Seeing the Broken
Looking past statistics to the outliers
Broken Poetry
"All is well, All is well!” –– or so the stats would say,
every average Joe and Bob are better off by far
making payments on a home and owning their own car.
No, alarm is necessary, no cause for
disgust.
At the median, there is no reason to distrust.
Everything is fine as long as interest rates behave.
Yet within the outliers, someone is called a slave.
But surely it's just cyclical, trends of boom and
break.
Brokenness is something that occurs outside the wake
Not the mainstream that we notice, where we make our claim
In the margins, with the weakest –– this will be our shame
If we do not care, it might be more than we can
survive.
Always at the weakest spots cruel forces strive
Never at the points of strength or even in the middle
All our failures predicted by looking at the little
Caring for the least of these is how we can stay alive..
Amongst the ruins of Pompeii after the eruption of Mt. Vesuvius in 79 C.E. it is striking that of the casualties discovered 85 were children, 80 were women, and only 45 were men. From the earliest times until the present there is remarkable consistency, the most vulnerable are always children and those who are burdened with caring for them.
In the introduction to his 2014 book Collateral Damage Polish sociologist Zygmunt Bauman draws attention to the importance of the weakest in society. He points out that in electronics, a fuse will fail first before other parts are damaged. Likewise, in structural design, the most important consideration is not the average load of all the pillars but that which the weakest one can bear alone. Bauman laments the shortsightedness of looking at society any differently. “In the case of society, it is widely, though wrongly, assumed that the quality of the whole can and ought to be measured by the average quality of its parts—and that if any of its parts falls below the average it might badly affect that particular part, but hardly the quality, viability and operational capacity of the whole.”1
It is imperative then that we look more closely at the most vulnerable and not lump them in with the rest of those who are more resilient. Children are categorically the most vulnerable portion of any society; they require someone to care for them, lack physical strength, lack experience or knowledge, are still developing cognitively, and will bear the effects further on in life. Yet most crisis response treats children as just smaller versions of adults. They focus on providing food, clothing and shelter and restoration of vital infrastructure, things necessary for sustaining human life, but ignore the unique vulnerabilities of children.
The Least of These
The current model of psychosocial intervention is called Psychological First-Aid. It is aimed at the entire population and seeks to foster senses of safety, calm, hope, self and community efficacy and connectedness. However, the same critique still applies. It was developed largely in response to the needs of adults who had been through a traumatic crisis. Children are an afterthought.
When I designed “OperationSAFE” we started with children as our target from the beginning. For a child to feel safe they need to understand that they are not alone. Children are essentially relational beings. Much of the clinical work with trauma and resilience has been measured using scales designed for adults. However, children are not just little adults. They are still developing. Much of their way of coping with stress is dependent on others; family, friends, and teachers. So a solely individual assessment produces an incomplete and inaccurate picture.
After the 2011 tsunami in Japan I asked psychologists Dr. Alan Oda and Dr. Emiko Koyama to develop a scale that we could use in the field after mass trauma with children. It needed to give an accurate assessment of their post-traumatic stress symptoms without being invasive or requiring the children to be literate. They came up with seven points of observation that could be conducted by trained local volunteers. What made it different than PTSD scales used with adults was that it measures physical and social expressions of distress as well as psychological symptoms. Children often don’t have words to explain how they are feeling but show their distress through a lack of appetite, reluctance to join in activities, or increased sensitivity to discomfort. The Rapid Trauma Assessment Scale for Children (R-TAC) allowed us to form a pre-intervention and post-intervention assessment of each child and see how their well-being had improved.
Over hundreds of camps with thousands of children attending after disasters and conflicts in places like Japan, China, Tibet, Philippines, Mongolia, and Indonesia we saw some patterns emerge. Younger children consistently scored lower well-being in their initial assessment. Older children scored higher. This made sense in light of child development. The younger children were still struggling with concepts like cause and effect or understanding sequences. They were still adjusting from the micro ecology of the home and family to the larger context of school and friends. They largely made sense of things by imitating their families’ responses. In comparison the older children were more familiar with the larger context and had more cognitive ability to understand what was happening. The implications were clear. Not only did we need to pay attention to children as different than adults, we also needed to be careful to compare scores of children at the same developmental stage.
When we compared children to their developmental peers we saw another pattern emerge. This showed up in the second assessment at the end of the camp. Within each peer group there were three different responses to exposure to trauma. 70-80% of each peer group would show a resilient trajectory where their well-being at the beginning of the camp was assessed as being normative and their final assessment at the end showed improvement. 15-30% of each group would exhibit well-being scores significantly lower than their peers. However, by the end of the camp their scores would improve enough to rejoin the normative grouping, or a “recovery” trajectory. Finally, there was a third response where 0-10% of the children in each group would exhibit significantly lower well-being scores by the end of the camp and did not improve as much as their peers. It was this “chronic” trajectory group that concerned me most.
The Chronic Trajectory
Our numbers over hundreds of camp implementations matched up proportionately with what resilience researchers have labeled as “trajectories.” While George Bonanno’s original research into these heterogeneous responses to trauma were originally conducted with adults recovering from grief, 2 a survey of these types of studies found that the resilience trajectory tends to be the largest group among children followed by the recovery trajectory, and that only a very small proportion of children exhibit chronic trajectories.3
Using the trajectory modeling approach also brought to light risk factors that “distinguished between the chronic and recovery trajectories across studies, including perceived life threat, perceived threat to parents, experience of evacuation, housing disruption, violence exposure, and low social support or family connectedness.”4 While researchers know the factors that promote resilience or increase risk, there is a paradox that Bonanno writes about as late as 2021, “We know that a resilient outcome following potential trauma is common, and we know the characteristics that correlate with a resilient outcome, but, paradoxically, we still can’t predict that resilient outcome with much accuracy.”5
The difficulty comes with separating the recovery and chronic trajectories because at the initial assessment they are indistinguishable. It is not until the child’s response to the intervention is compared with the response of their developmental peers that the difference becomes apparent. It is this difference that must not be glossed over, but paid attention to as identifying those who are the most vulnerable.
The field of disaster response has also had a long interest in resilience and approaches it in a more systems-aware manner than has psychology, with its preoccupation with the individual. Disaster researchers have also been aware that, faced with the same disaster, certain groups are more vulnerable than others. “Vulnerable groups are those groups that are more likely to experience a range of negative impacts when disasters strike and less likely to experience positive outcomes in the aftermath of disasters.”6
Resilience is no longer seen as something inherent in the individual but rather as a function of a dynamic system that includes the ecosystem of the child, the greater community they are a part of, as well as the traits or resources that the individual brings to bear. While we might not be able to predict which children will recover and which won’t, the R-TAC allows us to classify children in the chronic trajectory as more vulnerable than others and requiring further care.
This is important because this chronic response shows that they are more at risk of developing future psychopathology. Early intervention can mean the difference between growing stronger through what they have been through and lifelong impairment.
Brokenness
In a groundbreaking study conducted from 1995 to 1997, Vincent Felitti, Robert Anda, and their colleagues surveyed over 17,000 people enrolled in a California hospital system about their exposure to adverse childhood experiences such as abuse, neglect, and household challenges including parental substance abuse or separation.7 This data was then compared with later life health and well-being. Their research conclusively linked childhood trauma and a wide range of physical, mental, and social problems and has since been repeated widely. A longitudinal study was completed in 2018 and found that “childhood trauma exposure is a normative experience, statistically speaking, that affects the majority of children at some point.” 8 However, as seen in Bonanno’s trajectories, while there is a direct correlation between cumulative trauma and long-term negative life outcomes, it has also been found that trauma affects each child differently. Protective factors such as a warm and responsive adult caregiver, shared family activities, safe and supportive home environment, and safe an healthy schools can help mitigate trauma exposure that otherwise would be debilitating.9
Since resilience is built up through a dynamic system it is crucial that the church sees itself as part of it. Churches are one of the protective factors that can help children cope and thrive though they experience trauma. By providing a safe place, listening ears, and hope, churches can make a difference in a child’s resilience.
It is clearly not only disaster and war that lead to brokenness. As trauma has become normative in modern society, more people approach life primarily out of their brokenness. How are trauma and brokenness different from the biblical concept of sin?
Christians understand that God hates sin and that willful disobedience deserves judgement. But at the same time, the Bible teaches that sinners are loved and offered God’s mercy. Indeed, “all have sinned and fallen short of the glory of God.”10 It is not a dualistic world of good vs. evil with saints and sinners, but a complex one where saints are yet sinners and sinners are becoming saints. I define “brokenness” as an increased likelihood toward sinful actions because of experienced trauma and its lasting effects. A well-worn phrase in caring ministries is that “Hurt people, hurt people.” The idea is that people who are broken are more likely to act in ways that hurt others. Of course it does not excuse sinful choices, but perhaps it can lead to a better understanding of God’s mercy and continued love to sinners even though they persist in their sin.
With the prevalence of trauma, each person to whom the church ministers is hurting in some way. They have been exposed to violence, neglect, abuse, exploitation, separation, and loss. They are in some way broken, having a greater propensity to sin in certain ways because of the way they have been hurt. It is therefore not enough simply to call people to turn away from sin in repentance while brokenness continues. The church must become a place of comfort and compassion where broken people are welcomed and safe from being hurt again. The church must be a place where forgiveness is experienced and practiced not once but repeatedly and often. The church must be the place where lives that are broken can be transformed into wholeness again.
Seeing the Broken
To bring healing to the broken they first need to be seen. Statistics have a way of glossing over outliers. They are the “exceptions” that only serve to prove that things are mostly going fine. They are those very few chronic children out of hundreds getting better that assure us of the effectiveness of what we are doing.
Seeing the broken requires us to pay attention to the small, the least, the last. It means we need to leave the ninety-nine and spend an inordinate amount of time searching for the one. And yet it is these weakest who expose our weakness.
The broken are by their very brokenness difficult. They require more love, more grace, more forgiveness than we have available to give. So it is easier to push them to the margins, ignore their needs, assume that they can get by on the what is provided for everybody else.
Seeing the broken shows us where we are broken. We cover it up, hide it well, know the right things to say, but underneath are starting to crack under the strain. The broken invite us to a reconstruction, not a rescue. We are not saving them. They are saving us. Caring for the least of these is how we can stay alive.
Zygmunt Bauman, Collateral Damage: Social Inequalities in a Global Age (Cambridge: Polity, 2014), 2.
George A. Bonanno, “Loss, Trauma, and Human Resilience: Have We Underestimated the Human Capacity to Thrive after Extremely Aversive Events?” American Psychologist 59, no. 1 (2004): 21, https://doi.org/10.1037/0003-066x.59.1.20.
Betty S. Lai et al., “Posttraumatic Stress Symptom Trajectories among Children after Disaster Exposure: A Review,” Journal of Traumatic Stress 30, no. 6 (2017): 581, https://doi.org/10.1002/jts.22242.
Lai et al., 582.
George A. Bonanno, The End of Trauma (Basic Books, 2021), 83.
Kathleen Tierney, Disasters: A Sociological Approach (Cambridge: Polity Press, 2019), 125.
Maxia Dong et al., “The Relationship of Exposure to Childhood Sexual Abuse to Other Forms of Abuse, Neglect, and Household Dysfunction during Childhood,” Child Abuse & Neglect 27, no. 6 (June 2003): 625–39, https://doi.org/10.1016/s0145-2134(03)00105-4.
William E. Copeland et al., “Association of Childhood Trauma Exposure with Adult Psychiatric Disorders and Functional Outcomes,” JAMA Network Open 1, no. 7 (November 9, 2018): e184493, https://doi.org/10.1001/jamanetworkopen.2018.4493.
National Scientific Council on the Developing Child, “Young Children Develop in an Environment of Relationships,” (working paper no. 1, 2004), retrieved from http://www.developingchild.net.
Romans 3:23