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  I brought her foster mother into the room where we were to hold the session, a preschool classroom. Then, I took some crayons and paper and lay down on the carpet to color. In a minute or two Sandy came over and joined me on the floor. I looked over to the foster mother and said, “Sandy, Mrs. Sally* is going to go to church while we play. Is that OK?” She didn’t look up, but said, “OK.”

  We sat on the floor and colored in silence. For ten minutes our play was just like the initial visit in the court. Then, it changed. Sandy stopped coloring. She took the crayon from my hand, pulled at my arm and tugged at my shoulder to make me lay face down on the floor.

  “What game is this?” I asked playfully.

  “No. Don’t talk,” she said. She was deadly serious and forceful. She had me bend my knees and put my arms behind my back, as if I was hog-tied. And then, the reenactment took place. For the next forty minutes, she wandered the classroom, muttering things, only some of which I heard.

  “This is good. You can eat this,” she said, coming over to me with plastic vegetables and opening my mouth to try to feed me. Then, she brought a blanket over to cover me. During that initial therapy session she would approach me, lay on me, shake me, open my mouth and my eyes, and then leave again to find something in the room, almost always returning with a toy or another object. She did not reenact her own assault, and for the rest of the time I worked with her she never did fully reenact it, but she frequently said, “For your own good, dude,” as she walked around.

  While she did this, I had to do exactly what she wanted: don’t talk, don’t move, don’t interfere, don’t stop. She needed to have total control while she performed this reenactment. And that control, I began to recognize, would be critical to helping her heal.

  AFTER ALL, ONE of the defining elements of a traumatic experience—particularly one that is so traumatic that one dissociates because there is no other way to escape from it—is a complete loss of control and a sense of utter powerlessness. As a result, regaining control is an important aspect of coping with traumatic stress. This can be seen vividly in the classic research on a phenomenon that has come to be known as “learned helplessness.” Martin Seligman and his colleagues at the University of Pennsylvania created this experimental paradigm in which two animals (in this case, rats) are housed in separate but adjacent cages. In one of these cages, each time the rat presses a lever to obtain food, it is first given an electric shock. This is, of course, stressful for the rat, but over time, recognizing that it will receive food after the shock, it adjusts and becomes tolerant. The rat knows that the only time it will be shocked is when it presses the lever, so it has some level of control over the situation. As we’ve discussed, over time, a predictable and controllable stressor actually causes less “stress” on the system while tolerance increases.

  But in the second cage, while the rat can press the bar to receive food just like the rat in the first cage does, this one gets shocked when the other rat presses the lever. In other words, the second rat has no idea when it will be shocked and no control over the situation. This rat becomes sensitized to the stress, not habituated to it. In both rats major changes can be seen in the stress systems of their brains: healthy changes in the case of the rats with control over the stress, and deterioration and dysregulation in the others. The animals that don’t have control over the shock often develop ulcers, lose weight and have compromised immune systems that actually make them more susceptible to disease. Sadly, even when the situation is changed so that they can control the shock, animals that have been placed in a situation without control for long enough become too frightened to explore the cage to figure out how to help themselves. The same kind of demoralization and resignation can often be seen in humans who become depressed, and research increasingly links the risk of depression to the number of uncontrollable stressful events people experience during their childhood. Unsurprisingly, PTSD is frequently accompanied by depression.

  As a result of the link between control and habituation, and between lack of control and sensitization, recovery from trauma requires that the victim return to a situation that is predictable and safe. Our brains are naturally pulled to make sense of trauma in a way that allows us to become tolerant to it, to mentally shift the traumatic experience from one in which we are completely helpless to one in which we have some mastery.

  That’s what Sandy was doing in her reenactment behavior. She controlled our interactions in a way that allowed her to “titrate” the degree of stress during the sessions. Like a doctor balancing desired effects and side effects of a drug by choosing the right dose, Sandy regulated her exposure to the stress of her reenactment play. Her brain was pulling her to create a more tolerable pattern of stress; a more predictable experience that she could put in its place and leave behind. Her brain was trying, through reenactment, to make the trauma into something predictable, and hopefully, ultimately boring. Pattern and repetition are the key to this. Patterned, repetitive stimuli lead to tolerance, while chaotic, infrequent signals produce sensitization.

  To restore its equilibrium, the brain tries to quiet our sensitized, trauma-related memories by pushing us to have repetitive, small “doses” of recall. It seeks to make a sensitized system develop tolerance. And, in many cases, this works. In the immediate aftermath of a distressing or traumatic event we have intrusive thoughts: we keep thinking about what happened, we dream about it, we find ourselves thinking about it when we don’t want to, we often tell and retell the event to trusted friends or loved ones. Children will reenact the events in play, drawings and their daily interactions. The more intense and overwhelming the experience, however, the harder it becomes to “desensitize” all of the trauma-related memories.

  In her reenactments with me, Sandy was attempting to develop tolerance to her terrible traumatic memories. She had control of these reenactments; this control let her modulate her own level of distress. If it became too intense she could redirect our play, and that’s what she often did. I did not try to interfere with the process or push her to recall anything after that first time, when I had to do it for the evaluation.

  In the first months of our work together each session would start the same way: silently. She would reach up for my hand and lead me to the middle of the room, pull me down and gesture. I would lay down and curl myself into the hog-tied position. She would explore the room, coming back and forth to me. Finally she would come and lay on my back. She would start to hum quietly and rock. I knew better by then not to talk or change position. I let her have the total control she needed. It was heartbreaking.

  The responses of traumatized children are often misinterpreted. This even happened to Sandy at some points in foster care. Because new situations are inherently stressful, and because youth who have been through trauma often come from homes in which chaos and unpredictability appear “normal” to them, they may respond with fear to what is actually a calm and safe situation. Attempting to take control of what they believe is the inevitable return of chaos, they appear to “provoke” it in order to make things feel more comfortable and predictable. Thus, the “honeymoon” period in foster care will end as the child behaves defiantly and destructively in order to prompt familiar screaming and harsh discipline. Like everyone else, they feel more comfortable with what is “familiar.” As one family therapist famously put it, we tend to prefer the “certainty of misery to the misery of uncertainty.” This response to trauma can often cause serious problems for children when it is misunderstood by their caretakers.

  Fortunately, in this case I was able to educate those who worked with Sandy about what to expect and how to respond to it. But still, outside of therapy, at first her sleep, anxiety and behavioral problems persisted. Her resting heart rate was over 120, extremely high for a girl her age. Despite occasional profound dissociative behaviors, she was likely to appear “tuned up” and hyper-vigilant—similar, in some ways, to the boys I was seeing in the residential center. I discussed the potential posit
ive effects of clonidine with her foster family, her case worker and with Stan. They agreed that we should try it and, indeed, her sleep soon improved and the frequency, intensity and duration of her meltdowns decreased. She started to be easier to live with and to teach, at home as well as in her preschool classroom.

  Our therapy continued as well. After about a dozen sessions she started to change the position in which she wanted me to lie. No more being hog-tied; now I would lie on my side. The same ritual took place. She explored the room, always coming back to my body lying in the middle of the floor and bringing me the things she collected. She would still hold my head to try to feed me. And then she’d lie down on me, rocking, humming fragments of tunes, sometimes stopping as if frozen. Sometimes, she would cry. Throughout this part of the session, usually about forty minutes, I would remain silent.

  But over time, little by little, she transformed her reenactment. She did less muttering and exploring and spent more time rocking and humming. Finally, after many months of having me lie on the floor, as I started to walk to the middle of the room to lay down, she took my hand and led me to a rocking chair instead. She had me sit. She walked over to the bookcase, pulled down a book and crawled into my lap. “Read me a story,” she said. And as I started she said, “Rock.” Thereafter, Sandy sat in my lap and we rocked and read books.

  It was not a cure, but it was a good start. And even though she had to go through an awful custody battle as her biological father, her maternal grandmother and her foster family fought for custody of her, I’m pleased to say that ultimately, Sandy did all right. Her progress was slow but steady, especially after the custody case was resolved in favor of the foster family, with whom she spent the rest of her childhood. Sometimes, she struggled, but mostly she did amazingly well. She made friends, got good grades and was notably kind and nurturing in her interactions with others. Often, years would go by and I wouldn’t hear anything about her. But frequently, I thought about Sandy and what she had taught me in our work together. As I write this I am pleased to say that only months ago I received an update. She is doing well. Because of the circumstances of her case I cannot reveal any further details. Suffice it to say, she’s having the kind of satisfying and productive life we had all wanted for her. Nothing could make me happier.

  chapter 3

  Stairway to Heaven

  INSIDE THE BRANCH Davidian compound in Waco, Texas, children lived in a world of fear. Even babies weren’t immune: cult leader David Koresh believed that the wills of infants—some just eight months old—needed to be broken with strict physical discipline if they were to stay “in the light.” Koresh was mercurial: one moment kind, attentive and nurturing, and the next, a prophet of rage. His wrath was inescapable and unpredictable. The Davidians, as the members of the Mount Carmel religious community were called, became exquisitely sensitive to his moods as they attempted to curry his favor and tried, often in vain, to stave off his vengeance.

  With his volatile temper and fearsome anger, Koresh excelled at using irregular doses of extreme threat—alternating with kind, focused attention—to keep his followers off balance. He maintained an iron grip, controlling every aspect of life in the compound. He separated husband from wife, child from parent, friend from friend, undermining any relationship that could challenge his position as the most dominant, powerful force in each person’s life. Everyone’s love converged upon him, like spokes connecting to the hub of a wheel. Koresh was the source of all insight, wisdom, love and power; he was the conduit to God, if not God himself on earth.

  And he was a god who ruled by fear. Children (and sometimes even adults) were in constant fear of the physical attacks and public humiliation that could result from the tiniest error, like spilling milk. Punishment often involved being beaten bloody with a wooden paddle called “the helper.” Davidian children also feared hunger: those who “misbehaved” could be deprived of food for days or put on a bland diet of only potatoes or bread. Sometimes, they would be isolated overnight. And, for the girls, there was knowledge that they would ultimately become a “Bride of David.” In a unique form of sanctioned sexual abuse girls as young as ten were groomed to become Koresh’s sexual partners. A former member said Koresh once excitedly compared the heartbeats of the prepubescent girls he violated to those of hunted animals.

  But perhaps the most pervasive fear that Koresh instilled was the fear of the “Babylonians”: outsiders, government agents, nonbelievers. Koresh preached about and constantly prepared his community for the “final battle.” The Branch Davidians, including children, were being readied for the imminent end of the world (hence Koresh’s nickname for the compound, Ranch Apocalypse). This preparation involved military drills, interrupted sleep, and one-on-one fighting. If the children didn’t want to participate or weren’t vicious enough in battle training, they were humiliated and sometimes beaten. Even the youngest members were taught how to handle guns. They were instructed in the most lethal suicide techniques with firearms, being told to aim for the “soft spot” in the back of the mouth if they faced capture by the “Babylonians.” The rationale was that “unbelievers” would ultimately come to kill everyone. After this apocalyptic battle, however, members were promised that they would be reunited with their families in heaven and Koresh—God—would return to earth to smite his enemies.

  I CAME TO TEXAS in 1992 to become the vice chairman for research in the department of psychiatry at Baylor College of Medicine (BCM) in Houston. I also served as chief of psychiatry at Texas Children’s Hospital (TCH) and director of the Trauma Recovery Program at the Houston Veterans Administration Medical Center (VAMC). My experiences with Tina, Sandy, the boys at the residential center and others like them had convinced me that we didn’t know enough about trauma and its effects on children’s mental health. We didn’t know how trauma during development produced particular problems in particular children. No one could say why some came away from trauma seemingly unscathed while others developed serious mental illnesses and behavioral problems. No one knew where the devastating symptoms of conditions like post-traumatic stress disorder came from, and why some children would develop, say, primarily dissociative symptoms, while others would mainly be hyper-vigilant. The only way to figure this out, it seemed, was to closely study groups of children immediately after a traumatic event. Unfortunately, children were usually brought to us for help only years after they’d suffered trauma, not right away.

  It was to attempt to solve this problem that I, in coordination with BCM, TCH, and VAMC, put together a “rapid response” Trauma Assessment Team. It was our hope that while helping children cope with acute traumas like shootings, car accidents, natural disasters and other life threatening situations, we could learn what to expect from children in the immediate aftermath of a traumatic experience and how this related to any symptoms they might ultimately suffer. The children of Waco would provide one unfortunately apt sample to study.

  ON FEBRUARY 28, 1993, the “Babylonians” in the form of the Bureau of Alcohol, Tobacco and Firearms (BATF) came to the Branch Davidian compound to arrest David Koresh for firearms violations. He would not allow himself to be taken alive. Four BATF agents and at least six Branch Davidians were killed in the ensuing raid. The FBI and its hostage negotiation team managed to secure the release of twenty-one children over the following three days. It was at this point that my team was brought in to help with what we thought would be the first wave of children from the compound. What none of us knew at the time was that we would never meet more Davidian children. The siege would end with a second and far more catastrophic raid on April 19, which left eighty members (including twenty-three children) dead in a horrific conflagration.

  I heard about the first raid on the Branch Davidian compound like most people did: from the news on television. Almost immediately, reporters began calling to ask me how the raid might affect the children. When I was questioned about what was being done to help those who’d been removed from the compound, I replied
almost off-handedly that I was sure the state was making sure they were properly cared for.

  But just as soon as the words left my mouth, I realized that this was probably not true. Government agencies—especially the chronically underfunded and overburdened Child Protective Service (CPS) systems—rarely have concrete plans to deal with sudden influxes of large groups of children. Furthermore, chains of command between the federal, state and local agencies involved in law enforcement and CPS are often unclear in unusual, fast-moving crises like the Waco standoff.

  As I thought more about this I felt pulled to see whether the expertise on childhood trauma that our Trauma Assessment Team had been developing could be helpful. I figured we could provide the people working with these children some basic information, consult by phone to help them solve particular problems, and play a supportive role in helping them better understand the situation. I contacted several agencies but no one could tell me who was “in charge.” Finally I reached the governor’s office. Within a few hours I was called by the state office of CPS and was asked to come to Waco for what I thought would be a one-time consultation. That afternoon meeting turned into six weeks of one of the most difficult cases I have ever had.

  WHEN I ARRIVED in Waco I found disarray, both in the official agencies responding to the crisis and in the care of the children. During the first few days, when the children were released, they were driven away from the compound in large tank-like vehicles. No matter what time of day or night it was when they came out, they were immediately interrogated by the FBI and the Texas Rangers, often for hours. The FBI had the best intentions; they wanted information quickly so that they could help defuse the situation at the Ranch and get more people out safely. Witness’s statements were needed, and the Texas Rangers were charged with gathering evidence for future criminal trials in order to prosecute those involved in the shooting deaths of the BATF agents. But neither group had thought through how overwhelming it would be for a child to be taken from his parents, put in a tank after witnessing a deadly raid on his home, driven to an armory and questioned at length by numerous armed, strange men.