Psychological Poverty

Even in the war-torn Balkans, children had the developmental tools to cope with their lives blowing up around them. Dr. Paramjit Joshi of Johns Hopkins can't say the same for kids in Baltimore


A couple of black-and-white stick figures and a dead body: after 22 years in Baltimore, Dr. Paramjit Joshi had come to expect drawings like this from children traumatized by violence.

Then she went to the Balkans.

There she met children who had seen fathers and brothers lined up and shot, homes and churches burned to rubble.

These children drew in color and detail. In their pictures, people had flesh on their bodies and hair on their heads. Landscapes had trees, grass, butterflies and sun, along with warplanes, bombs, sirens and house fires.

"There is more substance to their pictures; they're less impoverished," Joshi says, in her office at Johns Hopkins Children's Center two days after returning from a recent trip to Macedonia.

"The kids had normal development until the war broke out, so they have some resources to fall back on. Our kids have absolutely none."

Joshi, who specializes in children and violence at Hopkins' department of psychiatry, was asked in 1994 to take her expertise to one of the most hostile places on earth, the Balkans.

What she discovered was that children back home were in even worse shape.

Among Balkan children, Joshi saw a surprising ability to bounce back. That sort of resilience, she says, forms in the earliest stages of life, when children in healthy environments develop feelings of trust, love, confidence and autonomy -- feelings many Baltimore kids never experience.

"So many of our kids are exposed to intrauterine drug abuse and poor prenatal care, and then there's lead poisoning and abuse. They're sent from foster home to foster home and, because they haven't had those early developmental milestones, there's absolutely nothing to fall back on. So they don't know how to cope," she says.

"It bothered me, and I said, you know it's fancy to go to a foreign land, but what are we doing for our own kids here? How blind could I have been?"

That realization started her on a new road, which she calls "from Bosnia to Baltimore."

As the Bosnian crisis began to subside in 1996, she invited experts from hot spots around the world -- people she'd met on her international missions -- to Baltimore, to figure out ways to deal with violence here.

Out of two international "colloquia" came partnerships among educators, mental health experts and police that helped put therapists and psychiatrists in city schools, train teachers in conflict resolution, pair therapists with police to help kids who are victims and witnesses to violent crime, educate parents in dealing with media violence and created a special unit at the Children's Center that coordinates the various agencies' efforts to prevent violence.

Now, as Joshi moves on to the next phase in her career, she hopes to copy some of those programs. In September, she will leave Hopkins to become chairman of the department of psychiatry at Children's National Medical Center -- a significant gain for Washington, her colleagues say, and a loss for Baltimore.

"She strikes you immediately as a kind and concerned person, but behind this kindness is courage," says Dr. Paul McHugh, chairman of the psychiatry department at Hopkins. "She's willing to risk her own life to go into these places where people get shot and bombs go off. She's just a brave lady."

A familiar problem

Joshi, 49, hadn't set out to do refugee work. But she took to it naturally -- probably, she says, because she grew up hearing her mother tell of her family's forced flight when India was split up in 1947. At the time, ethnic cleansing and street fighting -- most of it hand-to-hand with spears and swords -- left several million people dead and 10 million displaced.

After training to be a pediatrician in her native India, Joshi came to the United States in 1975 when her husband, Jai, an oncologist, got a fellowship in Denver. She stayed out of work for two years to raise her two young sons, Amit, now 23, and Arif, 22, then applied for an internship in child psychiatry at Hopkins -- a field that didn't exist in India at the time.

When the family's baby-sitting arrangement fell through, Joshi -- facing a precarious work schedule at Hopkins -- decided to leave her children with their grandparents in India for a year, six months with her parents, six months with Jai's.

The decision remains painful to this day. When Joshi went to pick up her children, her older son acted the perfect gentleman and shook her hand, while the younger ran into his grandfather's lap and wanted nothing to do with her.

Today, when she visits refugee camps, she's particularly drawn to children separated from their parents. "Of course I love my profession but I would never do it again," she says, sitting amid books and papers in her small, bright office, wearing an emerald green silk dress and a pearl necklace, her straight black hair clipped in simple barrettes on either side.

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