By Robert Grant Ph.D.
Introduction
Spiritual Care Professionals (SCP’s) are being asked more and more to provide support and care to victims of mass disasters. 9/11, the recent tsunami in South East Asia and Hurricane Katrina are three relatively current examples in which SCP’s have played an important role in national and international relief efforts.
This is new and uncharted territory for SC’s. Settings familiar to SPC personnel (e.g., office, hospital or parish), along with working with a relatively homogenous clientele (i.e. sharing the same faith-based commitment) will most likely not be available when working in a large scale disaster. The ability to help, coupled with what can be learned in such settings, hopefully will balance out the physical, emotional and spiritual challenges that one will inevitably face.
This article provides an introduction to a highly complex and evolving body of knowledge that is starting to emerge from the anecdotes and research of medical, anthropological, spiritual and psychological professionals working in large scale disasters. Having a few essentials at one’s disposal should enable the SCP to enter and progressively move forward in such milieus.
On Site Essentials
Self Care
Providing spiritual care on site in a large scale disaster is something that few are prepared for. Training to deal with enormous suffering and devastation is quite difficult. Every care provider needs to know how to take care of him/herself as well as not become desensitized to the point of sustaining personal damage and, therefore, being unable to offer help to anyone else. When the latter occurs the SCP has become a victim of the disaster and is in need of care. Knowing how to effectively utilize self-care protocols is, therefore, essential when working in the context of a mass disaster.
The matter of self care is paramount if one is to remain effective in environments of devastation, especially as one moves closer and closer to “ground zero” and/or enters immediately after a disaster (i.e., while the scene is still chaotic and the devastation raw).
Being Part of a Team
Ideally one should be a part of a team that sets up several perimeters and does not send every team member to “ground zero” (i.e., where one can easily become overwhelmed and thus shut down. Once one emotionally closes down and/or dissociates then s/he has been traumatize (i.e., his/her protective barriers/defenses have been breeched). If this is the case then the SCP needs to step out and receive some type of psychological/spiritual debriefing if s/he is to remain effective and not incur further damage. At the end of each day team members need to meet and go through a process of pastoral reflection (talk together how their values and beliefs are being challenged by the day’s events).
Setting up a Perimeter
It is best to have a Command Center where members are tiered into three different zones, i.e., Zone 1 (“ground zero”), Zone 2 (slightly off the perimeter of “ground zero” and Zone 3 (the Command Center). In this way team members can rotate into and out of the various zones with the intention of not letting anyone down load too much toxicity and/or become too depleted (i.e., physically, psychological and/or spiritually). Professionals can work in shifts in the various zones while utilizing detoxing and self care protocols on their off time.
Much of the above depends upon whether international relief agencies have arrived on the scene and disaster victims are receiving the basic essentials (i.e., food, water, clothing and shelter). When the aforementioned essentials are in place the SCP can work in more traditional ways. Otherwise attention should be on getting victims food, water, clothing and medical care, as well as to a safe place where they can find out about and/or connect with their loved ones. If these basics are not in place then the SCP should do his/her best to provide whatever is available to those most in need.
Initial and Primacy Needs of Victims
Disaster survivors initially need to be protected and helped to find a safe haven (i.e., free of predators and risk factors) that can allow them to access shelter, food and liquids, sanitation, privacy, and a chance to sit quietly, relax, and sleep (at least briefly). In such a space they can begin to work on immediate personal and family concerns` that will help them regain a sense of hope and purpose. At this time it is also important to dispel rumors, mobilize and strengthen social networks and encourage the use of natural support systems.
Once the aforementioned are in place many will feel a need to talk about their experience, i.e., to "tell their story" in order to ventilate, release stress and feel connected to a caring human being. This may occur geographically close to the scene of devastation or somewhere at a distance.
Many also need help identifying key resources such as those that are available from the Red Cross, Salvation Army, FEMA and various health departments (i.e., local, state and federal) that are involved in the aid and clean-up effort. They can also supply information about health issues, housing, and basic emergency services. When overseas the link will need to be made with local agencies, along with the International Red Cross, Catholic Relief Services, World Vision and various agencies associated with the United Nations.
All the while SCP’s need to be sensitive to the vulnerability, fear and psychospiritual needs of the disaster victims. Soon after such a tragedy, when chaos and disarray are still in play, many will feel very uncertain about their future either due to a lack of information (i.e., in terms of how bad things actually are and/or not knowing about the full extent of their injuries and losses). In regard to the former, what takes precedence is often to put things in order before one dies or loses consciousness.
This may mean having someone write and get a letter to loved one and/or make sure that an important object, such as a cross or amulet, gets to their loved one. It may also mean performing an important ritual, such as making a confession, receiving the last rites (even if the SCP is not an ordained minister or a member of the victim’s faith tradition). Many will ask for such favors. This type of spiritual care is enormously important to a wide range of victims, as is having a SCP say a prayer over a sick and/or recently deceased loved one.
Others times the SCP may be asked to just listen to a terrified and grief stricken individual as s/he tries to process a mélange of thoughts and feelings in an attempt ventilate and/or comprehend the enormity of what has transpired.
Sadly, in large scale disaster the SCP may encounter so many injured and dying that s/he will have to prioritize who gets his/her attention and care. This is something that may haunt the SCP later but it can not be helped. Most likely such experiences will need to be processed in private and in the daily pastoral reflection group.
As things begin to calm down and/or time passes the number of dead and living will be clarified. Things may get easier or harder at this point depending on a multitude of factors. Most likely no one on site will have a coordinated game plan (i.e., in terms of integrating the skills and services of everybody on site). Therefore the SCP will have to continually adlib in regard to the needs of people. S/he will continually have to ask what are the victim’s priorities (i.e., returning home, finding food/shelter, mourning the loss of a family member and/or making peace with God and the dead. Losing important possessions, one’s home, a neighborhood or an entire community, along with one’s financial assets are additional concerns.
Off Site
As things begin to get cleaned up and basic needs are relatively met certain realities and the profound questions they generate begin to emerge (e.g., how to live without a husband, wife, children, home or resources)? Others will raise matters related to religion, God-images and even whether they can on or not.
Many will question where was their God when they asked for help? Their questions and concerns will vary greatly depending on which religion they are affiliated with. Some will wonder if they are being punished for a previous sin or indiscretion. Karmically, they may ask if they or their ancestors did something bad in a past life. Shamamistically, many will look to the spirit world in order to determine who has been offended (i.e., an ancestor) or possessed their soul (e.g., an animal spirit).
These kinds of questions place SCP’s in more familiar territory despite cultural and religious differences. The key is for every SCP is to actively listen and try to understand the other’s world view (i.e., see things through the eyes of the other). This may be difficult without the benefit of an onsite cultural broker.
The entire business of spiritual care in these types of settings will typically be “out of the box” (i.e., outside the familiar frameworks of the SCP). Middle class and book based responses will typically not meet the needs of disaster victims.
There may also be racial, religious and colonial concerns (i.e., on the part of victims) to keep in mind regarding the approaches and ethnicities of the relief, government and SCP personnel (i.e., involved in the cleanup).
SCP’s will also encounter culturally affirmed ways of holding distress, pain and trauma that are unfamiliar to SCP’s coming in from the outside. Buddhists are typically taught to endure and bear suffering with equanimity. This coupled with the fact that many Buddhist cultures do not encourage the verbalization of distress to anyone. At the same time, in the wake of a mass disaster, such social guidelines are often temporarily suspended (i.e., due to the enormity of the suffering and the scarcity of available resources). Regardless the SCP will be challenged to be culturally sensitive and often non-verbal or ritualistic in the way in which s/he approaches a host of important issues.
Culturally-specific issues will also most likely arise. For example, a woman who has lost her children and husband in a disaster may be struggling, not only with a loss of her culturally-defined identity (i.e., as mother and wife) but also with the fact that she may wonder if her relatives (i.e., especially her husband’s) will continue to accept her as a member of the family.
Disinterred graves, a result of the recent tsunami, disturbed the spirits of many dead. Many were concerned that these displaced spirits were roaming aimlessly through the countryside causing wide spread fear and anxiety amongst the Hindu population.
Language and communication difficulties, especially when using an interpreter, must also be given careful consideration.
Finally collaborating with other agencies and professionals is essential. The SCP may also need to provide pastoral care to the professional community on site as well as figure out how to properly insert him/herself into a coordinated care delivery plan that involves several different professions and agencies.
Traumatic Grief
Having a loved one die through traumatic circumstances often generates a constellation of trauma and stress related symptoms, in addition to yearning, pinning and feelings that a part of one’s self has died, e.g., “I died with him.”
Psychological Reactions
Depression, substance abuse, generalized anxiety disorders, and adjustment disorders are common reactions to large scale disasters, as are organic mental disorders (i.e., secondary to head trauma), toxic exposure, various illnesses, dehydration, family violence and chronic stress. All of the above can be exacerbated by a continued apprehension of future risk. Post Traumatic Stress reactions may also emerge immediately and/or take months before they show themselves.
Confronting the Indifference of Nature and/or Humanity
Many feel shattered by the impact of a human-generated and/or natural disaster. The unleashing of such overwhelming forces makes many feel as if they have been reduced to the status of a thing or object (i.e., without a personal history, recognition of their responsibility to loved ones and/or their life-long dreams).
The Occidental World is short on theologies that can address the spiritual impact of such events. The most seriously injured (i.e., on a psychological and spiritual level) are usually left to struggle on their own with a host of problems that follow in the wake of a mass disaster. Issues related to suffering, personal vulnerability, a loss of meaning and will to live, along with invalidated images of God demand considerable attention.
Many need a great deal of accompaniment when trying to integrate the implications of their traumatic experience into wider frames of reference. It is essential that SCP’s avoid offering simplistic solutions to problems that refuse to fit into nice and clean packages. It is the struggle to take on more of reality than was previously possible that is often the most important need of disaster victims. In essence, their world will never be the same and, therefore they will not be at peace until they can integrate the meaning of what has happened to them into more comprehensive understandings of self, other, God and reality.
Therefore, the SCP will be spending a great deal of time outside the boundaries of mainstream awareness in an attempt to deal with the boundary phenomenon and questions that trauma victims will be raising. The SCP must adopt a humble position when accompanying one or many who have lost their former holds on reality and who are thus trying to traverse uncharted territory in search of a new relationships to God and life.
Suggested Readings
Figley, C. (Ed.) Trauma and Its Wake V.1-4. The Study and Treatment of Post Traumatic Stress Disorder. Bruner Mazel: 1985, 86, 96, 2000
Grant, Robert Healing The Soul of the Church (Ministers Facing Their Childhood Abuse and Trauma) 1995
The Way of the Wound (A Spirituality of Trauma and Transformation) 1997
Living and Working in Environments of Violence and Trauma (A Resource Manual for Humanitarian Workers) 2000
A Comprehensive Approach to the Diagnosis and Treatment of Trauma (A Working Manual for Therapists, Physicians and Pastoral Counselors) 2001
A Healing Response to Terrorism (A Handbook for Administrators, Educators, Mental Health and Spiritual Care Professionals). 2002
Vicarious Trauma (A Handbook for Professionals Working with Victims of Trauma) 2006
The Challenge of Forgiveness (As Faced by Victims of Trauma and Abuse) (a work in progress)
Herman, J. Trauma and Recovery. Basic Books. N.Y. 1 992
Horowitz, M. Stress Response Syndromes. Jason Aronson. New York: 1976
Kalsched, Donald. The Inner World of Trauma (Archetypal Defenses of
the Personal Spirit). Routledge, N.Y.,1996
Van der Kolk, B. Psychological Trauma. American Psychiatric Press. Washington D.C.: 1987
Information on self care protocols can be found in Vicarious Trauma (A Handbook for Professionals Working with Victims of Trauma) (Grant, 2006) and A Healing Response to Terrorism (A Handbook for Psychological and Spiritual First Responder)(Grant, 2002
Refer to pages 53-56 in Vicarious Trauma (A Handbook for Professionals Working with Victims of Trauma) (Grant, 2006)
The command center for SCP’s should be set up near the Command Center for all the relief and government agencies involved in the relief effort. In this way the team of SCP’s will have ready access to the most recent and accurate information (i.e., intelligence) flowing in and out of the disaster scene.
Sometimes a bottle of water, a blanket (to a cold and shivering and/or is immodestly exposed victim) is exactly what is needed in that moment.
I typically carry a small spiral bound notebook in my pocket in order to write down many of the requests, names and addresses of family members, as well as a physical description of what the concerned parties look like. I also bring something that I can place on their arm that will not fall or wash off in order to mark them as someone that I have talked to and need to get back to.
These factors are 1) number of dead, living and injured and 2) how many have been permanently displaced (i.e., due to complete destruction of their homes and community, as well as whether racial, religious and ethnic tensions are being played out between government workers and victims).
A cultural broker is someone who is familiar with the culture and religious beliefs of the populations on site. Most often these individuals are members of this same culture.
Much of this linking and coordinating must be done on site – typically because most cultures are not set up to respond to large scale disasters. This also includes the United States.
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