Excerpt from Trauma Through a Child’s Eyes (By Peter A. Levine and Maggie Kline) reprinted with permission from publisher.

Like very young children, older children often re-enact the details of a traumatic event during their play because they have developed language skills, they also re-enact by telling the story of what happened over and over again. Fear and helplessness often show up as disorganized or agitated behavior: Although they may recount the event, children usually are not able to put their feelings into words or even to understand exactly what it is they are feeling other than “mixed up,” “upset,” or “all shook up.”

These youngsters may be concerned with more than just the details of the event itself. Their preoccupation may center on a recounting of their own actions or inability to act during the incident. They may feel responsible and be plagued with feelings of self-blame or shame that they keep as a deep dark secret, frequently alienating them from family and friends. They think that if they had done something differently, the “terrible thing” would never have happened. This is particularly true with issues of separation, such as death and divorce.

Except from my overworked brain:

Gage only occasionally recounts the events around his illness and treatment and they are usually in relation to something else, like “remember the boy on dialysis who…” or “Do you remember that funny doctor with the bow tie who…”. I think maybe two or three times he’s talked about his treatment experience. But he doesn’t offer an abundance of words for anything health care related, except maybe to protest about labs. Since he’s been in play therapy he has talked about traumatic – frightening – sad experiences but always it has been in “dreams” and rarely “I am not sure if I remember this right, but…” and both instances show me how closed off he is to his own experience because he can’t recall many details surrounding his treatment/care.

When he’s talked about “bad things” happening in dreams he’s had they have involved him, me, a gurney, a doctor and a monster. Sometimes he can’t get up, sometimes I can’t get to him, sometimes I won’t get him, and most times we can’t get out of the hospital (sometimes he doesn’t say hospital, he says room or building) because of the monster. I have analyzed this scenario several times and they all come back to one thing: sadness for my boy.

The other part of this is that during the summer and fall when Gage’s depression and suicidal talks/behavior were at their worst his academic life and behavior followed. There’s a cycle to this that is unavoidable — the trauma of his experience has impacted him on all fronts. Which came first? The troubled boy or the sick boy?

But Gage is making small progress. For the first time in months it feels like he is engaging with us, his family. There is a mixture of compassion, patience, therapy, school support, medication and determination that is leading Gage and helping him bond to us and to life again. We all have a long way to go still, but he’s doing better with a heck of a lot of intervention.