Chapter Seven: Under siege Of the many types of stress, living under daily threat in our homes is one of the most severe. The main reason for this is obvious, when dealing with threats of terror or other trauma, most of it takes place outside our homes. As such we may have fears of traveling by bus or of crowded places but the one secure environment we have is our home. It is our womb of safety. When we are besieged in our homes we open an almost never-ending pressure of tension. There is no longer anywhere we can run to for relief. Even if we have the ability to leave the area for a while, just the idea of returning is enough to set off many reactions. Think about it for a second, how would you be able to fall asleep if you knew that at any time of day or night a siren could go off and you have a minute to take refuge in a secure room in your home? This pursues you in the shower, or even sitting in the bathroom. There is always that thought what happens if… Trying to sleep at night becomes a trial in itself. A parent will fear: "What happens if I don’t hear the siren? If I don’t jump out of bed quickly enough to get the kids into the safe room or shelter?" Naturally the solution is for you to sleep in the shelter at night but this produces a different kind of problem – privacy. Intimacy becomes almost impossible which naturally leads to tension between couples. Children who may vary in age from 3-16 and who were used to having "their own space" will have trouble acclimating to being in the same room watching the same TV shows with their younger sibling or even total strangers. Please note: Before I go any further I must stress that if you or any family members are anxious and fearful, seek professional help. You are not doing yourselves or your loved ones any good by trying "to be strong." There are many online and call in agency's who have excellent experience. The one point to remember similarly to any traumatic event is that you are not living in normal times and are not expected to feel “normal" what ever that is. The first question usually asked is “How do I handle my children's fears especially when I myself feel anxious.” I will try to break it down to practical headings: Media Although this is true for every traumatic event whether a hurricane or a terror attack. It is far more important when we are talking about a long-term difficulty, which effects us directly as in a war or siege. Many of us as I wrote regarding terror attacks become obsessively glued to the television. We feel that the more information we have the more power or control we will have over the event. When we think about it we realize that it isn’t true but many people simple cannot tear themselves away from the media whether radio or TV. Naturally there are times e.g. where there is a siren and we may not hear it that a radio can be of service but that is in a specific situation and even then if we are already in a protected area there is no reason for everyone to hear all of the "experts" which come out of the woodwork. The basic truth is that being addicted to the news raises our tension levels and this in turn will raise those levels of the people around us. I recently (Dec. 2008) found myself in a public shelter during a rocket alert in the south of Israel. Three sirens went off, one every 5 minutes, which meant we were there for about 20 minutes. During that time one mother with her two small children had her radio on and could not be persuaded to shut it or lower the volume. Although the rockets fell quite a distance from us, she began to moan and shake back and forth holding the radio in a tight grip. Her children seeing the distress of their mother began to cry as well. We were able to calm her by talking quietly to her and the children and then called in medics for further help. Her neighbor told me that for the past two weeks she has not left her home not even to the grocery store without her radio, a fact I passed on to the medics. So how much is enough? When it comes to children, I believe that less is better and as I wrote previously this must be monitored by an adult who is there to discuss what they have seen and what it means. Answering questions: How much to tell my children? It is not the child's age alone, which would determine what you discuss, but their personality as well. The key is while telling the truth only give enough information to answer the question which was asked. Believe me if your answer didn’t satisfy them they will follow it up with another question. Will we be hit by a missile? Is a question which has been asked in an untold number of homes. Do NOT promise something which you have no control over. You can say that “The chances or a missile hitting us are very slight but in case it does we will be in the protected shelter and nothing can happen to us when we are there." When we discuss stressful events it should be in a calm matter-of-fact way. Avoid becoming hysterical. Children are like magnets and can sense the level of a parent’s apprehension, which in turn boosts the child’s own level of anxiety. Children are afraid but they may feel like they’re the only ones experiencing theses feelings. When they ask questions the key is to help them understand that such feelings are normal. Routines How can I keep a routine when I have no idea when a siren will go off? You can, with a caveat. "We are going to have a bath, but if a siren goes off, I have your bathrobe right here so that we can put it on right away." Dinner is at the same time more or less every night, but if you have to stop in middle that is perfectly OK. The hardest part is how to keep some form of routine when you are in a protected shelter for a long period of time. Remember children need routines. It makes them feel safe and give order when chaos reigns outside. There is room for some flexibility but as a rule, sleep routines, (bedtime story, talking about their day etc.) should follow the normal daily practice. What do I say if they asked me if I am afraid? Answer honestly “Yes, of course I worry, but I am doing everything possible to keep us all safe." You can be even more specific in what you are doing showing that although there are fears you are being proactive and doing something positive to provide a protective environment. You may even encourage them to join in some activities like writing to soldiers on the front or keeping a blog (if age appropriate). Expressing themselves Although some children may be able to express themselves, most will only benefit from nonverbal expressions of feeling like coloring, playing with toys or figures. Keep in mind that you are not there to be judgmental. There is no such thing as a right or wrong feeling. All feelings are natural and legitimate and many adults (much to the child’s surprise) may feel just like him. Sleep and stress Although sleep disorders and nightmares are one of the significant components of severe stress as well as Post traumatic stress disorder (PTSD) this is not by any means universal. Some people including children actually find relief in sleep and may have no problems at all sleeping through the night especially when they are already in a secure room. In studies carried out during the gulf war (Lavie P, Amit Y, Epstein R, et al: Children’s sleep under the threat of attach by ballistic missiles. J Sleep Res 2:34-37, 1993) “No significant changes in sleep habits or sleep quality were found". According to that study many children even when awakened by an air aid alarm had no problem falling back asleep again once it was over. This being said, when there is a more personal connection with a traumatic event. E.g. if a neighbors house was hit by a missile, the child may exhibit various sleep disturbances including nightmares and difficulty falling asleep. What if he wants to sleep in my bed? This is probably the most asked question when pertaining to night disturbances. In order to understand it, let’s see it for what it is – separation anxiety. The child is, and has a right to be afraid. He wants the reassurance that being in close proximity with a parent or in a parents' bed (even if they are not there) will bring. As to when should I allow it? There is no one answer. A lot depends on the age of the child and their personality. What is appropriate for a six year old, may not be for a 12 year old. While our natural reaction as a parent would be to want to embrace the child and tuck them into our bed, in "normal circumstances” it may be sending a wrong message especially with an older child. It may be signaling that you don't believe that they can feel safe on their own. When it comes to a war or other major traumatic events there is definitely room for flexibility. I know of one parent who after assessing the anxiousness of her three young children announced that for the duration of the war the family would sleep in the secure room on a number of mattresses and called it the family bed. Once the war was over the children had no problem returning to their own routine. One benefit of this was that they never had to wake the children up when an air raid siren went off To surmise; while there is no clear-cut line, we need to be flexible. There are some experts who advise first talking with the child quietly, maybe bring them a favorite toy and see if they will return to sleep. One parent related that when a child would wake up, he would asks him "What would be the greatest dream you can think of" and after a short while he fell back to sleep. Bedwetting Bedwetting is a common reaction to stress. It is embarrassing for the child and often leaves them humiliated - so what to do. First of all remember: Bed-wetting is rarely intentional. Children are usually upset and ashamed when it happens. 1. Do not punish or scold the child. 2. Explain that it is natural and offer encouragement that the bed-wetting will stop with time. 3. Do not let siblings tease the child. 4. Don’t give the child anything to drink after 6 :00 in the evening. The other side of the coin – what to do with elderly parents? Logic tell us that the ages at both extremes will have the hardest time during long term stress. Ela a former Russian immigrant asked “what do I do with my mother. She is 78 has trouble walking and absolutely refuses to leave her apartment to come live with us until this mess is over" Elderly people thrive on order. Those of us who are lucky enough to have elderly parents understand that they need their daily regiment and get frustrated and anxious if you make changes which upset their daily routine. This even applies when we try to move furniture around to make it safer for them not to trip. "What wrong with the way it was? For 25 years it was good enough, it will good for another number of years" The best rule is - if you can convince them, wonderful do your very best, but do not force them. Stress how much you and especially your children would love to have the time with them. Keep in mind that Elderly people are extremely sensitive to losing their independence and see any hint of restriction as an attack. This applies to their daily lives as well. After a stroke most people want to return to their homes if at all and as soon as possible and studies show that the more independent they can be the quicker they will recover. They understand that you mean well but as long as they can, they want to be the one to make the decisions. Give them all the facts, offer to take some of the objects they need with you (" I cant do without my sewing machine") but in the end it is their lives and as long as they are capable of making the decision it is up to them how they want to live it - even if this puts them in some danger. The family factor While any crisis can exacerbate tensions within a family, it can also serve as a building experience. A family can be the core of strength to get through almost any crisis with the least amount of negative residue. So what can we do? Families should be encouraged to share values, ideals and beliefs. Try to foster an optimistic outlook on the future. Efforts should be made to keep the family together whenever possible. Share a commitment to work together to solve problems, encouraging ideas from all ages. Have meals together, spend quality time with you children. A family alone as good as it is - is not enough. Children benefit from a wider range of support including friends and other adults. Sharing experiences, fears and helpful ideas with other families in the same situation can provide a great relief especially to adolescents who are more afraid to discuss their fears but are relieved to hear that everyone is in the "same boat". Finally, don’t forget make use of the professionals which are at your disposal.