Every time a tragic event occurs I receive a call form someone in authority and am asked if I, or a team of my colleagues, can provide some psychological help. Whether the events are local (the suicide of a patient, the collapse of a highway overpass, the accidental death of a circus performer) or international (the Virginia Tech killing spree, the 2004 tsunami, or the recent Haitian earthquake), these events affect such a large number of individuals that it is natural to want to do something for them – something that will ease their suffering. While it is natural to want to help, what exactly can we do, or should we do?
The idea that a debriefing is important and helpful has not exactly been supported by research. In fact some studies have shown it to be counter-productive. My own experience is that group interventions should be used judiciously. There is so much individual variance in how people cope with such events that no single group intervention can be applied to everyone. There are two reasons for this variance: first the experience itself, and second, the personality of the person living that experience.
What I go through, what you go through
Just as a car accident can leave one passenger without a scratch and another with the loss of a limb, very few events result in the same experience for two people. In an earthquake, a person trapped in a pile of rubble with three dead family members does not go through the same experience as someone else who was untouched personally. How can we compare one individual’s experience to another’s even though they were both involved in the earthquake?
How I cope, how you cope
The second major factor is the personal make-up of the victim. Even two identical experiences will not be lived the same way by two individuals. For example, while directly witnessing a death may be difficult for both, the way these two people cope with the experience depends a great deal on their temperamental make-up. How we detach emotionally, how we understand existential issues, our spiritual beliefs, our ability to adapt to changes, our levels of anxiety, pessimism or optimism, are but a few of the factors that render experiences subjective.
The limits of debriefing
It is for these two reasons that a classic debriefing exercise, such as gathering everyone in a room to discuss their feelings, isn’t always the best idea. Of course, talking about feelings is a good thing. It normalizes our experiences. This is what we see happen at every wake, every Shiva, or every gathering at a funeral parlor. But the difference between these common experiences and a debriefing exercise is that we are not captive in a social mourning context. We talk to whom we want to and when we want to. We can leave if uncomfortable. We can cry on a loved one’s shoulders or we can gather in another room and share a few laughs with relatives we haven’t seen in years. In a debriefing exercise, it presumes that everyone had similar experiences and are in the same state of mind at the same time. Imagine having been forced to make a life and death decision (hiding under a table instead of trying to disarm an attacker) and then sitting in a room to share experiences with someone who was unaffected, having only heard the sounds of distant gunfire, or worse still, listening to him make some joke about the Wild, Wild West.
This is why I prefer to make myself available to people who would like to talk to someone rather than impose myself on them. I encourage people to talk about their feelings to anyone they feel comfortable with. It does not need to be a professional. I limit any group gatherings to general information sessions (what is the range of normal reactions, how to respect the grieving process of others, what are the signs of longer term problems such as PTSD, etc.) or offer it to a small subgroup of people who seem to be experiencing like-minded reactions. One size does not fit all. Our interventions must account for this.
The question of sending psychological help to Haiti has been raised by a number of organizations and lists of volunteers are being compiled. While I think this is good, and I may be among the volunteers myself, I am of two minds. I want to help but I do not want to impose myself. We in North America see the world through our own eyes and our own cultural beliefs. We tend to assume that our perspective is correct and that others are less advanced in some way. More importantly, we tend to think that there is a standard grieving process.
The more suffering we see, the more we want to help. Since the suffering in Haiti is almost infinite, it pushes us to want to do more and more. But if we push too much, at some point all we end up doing is adding to their misery. In order to best help, I think it is imperative to recognize the limits of what we can and cannot do and to be available to them as they wish. The determining factor should be their desire FOR help not our desire TO help.
Here is my column from last week which discussed some of the issues related to grief.
Can grief be relieved?
(Source: Peut-on soulager quelqu’un de sa peine? Journal Métro, February 9, 2010.)
Haiti – the latest scene of great human tragedy – and unfortunately not the last. Whenever we hear of such events, and especially when we are bombarded with images of grief and pain too great to fathom, our hearts go out to the victims. The first thing we want to do is help relieve their suffering. As a result we send money in hopes of providing food and water. While this is essential, how does one relieve the suffering of a parent who has lost a child or of a child who has lost a parent?
Beyond the basic needs of sustenance and shelter, how can we help when we see a child alone and crying, or a mother on the side of the road rocking in grief as she clutches a dead baby? One of the reflexive responses we have as a society is to offer psychological assistance by sending in teams of mental health specialists. Unfortunately, while the need certainly exists, the ability to address these needs does not.
When I personally intervene with an individual or a family following a tragic death such as a suicide or an accident, I do so with a solemn sense of responsibility and desire to help. Even though it is always appreciated by grieving families, it is still but a drop in an ocean of overwhelming grief.
This leads us a to an important and somewhat disconcerting question: Is psychological help useful in the wake of tragic events?
What we can and cannot do
I believe there are a few things that can help in such circumstances. Professionals can help people express themselves without feeling judged. They can help people remember the full life of a loved one lost instead of only their tragic end. They can help them understand that most reactions, no matter how intense, are usually completely normal.
What professionals cannot do is assume that they can do more than relieve but a small portion of the suffering. They cannot impose themselves on others no matter how much grief they may be going through. They cannot substitute for a person the griever trusts, such as another family member, a friend, or a spiritual leader. They cannot impose their cultural beliefs on people who live in a different world.
Unlike a glass of water that can quench a thirst, a compassionate ear can never undo a loss. Nevertheless, by respecting the victims and their grieving process, we may perhaps palliate a small portion of their pain.
15 Feb 2010