Indonesia

Indonesia: Warriors and lovers - Understanding the responses to horror

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David B. Stube, PhD, is a Licensed Clinical Counselor working for International Medical Corps in Aceh Province, Indonesia, in its mental health treatment and training program for survivors of the December 26th tsunami.

People ask how I listen to these tsunami stories all day. It isn't about sad stories. It's about hope, heroic struggle, and achieving an amazing humanity after enduring one of the greatest tragedies humankind has ever known. But the experience of the tsunami has become more than a tragedy; it has become an opportunity to open one's heart. It would be horrible if I just met each person once and never got to witness the healing and outpouring of love that follows.

I think of post-traumatic stress as an all-too-normal emotional complex we experience in response to a very abnormal life horror-one that prevents us from opening our hearts. I tell patients this is about warrior emotions.

When we survive an intense battle for our lives or the lives of our loved ones, we develop a very predictable way of feeling whenever we find ourselves on the war path again-we become warriors. The five emotions that make up this warrior way of feeling are stress (or anxiety, really), fear, rage, depression, and emotional dissociation. Let's look at each of these in turn.

Learning to "chill"

Clearly, warriors are more worried and stressed about life following an intense battle. They never want the event to happen again and guard against it. We keep having aftershocks following the earthquake that preceded the tsunami. The one yesterday came at 6:00 a.m. It rang up at 6.3 on the Richter scale. Because of our post-tsunami stress we all awoke from deep slumber and ran outside. Warriors are always on such full alert.

They also worry about other things happening, like poverty, unemployment, and heartbreak. Warriors stand guard against harm. This anxiety is not always easy to live with, but can typically be tolerated as long as it does little more than lead us to a safer life. And we have to remember that it is just an emotion and it does not necessarily have to lead to anxious action. We can learn to chill a little, just not right when the earth is shaking again.

Being fearful more effectively

Warriors are fearful having survived the worst battle (or disaster) of their lives. But usually they know what to be afraid of. If I am going into battle I want the most seasoned warrior on my side, preferably standing right next to me-the warrior that knows what to fear.

I met a 16-year-old girl, Umi, whose parents and relatives complained she was scared of everything. She was just growing into her adult-sized fears when everyone around her became too scared to face their own fears. Most every one in her family told me they were never scared. But I pressed them further; indeed they too had run outside during the recent aftershock. It reminded them of the 9.15 Richter shake from December 26, 2004, the fourth hardest earthquake ever recorded. It would be crazy not to be fearful.

How was this girl to learn about adult-sized fear, if the adults in her life were denying fear itself? So we began to talk about how useful fear could be when we protect our home and families. I encouraged them to stop telling Umi to not be afraid and start telling her how to be fearful more effectively. Running out of the house is a good way to act out fear. There are plenty more and Umi needs to learn.

I pointed out they were afraid something was wrong with Umi and that is why they brought her to counseling. I promised to see the family next week to see how they are doing facing and talking about their fears. Just because we are paranoid does not mean others are not out to get us.

Harnessing Rage

Bactiar, a middle school teacher, could not believe all the trouble he was having with rage. Since surviving the earthquake and tsunami, he found he had little tolerance for his students or family. He kept having fits of rage and wondered if it had anything to do with his tsunami experience.

We explored how rage, although a bit strong, helps propel a warrior into battle. Just as surely as fear leads to flight, rage can lead to fight. The rage empowers us to make sure we or any one we love will never have to face another horror like the one we faced. The rage fuels the actions that help us survive the trauma.

I encouraged Bactiar to embrace this rage, but learn how to act angry better. Instead of looking at how he could stop his rage, we looked at how he could begin to get mildly angry more often, taking advantage of life's minor frustrations to learn how to be politely or humorously angry. We tied this into Indonesian customs that frown on angry actions and encourage more refined ways of being angry. The Indonesian language has almost no words to express anger. It is done pretty politely, or not at all.

Arguing with the three types of depressive thoughts

Most of the half million people displaced by the Tsunami have a more depressive view of life, more serious, more appreciative of just how randomly and suddenly disaster can strike. Most warriors see survival more as a matter of life or death. They do not expect the best. Some even lose hope.

The worst are those like Bu Rinawati, who lost her husband and three children in the tsunami. Her depressive outlook made it hard to sleep, eat, or enjoy anything that used to make her happy or bring a little comfort. It even interfered with her grief work. Instead of grieving over her lost children's lives, she could not stop thinking about how they died. She could not forget her daughter's face as she was torn out of her arms by the waves.

She became too depressed to feel the love she used to feel for her husband. I encouraged her to take a mild anti-depressant and to argue with the three types of thoughts that plague depressed people: I am no good, there is no hope, and the world is a hard place to give and receive love.

The first depressive thought had her thinking she was to blame for her children's deaths as she asked them to run with her to avoid the waves, only to watch them get swept away.

The second thought was driving her to suicide. "What good is living when my husband and children are no longer alive." The third depressive thought made it impossible for her to receive love from her remaining family, her mother, and her three brothers. She did not want their outpouring of love as she could neither accept their grief nor mourn with them.

We talked about taking anti-depressing walks and taking better care of her self. I will check back with her next week to see how she is doing.

Re-engaging

The final warrior feeling is dissociation. This may not seem like much of a feeling, as we simply feel compelled to stop thinking of the trauma. Warriors do not like to think too much about long forgotten wars and hate the nightmares that come from forced forgetfulness. But during the tsunami it was very important to stop feeling some feelings and thinking some thoughts, to simply survive.

Sadrie had to walk across dozens of bodies to carry his two-year-old out of the chest-high water that destroyed his house. Warriors do what they need to do to make sure they come home from the war. They will do the same for home and family.

But sometimes dissociation can be a problem. When the ground shook, I was sleeping in my underwear. As I walked back in after the aftershock stopped, I made a note to myself to keep my sarong handy.

So we can see that the warrior way of feeling is full of stress, fear, rage, depression, and dissociation. This is normal, sort of. In fact, we might want to question how normal we are if we survive a tsunami and do not feel worried, wary, on red alert, sad, or disconnected. But it is important that we do not let these emotions dictate all of our actions.

The healing of the horror

Life is too short to always be on the warpath. We have to act and talk with lover feelings at home and there is little room to behave like a warrior, even when we feel that way. Our families deserve more tenderness and love. And when we accept that we have become warriors, but learn how to act only out of love, we undo some of the devastation of the tsunami. Now that I am not so dumbstruck by the devastation the tsunami wrecked in five minutes, I am better able to appreciate the love put into simple acts around me.

This Monday I was invited to the home of an Acehnese family whose boy I am treating for his fugues (an amnesiac condition during which one appears conscious of his actions but has no memory of them after returning to a normal state). His big sister was getting married. The whole village participated.

When I visited our doctors and nurses on my way home from the wedding, I discovered that they had very few patients and almost no complaints of hard-to-explain aches and pains-every one was celebrating the wedding, forgetting their ills. Dishes and dishes of wonderful Acehnese curries, rice, vegetables, cakes, and fruit were served. And the people celebrated the courage of the bride and groom to begin facing the future together.

This is all about that Indonesian phrase we translate as "Thank you." Indonesians say "Terima kasih." It literally means "Receive love." And the proper response is to give love back by replying "Sama-sama," literally "Together you too." The healing of the horror and pain comes with this outpouring of love, the kindness of strangers, the outstretched hand to others.