How Will the Boy Cope?

By Ian K. Smith, M.D.

In the lengthy tug-of-war over Elian Gonzalez, I have found myself asking a simple question: Have we forgotten the child? After the federal action last weekend in Miami, there is legitimate concern about the effect the forced removal at the end of a 9-mm MP5 submachine gun will have on his psychological well-being.

Not even the most precocious six-year-old could leave a home full of family and friends, watch his mother swallowed by the ocean and then be pulled again from family without suffering mental anguish. The immediate, daunting task for experts is to figure out just how much he has suffered and what can be done to normalize his life.

Finding the answers may be complicated by the delayed reaction commonly experienced after a stressful event. In many cases, it takes years before the psychological scars become evident. In the debilitating condition called post-traumatic stress disorder, psychological numbness can arise after exposure to an extremely traumatic event that involves actual or threatened death or serious injury.

The next few weeks and months will be critical in determining whether Elian is going to exhibit any early symptoms of psychological distress, according to Dr. Sharon Lieteau, a psychiatrist who is an expert in stress disorders. "The important thing is that young children who are exposed to this type of stress may show symptoms of developmental regression," she says. These can include such behaviors as wetting the bed, being afraid of the dark or not wanting to separate from a trusted figure. Such children tend to take part in repetitive play that expresses themes or aspects of the trauma. Most of them have frightening dreams but frequently don't remember the details.

Though Elian Gonzalez has been in the middle of an intense and factious war that would wreak havoc on even an adult's psyche, it is possible that he can heal and even avoid lifelong psychological injury. What he has needed all along and requires now more than ever is support, stability and environmental familiarity.

Politics aside, a reunion with his father means a return to a bond that Elian has known for the better part of his six years. He needs to see again the faces he once knew and to hear the voices of those who once soothed him. Play therapy, in which he can again be a little boy, is critical for him. More disruptive periods will only serve to stunt the growth of his young, innocent life.