Harold M. Koenig, MD, Vice Admiral, Medical Corps, United States Navy, Retired:
“What’s a pediatrician who became Surgeon-General for the Navy doing supporting stories of an injured cat and a confused dog? I have been working for several years to help physicians across the country become more aware and develop better skills to help our folks returning from combat. I want to introduce you to The Just Me Project as one innovative way to help.
“First a bit of history, I started in this field in the early 1970s, and the dogma then was that you never told a child their diagnosis, let alone that they had a fatal illness. Virtually no children with cancer of any form then, with few exceptions, survived more than two years. I was fortunate early in my career to be exposed to two child psychologists who, in their just completed doctoral work, had challenged that dogma. They demonstrated that children are smart — they figure out that being in a hospital hooked up to IV's around the clock, getting medicines that make them feel worse, having their hair fall out and in some cases losing an extremity or having their head operated on wasn't normal. The psychologists went on to show that the children knew they were seriously ill, but they didn't want their parents to know because it might make them sad. The parents of course were doing the same thing. So the psychologists suggested that it might be better to open up the dialogue between parents and children and be honest. They got some parents to agree and it worked. In families that had kept secrets from each other there were a lot of mental health problems, alcohol and drug abuse, spousal abuse, emotional neglect of other children, family separations, divorce and family members slid further into the vortex of failure and despair. In families that were open these problems were a lot less.
“What happened to the families that kept secrets sounds a lot like what happens to people and their families with PTSD doesn't it? No surprise. There are a well defined set of steps us humans go through emotionally when responding to stress. Most of us do pretty well handling stress, but about 20% don't, they get stuck in one of the steps along the way. That is when the problems start. Just as we learned over three decades ago that having children and their families talk about their illness, we have learned that for people with a variety of stress induced illnesses, talking about them is the best way to get through the process — over the speed bumps.
“For PTSD we call this form of therapy CBT — Cognitive Behavioral Therapy. We get people who are stuck in their recovery process to talk about their problems in a non-threatening environment. Mental health professionals tell me 5-6 sessions is sufficient for most cases. CBT isn't much different from what we learned over three decades ago was the best approach for dealing with childhood cancer — talking openly and honestly about it. I mentioned that most people handle stress pretty well, whether it is a loss of an object, love, an illness or even death. But some don't do well and even the strongest of us, if the stress is severe enough, will need the help of others to cope and move on.
“That is where the Just Me project comes in. It provides a non-threatening way to open dialogues with children — and we all were children and can all benefit from reading a book for children now and then. A lot of the world's best books were written for children and they carry powerful messages. The book about Henry is one of those kind of books and the only one I am aware of today that comes with a structured program to support it. We know that if people with stress talk about it they do better — that's that CBT thing again. Henry provides the non-threatening environment for the conversations to begin.
“Donors have asked why the military doesn't just buy these books? If I was still on ACDU and the SG you can bet I would buy them. Remember, I was the guy who got the old BCG glasses replaced with the "Frames of Choice" program. When I did this, the ASD (HA) told me to stop, that I shouldn't do this without his and the other service's concurrence. I told him he wasn't big or tough enough to stop me and besides, it was the right thing to do. A year later he ordered the other services to implement the program. So, you can bet that if I was still on ACDU I would buy the Henry books — again because it is the right thing to do.
“I took Heather Wood Ion, the Managing Director of the Project, to Camp Pendleton and the command, after reviewing the Just Me material, asked for 500 copies — to start. One of the staff suggested distributing the Just Me project materials just like the Gideon Bible. As you know, Camp Pendleton has had the greatest number of casualties of any base — or so the local media reports. I was in Pensacola by invitation to speak at a conference sponsored by the Navy Hospital I told the hospital Commanding Officer about the Just Me project and he asked, "How can I get a hold of this material?" He said he averages 115 members of the command deployed at all times and about half of them have children. He (also a pediatrician) feels the books and supporting material would be invaluable in helping children and families to cope with loss. He is not the first medical officer to make such a statement; Heather has other anecdotes like this.
“A few more things and I will close. We don't need drawn out clinical studies to prove this will work. We know it will empirically and because it already has. We also know that as adults the single best predictor of how we will handle stress is the quality of our childhood. Adults who had good, supportive childhoods handle stress well, those who had a childhood where the family unit was not maintained, where there were separations abuse and neglect handle stress poorly.
“So what we are investing in with the Just Me program is a better childhood for many children who are experiencing stress right now. Perhaps we can help them become adults with more resiliency and better able to handle the stresses that life will bring. I hope this is helpful.”