Mental health is a major concern in the areas devasted by last month's tsunami in the Indian Ocean. Relief agencies like the International Red Cross and Oxfam have sent grief-counseling experts to many of the damaged communities. Their plan is to train local officials -- people who know the culture and language -- to provide tsunami victims with mental health counseling.
"Imagine the case where people have lost all of their family, their children, their home, their future...stores and boats that many of these communities depend on for making a living through fishing," says Emilio Viano, an expert on mental health services at American University in Washington, D.C. "Very often victims have difficulty believing that this has taken place, have difficulty admitting this has occurred."
Many of these counselors will provide talk therapy to the survivors. "The idea is to allow the person to talk about what happened without insisting they do so," explains Dr. Rachel Yehuda, director of the Division of Traumatic Stress at Mount Sinai Hospital in New York City. "It's best for this to happen in a one-to-one setting. An appropriate mental health response is, 'Cry. It's okay to talk about and express emotions about how you feel.' Basically, we share a common humanity. When adversity strikes we have a common response. Depending on the culture, we may be more or less permitted to cry out loud. But that is what we need to do in all cultures when adversity strikes."
Some mental health experts recommend a different approach. Especially given the sheer number of victims, they say there is a better way to relieve grief than the traditional, Western model of talk therapy. "There are people who are skeptical about debriefing and grief counseling on a large scale," notes American University's Emilio Viano. "We have had misgivings on the part of psychologists who studied grieving individuals. They have found that those who focus on their pain -- either talking about it or displaying it -- tend to have more trouble, let's say, sleeping and maintaining everyday functions. In other words, there may be benefits to the discredited practice of keeping a stiff upper lip [rather] than to pour out one's grief."
Mr. Viano believes that societies in South Asia are probably better able to handle grief than those in the West. "Obviously there are cultural differences," he says. "For example, in the U.S.A. we have grown less tolerant of tragedy and its psychic consequences. It is almost standard today in our society to have counselors appear anywhere, particularly in schools, if anything happens like a suicide, homicide, if there's a death in a car accident of a student, etc. There are societies that are still more tolerant of tragedy because tragedy is more a part of their lives. It is not because they value life less, as some say. It is because tragedy is still so very much a part of their lives." Mr. Viano believes that assisting disaster victims in rebuilding their homes, livelihoods, and community infrastructures should help many renew their sense of hope in the future.
Mental health experts say that 5 to 10% of people who are victims of violence experience long-term psychological harm in the form of depression, anxiety, and exhaustion. They warn that the syndrome may become chronic, lasting years after the physical crisis is over. However, it may be impossible to provide mental health services to everyone who needs them in the area devastated by the tsunami. "When you think about 5% of several million people," says Dr. Rachel Yehuda of Mount Sinai Hospital, "you begin to see what is really a mental health epidemic. It's just not going to be possible to train so many mental health workers to provide the services needed for every single person psychologically affected by this event."
Dr. Yehuda also notes that mental health professionals have no idea who should receive services first -- the young, the old, or the parents. "We don't know as much as we should know about the short-term and long-term effects of these mental health interventions," she says. "The reason for this is that, almost always, doing research in the aftermath of a disaster is the last priority for fear that research further exploits people."
Mental health experts providing relief to victims of the tsunami say the survivors' emotional and psychological wounds -- much like the severe physical damage all around them -- could take decades to heal.