Thursday, January 13, 2005

Post-traumatic stress disorder

For those involved in the rescue, relief and rehabilitation operations in the aftermath of the recent series of disasters here and abroad, the realization that the problem is more than material and economic could be daunting. The psychological trauma of survivors could be paralyzing and the effects could be long-lasting if these are not addressed immediately and properly.

The recent killer landslides in our own home ground and the post-Christmas tsunami that killed more than 165,000 people in 11 countries and left millions bereaved and bereft have to mean something and result in something. Otherwise, is it all despair?

Last Monday we wrote about the experiences of a team of clinical psychologists who fanned out to several disaster areas in the aftermath of the 1990 earthquake, the 1991 Mount Pinatubo and 1993 Mayon Volcano eruptions. The team, called HEART (Holistic and Empathetic Approach to Rehabilitation and Training), was composed of Ateneo University masteral and doctoral psychology students led by Dr. Ma. Lourdes A. Carandang, a seasoned clinical psychologist, researcher and author. The effort was funded by Unicef.

One of the fruits of their experiences was the book ``Pakikipagkapwa-Damdamin: Accompanying Survivors of Disasters’’ (Bookmark, 1996). The book is now being updated and redesigned for reprinting. It is a rich source of insights and methodology for those helping survivors to cope with their trauma and find meaning in what is left of their lives. Empowering them is even more daunting. Note that I avoid using the word victim.
That tongue-twister in the title means empathy and more. If sympathy is pakikiramay, empathy goes farther and deeper.

As a journalist who uses words as a medium and as one who had trained in clinical psychology and worked with the breaking and the broken once upon a time, I could not help but note the therapeutic power of words and story-telling. Naming the pain, saying and sharing one’s pain, beholding the pain of others—these could be the beginning of healing.

For post-disaster rescuers and caregivers who must wade into the ocean of human sorrow and who might feel overwhelmed, bewildered and clueless, the book offers not only how-tos but comfort as well. Arellano’s book also deals with the burden and burnout of the caregivers.

This ``Diagnostic Critera for Post Traumatic Disorder’’ crafted by psychologists and psychiatrists (and by the HEART team) could equip those out there in dealing with the pain of survivors as well as there own.

A. the person has experienced an event that is outside the range of usual human experience and that would be markedly distressing to almost anyone, that is, serious threat to one’s life or physical integrity; serious threat or harm to one’s children, spouse, or other close relatives and friends; sudden destruction of one’s home or community; or seeing another person who has recently been or was being seriously injured or killed as the result of an accident or physical violence.

B. The traumatic event is persistently re-experienced in at least one of the following ways:
1. the recurrent and intrusive distressing recollections of the event (in young children, repetitive play in which themes or aspects of the trauma are expressed)
2. recurrent distressing dreams of the event
3. sudden acting or feeling as if the traumatic event were recurring (including a sense of reliving the experience, illusions hallucinations, and dissociative flashback episodes, even those that occur upon awakening or when intoxicated)
4. intense psychological distress at exposure to events that symbolize or resemble an aspect of the traumatic event, including anniversaries of the trauma

C. Persistent avoidance of stimuli associated with the trauma or numbing of general responsiveness (not present before the trauma), as indicated by at least three of the following
1. efforts to avoid thoughts or feelings associated with the trauma
2. efforts to avoid activities or situations that arouse recollections of the trauma
3. inability to recall an important aspect of the trauma (psychogenic amnesia)
4. markedly diminished interest in significant activities in young children, loss of recently acquired developmental skills such as toilet training or language skills
5. feeling of detachment or estrangement from others
6. restricted range of affect, that is, being unable to have loving feelings
7. sense of a foreshortened future, that is, does not expect to have a career, marriage, or children, or a long life

D. Persistent symptoms of increased arousal (not present before the trauma) as indicated by at least two of the following
1. difficulty falling asleep
2. irritability or outbursts of anger
3. difficulty concentrating
4. hypervigilance
5. exaggerated startle response
6. physiological reactivity upon exposure to events that symbolize or resemble an aspect of the traumatic event (for example, a woman who was raped in an elevator breaks out in sweat when entering any elevator)

E. Duration of the disturbance (symptoms in B, C and D) of at least one month.
Note: sometimes the onset of these symptoms could be delayed.


May I say again that there are websites that accept ``tsunami donations’’ via credit card, among them,, and Some people I know who are not internet-literate sent money and asked me to do it for them. I was touched. Unicef instantly issues a receipt in the donor’s name via the card holder’s email.

Now please do it yourself.