Special Team : Stockton--Tending to the Psyche

Nearly two years before gunshots shattered the tranquility of the Cleveland Elementary School playground, psychologists and social workers here were quietly putting together a special team of health professionals to deal with violent death.

Although they did not know how it would come or when it would happen--or that it would be so heinous--the Stockton experts were prepared, in ways that few are, to face the immediate and long-term effect of death on a community.

Health professionals around the country are applauding Stockton’s mental-health community for using findings of the latest research on bereavement in dealing with a crisis that left five children dead and 30 injured and hundreds of schoolchildren, parents and emergency workers psychologically devastated.

They all, to varying degrees, were the victims of Patrick Edward Purdy, who for no apparent reason slipped onto the Cleveland Elementary School playground Tuesday, sprayed 110 rounds from an assault rifle, then took his own life.

Death is not a subject that Americans like to discuss and, until the last two decades, it was a subject that most researchers shunned, said Stephen E. Goldston, a UCLA researcher, who spent 25 years at the National Institute of Mental Health near Washington. But what has been discovered in recent years--and what Stockton is putting into practice now--is a new way of approaching grief that contradicts many of the most deeply held beliefs about death and dying.

Rather than solving trauma cases on an ad hoc basis, Stockton’s psychological relief team systematically identifies people at risk, then designs group and individual treatment therapies. Composed of school counselors, community health workers and private therapists, the team teaches victims and their friends and families how to constructively confront the psychological pain of death. Too often, a growing body of experts now believe, victims are allowed to deny and avoid such painful, but necessary, therapy.

Immediate Start

“As soon as this thing happened (Tuesday) afternoon, we started the procedures to begin the healing process,” said Fred Busher, head of psychological services for the Stockton Unified School District.

Stockton set up its emergency psychology team in response to growing community concern about teen-age suicides and fatal automobile accidents, said David Love, executive director of Valley Community Counseling Services here.

Other cities, particularly in California, are beginning to form psychological response teams that take similar approaches to dealing with death. In Southern California, for example, some Los Angeles, Pasadena and Orange County schools are setting up such teams, partly in anticipation of a catastrophic earthquake, but also because of violent acts on their campuses.

Convinced of the importance of this approach, the National Institute of Mental Health, part of the National Institutes of Health, is supporting efforts at UCLA to counsel school districts around the nation on how to implement techniques similar to those now being used in Stockton.

Heading up this effort is Dr. Robert S. Pynoos, who has just finished a manual for schools to be published soon. The manual, according to Pynoos, will show health professionals how to do precisely what Stockton has done in recognizing that psychological wounds are often just as deep as physical ones, and sometimes slower to heal.

Fred Busher’s wife, Patricia, a psychologist who is principal of Cleveland Elementary School, said the community will keep counseling services in operation for years if necessary.

The fears, anger, guilt and other reactions that typically accompany sudden and violent death are contagious, experts say. The power and immediacy of television can spread the effects of a violent act far beyond its place of origin.

Extended Counseling

Stockton school officials say they are providing counseling services to neighboring schools as well as Cleveland.

“You can be sure that other kids in schoolyards throughout the Bay Area, probably throughout California and maybe even around the country, are going to be bouncing off the walls in the next few days,” said an official of the National Organization for Victims Assistance, which also has a team that provides emotional first-aid to people coping with disasters.

Professionals who help victims also are at risk of mental disturbances as a result of such a tragedy, so counseling is being provided to firefighters, police officers, parents, teachers. Even the counselors themselves may need help, Busher said.

Despite the overwhelming tragedy, Stockton in some ways is lucky, Patricia Busher said. “These are first-rate people . . . who just happen to be very involved . . . and very sophisticated about these issues,” she said.

“From everything I have heard, the professional response is very positive--all the right things seem to be happening,” Goldston said. “You couldn’t have said that five or even three years ago about any place in this country. . . . Americans have long held crazy, denying attitudes about death.

“You can see it,” he said, “everywhere in people’s inappropriate attitudes toward death. We like to pretend it didn’t happen, that it will go away. When a mother loses a child, a perfectly well-meaning person will invariably say, ‘Oh, get pregnant again as soon as you can so you won’t have to grieve the loss of this one so much.’ ”

Young Field

Death and bereavement as a sub-specialty of psychiatry and psychology is a relatively young field, beginning with only a handful of studies in the mid-1940s and 1950s and not commencing in earnest until the early- to mid-1970s.

Even today there are persistent myths about death and how people cope with it that are simply not supported by research, said Gerald Koocher, an expert in children’s death and family grieving. The public and even some mental-health professionals, he said, persist in believing that the best way to handle death is to get over it as quickly as possible. Some experts also mistakenly believe that suicide and divorce rates are higher among those who have suffered sudden and violent losses of loved ones or who have watched close up prolonged and painful death.

“That is not true if appropriate care is taken,” Koocher said.

The first step is to recognize that no one ever recovers from the death of a loved one, experts agree. Instead, they “rebuild” themselves to accept the change. For the professionals in Stockton, the first step is to get the survivors and their families to talk about what they had seen and felt. Psychologists call this process “ventilating.”

One boy, unable to express his reaction to the wounding of his brother Tuesday, was able to draw pictures of Purdy’s car exploding in flames. Purdy had set it afire before entering the schoolyard. Another boy, who was in a bathroom at the time of the shooting, admitted to a counselor that he is now afraid to go to the bathroom alone. The counselor suspects that the boy fears he somehow brought on the tragedy himself and could do so again.

Search for Reality

But by acknowledging these feelings, rather than dismissing them as silly or illogical, the teams hopes to pave the way for a more realistic understanding of what occurred.

Part of this process is to “validate”--to let the traumatized know that their feelings are normal, whether the feeling is rage at being abandoned or guilt at not preventing the tragedy. Here, experts say, it helps for patients to freely use words such as guilt , anger and loneliness to describe their feelings.

Being able to talk about emotions, a key to most kinds of psychological treatment, will be particularly difficult for many of the victims of the Stockton massacre.

The families of all five children who died are from various countries in Southeast Asia, where cultural traditions sometimes prevent open expression of emotions, particularly to strangers. Attitudes toward death also vary, not only by culture but by family traditions and experiences as well.

Because of this, Stockton has called in Asian counselors from neighboring cities. But because there are so few of these specialists, interpreters are being used by English-speaking psychologists and counselors.

“A great deal is being made of the cultural differences,” Pynoos said. “These children may respond differently on the outside but inside they are going through very similar experiences.”

Research has been done internationally, particularly in Israel and Northern Ireland, on death and bereavement, and it is clear that the patterns are “very comparable across national borders,” said Dr. Norman Garmazy, a psychiatrist at the University of Minnesota.

But research applicable to a school setting in the United States is only beginning to emerge. Psychiatrists and psychologists are still grappling with the effects of other violent killings involving children, notably a 1988 incident in Winnetka, Ill., and the 1984 shooting at 49th Street Elementary School in Los Angeles, as well as the 1984 massacre at a McDonald’s restaurant in San Ysidro.

One of the first problems therapists must confront in Stockton is destruction of the universal belief that a school is a safe place for children.

On the day after the shooting, every classroom at the school had at least one psychologist or social worker or psychiatric nurse and some had several to conduct one-on-one counseling. But because only about one-fourth of the children returned to school, counselors also went to hospitals and into the community, and the principal herself went to apartments buildings and housing projects, urging children to return to school.

“This is one day you can be late to school,” Patricia Busher told children, hugging and kissing them to restore trust and confidence.

Many of the Southeast Asian children in Stockton, and their families, face the added factor of being refugees from violence in their own countries.

Special Problems

The youngest of the children at the school and the small brothers and sisters of the victims will also have special problems, experts predict. Under the age of 6, for example, research shows that children do not believe death is permanent. So, many will have recurring fears that the gunman will return even though adults know he will not.

Teachers and parents, too, will face psychological traumas, particularly guilt feelings that they should have prevented the shooting, experts said.

Some psychological trauma is normal, even if it lasts months or years, for those going through a tragedy such as the Stockton shooting, Koocher emphasized.

The important thing, he said, is to teach families and loved ones to listen, and to be supportive of the victims and those who witnessed the tragedy, not just for a few hours or a few days but for months and years to come.

“The first aid that is going on now immediately after the trauma is very important,” Pynoos said. “But what is crucial is the work that will come. The kids have to be tracked and identified for how much exposure (to violence) they experienced. . . . Different therapies will have to be applied to different people. The real work is yet to come.”