• a Plea for Thoughtfulness and Care

by Jane Gilbert

The tsunami disaster has shattered thousands of lives, not just physically in terms of destruction of property and livelihoods but, even more catastrophically, in terms of the loss of loved ones – whole families, children, parents. It is difficult to even begin to try and comprehend the depth of this loss and the overwhelming pain of grief for individuals and communities.`A0

All human beings would experience grief in the face of such`A0appalling loss, but this paper is a note of caution, a reminder that, although grief and emotional distress is a universal human response to loss, the ways in which`A0this is`A0expressed and`A0what means of help might be appropriate`A0differs between cultures. When so much international aid is being provided to devastated communities it is essential to exercise caution when considering how best to support psychological recovery.

Every child is socialised into the culture of their own community. This process provides a child with the fundamental assumptions by which s/he makes sense of human experience, including values, attitudes, ways of perceiving and understanding the world, and, culturally specific ways of expressing emotional distress and what constitutes appropriate healing. All expressions of emotional distress, including the acute grief of the survivors of this disaster, are embedded within, and cannot be separated from, particular cultural frameworks.

People and communities retain and safeguard the knowledge and wisdom of their culture through language. Each of the thousands of languages spoken on the earth defines, in its own way, how things are talked about and what concepts are assumed for making sense of the world. Some of these fundamental concepts are unique to that community’s ways of perceiving the world, and cannot be directly translated into another language without serious loss of meaning. Even apparently "simple" notions, such as stress, anxiety, counselling have no direct equivalent in many other languages.

Each person speaks and experiences emotions, therefore, within the constraints of a particular language and the culture embedded within it. Thus there is an intimate connection between language and psychology. Even those who are fluent in English as well as their mother tongue are more likely to be able to express their deepest feelings most accurately in the language of their childhood. The mother tongue in all the areas affected by the tsunami is not English.

These language and culturally specific psychological factors are fundamental when considering the international response to the terrible grief and psychological distress now being experienced.

Any experience of loss fundamentally disrupts the ability to find meaning. Loss of loved ones, home, familiar surroundings and livelihoods is a catastrophic loss of the meanings which life held before the disaster. Everyone affected will grieve and mourn these terrible losses.

The mourning and emotional distress of people who have suffered this natural disaster are normal reactions to an extraordinary event. Throughout the grief, acute at first, and lasting a lifetime, the primary task, underlying everything to be done, is the restoration of meaning – restoration of meaning in a situation where most of the previous meanings by which life was lived have been obliterated.

Traditional cultural values and traditional family and social role expectations have a crucial role in restructuring life and restoring meaning. Joining with others who have suffered similarly can greatly aid the journey through unimaginable grief.

* The mending of social relations is essential for the expression of grief, the restoration of meaning, and the process of reconstruction.

* The primary role of humanitarian aid for the psychological aftermath of the disaster is to facilitate this process.

In other complex emergencies there has been much confusion and controversy in relation to the provision of appropriate psychological support. However, reviews of psychosocial programmes provided in Kosovo and Rwanda have clearly highlighted the lessons to be learned in relation to culturally appropriate interventions, and the recent review by WHO (2005) is a welcome acknowledgment of this. Particular concerns have been raised regarding the diagnosis of post-traumatic stress disorder (PTSD) within large populations, and the need to understand psychological distress as a normal response to abnormal events. The dangers of "medicalising" normal emotional reactions and the risk of the breakdown of traditional community healing mechanisms by the importation of external specialists are also now increasingly recognised.

Individual counselling has sometimes been provided in the past almost as a "prescription" for dealing with all kinds of traumatic experiences, but fortunately it is now recognised that this separation of someone from their social group for individual help can be alien to many cultures and can stigmatise people in their own communities. This is particularly the case in societies where the individual’s recovery is intimately bound up with the recovery of the wider community, as is the case in all the areas affected by the tsunami.

WHO (2003, 2005) make specific recommendations as to how external agencies can assist in the mending of social relations and the re-building of communities. The following section complements those specific strategies and recommendations by highlighting some overarching principles. .

* Local language, the expression of feelings and concepts of emotional healing within local communities must always take precedence over Western interventions.

* Sufficient time must be taken to understand the cultural context – how are the effects of the disaster being interpreted? How does the particular cultural group express distress? What are the appropriate ways of healing and dealing with loss?

* Every nation and community has its own peculiar "genius", its own ways of thinking, acting, communicating and caring for its citizens. Supporting that unique "genius" is the basis of psychological recovery.

* People themselves are always the experts in their own feelings, and some expressions of distress may be "untranslateable" into Western frameworks.

* Appropriate social interventions can have very powerful secondary psychological effects on well being, for example, restoration of normal activities, schooling for children, encouraging active participation in the community, and re-establishing cultural and religious events.

* Access to valid information is essential to reduce public anxiety and distress.

* Networks are crucial. Anything that can be facilitated to help reconstitute family and kinship ties and social and cultural institutions will be beneficial. Maintenance of traditions is central to the struggle to maintain the sense that there is still order in the universe and that life may once again provide meaning

It is essential to take care to avoid the creation of dependency on external knowledge and personnel for psychological recovery, and not to implicitly undermine community structures.

This paper was written as a plea for careful analysis and understanding of the specific local and traditional ways of grieving and dealing with loss in each of the countries affected by the tsunami. Psychological healing after such catastrophic loss is far more complex than the "technical" problems of physical survival and economic reconstruction, and therefore needs to be approached with thoughtfulness and care.