Handle the situation with care when children witness or undergo a traumatic experience

When children witness or undergo a traumatic experience, massive changes seep into their lifestyles and make them behave erratically. This time is hard for parents and children…handling the situation with care becomes imperative

Question: I'm the single father of a 17-year-old boy. My wife died 6 years ago. She committed suicide. It was a small argument, but she used to self-harm and threaten to kill herself from the beginning.

She leaned over the balcony to threaten me as always but slipped and fell. Died instantly. My son saw all this. For 3 years he too is behaving exactly the way she used to. Cuts himself, bangs head on the wall, threatens to kill himself. Drank floor cleaning liquid 3 days ago. He doesn't study, is very aggressive, bed wets and blackmails me. Please advise.

Ans: Hello sir, sorry for your loss, we will do our best to understand the situation of your son and have a road map to aid his journey back into the mainstream at the earliest.

But, before we talk about your son, it is also important to arrive at some understanding as to what might have been going on with your wife. While suicides are dreadful and cause a high amount of shock and grief, the family more often is also angry and sad because they cannot understand the reasons behind such an act.

Whatever you have described of your wife, it appears that she actually was suffering from a personality disorder called Borderline Personality Disorder (BPD), which may surprise you.

Usually, they pass off as difficult and stubborn people with anger issues.

Some of the common and characteristic features are:

1. Relationship difficulties, which you experienced in your marriage.

2. Self-harm and dangerous behaviour, both of which were present in her.

3. High impulsivity and suicidal ideation.

4. These behaviours can also be triggered by seemingly normal events or situations such as small arguments or changes in the expected.

Coming to the situation with your son, his episodes of anger and aggression, self-harm like banging head against the wall, blackmailing and attempting suicide are clear signs that he needs help and, as you rightly observed, that he may be behaving like his mother.

BPD can also be genetic. The incidence is higher in women. But environmental triggers play an important role. The violent death of his mother, which your son witnessed, could have been the trigger. Also, early adulthood is the time when the onset is seen. Possible that your wife too would have started showing some signs at that age.

1. Please seek help for medication as well as to have supportive therapy for your son. Medications help in controlling the associated problems like depression, anxiety, suicidal ideation and paranoid thoughts.

2. Counselling and psychotherapy help for your son is essential for dealing with the root emotions and perceptions that lead to self-harm. He would slowly learn to become aware of his feelings and monitor his own behaviours, which leads to control over impulsivity and anger and this process, in turn, keeps him safe.

3. He later has to start getting engaged in some focussed activity, whether it is creative arts or any form of self-expression, group activities will give an opportunity for socialising.

4. Please also seek some therapeutic counselling help for yourself, as you must have been under prolonged stress for years and your son needs you to be a strong individual and a father.

- Vasuprada Kartic, Anthroposophic Counsellor and Psychotherapist.

Question: Our son is 21 years old. About two years ago...he met with an accident. He suffered multiple injuries and fractures and was unconscious for 45 days. Since he recovered consciousness, his nature has completely changed. He is aggressive, violent, screams and has severe nightmares. He hits anyone with anything, sometimes grievously injuring us. He has broken every piece of furniture in the house. He is becoming unbearable. He is also forgetful, and suspicious. He feels that people are out to kill him, feels his mother and I are also against him. Two weeks ago, he hit a passerby on the road. We are medicating him as per doctors' advice. Please help.

Ans: First of all, let me express how sorry I am that all this happened to a boy so young. The trauma must have been terrible, both for you and for him. Personality changes are not uncommon following traumatic brain injury. The way we think and behave defines us, and this is called temperament. After Brain injury, the way one processes information gets disrupted. Which is why the behaviour and personality change after traumatic brain injury.

Personality changes are due to:

1. Changes in the brain following an injury that change perception, understanding of situations, reactions, and comprehension of how thugs are. This makes it hard to understand feelings or process them fully.

2. The second is more complex. Reactions to the sudden changes in lifestyle, abilities and circumstances can result in extreme reactions. Brain injury can damage connections that go from the brain cortex (the part that has a role in memory, attention, and awareness) to the limbic system (the seat of emotions and behaviour). These connections help us understand situations and guides reactions and behaviour. When these connections are injured, these responses get distorted and our understanding of situations gets distorted and so do our reactions. These are challenges both for the caregivers as well as the injured and are extremely excruciating situations to deal with. The other factor is the frustration of physical debility, memory lapses, a complete change in lifestyle and ability, and caregiving where none was necessary before.

All of a sudden there are restrictions on going out, independence, meeting people and education, career, etc.

It is normal to mourn one's previous lifestyle and overreact to inconsequential triggers.

As parents, I understand your anguish and helplessness. You have not mentioned details of your son's medication, and if he has any physical debility... nevertheless his condition now needs medical intervention as well as psychological intervention.

What to do:

1. Try to find his triggers, try to Stay away from them.

2. Try to discuss his reactions and see if he comprehended the consequences.

3. Encourage physical exercise so his energy can be channelised.

4. Encourage his friends to hang out with him.

5. Encourage your son to start journaling his thoughts and emotions.

6. Teach him lifestyle changes...regular sleep, good food, exercise. Encourage yoga, breathing exercises, and mindfulness.

7. Take psychological support both for him and for yourselves.

Maybe learning new coping skills will help all of you deal with the issues and also help you bond better.

8. Seek psychiatric help if you haven't already and speak to your doctor regarding his behaviour.

9. Cognitive behaviour therapy will help.

10. Play memory games with your son to enhance his memory and also encourage set and music therapy. This help regulate emotions and also enhance cognitive skills.

11. Lastly, don't lose hope, brain injury heals very slowly, with a collective effort, your son should show improvement over time.

- Dr Purnima Nagaraja, Consultant Psychiatrist and Psychotherapist.

- This feature is in support of 'Rotary Kshemam' initiative for safe and happy communities. Do you have any relationship-related queries or issues with your friends, loved ones or family? For informed advice by professionals, send in your questions to features.thehansindia@gmail.com.