Coping with post-traumatic stress disorder in Aceh

Yulia Wardhani, Jakarta

Barely a month after the tsunamis hit Aceh and parts of North Sumatra, the people of Indonesia continue to mourn the loss of their brothers and sisters.

What was witnessed on Dec. 26 was beyond the realms of usual human experience and distressing to almost everyone, both observers and survivors. For those who have experienced a deeply stressing event, a psychological reaction often follows.

During World War I, it was called shell shock. During World War II, it was called war neurosis, or combat neurosis. Nowadays it is called post-traumatic stress disorder.

Post-traumatic stress disorder is characterized by depression, anxiety, flashbacks and an avoidance of reminders of the event -- which may make it difficult to cope with everyday life. Many people who have witnessed such an event are psychologically scarred for life.

The death toll in Indonesia has soared, with over 166,000 people declared missing or presumed dead. Meanwhile, the survivors face life, often without their loved ones; their homes are gone and many no longer have jobs.

Trauma itself may result in aftereffects, either physical, such as injuries, bleeding, fractures, brain trauma etc., or psychological, which are particularly disabling. Survivors may suffer horrifying flashbacks and nightmares, emotional numbness, or personality disorders. They may have irrational fears or experience sudden bursts of anger.

Post-traumatic stress disorder can develop as far down the track as 30 years after the trauma. How many of the volunteers in Aceh and Medan are at risk of developing the disorder? Those who have observed survivors via the news may have noticed the despair in their eyes.

So many people, our sisters and brothers, continue to suffer, and our thoughts are with the children in particular. If we ignore the problem, the number of people with mental disorders will increase.

It is not just individuals who will suffer the repercussions of this. It could lead to serious production problem due to reduced efficiency at work and increased absenteeism. It could also lead to increased national expenditure as heavy demands are made of the welfare, social services and judicial systems.

Violent behavior could also increase, which would have an adverse impact on the economy, perhaps jeopardizing prospective foreign investment.

Rebuilding infrastructure requires money, which means budgetary allocations for other development projects may be reduced, thus slowing the economic growth of the nation.

What can be done?

In most cases, people who suffer from post-traumatic stress disorder either give up or learn to organize their lives around their disability.

Some traumatized people find it difficult to communicate, to express their feelings, their suffering and their hopes. There are ways to help them and you do not need to be a psychiatric or a psychologist to do so. If you notice that someone around you is showing signs of suffering post-traumatic stress disorder, you can follow these steps:

1. Address immediate/crisis/medical needs.

2. Assure the person they are safe, to win their trust.

3. Debriefing; relieving. The survivors are encouraged to express their fear.

4. Be an active and good listener. Sometimes, silence and understanding is better than directing a conversation toward a "result".

5. Let them cry, and shout if necessary.

6. Educate them about the causes, the process and the impacts of the trauma.

7. Educate them about coping strategies.

8. Help them to understand that every event has a purpose.

It is enough for them just to know that you are there, and that you will continue to be there as they move toward recovery.

The writer is a Lecturer on Psychiatric Nursing Sint Carolus Nursing School, Jakarta.