Sunday, January 17, 2010

Mental Health After a Disaster: Anecdotes from a Previous Earthquake

A word about mental health after a disaster. I visited Huaraz, Peru, in 1971, exactly one year after an earthquake registering 8.0 on the Richter scale left about one million persons homeless after killing about 80,000 persons in one of the most beautiful valleys in the Andes. I accompanied a woman who went to visit a friend, a woman who had lost her husband and children in the quake. At first the woman seemed reasonably well adjusted, talking factually about her life. But then she said her husband came to visit her sometimes at night, from a far away place he was living in because of the earthquake. And she said her children, also, were living far away, under good care, but she could visit them, and as she went on it became evident she was still unable, at times, to acknowledge her loss. The woman I was with told me later this kind of denial had become contagious, and had affected thousands of persons, in the absence of mental health relief and very sketchy assistance from the government, at that time a dictatorship.

Later that day I was in a pickup on a country road near Yungay, a village that had been completely buried by a landslide provoked by the earthquake. We picked up a rider, a man in his 30s, who, the driver told me just before he hopped in, had lost his wife and children when Yungay was destroyed. The driver, hoping to get him to talk, asked him if he was not one of the survivors of Yungay. The man began talking in a matter-of-fact tone, telling how he had been on the far side of the valley walking up a hill overlooking the city, on his way to the cemetary to place flowers on his mother's grave. He felt the earthquake and looked down at the village, which was not badly damaged, but then he heard a horrible rumble as millions of tons of rock fell off the highest mountain in Peru eleven miles away. He and others on the hill began running up the hill, without looking back until they reached the cemetary and when he looked down on his village all he saw was the mud slowly rising over what had been his village. A lake between the mountain and the village had been literally pushed by the avalanche down the mountain into the valley, creating a mud slide that buried his town. As he remembered that scene he broke down and cried uncontrollably for several minutes.

It dawned on me that day that in an earthquake, with random cruelty, a person can lose friends, neighbors, family structures, neighborhood, job, city, in just a few moments and these are, after all, what gives us identity, what provides us with our daily contact with meaning and reality. When they are gone, adjustment must be extremely painful and the temptation to create an imaginary world must be powerful, especially if delusion is mutually enabled and spreads throughout the dazed population.

Mental illness accompanies disaster, and Haiti will have its share of mental illness. There are ways people can be helped to cope with these losses, and we hope the world is better prepared to handle the mental aftermath than it was forty years ago.

The earthquake in Haiti has drawn global attention not only to the immediate urgency for massive injections of many forms of basic assistance--medical and psychological assistance, food, shelter, social organization--but also to the longstanding dismal poverty and lack of basic infrastructure which have complicated rescue and relief operations, and which have haunted this, by far the poorest country in the Western Hemisphere. Let us hope that in the coming months and years the world will be kind to Haiti. The country needs not only to recover from a colossal tragedy, rebuilding the physical space of what once was Port Au Prince, but also to build a more viable economic development model and political system to replace the corrupt oligarchic power structures of the past.

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