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On September 23-24, a two day seminar, Understanding Terror and Violence in the Lives of Children and Adolescents, was co-hosted in Oslo, Norway by ISTSS and the Norwegian Center for Violence and Traumatic Stress Studies (NKVTS) in collaboration with The European Society for Traumatic Stress Studies (ESTSS).

Although Anders Breivik, who perpetrated two terrorising incidents in Oslo and Utøya on July 22, 2011, was mentioned by name only once during this two day conference, he cast a long, wide and dark shadow over the proceedings. So did the gunmen who entered two schools in Finland intent on killing all who came into sight. Coincidentally, the timing of this international multidisciplinary meeting overlapped with the recently released film Hanna Arendt being shown in Norway for the first time. Her warnings to us all about “the banality of evil” and the terrifying consequences that may follow shed light and some clarity on all matters raised during conference proceedings. Resonances of Goya's etching “The Sleep of Reason Produces Monsters” were also strong. Poster copies should have been on sale at the conference centre, framed in black.

All participants have reason to celebrate what we saw and heard at the conference about the healing effects of supportive community initiatives for children, adolescents and their families. When sensibly delivered in close collaboration with survivors of trauma and terror it is possible to achieve remarkable outcomes. Community interventions by helping professionals, families and friendship networks, volunteer helpers, police and all who in their various ways step into the fray have established a good track record.

Yet, the dedication and commitment shown by those who gave help would probably have come to nothing had it not been for the strengths, resilience and resourcefulness of survivors who emerged from the rubble of the bomb set off in the narrow streets around government buildings in Oslo and the political activists who would not give up life despite being in the firing line of a terrorist on the rampage. Their positive reports confirmed the irrepressible force of healing which is fundamental to our human nature. Consistent with this, survivors told us that no one has a monopoly on effective intervention. What worked for survivors was flexible delivery of packages of diverse care. Therapeutic technique seemed to matter less than tactics, strategies, personal reflections and constant re-assessment of priority needs as times and contexts changed.

If a common theme emerged from these survivors and their families it was that their sense of quality of life is paramount throughout. This quality has many facets. Sustaining acceptable standards at times of crises is invariably resource intensive and their notion of quality is inextricably linked to the intimate presence of other people. Sustaining hope of eventually emerging from shock, horror and loss requires well-informed involvement of immediate family members, relatives, friends, the local community and a backing of a supportive nation. Social support is therefore a critically important facilitator of healing.

Its triumph is to give the most constructive aspects of human nature a freer rein. It is probably the premier consideration for recovery because without it, little else but stagnation is possible. Give social support its fair chance and it will work to a survivor’s advantage. But its effects are not immediate. Its processes do not eliminate distress in the short or immediate terms. Nor does healing take away painful memories. As helpers we are there to give human nature a chance to set in place processes which support the imperative of survival. All we can hope to do is to facilitate healing and as we see its slow unfolding we can but marvel at how nature works for restoration.

The evidence presented at the conference gives us reason to celebrate and be strengthened in our resolve to carry on with appropriate initiatives whenever terror and terror strikes next. That said, any inclination to bask in the glory of achievement is ill advised, because this conference also had a complementary message to the worldwide community of helpers committed to minimising the horrors that follow in the wake of trauma. It was to caution us against complacency in these matters. Any propensity to claim we know what is best blinds us to the range of evidence before us and the evidence which is absent. Conference participants were informed about a number of ways in which the survivor experience includes explicit dissatisfactions and frustration with help given. On occasions the support offered was deemed utterly irrelevant to some survivors' current needs.

If this were not enough to warn us against dismissing thoughts about that which is professionally unflattering, the conference brought additional evidence of the banality of complacency into the worldwide public domain. Namely, that we do not know the outcomes of that sizable group of survivors and their families who turned down offers of help. Research on other survivor groups gives us reason to be particularly concerned about suffering endured by these subgroups. We do not know what their distinguishing characteristics are other than their having said “no, thank you.” In itself this is critically important, but we do not know precisely how it is significant. We also have no idea about the processes that unfold in their lives to secure their respective outcomes for better or worse.

And if indeed it proves to be the case that many require neither help nor support, how can this be? What are the implications of this for the champions of systematic interventions? Are those who say no right to do so, because what we offer is not relevant to their needs? At present we are in no position to answer these questions. For all our efforts to be helpful, we have not given a voice to those who do not engage with us. Understanding their wishes to deny, be blind to and not wanting to hear us calls for professional courage. In doing so, our banality is laid open to public view as we acknowledge our dismissal by those who have not directly sought our helping roles. We have not thought enough about this as our practice has, in some respects, become unreflected.

Before closure of the first conference day we discussed the need to applaud achievements while also being cautious about complacency. The question was put, “What should we now do to remedy our propensity to be deaf to the voices and complaints of those who do not fall in line with what service providers say they should accept?” This is not a query of interest only for terror or disaster care planning. It is also relevant to all arenas of statutory and voluntary provisions upon which it is incumbent on providers to implement evidence based practice.

The conference highlighted an absence of essential evidence which is largely attributable to oversights or unwillingness to listen to what all survivor groups wished to say, had they been given an opportunity to do so. Speakers and some participants agreed this standard of practice is no longer acceptable. A remedy ready for immediate implementation is to give urgent priority to establishing new channels for survivors' feedback, comments, criticism and requests for better tailored help. Given the questionable record of statutory services in these regards with their propensity to overvalue positive feedback, the new alternative back channels should be set up to reflect the views of those who have so far been silenced. It seems reasonable to suggest that those listening should be of an organization that is completely independent of those already well-rooted in post trauma care.

After this conference it is forever more incumbent on all planning, oversight and evaluations of services to include considerations of the extent to which independent, freely accessible, confidential and appropriately resourced means are available to all survivor groups to express criticisms and define their unmet needs so that these can be addressed. Survivors of the terrors in Oslo and Utøya have opened our eyes to what has previously been hidden in the darkness created when we switched off the light of open-minded inquisitiveness and reflective thought. Even if we have become deaf to that which we have not wished to hear, survivors should be given the voices they were previously denied. As this happens we can now look to a future of building on our achievements while also showing a professional readiness to step away from the un-reflected banalities embedded in past endeavours.

About the Author

Dr Roderick Ørner, PhD, is Visiting Professor, University of Lincoln, UK and a clinical psychologist in private practice. Since retiring from the UK National Health Service, he coordinates a global specialist service for trauma survivors in the maritime industries. He was instrumental in developing modern psycho traumatology in Europe as organizer of the First European Conference on Traumatic Stress in 1989 and as a founder member of the ESTSS, of which he was president from 1998 to 2000.

ISTSS wishes to thank ISTSS Treasurer Grete Dyb and her colleagues at the Norwegian Center for Violence and Traumatic Stress Studies (NKVTS) and all the presenters at the meeting for contributing to a very successful event.