Wired magazine’s Haiti Rewired blog has an excellent piece on the ‘psychological typhoon eye’ phenomenon, discovered after studies of the 2008 Sichuan earthquake in China, where those closest to the centre of the devastation actually reported less concern about their safety and health.
From the Wired piece:
Two suggestions have been provided to account for the psychological eye, namely ‚Äúpsychological immunization‚Äù or ‚Äúcognitive dissonance‚Äù. The former seemed like a plausible explanation after the initial survey, since there is wide anecdotal documentation of ‚Äúcoping measures‚Äù adopted by those who experience significant personal trauma or hazards. However, the fact that subsequent surveys found relatives experiencing a variation of the psychological eye, suggests that the extent of personal experience, which strongly drives psychological immunization, is not sufficient to account for the observed effect.
Festinger’s theory of cognitive dissonance is defined as an uncomfortable psychological state in which two opposing cognitions are experienced and need to ultimately be reconciled. In the example of the psychological eye, the devastation of the area creates a sense of danger, yet the individual may have no choice but to remain close by, counter to the survival instinct. To reconcile these conflicting beliefs, the individual may unconsciously lower self-assessed risk to justify remaining in the area. Cognitive dissonance is very difficult (impossible?) to modify in the field, as noted by the authors, and thus, this proposal will remain more speculative until follow-up studies in a controlled fashion can be done.
The author, Nature’s Noah Gray, goes on to suggest that “Surveyors must maintain a cautious and healthy skepticism when interviewing survivors and assessing areas for aid because information provided and opinions given will not likely reflect the dire situations being experienced.”
One difficulty in these situations is that mental health workers usually hurriedly arrive from other countries and may not fully understand how trauma and psychological distress are experienced by the local population, or how they integrate with other sorts of decision-making.
We tend to assume that trauma is a universal reaction to a difficult situation but this singular concept is something of a mirage – common psychological reactions to devastation have differed over time and differ between cultures.
The model of trauma described as the diagnosis of post-traumatic stress disorder or PTSD simply doesn’t fit the common reactions of people from many cultures, despite the fact that this is the most common conceptual tool used by Western mental health workers.
In a 2001 article for the British Medical Journal psychiatrist Derek Summerfield noted:
Underpinning these constructs is the concept of “person” that is held by a particular culture at particular point in time. This embodies questions such as how much or what kind of adversity a person can face and still be “normal”; what is reasonable risk; when fatalism is appropriate and when a sense of grievance is; what is acceptable behaviour at a time of crisis including how distress should be expressed, how help should be sought, and whether restitution should be made.
In these cases, not understanding the local culture may mean that aid workers may assume that individuals don’t understand the risks of the situation, when, in fact, each may be basing their risk assessment on different priorities – as has been found in studies on cultural differences in risk perception.
Treating trauma seems like a no brainer. It intuitively seems like one of the most worthy and naturally important responses to a disaster, which is probably why disaster areas are now often flooded with ‘trauma counsellors’ after the event (Ethan Watters’s book Crazy Like Us charts the response to the 2004 tsunami in Sri Lanka where floods of well-meaning but poorly trained therapists arrived in the following weeks much to the bafflement of the locals and annoyance of the established relief organisations).
However, this is one of few areas where well meaning but poorly prepared therapists can actually do harm. Although experiencing extreme danger raises the risk of mental illness, contrary to popular belief, only a minority of people caught up in disasters will experience psychological trauma and immediate psychological treatment, either in single or multiple sessions has found to be useless or to make matters worse.
The psychological impact of devastation changes through time and space and we need to be careful to understand its local significance lest we inadvertently amplify the chaos.
Link to Haiti Rewired on the ‘psychological typhoon eye’.