News from the Johns Hopkins Department of Psychiatry and Behavioral Sciences
It might be walking by the body of a dead friend on the way to school, day after day, that pushes an Iraqi child into posttraumatic stress disorder. (Fear of hidden bombs keeps officials from picking up bodies.) It could be knowing that terrorists kidnapped your brother and that after months, your parents can’t raise the ransom. Or perhaps it’s the constant atmosphere of fear that grinds at mental health as surely as the grit that now pervades war-torn Iraq.
Last summer, hearing what Iraqi children experience raised the consciousness of Hopkins community psychiatry clinicians involved in an unusual exchange. As part of a U.S.-Iraq program—one sponsored by our federal Substance Abuse and Mental Health Services Administration—Hopkins mentored Iraqi professionals who aim to reverse trauma’s effects. “Thousands of children in that country don’t meet normal developmental milestones because of what they’ve suffered psychologically,” says psychiatrist Anita Everett.
Everett directs the Bayview campus’ Community Psychiatry Program (CPP) and has been part of an international network of clinicians who, since 2005, have offered medical education and assistance in reviving Iraq’s mental health system. Recently, she and colleagues held a Hopkins seminar about their experiences.
For three weeks, an Iraqi psychiatrist, two psychologists and a pediatrician studied community psychiatry in Baltimore and visited “marker” schools—both those where neighborhood violence or family indifference affects many students and those that stand as models of support. “We were the right choice for the visit because CPP has mental health care projects embedded in 14 Baltimore city schools,” says Kim Hauser, the projects’ manager.
Schools were a focal point because Iraq’s efforts to help traumatized children are schools-based. The stigma of mental illness in that country is huge, Hauser and colleague Paige Johnston explained, but parents find no shame in visiting a child’s school.
Traditionally, care for children with anxiety disorders has been the domain of grandmothers or other older women in the close-knit, stigma-wary families. For that and other reasons, “you’ll find no child psychiatrists in Iraq,” says Johnston. Also, medicines are less in use. Ritalin, for example, was banned after Saddam Hussein dosed soldiers with it to get them back to battle.
That’s why, in a country where roughly half of the population is under the age of 18, officials in Iraq’s health and education ministries see childhood trauma as an emergency. They embraced the idea of training teachers to recognize PTSD and to use basic therapeutic techniques. Perversely, many of the teachers suffer anxiety disorders as well. “The whole country is hypervigilant,” the Iraqis told Johnston.
As for lessons learned? Seeing the differences in the Baltimore schools was likely useful. “Our teachers are at a different starting point,” says Everett. “They’ve been educated to flag children at risk. Also, help for students here has two layers—the school counselors oriented toward learning-disabilities and CPP’s added-on layer that helps kids who need treatment. In Iraq, teachers must do a little of both.
“It’s hard to sort them out,” Everett adds. “The kids who can’t focus, who’re distracted—do they have underlying ADHD or are they just reacting to trauma?”
Mentoring the team, however, wasn’t all one-way. “The Iraqis did find negatives here,” Hauser says, “specifically the lack of family involvement. They were appalled at one visit to a group home. Where was the family?” Both sides came to realize the common points of childhood trauma—whether it comes from war and dictators or from addicted parents and neighborhood violence—and that effective ways of treating it know no borders.