Lost and found

From the annual meeting of the American Psychiatric Association, Washington, D.C., May 5, 2008.

Ishmael Beah knows that former child soldiers in war-ravaged African countries can reclaim their lives because that’s just what he did. In 1993, rebels in Sierra Leone killed 13-year-old Beah’s parents and two brothers, forcing him to join their bloody campaign for two years. Upon his release, he stayed at a rehabilitation center for six months with other formerly abducted children. Beah now lives in the United States, and he wrote a 2007 book about his transition from child soldier to college graduate.

His inspiring story illustrates the resilience of children forced into committing unthinkable acts, especially if they receive treatment that blends with their cultures, as well as acceptance back into their home communities.

New studies challenge the popular view that children forced to commit war atrocities end up as “lost boys,” incapable of ever leading constructive lives. “Declaring child soldiers to be ‘lost boys’ is simply unacceptable,” Beah says.

Beah spoke on May 5 at the annual meeting in Washington, D.C. of the American Psychiatric Association, along with researchers who study former child soldiers.

“Emotional resilience is the norm,” says psychologist Jeannie Annan of New YorkUniversity, who recently studied former child soldiers in Uganda. “Family rejection and emotional distress are the exception.”

Consider 40 boys abducted into a rebel army in the East African nation of Mozambique more than 20 years ago. By 2004, 37 of them had returned to their home communities and displayed good social and psychological functioning as adults, according to Neil Boothby, an education professor at ColumbiaUniversity.

“These are wonderful young men,” Boothby says. “They had done bad things in their home villages as child soldiers, but the villagers wanted them back.”

Psychiatrist Jon Shaw of the University of Miami in Florida first contacted the boys in 1988. Government forces had freed the youngsters from the rebel group and the government endorsed an effort to rehabilitate them and return them to their families. Shaw converted a Catholic school into a rehabilitation center that offered group activities, including sports, art and music. Boys stayed there for six months before going home to rural villages.

At that point, they participated in cleansing rituals run by local healers. These ceremonies allowed villagers to forgive the boys for having committed violent acts and to acknowledge that such behavior had been involuntary.

Abducted child soldiers serve many roles, Shaw notes, such as porters, cooks, human shields, spotters, spies, minefield sweepers and participants in suicide missions. About one-third of child soldiers are girls, who rebel leaders also use as sex slaves.

Boothby directed evaluations of each boy in 1988, 1989, 1990 and 2004. His team examined each young man’s ability to assist his neighbors in times of need, a cardinal sign of maturity in Mozambique. He also evaluated their psychological adjustment.

All the boys had recurrent thoughts or memories of traumatic wartime events, even as adults. Over the course of the study, the number of those who avoided places or activities that reminded them of past atrocities increased from 15 to 26. That tactic apparently aided emotional healing, Boothby says.

Despite their disturbing memories, 37 boys grew up to own their own homes. They primarily worked as farmers. Most married and had children.

In 2004, a large majority of the former child soldiers cited examples of having helped neighbors in the past year. Interviews with those neighbors confirmed the young men’s reports.

Three former child soldiers did poorly after returning to their villages. One repeatedly got into trouble and died in a police shooting. Another was ostracized for alcoholism. A third young man struggled with emotional problems and an inability to relate to others. He had been abducted by rebels at age 6 after seeing his parents brutally murdered and his house burned down. “This was the worst case of trauma that I’ve ever seen,” Shaw says.

Boothby plans to track the young men for at least another 10 years.

Ugandan communities have also welcomed back former child soldiers, NYU’s Annan says. Although these kids often avoid town-run “reception centers” that offer group support and activities for ex-combatants, they still do well upon rejoining their families

From 2005 to 2007, Annan and her colleagues interviewed a random sample of 1,000 families in parts of Uganda that had been exposed to 20 years of conflict between government forces and a rebel group called the Lord’s Resistance Army. About half of 741 males, ages 14 to 30, and 619 females, ages 14 to 35, reported having been abducted for various periods by the LRA.

Participants often described trauma and depression symptoms that lasted for years after their release. Yet they had largely reintegrated themselves into civilian life. Almost all the boys and 80 percent of the girls were accepted by their families without problem after leaving the LRA. These kids typically regarded their time with the rebels as what God had willed for them.

Family difficulties emerged for a minority who had spent many years as soldiers, who blamed themselves for what had happened and who felt haunted by spirits of those they had harmed or killed.

Psychological treatment for former child soldiers in Uganda shows promise as a way to ease lingering feelings of depression, adds Judith Bass of JohnsHopkinsUniversity in Baltimore. In a 2007 study, her team adapted a form of group therapy for use in Uganda. Trained, local counselors delivered this therapy to 105 teenagers living in either of two camps for displaced persons. The youngsters had been abducted by rebels, had witnessed murders or had experienced other war-related traumas.

Constant worrying, social withdrawal and other signs of depression substantially declined after four months of weekly therapy sessions. Other teens in the same camps who received no treatment showed much smaller depression drops, even if they had participated in sports and art programs.

Definitive treatment and outcome studies of former child soldiers have yet to be conducted, cautions psychiatrist Myron Belfer of HarvardMedicalSchool in Boston. As Ishmael Beah emphasizes, recovery takes many years. “I couldn’t sleep much as a child soldier, and I still don’t sleep more than three or four hours a night,” he says.