March 29, 2005

Post Traumatic Stress: How do people heal?

In this country, when traumatic events occur, we send in the counselors. Whether it’s a school shooting, a tragic fire or violence in the workplace, counselors are routinely sent in to help survivors deal with the trauma. Is that the best way to help people heal? Is it a universally accepted response?

After a recent conference in Rome called "Project One Billion," New York Times essayist Dr. Sally Satel raises some interesting doubts about the efficacy of counseling (registration required to read the article). The article is entitled "Bread and Shelter, Yes. Psychiatrists, No" -- a compelling title, given that Satel herself is a psychiatrist. The Conference was organized by Dr. Richard Mollica, a psychiatrist at Harvard, under the auspices of the World Bank, the World Health Organization, and humanitarian nonprofit organizations.

A Billion Sufferers?
"One billion" signifies the number of people worldwide, roughly one in six, suffering the psychological consequences of war, torture and terrorism. (Unless you include the trauma of abject poverty, I think – or at least I hope – that “one billion” may be an overstatement.) The conference addressed the fundamental issue of how to provide help: can therapy and counseling speed the healing process for the survivors of significant trauma?

Dr. Satel states that for the last 15 years or so, humanitarian workers have been exporting the concept of post-traumatic stress disorder and trauma counseling around the globe. They have rushed in to impose a Western-style "debriefing" - a group therapy technique intended to get victims to express their feelings about a horrific event and to relive it as vividly as they can - without regard to the needs of the victims, their natural healing systems or their very conception of what mental illness might be.

This particular conference appears to have concluded that the use of this type of debriefing is not what is really needed by people who have suffered from trauma. Instead, Dr. Mollica urges that Western mental health workers collaborate with indigenous healers. The W.H.O. now instructs aid workers to "listen, convey compassion, assure basic physical needs, not force talking, and provide or mobilize company preferably from family or significant others." That sounds like good advice in any post-traumatic stress situation, no matter what the circumstances.

Keep it Practical
Kenneth Miller, a psychologist in the Chicago area’s Bosnian Mental Health Program, saw much suffering among his clients - they had been placed in concentration camps before migrating to the United States - yet they did not really want to talk about the terrible things that had happened. The most successful feature of his program involved practical help such as education and job training. These people wanted to move on, not linger on their terrible recent past.


If you examine any traumatic situation, you will find a variety of responses among the victims. Some will want to talk, others will want to move on with their lives as quickly as possible. There is no “one size fits all” remedy. I imagine that the most important quality for any responders – any people who come face to face with victims in the immediate aftermath – is the ability to listen carefully. It is not helpful -- it can indeed be most harmful -- to impose on those who suffer our own belief systems and our own narrow views of the healing process.

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1 Comment

This is an interesting critique of so-called criticial incident debriefing, and one that needs to be made, so that the advocates thereof be asked to defend it with data.

In addition, it would help mightily if the workers comp systems in states recognize this condition as a valid one. Most do not.

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This page contains a single entry by Jon Coppelman published on March 29, 2005 11:28 AM.

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