Tuesday, January 25, 2005

In NY There Must be 40 Words for Depression

Smartmom was intriqued by an article in Monday's New York Times about the mental health situation in Sri Lanka following the tsunami.

According to the Times, there wasn't even a word for depression in Sri Lanka until a few years ago. Not that they didn't need it. Doctors there say that people express their unhappiness by having pain, back aches, or difficulty sleeping. And by commiting suicide. Apparently, Sri Lanka has one of the hightest suicide rates in the world.

In New York there must be 40 words for depression. If not more.

Sri Lanka, with a population of 20 milliion people, has only about 30 psychiatrists. Very few of them speak the language of the Meulaboh region, which was badly hit. Needless to say, therapy is not a common activity in that part of the world. Unlike New York City, the Sri Lankans are not held together by the loving thread of trained therapists. Not to mention Zoloft.

There must be thousands of therapists in Brooklyn alone.

No, a stop at the shrink's office is not a weekly occurrence in Sri Lanka. How spoiled we are in New York City where the examination of one's navel is considered a necessity not a luxury. And yet, Smartmom believes that navel examination truly is a form of preventive health care. In so many ways, New Yorkers benefit from their weekly exploration of self. Without it, Lord help us: New York would be a whole lot more neurotic and/or psychotic than it already is.

Just imagine New York without therapy.

But in other parts of the world, there's just too much else to do -- like survival -- to have time for such things. Religious institutions probably do their part. Buddhist meditation is just one example of a spiritual practice that is, in its way, deeply psychological in nature.

The people of Sri Lanka are a stoic people with a strong belief in god's will, and a different (maybe better) relationship to death. Even in a crisis of this magnitude, they carry on. Call it denial, call it pragmatism, they are grieving quietly and privately while rebuilding their lives. What other option do they have?

And yet, grief and trauma can wreak havoc on people's lives. Experts have observed that " suicide rates drop in times of crisis but then bounce back up again - to higher levels than they were originally," writes Denise Grady in the New York Times.

Mental health experts the world have made offers of help. But the Sri Lankian government is asking them to stand back and respect the nature of the Sri Lankan culture. They believe that the deep religious beliefs of the Sri Lankans and their strong sense of community and family will help them through this tragedy. And, in most cases, they are probably right.

One Sri Lankan official quoted in the Times said that "too many irrelvant, inept, strange ideas from other countries could do disservice to tsunami victims." He was especially adamant that de-briefing, a technique where disaster victims are encouraged to talk about traumatic experiences after a disaster, would be especially harmful.

Smartmom is familiar with this argument. She has been working with the FDNY since December 2001 on a newsletter for the families of those who lost loved ones on September 11th. After the WTC disaster, firefighters were debriefed and urged to talk about the tragedy in great detail -- apparently it helped them a lot. They were also encouraged to partake of the free counseling services available 24 hours a day at the Counseling Service Unit.

After 9/11, many health care professional from around the world offered their services to the FDNY. Fairly quickly, the FDNY realized that mental health professionals without the proper understanding of the fire department culture could do more harm than good. Over time, the FDNY expanded its counseling staff in order to provide appropriate care for those who were suffering from various degrees of post-traumatic-stress and grief.

Firefighters are also a stoic lot with a strong sense of family and religious ties. For them, therapy helped them with the on-going grief and stress. At first it was hard to convince those who are used to helping others that they needed help. But many of them came around because they were suffering so much. And their recovery was fairly rapid once they went in for counseling. There's no telling how much alcoholism, drug addiction, spousal and child abuse, and suicide was avoided because of this.

So, Smartmom wonders how the Sri Lankans will fare emotionally. What of the parentless children, the parents who lost their little loved ones, those who saw whole communities die -- how will they get through this? Is it true that this community will be able to escape "post traumatic-stress" simply because of their cultural background?

There is no one-size fits all solution to recovery from tragedy. A person's mental health prior to the event, resilience and resourcefulness must all be taken into account. People are very unique in the ways that they heal; in how they like to take care of themselves.

Smartmom is grateful for her weekly trips to her therapist, her shamen, the man who helps her "see." Her problems are fairly minor compared to those of people in other parts of the world. But still, she believes in the value of self-examination way and is thankful that she has the option.

Everyone needs help from time to time.


At 4:27 AM, Blogger red eft said...

"In fact, when I first heard the word 'self-hatred' and was first exposed to the concept of self-hatred, I was quite surprised and taken aback. The reason why I found it quite unbelievable is that as practicing Buddhists, we are working very hard to overcome our self-centered attitude, and selfish thoughts and motives. So to think of the possibility of someone hating themselves, not cherishing oneself, was quite unbelievable. From the Buddhist point of view, self-hatred is very dangerous because even to be in a discouraged state of mind or depressed is seen as a kind of extreme. Because self-hatred is far more extreme than being in a depressed state, it is very, very dangerous."
-The Dalai Lama

The things some folks don't have words for, really makes you think. I like the way the Sri Lankan official put it--"irrelevant, inept, strange ideas..." It has the ring of truth. This is all very interesting, the ethnography of disaster relief and stress treatment.

New York without therapy. Hm. How about New York without bad therapists? I'd like to see New York without this list of things:

1. motorized vehicles
2. caffeine
3. wheat (I mean it)
4. dairy (naturally)
5. sugar (while we're at it)
6. weapons (might as well go for the gold utopia)
7. alcohol (should have been #2)

When did Sri Lanka's suicide rate become one of the highest in the world?

At 2:19 PM, Blogger Little Light said...

Very insightful - we can't force our own ways and means on others, but I have to say that Zoloft the wonderdrug should probably be offered a bit more outside of our little world. My opinion, of course.

I've been meaning to say that I really appreciated your post on Brad and Jennifer and marriage in general. It's comforting to know that there are real live people in contemporary times who mean what they say and are willing to do what needs to be done to keep their promises.

At 2:34 AM, Blogger Tom Naka said...

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