Shmukler, D. (1989). Growing up in Violent Situations: The South African situation. Paper presented at the Centre for the Study of Violence and Reconciliation, Seminar No. 7, 31 August.
Seminar No. 7, 1989
Presenter: Diana Shmukler
Diana Shmukler is the former head of the Psychology Department at the University of the Witwatersrand.
Date: 31 August 1989
Venue: University of the Witwatersrand, Johannesburg, South Africa
I am going to discuss this topic from a number of perspectives. Firstly I will give a psychological perspective to the notion of resilience, invulnerability or stress resistance, as I think that the psychological factors form a crucial base from which to consider long term sequelae and plan ways of intervention and prevention. In order to place the South African situation in a context I will look at some of the descriptions of the traditionally described stressors of childhood, and then consider the more extreme stresses. Finally, I will present some of the research and ideas that are being formulated about the South African situation.
Children are not strangers to stress. Over a significant span of human history they have been more often the victims of the slings and arrows of an uncaring society than recipients of its beneficent protection. (Garmezy 1988, p 49)
The issue of stress, violence, coping and resilience has recently become a focus of interest in developmental psychology although the key theories and ideas have been developing over the last 20 years. Furthermore most of the stress research has been conducted on adults and the developmental aspects have been underplayed. The recent interest is in response to the emerging findings that there are a number of resilient children who do well, deal competently with themselves and life and appear to cope with a great deal of stress in spite of having grown up in the most adverse of circumstances.
Adopting a developmental perspective means that there are two important factors which will underpin the understanding and interpretation of the data:
the processes in stress and coping will differ according to the stage of the child's development.
Adverse experience or happenings in early life alter the course of subsequent development and influence the ways in which an individual responds to later stressful events.
As a clinical psychologist my interest and understanding arises from the psychological rather than the social or sociological features. I want to briefly introduce a psychodynamic perspective in order to place the research in perspective and to highlight that it is possible to consider this subject both from the intrapsychic and the interpersonal aspects. It is the interplay of these factors that always enriches our comprehension of a complex psychological situation such as this one. Further, the perspective adopted colours the way in which we interpret the data and I wish to consider both the intrapsychic and the interpersonal.
The notion of trauma was crucial in Freud's early thinking. He first saw it as an etiological factor and subsequently as a causal agent reaching back into early childhood. As he developed his ideas he placed less and less stress on trauma. However, from the drive theory perspective the function of the ego is described as discharging energy, organising, anticipating and building up reserves of counter energy. Thus providing an explanation of the post traumatic function of repetitive dreaming and imagery, the re-experiencing over and over of the traumatic event in order to regain a sense of control. From this theoretical perspective then, following traumatic events, vulnerable individuals will not make a spontaneous recovery but will always develop lasting defects of the ego resulting in impoverished ego functioning, less interest in the external world and restricted personality functioning. On the other hand Anthony argues that:
Within this theoretical context, resilience may ensue if infantile threats and anxieties are minimal and complications of the narcissistic nature have not developed. (Anthony, 1988, p.9)
In sharp contrast to this rather pessimistic perspective which emphasises pathology, adversity has often been described and seen as strengthening. What surprised the researchers in the 60's (Anthony and Cohler 1988) was not that egos held up under often very difficult and unconducive circumstances. The overall conclusion to emerge from this research is that early stress may be harmful or beneficial, sensitizing or steeling. The important factors to take into account are in the first place the severity of the stress, ie: whether it is mild, moderate or severe, and secondly whether it is chronic or acute. In the South African townships we are dealing with both chronic and acute stress, that against a backdrop of poverty, apartheid, unemployment and abuse, in recent years we have had the impact of violent arrests, troops in the townships, witnessing of violent events and detention, all of which form the acute stressors.
The Development of Resilience
I will return to the external factors that determine the effects of stress on the individual, after describing the early development of the capacity or potential for resilience or lack of personality integration. Locating myself at the interface of development and clinical perspectives (which implies a shift from a drive theory perspective to one of object relations) I have been powerfully influenced by the theories of Mahler (1982), Winnicott (1971) and Pine (1985). I identify with Pine's statement when he says "I find it impossible not to think in terms of the events of the months and years until, say three as primary determinants of subsequent functioning." (Pine 1985, p.4).
Pine continues: "Although he is not infinitely malleable, the child is nonetheless highly susceptible to influence in that early period well before the character has formed. It is character that later acts as filter and mould permitting the person to maintain a sameness in the face of varying stimulation; but character in that sense is not formed yet in this early period. The early influence of the parental inputs is not only impressive in itself, but is one of the major things the child observer without access to the inner experience of the child, witnesses and can think about; no wonder, then, that this influences his theorizing. (op cit. loco, p. 4, 5) (my emphasis)
Erikson's notion of ego identity is close to what Pine calls character. Erikson writes of "an internalized pattern, a basic ego space" (1980 p 32). Winnicott (1971) describes personalization as "psyche indwelling in the soma" representing a personal or inner psychic reality for the infant. All these difficult to define yet similar notions describe the origin and development of a buffer zone. Merle Friedman and I in several articles have developed and described the notion of the transitional space, which we have related closely to Winnicott's notion of transitional phenomena and potential space (Shmukler & Friedman 1988, Friedman & Shmukler, in process) (Winnicott 1971)
For the purposes of the present paper I want to summarise and emphasize that our perspective (Friedman and Shmukler) is that very early experience and particularly the relationship between the mother and child, the mother's capacity to meet the child in the earliest stages of life, build up this buffer zone, or capacity for resilience, or profoundly hamper its development leading to impairment.
I will return to this notion to examine it in the light of the evidence and some of the contradictory findings of the impact of stressful events on children's development in order to show that it gives us a useful place from which to understand these phenomena.
Traditional Stressors in Childhood
If we look at the developmental literature in the last 20 years there are a number of situations that have traditionally been described as stressful, and have led to a number of research projects investigating the nature of the stress and its effect on development. For example parents' divorce, hospitalisation and experiences of the separation from parents are seen as the main stressors of childhood. The salient features in terms of the psychological consequences of such events depend firstly on the child's age at the time of the separation. The greatest risk for subsequent maladjustment in terms of ongoing long term psychological sequelae is if the trauma occurs between the ages of 6 months and 4 years. This finding of course is entirely consistent with my previously made point on p. 3.
There is widespread general agreement that boys are more vulnerable than girls. I will return to the finding when describing some of the South African research, but it also leads me to speculate that there is something in the way mothers are likely to protect girl babies that allows for the buffer zone to develop more firmly. (this is pure speculation.) Temperamental factors play a role and adverse temperaments such as irritability, hypersensitivity are going to make it harder for an individual child to deal with change and disruption. These factors are likely to have a genetic base.
It is consistently shown that an important factor is related to the parents, specifically in terms of their responses to the trauma, to the child and their own stress reaction. Research shows that children are affected as much by parent's attitudes and mental state as they are by their own stress reaction. Good copers have parents who are models of good coping with whom they can identify.
A significant overall conclusion that emerges is that children's responses to psychosocial stressors depend not only on the frightening event but whether it has personal connotations in terms of changed personal relationships or negative self appraisals. Here too I would make the link to the early buffer zone developed by the child and the sense of self that is laid down in this context.
As we move further outward from the internal to the family to the community, we find that high social support makes a great deal of difference in terms of coping and resilience. In situations where highly stressful events are associated with high social support, considerably less pathology ensues than when the social support is missing.
Extreme Stressors: Children under the stress of war and terror
As the 20th Century draws to a close, tragically we have witnessed situations in which people and children have been exposed to violence and terror on an unprecedented scale. From the 2nd World War and the Holocaust in Europe to the ongoing situations in Northern Ireland and Israel, we have psychological documentation of some of these effects. Not that these are the only situations of War, violence, torture and terrorism by any means, but these are the main areas from which a body of psychological literature has developed. Freud and Burlingham (1943) were amongst the first to systematically examine the effect on children of wartime stress and the evacuation from the cities. They concluded that there is no significant difference between fear of war and other kinds of fear. On the other hand, children complained of homesickness, crying, nightmares etc. These effects, however, could easily be explained in terms of the separation from parents.
The studies of survivors of concentration camps show a direct correlation between the age of the victims and the severity and duration of their symptoms (Etinger & Strum 1973). The general conclusion also is that when young children are exposed to violence, terror and war, they will suffer a great deal if there are no significant adults available to them.
The studies in N. Ireland show that youngsters suffer more than adults. On the other hand, when the neighbourhood quietens down, there is an immediate decrease in the symptoms of children. (Fraser 1973). Fraser also confirms an early point made, that the reaction of children rests very much on the perception of the treat by the significant adults in their lives, ie parents, teachers etc.. McWhirtier (1983), who has extensively documented the effects of bombing, terrorist acts etc. on children, concludes "After 14 years of the present period of civil strife, it might be suggested that abnormality has become normality, even in the worse affected areas." (McWhirtier 1983, p1) Again suggesting that children generally adapt to any circumstance and start taking things for granted. It is the particular personality features and family circumstances that will determine an individual child's response.
In Israel, studies have been directed both to the effects of the ongoing shelling and bombing and to specific incidents of terrorist and hostage taking. Ziv and Kruglanski (1974) and Ziv (1973) showed that the level of anxiety was equal and relatively low in a group of children in a kibbutz under fire compared to children in a non-shelled kibbutz. No difference was found in children's attitude towards war, seeking peace or latent aggressiveness.
Milgram and Milgram (1976) showed a marked rise in anxiety during the 1973 war in Israel, however after the war the anxiety is no higher than that of average American children. An interesting finding in the Milgram's study is that normal children's anxiety doubles, whereas children who are normally very anxious do not show further increased anxiety.
Ayalon (1979) documents the stress reactions of children facing terrorists as: - freezing, shock, confused, crying, panicky, calling for help, felling, helping others etc. She concludes that where communities are prepared for stressful situations, they cope much better and the effects do not last as long. As a result of the work done by Ayalon (1979) Mooli Lahad (1988) and others, there are stress prevention programs, centres and research organizations in Israel. Many of the programs are fed through the educational system throughout the country. Most of the border and settlement communities that have been exposed to terrorist attacks have also experienced intervention. The conclusions are that group and individual therapy reduce symptoms.
The South African Situation
The South African research is scanty and scattered but has been given a lot of impetus by the events post 1985. As an example, there is the research done by a number of investigators who are working in the troubled areas in Cape Town, specifically examining the emotional status of children exposed to political violence in the squatter camps. In an investigation conducted by Dawes (1989) on children between 2 - 17 years, he showed that there was a significant relationship between post traumatic stress disorder in mothers and the presence of multiple stress symptoms in children. This finding confirms that there is a direct relationship between the child's reaction and the parent's attitude. He also found boys were more vulnerable to trauma than girls during early childhood but that by adolescence this trend reversed, which is an interesting interaction between age and sex.
I will report specifically on a study done by Serenne Lab in 1987, under my supervision, on the psychological effects of the unrest conditions on children growing up in South African townships. Where I think this study is unique at present, and fills a gap in the South African literature, is that Serenne specifically collected data using a number of techniques to throw light on the child's perspective or views of their situation. She used drawings, a worry list, sentence completion, wishers and an essay measure. The drawings dramatically illustrate black children's perception of their environment. 71.2 % drew police, troops or soldiers in the street where they live, showing the police presence to be a major feature of the children's daily life at that time. The drawings contained specific acts and incidents of violence, showing how familiar these had become in the children's lives. There were few depictions of other forms of violence or aspects of the other social problems which are rampant in the townships, [(23.1%)], showing these to be of less concern to the children than the police presence.
Games, family and community life emerged in 63.5% of the drawings, and illustrated the starkness and barrenness of the black living areas in South Africa. Church and religious activities occurred in some of the drawings.
On the worry check list, the usual things that concern children were included. School related items, such as being late for school worried 44.2%, whereas not having done homework worried 47.3% and being sent to the principal 31.4%. Separation from parents and money were both checked highly. However, by comparison 92.3% were worried about "being questioned by the police". 96.2% "seeing someone I love being shot by soldiers" and for the entire sample (100%) "a member of the family or friend detained". The force and power of the police presence and the anxiety it causes children in the township clearly overrides the concerns they have about ordinary worries of childhood.
Again on a person rating scale "a soldier" emerges as the most disliked person (93.9%) rating him on the lowest level.
On sentence completion 75% of children indicated that having their house raided was the most frightening thing. However on being asked their chief worry, children indicated that it was related to money matters.
Their three wishes confirming this with the desire for material possessions emerges as the highest preference. When asked what they would want to alter, however, 16.9% wanted to change poverty for riches, 44.2% for a cessation of political unrest, violence and inequality, and 23.1% wanted freedom and peace.
Children saw their parent's main worry as themselves and particularly their education. Themes of political violence and unrest emerge in some 73% of the essays.
Clearly what is reflected in this study, is a picture of the black child's world dominated by political events, police presence and violence against a backdrop of deprivation and poverty. Although it is a limited study carried out on a small sample of children (52) in the Johannesburg area, nonetheless the striking evidence of the impact of civil unrest on these 9 - 16 year-olds is powerful. Gibson (1986) emphasizes that specificity of civil unrest is a uniquely stressful experience and the evidence accumulating South Africa seems to confirm this.
In conclusion then it seems as though the circumstances in which we grow up will colour our personalities and view of life thereafter. It seems also that the situation of growing up in South Africa has similarities and differences to the other trouble spots in the world. These factors are complex and include intrapsychic, interpersonal, familial and community. And in order to gain a full picture we need to look at these situations in a multifaceted way.
Anthony, E. J. and Cohler, B. J. (Editors) The Invulnerable Child. New York and London, Guilford Press, 1988.
Ayalon, O. "Community Oriented Preparation for Emergency (C. O. P. E.)" Journal of Death Education, 222 - 441, 3, 4, 1979.
Eitinger, L. and Strum, A. "Mortality and Morbidity After Excessive Stress", New York: Universitet et forlaget , Oslo, and Humanistic Press, 1973.
Erikson, E. Industry and the Life Cycle. (2nd Ed.) New York. W.W. Norton., 1973.
Fraser, M. Children in Conflict, Penguin Books, England. 1973.
Freud, A. and Burlingham, D., War and Children. New York Willard Press, 1943.
Friedman, M. and Shmukler, D. "The Transitional Space as a Context for Therapy, Under review for The Transactional Analysis Journal.
Garmezy, N, "Stressors of Childhood" in Garmezy N, and Rutter M, (Eds) Stress, Coping, and Development in Children. Baltimore, John Hopkins University Press, 1988.
Garmezy, N. and Rutter, M, (Editors) Stress, Coping and Development in Children. Baltimore, John Hopkins University Press, 1988.
Journal of Personality and School Psychology, 30, 1, July, 1974.
Lab, S. "The Psychological Effects of Violence on Black South African Children", unpublished Honours thesis, submitted to the University of the Witwatersrand, Johannesburg. 1987.
Lahad, M. and Cohen, A. Community Stress Prevention, Merkaz Habriut, Kiriat Shmona: Israel, 1988.
Mahler, M.S., Pine, F. and Bergmann, A. The Psychological Birth of the Human Infant. New York, Basic Books, 1982.
McWhitier, L., "Looking Back and Looking Forward: An inside perspective". In Harbisan, J. (Ed.) Children of the Troubles - children in Northern Ireland, Stanmillis College, Belfast Learning Resources Unit, 1983.
Milgram, R., & Milgram, N. "The Effect of the Yom Kippur War on Anxiety Level in Israeli Children". Journal of Psychology, 94, 107 - 13, 1976.
Pine, F., Developmental Theory and Clinical Process, New Haven and London, Yale University Press, 1985.
Shmukler, D., and Friedman, M. "Play and Development of Child Ego State", Transactional Analysis Journal, April 1988 Vol.
Winnicot, D.W. Playing and Reality. New York: Basic Books, 1971.
Ziv, A., Kruglanski, A. and Schulman, S., Children's Psychological Reaction to Wartime Stress.
Ziv, A. and Israeli, R., "Effect of Bombardment on the Manifest Anxiety Level of Children Living in Kibbutzim". Journal of Consulting and Clinical Psychology, 40, 1, 1973.