On the night before his inauguration, Haitian president-elect Michel Martelly came to the Hotel Karibe, where our US team and our Haitian program director Linda Metayer were staying. He sat outdoors among us as the band began to play. There were watchful bodyguards, but also a feeling of welcome, of fraternity.
The people I spoke with were happy, excited; not just the tent-camp organizers who had always been solidly behind “Sweet Micky”, the popular singer, as President Martelly was known, but also wealthy people and the intelligentsia. There had been a shift in the weeks since the election, a sense of possibility that, freed from narrow, self-serving needs—he’d already had plenty of fame, adulation, and devotion, and had made plenty of money—he might really mean what he’d said: about rebuilding the infrastructure and making, for the first time, education available to all.
It felt important to talk to him, to tell him how hopeful we were as well as what we were doing. And so, Linda and I arrived at his table. She explained in Creole—the people’s language here in Haiti—about the Center’s work and our hopes for establishing a National Program of Self-Care and Mutual Help. “Thank you,” he said to us in English, “for everything you are doing for Haiti.” He gave us names and contact information for key advisors and the next Minister of Health, embraced us with a kind of warmth and ease that is rare in politicians.
In the background, the guitarist, Belo, was joined by backup singers and other musicians—two, three, five, ten of them. The music, a kind of joyful Haitian reggae, had us smiling and dancing. I wish you all could’ve been there. The president stayed at his table for awhile, happily greeting supporters, many of whom had returned from the Haitian diaspora, enjoying his evening and everyone’s music.
I’m not quite sure when or even how it happened but Haiti is starting to feel like home. Not in the sense that I have my family with me, or know where to do grocery shopping, or can lay my hands on the books I love most.
It’s something else, an ease with people, a sense of words and actions contributing to something really good – right now and for the future — a welcome, even an embrace that keeps expanding. It swells from the team around me, and from the 120 people — doctors, psychologists, nurses, midwives, teachers, priests and nuns and voudoun healers — who come to our training with great fidelity and teach the techniques they are learning from us to friends, family, and patients as soon as it is humanly possible. “In order to keep the training inside me always, I have to share it with others,” one young teacher announced this morning.
In the days after Yehlie’s first communion we complete the training we began in December. My ‘small group’ of participants, gathered together again, begins as always with a few minutes of soft belly meditation – slow deep breathing, in through the nose, out through the mouth, with the belly soft and relaxed — quieting our nervous systems, our minds and bodies. And then we “check in”, tell each other what has happened since we last saw each other and share what we are feeling “right now.” Already it is becoming a commonplace for us, a way to regularly connect with those around us, outside as well as within the training. “Check in,” laughs one priest, “is almost now a second religion.”
There are still major problems and issues – almost half of our group is still not living in their homes, and there is abiding sadness for those who have died, but there is more energy for understanding and meeting current challenges.
We discuss the short term memory loss that bedevils several people and makes them apprehensive, even in their thirties or forties, about Alzheimer’s disease. I say it is highly unlikely, that trauma has long been known to obscure memory. And one of the other doctors in the group assures us that her memory – devastated amidst the loss of her brother and her husband — has begun slowly to return: “Sharing my emotions, accepting help from others, permitting my own tears – it as if the memory flows back with them.”
This doctor’s face is no longer constricted in pain as on our last visit, but open, changeable, easy with laughter as well as tears. Many of the faces I see are equally changed. James, who is head of psychology for the National Police, scrupulously kind, but painfully thin and equally serious in December, is ten pounds heavier, relaxed, expansive. And the woman I think of as “the Teacher,” as immobile and expressionless as mahogany in devastated grief at the loss of husband and home two months ago, is now a river of feeling and words.
One participant says, “The earthquake brought us so much pain, but also we are seeing it brings good things to the people who survive. Psychology [i.e. traditional therapy] was useless to me and my community – no one could go because it meant you were crazy. Now with CMBM approach I am helping myself and others too.”
Says another, “On January 12th, the anniversary, when everyone in my church was so tense, I taught them the breathing. And as I relaxed I let myself cry, and found my strength, and then we cried together, my children and my friends. And then I sang a song – I have never led a song any time – and I asked everyone to sing with me and praise god. And we did, three songs, and then we all felt more calm.”
It is so encouraging to see the positive changes in our trainees, and to hear that our participants are taking the techniques back to their homes, churches, workplaces. Giving the people of Haiti practical tools for their own emotional healing, and empowering them to teach these tools to everyone they meet, will, we hope, help the Haitian people heal themselves.
On the anniversary of their earthquake, Haitian men, women, and children are more likely to tremble anew with fear and contend with reawakened physical, emotional and behavioral symptoms. Chronic headaches and stomachaches that had subsided over months are now returning with renewed force in those living in their own homes as well as in the more than a million demoralized tent dwellers. Sleep, increasingly restless, is more often riven with nightmares of family members buried in the rubble. Children whose beds were dry are once again wetting them. The free-floating anger that had ebbed in many is rising, increasingly visible in family quarrels, child abuse, and street conflicts.
These phenomena, occurring at the same time as the original trauma, a year later (or indeed 5 or 10 years later) are called “anniversary reactions”. They were observed by Freud in 1895 and have been the subject of case reports ever since.
Sometimes a quite conscious understanding and anticipatory dread of the anniversary appear to set the stage: Winston Churchill dying at the same age, and on the exact same day as his father; Elvis Presley, who had announced that “my life is ended,” after his mother died at 42 in August 1958, himself dying early in August 1977, also at 42.
Often, however, the person suffering the anniversary reaction seems to be unaware of the connection. There is ample documentation of people who are surprised to learn that their unexpected anxiety attacks, nightmares, blood clotting disorders, chest pain, or heart attacks have occurred a day or two before the date a family member had died.
Some investigators have hypothesized that ”incomplete mourning” makes one more vulnerable to anniversary reactions, but it’s hard to say, especially in a situation of catastrophic loss and ongoing horrific hardship, like Haiti’s, what ‘complete mourning’ might be. Others see the reactions primarily as conditioned responses triggered by preparation for a memorial, for example, or an awareness of the coming of the season of loss, producing a variety of psychophysiological reactions.
Whatever the mechanisms, it is clear that these anniversary reactions take place on a population wide as well as an individual level. Many New Yorkers report a growing apprehension on clear days in early September that precede each 9/11, and since Hurricane Katrina, New Orleanians’ level of distress increases precipitously each August . Scientific observations confirm these reports. A study of Gulf War veterans published in the American Journal of Psychiatry in 1999 revealed a significant increase in symptoms of posttraumatic stress disorder (agitation, reliving of the traumatic experience, emotional withdrawal) in the same month that the original trauma occurred. And a 2007 study in Stress and Health, showed that a gradual decline in physical and psychological symptomatology in the months after a flood in Thailand, was followed by a marked increase in symptoms as the one-year anniversary drew near.
It is certainly possible to mitigate these anniversary reactions and indeed transform them into opportunities for mastery. The commemorative services that religious and civic groups, and governments organize often combine mourning with a shared experience of gratitude for what survivors do have. The work The Center for Mind-Body Medicine is doing in Haiti and elsewhere unites this approach to practical instruction in self-care techniques like deep breathing; self-expression in words, drawings and movement; and small group support.
Still, the usefulness of commemorations and therapeutic instruction depends in part on the circumstances in which people find themselves. In Thailand, those who were still living in tents had the most severe anniversary reactions. I have observed that it is far easier for children going to rebuilt schools in postwar, independent Kosovo to move through reawakened pain than for those in Gaza, who continue to attend overcrowded, still damaged schools in a besieged and isolated territory.
Today on Haiti’s earthquake anniversary the situation is far more desperate and discouraging for many than it was in the first months after the earthquake. Some are of course putting their lives back together – kids going to school, adults back at work, many selflessly teaching and helping others. Well over 1 million, however, are still living in tent encampments and the conditions are, if anything, less supportive than they were six or 10 months ago. Supplies of food and water are less reliable; robbery and rape seem to be more frequent. The government is in disarray and is, after the recent postelection rioting, fearful rather than welcoming of public gatherings like the helpful and cathartic day of mourning it organized on February 12, 2010.
After the earthquake, there was an enormous, spontaneous outpouring of goodwill toward Haiti, particularly from the United States – and commitments of funds to match. Since then, the Haitian government and local and international nongovernmental organizations have done much good work, but it has often been poorly coordinated by a still devastated bureaucracy;, and only a small portion of committed funds have actually arrived.
The Anniversary brings up memories of the extraordinary pain that the entire Haitian population has suffered, that old symptoms of demoralization and despair as well as renewing emotional and physical distress. We are working, along with the Ministry of Health, Partners in Health, and other organizations to address these symptoms and mobilize the Haitian people’s resiliency and hope. Our efforts, however, depend significantly on whether the international donors and the American people will fulfill the commitment to rebuild we made a year ago –a commitment that can help transform this anniversary crisis into an opportunity for the Haitian people to recover their wholeness and celebrate their surviving community.
CMBM Training, Days 2-3, continued
During the training, we do a drawings exercise, a sequence of three pages: one of “one’s self,” “one’s biggest problem” and “the solution to the problem”- and they are as always a revelation. They display what is inside each person and the images of one participant so often are a mirror for those of others.
The biggest problem of one physician here is shown as a clot of black guilt and fear and shame, of inhibited action and feeling buried under a mountain. She is straining for faith, toward a distant Jesus, and to do what must be done. But she feels unable to move or believe. In the third drawing all the conflicted colors of the mountain are striped in an arc du ciel, a rainbow. “ I was buried,” she says, “and now in this drawing I can see myself free, imagine myself again with my God.” (To learn more about our drawing exercises, read this post, “CMBM’s Drawing Exercise Resonates in Haiti,” when we introduced it in June.)
“I have in my drawings,” says Linda, the psychologist who coordinates our Haiti program, “dropped the mask of sunny happiness that I felt I had to put on. I have allowed myself to feel the loss of my father last week. And dancing and crying,” she adds, pointing to her third drawing, “I have found the authentic happiness inside myself.”
Checking in emotionally on the second day, my group members find their own choked-off voices- amazing how many cough and clear their throats and say they have forgotten how to say how they feel. They speak and are heard, listened, and they recognize that they are actually here with others who care and not alone. A nun and teacher who at first had felt so lonely as the only religious (woman) in the group realizes that she is not alone at all, “My images of pain and sadness are so similar to those of others. Showing you my drawings, telling you about them, I feel you are my sisters, and my brothers too.”
After the first day our participants are already using what they have learned. Several speak of “traffic meditation,” pulling over to the curb amidst Port-au-Prince’s daily madness, soft belly breathing (click here for a short guided meditation) until they are “calme” and “douce,” peaceful, soft and amazingly unhurried. A psychologist at odds with her teenage son reports asking him to breathe deeply with her and dissolving the tension that had led to fights, “…every night since the earthquake.” Several say that deep breathing and shaking and dancing had allowed them to sleep peacefully for the first time ever since January 12th.
Here is a short video of Linda Metayer, our Haiti Clinical/Program Director, describing what she feels Haitian trainees are gaining here:
(video by Mark Silverberg for CMBM)
CMBM Training in Port-au-Prince
Our team has been gathering for the last two days, long flights and sometimes long delays as well.
Jamil Atti is in from Gaza, Afrim Blyta and Jusuf Ulaj from Kosovo, and Naftali Halberstadt from Jerusalem- psychiatrists and psychologists who have lived through war and terrorism themselves, leaders of our program in their country, friends and brothers. From the US, Amy Shinal (our Clinical Director) Lynda Richtsmeier Cyr, Kathy Farah, Lora Matz and Jerrol Kimmel, physicians and psychotherapists–long time friends of 10 to 15 years, talented, adventurous, deeply committed to this international work.
Linda Metayer is our Haitian Program Coordinator, a psychologist with a degree in public health, as brave and courteous as she is smart and competent. Lee-Ann Gallarano, who organizes all of our work with trauma around the world, was working with Linda before we arrived with Jesse Harding, our newest staff member, who several years before worked with Lee-Ann when they were Peace Corps Volunteers in Mali. Tod and “B”, gifted documentarians, are filming us, and Mark, who has volunteered his time, is taking most of the still photos you’ll see on this blog.
We spend this first day “checking-in”, hugging, laughing, sometimes crying, as we tell the stories of our first meetings, recalling the power of soft belly breathing to help us relax in the middle of fire fights, of Afrim informing us in Gaza City that the 3AM earth shaking noises were in fact sonic booms. And everyone is speaking of the realization, growing over the years that, “You are my people,” “This is the work I want to do,” “I am at home.”
In the early evening Linda, Amy, Jesse and I walk with our camera crews into the sprawling tent camp across from our hotel- 10,000 people in the Champs de Mars. We had been told that “from the outside things look better.” There were fewer tents, less crowding. Up close the opposite turns out to be true- some people have indeed left, clearing out in terror of cholera, but everyone doubts they have found places much better. Meanwhile, moving from one clump of canvas, plywood, plastic and corrugated metal– one collection of shelters to another — we hear similar disturbing, dispirited stories: there is actually less food and water than there was four months ago and far more violence. Women, and muscular men as well, tell us that if and when they are able to sleep, it is with one eye open, alert to robbers who are often armed, and to rapists. The jobs cleaning rubble that once helped sustain these encampments have moved on, though no one knows exactly where.
Though some people are shy and wary, virtually everyone is gracious and within a few moments, eager to talk to us. Mothers tell us that so many of the children are “hyper” since the earthquake. We see them shuffling from foot to foot, eyes shifting with their bodies. The mothers say they have lost weight. When I ask about emotional problems everyone- men, women, teenagers- says they are angry. “What do you do?” I say. “I pray to God,” several say. “I take this medicine,” says a man raising a small bottle of homebrew. A woman says, troubled, but resigned, “I beat my children.” Several others nod.
As we move from one section of the camp to the other, two teenagers run past and jostle Linda. A moment later we see that her necklace is gone. She is a bit shaken, but philosophical, “They do it to eat,” she says. Other camps are likely to be somewhat better, but some are not and there are 10,000 people here. Walking back to our hotel I feel the weight of life here in Haiti, people stretched and pushed beyond breaking. I think of how much our work is needed, and I feel frustration along with everyone else. “Where is the organization?” I ask rhetorically, “The benefits of all the money the international community has committed?”
The school is the College Canado Haitien, one of the best in Port-Au-Prince, we are told, before the earthquake and afterwards, too. The students, a few weeks after the school has reopened, are sharp in well-pressed maroon and khaki uniforms—the girls’ hair pulled through berets, the boys sideburns neatly trimmed, tout propre, I think.
Instead of the pre-earthquake concrete buildings, there are open sided wood and metal sheds. Sounds flow from one classroom to another, overlapping in a kind of reverberating clamor. Toward the end of one of our classes, when time of dancing is kept by nimble palms on desktops, the whole campus rocks.
Our equipe, our “team,” –the French is beginning to emerge from deep layers of my unconscious—includes six of us: Lee-Ann juggling logistics as before, with Cassidy, my assistant back home, here to help her and me; Amy, the social worker who is our clinical director, will come tomorrow. Today, Lynda and Kathy, psychologist and family physician, are with me. They are CMBM senior faculty who are adventurous enough to come and to commit to coming again and again. They and Amy will teach our Haitian colleagues and provide consulting and supervision as we build our program.
Today we have been invited by Frere Jacques Anthony Germeil, the principal, to College Canado Haitien. We will have an hour in each of four classrooms with eleventh and twelfth graders who have been told they will learn “lessons in dealing with stress.”
I lead the first class and the third, forty twelfth graders in each, sitting shoulder to shoulder at their desks. Lynda and Kathy, experienced with kids, but new to Haiti and to the trauma and loss that overwhelms the population, will lead the second and fourth classes.
We begin our classes lightly—a little goofily—“How do you breathe?”, I ask to general puzzlement, and then talk about babies doing it easily—naturally—their bellies rising and falling, while adults, and even high school students, cramped in chairs and on benches, barely move their chests. Laurent, my interpreter, and I act out the roles of cats in full fight or flight mode—hissing and growling at each other, and then stepping back to breathe easily. Lynda has her all-boys class—a surprise—consider Kobe Bryant, cool and relaxed, imagining his shots, inspiring the boys to imagine theirs swishing the net.
When we turn the topic to relaxation’s antipode, stress, the bravado of a few—“I’m fine, we’re all fine,” claims one boy; “it was simply a natural disaster” intones another—contends with the more complex memories of their classmates.
Soon, in each and every class, there is a rush of sharing of what happened on January 12th, of how surprise and relief yielded to horror. “I thought the shaking would be eternal. Then, it stopped, and I thought, ‘that’s not so bad, I am ok,’ and I laughed, then I saw my sister covered in dust like a ghost, and I was afraid. And then, underneath my neighbor’s house, there were twisted bodies.”
And the stories come—many, we learn, shared for the first time—and the classmates’ losses pile up: a mother gone, an older brother, “my best friend,” “almost my whole family,” We hear of bodies discovered under rubble and strewn on sidewalk, of dogs chewing on corpses.
When we ask if there are questions, a small forest of hands rises: “How do you go to sleep when these memories keep coming in nightmares?” “How can you breathe deeply to relax when the air is so bad?” “How do you deal with family members who now are arguing all the time?” “What do you do with your belief that another earthquake is coming, or as some say, ‘a tsunami’?”
More about the techniques we use to address these questions coming soon . . . .