One of the best papers presented last November during the annual convention of the Pambansang Samahan ng Sikolohiyang Pilipino (National Association of Filipino Psychology) or PSSP was by Lyra Verzosa, who spoke on the applications of psychology during disaster rehabilitation.
I made it a point to listen to Verzosa and bring along my students from a graduate class, because I had read her contribution to an anthology, entitled “Ginhawa: Well-being in the Aftermath of Disasters,” edited by psychiatrist Dr. Lourdes Ladrido-Ignacio.
I will get back to the book shortly but I wanted to start by bringing out Verzosa’s main lecture points at the convention. She mentioned the low level of public awareness among Filipinos about the need for psychological rehabilitation after a disaster. Psychologists and psychiatrists, on the other hand, also often lack the skills needed to deal with the rehabilitation needs, including an understanding of the Filipino psyche and how it is affected by disasters.
There is in fact a language gap between the counselors and people needing psychological counseling. This language gap is very much class-based, with psychologists (and even more so, psychiatrists) often coming from the upper classes, more comfortable in English than local languages, and trained mainly around American psychological concepts. Dramatizing this gap, Verzosa distributed flyers they produced in Filipino to talk about what households and communities can do after a disaster, pointing out that so many of the materials that are given out are in English, and make no sense to the average Filipino.
Post-traumatic stress syndrome
I thought about post-traumatic stress syndrome, which affects people after all kinds of exposure to trauma: soldiers who have seen the carnage of the battlefield, as well as those who have seen the full force of nature as it kills and maims people.
For the psychologist, the definitions of post-traumatic stress syndrome are drawn mainly from the work of Westerners. For the average Filipino, the term is alien. And as a nation, we tend to be in denial, fond of claiming that we are a resilient people, always smiling even under the most adverse of circumstances. Few people realize the smiles often camouflage extreme distress which is kept suppressed, ready to boil over any time.
“Ginhawa” gives many more insights into the needs around psychosocial rehabilitation after disasters, made even more urgent in the aftermath of the destruction after Tropical Storm “Sendong.” We think mainly of relief goods during the disasters but forget people need nurturing and healing that cannot come from food and medicines.
Verzosa’s contribution to the volume elaborates on the word “ginhawa” as a more powerful concept than “well-being” or “wellness” with its integration of the physical, social, emotional and spiritual. The term resonated for me as a medical anthropologist since our work is to highlight the cultural context of health and illness. The work around ginhawa goes back to historian and ethnologist Dr. Zeus Salazar, who first wrote many years ago about how it relates to our notions of hininga, which isn’t just physical but carries notions of inner energy and the spirit.
Verzosa took up these concepts to write about how disasters and catastrophes affect our ginhawa by reducing our hininga. Thus, our distress is described by words like “paghahabol-hininga” (literally a chasing after the breath), naghihingalo (panting for breath), buntong-hininga (sighing), kapos sa hininga (running out of breath), all possibly ending with huling hininga (last breath). Our psychologists and psychiatrists need to see how these words, when used by disaster survivors, might be signs or symptoms of possible post-traumatic stress syndrome or other psychological problems.
At the same time, our local terms need to be tapped for rehabilitation. Verzosa writes about how ginhawa, now defined as a breath of life, can be used to remind people that there is life, even after the worst of disasters. The rest of the book brings in a wealth of information about how this might be achieved at different levels, as well as phases after a disaster, aptly described as a transformation process.
Looking at the background information on the authors, I realized that most of them are psychiatrists (Lourdes Ignacio, Felicitas Artiaga-Soriano, Norieta Calma-Balderrama, Cynthia Ramos-Leynes and Angela Halili-Jao) with Verzosa as the only psychologist (actually a chemical engineer turned psychologist). What is impressive is the representation from people involved in social work and community development, including Juliet Bucoy, Jorge Ebay, Nicanor Perlas (alternative development), Rose Olympia-Bautista (organizational development).
The community perspective is strong throughout the book, highlighting the need in Philippine settings to tap into the communities, and to borrow from social workers’ techniques of social analysis and evaluating needs. There is a whole section emphasizing the need to address structural aspects of disasters, mainly social neglect and environmental degradation.
A section on vulnerable populations deals with children, people with disabilities and “responders,” the last group being particularly neglected. These are the rescue teams and people bringing in relief goods and services, who are always in danger of burning out, overwhelmed by the needs and suffering they see.
Stages of grief
The mixed content of the book, with contributions from various disciplines, makes it valuable because it offers something for everyone, whether one is totally new to the field or already has trained in psychology or psychiatry.
To give one personal example, before reading the book I was familiar with the Kubler-Ross model of dying, now popularized as the classic five stages of grief (or loss), used to describe patients with terminal illnesses as well as their loved ones: denial, anger, bargaining, depression and acceptance. The model is now used as well to apply to disasters, but needs refinement in different cultural settings. Reading “Ginhawa” helped me to realize, too, that the Kubler-Ross model is very much based on the individual, while in the Philippines, we go through all these stages as families or communities, sometimes with unexpected outcomes. For example, the constant cheering up and smiling may in fact prolong the denial and lead to more problems.
With so many natural disasters hitting us each year, and with many more to come because of climate change and our abuse of the environment, we need to document the many efforts in relation to psychosocial rehabilitation. I am thinking, for example, of Dr. Ma. Lourdes Carandang’s work, and books, with emphasis on children. I would like to see documentation of the work with the elderly, who go through so much more grief and trauma, not just because of their physical vulnerability but also because those who survive disasters will be thinking, “I’m old, I should have died rather than my children and grandchildren.” Being left behind, alone, old, depleted of hininga, will require much more rehabilitation.
Do read “Ginhawa.” We have copies for sale at the Social Science and Philosophy Research Foundation (426-3801) in UP Diliman and at the Philippine Psychiatrists Association. I am told an e-book version will soon be available.
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