Children are also affected by strong guilt feelings. During an earthquake at lunchtime, part of the roof and the weak south wall of a school cafeteria fell down. As seven year old Timmy ran with his peers to escape, he turned to look back at the falling roof and wall. He saw a little girl lying motionless on a table. He struggled painfully with whether or not to go back for her, but the glass and debris flying toward him ended the debate, and he ran to safety. His sense of shame and guilt were intense and his trauma symptoms severe. In fact, the little girl was already dead when he saw her, and Timmy also would have died if he had gone back. He was unable to function as a student and unable to address the rest of his traumatic experience until he processed his guilt feelings about the little girl.
Assessing responsibility is generally a less formal process with children. Play therapy, sometimes combined with cognitive behavioral approaches, has assisted children to contend with guilt. For example, in trauma/grief focused therapy, in addition to any exploration of what was actually possible during an event, a clinician may skillfully assist a child to play out the action of an experience and to play out fantasied desired actions (Nader & Mello, 2000; Nader & Pynoos, 1991). For some specific types of trauma, corrective dénouement therapy helps the youth to find, in retrospect, a real solution that might have avoided the trauma or stopped the assault. This procedure permits the youth to realize (a) it was not possible to avoid the traumatic event because he or she did not know how; and (b) that the youth now has the coping skills to deal with a similar event (Terr, 1983).
I find it refreshing to find someone admitting when there is no unarguable answer. I became a Physicians Assistant in 1980, had my own first significant orthopedic surgery (total knee replacement) two weeks ago, and notice from then to now it was and is possible to find those who say NSAIDs harm, don’t affect, or help healing post op. Since there is no consensus, I prefer to not wishfully believe there is. I’m taking naproxyn 440 mg twice a day. It’s a dose I have taken occasionally in the past for sprains and strains, with no ill impacts other than easy bruising. Is it reducing my swelling and pain? Maybe. Swelling and pain are going down. John Laudenslager