The Psychological Effect of Crisis

Answer Tips enabled

In light of the Haitian earthquake and the subsequent aid efforts there, and having recently attended a meeting at one of the UN cluster agencies' headquarters in NYC on psychology, development issues and crisis, it was disconcerting to me that there is no current permanent program in place at the UN or among many different aid agencies, or one that can be immediately implemented, to commonly do psychological needs assessments among both crisis-affected populations and for workers in the field.

After food, water, and shelter, such needs are considered a tangential, secondary, or non-essential matters that only get ad hoc attention in rare circumstances. Some agencies or organizations are better than others at recognizing this as a critical need, which is especially true among crisis-affected populations, as the psychological well being--which includes issues of safety, security, and trust--fundamentally affect long-term recovery and development in post-conflict and post-disaster areas. This is indeed something that we will be seeing prove true, and with veritable profundity, during Haiti's post-earthquake reconstruction.

At the moment, the Humanitarian Media Foundation (HMF), of which I am Co-Founder and Board Chairman, is working on a documentary project about a representative case of this very issue--humanitarian action and intervention and the subsequent psycho-social and economic effects of such action--in partnership with a trusted friend and colleague out of Europe, in association with an Ivy League university here in the States. His is ground-breaking work that needs to be done, not just for the specific issue being addressed, but also in terms of broader implications concerning any post-conflict interventions by international agencies.

There are many harrowing instances in which certain interventions undertaken do more harm to a population than good--having been created as protocols that look good on paper by bureaucratic ivory-tower contingents with multiple university letters after their names--who have rarely if ever been to the field--and are operating on well-meaning but deluded projections of what they believe to be critical issues and aims, often without taking the trouble to ask the affected populations themselves, or bother to go into the trenches, thereby creating operational programs based on theory and not on actual operational experience.

There is something fundamentally wrong with this. Imagine writing an instruction booklet on how to do complex brain surgery when you've never even seen a real brain, know its workings, or much less held a surgical instrument in your hand. You can be sure that unless there is some intervening miracle, you're about to kill your patient.

This is, however, how many intervention protocols are formed, and there has been little discussion about the effects. According to both my own experience in the field and the experiences among those whom I know well, this is how it has been done for such a long time, until now, no one has bothered to give a damn enough to both question its logic and do an empirical study to determine the effects of such interventions. The issues go into ethics, transparency, efficacy, and accountability, and this is a seemingly inopportune time to be asking such questions when the media is focusing on making heroes of everyday people, and when people want to be feeling good about humanitarian action--enough to perhaps look askance at anyone who might raise his or her hand and ask: when do we ask the hard questions about when and how things are done, can perhaps can be done better even in the midst of crisis, and with a greater sense of responsibility to those whom we are supposed to be serving?

The vitriol with which this is met by organizations is alarming, and the reasons are understandable: no organization can look at itself with impartiality, and no one at such agencies will trust anyone else to do it, as competing organizational fiefdoms, even in the field, are a reality which make asking such questions difficult. To get agencies to work with one another, in some cases, much less tap someone from the truly small world of humanitarian action whom everyone knows, is an issue. This allows humanitarian agencies to often act with impunity, as they are seen, unquestionably, as the experts. And, because of the very nature of their work, one can be easily demonized if questions are ever asked because to do so would be akin to looking a gift horse in the mouth. Their work, after all, is to do good. Why question their methods when their intentions are so honorable?

But the questions remain, and if the good of affected populations is of more importance than the interests of organizations there to help them, they indeed should remain. We have to remember whom we are serving. Is it ourselves, our reputations, and our own interests that are most important, or are they the populations in question?

But this is an aside, and later on I'll be writing about this subject in particular, and with greater specifics. I'm introducing it now because with issues surrounding the response in Haiti, subsequent commentary will indeed be more and more poignant.

The commentary below instead and in this case is not about humanitarian agencies themselves or crisis-affected populations, but about those individuals on the ground now immersed in humanitarian action who serve such crisis-affected populations in the field, and the psychological effect of such crisis. This has come home to roost among those whom I love very much and who are friends, who serve all over the world in the field in humanitarian action, and for whom I and others have been staunch shoulders, because often enough, they have been the one to be the shoulder to others.

Strength is something some of us wear like armor in crisis--to not do so means you will be eaten alive by the experience, and then you are no help to those whom you have committed to serving. Serving others in this way becomes something that becomes a part of you to the very marrow--rarely are you ever the same once you have been in the field and have dedicated your life to helping others. This is no foray into idealism; this is about looking into the very heart of darkness and coming out of it hoping hard your soul is indeed intact.

Now, with those going to Haiti to help in post-earthquake humanitarian humanitarian action, this will be something that is equally important, though I know will not be given enough coverage. It is right to report on the crisis itself and those who suffer it. The coverage has gone from offering positive assessments to depicting that akin to disaster porn. But amidst all of that, and without sensationalism and hardcore, cloying hyperbole, I would ask, let's also remember those who come home after serving.

There has been a topic of conversation which has come up lately among friends of mine, many of whom are in the trenches of certain world crises. There is understandable emphasis--when there is emphasis at all, or even research--on the psychological effects of populations in crisis, whether in terms of genocide, service as child soldiers, populations subjected to civil war and conflict, populations as victims of epidemics, populations during and after natural disasters, just to name a few. There absolutely should be extensive emphasis on this--the mental health of affected populations is often secondary in comparison with physical well-being. At refugee and IDP camps, for instance, in addition to doctors treating physical ailments, how many are there to affect the mental health of these populations--including children? How much that is being done is effective? How about populations which are still ensconced in areas of conflict or disaster--how much support is given in terms of their psychological states?

My mother was an art therapist--she was the art therapist for The Ohio State University Hospitals, and she was included on grand rounds, and in many cases, her assessments were used in diagnosis, as a person's art--the patterns, colors, subject matter--were often clues in difficult and sometimes harrowing cases as to diagnosing which disorder from which a patient might be suffering. These were often people who had undergone some of the most horrific experiences known in a non-conflict situation (meaning international or civil conflict)--or whose conditions, in the alternative, were biological, but the effects were just as debilitating. But I wanted to know what she would think in terms of international crisis or conflict. I remember asking her once, when I got back into international relations (having once been in International Security Policy, the Psychology of International Relations, and International Media Policy)--what she would say about some of the art I showed her from the kids in an IDP camp to whom doctors and aid workers had happened to hand paper and crayons--because even in crisis, kids need to be kids if at all possible. The pictures were horrific--and evoked more emotion in me than much had in some time. This was the expression of the truly vulnerable. Those who had, for the most part, no means of protecting themselves, and had often had to take on the role of an adult in many cases just to survive. My mother looked at it with a practitioner's eye after assessing it as a human being, and she said, rather bluntly, "These kids are suffering from intense PTSD [Post Traumatic Stress Disorder]."

What I wanted to say, in between trying like hell to not be shaken by the images--even though in context, they were to have been expected--was an instant, angry response of recognition. But then she looked at me, and she asked, very specifically, "How much treatment are they being given psychologically? Are there art therapists there? Are there psychologists? Is there anyone there letting them go through anything cathartically? Are they getting any kind of help at all other than physically?"

Good questions all. And this is something that I know there is currently research being done in terms of how much this is the case, and trying to advocate for just this kind of treatment. These are the future generations who are likely to repeat the cycle unless it is broken, and that doesn't just require a change in circumstances; this also requires a dedicated effort to help them to survive mentally and emotionally as well, give them greater coping mechanisms if at all possible, and address the long-term psychological effects of crisis. If crisis is all you have ever known, then, chances are, it will be ingrained enough to perpetuate. Humanity repeats patterns, because all to often, we do not learn how to break them. We do what we know.

But one thing I also want to address here is something else that is also not addressed often enough. It is the psychological effect of being in the trenches as a humanitarian aid worker, as a journalist, or in any other capacity in which you are deep in the heart of the situation itself, not among the affected populations as one of them, but being among them as the one to whom they are looking for help.

There have been various articles and studies done--not enough--about what happens when the practitioner comes home--and not nearly enough on how they deal with the situation when in the trenches. I have posted on the HMF site links to some of the ones I can find, as well as the ones post-crisis. But I think more needs to be done on both counts.

Any of us who has been a practitioner of one kind or another, in any kind of crisis, know the toll intimately. We are there to serve others--we know we will be doing so and take on that knowledge as well that we will never be the same in having done so. It is a life which is incomparable, and necessary for some, who cannot imagine themselves doing anything else, but it does come at a cost.

I have been in the field at different points--and also had an intense experience on the home front, in caring for my father when he became ill--but it was only afterward that I recognized some of the same signs of those of us who know, inherently, the reality of crisis situations and the kinds of pressures that come from living them 24/7. Anyone who has ever been a practitioner in crisis situations--including in the field--are familiar with those pressures and that life--with little rest, little ability to address any other aspects of life, and little time to think about anything else but the crisis to which you are currently responding. Those of us who take to that kind of work, no matter where it is in the world or under what circumstances, are known to be counted on in a crisis situation, because you learn to instantly and intensively focus on the situation at hand, wade through whatever important nuances which would influence the making of whatever decision, and hone in without any time wasted on what needs to be done, and the implementation of whatever action is necessary. To this day as a result (in the professional and not creative sphere) I have little patience for endless talking and endless ruminating--it wastes precious time when action can be taken and you can immediately go on to the next thing which needs to be done. It's not about taking action because it's a matter of accomplishment, but because you know that any moment, something can change--and can change critically--so that any wasted time which could have been used on action puts you further back. And, often, you do not have that opportunity to make up for lost time. It can put a situation in jeopardy. It can mean not acting fast enough on rapid-fire critical information. It's the operational equivalent of the adage that life is too short. You learn to be streamlined, efficient, assess things instantly regardless of the number of factors, and create instant priorities which are then executed. It becomes a matter of necessity when the stakes are truly high. Any other considerations are extraneous--even if they might be personally necessary on some level--including emotion. You put those off, perhaps, for the good of the project, for the good of the people involved, even if, perhaps, it is not good for your own well-being.

And this is the issue which comes home to roost, and in particular when you come home, as it were, from the trenches or in extended periods of time after a crisis has ceased, or when you have ceased to become involved. Those who have lived in a high-intensity, high-demand crisis situation for extended periods of time do not know what to do with themselves when they have extended time off--or when they come home. They are used to the day being filled 24/7--putting all emotion to the side except that which is necessary to do the job. Your own needs are secondary. Your own desires--except those that can be satisfied in moments when the opportunity presents itself--and you feel as though you're stealing time for a quick fix of any larger emotional response--which is at that moment impossible--are irrelevant, and therefore ones to be ignored out of necessity. It is counter-intuitive to those who know better--the old wisdom is how can you fill the cup of others if your own is empty. Even stealing time--and momentary fulfillment of desire, camaraderie, socializing--is a quick, necessary fix to let off steam--but there is no long-term sustaining it, because the situation doesn't allow for it. So you condition yourself on some level not to need it, and then have a blow-out during that intense, short, punctuated of time when you can let off steam. There will be plenty of time when you go home to become "normal" again and live a normal life--if that is even of any interest.

With past experience, and after taking care of my father, I used to joke with friends that I'm a hell of a lot better in a crisis--or in the trenches--than out of them. In those situations--everything seems a hell of a lot more clear. You know what needs to be done and you do it. The more ephemeral issues are secondary and are the fodder of reflection afterward, and indeed, that's the problem. It's intensive fodder, with intense emotion attached, when concerning returning from a crisis situation--that emotions that were subsumed suddenly reappear with a vengeance. Issues you never dealt with--that you perhaps should have--on a personal basis all of a sudden appear like a shadow in the mirror. Questions about what you should have done in certain situations instead of what you actually did rear their heads. I am wondering how familiar a sentiment that is. Crisis situations necessitate not thinking too much--there is no time to. You do what needs to be done. But in the aftermath, all of those questions have excruciating time to be pondered. Memories of past events come back which you shoved to the back of your mind, knowing they could not help you when you needed to be the responsible party. You know yourself to be human, but you feel as though you are responsible for not being to a certain extent--or else be vulnerable, and vulnerability in those situations are at best inconvenient and at worst--in harrowing moments--dangerous. People can spout off psychological tenets that vulnerability and weakness are not the same thing---but in the field, they have similar faces. The only vulnerability--in moments--you allow yourself is the recognition of the anger, passion, or inherent compassion that brought you there in the first place. You know better on the basis of intellectual understanding--but personally, emotionally, having put your feelings to the side for so long, there becomes a disconnect between what you know intellectually and what you allow yourself to feel. You can't afford to lose it...so you don't. You wait for that when you come home.

Those of us who have faced any kind of crisis response know the answer to that question about the difference between knowing something intellectually and knowing something emotionally. Like anyone who is not treated for PTSD after crisis or conflict--no matter where that may be in the world--no matter if it is even being a caregiver for an elderly parent which becomes--for years--a 24/7 experience, or a veteran home from war, among whom there are too many to count who continue to be forgotten...after learning to subsume emotion for the good of the situation--it will rear its head with a vengeance when you least expect it--in moments when you feel most vulnerable. You will question yourself, beat yourself to a pulp for not handling something as well as you damned well know you should, and start spinning amidst emotions that for even a moment, get out of control. After doing that so long, it becomes ingrained, and something, with time, you can re-train. But, for the next many years, it will reveal itself when you least want it to.

And here is where I wanted to give a friend of mine, whom I wrote to on Facebook some months ago, posting a status update so no one else would know whom I was addressing--and every other person experiencing this--encouragement. Those of us who have had to be strong in any number of unimaginable situations are used to being so. We're used to being responsible, accountable...a veritable rock on whom others can depend, always. We raise the torch aloft, smile, crack a wry joke, and walk forward, saying, "Follow me. I will keep you safe." But then when you come home, and there is silence, and the only thing to keep you company are your thoughts, it is then that the demons arise. It is then the vulnerability hits like a freight train, and it is then when you run the risk--if even for a while, of falling apart. The strongest human beings fall apart on occasion. We are all human. We may make an ass of ourselves--we may become so goddamned self-conscious we can't see straight because we can't believe we're being overwhelmed by emotion, and it is affecting that perceived strength. If people can't count on us, what the hell good are we? Better question still, who are we?

It was here that I became angry, and I decided to write this, for it was when my friend told me his girlfriend ran for the hills when he fell apart--he a doctor on the front lines, and one of the strongest, most powerful, and most extraordinary men I know--that I wanted to throw something across the room and smash it against a wall--an instant and powerful fury building. For someone who has spent the better part of his life putting his life in jeopardy to be there for others--he suffers a few days of not being "himself," not being the strong, good, powerful, warm, wry man he is, and his girlfriend flips out and castigates him for not being the man she knows. Of course, I leveled the usual wisdom--if she is going to run for the hills because you have a few off days, then she can go straight to hell. But still, as much as I believe that, I could feel a certain pang of profound recognition. When everyone is used to you being the strong shoulder--the rock--and all of a sudden you fall apart, you know who the real people of substance are. They are the ones who come to you--recognizing you're not yourself--and maybe a little worried, will still stand at your back and say, go through this if you need to. I'm here. Maybe I don't understand it completely, but we're all human. If you need a rock for once, instead of the other way around, I'm it, and I'm not going anywhere. You'll be okay in a moment. You just need to remember yourself. Don't worry...it will come.

All I can say for anyone--whether he or she is dealing with crisis in the trenches of Haiti, Sudan, PNG, Sri Lanka, or anywhere else in the world--or alternately, is dealing with a crisis in the home which has the same emotional hallmarks--to everyone else, have compassion, if you can. The person whom you love--or respect--or are involved with--would not be doing what they are, or have done, if he or she weren't extraordinary. Remember that, and know that we all deserve a moment to fall apart. Even those from whom you least expect it.

K.J. Wetherholt is a published author, Co-Founder and Board Chairman of The Humanitarian Media Foundation (HMF), executive editor of the upcoming international Media and Information Policy Journal (MIPJ), author of the upcoming book, Critical Nexus: Media, Information, and Humanitarian Crisis, and producer of HMF documentaries currently in development.