Let me play with you

    - Jia Youchun

Under rubble for three hours, in tears for three months

We were situated in a heavily-affected disaster area. The hot and humid air, muddy paths, and constant racket were discomforting. A local volunteer came up to me and brought me to see a young girl with serious problems, Xiaoxue.

When I saw Xiaoxue, it had been only three months since the earthquake.

Xiaoxue was three and a half. When the earthquake had struck, she and her mother had been trapped underneath a collapsed house---under the rubble, in darkness---for three hours.

Xiaoxue was rescued with superficial injuries. Her mother, however, had half her body pinned down by a heavy board which couldn''''t be moved; in order to save her life, rescue teams had no choice but to amputate her entire left arm and leg. Xiaoxue witnessed this brutal scene with her own eyes.

Soon after, her mother was sent to Chengdu for treatment, and then a few days later further transferred to Shanghai. Xiaoxue''''s father had no choice but to leave his young daughter behind in order to look after his wife as she was moved between various far-flung hospitals.

Xiaoxue was being cared for by her grandmother. After having gone through an immense calamity, her parents suddenly "went missing" and disappeared from her life; Xiaoxue did not know what happened, and she felt helpless and fearful.

The first time I saw Xiaoxue, she was crying in her grandmother’s lap. The sound of her crying was feeble and intermittent, her body small and thin. She buried her face in her grandmother’s lap; her face was hidden from view, and I could only see her thin and yellowed hair softly drooping down.

Xiaoxue’s grandmother told me that before the earthquake, Xiaoxue had lived with her parents as a healthy and happy child.

After the earthquake, she changed completely. She sobbed constantly, and stuck tightly to her grandmother all day. Most of the time, she clung around her grandmother’s neck and hung onto her like a little monkey. It hindered her grandmother’s ability to perform even simple tasks like washing and cooking rice. Moreover, Xiaoxue started to wet her pants daily. It was rainy season, and her trousers would take days to dry after being washed. Sometimes she could only go bottomless for want of clean pants to wear. Her grandmother said that Xiaoxue had many strange problems after the earthquake: fear of the dark; fear of the slightest disturbance; fear of meeting others. She didn’t talk and she didn’t smile. Before, Xiaoxue had loved to smile, and dimples would appear on her cheeks. However, the earthquake had flattened even Xiaoxue’s dimples.

Her grandmother said that after the earthquake many people came to see them, including, apparently, experts specializing in psychological counselling. But there were simply too many visitors; it was like a market fair. Xiaoxue couldn’t cope with the constant bustle, and her psychological problems grew more severe and complicated. Each expert had his own theory and methods of treatment; there was no stability or continuity, and repeated delving into traumatic memories tends to harm trauma sufferers further. The month before, there had even been a master hypnotist who came from another province. He tried all sorts of things to treat Xiaoxue, but, for the longest time, she wouldn’t cooperate; the situation became very awkward for her grandmother and for the "master hypnotist". She said that if things were to go on like this, she would go crazy herself.

As I listened to her grandmother, I keenly felt her worry and anxiety.

The entire time we were talking, Xiaoxue kept her head buried in her grandmother’s lap and cried; soon she fell asleep.

At present, the head of the village led a group of people over. From their accents one could tell they were from other provinces. They gave the family food, clothing, and other necessities, and then started to take souvenir photographs. Xiaoxue’s simple and honest grandmother hurriedly awoke Xiaoxue from her dreams and got her to pose in a group photo with these do-gooders. As Xiaoxue rubbed her eyes and cried, her pitiful state struck a deep thorn into my heart.

These people meant to do good by coming here, but because they lacked psychological knowledge and failed to put themselves in the shoes of the victim, their visit and "assistance" had the adverse effect of preventing Xiaoxue’s psychological recovery and compounding her trauma.

When the group had left, I made a point of going to the head of the village to discuss the possibility of not bringing any more "tour groups" to visit Xiaoxue’s home. Xiaoxue had, by now, evident signs of psychological problems associated with post-traumatic stress disorder; being disturbed by strangers was detrimental to her physical and mental health, and would worsen her situation even further. She should not remain in such an extraordinary situation for extended periods of time.

Since I was well-acquainted with the head of the village, and on good terms with him, he readily agreed.

I repeated what I said to the head of the village to Xiaoxue’s grandmother.

Helping Xiaoxue would require knowledge and strategy. I planned for Xiaoxue’s therapy to take the form of play therapy and trauma counselling for children, and, at the same time, planned mental health education for her grandmother. In my opinion, interacting with the child and her guardian at the same time in this way can vastly increase the efficacy of the treatment.

That day, I carefully gathered information about Xiaoxue’s response after the earthquake and details of how her grandmother looked after her, and started a systematic, step-by-step process of consultation.

I first explained to Xiaoxue’s grandmother why, after the earthquake, Xiaoxue started displaying symptoms such as frequent crying, clinginess, enuresis (wetting her pants), and timidity: when children experience severe trauma and are unable to find a release for their bottled--up emotions, or do not receive effective comfort in time, they will display many biological, psychological, and behavioral symptoms. Xiaoxue was expressing fear, avoidance, and regression. I wanted her grandmother to understand these things more clearly, in order to assuage her worries. It is important for adults to maintain their calm and cool in order to give children a sense of security.

Her grandmother told me that she would hit Xiaoxue whenever she soiled her trousers, and warn her not to do it again.

I asked her, "Does hitting her stop her from wetting her pants?"

She answered, "No, it doesn’t. But I get upset, and then I can’t help but hit her."

I explained to her why Xiaoxue would wet her pants after the earthquake: this is a sign of regression in children; one must not scold or beat the child, as that would only worsen the problem. Only by seeking effective treatment would Xiaoxue slowly get better.

Her grandmother was quite sharp; she said regretfully, "I shouldn’t have hit her then! Xiaoxue would not leave me alone with her bouts of tears; sometimes I would scold her and tell her that I didn’t want her around anymore, that I would leave her with someone else. Never shall I say such things again."

Following the direction of what she said, I further explained to her the severity of Xiaoxue’s trauma from having been buried under rubble for several hours, and then having witnessed with her own eyes her mother’s arm and leg being cut off---the raw horror and bloodiness of which even adults would be hard-pressed to cope with, let alone a three-year-old child. It was not difficult to imagine her fear and anxiety.

There was another major source of trauma for Xiaoxue: the sudden absence of her parents. She could not understand why her father and mother, who had been with her everyday before, would leave her. Had they decided to abandon her? Were they gone forever? When she was separated from her mother, the close emotional bond between them was disrupted and this sparked a strong emotional reaction in her. This was why she clung tightly to her grandmother without ever letting go: she was afraid her grandmother would also abandon her and leave.

When her grandmother, in anger, said that she didn’t want her anymore, this further increased her fear and anxiety. Her grandmother was now her closest kin and source of support; she should continually let Xiaoxue know, through her words and actions, which she loved her dearly and would not leave her.

I explained all this to her grandmother using language an elderly villager would understand; she understood.

I advised Xiaoxue’s parents to give their daughter a telephone call as soon as possible, so that she could hear her father’s and mother’s voices for herself. It would be best if her mother could tell Xiaoxue herself that she loved her, that she was still alive, that she would surely return to her side.

As for Xiaoxue herself, we brought a flannel doll for her to hug, to give her physical comfort and a sense of security. I also brought a bunch of toys that girls use to play house and played with her; I let her play nurse and give me an injection, to give her confidence in her own abilities and boost her self-esteem.

In the few times I met Xiaoxue after that, I called over a few of the neighbor’s kids who were about the same age as she was, and got them to play with her. This process of play, which the children shared in, helped build connections and facilitate emotional expression.

For example, when we played the game of "Bunny moves house," I asked her, "When Bunny’s house collapsed, how did Bunny feel? What would he do? How would you help Bunny overcome his fear?" Xiaoxue said Bunny would be scared and he would think of his mother. How Bunny would feel--that was exactly how Xiaoxue had felt.

After several counselling sessions with Xiaoxue, we suggested that she go to kindergarten as soon as possible. Xiaoxue was initially afraid of going to kindergarten, but our method of behavioral therapy through systematic desensitization was very effective.

We first found several kids to take Xiaoxue to see the kindergarten and play with her near the kindergarten, and then let her grandmother take her into the courtyard of the kindergarten look and to familiarise her with the environment. When she was no longer so afraid, Grandma accompanied her to attend kindergarten; at the beginning she could stay for maybe only an hour or two each day, but as she became familiar with the other children and teachers, this eventually became three or four hours. Thus, she slowly adapted to kindergarten life. It was important that Xiaoxue not remain at home for extended periods of time, but go out and interact with other children, in order to return to a normal life as soon as possible.

After two months of play therapy, along with guidance for Xiaoxue’s grandmother, Xiaoxue’s symptoms have noticeably ameliorated. She is now attending kindergarten regularly.

(The simplified Chinese version was originally published in《社區心理康復專刊》, 9 October 2009, Issue No.2, reproduced with permission.)