. For some children, the spoken word is more accessible than the act of writing, so they either tell their stories themselves, or entrust their stories orally to receptive adults. Jeanne Umubyeyi, who was 9 years old at the time of the Rwandan genocide, and whose entire family was killed, told her story to her adoptive German mother, Hanna Jansen (2002). The title, Over a Thousand Hills I Walk With You, intimates the poetic writing one encounters in this fine book. Jeanne's memories of her wonderful life before the genocide frame the opening third of the text, highlighting the positive aspects of her childhood prior to April 6, 1994. Nothing in her small-village life prepared her for the days following. It may surprise some readers that Jeanne, unlike some Rwandan survivors, had no inkling of the catastrophe that awaited in which 800,000 Rwandans were killed in 100 days--the fastest, most ruthlessly efficient genocide in human history. In closing, Jansen writes, "The book is not an end.... You can ramble through its pages or leap, zigzagging, back and forth. Even a bit forward, to pages that aren't written yet! And you can linger where you want to" (p. 330). Then, reassuringly, "And if ever the horror catches up with you again, then you know that I am very close by" (p. 331). In an interview with Hazel Rochman (2006), Jansen reports that Jeanne, having shared her story multiple times in its entirety with Jansen, "could feel like a complete person again" (p. 42). It was in the telling and retelling to an adult who listened that Jeanne became able to regain some sense of normalcy.

Like Jeanne, other children can benefit from the telling of their own personal stories--in their own time and in their own way. They also can benefit from hearing stories told, as did Zoya, a child in Afghanistan during the Soviet occupation, the feudal wars, and the Taliban takeover (Zoya, Follain, & Cristofari, 2002). Zoya stayed underground for long periods, paralleling the experience of many children during bombings. During those excruciating times, Zoya drew or read when there was enough light. When there was no light, Zoya's grandmother told her stories or, if the radio was working, they listened to music and the news. Zoya agreed to tell her story to Follain and Cristofari only "as a memorial for the suffering of all Afghan women" (p. 234). Her experiences in Afghanistan propelled her as she grew older to become a member of Revolutionary Association of the Women of Afghanistan (RAWA). She writes,

When I see the ... pain and sorrow that my country suffers, I feel that what we are doing is smaller, much smaller, than a drop of water. But I must continue my work because I believe in it. I believe that it does make a difference. (p. 204) As an adult, Zoya sees her own hardships in connection with a larger community of fellow sufferers. Sharing their stories becomes a way to find meaning.

Theater, Radio, and Poetry. During Ellis's travels in Malawi and Zambia, she met children who performed in plays, both live and in radio broadcasts, as ways of educating people about AIDS. Ellis wrote a nonfiction book, Our Stories, Our Songs: African Children Talk About AIDS (2005), in which children tell their own stories, as well as a novel The Heaven Shop (2004). Binti, the protagonist of The Heaven Shop, is based on children Ellis met. Binti loses both parents to AIDS, then loses her cherished radio job because she must move away to relatives' homes. There, she is treated harshly. She runs away and finds her kind grandmother (Gogo), but also takes on more responsibilities to help with all the orphans her Gogo has adopted.

Youme's (2004) Selavi: A Haitian Story of Hope also shows the powerful role of a radio station (provided in this instance by the influential Haitian politician Jean-Bertrand Aristide) as a way to give children a voice. Halilbegovich (2006) cherished radio, the only source of information during the bombings in Sarajevo. "But there were no children's voices," she writes. So she phoned the station and offered to read her poetry, which, surprisingly, the announcer subsequently replayed through the day. And a children's publication of Mama, I Don't Want To Go to the Basement offered Halilbegovich opportunities for writing poetry, which pushed her to keep writing.

Music. Michelle Lord's (2008) A Song for Cambodia is a picture book based on the true story of Arn ChornPond, who was separated from his family by the Khmer Rouge. He was never to see his family again after the Cambodian genocide in the late 1970s, during which one-quarter of the Cambodian population was killed. Throughout his long ordeal the music of a khim soothed and nurtured him. Lord writes,

The gentle sound of the khim was heaven to Am. When he practiced he thought of a world far from the pain and suffering of the work camp. Songs filled Arn's empty stomach and soothed his broken heart. Hidden feelings flowed through him as the mallets struck various tones on the khim. (n.p.)

Arn was eventually adopted by an American; as an adult, he returned to Cambodia to collect Cambodian songs. "When Arn was a young boy, music saved his life," Lord writes. "Now it is Arn's mission to save the music" (n.p.).

In Our Stories, Our Songs: African Children Talk About AIDS (Ellis, 2005), young people speak of music. Seventeen-year-old Oscar tells Ellis,

Singing makes me feel better, especially church songs. I'm in the choir at school. People tell me I have a good voice, and I think they are right, although I don't think I'll be able to do it for money. What I would like to do for money is be a bus driver so I could go to other places. (p. 14)

And 13-year-old Loni tells her, "I am happiest when I sing. Singing makes me feel like I can do anything" (p. 18). It is as if music allows some children to "go to other places"--a better universe, if only for a brief time, than the one they usually inhabit.

Visual Arts. Numerous books and websites collect the artwork of traumatized children, such as The Iraqi Children's Art Exchange (2008). In Witness to Genocide: The Children of Rwanda: Drawings by Child Survivors of the Rwandan Genocide, Salem (2000) explains that "traumatized children who had been unable to talk about their experiences ... could draw the pictures that kept them awake at night" (p. 6). Most of the visual art in this book is accompanied by captions, showing that the children are working to make meaning through two symbol systems--one written and one visual. One young person even moves into a third symbol system: A child is depicted speaking to a group of friends, "Let's dance so we don't become traumatized" (p. 32). The mission of one group, the Silent Work Foundation, is to provide "trauma aid through singing, dancing, drama and music. But especially through writing and drawing" (Oosterom, 2004, p. 94); examples of children's work are in Oosterom's Stars of Rwanda: Children Write and Draw About Their Experiences During the Genocide of 1994.

Visual art in picture books for children offers compassion and understanding to children who have undergone experiences never faced by many adults. Williams (2005), author of Brothers in Hope: The Story of the Lost Boys of Sudan, tells the story of victims of the world's longest running civil war. Because of their role in the family, boys were often out in the fields tending livestock when marauders attacked their villages, killing their families. Thousands of orphan boys made their way to refugee camps. Older boys recognized that younger boys needed stand-in parents, and so they created small groups, purposefully pairing an older boy with a younger boy. R. Gregory Christie's brilliant expressionistic paintings convey the tragedy and the dignity with which children faced the unendurable.

Other books that capture children's war experience through color, shape, line, and form are Argueta's (2003) Xochitl and the Flowers/Xochitl, la nina de las flores, about a family from war-torn El Salvador that finds beauty in growing flowers, only to confront a zoning problem. Similarly, there is Zhang's (2004) Red Land, Yellow River: A Story From the Cultural Revolution, a magnificently illustrated book based on the author's experience growing up during Mao's Cultural Revolution in China. The Colour of Home, by Hoffman (2002), tells the story of a Somalian boy now living in the United Kingdom who paints colorful memories of his Somalian home, then adds dark streaks to represent the death of his uncle and other violent acts he witnessed. Later, caring adults use the picture to help him tell his story verbally, which helps him realize a brighter future. Aliki's (1998) Marianthe's Story One: Painted Words, based on Aliki's own story as an immigrant from Greece, shows how Mari does not cry when another child calls her "dummy," but instead paints a broken heart. Her teacher uses the painting for a class discussion. Gunning's (2004) A Shelter in Our Car portrays a homeless, widowed Jamaican mother and her daughter living in their car. The story shows that the United States, for all its wealth, is also a place where children fight to survive; the theme is also movingly expressed in Pedlar's paintings.

One Boy From Kosovo (Marx, 2000) features children's art, and the stories they tell with it. The Iraqi Children's Art Exchange (2008) takes such activities online, with the mission to create "important learning opportunities, foster communication, and promote peace and nonviolence."

Textile art (embroidery, knitting, rug-making) is another venue for children's expression and reshaping of their experiences. Textile art is found in Khans (1998) The Roses in My Carpets and Cha's (1996) Dia' s Story Cloth: The Hmong People's Journey of Freedom. Halilbegovich (2006) reports having enjoyed knitting, sewing, and making stuffed toys, and even organizing an exhibition. Such activities provide relief and comfort in the face of unbearably harsh realities.

While this article focuses on children traumatized by events beyond their control, it is also worth mentioning how arts approaches can be effective with their more fortunate counterparts. Reilly and Cohen (2008) discuss their work with affluent 8th-graders in the United States, using Wilkes's (1994) One Day We Had To Run/ Refugee Children Tell Their Stories in Words and Painting as a starting point to explore genocide. After Cohen's dramatic reading of one child's story, accompanied by music, students engage in nonverbal Art Conversations by finger painting in pairs for an extended period of time. Then, the instructors modeled creating poems, based on their paintings, with powerful results. Such an approach raises awareness and evokes empathy in children who have not experienced war, terrorism, or disaster. While there is a danger of acquainting children with the terrors of the world too soon, there is also the danger of isolating non-affected children too much from the world in which they live. "If children are tough enough to be bombed and starved," writes Ellis, "then they are also tough enough to read about it" (2006, p. A18).

Selecting Children's and Young Adult Literature

When considering children's literature as a vehicle for healing, it is important to note that children need two kinds of books--"window" books, in which they see into worlds beyond their own, and "mirror" books, which reflect their lives and themselves (Bishop, 1990). Children who have experienced war, terrorism, and disaster need books that reflect their terrible experiences; trusted adults can give brief "book talks," then allow children to select books that interest them. Having access to such books helps children know the world has not forgotten them, and may help decrease their feelings of isolation by providing a bond with others when they learn of those who have experienced similar circumstances. (See Gangi, "Annotated Bibliography of Children's Literature on War, Terrorism, and Disaster," in this issue.) Window books are equally important, for those are the books that may help them envision a different future.

Conclusion

Many children of war, terrorism, and disaster have been betrayed by the very adults they trusted to protect them. Therefore, they may not be receptive to adults' guidance. However, sympathetic adults can, through the arts and literature, provide choices for children, thus inviting self-direction, which can be empowering. Offering choices in symbol systems--music, drama, visual art, textile art, poetry, writing, literature, oral storytelling, radio, and, if available, film and video--is a nonintrusive way to invite children to come to terms with their past and move forward. When Ellis interviewed Israeli and Palestinian children in Three Wishes: Palestinian and Israeli Children Speak (2004b), Mai, an Israeli, told her, "Through art, we can all understand the world and each other better" (p. 104). An area for research is to expand our knowledge of how the arts and literature can help children of trauma. Guidelines for using different art forms are available in Gangi (2004), Grant (1994), Hamilton and Moore (2004), Harris (2007), Oosterom (2004), Reilly (2008), and Reilly and Cohen (2008).

Of the children of Rwanda, including 300,000 orphans, Ambassador Richard Sezibera says, "The world looked on in impotent horror as carnage was wreaked on their young minds and bodies. It should not look on as they struggle through the process of healing" (cited in Salem, 2000, p. 27)--an appeal appropriate for children in distress everywhere.

The authors thank Peter Gangi, Mary Ellen Levin, and Mary Ann Reilly for their helpful comments and editing.

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Jane M. Gangi and Ellis Barowsky

Jane M. Gangi is Chair, Department of Literacy, and Ellis Barowsky is Chair, Department of Special Education, Manhattanville College, Purchase, New York.
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Author:Gangi, Jane M.; Barowsky, Ellis
Publication:Childhood Education
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Geographic Code:1USA
Date:Aug 15, 2009
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