A longitudinal study is following kidnapped child soldiers in Africa, for all their lives. Theresa Betancourt has written up a lot of interesting stories from them after the first 22 years of it, called Shadows Into Light. It is not a report; it’s more like the ancient art of storytelling for the 21st century.

Sierra Leone broke down in 1991 and all kinds of rebel groups and their so-called commanders attempted to take over the country, or parts of it. One particularly disgusting tactic, used in other such situations in Nigeria, Rwanda and Uganda, was/is to kidnap whole villages or schools’ worth of children. The prettier girls were kept as sex slave/servants, the boys given guns and beaten into ignorant killing machines.

Very few could escape without being killed, until peace broke out and interim care centers began popping up, where the children could tell their stories, and parents could search for them. The girls often brought their own new children with them. The boys, it was feared, would bring crime. It is estimated that nearly 500 million children live in war zones around the world – one in six. While they all could use help, very few get it, even fewer get it well. Sierra Leone only had three licensed psychiatrists for its eight million people. Worse, some 51.6% of males and 34.9% of females over 15 in the general population are illiterate.

Betancourt’s team tracked down 529 such children, 128 girls and 401 boys, all aged 10 to 17 in 2002, interviewed them and has been following up with further interviews over the years and now decades since. What she found was that they just wanted to revert to the mean – be normal contributors to society. Standing in their way were history, poverty, and particularly mental anguish that went undefined, unrecognized and untreated. For some, just giving them the ability to look at themselves in perspective was sufficient for them to eventually fit back in. Many could not do that. They remained outliers. Some simply became loners, which turned out to often be fatal in an impoverished society where community was everything. PTSD is a plague.

The boys had difficulties overcoming the suspicions of the villagers, who thought of them as cold-blooded killers, when in fact they were hostages. Their stories were of other children being beaten to death for the slightest infringement, real or imagined. Their schooling and training was blind obedience and nothing else. Without friends, families or teachers, they hollowed out, and nightmares followed them everywhere, even in freedom. This is of course typical of PTSD, and needs treatment, not criticism, blame, isolation and avoidance.

Betancourt’s findings are hardly out of the ordinary. She found that the younger that the children were when abducted, and the longer they were kept, were “particularly vulnerable to increased internalizing problems.” And that every child needs an adult who is simply crazy about them, who will protect and defend them, promote and teach them, and in general, be a backstop for them. Even the children recognized that their loss of immediate help and mentorships was holding them back.

It did not and does not help that education is not free in Sierra Leone. Parents have to pay a pittance they do not have to send their children to school, and if things don’t go well at home, schooling gets dropped. Foster children are at the bottom of their list. Probably the most common story Betancourt reported was how much both males and females wanted to go back to school. But then, some who did get the chance became uncomfortable at being so much older than their classmates who didn’t waste ten years as child soldiers.

Sierra Leone has changed, and become even more expensive to survive in. The result is “most children now care for themselves and become street children,” because parents and extended families no longer have time for them. What this means is that the children of these child soldiers are not benefitting from the good intentions of these returning vets, and might be suffering additionally because of it. Betancourt plans to analyze both behavioral data and physiological data – inflammatory markers, telomeres, autonomic nervous system regulation – between caregivers and their children to help determine mental health difficulties in both generations. It is now at the point where she says the study has become “squarely focused on the topic of family-based prevention.”

But the same poverty the whole country suffers from interferes with this good work. For example, Betancourt’s team has found a way to deal with individuals without recourse to (non-existent) psychiatrists, and have got the cost of this intervention down to $104 per person. But that sum is out of the question impossible in the economy’s current state, regardless of how profitable it would be to the country going forward.

The stories of individual cases run the gamut from the rewarding to the tragic to the genuinely heroic, as one might expect. But there is no conclusion drawn from it. There is no section where Betancourt says this percentage of boys and girls have successfully reintegrated, have gone on to bigger things, become leaders in their villages, or employers. Indeed, the latest attempt to interview them again has proven difficult as people are moving on – and away. And it’s not like they leave a forwarding address.

Instead, the Conclusion is all about how much Sierra Leone is changing, how government is making headway in the lives of residents, and how politicians who were there at the beginning are still there today, and how much they have accomplished. All of which has little or no relevance to the lives of these veterans.

This book reminded me of another I reviewed a decade ago, called The Exit Wound Is Always Larger. It was stories of (adult) American war veterans trying to reintegrate into society. In it, US Senator Ron Wyden wanted to help veterans. He challenged his staff to come up with one thing he could do to make veterans’ lives better. Their answer was simple and elegant: Stop making them.

David Wineberg