Psychological first aid

There is such a thing as a honeymoon phase in disaster response. Remember the overwhelming bayanihan spirit that swept the nation just after the onslaught of tropical storm Ondoy and after that, typhoons Pepeng and Santi? Images we saw on television and our own experiences, or those of people we actually knew, prompted Filipinos to make unprecedented donations and even volunteer to join relief distribution activities. The community spirit gave us a high. For those who were themselves affected, the honeymoon came in the form of gratefulness at simply being alive, a strong sense of purpose and a will to be strong despite the tragedy.

These feel-good days hardly last. The rest of us go back to our routine, comforted by the thought of at least having done “something”. On the other hand, disillusionment descends upon the victims. They become vulnerable to survivors’ guilt, feeling as though they did not do enough to save their loved ones as they were themselves saved. The disaster hits home, so to speak. A woman realizes that her husband, or child, or a parent, is dead. A man must come to terms with the fact that the house, income source and all other things he has toiled for have been washed away. Grief then becomes the more prominent emotion. Material and emotional recovery seem like a distant dream.

Director Suzette Agcaoili of the Social Welfare Institutional Development Bureau of the Social Welfare Department says disaster stress is normal reaction to abnormal circumstances such as disasters. It is normally manifested as irritability and anger, self-blame or blaming of others, isolation, fear of recurrence, numbnessm helplessness, mood wings, sadness and depression, denial, concentration and memory problems as well as relationship conflicts.

Different individuals have different built-in capabilities in dealing with disaster stress. It depends on their natural attributes as well as their pre-existing vulnerabilities, mainly the cache of memories and emotions stored in their brains. Some people are remarkably resilient and are able to deal with their loss head on and hence move on to rebuilding faster, with minimal or no intervention.

Some, however, manifest the symptoms of a more advanced problem. They have panic attacks and have reduced ability to function for months, even years. Its not quite a post-traumatic stress disorder situation, but it could lead there if it goes unattended. Their reactions are most likely occasioned not by a single event but by an event that unleashes all other stored emotions from the past. These need a different kind of attention from professionals, although it does not in any way suggest they are already mental patients. One of the ongoing programs of the Social Welfare Department is the critical stress debriefing program, which is applied in seven stages by trained individuals and completes a process from introduction to closure.

The challenging part is that some of the members of the Social Welfare Department debriefing team are themselves victims of the devastation and must cope with their own experiences before being able to help others. Agcaoili herself lives in Concepcion, Marikina and has had to deal with her own reactions to Ondoy’s devastation and the threat it posed on her person and her 85-year-old mother who lived with her.

The Social Welfare Department director talks about a teacher who also lives in Marikina and was a victim of Ondoy. What stand out in their meetings are the teacher’s extraordinarily vivid memories of the July 1990 earthquake, which she has witnessed as a high school student in Baguio. Apparently, in her school, there was a security guard who always greeted her in the morning, and she saw this guard buried in the resulting rubble. As a result, even up to now, any vibrations on the ground (caused by passing trailer trucks, for instance) cause her to freeze and compulsively look for the stairs so she could head for the ground floor. Only then can this teacher feel safe.

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Last week, Agcaoili, a practicing clinical psychologist, talked to a group of volunteers from member-organizations of the Nutrition Research Information Network on psychological first aid. There is nothing advanced about the subject matter, no need for graduate degrees in clinical psychology. These volunteers are about to be fielded into their respective communities to simply “talk” to disaster victims in the event new disasters come along. It’s psychological first aid, a crucial step that’s as vital as making sure the victims have something to eat and have a place to stay immediately after the tragedy.

Talking about what’s wrong is always good therapy, Agcaoili says, and the best thing is that anybody—students, employees and civil servants, vendors, tricycle drivers and housewives —with a sense of compassion and pakikipagkapwa-tao can do it. People who feel vulnerable and insecure won’t probably open up to a mental health worker in a white coat or a psychologist who comes with a pen and paper; they will talk, however, to somebody who tells them they can talk about anything and is ready to offer not rehearsed answers but a simple hug.

And just as being a psychological first-aid giver does not require an academic degree, not everybody can be an effective one. One has to exude kindness, sincerity, compassion and a non-judgmental nature in order to draw the other person out.

Sometimes in an effort to offer comfort to another, we utter words and phrases that may be well-meaning but may have adverse effects. Agcaoili cautions the first-aid giver to refrain from saying the following; “I understand what it’s like” (unless one has been in an exact same situation, one can never understand); “don’t feel bad” (commanding); “you are strong, you can do it, don’t worry” (trivializes the disaster’s effects); “it could be worse, at least, you still have…” (providing false consolation); and “it’s God’s will” (when a person’s faith is shaken, this is probably the last thing he or she would want to hear.)

In no way shall a first-aid giver exert pressure on the other person to talk, or be disheartened by initial adverse reaction such as extreme emotions or refusal to communicate. He should not make grand promises (“the government will build you a new house!”), give false hopes (“your child is still alive and is recovering in the hospital” when the child is actually dead), or criticize relief efforts by other organizations.

In the end, the objective of psychological first aid is to occasion a feeling of safety, calm, connectedness, self-efficacy, and hope.

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We often think relief always takes the form of noodles, canned goods, toiletry and other basic things contained in a plastic bag and distributed to the “poor” victims. That’s good for the first few weeks—remember the honeymoon period I mentioned in the first paragraph?—but beyond that, and after all the donations have been handed out, what else is left?

Continuing relief is just as important, Agcaoili says, and it does not always take the form of tangible, consumable goods. Psychological first aid, as well as the more advanced critical incidents stress debriefing, plays a big part in the recovery process and in the person’s total well-being. Most often, not everybody needs special attention. People just need to talk about their experience and heal, over time. It prevents them from feeling helpless and resorting to depending on doles all the time. It ensures that in time, they will be ready to prevent similar incidents or cope better if he cannot prevent them. –Adelle Chua, Manila Standard Today

adellechua@gmail.com