New York Times
Jan 4 2005
After Food and Shelter, Help in Coping With Unbearable Loss
By BENEDICT CAREY
Providing psychological services for millions who have lost family
members, homes and communities in Sri Lanka, Indonesia and other
countries will become critical in the coming weeks, officials from
the World Health Organization, Unicef, and other relief agencies say.
The scope of the emotional fallout will be impossible to predict. The
first priority, the officials said, is to deliver food, shelter and
drinking water. But the United Nations has already set up a network
for counseling in Sri Lanka and, on Friday, sent mental health
workers to the Maldives.
Any natural disaster takes a steep emotional toll, the experts said,
but this one is distinguished by its sheer size and scale. Studies of
earthquakes, fires, hurricanes and other disasters that have
devastated communities find that a majority of survivors eventually
learn to live with awful memories and to work through their grief.
But a significant number suffer either chronic mental distress or a
more immediate emotional numbness that can isolate them from others.
“At this point we have to be very careful not to label as a mental
health problem this natural psychological response to being displaced
in a split second, to seeing that everything you had now no longer
exists,” said Dr. Rachel Yehuda, director of the traumatic stress
program at Mount Sinai School of Medicine and the Bronx Veterans
Affairs Hospital. Those who are deeply scarred emotionally will need
long-term care, she said, not a few hours or days of emergency care
by grief counselors or other mental health workers.
After suffering a violent injury, or witnessing a catastrophe, some 5
percent to 10 percent of people suffer from lingering nightmares,
moodiness, nervous exhaustion and other symptoms of post-traumatic
stress syndrome, researchers say. These symptoms are considered
worrisome if they become chronic; they can appear months or even
years after the crisis.
Yet the rates of severe traumatic reactions can be much higher among
people sitting directly in the impact zone of a seemingly apocalyptic
event. After a 1988 earthquake that leveled the Armenian town of
Spitak, killing half its schoolchildren, researchers from the
University of California, Los Angeles, found that more than half the
town’s children suffered from post-traumatic stress and depression.
The rate was less than half that in Gumri, some 30 miles away, and
was negligible in Yerevan, the capital, 50 miles away.
“It’s very clear, the more extreme the experience, the higher the
risk of severe psychological reactions,” said Dr. Alan Steinberg, one
of the study’s authors. “Those people who were on the beach in this
case, or close, are going to be at highest risk” of chronic emotional
distress.
Even in areas farther inland, psychiatrists say, the grieving among
people who have lost homes and family members may be complicated by
the trauma and violence. When the final memory of a lost loved one is
violent, or suffused with guilt or helpless rage, experts say, it
interferes with the natural ability to mourn loss, leaving people
numb, at risk for serious depression, and cut off from others around
them.
“If there’s a signature image of this catastrophe, it’s the loss of
children, the parents right there struggling for their own lives but
unable to protect or save their children,” said Dr. Robert Pynoos,
co-director of the National Center for Child Traumatic Stress, and a
professor of psychiatry at the University of California’s
Neuropsychiatric Institute in Los Angeles.
The risk that this prolonged grief can cause depression is greater
still, experts say, when the death of a loved one is not confirmed,
or the body is swept into a mass grave without being identified – as
has occurred in some areas hit by the tsunami.
In such circumstances, when the normal cultural rituals surrounding
death are disrupted, wild rumors often circulate, experts say. In
1985, volcanic ash and rubble killed some 80 percent of the
inhabitants of the Armero, Colombia, sweeping away the bodies. For
months afterward, there were stories and “sightings” of some of the
dead wandering in far-off places. Only after the corpses were found
two years later and proper ceremonies were conducted, did the
survivors accept their loss, according to a World Health Organization
report.
In 2001, a fire in Lima, Peru, killed some 270 people, charring many
bodies beyond recognition and depriving families of identifiable
remains to bury and mourn. In the resulting confusion, rumors
circulated that relief workers were stealing cadavers for medical
experimentation, or selling harvested body parts, the W.H.O. report
said.
In the weeks and months to come, experts say, relief workers can help
dispel such rumors, as well as identify survivors who are at risk of
prolonged depression or traumatic stress. The health organization has
issued guidelines for relief workers on how to deal with traumatized
victims, and a group affiliated with the University of Oslo is
planning a program to provide information on counseling to teachers
and others in the areas hardest hit by the disaster.
From: Emil Lazarian | Ararat NewsPress