"White Cloth" - Nearly two years after the Tsunami of 2004

It's hard to imagine that we are coming on almost two years since we were traveling around Asia during the time of the Great tsunami of 2004. It was an interesting experience to say the least. Fortunately we were not directly in the tsunami's path. But the devastation was on all the local news networks thought-out Australia and Southeast Asia. Of course we were asked if we were going to volunteer to help. Many people were offering their services. In reality, what could we really do? What could social workers past middle age actually do to help? If I were 20 years younger and more than a recreational scuba diver I suppose I could have joined the rescue operation or the search for bodies. But my fear was that we would only be in the way.

But what about the mental health needs some asked. Surely there will be many people who suffer devastating trauma at the loss of loved ones. Will that not lead to all kinds of mental illness? Skilled therapists could be in the right place at the right time to be helpful. Perhaps. It did get me thinking about the mental health needs in catastrophic events like the this and related situations. Katrina comes to mind.

The Tsunami of 2004 was already estimated to have 100,000 dead and possibly as many who died of disease related to the tragedy. Many survivors have lost whole families- spouses, parents, and children. Some are the last of their gene pool. Many lost their livelihood and their ability to earn a meager living for some time. Countless individuals were barely subsisting at above poverty as it was. So what can one expect in terms of mental health problems?

Well it depends on whom you ask. Many psychotherapists in the west might predict that the mental health problems of tsunami survivors will be astronomical. A major mistake made by even seasoned therapist is to equate the seriousness or magnitude of the horrific event with the gravity of the mental health problems of survivors. To some mental health professionals the more horrific the event the more serious the symptoms and the more prevalent the mental health problems.

For example after the 911 Terrorist Attacks in New York City and Washington DC, therapists were predicting greatly increased numbers of PTSD and a host of mental health problems among the American people. Not just with survivors and family members, but with the general public as well. If you believed some of these therapists of doom, Al Quada had won the war. It was only a matter of time before we all would come down with PTSD. These predictions did not prove to be correct. Of course there were some who were immediately effected, but not all. It is understandable in a way. Therapists dedicate their lives to helping others. So for some it is difficult to imagine that people may not want or need their help. In my experience one of the most difficult things for a therapist to accept is that there are people who do not need them. Whether we are aware of it or not, predicting a higher need of our services than actually exists can actually artificially create demand.

Back to the tsunami.

Researcher for the World Health Organization who spent time at the tsunami sites reported, "These are normal people experiencing a highly abnormal event," said Dr. Shekhar Saxena, a mental health researcher for the World Health Organization, in an interview in Colombo, the capital of Sri Lanka. Soon after a catastrophe, 30 percent to 50 percent of survivors will suffer for a short time from acute emotional problems like anxiety, depression, vague aches and pains and other ill-defined symptoms of stress, Dr. Saxena said. But about 90 percent will recover.

90% will recover! It is normal to experience some of these symptoms after such an event and if I understand Dr. Saxena correctly, most survivors will recover without any intervention from mental health workers, therapists, trauma counselors and debriefers. In short there is a limited role for mental health service in such situations. We are at best back up and support personnel not or rarely first responders. That is not to say there is no role but only perhaps 5 or 10 percent may need professional heap at all.

10% is still a lot to people who may need professional help. But what kind of help do they need? That is the question. Let us for the moment assume that language barriers can be surmounted either by therapists fluent in the language or through interpreters. What is the best form of therapy?

Would the traditional forms of psychotherapy have any utility in such a situation? Despite claims made by some therapists that their theories and interventions are universal that is highly doubtful. Would grief counseling as it is marketed in the US work? Debriefing? Sadly despite the fact that such notions fly in the face of research as well as observations there are therapists who would simply try to import their western techniques and think they would have validity in another part of the world.

What is needed is not so much mental health services but basic health services from water food, medicine etc. Before one can even think of mental health basic health levels must be established And white cloth, lots of it.

White Cloth! Why white cloth?

I interviewed a fellow who has been aid worker in South East Asia for years. The Tsunami of 2004 make have taken over 100,000 lives, but in this part of the world that many people die of malaria and related diseases every year. And the rest of hardly notice.

He said often they would go into communities that have suffered one disaster or another and assess the needs. And most often they needed everything from clean water, food shelter. You name it. However when they asked the people what they wanted almost in variably he said, they asked for white cloth.

Why white cloth? Well they are not looking to make slips from white cloth, Freudian or otherwise.

What possibly could be the importance of white cloth? I had to wonder of all the interpretations and hidden unconscious meanings some therapist would make of the white cloth. Some would be letting their unconscious run wild and free associating and trying to figure out the meaning of white cloth. The possibilities are endless of course and many sessions could be spent interpreting the meaning. To some it would be inconceivable that white cloth was what they wanted above all their many other needs. They would insist that the white cloth is a symbol for something else.

It is not all that complicated however. It seems white cloth is what is used to wrap the dead for burial. To give a proper burial to their lost loved ones meant more than just about anything else.

But that got me to thinking. How many therapists in the US or in western countries for that matter trained in all our fancy techniques and theories would recognize the importance of the white cloth for what it is? There are quite a few who are so weeded to their particular theories that they would simple see the request for white cloth as the presenting problem and search for some deep unconscious meaning which they would call the real problem. If you read some of their writings they say as much.

How many would attempt to take such clients through the stages of death and dying that were made popular by Elizabeth Kubbler-Ross? This is despite the fact that research has shown that most people do not experience these stages. Yet some therapists are wedded to them anyway.

As I think about it, the concept of the white cloth has meaning for people seeing therapy under many types of circumstances. I think about all the people who may see a psychotherapist for any number of reasons in the US. Therapists of course make a professional assessment of their situation, symptoms needs etc. Yet how many therapists truly pay attention to what the consumer says they want? Often what the client wants gets dismissed as unimportant or put on the back burner to be replaced with what the therapist thinks they need.

Some do of course actually listen to their clients and treat them as consumers, but a surprising number do not. Many therapists think their theories and training make them somehow superior to their patients.

Those therapists are the ones who will do far more harm than good. That to me is part of the lesson of the white cloth and the tsunami survivors. People are quite resilient and need very little help from professionals. Sometimes all they really need from us is something as simple as a meter of white cloth and they can do the rest themselves.

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