Indero: Intergenerational Trauma and Resilience between Burundian Former Child Soldiers and Their Children SUZAN JOON SONG* WIETSE TOL† JOOP DE JONG‡
Since many former child soldiers are aging and having children of their own, this study aimed to understand how the effects of trauma are passed to the next generation. In this qualitative study, semistructured interviews, focus groups, and observations were conducted with 25 former child soldiers and 15 matched civilian parents. Analysis used a grounded-theory approach. Trauma may be transmitted from former child soldiers to their offspring via (a) the effect on indero (how to raise a child); (b) severe parental emotional distress; and (c) community effects. Incorporating themes of indero values on how to raise children, the effects of parental posttraumatic stress and depressive symptoms on offspring, and the stigma associated with the families of former child soldiers may provide key areas of intervention in mental healing. Keywords: Intergenerational; Child Soldier; Trauma; Violence; Family Fam Proc 53:239–251, 2014
INTRODUCTION
O
ver the past decade, two million children have been killed in armed conflict, with 20 million displaced and 6 million disabled (UNICEF, 2007). Around the world at any moment, an estimated 300,000 children under the age of 18 are involved in armed forces (Coalition to Stop the Use of Child Soldiers, 2008). A child soldier is “any person under age 18 who is part of any kind of regular or irregular armed force or group in any capacity, including but not limited to cooks, porters, messengers and those accompanying such groups, other than purely as family members . . . it does not only refer to a child who is carrying or has carried arms” (United Nations Children’s Fund (UNICEF), 1997). Being a child soldier is associated with exposure to multiple severe forms of violence, including perpetration of and enduring violence (Bayer, Klasen, & Adam, 2007). A systematic review of the literature on the mental health of former child soldiers (FCS) shows varying prevalence rates of mental health problems (Betancourt et al., 2012). Child soldiering has been shown to be detrimental to both development (Machel, 2001; Wessells, 2006) and mental health (Kohrt, Tol, Pettigrew, & Karki, 2010).
*Pediatric and Adult Psychiatry, Center for Survivors of Torture, San Jose, CA. † School of Public Health, Johns Hopkins University, Baltimore, MD. ‡ Cultural Psychiatry, University of Amsterdam, Amsterdam, The Netherlands.
Correspondence concerning this article should be addressed to Suzan Joon Song, Pediatric and Adult Psychiatry, Center for Survivors of Torture, 2400 Moorpark Ave., San Jose, CA 95128. E-mail: suzan.
[email protected]. 239
Family Process, Vol. 53, No. 2, 2014 © 2014 FPI, Inc. doi: 10.1111/famp.12071
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FAMILY PROCESS
Intergenerational Trauma Child soldiers are now becoming adults and having children of their own. However, studies have not examined if and how trauma is passed to their children. Examining studies on similar populations may give insight. Limited literature on refugee fathers showed that traumatic symptoms negatively impact the quality of parent–child interaction (Van Ee, Sleijpen, Kleber, & Jongmans, 2013). In a review of intergenerational posttraumatic stress disorder (PTSD) among Vietnam veteran fathers and their sons, Dekel and Goldblatt (2008) found that paternal PTSD was more influential than combat participation in predicting their children’s traumatic stress. Moreover, family violence predicted greater distress in children than the parent’s PTSD itself. The review found a direct transmission of trauma to the child via parental PTSD symptoms of numbness, dissociation, anxiety, and more likely use of corporal punishment when compared with veterans without PTSD (Dekel & Goldblatt, 2008). An indirect transmission of violence to offspring was also shown through less paternal involvement in routine family activities (Ruscio, Weathers, King, & King, 2002), distancing, withdrawal, difficulties with attachment and intimacy (Cohen, Dekel, Solomon, & Lavie, 2003), and fathers being psychologically absent though physically present (Boss, 1999). The literature concerning Holocaust survivors is more mixed, with clinical reports of Holocaust survivors having intergenerational trauma (Danieli, 1998) despite a metaanalysis on intergenerational trauma showing no substantial evidence that parental Holocaust experiences influenced children (Van IJzendoorn, Bakermans-Kranenburg, & Sagi-Schwartz, 2003). Through these studies of war veterans and Holocaust survivors we question if there is intergenerational trauma between former child soldiers and their children. Many FCS have now grown into adults and parents, but studies have focused mainly on the individual FCS.
Rationale for This Study A previous mixed methods study compared 15 Burundian FCS parents (male and female) and their children (aged 5–18 years old) to 15 age-, gender-, and provincematched civilian parents and their children. Results showed that the children of FCS had more conduct problems, less sense of belonging, more perceived family problems, felt less support from siblings, and used less problem solving coping methods compared to civilian children (Song O’Hara, & Koopman, 2013). Observations of parents and children showed some FCS’s children with more clinging, reserved, and apprehensive behavior than civilian children. Moreover, FCS parents were observed to have more distress when talking about their children. These findings and observations encouraged us to add ten additional qualitative interviews of FCS in an exploratory study to question, “How is trauma transmitted from former child soldiers to their children?” using a grounded-theory approach to analyzing qualitative and observational data.
METHODOLOGY Setting Burundi is a land-locked country in Central Africa with an estimated population of 10 million people. Since independence in 1962, the country has endured ethnic tension and violence, with a 12-year civil war leaving an estimated 300,000 Burundians killed and hundreds of thousands displaced (Amnesty International, 2004). A peace treaty was signed in 2001 and the last rebel force disarmed in 2006. The aim of this study was to www.FamilyProcess.org
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examine intergenerational trauma in FCS families using qualitative and observational data from 8 weeks between January 2011 to August 2011.
Design A grounded theory approach (Glaser & Strauss, 1967) was used for this qualitative study. We attempted to maximize the validity of our data using triangulation of qualitative interviews (i.e., individual interviews, focus group discussions) and observations. Since there are few studies on Burundian families, and the first author is a foreign researcher to Burundi, naturalistic observations of families and children in their home environments were added for ecological validity to determine how well qualitative findings correlate with real-life circumstances.
Participants Participants were a total of 40 adults: 25 FCS parents and 15 age-, gender-, and province-matched never-conscripted civilian parents for comparison (refer to Table 1). Criteria for involvement were FCS that possessed a demobilization card (to ensure they were truly child soldiers), lived in one of four provinces, and had at least one biological child. Inclusion criteria for all children were (a) if available, (b) aged 5–18 years old, and (c) willing to speak with us. Only one 14-year-old child was willing to speak at length with us; therefore, child data included observations with their parents, but not qualitative interviews. Four of 17 provinces were chosen (Cibitoke, Kamenge, Kinama, and Sorerezo) since we were interested in finding FCS in provinces that were involved in the armed conflict, from any ethnic tribe or rebel group, and where home visits were possible with minimal security risks. The first two provinces have a high density of FCS. Participants were derived from expert purposive sampling, working with a local nongovernmental organization that provides social support to FCS.
Data collection This study added on to the original mixed methods study of 15 FCS and 15 matched civilians by including the same qualitative methodology (excluding quantitative measures) for 10 additional FCS until data saturation was met. Qualitative data were collected in three phases (refer to Table 2). During the first phase of the study, individual semistructured qualitative interviews were conducted with all parents. Questions focused on prewar childhood (ex. “What was your life like before the war?”), rebel war experience (“What TABLE 1 Demographics of Participants
Male Female Mean age Age range Female FCS separated from husbands Male FCS separated from spouse Mean no. children Mean age children Range of child age >6 years in rebellion >2 years in rebellion Join
