THURSDAY, Jan. 14, 2010 (Health.com) — The earthquake that hit Haiti on Tuesday has caused untold physical devastation, flattening much of the capital of Port-au-Prince and leaving tens of thousands dead. The psychological effects of the disaster may be similarly devastating, and they are likely to persist long after the aftershocks have subsided, for the people in Haiti as well as for Haitians abroad who are watching the events unfold on TV.
Haitian-born clinical psychologist Guerda Nicolas, PhD, the chair of the department of educational and psychological studies at the University of Miami, has written extensively about how Haitians cope with tragedies, especially hurricanes and other natural disasters. (A study of hers appears in a new book, Mass Trauma and Emotional Healing Around the World.) Nicolas is currently coordinating counseling efforts in Miami's large Haitian community and plans to travel to the island next week to assist with mental-health outreach.
Health.com spoke with Nicolas about the psychological impact the earthquake is likely to have on Haitians, and what can be done to support friends and family members who are suffering beyond the disaster zone.
Q: What are the immediate psychological concerns following a disaster like this?
A: There isn’t an immediate response. When an individual is in the midst of that—and I’m saying this not just as a professional, but from experience and the work I’ve done in Haiti—you’re in action mode, and you're just thinking about what’s going to happen. The actual trauma, the psychological impact, doesn’t occur until several months after. It’s when things get quiet and there’s not much going on that you start to feel the impact and the sadness of the images that you witnessed. Having come so close to death starts to set in.
Q: Is that when post-traumatic stress begins?
A: Exactly. After the relief effort has ended, after the funerals are done—that's when post-traumatic stress disorder (PTSD) occurs. In the event of any type of trauma, a person can have acute stress and anxiety, but PTSD doesn’t occur until six months after, after the person has been experiencing the symptoms of not being able to sleep, and the flashbacks.
Q: Are there other symptoms that accompany this kind of trauma?
A: Depression is one of them; often it’s a marker for PTSD. Anxiety is another common response. Oftentimes [PTSD] is associated with substance abuse. There’s a desire to numb the pain, so people have a tendency to drink more heavily to cope and deal with the pain. But different individuals have a different cultural response to situations, and there’s not a uniform way [to respond].
Q: Can people at a distance from the event experience shock and post-traumatic stress as well?
A: Yes, absolutely. We call that vicarious traumatization. And it can be more damaging psychologically because there’s a feeling of helplessness—watching the images, seeing the devastation, and knowing you can’t do anything about it. The people there are really trying to do something to alleviate others' suffering, and that can be helpful.
The symptoms are very similar to PTSD. People will have nightmares; they’ll have flashbacks of the images they’ve seen on television. They may have sleeping difficulties, they may not be able to eat, they may not be able to concentrate.
Next page: Preventing vicarious traumatization
Q: How can you prevent this traumatization?
A: The first thing I’ve been saying to people here in Miami is, “Stop watching the news.” Honestly, the images that are being portrayed in the media can really be hard on a lot of people. Television is not a good way to hear news of family members in Haiti.
Something we do in Haiti is a neighborhood get-together. Have your friends come over and make some tea and food, and have an opportunity to talk and share about what the person is experiencing. I would really encourage everyone to talk about it rather than just watching, because when you’re watching you’re not really able to express the emotions you're going through.
Q: If you have a friend or neighbor who is cut off from family in Haiti, what can you do to support him or her?
A: I think it’s helpful to just offer an ear. You may need to knock on the person’s door and say, “I know you have family members in Haiti; do you want to talk about what’s going on?” They're feeling a loss in not being able to be there, and through that conversation it will become obvious what the person is in need of. If they have kids, you might say, “I can bring your kids to school for you, or I can pick them up." Or, "I’ll bring you some food.”
In Haiti, when somebody has lost [a family member], or in any kind of family trauma, people will bring them the resources they need—the tea and the coffee and the food. They don’t have to worry about the mundane things of everyday life, so they can focus on their own healing. Neighbors can reach out that way.
Q: In your study about how Haitians cope following natural disasters, you talk about the lakou, the extended social network that Haitians rely on. Is that missing for Haitians in the U.S.?
A: Absolutely. In Haiti, there’s a sense of neighborhood, not just a sense of being connected to people who are related to you by blood. People in your neighborhood are an integral part of your family. It’s almost like, if you’re a family of two, and you live in a lakou, you have 15 family members that will be responding to you at any given time if you need it.
That sense of community is lost when you come here. I do believe that it’s much harder for Haitians to deal with [tragedy] not having that network. People in the U.S., or in Canada and other places, don’t have that same sense of trying to do something to help their neighbors [in Haiti]. They’re caught just watching the events.
Q: Are there cultural differences that people in the U.S. should be aware of in trying to support Haitians in the U.S.?
A: I think it’s important to realize that we don’t experience things the same way. We express what we feel differently. There may be a lot of crying and wailing. They might faint; they might fall down. All of that is part of responding to the trauma—but it doesn’t mean they’re not able to cope and function. A person in a state of shock may look like they’re going to fall down or faint, and then an hour or so later they’re fine. This is one of the remedies for dealing with that sense of shock.
It’s not part of the Haitian mentality that we’re not able to do for ourselves. There’s always the sense that bad things happen in Haiti and to Haitian folks, but that we have the ability to overcome and get through it.
Next page: How you can help
Q: Do you have family in Haiti now?
A: I do. I have an uncle, an aunt, and several cousins, nieces, and nephews.
Q: Have you been able to contact them?
A: We’ve spent all night and all day trying to connect with them. We’ve been able to, but it’s really been through a network of a network of a network. We’ve called the immediate folks, then the members of the lakou, the neighbors, asking, “Have you seen so and so?” We heard from one of them that our uncle’s leg is broken and that he’s getting care from the local folks.
It’s been really hard not being able to be in touch with family members. Not being able to hear how they’re doing—that’s the hardest part.
Q: What can people do to help on that score?
A: Sant La, a community center here in Miami, in Little Haiti, has set up a place where people can make phone calls. Calling people is really expensive and buying the phone cards is very expensive, so they’ve set up a place where people can come and call family members as often as they want. There are other places that are providing phone cards to family members. On the immediate level, these are things we can do in the U.S.
I know [my family] purchased 50 phone cards today and we’ve gone through about 30. They can be very useful and it’s a small way of providing help to these people.