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“The psychological damage in terms of the PTSD and the anxiety and depression was only going to grow as a problem. I told them that the impact could be multigenerational.”
“But without a sophisticated mental health system or trained counselors, where were the survivors going to turn?
Wentz assumed, as do many Western mental health specialists who focus on trauma, that the psychological reaction to horrible events is fundamentally the same around the world.
Wentz’s concern that Sri Lankans would have to face the psychological impact of the disaster without a “sophisticated” mental health system or “trained counselors” was repeated in many quarters during the days and months after the disaster.
Given the certainty surrounding the need for such an effort, it is remarkable to remember that we are the first generation to include psychological first aid with other forms of assistance after wars and disasters. As late as the mid-1980s, in fact, the manuals for postdisaster relief focused exclusively on medicine, food, and shelter and contained no advice for treating the psychological wounds of a population.
that retelling or reworking the memories of the trauma, often in emotionally charged group settings, promotes mental health; and that truth telling is better for the mind than stoic silence. Against a growing body of evidence, traumatologists assume these ideas to be universally true.
There was, for instance, a remarkable memo emailed just days after the disaster by faculty members from the University of Colombo in Sri Lanka. The professors acknowledged that “disaster zones attract ‘trauma’ and ‘counseling projects,’” but they pleaded with the arriving army of counselors not to reduce survivors’ experiences “to a question of mental trauma” and the survivors themselves to “psychological casualties.”
“A victim processes a traumatic event as a function of what it means,” they wrote. “This meaning is drawn from their society and culture
and this shapes how they seek help and their expectation of recovery.”
One trauma counselor being interviewed on BBC radio from a small coastal village expressed his worry that the local children appeared more interested in returning to school than discussing their experience of the tsunami. These children were “clearly in denial,” the expert told the listening audience.
Similarly CNN reporters expressed their amazement when tens of thousands of Sri Lankans attempted to abandon their refugee camps just days after the disaster, preferring to go back to their devastated villages or depend on friends or family.
Within days bitter rivalries broke out between counseling groups over which populations would receive which services. As one journalist documented, different support services attempted to “stake their claim to refugee camps.” The haggling between groups vying to help sometimes caused confusion and bad feelings among the survivors. One Sri Lankan health care worker described how children were lured away from one set of volunteer mental health care providers by other groups with toys and other incentives.
“It was common for the [facilitators] to differentiate between ‘our’ children and ‘their’ children,” he reports. “At times children were asked not to play with children belonging to other groups. This often led to conflicts… and at times brought about animosity between the children themselves.”
counselors often relied on those with marginal translation skills, such as local drivers who plied the tourist trade, to facilitate their therapy sessions.
Over two four-day periods in late January and February, one organization reported giving “psychotherapy and counseling” to 1,724 people, including 631 children. This was an impressive feat given that they had only two dozen counselors to do the work. Another group of Western counselors debriefed twenty-five traumatized survivors at a time, with the goal of one hundred treated for each five hours of work.
“We found one organization just handing out anti-depressants to people.”
Many of the Western counselors and experts who rushed in after the tsunami assumed that the long and brutal civil war had made the individuals in the population ever more psychologically vulnerable and therefore more likely to experience PTSD after the tsunami. There was, of course, an alternative possibility: that the Sri Lankans—because of their intimate familiarity with poverty, hardship, and war—had evolved a culture better able to integrate and give meaning to terrible events.
Fernando came to the conclusion that Sri Lankans’ experience of trauma differed from Americans’ in two main ways. Unlike the PTSD symptomatology, Sri Lankans were much more likely to experience physical symptoms after horrible events.
Rather Sri Lankans tended to see the negative consequences of an event like the tsunami in terms of the damage it did to social relationships.
“Some may be in denial or simply not aware of the extent to which they’ve been traumatized, while others may not seek out therapy because of social or cultural stigmas.
