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04/11/93
Freed cult children given help in coping; They may suffer from stress disorder after traumatic events, psychiatrist says
By Victoria Loe / The Dallas Morning News
HOUSTON-Dr. Bruce Perry works with combat veterans-children who have been emotionally scarred by abuse, family violence or the terrors of the nation's urban war zones.
So he knew all too well what could happen to the children of Mount Carmel and how the Feb. 28 shootout and the separation from their families could damage them for life.
That's why Dr. Perry, an associate professor of psychiatry at Baylor College of Medicine, offered his services as a consultant to the state child welfare workers who are caring for the children who have left the compound.
"It's very difficult to make sense of a major traumatic event,' says Dr. Perry, who is a pioneer in the study of post-traumatic stress disorder among children.
"You can't take the memory away,' he says. "But you can teach them (the children) how to work around what's in there.'
Twenty-one children emerged from the Branch Davidian compound in the days soon after the shootout. Seventeen remain inside with David Koresh and his followers. Of those who left, many still have family members inside.
Eight children have gone to live temporarily with relatives.
Thirteen remain in the care of child welfare workers in Waco. Authorities probably will release most of them to the custody of family members by the end of the month.
Each child will cope with the terror and upheaval in his or her own way, depending on age, past experiences, the care received and a host of other factors. No one knows how pervasive or how deep their emotional wounds will be.
"They're doing very well' under the circumstances, says Bob Boyd, program director for Children's Protective Services in Waco.
But Dr. Perry, who also is chief of psychiatry at Texas Children's Hospital in Houston, says their world will never be the same-and neither will they.
Altering the brain
His research has shown that severe trauma can permanently alter a person's brain chemistry, changing forever the way he experiences the world. In very young children, trauma may even affect the structure of the developing brain.
"The brain develops as a mirror to the environment,' he says. "The brain is exquisitely sensitive to environmental cues.'
The psychiatrist knows firsthand the devastation of sudden loss.
Just months after he was married in 1974, his wife was murdered on the campus of Stanford University, where he was a sophomore.
Dr. Perry began studying the biochemistry of post-traumatic stress disorder during his psychiatry residency at Yale University. Typically, his research subjects were military veterans, the first people whose post-traumatic stress disorder was widely recognized.
Although he still runs a clinic for such victims at the Veterans Affairs hospital in Houston, he is most passionate about a group he says is often ignored-children with the stress disorder. By his estimate, as many as 1 million U.S. children may fall prey to the disorder each year.
His dream, outlined in one of the many articles he's written, is nothing less than "to bring an end to the war on children.'
Dr. Perry moved to Houston last year from the University of Chicago, drawn largely by the chance to create his own post-traumatic stress disorder center in conjunction with Children's Protective Services in Harris County. He envisions a program with more rigorous assessment, treatment and documentation.
"I'm happy to help CPS pioneer the model,' he says.
Meanwhile, he's commuting back and forth to Waco.
Dr. Perry will not say what the Branch Davidian children have
revealed about their lives at Mount Carmel or whether any of them might have been abused there.
Ex-followers of David Koresh have charged that he subjected children to severe physical punishment and sometimes "married' girls as young as 12. Dr. Perry says it's not clear whether those reports are accurate.
Children's Protective Services received allegations of child abuse by the Branch Davidians more than a year ago. Investigators visited the compound but found "no credible evidence' of abuse, Mr. Boyd says.
That picture has not altered since the children emerged, he says.
"They are in very good condition and show no signs of abuse.'
Investigators are still gathering information from the children, however, and "as time goes on we will know more and more,' Mr. Boyd says.
Traumatic uprooting
Whatever the children experienced inside the compound, the brutal way they were uprooted is sure to strain their abilities to adapt.
"Whether it was good or bad, it was their world,' says Mr. Boyd.
That world ended Feb. 28 in a 45-minute fusillade of bullets.
Even though Dr. Perry was not there that day, he knows how the children reacted-because every human body reacts identically to danger.
Certain centers in the children's brains gave the signal to flood their systems with adrenaline and other biochemical messengers. Their heart rates, blood pressure and respiration shot up. Stored sugars poured into their bloodstreams, their eyes dilated and their muscle tone increased. They became oblivious to everything but the mayhem around them, even their own feelings.
Once the shooting stopped, their bodies gradually returned to normal. That's when they began to be aware of the internal environment -- their feelings about the shootout.
For people who've undergone a small- or medium-sized scare, that's the end of the story. There is little or no lasting effect.
But Dr. Perry and other researchers have found that if a trauma is severe, or if it is repeated, the brain centers that control the "alarm response' may go into permanent overdrive. Those changes underlie the symptoms associated with post-traumatic stress disorder.
Stress disorder sufferers typically relive their trauma long after it is over through intrusive thoughts, dreams and flashbacks. These are the brain's dogged attempts to make sense of an event so far outside the normal range of experience that it is virtually incomprehensible.
Often hypervigilant
To avoid further pain, victims retreat into themselves, becoming emotionally numb. In times of acute stress, they may disengage entirely from the outside world, a phenomenon known as dissociation.
People with post-traumatic stress disorder are hypervigilant, constantly scanning the environment for signs of danger. They startle easily and often overreact to events that others find innocuous.
All these adaptations are normal, even vital, when one's life is in danger. And it's natural for them to persist or recur for a while.
But the brain of a person with the stress disorder reacts this way all the time, perceiving everyday stresses as life-threatening events.
It's far too soon to say whether any of the children from Mount Carmel will develop the disorder. It takes at least six months to distinguish between a temporary reaction to trauma and the persistent fearfulness that characterizes the disorder.
But those responsible for aiding the Branch Davidian children are doing all they can to help the children cope with their fears. Dr. Perry lauds Mr. Boyd's staff for swiftly placing children with relatives and helping their new families find support services.
"The key,' says Dr. Perry, "is to be pro-active rather than reactive.'
By giving children opportunities to talk about or otherwise communicate their experience, he says, adults can help them "take control of it.'
Adults also must reassure the children that what they're feeling is normal, no matter how bizarre and frightening it seems.
"You have to be with them and help them through it,' Dr. Perry says.
It's hard for the Branch Davidian children to accept those reassurances. The sect trained them to distrust outsiders-and that distrust was powerfully reinforced by the raid on their home.
At first the children couldn't distinguish between the people who came to the compound with guns and the people who were housing and feeding them, Mr. Boyd says.
"They have to learn to trust,' he says.
But with time they have begun to do that, he says. With more time,
everyone hopes, the children can heal.
Good experiences as well as bad can etch themselves in the brain, Dr. Perry says. Showing the children that they're safe and loved can, over time, soften, if not erase the damage.
"The key to treatment,' says Dr. Perry, "is predictability, stability and nurturance.'
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