And God Will Fill the Bullet Holes with Candy

EXCERPT

BMJ 1996;313:1585-1587 (21 December)

UNEQUAL IN DEATH

And God will fill the bullet holes with candy

Barbara J Genovese, research assistant *

* Health Sciences Program, Santa Monica, California 90407-2138, USA

“Do not weep for them, madre. They are gone forever, the little ones, straight to heaven to the

saints, and God will fill the bullet-holes with candy.”

NORMAN ROSTEN, In Guernica from The Fourth Decade and Other Poems, 1943

“I wish I could be very far from here-pretty much. I am secretly afraid of a lot of things--very

much. I feel alone even when there are people around me--pretty much. I worry most of the

time--very much. I worry about what my parents will say to me--very much. Often I have

trouble getting my breath--very much. I have trouble swallowing--very much. My feelings are

easily hurt--very much. It is hard for me to go to sleep at night--very much. I feel someone will

tell me I do things the wrong way--very much. I often feel sick in my stomach--very much. I

worry when I go to bed at night--very much. I often worry about what could happen to my

parents--very much. I get tired easily--very much. I am nervous--very much.”

These answers were given by a 9 year old as he responded to questions on a psychological

battery of tests that measured the mental health of children. Another section had to do with

emotional support: "Who do you talk to when you're upset?" An innocuous enough question, as

was his answer: "My brother." Then I asked, "How old is your brother?" "4."

In 1991 I moonlighted as a research assistant on a study to look at the mental health of children

between the ages of 6 and 12 living in homeless shelters in Los Angeles County. The objectives

of our study were threefold: to describe the mental health and academic problems among

sheltered homeless children--depression, behaviour problems, severe academic delays, witness to

violence; to identify which homeless children have more problems; and to relate the use of health

services and mental health interventions to children's needs.

In our sample of 169 children, the following emerged in the battery of child mental health

problems: depressive symptoms--37%; total behaviour problems--28%; receptive vocabulary

delay--47%; reading delay--39%; and witness to violence--42%.

Fifty six per cent of the children were between the ages of 6 and 9; 44% were between 10 and 12.

They were evenly divided between male and female. The ethnic breakdown was 44% black,

35% Hispanic, and 21% white. The mean age for the onset of homelessness was 7.6 years; 28%

had been homeless for more than one year; 36% had been homeless for more than two months in

the past year; and 48% had had two residences in the past year.

Of the parents we interviewed 61% had an income of less than $10 000 (£15 000) and their mean

age was 34.