For the War's Wounded Troops and Families, Elmo Can Help

How can you gently explain to a 4-year-old that Daddy has been killed in Afghanistan and will never come home?

How does a combat-wounded Marine convince his scared young son that he's still the same loving Dad, even though his thighs now end in stumps?

How does a family cope with their returned soldier who looks the same, but whose traumatic brain injury from a near-miss IED slurs her speech and dims her memory and sometimes wracks her with unreasoning spasms of hot fury?

How does a family celebrate Christmas while a loved one is hundreds of miles away in a military hospital ward?

War doesn't pause for the holidays, and for American military families who have suffered beyond the "ordinary'' stress of a year-long combat deployment, this can be an extraordinarily difficult season.

In nine years of combat in Iraq and Afghanistan, more than 5,800 families have lost a mother, father, son or daughter to the war. Some 42,000 families are caring for a family member with physical wounds or the less visible damage of traumatic brain injury or combat stress. Many of these painful struggles have gone on for years.

Among those most severely affected are the children of military families, kids struggling with sorrow, fear, anger, resentment and a sense of betrayal: My Dad promised he'd be OK but he isn't, and the military didn't keep him safe either, so who can I trust?.

For these children and their families, a new hero has emerged: a Muppet named Elmo.

In a series of free videos distributed widely to military families and to those who support them, Elmo and his Muppet parents and friends, together with real humans, figure out how to talk through anguishing situations, how to find the words to use to express grief, fear, anger, and how to harness the healing power of love.

In this video, for instance, Elmo encourages his friend Rosita to tell her father how upset she is that he needs a wheelchair and can't play kickball.

In a voice breaking with emotion, Rosita tells him, "I wish your legs were OK, Poppi, and I wish you didn't have to go to the doctor's so much. . . . I just wish things could go back to the way they were!''

He strokes her and answers, "Listen . . . I may be a little different, but I am still your Dad, still your Poppi. Even though some things have changed, my love for you has not.''

The videos were produced by Sesame Workshop (the creator of "Sesame Street") and by Navy Capt. Russell Shilling, an aerospace experimental psychologist at the Defense Advanced Research Projects Agency, with the support of the Pentagon, corporate underwriters and mental health organizations. And while the videos are targeted at children between the ages of 2 and 8, they are equally instructive -- and emotional -- for adults.

A recent showing at the Pentagon left "a roomful of generals dabbing their eyes,'' said a Marine staff officer.

One reason is that the videos are relentlessly upbeat while acknowledging profound tragedy and loss.

"At first I didn't think she wanted to hug me, she was scared of me, maybe,'' an amputee soldier, speaking on a Sesame Workshop video, said about his daughter. As she clung to him, he said, "That hug made me so happy. . . It made me feel I didn't really lose anything at all.''

Said another wounded trooper: "As macho as you think you are -- that you are a U.S. soldier and a fighting machine -- this particular fight, you can't do it alone, you need family.''

That it has taken this long -- nine years into the war -- for the trauma of military families and children to be recognized is a testament of sorts to the stoic toughness of the troops and their loved ones.

"The majority of military families come from a place of strength; the parents and children have a sense of cohesion, mutual support, pride in service,'' said Gregory Leskin, a clinical psychiatrist at UCLA's Neuropsychiatric Institute. But under severe stress, military families risk losing cohesion and shattering into lonely individuals. Being able to communicate is a "key factor'' in keeping the family together, said Leskin, who specializes in working with military families.

Researchers also are coming to understand what military families have long realized: while a combat deployment lasts a year or less, the impact of a combat death or injury can be infinite.

"Combat injury is not an event, but a cascade of events, starting with the shock of notification'' that a loved one has been badly injured, said Dr. Stephen Cozza, professor of psychiatry at the Uniformed Services University and former chief of child and adolescent psychiatry at Walter Reed Army Medical Center in Washington.

After absorbing the shock, one or more family members typically travels to a military hospital at some distance from home. A severely injured military member may be hospitalized for years, requiring long family separations. Often the kids must be farmed out to relatives or brought to spend hours at the hospital bed, upsetting school and other routines.

"In short, there's a lot of stress on military families, exacerbating the stresses and strains of normal family life,'' said Cozza.

What many military families find hard to share, with each other and with friends, is the most disturbing or awkward information about a wound, especially when a vigorous young father or brother suddenly needs a wheelchair, a colostomy bag or a prosthetic hand, or is bedridden with partial paralysis. "Parents who have difficulty discussing questions of sex with their kids are going to have trouble here,'' said Cozza.

That's where the "Sesame Street" videos can be useful. Left on their own, "kids tend to act out instead of saying, 'I'm scared,' '' said Lynn Chwatsky, Sesame Workshop's senior director for outreach. "You see kids regress -- bed-wetting, temper tantrums, misbehavior at school, all from emotions that they don't know how to express.

"What we try to do is help them communicate their feelings,'' she said. "Muppets provide hope and a bit of levity from some real tough situations. They can feel what kids are feeling, even when kids don't realize what they are feeling.'' The writers and producers of the Sesame Workshop videos have found the videos also help parents. "They open the door to a dialogue they've never been able to have with their kids,'' said Chwatsky. "Elmo can do that.''

As the population of wounded military families expands, therapists are urging communities to help integrate them back into civilian society.

There is a wealth of resources for military families and civilians who want to get involved, not just for a one-time event, but on a continuing basis.

"There's sort of a waxing and waning of interest and support for our military families,'' said Leskin. "More and more, we are seeing the need for regular, ongoing support, activities that acknowledge and support them over a lifetime.''