Sunday, September 19, 2010

Abuse – is escape to safety a mistake?

The idea is clear and obvious. A traumatized person needs to be rescued and brought to a safe area where he can begin recovery.  For example, a soldier is suffering from shell shock. He is surrounded by death and destruction. He has finally snapped under the stress of random explosion of mortar shell and the screams of wounded companions. Would any rational person insist that he be forced to stay on the battle field with his unit?

A young boy has been abused by his teacher who has just been fired. The parents are told that it is best if their son were sent to his relatives 5000 miles away where he will be able to forget about the trauma. "Just being in the school will perpetuate the trauma", notes the social worker. "He needs a new place that has no reminders of what happened to him in order to recover."

A teenage girl has an alcoholic mother and no father. She has suffered much from her mother's incompetence as well her mother being overwhelmed 7 other children and by her many psychiatric and medical problems. It is recommended that she be placed in foster care.

The problem with the above is that removal from the traumatic environment is often itself very traumatic. It often means being stigmatized as a failure and the removal of support systems and more important a loss of identity. Studies with the Israeli army have shown that it is best to treat shell shock as an entirely normal reaction to stress. It works best if the soldier is not stigmatized by sending him to a hospital as well as not causing the loss of his identity and friends. Even forcing a hysterical soldier to take his gun and go back to his unit – is more beneficial in the long run than filling him with tranquilizers and having him escape the stress and horrors of war. Obviously there are extreme cases which need escape – but they are viewed as the exception rather than the rule.

Studies with foster family placement indicate that in most cases it is better to work with the family rather than to dismember it. Even moving to the safe environment of relatives is traumatic because the trauma is not dealt and unhealthy coping mechanisms develop. There are no friends and he learns to view himself as damaged goods – without familiar environment and resources to help with coping.

While obviously there has to be protection of the traumatized person, but it seems it is far better that treatment occur on familiar territory. The reaction of rachamim (mercy) does not work as well as din (strict law) for most people.

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