Case Studies: Long-Distance Therapy: Helping an Isolated Family Heal Their Trauma

Article excerpt

IN THE SPRING OF 1991, MY MOTHER, A MENNONITE AND a nurse-midwife, called me from rural Pennsylvania. "Can you give me some advice," she asked, "for the parents of an Amish boy? Since you're a therapist, you might know better than me what to suggest."

I thought fast and hard. Pennsylvania is a long way from Iowa, and my instincts were to refer the family. But I knew that the family lived far from any town with a mental health center or private psychotherapist. Getting their son to see a therapist would have been a great burden to the family: the Amish rely almost solely on horse-drawn buggies for transportation, live modestly out of religious conviction and have no health insurance. So I told my mother to go on.

Manuel, a 7-year-old Amish boy, had been brought to a colleague of my mother's, an Amish lay-midwife named Leah, six months after his family had been robbed. Since the robbery, he had begun to drink large quantities of water and wet his bed at night. Formerly quiet, he had become increasingly hyperactive. His eyes frequently jerked rapidly from side to side and he showed other nervous movements. Leah had treated him with reflexology for six months, but it hadn't really helped. With the family's permission, she had turned to my mother, who called me.

The robbery was one of a series against Amish farmers in the region that winter and spring. Three men, apparently operating on the mistaken belief that the Amish hoard large sums of money in their homes, had roamed the countryside at night, holding farmers up with knives and guns and threatening to kill them in front of their families. The Amish were inviting targets because they live in isolated areas, are nonviolent, have no telephones or electricity, and therefore could not quickly summon help.

In May, they struck Manuel Zimmerman's family, dragging everyone out of bed. They beat Manuel's father, broke doors and furniture, demanded money and fired a pistol through a door. In the chaos, Mrs. Zimmerman escaped and ran through the darkness over the fields to a neighbor, who called the police. As luck would have it, a Pennsylvania State Trooper was patroling nearby and arrested the men soon after they left the Zimmerman farm.

The robbers were tried, convicted and jailed. At first it seemed that the Zimmermans and their children 7-year-old Manuel, 10-year-old Lois and 5-year-old Anna Mae were unhurt, although they were understandably upset. With the help of their close-knit community, the family soon put the incident behind them. Or so it seemed.

Not everyone reacts to traumatic stress in the same way. In the six months following the robbery, Manuel's symptoms began to appear. By harvest time, everyone knew something was wrong, and the Zimmermans brought Manuel to Leah. When that didn't work, they gave Leah permission to consult with the world outside in this case, my non-Amish mother and me. This was where things stood when my mother called me. I told my mother that children like Manuel, who have experienced a trauma and are unable to talk about it, may express it in other ways. The necessary task was to find a way to help him externalize the trauma. I suggested that the whole family sit down together and begin to talk about what had happened the year before, and that the parents encourage the children to draw pictures about the event. I had also learned that there were still bullet holes in walls and doorframes and I suggested the family work together to make repairs. I explained that it was possible that the damage somehow continued to trigger flashbacks of the trauma for Manuel. Since he had never talked about what had happened, I suggested that they attempt to get him to play it out. Knowing that their religious faith was central to their way of life, I also suggested they ask the ministers in their district to come to the house and pray with them that their family and home would recover from the trauma. And, finally, I cautioned that doing these things might not lead to any improvements for a while, if at all, and that they might even see a worsening of Manuel's symptoms, or more bizarre behavior, before any changes occurred. …