Recognizing trauma and isolation

Starting Early: Recognition
Recognizing trauma and isolation

Nelba Márquez-Greene’s family experienced a high-profile trauma when her daughter, Ana, was killed at Sandy Hook Elementary School. But before that, she understood trauma as a mental health professional. She says we need to do a better job of recognizing and responding when children need help.
The last article in a four-part series.


by Arielle Levin Becker

Nelba Márquez-Greene, second from the right, stresses the importance of strong relationships in healing from trauma. Her daughter, Ana (right), was killed at Sandy Hook Elementary School in December 2012. (Courtesy of the Márquez-Greene family.)

“We’re looking for people to understand, when they see a kid, rather than asking, ‘What’s wrong with them?’ we want them to know to ask, ‘What’s happened to them?’”
—Alice Forrester, executive director of the Clifford Beers Clinic

The first thing Isaiah Márquez-Greene said when he learned his sister, Ana Grace, had been killed was, “I don’t want to be an only child.”

The second was, “Who’s going to return her library books?”

And then his body shut down. He shivered. His parents couldn’t make him warm enough. They put him in a coat and hat and under lots of blankets. His body went into shock.

About once a month after that, it happened again. Even when it was 95 degrees out, he would look at his parents and declare that he was cold.

Nelba Márquez-Greene, Isaiah and Ana’s mother, told the story at a conference last summer, one of many places she’s been asked to speak since her daughter was killed in her first-grade classroom at Sandy Hook Elementary School.

She told the story in part because, before her family experienced a trauma that drew worldwide attention, Márquez-Greene understood trauma as a professional, a licensed marriage and family therapist who’d worked with children and families across Connecticut.

She pointed out that if she and her husband, Jimmy Greene, didn’t understand the trauma that had caused Isaiah’s body to freeze even in the summer, they’d probably tell him, “How could you be cold? It’s 95 degrees outside.”

And that was the point of telling the story: She and Jimmy understood why their son reacted the way he did because they understood it was a response to trauma. They made sure they could be available to him, even through their own grief, and that he had the support of a strong network of family and friends.

“We have thousands of kids in our state that are constantly retriggered based on an experience that we don’t even know about.”
— Nelba Márquez-Greene
Professional marriage and family therapist and mother of Ana Grace Márquez-Greene, a Sandy Hook victim

But what, she said, about all the other children who’ve faced trauma that no one knows about, whose reactions are treated as strange or bad behavior, not symptoms that require love and care and sometimes treatment? What happens when they get told to sit down and be quiet, or to stop bothering the teacher, when no one reads their actions as the result of hurt?

“We have thousands of kids in our state that are constantly retriggered based on an experience that we don’t even know about,” she said.

“Not all of our kids have stories that make the news. But all of our kids have a story.”

And for many children, that story involves trauma.

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Data on trauma prevalence varies, in part because definitions vary. The clinical definition refers to exposure to an event that carried a threat of death or serious injury. But many people speak more broadly, about adverse experiences or chronic forms of severe stress, situations that can produce feelings of terror and helplessness and overwhelm a person’s ability to cope.

In one national survey that included a relatively wide range of experiences, researchers found that 60 percent of children under 17 had been victimized or witnessed violence in the previous year. Other research has found similarly high levels of exposure to potentially traumatic experiences.

Resources: Find help

If you or someone you know needs help, there are resources that can help. We’ve compiled a list of services that can provide information and assistance on topics including finding mental health care, help coping with trauma and answers to questions on a child’s behavior or development.

How to talk about trauma »

Not all children who go through a potentially traumatic event will develop symptoms.

“On the one hand, we have all these kids out there that have been victims of trauma, some of whom adjust and adapt fairly well, and they don’t need treatment,” said Jason Lang, a psychologist with an expertise in trauma who works at the Child Health and Development Institute of Connecticut. “But there’s a relatively large subset, especially those that are chronically exposed, that kind of avoid talking about it or mentioning it unless they’re asked directly.”

Sometimes, children go through multiple unsuccessful treatments for other problems – like acting out, school troubles or aggressive behavior – before it becomes clear there’s an underlying cause, like physical or sexual abuse, mental health providers say.

And sometimes, they end up in other systems. More than 80 percent of youth in Connecticut’s juvenile justice system report having a history of trauma.

“I think we’ve done a pretty good job of making sure that our juvenile justice system is trauma-informed,” said Abby Anderson, executive director of the Connecticut Juvenile Justice Alliance. “But we’re really trying to push, what do we do to catch those cases before they come into the juvenile justice system?”

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A coalition in New Haven is trying to do that, training teachers to recognize the signs of trauma and potential triggers, and trying to make students feel comfortable speaking up about scary experiences. At a handful of schools, they’re providing trauma treatment on site.

It might not be possible to prevent a child from experiencing trauma, noted Monica Daniels, project coordinator for the New Haven Trauma Coalition, the group behind the effort. But she said there’s a chance to prevent some of the consequences of unaddressed trauma, like poor school performance, acting up, getting identified as a troublemaker or worse.

The coalition includes the city, New Haven Public Schools, the Clifford Beers Clinic and United Way. It’s funded by the state Department of Children and Families.

“His anger or bullyish behaviors or dysregulated behaviors were understood from a whole different perspective.”
— Alice Forrester
Clifford Beers’ executive director, on what happened after telling a teacher a student had been sexually abused

“We’re looking for people to understand, when they see a kid, rather than asking, ‘What’s wrong with them?’ we want them to know to ask, ‘What’s happened to them?’” said Alice Forrester, Clifford Beers’ executive director.

As a clinician, she occasionally spoke to a client’s teacher – with the parent’s permission – to let them know he had been sexually abused

“His anger or bullyish behaviors or dysregulated behaviors were understood from a whole different perspective,” Forrester said.

The idea isn’t to excuse bad behavior, Forrester and others who advocate this type of approach say. Instead, they say it’s about trying to understand if there’s something underlying a child’s actions and, if so, to respond more effectively, to help him heal and change his behavior.

“I think we do that normally,” Anderson said. “If you have a kid who fails a test, you don’t just say, ‘Well, you’re stupid.’ You say, ‘What didn’t you understand? Maybe you have a learning disability, or we need to go through this one more time.’ I think it’s just another tool if our overall goal is to have as many kids as possible be successful.”

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Márquez-Greene does a lot of public speaking about trauma. She wants people to know that it can happen to anybody, that it doesn’t have to define people. She wants people to understand the importance of relationships in healing from trauma and building resilience — and in potentially preventing violence. She worries about the alternative, isolation.

It’s something she knows as a mental health professional and from her own experience. She knows children who have been through horrible things but will be alright because they have a rich network of support. Long before the Dec. 14, 2012, shooting, her family had a big group of family and friends, some of whom would gather for the dinners they’d hold at their home.

“I think we live in the smallest house in Newtown, so we didn’t have some of those [material] things, but you know what we had? An amazing relational network.”
— Nelba Márquez-Greene
On what sustained her family after her daughter’s death

“When I think about 12/14, and I think about what has sustained us, it’s really been an awareness of what’s important, and a large extended relational network,” she said.

“I think we live in the smallest house in Newtown, so we didn’t have some of those [material] things, but you know what we had? An amazing relational network,” she said. “We had already been a family that privileged spending time together.”

She sees a dramatic contrast between her daughter’s life and that of Adam Lanza, the 20-year-old who killed Ana, 25 other children and educators, his mother and himself.

“He lived in material wealth, but relational poverty,” Márquez-Greene said.

Some people have chosen to avoid saying Lanza’s name. Márquez-Greene hasn’t.

“If we want to fix anything in our society,” she said, “We also have to include those that committed the tragedy.”

Lanza had a cell phone but never took a call on it, she noted, citing a finding from one of the investigations. Although they lived together, he only communicated with his mother by email. By the end of his life, Márquez-Greene said, it seemed that there was no one available in a significant way to figure out what was going on for him.

To understand the importance of relationships and the dangers of isolation, think about what you do when something scary happens.

“If you just about had a car accident, you probably call somebody and say, ‘Oh my God, you can’t believe what just happened to me,’” said Patricia Wilcox, a colleague of Márquez-Greene’s who leads the Traumatic Stress Institute at Klingberg Family Centers in New Britain. You might think about a loved one who gave you advice or helped you cope in the past.

How to talk about trauma

Studies indicate that most children will be exposed to at least one potentially traumatic event by the time they’re 18. Many of them won’t develop symptoms or require treatment. But many who need help don’t get it, experts say. Here are some things to know about trauma and how to address it.

How to talk about trauma »

“If you haven’t had people that cared about you that much, and people that you know have just run away or disappeared, you don’t have those good feelings in your mind to help you with difficult times,” Wilcox said. “When difficult times happen, you feel so lost and alone.”

The program Marquez-Greene and her husband started in their daughter’s name, The Ana Grace Project, is aimed at strengthening connections and relationships, things they believe can help prevent isolation and violence, and help people heal. One of their efforts is to develop a curriculum that classrooms can use to help students learn self-regulation skills and empathy.

Márquez-Greene wants it to be something that could have helped “both an Ana and an Adam.”

“People like to talk about how sad it is that Ana died,” she said. “I spend a lot of time thinking about what we could’ve done to make Adam’s life more comfortable.”

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Márquez-Greene worries about the disparity in the way children with symptoms of trauma are viewed. In urban settings, she said, they’re often treated punitively.

‘The Big Book of Granny’ was something Adam Lanza and a classmate made in elementary school. It depicts a grandmother with a cane that shoots bullets.

She made a slide to use in presentations to make that point. It has three photographs on it.

One is the cover of “The Big Book of Granny,” something Lanza and another student made in elementary school, depicting a grandmother with a cane that shoots bullets. A report by the state’s child advocate said the book portrayed “intense violence” that experts said should have warranted referral to a mental health professional.

Next to it on the slide is a picture of a bathroom light switch plate from Márquez-Greene’s house, with four letters carved in it: “Ana G.” Isaiah did it about two weeks after the shooting.

The third image came from the playground in Hartford’s Elizabeth Park that was built in Ana’s memory. Near the playscape, there’s a sign that says “Ana Grace” and “Love wins.” Not long after the playground opened, graffiti appeared. “Peace 2 Sandy Hook,” someone wrote on a corner of the sign.

A playground was built at Elizabeth Park in Hartford in Ana’s memory. (Arielle Levin Becker / CT Mirror)

“For me, they are all symptoms of expression in children,” Márquez-Greene said during a presentation last summer. “And we need to pay attention when our kids are vulnerable enough to share what’s on their minds.”

But each picture got different reactions.

The carving in the switch plate brought support.

“When my son was grieving and he did this, no one got on him about drawing on the wall,” she said. “We were there. We caught him. We loved him. We said, ‘Oh my gosh, we miss her too, let’s all draw on something.’”

She’s not sure what kind of response Lanza got when he made those drawings, who might have been able to read the signs.

The graffiti at Ana’s playground made the news. Márquez-Greene got phone calls asking, “What do you think should happen to the person who tagged her playground?”

#talktrauma

Continue the conversation on Twitter and Facebook using the hashtag #talktrauma.

She hadn’t seen it yet. When she did, she said, “I was moved.”

It happened in a city where violence is far more commonplace than in Newtown, but where residents don’t get the sort of outpouring of love and support that people in Sandy Hook did.

“Someone in the Hartford community, despite the disparity in response, was wishing us peace,” she said. “Yet the response was, ‘What do you think should happen?’ It was very punitive.”

“Every one of those individuals are children who reached out and asked for help,” she said. “It deserves our response.” ♦

Arielle Levin Becker wrote this story while participating in the National Health Journalism Fellowship, a program of USC’s Annenberg School for Communication and Journalism.

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