Category Archives: resilience

Too Young for Powerless—Cancer Through the Eyes of the Siblings

Comfort to sibs pix

“Scary”, “hard”, and “difficult” are words that youngsters frequently use to describe the feelings they have about cancer treatment of a sibling.  Watching a sibling lose weight, lose his hair, be hospitalized, etc. engenders fears of death that children left to their own devices are ill equipped to work through.  Siblings also often feel guilt, powerless, loneliness, anxiety, depression, anger, and jealousy.  Unable to understand what “cancer” even means—they know their sibling is sick, but they may not be able to understand why their brother or sister is getting so much extra attention, gifts, and invited to special events focused on them meanwhile their own feelings may be unintentionally discounted.

If these feelings are left unattended the sibling without cancer may end up with issues of their own.  They may stumble in their academic achievement or suddenly show misbehaviors.  Some siblings after the death of a sister or brother may suddenly also get “sick” often and need to stay home close to Mom or Dad—perhaps unconsciously wanting to be cared for and safe.  Siblings may also have trouble at school or in social settings when adults or other children express kind sympathies (adults) or awkward questions (children) that the sibling has no idea how to respond appropriately.

Sephora siblings week

During cancer treatment, or in a time of bereavement, a sibling may become super responsible and take on the role of caring for their distressed and often overwhelmed parent—a role that may be dearly appreciated during a crisis but shouldn’t be left in place for a long time afterward—as children need to be parented versus having this role reversed.

Mom and cancer kidChildren also want to believe that their parents are powerful versus powerless in the face of challenges and they may suddenly move into crisis finding their parents cannot prevent the suffering or death of their sibling.  These feelings of fear that a parent isn’t as strong as the child hoped may lead to inexplicable outbursts of anger or blame—words that a bereaved parent may not be equipped to hear in their time of grief.

Childhood cancer, treatment, and sometimes the death of a sister or brother, are extremely challenging events for a sibling to face.  When cancer strikes a child, a lot of things happen and fail to happen for the siblings at home—despite the best wishes of their parents who want all their children to thrive.

As parents support their sick child and literally engage in a life and death medical battle to save the child with cancer they may unintentionally overlook the emotional and even physical needs of their other children.  Healthy children may witness the physical and emotional pain of their loved one as well as the distress of their parents—often all without a good support system around them.

Good and loving parents may be too overwhelmed to explain things properly and children who are too young to understand concepts like “cancer” and “death” may find themselves floundering in a sea of anxiety for which there are not adequate supports in or outside of the family.  If the cancerous child is hospitalized out of town, parents may literally not be present to help the siblings work through their own adjustments to this very difficult challenge.

Children with cancer clearly suffer and may even die, but the overlooked siblings also suffer—from anxiety and sometimes even posttraumatic stress—with these issues displaying as nervousness, intrusive thoughts, nightmares, and avoidance which all need to be addressed—lovingly in the family or also with professional help depending on the need.

While the challenges of cancer, death, and bereavement, if the battle is lost are substantial, parents should recognize that their other children are also going to be deeply affected.  They can take steps to mitigate their other children’s suffering by turning to other family members, teachers, clergy, and even professionals to ask them to offer much needed support.  Siblings will need opportunities to sensitively talk with their parents and perhaps even with a grief counselor about what death means, if the cancerous child is likely to die, what the suffering is about and how to deal with a grieving and overwhelmed parents.  While it isn’t easy they will ultimately need to find healthy ways to grow through and beyond this difficult time in their lives.

Anne Speckhard, Ph.D. is Adjunct Associate Professor of Psychiatry at Georgetown University Medical School. This is the second in a series of blogs for Donna Speckhard’s initiative My Truth in 365 – A Virtual Journal Project on Pediatric Cancer.  Check out her site at and please donate to the cause….  http://mytruthin365.wix.com/mytruthin365#!Finding-Courage-Healing-in-Story-Telling/cke9/B75436BB-E716-4D13-BF7A-447C9F84E58B

We Served Too—Remembering Civilian Sacrifices made in Behalf of our Country—Honoring those who Served alongside the Military in Conflict Zones and High Threat Security Environments

This Memorial Day all Americans send a heartfelt salute to all those warriors who fought and died so gallantly in recent and far off wars in behalf of our freedoms and safety.  In behalf of those who died, we can never thank them or their families enough for the ultimate sacrifice they made for our country.

Alongside that salute we now also need to begin to honor the oft forgotten civilians who also serve in war and high threat security environments alongside the military, supporting their efforts and working in concert with them—especially all those civilians who served in the two recent U.S. wars in Iraq and Afghanistan—as many civilian workers have also lost their lives while serving our country.

While we don’t often remember the sacrifices of civilian workers in conflict zones, or have a holiday to commemorate their service, we do need to honor that they too serve their country. 

A little known fact is that in September 2007 there were more contractors in Iraq than combat troops.  According to a 2013 report of the Special Inspector General for Iraq Reconstruction (SIGIR) reports that, “In September 2007, the United States had more than 170,000 combat personnel in Iraq as part of the counterinsurgency operation, with more than 171,000 contractors supporting the mission.”  These contractors are credited in the report for supporting “the counterinsurgency mission in unstable, yet strategically significant, areas such as Baghdad, Anbar, and Babylon provinces.” (Emphasis added)

Civilian contractor casualties it turns out may be one of the least known aspects of our recent wars. For instance, the Defense Base Act case summary report lists three hundred defense base act death claims filed for 2012 and since September 2001 it lists three thousand, three hundred and two civilian contractor deaths and ninety-one thousand civilian contractors injured in that time frame.  While not all of these deaths occurred in combat zones, the majority did.  Likewise not all of the civilian deaths are Americans—the Department of Labor does not release the names of the claimants or their nationalities so it is difficult to parse.  Many different nationalities—from Americans, Europeans and third world countries—serve our military and civilian efforts in conflict zones, with deaths and injuries spread across all.

As traditionally held military jobs have increasingly shifted to the private sector, including mess hall cooks, guards, drivers, interpreters, analysts, culture experts, trainers, etc. the risks to civilians serving inside conflict zones has also risen.  The New York Times reported in February 11, 2012 that, “More civilian contractors working for American companies than American soldiers died in Afghanistan last year for the first time during the war,” reporting that “at least 430 employees of American contractors were reported killed in Afghanistan: 386 working for the Defense Department, 43 for the United States Agency for International Development and one for the State Department”. 

Contractor deaths exceeded military deaths in Iraq in 2009 also and were nearly equal last year—fifty-four soldiers compared to forty-one contractor deaths according to the U.S. Department of Labor statistics.  Clearly civilians are just as likely to make the ultimate sacrifice as soldiers in Iraq and Afghanistan—yet so few know about or recognize civilian service to our nation.

When, Major General Arnie Fields was asked to comment for our newly formed organization We Served Too—an organization that supports and honors American and international civilian service in conflict zones and high threat security environments—he had a lot to say on how the shift to asymmetrical warfare now places civilian workers in the same danger that front line soldiers traditionally faced.  He states:

The dynamics of war have considerably changed in recent years.  The past ten years have been most significant.  The parameters that have heretofore defined the battlefield—or battle space—have been dramatically altered.  Military commanders in Iraq and Afghanistan have learned early on that the conventional ‘front’ and ‘rear”, which in earlier wars defined the most dangerous areas of the battlefield and the safest, respectively, do not exist.  The enemy’s threat is virtually omnipresent.  Soldiers not in direct pursuit of the enemy are in almost as much danger as those who are.  This new paradigm, often referred to as asymmetrical warfare, places civilians assisting in the war effort in about as much imminent danger as the traditional uniformed warrior…For example, as a civilian department of State employee in Iraq and as the U.S. Special Inspector General for Afghanistan Reconstruction, I wore my military flak jacket and helmet with more consistency while conducting my work than I did on active military duty in the Marine Corps.”  (Emphasis added).

Commenting on the medical aspects of service to our nation in conflict zones, Lt General Dr. Paul K. Carlton, Jr. also states “Military medicine has served as the tip of the spear in this conflict!
Our civilian medical system has been a superb partner to us and has to be
considered the shaft of the spear! They are integral to our entire effort!”
 

Indeed it is no longer only our military that are serving and sacrificing their lives in conflict zones.  As the Special Inspector General in Iraq pointed out in his 2013 report, government contractors, government civilian workers, nongovernment workers and even journalists are serving alongside our military and as Major General Arnie Fields states—while serving in asymmetrical warfare they may serve in equal danger to those previously considered to be in the “front” lines. 

While our military serviceman returning from Iraq and Afghanistan have faced shameful delays and nonresponsive replies from the Veterans Health Administration to get their claims covered—civilian contractors who return from the battle space with similar injuries—including limbs blown off, traumatic brain injury, PTSD, depression, traumatic bereavement and the like—have found they too have had to battle with the insurance coverage provided under the Defense Base Act (DBA)—a law requiring insurance coverage for those contracting with any agency of the U.S. government for work outside the U.S.

At present the recording of civilian contractor deaths in conflict zones is tought by many to be underreported and clearly these civilians die unheralded.  Likewise those who are wounded are finding it difficult to get their needs met. 

My wish today is for all service persons—civilian and military veterans alike—who return from our recent wars in Iraq and Afghanistan and from serving our great nation in other high threat security posts, to be honored—for their needs and those of their family members to be well taken care of, and for none of us to ever forget all those who served our country—civilian and military alike. 

In behalf of that, I and some other colleagues have begun an organization entitled We Served Too (www.WeServedToo.org) in order to honor and support civilian veterans of conflict zones and high threat security environments.  We are only on our first steps in that initiative, but invite you to join us in giving a hearty and respectful salute on this Memorial Day to all the civilians who also serve alongside their military counterparts and especially to those who gave the ultimate sacrifice.  May they be honored and never forgotten.

Anne Speckhard, Ph.D. is Adjunct Associate Professor of Psychiatry in the Georgetown University Medical School and author of Talking to Terrorists: Understanding the Psycho-Social Motivations of Militant Jihadi Terrorists, Mass Hostage Takers, Suicide Bombers & “Martyrs” In the last decade she interviewed over four hundred terrorists, suicide bombers, terrorist supporters, family members, close associates and hostages.