The disaster in Haiti once again brings up a question for relief workers: Are methods such as critical incident stress debriefing or similar forms of intervention appropriate? And, in fact, can they be harmful? I believe that telling the story is a necessary part of recovery. The question is really when and how to "apply the brakes."
The children and families in Haiti have been on my mind for more than a week now. Having worked for twenty-five years with children who have been abused, witnessed violence, or experienced disaster or terrorism, the aftermath of the Haitian earthquake has captured my interest just as it has many other mental health professionals. It's impossible to comprehend how many lives have been lost and how many more will be affected. This particular disaster haunts me with images of children whose limbs are being amputated, stories of newborns who may not survive, and the cries of hunger, desperation, and pain. And like many of my colleagues who work in disaster relief, I keep thinking and asking myself, if given the chance, what would I do to help?
While my fantasies of rescue mitigate my personal reactions, I agree with Susan Pinker in some respects when it comes to some mental health protocols for disaster debriefing. Sprinting to have survivors rehash painful experiences can be counterproductive during what is still a stage of emergency in this particular tragedy. In art therapy, I don't rush to have survivors "draw what happened" as the first line of intervention while they are in shock. I also admit I am not a fan of critical incident stress debriefing (CISD), but not for the same reasons that Pinker notes. While CISD may in fact exacerbate distress in survivors as some research indicates, it is not necessarily a steadfast rule that survivors should not discuss their feelings and experiences at an early stage.
In Haiti, there are many whose medical conditions and basic needs dictate a triage of water, food, medication, sanitation, and secure shelter. After all, Maslow's hierarchy is in play when it comes to what sustains human life at the basic level. But it is already apparent that there are those who want to share their stories of hunger, pain, loss, destruction, fear, frustration, and survival. Just talking is not, in and of itself, the cure; in fact, it may increase distress without other supports in place. On the other hand, humans are also a "storied" species by nature and story-telling is part of the process of reparation and emotional restoration.
How the body reacts to remembering a traumatic event is a critical aspect that must be addressed when a narrative emerges or is encouraged at any stage of intervention. Unfortunately, many incident debriefers do not know the simple principles of "putting on the brakes" when it comes to how the body reacts when recalling a distressing event. Therapist Babette Rothschild coined this phrase to describe the necessity of slowing down the body's reactions. She believes that it is not good practice to proceed with a trauma narrative unless both client and therapist first know how to find and apply these brakes. Otherwise, the counseling, therapy, or debriefing will destabilize the individual, whether adult or child, and bring on distressful physical sensations and reactions without resolution (for a brief introduction to this concept, please see "Safe Trauma Recovery" at http://www.youtube.com/watch?v=LhuzpUlaX_k).
In situations where mass trauma is present, as an expressive arts therapist I often recommend sensory interventions such as music, drumming, singing, chanting, or prayer as the first line of slowing down the body's reactions. 
Whatever the mode, an experience that involves soothing repetition, has familiarity, and connects survivors to each other will generally relax the sympathetic nervous system. For children, this may also include certain forms of drawing, constructing, and playing, even during the days immediately following disaster. This is the safety that Pinker reminds us is essential in the early stages of trauma intervention, the internalized sensation of connectedness and of self-efficacy.
Admittedly, the situation in Haiti will teach us a great deal about mental health intervention due to history of the region and the social context. Long-term relief will inevitably have to address the universal outcomes that come with mass trauma. There will also be challenges of poverty, homelessness, a nation of amputees, and systemic illnesses that will emerge during the months after the initial event. It all seems so overwhelming to this trauma worker. But taking care of the Haitian people's emotional needs is just as important as adequate housing and antiseptics. In my current wishful thinking, I hold a vision for this type of relief to come to the people of Haiti as soon as possible. Let's not forget to help the survivors find the psychological safety to tell their stories. In doing so, maybe we can restore some dignity and humanity, despite the overwhelming nature of this disaster and what will be a formidable road of reconstruction and reparation.
© 2010 Cathy Malchiodi, PhD, LPAT, LPCC
www.cathymalchiodi.com
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