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Medical lessons from the schoolchildren of Chowchilla
August 1980 TheJournalofPEDIATRICS
251
Medical lessons from the schoolchildren of Chowchilla
ON JULY 17, 1976, 26 Chowchilla, California, schoolchildren were kidnapped at gunpoint by three young men. They were driven about in blackened vans for approximately 11 hours and then buried alive in a truck-trailer for 16 hours. The children eventually dug themselves out and were transferred to Santa Rita Prison, Alameda County, for questioning and medical examination. Two consulting physicians, a pediatrician and a general practitioner, were asked by the sheriff to determine what harm, if any, had been done to the children. The physicians who examined each child for 15 minutes saw no need to refer the youngsters to specialists. 1 The children were returned to their community with the expectation that no further problems would ensue. The director of the Family Service of Fresno, who on behalf of her agency offerred immediate crisis treatment to the group, was told by the sheriffs office that such help would not be needed and that everything was under control. 2 A psychiatrist who had conferred with the superintendent of schools while the children were missing met with a group of parents and kidnapped children a few weeks after the episode and predicted to them that only one in 26 would be affected emotionally by the kidnapping. For many months thereafter, no parent could admit that his/her child was the one in 26! The children went for five months with no direct psychiatric intervention until a group of parents complained to newspaper reporters that their children were fearful, experiencing nightmares, and behaving differently than before the episode? In response to this published parental plea for help, I began a research study and brief psychotherapy program in Chowchilla which lasted seven months and eventually included each of the 23 children and 14 families who had remained in the town. The extensive psychiatric findings have recently been published, ~ and a summary is presently in print. ~ When I first came to Chowchilla, the parents and children asked that all physicians be informed about their ordeal, and their request prompts these comments. In general, I believe that there are three medical lessons to be learned from the schoolchildren of Chowchilla. (1) The study of the group illuminates a great deal about the
0022-3476/80/080251 +02500.20/0 9 1980 The C. V. Mosby Co.
effects of a sudden, unanticipated, intense blow (a traumatic event) upon the individual's thinking, coping, and defense mechanisms. (2) They "teach" us that medical professionals must far more effectively and promptly evaluate and treat children who have been attacked, kidnapped, or otherwise subjected to a sudden threatening event. (3) They warn us that extremely frightening events are widespread in these days of terrorism and violence, and that a general medical effort must be made to treat victims of psychologic as well as physical harm. The study of the Chowchilla youngsters developed several new findings related to phychic trauma. Immediately during the experience, many children misperceived or hallucinated. They all became extremely cautious of new moves and fearful of further trauma. The Lieutenant Sheriff recalled that the children, after their escape, believed the sheriffs to be "not real police officers.., they were afraid we were still dressed in disguises and we were going to bury them again. TM Many children, from the beginning, connected their perception of prior events and the trauma itself into one unbreakable unit. Their "omens," warnings, and stress signals became crucial parts of their later psychopathology. Later post-traumatic psychopathologic signs in the Chowchilla children were repetitive phenomena, symptoms related to the destruction of trust, and thinking disturbances. Repetitive phenomena included "traumatic play" (repeated, .monotonous, unrelieving replay of parts of the traumatic event), "re-enactment" (the behavioral repetition of actions or thoughts which occurred originally during the kidnapping), repeated dreams, occasionally highly unusual dreams in which the child allows himself to die, and some personality changes. Phenomena related to the destruction of trust included intense fears in all children, panic attacks, anniversary reactions, and instances of personality changes. Thinking abnormalities included omens and retrospective reconstructions, overgeneralizations, perceptual distortions, and time skew. There is far more to learn from future studies of the Chowchilla children as well as from other groups of traumatized individuals. How long do the symptoms last? What are the best treatment techniques? How can the
Vol. 97, No. 2, pp. 251-252
252
Editor's column
omen-trauma complex be broken? Does the sense of "foreknowledge" usually originate from a psychic trauma? How can "traumatic play" be used diagnostically or therapeutically? Do post-traumatic panic attacks in children masquerade as physiologic disturbances? In World War II, it was found that prompt treatment (removal of the soldier from the front lines, emotional catharsis in psychiatric interviews, often with the aid of barbiturates or hypnosis, and prompt return to the combat zone) often prevented the long-term sequelae of psychic trauma. ~ A uniform treatment technique for traumatized children has not been worked out, but the principle of prompt intervention has been generally accepted. 7.~ Even though the Chowchilla children were picked up and examined promptly, no mental health team appeared to see the children nor was one called by the two examining physicians. No one sat with the waiting parents in Chowchilla; some families without nearby relatives or friends were entirely alone during the crisis period. After the ordeal was over, no one offered to work individually with the children. Reporters who seemed interested received and recorded children's horror stories of hallucinations, misperceptions, and panicky periods, but the reporters obviously could provide no means of help. A local minister offered to give Sunday prayers of thanks for the children's return, but when one family was surrounded at church by photographers and reporters, Who, they believed, had been summoned by the minister, the family did not attend church services for the next year. The eventual picture in Chowchilla at the time I arrived five months after the kidnapping was one of fragmentation among both parents' and children's groups and a general distrust of the community-at-large.
The Journal of Pediatrics August 1980
The Chowchilla group is not unique by virtue of its horrifying experience. Increasingly, individuals are being exposed to violent assault, loss of freedom, and uncontrollable fright. It is crucial that physicians respond promptly to these occurrences. The recent kidnapping of Americans in Iran is a case in point. We must accept the fact that psychic trauma creates harmful and long-lasting effects in both children and adults. All physicians must be prepared to plan for and to work with these problems. Lenore C. Terr, M.D. 450 Sutter Street San Francisco, CA 94108 REFERENCES
1. People v F Woods, J Schoenfeld, R Schoenfeld: Superior Court, Alameda County, Calif, No. 63187, 320-444, Nov 3, 1977. 2. Amacher, Mary (formerly Director, Family Service, Fresno): Personal communication. 3. Miller G, and Tompkins S: Chowchilla: the bitterness lingers, Fresno Bee, Nov 14, 1976. 4. Terr L: Children of Chowchilla: a study of psychic trauma, Psychoanal Study Child 34:547, 1979. 5. Terr L: Psychic trauma in children: observations following the chowchilla schoolbus kidnapping, Am J Psychiatry (in press). 6. Grinker R, and Spiegel J: Men under stress, Philadelphia, 1945, Blakiston. 7. Block D, Silber E, and Perry S: Some factors in the emotional reaction of children to disaster, Am J Psychiatry 113:416, 1956 8. Blaufarb H, and Levine J: Crisis intervention in an earthquake, Social Work 17:16, 1972.
251
Medical lessons from the schoolchildren of Chowchilla
ON JULY 17, 1976, 26 Chowchilla, California, schoolchildren were kidnapped at gunpoint by three young men. They were driven about in blackened vans for approximately 11 hours and then buried alive in a truck-trailer for 16 hours. The children eventually dug themselves out and were transferred to Santa Rita Prison, Alameda County, for questioning and medical examination. Two consulting physicians, a pediatrician and a general practitioner, were asked by the sheriff to determine what harm, if any, had been done to the children. The physicians who examined each child for 15 minutes saw no need to refer the youngsters to specialists. 1 The children were returned to their community with the expectation that no further problems would ensue. The director of the Family Service of Fresno, who on behalf of her agency offerred immediate crisis treatment to the group, was told by the sheriffs office that such help would not be needed and that everything was under control. 2 A psychiatrist who had conferred with the superintendent of schools while the children were missing met with a group of parents and kidnapped children a few weeks after the episode and predicted to them that only one in 26 would be affected emotionally by the kidnapping. For many months thereafter, no parent could admit that his/her child was the one in 26! The children went for five months with no direct psychiatric intervention until a group of parents complained to newspaper reporters that their children were fearful, experiencing nightmares, and behaving differently than before the episode? In response to this published parental plea for help, I began a research study and brief psychotherapy program in Chowchilla which lasted seven months and eventually included each of the 23 children and 14 families who had remained in the town. The extensive psychiatric findings have recently been published, ~ and a summary is presently in print. ~ When I first came to Chowchilla, the parents and children asked that all physicians be informed about their ordeal, and their request prompts these comments. In general, I believe that there are three medical lessons to be learned from the schoolchildren of Chowchilla. (1) The study of the group illuminates a great deal about the
0022-3476/80/080251 +02500.20/0 9 1980 The C. V. Mosby Co.
effects of a sudden, unanticipated, intense blow (a traumatic event) upon the individual's thinking, coping, and defense mechanisms. (2) They "teach" us that medical professionals must far more effectively and promptly evaluate and treat children who have been attacked, kidnapped, or otherwise subjected to a sudden threatening event. (3) They warn us that extremely frightening events are widespread in these days of terrorism and violence, and that a general medical effort must be made to treat victims of psychologic as well as physical harm. The study of the Chowchilla youngsters developed several new findings related to phychic trauma. Immediately during the experience, many children misperceived or hallucinated. They all became extremely cautious of new moves and fearful of further trauma. The Lieutenant Sheriff recalled that the children, after their escape, believed the sheriffs to be "not real police officers.., they were afraid we were still dressed in disguises and we were going to bury them again. TM Many children, from the beginning, connected their perception of prior events and the trauma itself into one unbreakable unit. Their "omens," warnings, and stress signals became crucial parts of their later psychopathology. Later post-traumatic psychopathologic signs in the Chowchilla children were repetitive phenomena, symptoms related to the destruction of trust, and thinking disturbances. Repetitive phenomena included "traumatic play" (repeated, .monotonous, unrelieving replay of parts of the traumatic event), "re-enactment" (the behavioral repetition of actions or thoughts which occurred originally during the kidnapping), repeated dreams, occasionally highly unusual dreams in which the child allows himself to die, and some personality changes. Phenomena related to the destruction of trust included intense fears in all children, panic attacks, anniversary reactions, and instances of personality changes. Thinking abnormalities included omens and retrospective reconstructions, overgeneralizations, perceptual distortions, and time skew. There is far more to learn from future studies of the Chowchilla children as well as from other groups of traumatized individuals. How long do the symptoms last? What are the best treatment techniques? How can the
Vol. 97, No. 2, pp. 251-252
252
Editor's column
omen-trauma complex be broken? Does the sense of "foreknowledge" usually originate from a psychic trauma? How can "traumatic play" be used diagnostically or therapeutically? Do post-traumatic panic attacks in children masquerade as physiologic disturbances? In World War II, it was found that prompt treatment (removal of the soldier from the front lines, emotional catharsis in psychiatric interviews, often with the aid of barbiturates or hypnosis, and prompt return to the combat zone) often prevented the long-term sequelae of psychic trauma. ~ A uniform treatment technique for traumatized children has not been worked out, but the principle of prompt intervention has been generally accepted. 7.~ Even though the Chowchilla children were picked up and examined promptly, no mental health team appeared to see the children nor was one called by the two examining physicians. No one sat with the waiting parents in Chowchilla; some families without nearby relatives or friends were entirely alone during the crisis period. After the ordeal was over, no one offered to work individually with the children. Reporters who seemed interested received and recorded children's horror stories of hallucinations, misperceptions, and panicky periods, but the reporters obviously could provide no means of help. A local minister offered to give Sunday prayers of thanks for the children's return, but when one family was surrounded at church by photographers and reporters, Who, they believed, had been summoned by the minister, the family did not attend church services for the next year. The eventual picture in Chowchilla at the time I arrived five months after the kidnapping was one of fragmentation among both parents' and children's groups and a general distrust of the community-at-large.
The Journal of Pediatrics August 1980
The Chowchilla group is not unique by virtue of its horrifying experience. Increasingly, individuals are being exposed to violent assault, loss of freedom, and uncontrollable fright. It is crucial that physicians respond promptly to these occurrences. The recent kidnapping of Americans in Iran is a case in point. We must accept the fact that psychic trauma creates harmful and long-lasting effects in both children and adults. All physicians must be prepared to plan for and to work with these problems. Lenore C. Terr, M.D. 450 Sutter Street San Francisco, CA 94108 REFERENCES
1. People v F Woods, J Schoenfeld, R Schoenfeld: Superior Court, Alameda County, Calif, No. 63187, 320-444, Nov 3, 1977. 2. Amacher, Mary (formerly Director, Family Service, Fresno): Personal communication. 3. Miller G, and Tompkins S: Chowchilla: the bitterness lingers, Fresno Bee, Nov 14, 1976. 4. Terr L: Children of Chowchilla: a study of psychic trauma, Psychoanal Study Child 34:547, 1979. 5. Terr L: Psychic trauma in children: observations following the chowchilla schoolbus kidnapping, Am J Psychiatry (in press). 6. Grinker R, and Spiegel J: Men under stress, Philadelphia, 1945, Blakiston. 7. Block D, Silber E, and Perry S: Some factors in the emotional reaction of children to disaster, Am J Psychiatry 113:416, 1956 8. Blaufarb H, and Levine J: Crisis intervention in an earthquake, Social Work 17:16, 1972.