EPILOGUE: CHOICES TO BE MADE

We are on the verge of becom­ing a trau­ma-con­scious soci­ety. Almost every day one of my col­leagues pub­lish­es anoth­er report on how trau­ma dis­rupts the work­ings of mind, brain, and body. The ACE study showed how ear­ly abuse dev­as­tates health and social func­tion­ing, while James Heck­man won a Nobel Prize for demon­strat­ing the vast sav­ings pro­duced by ear­ly inter­ven­tion in the lives of chil­dren from poor and trou­bled fam­i­lies: more high school grad­u­a­tions, less crim­i­nal­i­ty, increased employ­ment, and decreased fam­i­ly and com­mu­ni­ty vio­lence. All over the world I meet peo­ple who take these data seri­ous­ly and who work tire­less­ly to devel­op and apply more effec­tive inter­ven­tions, whether devot­ed teach­ers, social work­ers, doc­tors, ther­a­pists, nurs­es, phil­an­thropists, the­ater direc­tors, prison guards, police offi­cers, or med­i­ta­tion coach­es. If you have come this far with me in The Body Keeps the Score, you have also become part of this com­mu­ni­ty.

Advances in neu­ro­science have giv­en us a bet­ter under­stand­ing of how trau­ma changes brain devel­op­ment, self-reg­u­la­tion, and the capac­i­ty to stay focused and in tune with oth­ers. Sophis­ti­cat­ed imag­ing tech­niques have iden­ti­fied the ori­gins of PTSD in the brain, so that we now under­stand why trau­ma­tized peo­ple become dis­en­gaged, why they are both­ered by sounds and lights, and why they may blow up or with­draw in response to the slight­est provo­ca­tion. We have learned how, through­out life, expe­ri­ences change the struc­ture and func­tion of the brain—and even affect the genes we pass on to our chil­dren. Under­stand­ing many of the fun­da­men­tal process­es that under­lie trau­mat­ic stress opens the door to an array of inter­ven­tions that can bring the brain areas relat­ed to self-reg­u­la­tion, self-per­cep­tion, and atten­tion back online. We know not only how to treat trau­ma but also, increas­ing­ly, how to pre­vent it.

And yet, after attend­ing anoth­er wake for a teenag­er who was killed in a dri­ve-by shoot­ing in the Blue Hill Avenue sec­tion of Boston or after read­ing about the lat­est school bud­get cuts in impov­er­ished cities and towns, I find myself close to despair. In many ways we seem to be regress­ing, with mea­sures like the cal­lous con­gres­sion­al elim­i­na­tion of food stamps for kids whose par­ents are unem­ployed or in jail; with the stub­born oppo­si­tion to uni­ver­sal health care in some quar­ters; with psychiatry’s obtuse refusal to make con­nec­tion between psy­chic suf­fer­ing and social con­di­tions; with the refusal to pro­hib­it the sale or pos­ses­sion of weapons whose only pur­pose is to kill large num­bers of human beings; and with our tol­er­ance for incar­cer­at­ing a huge seg­ment of our pop­u­la­tion, wast­ing their lives as well as our resources.

Dis­cus­sions of PTSD still tend to focus on recent­ly returned sol­diers, vic­tims of ter­ror­ist bomb­ings, or sur­vivors of ter­ri­ble acci­dents. But trau­ma remains a much larg­er pub­lic health issue, arguably the great­est threat to our nation­al well-being. Since 2001 far more Amer­i­cans have died at the hands of their part­ners or oth­er fam­i­ly mem­bers than in the wars in Iraq and Afghanistan. Amer­i­can women are twice as like­ly to suf­fer domes­tic vio­lence as breast can­cer. The Amer­i­can Acad­e­my of Pedi­atrics esti­mates that firearms kill twice as many chil­dren as can­cer does. All around Boston I see signs adver­tis­ing the Jim­my Fund, which fights children’s can­cer, and for march­es to fund research on breast can­cer and leukemia, but we seem too embar­rassed or dis­cour­aged to mount a mas­sive effort to help chil­dren and adults learn to deal with the fear, rage, and col­lapse, the pre­dictable con­se­quences of hav­ing been trau­ma­tized.

When I give pre­sen­ta­tions on trau­ma and trau­ma treat­ment, par­tic­i­pants some­times ask me to leave out the pol­i­tics and con­fine myself to talk­ing about neu­ro­science and ther­a­py. I wish I could sep­a­rate trau­ma from pol­i­tics, but as long as we con­tin­ue to live in denial and treat only trau­ma while ignor­ing its ori­gins, we are bound to fail. In today’s world your ZIP code, even more than your genet­ic code, deter­mines whether you will lead a safe and healthy life. People’s income, fam­i­ly struc­ture, hous­ing, employ­ment, and edu­ca­tion­al oppor­tu­ni­ties affect not only their risk of devel­op­ing trau­mat­ic stress but also their access to effec­tive help to address it. Pover­ty, unem­ploy­ment, infe­ri­or schools, social iso­la­tion, wide­spread avail­abil­i­ty of guns, and sub­stan­dard hous­ing all are breed­ing grounds for trau­ma. Trau­ma breeds fur­ther trau­ma; hurt peo­ple hurt oth­er peo­ple.

My most pro­found expe­ri­ence with heal­ing from col­lec­tive trau­ma was wit­ness­ing the work of the South African Truth and Rec­on­cil­i­a­tion Com­mis­sion, which was based on the cen­tral guid­ing prin­ci­ple of Ubun­tu, a Xhosa word that denotes shar­ing what you have, as in “My human­i­ty is inex­tri­ca­bly bound up in yours.” Ubun­tu rec­og­nizes that true heal­ing is impos­si­ble with­out recog­ni­tion of our com­mon human­i­ty and our com­mon des­tiny.

We are fun­da­men­tal­ly social creatures—our brains are wired to fos­ter work­ing and play­ing togeth­er. Trau­ma dev­as­tates the social-engage­ment sys­tem and inter­feres with coop­er­a­tion, nur­tur­ing, and the abil­i­ty to func­tion as a pro­duc­tive mem­ber of the clan. In this book we have seen how many men­tal health prob­lems, from drug addic­tion to self-inju­ri­ous behav­ior, start off as attempts to cope with emo­tions that became unbear­able because of a lack of ade­quate human con­tact and sup­port. Yet insti­tu­tions that deal with trau­ma­tized chil­dren and adults all too often bypass the emo­tion­al-engage­ment sys­tem that is the foun­da­tion of who we are and instead focus nar­row­ly on cor­rect­ing “faulty think­ing” and on sup­press­ing unpleas­ant emo­tions and trou­ble­some behav­iors.

Peo­ple can learn to con­trol and change their behav­ior, but only if they feel safe enough to exper­i­ment with new solu­tions. The body keeps the score: If trau­ma is encod­ed in heart­break­ing and gut-wrench­ing sen­sa­tions, then our first pri­or­i­ty is to help peo­ple move out of fight-or-flight states, reor­ga­nize their per­cep­tion of dan­ger, and man­age rela­tion­ships. Where trau­ma­tized chil­dren are con­cerned, the last things we should be cut­ting from school sched­ules are the activ­i­ties that can do pre­cise­ly that: cho­rus, phys­i­cal edu­ca­tion, recess, and any­thing else that involves move­ment, play, and oth­er forms of joy­ful engage­ment.

As we’ve seen, my own pro­fes­sion often com­pounds, rather than alle­vi­ates, the prob­lem. Many psy­chi­a­trists today work in assem­bly-line offices where they see patients they hard­ly know for fif­teen min­utes and then dole out pills to relieve pain, anx­i­ety, or depres­sion. Their mes­sage seems to be “Leave it to us to fix you; just be com­pli­ant and take these drugs and come back in three months—but be sure not to use alco­hol or (ille­gal) drugs to relieve your prob­lems.” Such short­cuts in treat­ment make it impos­si­ble to devel­op self-care and self-lead­er­ship. One trag­ic exam­ple of this ori­en­ta­tion is the ram­pant pre­scrip­tion of painkillers, which now kill more peo­ple each year in the Unit­ed States than guns or car acci­dents.

Our increas­ing use of drugs to treat these con­di­tions doesn’t address the real issues: What are these patients try­ing to cope with? What are their inter­nal or exter­nal resources? How do they calm them­selves down? Do they have car­ing rela­tion­ships with their bod­ies, and what do they do to cul­ti­vate a phys­i­cal sense of pow­er, vital­i­ty, and relax­ation? Do they have dynam­ic inter­ac­tions with oth­er peo­ple? Who real­ly knows them, loves them, and cares about them? Whom can they count on when they’re scared, when their babies are ill, or when they are sick them­selves? Are they mem­bers of a com­mu­ni­ty, and do they play vital roles in the lives of the peo­ple around them? What spe­cif­ic skills do they need to focus, pay atten­tion, and make choic­es? Do they have a sense of pur­pose? What are they good at? How can we help them feel in charge of their lives?

I like to believe that once our soci­ety tru­ly focus­es on the needs of chil­dren, all forms of social sup­port for families—a pol­i­cy that remains so con­tro­ver­sial in this country—will grad­u­al­ly come to seem not only desir­able but also doable. What dif­fer­ence would it make if all Amer­i­can chil­dren had access to high-qual­i­ty day care where par­ents could safe­ly leave their chil­dren as they went off to work or school? What would our school sys­tems look like if all chil­dren could attend well-staffed preschools that cul­ti­vat­ed coop­er­a­tion, self-reg­u­la­tion, per­se­ver­ance, and con­cen­tra­tion (as opposed to focus­ing on pass­ing tests, which will like­ly hap­pen once chil­dren are allowed to fol­low their nat­ur­al curios­i­ty and desire to excel, and are not shut down by hope­less­ness, fear, and hyper­arousal)?

I have a fam­i­ly pho­to­graph of myself as a five-year-old, perched between my old­er (obvi­ous­ly wis­er) and younger (obvi­ous­ly more depen­dent) sib­lings. In the pic­ture I proud­ly hold up a wood­en toy boat, grin­ning from ear to ear: “See what a won­der­ful kid I am and see what an incred­i­ble boat I have! Wouldn’t you love to come and play with me?” All of us, but espe­cial­ly chil­dren, need such confidence—confidence that oth­ers will know, affirm, and cher­ish us. With­out that we can’t devel­op a sense of agency that will enable us to assert: “This is what I believe in; this is what I stand for; this is what I will devote myself to.” As long as we feel safe­ly held in the hearts and minds of the peo­ple who love us, we will climb moun­tains and cross deserts and stay up all night to fin­ish projects. Chil­dren and adults will do any­thing for peo­ple they trust and whose opin­ion they val­ue.

But if we feel aban­doned, worth­less, or invis­i­ble, noth­ing seems to mat­ter. Fear destroys curios­i­ty and play­ful­ness. In order to have a healthy soci­ety we must raise chil­dren who can safe­ly play and learn. There can be no growth with­out curios­i­ty and no adapt­abil­i­ty with­out being able to explore, through tri­al and error, who you are and what mat­ters to you. Cur­rent­ly more than 50 per­cent of the chil­dren served by Head Start have had three or more adverse child­hood expe­ri­ences like those includ­ed in the ACE study: incar­cer­at­ed fam­i­ly mem­bers, depres­sion, vio­lence, abuse, or drug use in the home, or peri­ods of home­less­ness.

Peo­ple who feel safe and mean­ing­ful­ly con­nect­ed with oth­ers have lit­tle rea­son to squan­der their lives doing drugs or star­ing numbly at tele­vi­sion; they don’t feel com­pelled to stuff them­selves with car­bo­hy­drates or assault their fel­low human beings. How­ev­er, if noth­ing they do seems to make a dif­fer­ence, they feel trapped and become sus­cep­ti­ble to the lure of pills, gang lead­ers, extrem­ist reli­gions, or vio­lent polit­i­cal movements—anybody and any­thing that promis­es relief. As the ACE study has shown, child abuse and neglect is the sin­gle most pre­ventable cause of men­tal ill­ness, the sin­gle most com­mon cause of drug and alco­hol abuse, and a sig­nif­i­cant con­trib­u­tor to lead­ing caus­es of death such as dia­betes, heart dis­ease, can­cer, stroke, and sui­cide.

My col­leagues and I focus much of our work where trau­ma has its great­est impact: on chil­dren and ado­les­cents. Since we came togeth­er to estab­lish the Nation­al Child Trau­mat­ic Stress Net­work in 2001, it has grown into a col­lab­o­ra­tive net­work of more than 150 cen­ters nation­wide, each of which has cre­at­ed pro­grams in schools, juve­nile jus­tice sys­tems, child wel­fare agen­cies, home­less shel­ters, mil­i­tary facil­i­ties, and res­i­den­tial group homes.

The Trau­ma Cen­ter is one of NCTSN’s Treat­ment Devel­op­ment and Eval­u­a­tion sites. My col­leagues Joe Spinaz­zo­la, Mar­garet Blaustein, and I have devel­oped com­pre­hen­sive pro­grams for chil­dren and ado­les­cents that we, with the help of trau­ma-savvy col­leagues in Hart­ford, Chica­go, Hous­ton, San Fran­cis­co, Anchor­age, Los Ange­les, and New York, are now imple­ment­ing. Our team selects a par­tic­u­lar area of the coun­try to work in every two years, rely­ing on local con­tacts to iden­ti­fy orga­ni­za­tions that are ener­getic, open, and well respect­ed; these will even­tu­al­ly serve as new nodes for treat­ment dis­sem­i­na­tion. For exam­ple, I col­lab­o­rat­ed for one two-year peri­od with col­leagues in Mis­soula, Mon­tana, to help devel­op a cul­tur­al­ly sen­si­tive trau­ma pro­gram on Black­foot Indi­an reser­va­tions.

The great­est hope for trau­ma­tized, abused, and neglect­ed chil­dren is to receive a good edu­ca­tion in schools where they are seen and known, where they learn to reg­u­late them­selves, and where they can devel­op a sense of agency. At their best, schools can func­tion as islands of safe­ty in a chaot­ic world. They can teach chil­dren how their bod­ies and brains work and how they can under­stand and deal with their emo­tions. Schools can play a sig­nif­i­cant role in instill­ing the resilience nec­es­sary to deal with the trau­mas of neigh­bor­hoods or fam­i­lies. If par­ents are forced to work two jobs to eke out a liv­ing, or if they are too impaired, over­whelmed, or depressed to be attuned to the needs of their kids, schools by default have to be the places where chil­dren are taught self-lead­er­ship and an inter­nal locus of con­trol.

When our team arrives at a school, the teach­ers’ ini­tial response is often some ver­sion of “If I’d want­ed to be a social work­er, I would have gone to social work school. But I came here to be a teacher.” Many of them have already learned the hard way, how­ev­er, that they can­not teach if they have a class­room filled with stu­dents whose alarm bells are con­stant­ly going off. Even the most com­mit­ted teach­ers and school sys­tems often come to feel frus­trat­ed and inef­fec­tive because so many of their kids are too trau­ma­tized to learn. Focus­ing only on improv­ing test scores won’t make any dif­fer­ence if teach­ers can’t effec­tive­ly address the behav­ior prob­lems of these stu­dents. The good news is that the basic prin­ci­ples of trau­ma-focused inter­ven­tions can be trans­lat­ed into prac­ti­cal day-to-day rou­tines and approach­es that can trans­form the entire cul­ture of a school.

Most teach­ers we work with are intrigued to learn that abused and neglect­ed stu­dents are like­ly to inter­pret any devi­a­tion from rou­tine as dan­ger and that their extreme reac­tions usu­al­ly are expres­sions of trau­mat­ic stress. Chil­dren who defy the rules are unlike­ly to be brought to rea­son by ver­bal rep­ri­mands or even suspension—a prac­tice that has become epi­dem­ic in Amer­i­can schools. Teach­ers’ per­spec­tives begin to change when they real­ize that these kids’ dis­turb­ing behav­iors start­ed out as frus­trat­ed attempts to com­mu­ni­cate dis­tress and as mis­guid­ed attempts to sur­vive.

More than any­thing else, being able to feel safe with oth­er peo­ple defines men­tal health; safe con­nec­tions are fun­da­men­tal to mean­ing­ful and sat­is­fy­ing lives. The crit­i­cal chal­lenge in a class­room set­ting is to fos­ter reci­procity: tru­ly hear­ing and being heard; real­ly see­ing and being seen by oth­er peo­ple. We try to teach every­one in a school community—office staff, prin­ci­pals, bus dri­vers, teach­ers, and cafe­te­ria workers—to rec­og­nize and under­stand the effects of trau­ma on chil­dren and to focus on the impor­tance of fos­ter­ing safe­ty, pre­dictabil­i­ty, and being known and seen. We make cer­tain that the chil­dren are greet­ed by name every morn­ing and that teach­ers make face-to-face con­tact with each and every one of them. Just as in our work­shops, group work, and the­ater pro­grams, we always start the day with check-ins: tak­ing the time to share what’s on everybody’s mind.

Many of the chil­dren we work with have nev­er been able to com­mu­ni­cate suc­cess­ful­ly with lan­guage, as they are accus­tomed to adults who yell, com­mand, sulk, or put ear­buds in their ears. One of our first steps is to help their teach­ers mod­el new ways of talk­ing about feel­ings, stat­ing expec­ta­tions, and ask­ing for help. Instead of yelling, “Stop!” when a child is throw­ing a tantrum or mak­ing her sit alone in the cor­ner, teach­ers are encour­aged to notice and name the child’s expe­ri­ence, as in “I can see how upset you are”; to give her choic­es, as in “Would you like to go to the safe spot or sit on my lap?”; and to help her find words to describe her feel­ings and begin to find her voice, as in: “What will hap­pen when you get home after class?” It may take many months for a child to know when it is safe to speak the truth (because it will nev­er be uni­ver­sal­ly safe), but for chil­dren, as for adults, iden­ti­fy­ing the truth of an expe­ri­ence is essen­tial to heal­ing from trau­ma.

It is stan­dard prac­tice in many schools to pun­ish chil­dren for tantrums, spac­ing out, or aggres­sive outbursts—all of which are often symp­toms of trau­mat­ic stress. When that hap­pens, the school, instead of offer­ing a safe haven, becomes yet anoth­er trau­mat­ic trig­ger. Angry con­fronta­tions and pun­ish­ment can at best tem­porar­i­ly halt unac­cept­able behav­iors, but since the under­ly­ing alarm sys­tem and stress hor­mones are not laid to rest, they are cer­tain to erupt again at the next provo­ca­tion.

In such sit­u­a­tions the first step is acknowl­edg­ing that a child is upset; then the teacher should calm him, then explore the cause and dis­cuss pos­si­ble solu­tions. For exam­ple, when a first-grad­er melts down, hit­ting his teacher and throw­ing objects around, we encour­age his teacher to set clear lim­its while gen­tly talk­ing to him: “Would you like to wrap that blan­ket around you to help you calm down?” (The kid is like­ly to scream, “No!” but then curl up under the blan­ket and set­tle down.) Pre­dictabil­i­ty and clar­i­ty of expec­ta­tions are crit­i­cal; con­sis­ten­cy is essen­tial. Chil­dren from chaot­ic back­grounds often have no idea how peo­ple can effec­tive­ly work togeth­er, and incon­sis­ten­cy only pro­motes fur­ther con­fu­sion. Trau­ma-sen­si­tive teach­ers soon real­ize that call­ing a par­ent about an obstreper­ous kid is like­ly to result in a beat­ing and fur­ther trauma­ti­za­tion.

Our goal in all these efforts is to trans­late brain sci­ence into every­day prac­tice. For exam­ple, calm­ing down enough to take charge of our­selves requires acti­vat­ing the brain areas that notice our inner sen­sa­tions, the self-observ­ing watch­tow­er dis­cussed in chap­ter 4. So a teacher might say: “Shall we take some deep breaths or use the breath­ing star?” (This is a col­or­ful breath­ing aid made out of file fold­ers.) Anoth­er option might be hav­ing the child sit in a cor­ner wrapped in a heavy blan­ket while lis­ten­ing to some sooth­ing music through head­phones. Safe areas can help kids calm down by pro­vid­ing stim­u­lat­ing sen­so­ry aware­ness: the tex­ture of burlap or vel­vet; shoe box­es filled with soft brush­es and flex­i­ble toys. When the child is ready to talk again, he is encour­aged to tell some­one what is going on before he rejoins the group.

Kids as young as three can blow soap bub­bles and learn that when they slow down their breath­ing to six breaths per minute and focus on the out breath as it flows over their upper lip, they will feel more calm and focused. Our team of yoga teach­ers works with chil­dren near­ing ado­les­cence specif­i­cal­ly to help them “befriend” their bod­ies and deal with dis­rup­tive phys­i­cal sen­sa­tions. We know that one of the prime rea­sons for habit­u­al drug use in teens is that they can­not stand the phys­i­cal sen­sa­tions that sig­nal fear, rage, and help­less­ness.

Self-reg­u­la­tion can be taught to many kids who cycle between fran­tic activ­i­ty and immo­bil­i­ty. In addi­tion to read­ing, writ­ing, and arith­metic, all kids need to learn self-aware­ness, self-reg­u­la­tion, and com­mu­ni­ca­tion as part of their core cur­ricu­lum. Just as we teach his­to­ry and geog­ra­phy, we need to teach chil­dren how their brains and bod­ies work. For adults and chil­dren alike, being in con­trol of our­selves requires becom­ing famil­iar with our inner world and accu­rate­ly iden­ti­fy­ing what scares, upsets, or delights us.

Emo­tion­al intel­li­gence starts with label­ing your own feel­ings and attun­ing to the emo­tions of the peo­ple around you. We begin very sim­ply: with mir­rors. Look­ing into a mir­ror helps kids to be aware of what they look like when they are sad, angry, bored, or dis­ap­point­ed. Then we ask them, “How do you feel when you see a face like that?” We teach them how their brains are built, what emo­tions are for, and where they are reg­is­tered in their bod­ies, and how they can com­mu­ni­cate their feel­ings to the peo­ple around them. They learn that their facial mus­cles give clues about what they are feel­ing and then exper­i­ment with how their facial expres­sions affect oth­er peo­ple.

We also strength­en the brain’s watch­tow­er by teach­ing them to rec­og­nize and name their phys­i­cal sen­sa­tions. For exam­ple, when their chest tight­ens, that prob­a­bly means that they are ner­vous; their breath­ing becomes shal­low and they feel uptight. What does anger feel like, and what can they do to change that sen­sa­tion in their body? What hap­pens if they take a deep breath or take time out to jump rope or hit a punch­ing bag? Does tap­ping acu­pres­sure points help? We try to pro­vide chil­dren, teach­ers, and oth­er care providers with a tool­box of ways to take charge of their emo­tion­al reac­tions.

To pro­mote reci­procity, we use oth­er mir­ror­ing exer­cis­es, which are the foun­da­tion of safe inter­per­son­al com­mu­ni­ca­tion. Kids prac­tice imi­tat­ing one another’s facial expres­sions. They pro­ceed to imi­tat­ing ges­tures and sounds and then get up and move in sync. To play well, they have to pay atten­tion to real­ly see­ing and hear­ing one anoth­er. Games like Simon Says lead to lots of snig­ger­ing and giggling—signs of safe­ty and relax­ation. When teenagers balk at these “stu­pid games,” we nod under­stand­ing­ly and enlist their coop­er­a­tion by ask­ing them to demon­strate games to the lit­tle kids, who “need their help.”

Teach­ers and lead­ers learn that an activ­i­ty as sim­ple as try­ing to keep a beach ball in the air as long as pos­si­ble helps groups become more focused, cohe­sive, and fun. These are inex­pen­sive inter­ven­tions. For old­er chil­dren some schools have installed work­sta­tions cost­ing less than two hun­dred dol­lars where stu­dents can play com­put­er games to help them focus and to improve their heart rate vari­abil­i­ty (HRV) (dis­cussed in chap­ter 16), just as we do in our own clin­ic.

Chil­dren and adults alike need to expe­ri­ence how reward­ing it is to work at the edge of their abil­i­ties. Resilience is the prod­uct of agency: know­ing that what you do can make a dif­fer­ence. Many of us remem­ber what play­ing team sports, singing in the school choir, or play­ing in the march­ing band meant to us, espe­cial­ly if we had coach­es or direc­tors who believed in us, pushed us to excel, and taught us we could be bet­ter than we thought was pos­si­ble. The chil­dren we reach need this expe­ri­ence.

Ath­let­ics, play­ing music, danc­ing, and the­atri­cal per­for­mances all pro­mote agency and com­mu­ni­ty. They also engage kids in nov­el chal­lenges and unac­cus­tomed roles. In a dev­as­tat­ed postin­dus­tri­al New Eng­land town, my friends Car­olyn and Eli New­berg­er are teach­ing El Sis­tema, an orches­tral music pro­gram that orig­i­nat­ed in Venezuela. Sev­er­al of my stu­dents run an after-school pro­gram in Brazil­ian capoeira in a high-crime area of Boston, and my col­leagues at the Trau­ma Cen­ter con­tin­ue the Trau­ma Dra­ma pro­gram. Last year I spent three weeks help­ing two boys pre­pare a scene from Julius Cae­sar. An effem­i­nate, shy boy was play­ing Bru­tus and had to sum­mon up his full force to put down Cas­sius, played by the class bul­ly, who had to be coached to play a cor­rupt gen­er­al beg­ging for mer­cy. The scene came to life only after the bul­ly talked about his father’s vio­lence and his own vow nev­er to show weak­ness to any­one. (Most bul­lies have them­selves been bul­lied, and they despise kids who remind them of their own vul­ner­a­bil­i­ty.) Brutus’s pow­er­ful voice, on the oth­er hand, emerged after he real­ized that he’d made him­self invis­i­ble to deal with his own fam­i­ly vio­lence.

These intense com­mu­nal efforts force kids to col­lab­o­rate, com­pro­mise, and stay focused on the task at hand. Ten­sions often run high, but the kids stick with it because they want to earn the respect of their coach­es or direc­tors and don’t want to let down the team—all feel­ings that are oppo­site to the vul­ner­a­bil­i­ty of being sub­ject­ed to arbi­trary abuse, the invis­i­bil­i­ty of neglect, and the god­for­sak­en iso­la­tion of trau­ma.

Our NCTSN pro­grams are work­ing: Kids become less anx­ious and emo­tion­al­ly reac­tive and are less aggres­sive or with­drawn; they get along bet­ter and their school per­for­mance improves; their atten­tion deficit,