Spiritual approach to addressing trauma

Andayani, Canada

The World Health Organization (WHO) estimates that 10 percent of tsunami survivors are suffering severe psychiatric problems and as many as 50 percent, less acute psychological disturbances (The Jakarta Post, Jan. 28).

This is hardly surprising considering the nature of the catastrophe. Indeed, following the 1993 Latur earthquake in India, the Voluntary Health Association reported that 89 percent of survivors suffered depression.

For many tsunami survivors, life may seem futile and meaninglessness as they start to internalize the reality of the disaster. They have experienced multiple losses, including the deaths of loved ones; loss of jobs, property, social network and status; cultural and symbolic losses. This is a complete sense of loss in that survivors are in the position of coming to terms with the losses of the present day as well as setting aside their ambitions for the future.

As newspapers and other broadcasting media have related, many of the survivors continue to suffer nightmares and flashbacks, often triggered by colors, sounds etc. The survivors may exhibit phobic symptoms, be afraid of waves, the sea, tremors, and other reminders, and thus react in an "irrational" manner.

Profound self-blame is also evident among the population, as many individuals feel guilty for their inability to save their loved ones. For people with missing family members, the situation is worse since this status generates ambiguous loss.

This manifests when the individual is physically absent but psychologically exists. The family may become preoccupied with the victims, secretly developing and maintaining a hope that they are safe. The survivors may only be satisfied if clear-cut information is given, in the absence of such information the loss remains ongoing and for many, completely consuming.

The responses of excessive crying, lack of concentration, loss of appetite, angry outbursts, sleeplessness and a sense of alienation are not considered pathological if they cease within three months after the event. Those whose symptoms persist after three months, however, are vulnerable to post-traumatic stress disorder (PTSD). If post-traumatic stress disorder surfaces, it should be assessed and treated by trained professionals.

It should be noted that the trauma is likely to be unresolved if the proper therapy is not sought by the survivors. Research has shown that trauma can be repressed only to resurface months or years later. Signs of this would include depression or disruptive behavior, such as substance abuse, violent behavior, suicidal tendencies, and so on. Thus, the trauma becomes more complex, long-lived and even multi-generational. The next generation of survivors would view disruptive behavior as an acceptable form of problem-solving.

WHO recently announced that it would initiate the re- establishment of mental health services with the Indonesian government. The number of psychiatric patients is staggering; on average, following the tsunami, 30 people have sought services on a daily basis in Aceh.

Mental health professionals require culturally sensitive approaches in working with the survivors. Without overlooking the compassion as well as the professionalism of the United Nations and other multilateral agencies, we should be mindful of the sociocultural needs and natural healing systems of local people otherwise we are imposing a western-style of intervention that could even be detrimental to the residents.

In this case, spiritually sensitive intervention is recommended.

In order to move on, survivors must integrate and accept the tragedy as a reality. Spiritualism encourages people to accept the tsunami as God's will, and gives them greater resilience.

Failing to recognize spiritualism as the Acehnese people's natural healing system, therefore, would cause the victims to feel more alienated and disengaged with the approach itself, and thus the outcome of therapy would be affected.

International relief workers should work side-by-side with local professionals and community leaders in order to provide appropriate psychiatric services. They need to explore this natural coping mechanism and integrate it into problem resolution. Prayer, rituals, ceremonies, traditional modes of healing and the like could also be accommodated in psychiatric services.

Decision makers must take into account the spirituality and religions of the Acehnese in the rehabilitation phase so that the mental health services offered are suited to the population in need.

The writer is a lecturer at the Sunan Kalijaga State Islamic University (UIN). She is pursuing her Masters of Social Work at McGill University, Canada and can be reached at andayani_safwan@yahoo.ca.