Tag Archives: humanitarianism

Is it trauma or is it intensity/identity loss?


The current definition of PTSD requires an exposure to an intensely distressing event or events (either witnessed or told about in great detail) resulting in a pattern of intrusive re-experiencing, attempts to avoid such experiences and an ongoing negative cognitive/mood pattern. Such a diagnosis might be made after domestic and sexual violence, accidents, natural disasters, war, betrayal traumas, and even after hearing repeated stories of traumatic experiences to others (called secondary trauma).

Someone experiencing PTSD after life-threatening events might feel disconnected from family/friends, find it difficult to sleep, experience repeated nightmares, have difficulty not thinking about events during and after the traumatic experience, choose unhealthy coping patterns like alcohol abuse, or place themselves in situations where they re-enact parts of their trauma story.

But not everyone who has intrusive thoughts about a challenging situation, feels disconnected from their community (and previous self), drinks too much, or impulsively jumps back into danger have PTSD. Some of these same behaviors and experiences also show up in those who have left dangerous and all-consuming experiences and now do not know how to re-engage in regular life.

Consider these words of Dr. Steven Hatch, who spent time in Ebola clinics in Liberia at the height of the 2014 pandemic crisis in West Africa. He describes his experience after returning to his job at the University of Massachusetts.

To match the outside weather, my mood willingly turned dark. I withdrew from people, wandered about in a daze, and avoided public gatherings. When I did venture out, I carried myself in a completely different manner than I had before in my life.


The simple explanation was that I had post-traumatic stress disorder, and a few people, including some whose job it is to make such diagnoses, thought this to be true. (p. 239, Inferno)

He goes on to dispute his experience fighting Ebola as trauma. While difficult, he did not think it rose to the level of trauma experienced in war or even other more overwhelming Ebola clinics.

I could, however, recall the event [death of a toddler] in my mind without being emotionally overwhelmed, but also just as importantly I was able to still experience emotions about it, feeling appropriately somber. I just didn’t feel traumatized. (p 240)

So, what was his problem?

What I did share with many other volunteers was a sense that I didn’t belong in the States, for the work in West Africa was far from over. I desperately wanted to return, and almost within days of coming home I was trying to figure out how I could get back to an ETU [crisis Ebola center]. What I missed was the profound sense of purpose that such work had provided, and I slowly realized why people talked of “missing the war,” a phrase that always seemed discordant to my ears. You miss being in the midst of senseless butchery? Great. But I belatedly realized it was that purposefulness, the sense that you were doing something that was deeply and truly meaningful, that drove people back to such unstable situations. (p. 240-41)

There you have it. The seeming loss of crystal clarity or purpose in life can be very painful. When you are in an intense helping situation as Dr. Hatch was, every movement leads towards life or death. At the end of a day, you can count who lived and who died. No ambiguity. In addition, you are doing it with a team of people all committed to the same thing. You share the same vision, goal, and daily experience. You do not have to explain anything. And in these intense situations, you can have the kinds of intimacy not often experienced even in your immediate family. Also subtract mundane activities (grocery shopping, cleaning, taking care of children, etc.) that may not need to be done.

This is a recipe for distress upon return.

Return to regular life where you are expected to do these seemingly inconsequential activities AND where you have no one around to save AND no one who was present with your toughest experience…and you have a recipe for trouble. You may find it difficult to find joy in light of intrusive thoughts of recent emotionally intense experiences. You may long for a return to that sense of purpose and value. Because others do not understand and aren’t part of your “tribe” you may withdraw or find other ways to numb the pain.

Loss of identity and intensity may mimic trauma symptoms. They may be significant to need treatment. Military ending tours of duty, missionaries returning from field, humanitarians returning from doing crisis work, church planters leaving high stakes urban church plants, and trauma healing trainers returning from intense experiences may be at risk.

What can be done to prevent this distress?

  1. Probably nothing will take care of the problem. One could not go do intense work. Or one could become a crisis junkie. Neither are good options.
  2. But developing re-acclimation plans can help. Yes, training done before entering the intense experience will set the stage for healthy returns but post-tour of duty re-entry work is more important. The Army has develop protocols for re-entry by beginning the process even before leaving the “theatre.” Creating space for coming off the “high” giving time to process and following-up in the early days back can help. Involving family in the re-entry planning and building activities that can elevate family intimacy upon return will help immensely.
  3. Encouraging time and space to lament and process in group settings. This is where a therapist can help. Group process helps to put words to experiences and acknowledges impact on identity. This can also help re-connect with meaningful activities and experiences at home. One has to re-learn that meaning is not solely connected to intensity.

I have some very small personal experience with this. I’ve had intense experiences in international settings. When I have returned, I have sometimes found it hard to be at home when my head was still overseas. Being able to share with Kim and others helped. Practicing lament helped. Learning to be mindful of the present also helped me remember what has meaning and value in everyday life.

3 Comments

Filed under Post-Traumatic Stress Disorder, Psychology, trauma, Uncategorized

Volunteerism in Africa: To Go or Not to Go?


From time to time you can find essays identifying serious problems with volunteerism by Americans in developing nations. Last year I wrote a short response to acknowledge the real problem with some trips but countered with several reasons why not all trips are created the same and how some short-term trips can be beneficial.

Now, one year later, I have just returned from leading another Global Trauma Recovery Institute group of mental health professionals on a trip to Rwanda (my 6th trip to this tiny country). And once again, I just finished reading an essay by Heather Ruiz who documents some of the more egregious problems created by short-term trips–unneeded “help”, creating a culture of dependency, and a false perception of a need to develop.

Wrestle with the Problems

As a leader of short-term trips, I highly encourage anyone planning a trip to wrestle with these issues. Do not easily dismiss the reasons your trip might not need to happen. If you are unaware of the complexities of “help” I urge you to read the following books:

Preparing to Go

If you decide your trip is still in the best interests of those you will visit, consider the following preparations as absolutely essential:

  1. Pray. Obviously.
  2. Study the region. Know its history, culture (from multiple vantage points), its successes and struggles. Know who is providing aid/help/ministry in this region. Try to make contact before you go to see if you can learn from them.
  3. Ensure you have been invited. Don’t go if you haven’t had a solid invitation, a “come over and help us” request.
  4. Find a cultural guide. Having a bridge person is essential. Such a person should be well-respected by many and already considered a leader among her people.
  5. Examine goals. What really is your purpose? How will you know you have achieved your goals? For example, just because you want to teach pastors how to preach and you deliver classroom training doesn’t mean you have met your goal. Key Question: Did you ask who
  6. Think about after you leave. What do you expect will happen after you leave? Benefits? Struggles? If one of your goals is “relationship strengthening” then consider how this will continue after you leave. Be realistic. How has your work supported local leadership. How will it make their job easier?
  7. Review training materials. One of the biggest failures I have made is not to have my training materials reviewed prior to departure. Review by multiple eyes can catch obvious cultural disconnects. Don’t lecture. Always use dialogical forms of education. You may not be able to cover as much material but what you deliver will be better and more useful. You will learn what works and does not work.
  8. Stay in locations that benefit the local population. Consider your footprint. How will you ensure you are not a burden to your new friends? Try to stay in locations that provide local jobs and where profits go back into local ministries.
  9. Working with children? Plan ahead what you will give. Likely, you won’t be the first to arrive at their village. We’ve had the experience of children asking for things like watches, bracelets, money, candy, etc. Re-read the essay by Heather Ruiz (above) as to the impact of gifts. They aren’t always helpful. Of course it is nice to please children with a treat. Buy a local treat and share that with them.

Telling Stories When You Return

I confess that I have had many judgmental thoughts when viewing social media pictures of (primarily) white people hugging little African children. Do they not understand how such pictures foster the “great white hope” mentality that is so destructive to Africans and Americans? I have been a bit sheltered from this during my trips to Rwanda as I mostly interact with other counseling and ministry professionals. Also, I tend not to take pictures because I do not like the way taking them makes me feel distant from my friends and even at a zoo when taking pictures of strangers.

And yet, I want to convey my experience to my friends who have prayed for me and who sacrificially supported the trip. Work to share stories (only with permission if identifying information given!) and pictures that show the strength, fortitude and honor of the people you met. Consider, for a moment, what the reverse would be like if they traveled to see you and brought back pictures of you, your family, and the interior of your house to share with their friends. How would that feel?

And if you are going to share pictures of children mobbing you, make sure you first ask yourself about the meaning of the mobbing. Why are these strangers holding your hand, fighting to be next to you, jumping in your lap. Sometimes it is as sweet and innocent as children getting the opportunity to meet

Waiting for Elders to start a village meeting

Waiting for Elders to start a village meeting

someone they consider exotic, sometimes it may be due to a lack of parental love (once a child asked if he could make an application to join my family), or worse, it may be learned behavior and lacking the feelings you might expect (once I watched a group sing a song but there was no music in their eyes, just rote behavior).

1 Comment

Filed under Africa, Missional Church

Orbinski on humanitarianism, dignity, and hope


 

Two days ago I had the privilege of meeting and hearing Dr. James Orbinski at the 2009 Frobese Day, an educational conference held at Abington Memorial Hospital each year. Dr. Orbinski is the former head of Medicins Sans Frontiers (Drs without Borders), current head of Dignitas, professor at U. of Toronto, author of An Imperfect Offering, and central figure in the documentary, Triage. Of interest to me was his work in Rwanda during the genocide.

On a personal note, I found him very engaging. When I was introduced to him, he didn’t do the usual handshake and move on. He really engaged me about Rwanda and what work we did and plan to do there and gave a number of encouraging comments that went above and beyond the call of duty. I guess that is one of the characteristics you need if you are a person who goes into distressed areas. You need to connect to the people, figure out what they need and what can be done, and then do it.

First, an assortment of observations presented:

  • There are about 6.8 billion people in the world. Some 3.8 billion, or about half, subsist on less than 2 dollars a day
  • 1.1 billion go to bed hungry each night. This number grows by about 100 million each year
  • Nearly all famines are the function of political conflict rather than acts of nature
  • There has been a 24% increase in food prices in impoverished areas. One of the key causes is the increase of developing biofuel. Food is more valuable if it can be made into fuel.
  • The World Food Bank is begging for about 23 billion dollars to feed this number of poor. It can’t get it. But, 13 TRILLION dollars has been recently expended to prop up a collapsing international economy.
  • In 2000, it cost 15,000 (a year, I think) to provide an individual in Africa the antiretroviral meds needed to survive. Today, with political pressure, it costs 99 dollars
  • The drug companies say that it costs 1.6 billion dollars to bring a drug from a new chemical to market (through research & Development). While they do not reveal how it costs this much, it is clear that part of the costs they factor in is the income they expect to make on the drug. So, if you expect to make 10% on your investment, can you really consider that a cost to develop a drug. Apparently, they do
  • A recent nonprofit just released three new drugs dealing with neglected diseases in Africa. The costs to bring these drugs to the market was 100 to 300 million dollars. And, the companies selling them are indeed making a profit

A couple of his key ideas:

  • Dignity cannot be granted; it must be acknowledged via engaged collaboration and solidarity
  • Solidarity is not pity but active compassion
  • Hope is not some naive utopian dream, it is “what we do”
  • We all need to be political. The first act of politics: speak the truth; The second act: listen
  • The worst form of suffering is suffering alone
  • We must see it, acknowledge it, give voice to the voiceless and thus allow for dignity even if we cannot solve it
  • Optimism and Hope are two distinct concept. Optimism is confidence that one’s actions will work for the best. Hope is confidence that the action you are about to undertake is the RIGHT one no matter the outcome
  • We need those with daring ideas, with visions of possibilities. That is all there is. Hope, is in his estimation, in himself–that he will do the right thing.

While I do not agree with his definition of hope, I do agree that we need more people to move from insight (that a problem exists) to action (that I can do something of value in a hopeless situation). Folks like Orbinski certainly put many of us to shame.

1 Comment

Filed under Civil Rights, Cultural Anthropology, Psychology, Rwanda, suffering