After the immediate horrors of Haiti quake, the survivors are menaced by long-term danger of post-traumatic mental damage.
As thousands of traumatised Haitians remain without food and shelter following Tuesday’s earthquake, mental health experts say the psychological effects of the disaster could take months to fully emerge.
The people of Haiti—already worn down by conflict, cyclone, hunger and floods—are vulnerable to an outbreak of mental-health disorders that the country’s dilapidated health system could not begin to cope with. Aid agencies are working to minimise some of the risks that lead to suffer post-traumatic shock syndrome (PTSD), having learned lessons during previous disasters such as the 2004 Asian tsunami and the Chinese earthquake of 2008.
“To prevent lasting mental injury people need shelter, warmth, a meaning to life, things to do—and as fast as possible,” said Mark Brayne, a psycho-therapist specialising in individual and collective trauma.
“After the tsunami, many people were not able to see or bury their dead because of panics over public-health issues, but actually the rituals of death are hugely important to how we cope with grief and death, and you can cause enormous damage by preventing people doing that.”
He said that in the immediate aftermath of a disaster people are focused on self-preservation and taking care of their families, and although they experience intense grief, shock and anxiety, PTSD can take six months to show itself.
After the tsunami, PTSD rates averaged around 10% in the population. In Haiti, and on the wider island of Hispaniola, four million people experienced the extreme effects of the earthquake and 17-million suffered moderate shocks—exposing a vast number to the risk of long-term trauma.
Issues of aid distribution will also be vital. Research after the China earthquake found higher trauma rates in villages that were less affected by the earthquake, but also received less support, than in villages worse affected. Prompt intervention kept rates down, the study concluded.
However Brayne suggests that Haitians do have a slight advantage in their susceptibility to PTSD.
“The bottom line is that there is a risk of rushing in with our Western understanding of trauma, and expecting everyone to have either PTSD or need psychiatric treatment. People are kept psychologically well by connections and attachments in their communities. Friends and family are what gets people through, and in a tight-knit place like Haiti, we have to be careful about imposing western understandings. People will feel shock and pain but there will also be resilience.”
Anxiety and despair
Children are especially vulnerable to trauma, and several projects in trouble spots around the world have shown remarkable success by helping them cope through play—especially using drawing to express themselves.
Unicef is already taking “recreation kits” to Haiti. Patrick McCormick, an emergencies communication officer for the UN children’s organisation, said: “The worst thing for children in natural disasters isn’t just the damage that they see around them, but also when they sit around and have nothing to do. It ramps up anxiety and despair, and that’s what does even more damage.
“Using recreation kits, which are going into Haiti now, with soccer balls, things they can draw and paint with, games—we are encouraging them to get moving and do things and start the healing process. Art is famous for its healing qualities with children. I’m not a psychologist myself, but it is a way for them to get all those emotions out.”
Poverty may be endemic but social support—although eroded by emigration, war and hunger—is deep in Haitian culture. The country has a strong sense of mutual responsibility among extended families and communities or “lakou”—a system where people work cooperatively while still living in individual properties. The distinctively Haitian tradition, along with the dominance of the Catholic faith, forms a tight-meshed social net through which few can slip.
That strong sense of community is also felt within the diaspora. Haitians abroad have been in a desperate state of grief and anxiety as they try to find out if their loved ones are safe.
Haitian-born clinical psychologist Guerda Nicolas has written extensively about the country’s ability to cope with disaster. An associate professor at Miami University, she is helping counsel the city’s Haiitan immigrants who have watched the disaster on television with a feeling of impotence.
“We call that vicarious traumatisation,” she said. “It can be more damaging psychologically because there’s a feeling of helplessness—watching the images, seeing the devastation, and knowing you can’t do anything about it.
“The symptoms are very similar to PTSD. People will have nightmares; they’ll have flashbacks of the images they’ve seen on television. They may have sleeping difficulties, they may not be able to eat, they may not be able to concentrate,” she said. “The first thing I’ve been saying to people here in Miami is, ‘Stop watching the news.’ Television is not a good way to hear news of family members.”
Her previous studies suggest the higher rates of depression among Haitian expatriates were linked to the drop in family contact the immigrants experienced. “It’s much harder for Haitians to deal with tragedy not having that network.” - guardian.co.uk