ICSA e-Newsletter, Vol. 6, No. 3, 2007

Stairway to Heaven: Treating Children in the Crosshairs of Trauma

Bruce Perry, M.D., Ph.D.

Maia Szalavitz


Abstract

This article discusses the experiences, observations, and conclusions of Dr. Bruce Perry’s child trauma team, which was asked to help 21 children, ranging in age from 5 months to 12 years, who had been released from David Koresh’s compound in Waco, Texas in 1993.  Children were in constant fear of physical attacks, public humiliation, and outsiders, i.e., the “Babylonians.”  They were readied for an apocalypse by being taught, for example, lethal suicide techniques.  The child trauma team found these children to be experiencing the common symptoms of trauma, e.g., elevated heart rates.  Feeling like hostages rather than victims, the children resisted the team’s attempts to communicate. However, by creating a stable, predictable, and patiently loving environment and by giving children an opportunity to express themselves (e.g., through drawings) at their own pace, the team was able to build relationships with the children. The disastrous raid on Koresh’s compound was a serious setback for the children.  Informal followups indicated that those who were placed in loving environments fared best.  The team concluded that loving, supportive people, not programs, change children.

Inside the Branch Davidian compound in Waco, Texas, children lived in a world of fear. Even babies were not immune: cult leader David Koresh believed that the wills of infants—some just eight months old—needed to be broken with strict physical discipline if they were to stay "in the light." Koresh was mercurial: one moment kind, attentive and nurturing, and the next, a prophet of rage. The Davidians, as the members of the Mount Carmel religious community were called, became exquisitely sensitive to his moods as they attempted to curry his favor and tried, often in vain, to stave off his vengeance.

With his volatile temper and fearsome anger, Koresh excelled at using irregular doses of extreme threat—alternating with kind, focused attention—to keep his followers off balance. He maintained an iron grip, controlling every aspect of life in the compound. He separated husband from wife, child from parent, friend from friend, undermining any relationship that could challenge his position as the most dominant, powerful force in each person's life. Koresh was the source of all insight, wisdom, love and power; he was the conduit to God, if not God himself on earth.

And he was a god who ruled by fear. Children (and sometimes even adults) were in constant fear of the physical attacks and public humiliation that could result from the tiniest error, like spilling milk. Punishment often involved being beaten bloody with a wooden paddle called "the helper." Davidian children also feared hunger: those who "misbehaved" could be deprived of food for days or put on a bland diet of only potatoes or bread. Sometimes, they would be isolated overnight. And, for the girls, there was knowledge that they would ultimately become a "Bride of David." In a unique form of sanctioned sexual abuse, girls as young as ten were groomed to become Koresh's sexual partners. A former member said Koresh once excitedly compared the heartbeats of the prepubescent girls he violated to those of hunted animals.

But perhaps the most pervasive fear that Koresh instilled was the fear of the "Babylonians": outsiders, government agents, nonbelievers. Koresh preached about and constantly prepared his community for the "final battle." The Branch Davidians, including children, were being readied for the imminent end of the world (hence Koresh's nickname for the compound, Ranch Apocalypse). This preparation involved military drills, interrupted sleep and one-on-one fighting. If the children did not want to participate or were not vicious enough in battle training, they were humiliated and sometimes beaten. Even the youngest members were taught how to handle guns. They were instructed in the most lethal suicide techniques with firearms, being told to aim for the "soft spot" in the back of the mouth if they faced capture by the "Babylonians." The rationale was that "unbelievers" would ultimately come to kill everyone. After this apocalyptic battle, however, members were promised that they would be reunited with their families in heaven and Koresh—God—would return to earth to smite his enemies.

I came to Texas in 1992 to become the vice chairman for research in the department of psychiatry at Baylor College of Medicine (BCM) in Houston. I also served as chief of psychiatry at Texas Children's Hospital (TCH) and director of the Trauma Recovery Program at the Houston Veterans Administration Medical Center (VAMC). My past experiences at a residential center had convinced me that we did not know enough about trauma and its effects on children's mental health. We did not know how trauma during development produced particular problems in particular children. The only way to figure this out, it seemed, was to closely study groups of children immediately after a traumatic event. Unfortunately, children were usually brought to us for help only years after they had suffered trauma, not right away.

It was to attempt to solve this problem that I, in coordination with BCM, TCH and VAMC, put together a "rapid response" Trauma Assessment Team. It was our hope that while helping children cope with acute traumas like shootings, car accidents, natural disasters and other life-threatening situations, we could learn what to expect from children in the immediate aftermath of a traumatic experience and how this related to any symptoms they might ultimately suffer. The children of Waco would provide one unfortunately apt sample to study.

On February 28, 1993, the "Babylonians" in the form of the Bureau of Alcohol, Tobacco and Firearms (BATF) came to the Branch Davidian compound to arrest David Koresh for firearms violations. He would not allow himself to be taken alive. Four BATF agents and at least six Branch Davidians were killed in the ensuing raid. The FBI and its hostage-negotiation team managed to secure the release of twenty-one children over the following three days. It was at this point that my team was brought in to help with what we thought would be the first wave of children from the compound.

I heard about the first raid on the Branch Davidian compound like most people did: from the news on television. Almost immediately, reporters began calling to ask me how the raid might affect the children. When I was questioned about what was being done to help those who had been removed from the compound, I replied almost off-handedly that I was sure the state was making sure they were properly cared for.

But just as soon as the words left my mouth, I realized that this was probably not true. Government agencies—especially the chronically underfunded and overburdened Child Protective Service (CPS) systems—rarely have concrete plans to deal with sudden influxes of large groups of children. Furthermore, chains of command between the federal, state and local agencies involved in law enforcement and CPS are often unclear in unusual, fast-moving crises like the Waco standoff.

As I thought more about this I felt pulled to see whether the expertise on childhood trauma that our Trauma Assessment Team had been developing could be helpful. I contacted several agencies but no one could tell me who was "in charge." Finally I reached the governor's office. Within a few hours I was called by the state office of CPS and was asked to come to Waco for what I thought would be a one-time consultation. That afternoon meeting turned into six weeks of one of the most difficult cases I have ever had.

When I arrived in Waco I found disarray, both in the official agencies responding to the crisis and in the care of the children. During the first few days, when the children were released, they were driven away from the compound in large tank-like vehicles. No matter what time of day or night it was when they came out, they were immediately interrogated by the FBI and the Texas Rangers, often for hours. The FBI had the best intentions; they wanted information quickly so that they could help defuse the situation at the Ranch and get more people out safely. But no one had thought through how overwhelming it would be for a child to be taken from his parents, put in a tank after witnessing a deadly raid on his home, driven to an armory and questioned at length by numerous armed, strange men.

It was only dumb luck that kept the Davidian children together after the first raid. Originally, Texas CPS had planned to place them in individual foster homes, but they could not find enough homes fast enough to take all of them. Keeping them together turned out to be one of the most therapeutic decisions made in their case. After what they had just experienced, ripping them from their peers and/or siblings would only have increased their distress.

Instead of foster homes the children were brought to a pleasant, campus-like setting, the Methodist Children's Home in Waco. There, they lived in a large cottage, initially guarded by two armed Texas Rangers. They were cared for by two rotating live-in couples, the "house mothers" and "house fathers."

In those early days the atmosphere of the cottage was chaotic. Officers from various law enforcement agencies would show up at any time, day or night, and pull aside particular girls or boys for interviews. There was no schedule to their daily life and no regularity to the people that they would see. One of the few things I knew for sure by then about traumatized children was that they need predictability, routine, a sense of control and stable relationships with supportive people. This was even more important than usual for the Davidian children: they were coming from a place where they had for years been kept in a state of alarm, led to expect catastrophe at any minute.

During my initial afternoon meeting with the key agencies involved, my advice boiled down to this: create consistency, routine and familiarity. That meant establishing order, setting up clear boundaries, improving cross-organizational communication and limiting the mental health staff to those who could regularly be there for the children. I also suggested that only those who had training in interviewing children be allowed to conduct the forensic interviews for the Rangers and the FBI. At the end of the meeting CPS asked me if I would be willing to lead in the coordination of these efforts. Later that day, after meeting with FBI agents, I was also asked to do the forensic interviews myself. At that point we still thought that the crisis would be over in days, so I agreed.

When I got to the cottage one of the Rangers stopped me at the door. He was tall and imposing in his hat, the archetype of Texas law enforcement. He was not impressed by this long-haired man in jeans claiming to be a psychiatrist who had come to help the children. Even after I had established that I was indeed Dr. Perry, he told me that I did not look like a doctor, and further, "Those kids don't need a shrink," he said. "All they need is a little love and to get as far away from here as possible."

Ultimately, this Ranger would turn out to be one of the most positive and healing figures in the children's lives for the weeks they stayed at the cottage. He was calm, good with children, and intuitively seemed to know how to provide a supportive but not intrusive presence. But right then, he was in my way. I said to him, "Okay, I'll tell you what. Do you know how to take a pulse?" I directed his attention to a young girl who was fast asleep on a nearby couch. I told him that if her pulse was less than 100, I would turn around and go home. The normal heart rate range for a child her age at rest is 70-90 beats per minute.

He bent down gently to pick up the girl's wrist, and within moments his face filled with anxiety. "Get a doctor," he said. "I am a doctor," I replied. "No, a real doctor," he said, "This child's pulse is 160."

After reassuring him that psychiatrists are physicians with standard medical training, I began to describe the physiological effects of trauma on children. In this case an elevated heart rate was likely a reflection of the girl's persistently activated stress-response system. The ranger understood the basics of the fight or flight response. I noted that the same hormones and neurotransmitters that flood the brain during a stressful event—adrenaline and noradrenaline—are also involved in regulating heart rate, which makes sense since changes in heart rate are needed to react to stress. The Ranger let me in.

The Davidian children had been released in small groups in the first three days following the February raid. They ranged in age from five months to twelve years old. Most were between four and eleven. They came from ten different families, and seventeen of the twenty-one were released with at least one sibling. Although some former members have disputed accounts of child abuse among the Davidians, there was never any doubt that the children had been traumatized, certainly by the raid on the compound, but also by their life beforehand.

These children did not feel as though they had just been liberated. Instead, because of what they had been taught about outsiders and because of the violence they had survived, they felt like hostages. They were more frightened of us now than they had been at home, not only because they were suddenly deprived of family and familiarity, but also because Koresh's predictions about an attack had come true. If he was right that the "unbelievers" had come for them, they figured, his assertion that we intended to kill them and their families was probably correct as well.

We immediately recognized that we had a group of children that had essentially been marinated in fear. The only way we could get them the help they needed was to apply our understanding of how fear affects the brain and then consequently changes behavior.

Fear is our most primal emotion, and with good evolutionary reason. Without it few of our ancestors would have survived. Fear literally arises from the core of the brain, affecting all brain areas and their functions in rapidly expanding waves of neurochemical activity.

The brain evolved from the inside out, and it develops in much the same order. The lowest, most primitive region—the brainstem—completes much of its development in utero and in early infancy. The midbrain and limbic systems develop next, elaborating themselves exuberantly over the first three years of life. Parents of teenagers will not be surprised to learn that the frontal lobes of the cortex, which regulate planning, self-control and abstract thought, do not complete their development until late in adolescence, showing significant reorganization well into the early twenties.

The fact that the brain develops sequentially—and also so rapidly in the first years of life—explains why extremely young children are at such great risk of suffering lasting effects of trauma: their brains are still developing. The same miraculous plasticity that allows young brains to quickly learn love and language, unfortunately, also makes them highly susceptible to negative experiences as well. As a result different symptoms may result from trauma experienced at different times.

At any age, however, when people are faced with a frightening situation their brains begin to shut down their highest cortical regions first. We lose the capacity to plan, or to feel hunger, because neither are of any use to our immediate survival. Often we lose the ability to "think" or even speak during an acute threat. We just react. And with prolonged fear there can be chronic or near-permanent changes in the brain. The brain alterations that result from lingering terror, especially early in life, may cause an enduring shift to a more impulsive, more aggressive, less thoughtful and less compassionate way of responding to the world.

This is because systems in the brain change in a "use-dependent" way. Just like a muscle, the more a brain system like the stress response network gets "exercised," the more it changes and the more risk there is of altered functioning. At the same time, the less the cortical regions, which usually control and modulate stress, are used, the smaller and weaker they get. Exposing a person to chronic fear and stress is like weakening the braking power of a car while adding a more powerful engine: you are altering the safety mechanisms that keep the "machine" from going dangerously out of control. Understanding the importance of use-dependent development was vital to our work in treating traumatized children like those we saw in the immediate aftermath of the first raid on Ranch Apocalypse.

During my first two days in Waco I began the delicate task of individually interviewing each child to try to get useful information to help the FBI negotiators defuse the standoff. In any situation where child abuse is suspected, such interviews are difficult because children, quite reasonably, worry about getting their parents in trouble. In this case, it was further complicated by the fact that the Davidians had been brought up to believe that it was okay to deceive "Babylonians" because we were the enemies of God. I knew they might fear that being honest with us was not only a possible betrayal of their parents, but a grievous sin as well.

To my horror, every child gave me the distinct sense that they had a big, terrible secret. When I asked what was going to happen at the Ranch, they would say ominous things like, "You'll see." Every child, when asked explicitly where his or her parents were, replied, "They're dead," or, "They're all going to die."

It is not unusual for children to be deceptive or withholding or to purposefully lie in order to avoid things they do not want to share, especially when they have been instructed to do so by their families. However, it is far more difficult for them to hide their true thoughts and feelings in their artwork. And so, with each child old enough to color, I sat with him and colored as we talked. I asked one ten-year-old boy named Michael, who was one of the first children interviewed, to draw me a picture of whatever he wanted. He went to work quickly, producing a fine unicorn surrounded by a lush, earthly landscape of forested hills. In the sky were clouds, a castle and a rainbow. I praised his drawing skills and he told me that David loved it when he drew horses. He had also received kudos from the group and its leader for his renditions of heavenly castles and the incorporation of the group's symbol into his drawings: the star of David.

Then I asked him to draw a self-portrait. What he drew was virtually a stick figure, something that a four-year-old could produce. Even more shockingly, when I asked him to draw his family, he paused and seemed confused. Finally, he created a page that was blank but for a tiny picture of himself, squeezed into the far right-hand corner. His drawings reflected what he had learned in the group: the elaboration of things that Koresh valued, the dominance of its supreme leader, a confused, impoverished sense of family and an immature, dependent picture of himself.

Inside the compound almost every decision—from what to eat and wear to how to think and pray—had been made for them. And, just like every other area in the brain, the regions involved in developing a sense of self grow or stagnate depending upon how often they are exercised. To develop a self, one must exercise choice and learn from the consequences of those choices; if the only thing you are taught is to comply, you have little way of knowing what you like and want.

One of my next interviews was with a little girl, almost six years old. I asked her to draw a picture of her home. She drew a picture of the compound. Then I asked her what she thought was going to happen at home. She redrew the same compound building with flames everywhere. Atop it was a stairway to heaven. I knew then—just days after the first raid—that the siege was headed for a potentially cataclysmic conclusion.

Earlier, we had created a group to facilitate communication between the various law enforcement agencies and our team. We had made a deal with the FBI: if they would respect the boundaries that we had created to help these children heal, we would share any information our work revealed that might help them negotiate an end to the standoff. After I saw these drawings and heard these remarks I immediately communicated my concerns that any further attack on the compound had the potential to precipitate some kind of apocalypse. I did not know the exact form it would take, but it seemed it would be an explosive, fiery end. The words, the drawings and the behaviors of the children all pointed to a shared belief that the siege would end in death.

I met repeatedly with my FBI liaison and members of the behavioral science team, who, I later learned, agreed with me that further escalation by law enforcement would more likely provoke disaster, not surrender. But they were not in charge. The tactical team was, and they would listen but not hear. They believed that they were dealing with a fraud and a criminal. They did not understand that Koresh's followers truly believed that their leader was a messenger of God, possibly even Christ returned, with the self-sacrificing devotion and commitment such a belief implies. This clash of group worldviews shaped the escalating actions that contributed to the final catastrophe.

After I had completed my initial interviews more than a dozen people from my home institutions in Houston joined me in Waco to form the core of our clinical team. Along with the guards, CPS workers and Methodist Home staff, we worked to end the unstructured chaos in the cottage. We scheduled a regular bedtime and regular meal times, created time for school, for free play and for the children to be given information about what was happening at the Ranch. Since the outcome of the siege was unpredictable, we did not allow them to watch TV or expose them to any other media coverage.

In the beginning there was a push by some in our group to start "therapy" with the children. I felt it was more important at this time to restore order and be available to support, interact with, nurture, respect, listen to, play with and generally "be present." The children's experience was so recent and so raw, it seemed to me that a conventional therapeutic session with a stranger, particularly a "Babylonian," would potentially be distressing.

Incidentally, since Waco, research has demonstrated that rushing to "debrief" people with a new therapist or counselor after a traumatic event is often intrusive, unwanted and may actually be counterproductive. Some studies, in fact, find a doubling of the odds of post-traumatic stress disorder following such "treatment." In some of our own work we have also found that the most effective interventions involve educating and supporting the existing social support network, particularly the family, about the known and predictable effects of acute trauma and offering access to more therapeutic support if—and only if—the family sees extreme or prolonged post-traumatic symptoms.

I thought these children needed the opportunity to process what had happened at their own pace and in their own ways. If they wanted to talk, they could come to a staff member that they felt comfortable with; if not, they could play safely and develop new childhood memories and experiences to begin offsetting their earlier, fearful ones. We wanted to offer structure, but not rigidity; nurturance, but not forced affection.

Each night after the children went to bed our team would meet to review the day and discuss each child. This "staffing" process began to reveal patterns that suggested therapeutic experiences were taking place in short, minutes-long interactions. As we charted these contacts we found that, despite having no formal "therapy" sessions, each child was actually getting hours of intimate, nurturing, therapeutic connections each day. The child controlled when, with whom and how she interacted with the child-sensitive adults around her. Because our staff had a variety of strengths—some were very touchy-feely and nurturing, others were humorous, still others good listeners or sources of information—the children could seek out what they needed, when they needed it. This created a powerful therapeutic web. And so children would gravitate toward particular staffers who matched their specific personality, stage of development or mood.

But these children needed more than just the ability to choose whom to talk to and what to discuss. They also needed the stability that comes from routine. In the first days following the assault with no external organization imposed upon them, they immediately replicated the authoritarian, sexually segregated culture of the Davidian compound, where men and boys over twelve were segregated from women and girls, and where David Koresh and his representatives ruled with absolute power.

Two of the oldest children, siblings, a boy and a girl, declared themselves "scribes." The female scribe dominated and made decisions for the girls, and the boy led the boys and also held sway over the female scribe, with the other children falling into line and complying without complaint. The girls and boys sat at separate tables for meals; they played separately and deliberately avoided interaction if at all possible. The oldest girls, who had been in the process of preparing to be David's "Bride," would draw stars of David on yellow Post-it notes or write "David is God" on them and put them up around the cottage.

But none of the children knew what to do when faced with the simplest of choices: when offered a plain peanut butter sandwich as opposed to one with jelly, they became confused, even angry. Having never been allowed the basic choices that most children get to make as they begin to discover what they like and who they are, they had no sense of self. The idea of self-determination was, like all new things for them, unfamiliar and, therefore, anxiety provoking. So the children turned to the scribes for guidance and let them make these decisions.

We were not sure how to deal with this issue. We wanted them to have a sense of the familiar and to feel "at home," and we thought that allowing them these rituals might help them feel safe. On the other hand we knew that they would need to learn what would soon be expected of them in the outside world.

We had only trial and error to guide us. My first attempt to break the segregation between the boys and the girls was a disaster. One day I sat down at the girls' table for lunch. Immediately, all of the children seemed to tense up. A three- or four-year-old girl challenged me, saying, "You can't sit here." I asked why. She said, "Because you're a boy."

"How do you know?" I asked, trying to use humor to defuse the situation, but she stuck with her challenge and looked to the female scribe, who confirmed to her that I was male. When I continued to sit there almost all of the children became angry and the air became so charged and hostile that I was afraid they would riot. Some of them stood up, taking an aggressive stance. I backed off. After that, we allowed them to maintain their separate tables and the bizarre dietary restrictions that Koresh had imposed, such as not eating fruit and vegetables at the same meal.

We decided that all we could do was to allow them to see how we adults lived and interacted with each other, and hope that over time they would see that there would not be negative consequences if they chose to live as we did.

And we began to see that as children coped with the aftermath of terrifying experiences like the first raid on Ranch Apocalypse, they responded to reminders of what happened similarly to the way they responded at the time. So, for example, if they were able to flee, they might respond with avoidance; if they fought back, they might respond aggressively; if they dissociated, they would do that again. During an interview with one of the girls, Susie, a six-year-old, I saw one of the most extreme dissociative responses I had ever witnessed. I had asked Susie where she thought her mother was. She responded as though she had not heard the question. She crawled under a table, tucked herself into a fetal position and did not move or talk. Even when I tried to touch her to comfort her, she was so nonresponsive that she did not notice when I walked out of the room six minutes later.

Our questions, of course, were not the only reminders of what they had witnessed. One day a press helicopter flew over the cottage when the children were playing outside. They had been told by Koresh that the FBI would fly over them with helicopters, douse them with gasoline and light them on fire. Within seconds, the children had disappeared and taken cover, like a platoon in a combat movie. When the helicopter had passed, they formed two single-file lines, one of boys, one of girls, and marched into the building chanting a song about being soldiers of God. It was one of the eeriest things I have ever seen.

During the standoff at Waco our team literally lived with the Branch Davidian children. I would make the hours-long drive to Houston now and then to take care of the bare minimum of my administrative duties and family responsibilities. I spent hours in meetings with partner organizations dealing with the crisis, trying to ensure that when they left us, these children would go to safe, healthy families, and also trying to see to it that those who needed it received continuing mental health care. I also spent many frustrating hours trying to get the information we had learned about the high probability of a mass suicide or suicidal terror attack on the officers surrounding the compound to someone who would listen and who could change the tactics being used.

Unfortunately, however, the tactical team in charge of operations continued to see Koresh as a con man, not a religious leader. Just as the group dynamics within the cult pushed them toward their horrific conclusion, so too did the group dynamics within law enforcement. Both groups tragically disregarded input that did not fit their world view, their template.

Working with the Davidian children—and seeing the unfolding crisis in Waco from the inside—repeatedly reiterated to me how powerful group influences are in human life and how the human brain cannot really be understood outside of its context as the brain of a member of a highly social species.

Early in the morning of April 19, while in Houston, I received a call from an FBI agent I did not know. He said that I needed to come to Waco immediately: the government had begun a raid on the compound intended to end the siege and free the young people who remained inside. As I drove I listened to the radio. When I crested the hill at the boundary of the city, I saw a massive pillar of thick gray smoke and orange fire. I continued immediately to the Methodist Children's Home. The adults looked stricken, but they had managed so far to avoid betraying their distress to the children. They had been preparing to care for the twenty-three children still inside the compound, getting to know them through their siblings and through videotapes made of the children inside the compound by Koresh and released to the FBI. Now they felt their loss, and were all too aware of how their deaths would affect the children they were already treating.

Adding to our pain was the fact that we knew that much of the trust we had developed with these children would probably now evaporate. We had told them that we were not their enemies and that their parents, siblings and friends would not be killed. But events would now further confirm the accuracy of Koresh's prophecies.

We had to carefully decide the best way to break the news. Due to the unfolding of events, we waited until the next day because we did not have information about survivors until then.

We set up a meeting in the living room of the cottage. Each child there had developed a close relationship with at least one or more of the staff in our team. Our plan was that I would tell the group what happened in as factual and clear a manner as possible. We would ask them if they had any questions. After that, each child or sibling group would spend time with the two or three staff members they were close to.

It was one of the most difficult moments of my clinical life. How do you tell a dozen children that their fathers, brothers, mothers, sisters and friends are dead? And yes, they died just as Koresh foretold. And yes, we assured you that this would not happen. At first, some simply refused to believe me. "It's not true," they said over and over, as many people do when faced with the death of loved ones, "It can't be." Others said, "I knew this would happen," or, "I told you so."

The worst part of all was knowing that things did not have to end this way. The response of the Davidians to the final assault was predictable, and the loss of life could have certainly been mitigated if not entirely prevented. Nonetheless, the federal government had taken the action most likely to result in a disaster, and eighty people, virtually everyone these children knew, had died.

By the time of the fire many of the children had already gone to live with relatives outside the group; only about eleven girls and boys remained at the cottage. The raid was, unsurprisingly, a setback for most of them. Their traumatic symptoms returned, as did their observance of Koresh's dietary rules and sexual segregation.

By this time we had learned how careful we had to be. There was a big debate, for example, as to what to do about the fact that the girls and boys still took their meals at two separate tables. I finally suggested that we remove one of the tables and see what happened. When one of the girls asked why we were taking it away, I told her that we did not need it any more. She accepted my reply without further inquiry; it was clear that there were far fewer children living at the cottage by then. At first the girls sat at one end and the boys at the other. Then slowly and naturally, they began to interact and mix. Over time their traumatic symptoms and their observance of Koresh's rules began to recede again.

Now, fourteen years later, we have had various opportunities to follow the Davidian children—all informal. We know that all of them have been permanently and profoundly affected by what occurred. About half left to live with relatives who still believed in Koresh's message, and some still follow the religion in which they were raised. Some have gone on to college and careers, and have had their own families; others have led troubled and chaotic lives.

There were inquiries, Congressional hearings, books, exposes and documentaries. However, despite all this attention, it was still only a few short months before interest in these children dropped away. There were criminal trials, civil trials, lots of sound and fury. All of the systems—CPS, the FBI, the Rangers, our group in Houston—returned, in most ways, to our old models and our ways of doing things. But while little changed in our practice, a lot had changed in our thinking.

We learned that some of the most therapeutic experiences do not take place in "therapy," but in naturally occurring healthy relationships, whether between a professional like myself and a child, between an aunt and a scared little girl or between a calm Texas Ranger and an excitable boy. The children who did best after the Davidian apocalypse were not those who experienced the least stress or those who participated most enthusiastically in talking with us at the cottage. They were the ones who were released afterwards into the healthiest and most loving worlds, whether it was with family who still believed in the Davidian ways or with loved ones who rejected Koresh entirely. In fact, the research on the most effective treatments to help child trauma victims might be accurately summed up this way: what works best is anything that increases the quality and number of relationships in the child's life.

I also saw how bringing disparate groups together—even those with conflicting missions—could often be effective. Dozens of state, federal and local agencies had worked together to care for these children. The power of proximity—spending time side-by-side—had pulled us all to compromise in our efforts to help.

Relationships matter: the currency for systemic change was trust, and trust comes through forming healthy working relationships. People, not programs, change people. The cooperation, respect and collaboration we experienced gave us hope that we could make a difference, even though the raids themselves had ended in such catastrophe. The seeds of a new way of working with traumatized children were sown in the ashes of Waco.

Acknowledgment

From the book, The Boy Who Was Raised as a Dog, by Bruce Perry and Maia Szalavitz. Copyright © 2006 by Bruce Perry and Maia Szalavitz. Reprinted with permission.