Vol. 2 No. 2 Specials

A prominent aspect of the response to December’s tsunami has been attention to the mental health needs of the survivors This emphasis continues a trend traceable at least as far back as the early 90s, when post-traumatic stress disorder (PTSD) was a highly profile concern in the war-torn Balkans. Since then there has been a marked evolution in thinking about “psychosocial intervention” to treat emotional trauma.

In Bosnia and Kosovo there was a sense of urgency attached to the diagnoses of PTSD given to thousands of war-afflicted people. PTSD was considered a medical problem to be treated by psychiatrists and compensated by disability payments. It was thought that if PTSD could be detected early in its course, emotional suffering could be averted. However, since then, a global consensus has arisen that the most appropriate initial response to trauma resulting from wars or natural disasters is a combination of material aid like housing, food, and employment alongside vaguely-defined “community-building” programs – rather than a focus on specific emotional support.

The diagnosis of PTSD, in particular, has proven difficult to operationalize. There remains no consensus about the most effective treatment for people diagnosed with PTSD. Anti-depressants have proven ineffective in trials, they are often incompatible with cultures and beliefs, and they are prohibitively expensive to most people in most parts of the world. A single session of psychological “debriefing” – asking a person to recount trauma – is not linked to any cathartic mental health benefits, and it may even lead to increased emotional problems.

After a disaster, most survivors are deeply upset by their losses and by the hardship present in their new lives. The task of separating out from a group of emotionally disturbed people those whose emotional state constitutes a mental disorder is extremely difficult, and not necessarily productive. Post-traumatic stress disorder has three diagnostic criteria: A person must have suffered trauma; he must think about the trauma consistently and vividly; and he must feel jittery and emotionally numb. Due to the scarcity of psychiatrists in most disaster settings, these diagnoses are usually performed through trauma questionnaires. When cultural confusions and language mistranslations are taken into account, it is little surprise that in the few longitudinal studies conducted, a PTSD diagnosis is only a mediocre predictor of whether someone will still be suffering from traumatic memory symptoms several years later.