In the aftermath of the tsunami in Southeast Asia, the Baltimore Washington Center for Psychoanalysis has set up a Tsunami Survivor Mental Health Relief Fund to collect money to be sent to two trauma intervention groups, one in Indonesia and one in Sri Lanka.
In the Aceh province of Indonesia and Jaffna district of Sri Lanka, family and community life has been dramatically altered. Hundreds of thousands have died, gone missing, or been displaced by the tsunami that ripped across Southeast Asia.
The initiative to set up the fund came from Noreen Honeycutt, a member of the center and the director of its consultation and referral service. Honeycutt, already involved in disaster response training and a member of the Maryland Volunteer Corps, felt “horrified and overwhelmed” upon hearing the news of the tsunami on December 26, 2004, and decided she had “to do something.” And so, she did.
Enlisting the help of Patrick Cody, community liaison director of the Baltimore Washington center, Honeycutt set up mailing lists, flyers, and a national listserv. Donations totaling $13,000 have been received. Half the money came from a benefit concert organized by Lizbeth Moses, a member of the center, and the rest from all over the United States.
Cody got the co-directors of the National Child Traumatic Stress Network, Robert Pynoos and John Fairbank, to recommend contacts in Sri Lanka and Indonesia whom they had previously trained in trauma intervention. The two trauma intervention groups sent Honeycutt their assessments of the effects of the disaster on mental health. They also sent an outline of resources and mental health services needed and proposals for trauma intervention programs.
The psychological impact of the disaster in Indonesia and Sri Lanka has been overwhelming. Immediately after the disaster, due to the sheer loss of life, there was a high incidence of acute stress disorders and grief reactions. Survivors have experienced intense guilt for not having been able to save loved ones. There has also been a tendency to blame others for not having saved a family member.
In some places the natural recovery from acute stress disorders did not occur. Over time, post-traumatic stress disorders (PTSD), severe depression, and psychotic relapses have been identified. These developments have created an unprecedented demand for mental health help, which the local communities are unable to meet. The existing mental health structures are disorganized and underequipped, partly because they have been beaten down by long-standing military conflicts.
One of the goals of Western psychological aid is to help the Southeast Asians to build and strengthen their own mental health support systems and infrastructure.
The money that has been received by the two intervention groups is being used for both treatment and training. Training in trauma treatment is a high priority because many of the mental health workers themselves are traumatized by the catastrophe. As the contact from Aceh, Ninik Suparatini, said:“One of the psychologists we sent two weeks ago had to return home after being there for just a few days…unable to witness the suffering the people have to undergo in Aceh. Everybody who was sent there needs at least a few days to ‘clear the mind’ before going back to their daily routines. There were also a few MDs from our university who returned home with deep trauma that needed special treatment.”
The first line of work that trauma workers have done is disseminating information about normal responses to trauma, such as shock, denial, intense emotions, and flashbacks. They have encouraged normal coping methods and the expectation of a natural recovery without psychiatric intervention. Trauma workers have also stressed supportive listening, reuniting families, and structured activities.
In areas that have been hard hit by the tsunami, trauma therapists are trying to integrate the community's culture with trauma therapy. For example, in Aceh where the meunasah (village mosque) is at the center of the community's culture, religion is very much part of the therapy. Suparatini said, “They have notions that the disaster should be viewed as ‘honor’ from God, that they're chosen as strong people to bear the loss and grief. It becomes easier for them to accept what happened because hundreds of thousands of ‘brothers and sisters’ suffer the same things.”
The cultural integration of local customs with therapy techniques is especially important because it allows the whole community to mourn together. Collective mourning helps to diminish the potential denial of the trauma at a societal level where severely entrenched and long-standing political troubles can complicate conflicts created by the trauma and divide people.
One of the goals of Western psychological aid is to help the Southeast Asians to build and strengthen their own mental health support systems and infrastructure. With this in mind, Honeycutt states it is time for all psychoanalytic institutes to reach out beyond their own circles, be part of the community at large and respond to the tremendous needs of others in crisis.
Christine Ury, D.Ps., is international editor of TAP. She is a faculty member at the Canadian Institute of Psychoanalysis and has a private practice in Montreal.