CHILDREN / The night the bad men came and killed my daddy: Mentally scarred children are the unacknowledged victims of the Troubles. Belfast's first trauma clinic has been set up to help them. Seth Linder reports

Liam Gallagher, aged five, was sleeping in his parents' bed when three masked UVF gunmen broke down the door of his North Belfast home in the early hours of the morning. Four years later his mother, Patricia, is still not sure what Liam or his elder brother, Paul, saw or understood of what happened next: 'Joe (Liam's father) tried to push the gunmen back down the stairs with a ladder but they shot him dead. I ran out into the street screaming for help. This neighbour ran in and he told me he saw the two boys kneeling down beside their daddy and the wee boy was holding his hand.'

Liam's experience is by no means an isolated one. Over the past 25 years the numbers affected by Troubles-related violence must run into many thousands.

In what is hopefully the final count, 3,170 people have been killed since 1969 and a further 36,737 injured. Those figures only hint at the true legacy of the violence, a legacy with disturbing implications for the future. Ironically, only now, as the people of Northern Ireland contemplate the prospect of peace, is there a growing realisation of the intense and long-term suffering of children like Liam.

Liam Gallagher is nine now and the psychological scars of his father's murder are clearly evident. A nervous, restless child, he seems unable to stay in one place for long. Each evening, too scared to go to bed alone, he falls asleep in front of the television and his mother carries him upstairs.

Even while he is asleep his movements are jumpy and fretful, and though he no longer wets the bed he wakes frequently. He cannot concentrate at school and shows no interest in the future. In the past few weeks, since finally discovering the true cause of his father's death (he had been told he died falling down the stairs), he has barely touched his food and his mother is anxious for his health.

Liam's symptoms are known collectively as Post Traumatic Stress Disorder (PTSD), a reaction to severe trauma that has been recognised in children since the mid-Eighties. Yet in Northern Ireland, home to the longest continuous civil violence in modern times, widespread acceptance that children can suffer in this way has come only in the later stages of the Troubles.

At least part of the problem lies in the fact that conclusions derived from general surveys of Northern Irish children in the early Seventies and Eighties have, in their over-generalisation, distorted the picture. These surveys, usually in the form of questionnaires answered by schoolchildren, indicated that most children were not unduly affected by the violence. While this may have been correct, the impression that even children directly affected by the violence were coping well was allowed to gain credence. Such surveys only reinforced the conventional wisdom of the period: that children were resilient and that if they had a reaction to violence at all, it tended to be short-lived.

But clinical child psychiatrists and psychologists, largely based at the Royal Belfast Hospital for Sick Children, have been seeing a different picture. Last October, after the Shankill and Greysteel bombings, Dr Geraldine Walford, consultant child psychiatrist at the Royal, set up the first psychiatric trauma clinic for children affected by Troubles-related violence. The findings of the clinic's first year, currently being compiled, will give a clear indication of the extent of the children's suffering.

So far the clinic has seen about 60 children, most of whom have lost a parent or close family member to the violence, witnessed a bombing or shooting, or been taken hostage with their families. Nearly all the children, split evenly between Protestants and Catholics, have symptoms of PTSD. While clinicians are still only able to see a minority of children affected in this way, at least their needs are now widely recognised in the community at large. One of the great strengths of this community, some professionals believe, helped obscure the extent of the problem in the first place. The extended family is probably stronger in Northern Ireland than elsewhere in the United Kingdom. This supportive network of relatives may have disguised the extent of these children's suffering. The strong religious influence, encouraging people to regard the Troubles as something that has to be endured, may also have been a factor.

The stigma of needing psychiatric help and a general fear of mental illness, keenly felt in Northern Ireland, have long been an obstacle, and Dr Walford believes that calling her unit a 'trauma clinic' allows parents to understand 'that this is a normal reaction to an abnormal event'.

A common reaction of traumatised children, to become withdrawn, has also compounded the problem. 'The parents assume the children are all right,' Dr Walford says, 'because they are quiet and not asking questions. It's often a few months later, when the shock has worn off, that symptoms emerge. In some cases it is three or four years after the incident that children start to relive the experience and you see chronic anxiety and panic attacks.' One of the advantages of the trauma clinic for Dr Walford has been the opportunity to see children as soon after the incident as possible, for what is called a 'debriefing', while the experience is still fresh in the child's mind and they are willing and indeed anxious to talk openly of what they saw.

Parents, seeking to protect their child and still numbed by their own grief, will not wish to answer a child's pressing questions, even if they are capable of doing so. The child, anxious not to see the surviving parent any more distressed, will not pursue their questions. This can often lead to a damaging confusion in the child's mind. If this is not confronted the child is likely to relive the trauma repeatedly as he or she grows older. When friends told Liam Gallagher that his father had been shot, his mother, trying to protect him, at first denied it. He only learnt the truth after overhearing a conversation between his mother and aunt.

It is precisely to avoid this kind of confusion that the initial session at Dr Walford's clinic is a joint one, at which parent and child openly discuss the incident together. 'Everyone will talk about exactly what happened, where each one was at the time. The children seem to sense that this is a place where it's all right to talk and to cry together, a safe environment where you can let go of your feelings with people who are trained to listen to you. And children do want to talk. Often parents will say, 'I had no idea that my child took in or saw that much'.'

There is an added urgency, particularly with younger children, to ensure there that any 'mis-attribution' the child might have made is speedily eradicated. 'Younger children,' Dr Walford says, 'refer everything back to themselves. They can attribute the reason for the incident to the most surprising things - because they were naughty, they didn't eat their dinner or something, their daddy was killed.' Guilt takes other forms. 'Even children as young as five will think, 'If only I had hit the terrorist with a saucepan my daddy would still be alive'.'

In the second session the clinic team see the child alone, to talk over the incident and their anxieties in their own terms. With younger children (the youngest so far seen is two), whose vocabulary is more limited, the information is often teased out with the aid of a dolls' house and dolls.

'We would say to the child, 'We can use this dolly to be your daddy, could you show me where your daddy was when the bad men came in, was he asleep or awake?' With other dolls the child would show us what they saw of the gunmen and where they were themselves.'

Before symptoms can be treated they have first to be identified. A common fault of early research, Dr Walford believes, was that the right questions were not asked and the true problems were not discovered. Therefore, in subsequent sessions, using detailed questionnaires, the team will concentrate on drawing out the child's feelings and apprehensions. In discussion with the parents a comprehensive list of the child's symptoms can then be compiled and addressed.

Some symptoms are more obvious than others. In younger children separation anxiety is most common, clinging to the surviving parent, never letting them out of their sight. Hyperarousal or its reverse, a tendency to become withdrawn, is often observed. Bedwetting, aggression and fear of the future are also usual. When asked what they want to do when they grow up, the children say they 'don't know'. 'They see the road ahead as full of pitfalls. They feel isolated and detached from people. They can't look forward without anxiety and seem to have no interest in the future. Their trust in life has gone.'

Sometimes the most striking symptom is simply fear. Dr Walford has treated children so frightened they couldn't stay in one place for any length of time, starting a drawing of the incident and then running to another part of the room. 'One can almost feel their fear,' Dr Walford says. Dr Richard Wilson, a child psychiatrist who worked with Dr Walford in the first months of the trauma clinic and is now compiling its findings for research, has found that fear of the gunmen returning is widespread: 'Children sometimes may lie awake at night, staring through the window to make sure that no one is coming. Gunmen will tell the children, 'If you talk about us, we'll come back and shoot you.' Even the youngest children understand that their lives might be in danger because they could identify the gunmen. It's a very cruel situation.'

The most vulnerable times for most children are the quiet moments, when intrusive memories or flashbacks of the incident occur. Sleep is hard to come by and is often marked by jumpy movements or talking. Sleepwalking and bad dreams are other manifestations. Dr Wilson cites an example of what he terms 'sleep terrors': 'This is a child who gets up most nights, not fully awake, and wanders around the house. His mother finds him standing at the top of the stairs screaming, 'Look mummy, the cars are coming through the walls'.' In the daytime, the child, who witnessed gunmen driving through his front garden, remembers nothing of the night.'

Though medication might be used in severe cases, the clinician can also apply strategies that help a child develop a masterful ending to a bad dream or intrusive thought. Adrian McKinney, principal clinical psychologist at the Royal, recalls how he treated a young girl troubled by a recurring dream: 'In this dream the girl described her living-room full of thousands of men with blond hair and caps, one with a face half-burnt and half-normal, who chased her and her sister down the hill in their car.' After working with Mr McKinney the girl was able to change the end of her dream so that she called the police and the men were captured. 'She was the hero because she saved the day and had her photo in the paper.'

Perhaps the most distressing symptom encountered by the clinic team is the desire for reunification with the dead parent. A number of bereaved children in the early stages of therapy have told Dr Walford, 'I wish I could die and be with daddy in heaven.' Teachers in parts of Belfast most heavily afflicted by the violence are reporting a worrying increase in the numbers of children attempting suicide. Patricia Gallagher recalls the reaction of Liam's elder brother, Paul, to his father's funeral: 'He broke his heart the day his daddy was buried. Both boys were clinging to the coffin. Their uncle had to take them out, they were crying so much. A few days after, I was told Paul had tried to throw himself under a car. I tried to talk to him but he just sat watching TV. He wouldn't say anything, just kept it all inside.'

It is hardly surprising that one of the strongest reactions to this kind of trauma is anger. But in Northern Ireland, with its strong religious influence, children are often asked to forgive the gunmen by well-meaning clergymen or relatives. Clinicians, however, feel it is important that children are allowed to express their anger. 'Forgiveness is a rational thing,' Dr Walford says. 'Anger is a part of healing and a natural emotion.

One shouldn't make the child feel guilty about it.'

But anger is only part of healing when it is properly treated. If peace is to eventually bring the two communities in Northern Ireland together something will have to be done about the thousands of children like Liam and Paul Gallagher, who will take their lingering resentment of the 'other side' into adulthood. Patricia Gallagher has seen Paul shouting IRA slogans at the soldiers or throwing stones at Protestant boys and has always feared he might join the IRA when older.

Gerry Casey was nine when the UVF killed his grandfather. The previously good-natured child became deeply embittered towards Protestants. His worried mother brought him to Adrian McKinney late last year, fearful of the kind of adult Gerry might turn into. Mr McKinney helped Gerry grieve for his grandfather while at the same time dealing with his intense anger with his grandfather's killers. His progress was reflected in a series of paintings.

The first shows a smiling Gerry shooting an UVF man in the head while another lies dead in a pool of blood. Two months later, a close-up of Gerry's face reveals tears being siphoned off into a series of bottles.

This, Mr McKinney says, was a way of expressing his sorrow: 'Gerry had found it very hard to cry, these tears were to represent the sad things and what we wanted to do is put them in a bottle and get rid of them.' In his tenth session Gerry painted a picture of a Catholic boy shaking hands with a Protestant boy.

When Dr Walford asks children what they would most like to happen, the majority answer 'for the fighting to stop'. Peace will, unquestionably, bring some comfort. No more will each TV report of further killings reactivate the children's own grief. Perhaps even the fear of the gunmen returning will gradually fade. But nonetheless, because of the nature of a child's development, the trauma may need to be reassessed at key stages of their growth: between six and seven, when a child begins to understand the irreversibility of death and realises that daddy isn't coming back; at the pre-teen stage when the child has a more complex understanding of why the incident happened; and in later adolescence when children search for identity, a particularly vulnerable time for the child of a murder victim.

But the future is not without hope. Despite the often distressing nature of their work, the clinicians find great satisfaction in seeing the once-traumatised child facing up to life again with a belief in the future.

A few days before the IRA ceasefire, Gerry Casey painted his final picture for Adrian McKinney before being discharged, an IRA man shaking hands with a British soldier above the caption, 'Friends for Ever.'

But for every child like Gerry, how many Liam Gallaghers must face up to a life without resolving the trauma that took away their childhood? All the experts agree that, over the years, the majority of such children have been given no professional support, and what that means for their future and that of post- Troubles Northern Irish society can only be conjectured.

Depression, an inability to form relationships and hostility towards the 'other side' are all likely. These are still early days and Dr Walford is still not sure how her clinic will adapt to the changing situation, but she is acutely aware of what might be the most important peace dividend of all: 'It's my hope that there is now an opportunity for all those children who didn't get help at the time to be referred now.'

Patricia Gallagher says that with each year since the death of their father, life is getting harder for Liam and Paul: 'What's wrong with here is that there are too many widows and too many orphans and not enough people to help.' Perhaps peace, if it lasts, can change that.

(Photographs omitted)

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