Survivors of Tsunami Are Haunted by Loss, Trauma
If only Tilek Pushpakumara had held on tighter, maybe the wave wouldn’t have torn his wife from his grip. If he keeps drinking the way he has since the tsunami hit, maybe he will be able to forget her scream.
Even though he’s plagued by echoes all around him, he remains amid the wreckage of his home. Maybe if he waits there long enough, sitting up night after night next to the outdoor tap where they used to talk while she washed her hair in the moonlight, she might return.
The tsunami is over, but it left hundreds of thousands bewildered by the loss of loved ones, homes and livelihoods.
Like Pushpakumara, many have a shattered sense of their ability to control their own lives, to take care of themselves or their families. The Dec. 26 disaster has stripped them of the sense of security that comes from knowing what they can rely on -- such as the sea staying where it belongs.
Pushpakumara, a net fisherman, believes that he can no longer depend on anything. At 40, he can’t even imagine a future. The tsunami, he says, was punishment from God for man’s mistreatment of the ocean -- for pollution and fishermen dynamiting blowing up coral reefs. A Buddhist, he believes that he is paying for the sins of a past life, and he fears that the tsunami was only the beginning of his suffering. “God is not done with me yet,” he said.
Sometimes he can’t see the point in living. The only thing keeping him going, he says, is that his two teenagers need him.
Psychologists say his feelings are normal now, although other survivors may react differently. There is no single way to grieve.
The World Health Organization estimates that although everybody has been traumatized, many have already recovered emotionally. Based on experiences of previous disasters, between 40% and 50% of the survivors are still suffering; but with some psychological first aid, most will heal in a few months.
About 5% to 10%, however, could become stuck in perpetual panic, crippling anxiety, sleep disorders, alcohol abuse, severe depression or, in extreme cases, post-traumatic stress disorder.
The key to minimizing the number is to restore normalcy as quickly as possible, said Dr. Benedetto Saraceno, WHO’s chief of mental health.
“These people don’t need counseling,” said Dr. Shekhar Saxena, a WHO mental health expert based in the Sri Lankan capital of Colombo. “Their capacity to recover will depend on how quickly the development aid gets to them -- how quickly they get houses, jobs and return to normal life. If you can’t do that, you have continued trauma and the things that brings -- alcohol abuse, suicides, violence and mental illness.”
Experts say natural disasters, which indiscriminately affect entire communities but are over quickly, are easier to deal with emotionally than lingering wars or violent attacks in which the victims are targeted.
“In an earthquake or wave, it’s the awesome incredible power of nature, but it’s over. Entire cities wiped out in minutes, but it’s over,” Saraceno said. When people “are living with fear day after day, it’s probably harder to recover from.”
Communities find the energy to rebuild after a natural disaster, experts said, and harnessing that solidarity is part of the strategy for healing.
Many tsunami survivors, especially those in camps, are now dependent on aid groups for necessities they used to provide for themselves. This can lead to a sense of helplessness and despair, particularly among men.
In the relief camps around the Sri Lankan city of Batticaloa, which was hit hard by the tsunami, women cook and look after the children. The men are often left idle, and are turning to gambling and alcohol, said Dr. Mahesan Ganesan, a psychiatrist there. Child abuse and domestic violence are creeping up.
In contrast, none of those problems have been detected at a camp on the other side of the island, where every resident is delegated responsibilities, providing a sense of control and purpose.
“Every day, everyone has a job and everyone is involved,” said the camp’s manager, Praneeth Peiris. The camp, financed by the Sri Lanka national cricket board, is considered a model, said Canadian psychologist Phil Ritchie of the U.S. trauma relief group Green Cross Foundation.
Unfortunately, he said, most tsunami survivors are probably not getting much support. In roadside communities like Pushpakumara’s relief agencies drop off rice and oil, but that’s about it.
Ritchie and his team arrived a few weeks ago at the request of the Sri Lankan government. So far, they have trained 83 Sri Lankan athletes in “psychological first aid.” The volunteers are stationed at camps where they establish daily routines, encouraging recreation and the resumption of religious and cultural life. They watch for symptoms that may need special attention, such as parents not looking after their children or people who have detached themselves from camp life.
After a week or so at a camp, the Green Cross team moves on, leaving the trained volunteers to carry on.
One thing they are not doing is “trauma debriefing” -- a technique that began as an attempt to prevent post-traumatic stress disorder among Vietnam War soldiers and has been used by relief agencies in disaster zones.
The technique, involving one psychological session, can help relieve feelings of helplessness and isolation, WHO experts said. But in cases of widespread natural disasters, they said, forcing people to relive their experiences before they are ready can do more harm than good.
“Debriefing can increase the incidence of post-traumatic stress disorder and depression,” said Saxena of the WHO.
Not everyone agrees. Around Batticaloa, counselors are sweeping up and down the coast, debriefing survivors in a matter of days and then going home, said Ganesan, the town’s psychiatrist.
Before Green Cross arrived, the same thing was happening on the other side of the island, Peiris said. Small teams would show up, debrief scores of camp residents in the space of an hour or two, then leave. Peiris said the visits upset camp residents.
“All they were doing was retraumatizing the people,” he said. “I said, ‘No more; go away.’ ”
The problem arises because well-meaning groups are imposing the Western concept of trauma treatment on societies where it is not applicable, Saxena said. In Sri Lanka, the concept of psychotherapy barely exists, Ganesan said.
In Western societies, Saxena said, there is an obsession with one-on-one psychological counseling. That’s partly because Western culture is more individualistic, accustomed to people coping with problems alone.
But in countries hit by the tsunami, community support systems are strong. Families are extended, and many areas have emotional support built into their ethnic and religious traditions. Those are the resources that have to be enhanced, at least in the early stages, Saxena said.
Westerners also medicate emotional distress, and some aid groups “are sending truckloads of drugs,” Saxena said. There are no reports that large numbers of tsunami survivors have been given antidepressants, but health officials here are trying to make sure that it doesn’t happen.
While all the survivors have been traumatized, only a fraction will need to see a psychiatrist or, perhaps, receive medication, experts say, and it’s too early to know who they are.
That’s partly because a broad spectrum of emotional reactions -- including no apparent distress -- are normal in the first month or so after a disaster.
Those like Pushpakumara who show distress early may heal spontaneously or with community support. For those who have been forced to function because they have bodies to bury, debris to clear up or children to care for, the emotional fallout may not even have started yet.
But experts say those who do well in the beginning are less likely to suffer emotional symptoms later.
Janaki Patabedige, Pushpakumara’s 36-year-old cousin, is coping with the loss of her 19-year-old daughter and her home by throwing herself into caring for her husband and remaining family.
She cries a lot, but her face is full of determination. She says she can’t afford to melt into her grief because she must hold the family together.
Her husband, a door-to-door lottery ticket salesman, has taken the loss badly. After inspecting body after body while searching for his daughter, he collapsed, rolled himself into the fetal position and vowed to commit suicide if she were dead.
When the worst was confirmed, though, he didn’t fall to pieces. Patabedige is trying to keep it that way, terrified that if she doesn’t provide the strength, her husband will become another casualty of the tsunami.
“I feel the tears coming, but I choke them back,” she said. “I won’t let myself feel it.”
Patabedige acknowledges that she may not be able to maintain the strength forever. But as long as she keeps reminding herself how lucky she is to have her other four daughters, she says, perhaps she won’t crack.
For a small portion of the tsunami survivors, the emotional pain they feel now may evolve into something disabling.
Children may develop developmental or behavioral problems. Adults may become addicts. Some may become plagued by depression, anxiety or panic attacks. For others, the distress may be vented through skin rashes, headaches, back pain, or numbness of the fingers and toes.
A smaller fraction of survivors may develop post-traumatic stress disorder, Saraceno said. Sufferers get nightmares or flashbacks. They tend to avoid the emotional triggers by numbing their feelings or detaching from experiences. They are often overtly alert and easily startled. The disorder can be accompanied by immune system problems and digestive disorders, and it can interfere with people’s ability to do their jobs or have healthy relationships.
For some, it can last a lifetime. It is usually treated with psychotherapy, antidepressants, or both, but success is inconsistent.
Many communities struck by the tsunami have weak mental health systems. Sri Lanka, for instance, has only 45 native psychiatrists, and only 1% of the health budget is spent on mental health. The WHO says it should be about 10%. Many communities are remote, and many survivors with emotional problems are unlikely to seek help, experts say.
So a major determinant of whether individuals recover from the trauma is the degree to which they are connected with others. “It’s feeling that you matter, that there are other people who care about you,” said Dr. Anula Nicopanti, a Sri Lankan psychiatrist based in London who has returned to help.
Pushpakumara’s strongest connection these days is with his four best friends.
His mother is looking after his two children because he can’t face them now. He doesn’t want them to see him hurting; they’ve got enough pain of their own.
Pushpakumara’s friends stop by the wreckage of his home every day, sometimes dragging him out with them at night.
“He comes out with us, but he doesn’t stay long,” said his friend, Kalpa Sanjaya. “He joins in the conversation, but not really. He doesn’t really engage.”
He still chases shadows, traveling to distant communities to investigate sightings of his wife, who is said to be wandering like a crazy woman. The rumors never pan out.
His friends worry that he has lost interest in eating and doesn’t seem to care about his appearance anymore. They worry about his drinking. They are determined to help him.
“We will not allow him to become stuck,” Sanjaya said. “He’s finding it hard to be a good father, but he has the courage to face his problems and he will be OK. We are going to make sure of that.”
