Post-post-trauma

Much has been claimed about Filipinos being resilient, able to bounce back rapidly after personal and collective trauma, sometimes to the point of saying we don’t have serious problems with post-traumatic stress disorder or PTSD, where a person’s memory of traumatic incidents keeps coming back, causing all kinds of problems ranging from insomnia to thoughts of suicide.

I’ve always been ambivalent about the claims of resiliency.  On one hand, I’ve always felt PTSD does exist in the Philippines and is most probably greatly underestimated because many people don’t even recognize the problem.

On the other hand, as an anthropologist, I do recognize there may be elements in our culture that offer us an advantage in terms of coping mechanisms. Religion is one, offering some kind of explanation for a disaster—for example, that God is testing your faith (pagsusubok), or, as we saw recently when bishops and priests said a typhoon was punishment from God for advocating reproductive health. In the long run, some of these (ir)rationalizations can be counterproductive, but in the short term, they do allow people to cope.

Research from the United States suggests that what happens after a trauma is as important as the trauma itself in shaping the long-term consequences of an adverse event. The revisiting of PTSD came about during an Interdisciplinary Conference on Culture, Mind and Brain at the University of California in Los Angeles. One of my anthropology graduate students attended that conference and came back excited about how anthropologists were among the scientists deciphering the mysteries of the brain. When I asked her about the presentation on PTSD, she said she did remember it.

Familiarity…

The paper was based on two research projects. One project was directed by neurobiologist Paul Plotsky who, in the early 1990s, examined the effects of maternal separation in rats. I won’t go into details here but it seemed that even after the prolonged separation of the mothers and their pups (baby rats), there was no “post-traumatic stress syndrome” if they were separated, and then reunited, in familiar surroundings.

Even more intriguing was a project of Dr. Brandon Kohrt, a psychiatrist and medical anthropologist who followed 141 Nepalese child soldiers recruited by Maoist rebels when they were aged 5 to 14 years old, and returned to their villages after the insurgency ended in 2006. Kohrt reported that the former child soldiers’ mental health depended not so much on their exposure to war as on how the families and villages responded to their return. Those who were ostracized after they got back suffered symptoms of PTSD, while those who were welcomed back were not any different from their peers who had not gone to war.

All that seems commonsensical enough, but what does it mean for the Philippines, where poverty and natural disasters, plus scattered armed conflicts, make us so terribly vulnerable to PTSD?

…And support

The animal experiments suggest that a familiar environment is important to reduce, if not eliminate, PTSD. In terms of disaster rehabilitation, that means a return to people’s homes as soon as possible after a disaster, even if the homes have been destroyed. And if people can’t return yet to their homes, evacuation centers need to provide some familiarity.

The study on the Nepalese child soldiers underscores the need for supportive social networks. It’s interesting that the study mentions the use of rituals to reintegrate the children. We’re good at that in the Philippines, with  despedidas  to send off people and  bienvenidas  to welcome them back home.

It would be unethical to conduct experiments to see what works and what doesn’t, but the Philippines, with our year-round exposure to all kinds of disasters, allows psychologists and social scientists a chance to document what our resiliency and coping mean in terms of social networks and rituals.

I’m thinking not just of typhoons and earthquakes and volcanic eruptions but also of the day-to-day traumas we face—for example, a death in a family. Our prolonged 24/7 wakes seem excessive; these are held supposedly to keep the dead company but function more to create a sense of normalcy for the bereaved family and friends through the eating and storytelling, and even karaoke sessions.

I should warn against thinking that our culture has built-in solutions that all work to alleviate trauma. Culture can be a source of stress as well, and we can go right back to our prolonged wakes as an example. The wakes can be comforting if done properly, but can also add to the stress of family members as they’re made to repeatedly recount the circumstances around the death, and also to entertain the never-ending stream of visitors.

We also have to be careful in assuming alleged social solidarity and support in times of disaster. I’m thinking of that recent fire in San Juan City where residents beat a man to death simply because they suspected that he was responsible for the conflagration. In times of disaster, people’s levels of mistrust of each other rise quickly, fed by rumors and gossip and amplified when people move into evacuation centers, with the overcrowding and lack of resources. We need to look into how the evacuation centers can mobilize a more caring side of people and get them to work together. Again, rituals will be important, some of them religious. But other, more secular forms can be used, maybe even collective mourning for the lost community, but accompanied by a declaration of solidarity and of hope for rebuilding and reconstruction.

The research on PTSD also suggests that some people are more vulnerable than others because of genetics—meaning some people have more problems adjusting than others. Then there are demographic variables: sex (we don’t really know yet for the Philippines, but I suspect women may actually be more resilient than men) and age (older people being most vulnerable). The kind of disaster or trauma is also important: Children may be more resilient when it comes to natural disasters, but more vulnerable when it comes to seeing violence, or even gunfire. In some areas of the Philippines marked by civil conflict, mothers actually threaten their misbehaving children by invoking soldiers or rebels.

Understanding differences in vulnerabilities means we can be in a better position to plan out the social support. We presume only adults are involved in social support and forget that children, who are often the most resilient, can also be mobilized to comfort the elders and provide strength for parents to look for ways to rebuild their homes, and their lives.

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