Because our training in Mind-Body Medicine was interrupted by election riots in December, we scheduled half day workshops for our December trainees on January 11th, 2011. It was a place for us to share feelings just before the anniversary of the earthquake, a refresher course, a time for questions and guidance, the opportunity to gather and sit and eat together in our new CMBM Port-au-Prince office. What a treat to have space for people to come- 60 or 80 at a time if we need it – windows that shed light, and a kitchen to cook in.
At the end of our time together we sit silently for a few minutes, morning and afternoon, remembering losses, allowing tears to wet our cheeks and spot our clothes. And then we hear about the help that these men and women are already offering others — in hospitals, schools, churches and tent camps. We make plans for how we will work together with Haitian people everywhere, and the ways we will continue to share ourselves and what we are learning.
Sometimes, on this first anniversary of the earthquake, it feels like very large, steady hands are needed to pull together the two sides of the gaping wound that is Haiti, hands that Michelangelo might fashion for this purpose.
I find myself looking around as we circulate through tent camps with little food and water, no health care or education or employment for the tens of thousands of people I see, for the hundreds of thousands who still live like this all across the region. “How can this be?” I shout – but only inside my head – how can we, Americans, the world community, all of us, let this continue? Our hearts were touched a year ago. Politicians said the right things, famous people answered phones on television and lent their shine to the pleas for help. Billions of dollars were pledged. Where are they? Why is there scant organization, no plan, so little mercy and fellow feeling?
It worries me, as much for ourselves–the privileged, literate, and apparently protected– as for those who live exposed to heat and rain and hurt.
In one of our workshops on January 11, 2011, the day before the anniversary, two men – a priest who tends a devastated parish and an accountant who has left his paying job to bring whatever order he can to two tent camps– share their drawings. (Read more about CMBM’s drawing exercise in this earlier Haiti entry.)
The accountant, a large serious man, sees himself planted in the midst of a quilted crop of families, cooking fires and plastic sheeting; the priest’s drawing of his slim black-clad figure is bright with God’s light refracted through a mirror framed in rainbow colors. The drawings of their “biggest problems” are, with no other guidance, no consultation, virtually identical. One side of the pages shows effort – to salvage and succor, hands reaching out, shovels in the earth – and a row of disconnected figures: “the ones who could help but don’t” “the rich and powerful who do not care.” They are barely sketched, drained of color. On the other side of the page, the people in the camps are suffering, but they do have bodies and expressions.
We need to offer them help, ourselves, in order to be human; and we need this at least as much as they need our help. That is the key to a happier future anniversary.
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.
As the anniversary of Haiti’s catastrophic January 12, 2010, earthquake approaches, physical and emotional symptoms that were ebbing or had disappeared, are rising. We hear it everywhere as we– Linda Metayer, our Haiti program director, and I–move through a day of visits and talks with staff at the General Hospital and the Ministry of Health, as well as with kids and adults in tent camps in Petionville, a suburb of Port-au-Prince that is a city of half a million.
Headaches have intensified, and sleep is ever more disturbed by sudden awakenings and half remembered nightmares. Irritability and anger sweep people away in rage at children, who are themselves agitated by neighbors who are too close and too ever-present, too troubled and helpless, too painfully mirroring their own suffering.
Everyone knows in their bodies, as well as from the calendar, that the anniversary is coming, but there is little plan for public ceremony that might make remembrance and mourning easier, and bring hope for a happier future. The program that Linda Metayer and Rene Domercant (a Ministry of Health official who attended our first training in December) have organized at the General Hospital is a happy exception.
After an introduction by Dr Jocelyn Pierre-Louis, one of the Ministry of Health’s leaders and a strong supporter of CMBM’s program, Linda, Rene and I speak. Our talks are nicely paired: Linda and I discuss the extent of psychological trauma and the practical steps people can take to heal themselves and their communities psychologically, and I teach slow, relaxing soft belly breathing and get everyone to move their body. A number of these professionals appreciate the immediate effectiveness and ease of the techniques – “I feel so calm,” says one; “So calm I went to sleep,” adds another, and everyone laughs, recognizing the tension that keeps them awake and the need for rest. “I felt tears come,” another woman adds – all the emotion that needs to be released, I suggest, and she nods.
Afterwards Rene, who is an engineer as well as a psychologist, shows slides from a manual for safe rebuilding: foundations propped and buttressed so they are no longer unbalanced and unstable, second stories supported by first floors that have sustaining walls. Each slide is paired a “Don’t” in red which can lead to collapse in a future earthquake, a “Do” in green – the safe way to sustain a dwelling and save lives. These slides will be shown everywhere in Haiti and distributed in booklets, Rene tells us.
What a pleasantly surprising symmetry and pairing: principles and building blocks for new safe houses, and for emotional and physical self-care–a hopeful beginning for the new year.
To be continued tomorrow–the anniversary of the Haiti earthquake . . .
The Training Begins– Day Two & Three
Tears are everywhere. Like high water behind a dam, you can see them swelling, pressing for release in the stiff bodies and taut faces of men and women who gather for the first day of our training.
We’ve selected 120 clinicians, educators and religious leaders. About that many crowd the registration desk and fill the chairs in our lecture hall. But they aren’t exactly the 120 that we invited.
This is the beginning of our Haiti training, but before I tell you about these new colleagues of ours and about what we are learning together, I have to jump to Wednesday morning—Day Four– and to the hours last night, after the election results were in. Demonstrators filled the streets outside our hotel in front of the Champs De Mars, angry thousands protesting results which certified President Preval’s son-in-law in-waiting, Jude Celestin, as a participant in a run-off election. Last night our team heard the pop of gunshots as a counterpoint to the rhythm of music from the hotel band. This morning, smoke from fires fills the air as demonstrators march toward, and, we are told, destroy Celestin’s headquarters.
Everyone we meet believes Mrs. Mirlande Manigat was indeed the legitimate top vote getter, and they are convinced that another candidate, Michel “Sweet Mickey” Martelly, the pop singer, had more votes than Celestin and if he didn’t, someone else certainly did.
The election results seem to the Haitians only the most recent insult, the latest dismissal of their sovereignty, indeed of their humanity- -once again the big man appoints his successor. All the frustration of all of their months since the earthquake and all the years before, all the pain we’ve seen in the tent dwellers on the Champ de Mars and in the faces of the men and women we are training is erupting- moving this afternoon uphill towards Celestin’s headquarters, and the homes of the rich and powerful.
On this day of anger and danger, only half a dozen of our participants have made their way through large, angry, often armed mobs and small fires. The rest however, have been on the phone, “Tomorrow?” “Don’t do too much today; we don’t want to miss anything.” “Can your international team stay another day?”
Back to the Beginning-Training, Day 2
On Day Two some of our invited participants were kept away by the urgent demands of cholera care, and by fears of the demonstrations that had not yet occurred. But others arrived from the Ministry of Health, the universities, the schools and churches to take their place. By the second day these eager volunteers and the original invitees were joined by the latecomers and by some who have somehow heard stories about unexpected relaxation and education, welcome, and safety. At lunch we feed 145.
The small groups which are central to this adventure in self discovery and self-care- so supportive and inviting for men and women who have held back personal feeling in favor of continual service to others- have swollen in size.
12 or 14 men and women sit in circles meditating, breathing in through their nose and out through their mouth, allowing their bellies to relax, expand, become soft. After they open their eyes they share who they are, what they do, and why they took five days from over burdened schedules to be with us. They speak in turn about the first morning’s large group lectures and “experiential exercises.”
“After the shaking and dancing,” an anesthesiologist begins, “I felt freer. There are not many people in my profession and after the earthquake we did amputations all the time. It was painful. I lost my spontaneity. I think we all have. It was good to dance.” (Read more about the shaking and dancing we used in Haitian schools here)
As we go around the circle the possibility of sitting peacefully, of relaxing at the end of the day, rises on horizons dimmed by almost unimaginable loss, “I have tried,” another physician says, “to bury myself in work so that I do not think of all of those who have died and are buried in the ground.”
“Or are still buried under piles of concrete,” another adds with grim precision.
To be continued tomorrow–check back to learn about how CMBM’s healing drawing exercises and what the participants appreciate about the training.
Already at 9am, the air is hot and heavy in the workshop tent. Fifty or sixty people are present, most of them quite young, taking notes, wonderfully attentive and responsive. They are a bit shy at first, but as we all introduce ourselves, they offer stories of trembling bodies, panicked hearts, of sights beyond endurance—watching family members crushed under falling concrete.
We teach them slow breathing to quiet the mind and body and relieve stress. They participate with eagerness and enthusiasm. Afterwards they clamor eager to “partager,” to share: “A feeling of calm for the first time since January 12th;” “a letting go in the shoulders;” “this is the first time also,” one adds, “that we’ve had an opportunity to learn about our own psychology, to share our feelings, to look at what stress causes in the body and to feel relief from it.”
After a mid-morning break, 30 or 40 more people join. “We have spread the word,” one of the young men says with a grin. After we do drawings (of “yourself,” “your greatest problem,” and “the solution to that problem”), the HRC staff and volunteers share them in animated groups of three. “There is hope here,” say several, of their third drawings.
They are filled with sunlight after darkness of the second drawing; with music—drums and guitar—and dance and movement, after “the biggest problem” of buried and walled off emotions, broken bodies and silence: “It gives me direction,” says one young woman, and others agree. Several stand to show their drawings to the whole group; many more want to.
Then we push back the chairs and stand together, shaking our bodies and releasing tension. When the music changes, the young people sing together, clapping their hands. Afterwards, no one seems to want to leave. Little groups form around each of our faculty and staff.
Twenty-five or thirty of the Red Cross volunteers and staff write notes of appreciation. Most are translated from Creole and French by our interpreters, and a couple are in English. Here, in English, are a few:
“Today I have found the means to comfort myself when I have a problem, to change my way of thinking and looking at things in other people and in myself.” Jeanty
“I feel so good. If everywhere they could have someone learn these exercises and teach them in their neighborhood, everything would be okay for everybody, and accept life as it is. Thank you so much to teach us. May God bless you and protect you.” Myrka
Many of the young people say spontaneously that the experience, has, in the words of one, “taught me how to face the dangers that present themselves to me instead of flying from them.” Another adds, “I’m very happy with the information that I learned today. Now I know how to confront my fears. I would like to be a part of another one of your workshops. Thanks a lot. I’ll never forget you. We needed it.”
“I’m Elder,” writes a third, “I’d like to say I’m very happy and I say to you a big thanks to you for that. You’ve made me a messenger to a lot of people in the world. Thank you so much for your encouragement and the hope of living you bring to me. I love you very much.”
Many, many of the HRC volunteers and staff tell us how much they appreciated the copies of the exercises that we gave them, as well as the workshop, and that they plan to share what they have learned with others. But still, “we want to learn more.” A number invite us to come to visit with them, to bring “workshops of healing” to family members and friends in schools, tent camps, and churches in Port-Au-Prince and beyond.
These idealistic, committed, bright young people (some Red Cross staff, most volunteering), are such an important resource for Haiti’s future. They have a tremendous appetite for learning about themselves and the world, and for helping others. I would very much like to do a full professional training for them.
We move during the rest of our week in Haiti from one group of health professionals and community leaders to another. It is a slow progress through the traffic jams in Port-Au-Prince’s rubble-narrowed streets, and sometimes even slower over the gorged-out, flooded dirt roads that take us to Bishop Pierre Andre Dumas’ diocese in Anse-a-Veau, three hours outside the city.
We use a variety of techniques in our workshops, including explanation of the fight-or-flight and stress responses, meditations, guided imagery, and shaking and dancing. We also do a drawing exercise that has been enormously helpful to children and adults in war, post-war, and post-disaster situations, in Kosovo, Gaza, Israel, and New Orleans, and with US military. For a while, everyone—bent over paper, crayons in hand—becomes young, earnest, playful, surprised.
The drawings allow people to tap into their intuition and imagination without effort. As a series of pictures unfolds, they find themselves creating images they’d never imagined, sketching solutions to problems that seemed insoluble.
In Haiti, we guide our groups through three drawings. The first picture is of “yourself,” the second, “you and your greatest problem,” and the third calls for “the solution to that problem.” (We modify the exercise when we use it with children: read my post about using the drawing exercise with Haitian children in the General Hospital.) Afterwards, participants share their drawings in groups of two or three, telling what they see in what they’ve created and how it makes them feel. Then they have the opportunity to share with the entire group.
As you will see, the results are often touching, and almost always surprising.
Here are a few examples and snapshots of the workshops in which they are created:
For L’Institut Haïtien pour la Doctrine Sociale Chrétienne (Haitian Institute for the Christian Social Doctrine)
Such wonderful, accomplished people: 100 of them—physicians, architects, lawyers, police officials, business men and women. All, in this time of crisis, are renewing their commitment to the welfare of those who have suffered even more than they have. They tell us about the terrible sadness—their own, and others—and about unaccustomed irritation that surfaces at home and at work, as if, somehow, angry will could restore what has been lost.
An obstetrician/gynecologist, tall, broad-shouldered, powerful and handsome in a bright, tailored shirt, has come “for rest and peace—I have not slept since January 12th.” He says he works “always” to forget the loss of his house, the deaths in his family—his sister, nieces, nephews—as well as to care for his patients. In his second drawing (a picture of his biggest problem), he is inside a tunnel, tiny as an ant, lost, unable to touch the equally tiny figures outside. In the third (a picture of his problem’s solution), the figures are larger, recognizably human. They are dancing together and he is laughing, “for the first time since the quake.”
For Anse-a-Veau diocese—nuns, priest, lay brothers
Out in the countryside a couple days later, we are meeting with priests, nuns, and lay brothers in Bishop Dumas’ diocese. It’s like rural Africa out here: lush, green and very still, faded pastel cottages with tiny yards in which seeds, sown or thrown, produce a few vegetables and fruits. We begin and end our visit with Bishop Dumas’ blessing and simple ceremonial meals: tiny, boned, tender white fish, rice, beans, greens, fresh lemonade and thick coffee.
The religious, in straight-backed chairs, are as still and elegant as the statues in the porticos of Chartres. They are so attentive, so sweet tempered amidst the flood of suffering, homeless, city people that the earthquake has forced back to the countryside. One priest draws a scene of despair—“The Cross of Death—Good Friday without Easter Sunday,”—and then, in his third picture, much to his amazement, produces a sun that covers the page with radiant yellow. “It’s the sun of freedom. Together we can overcome.”
They dance, too—nuns, brothers, and priests together—as freely and as happily as children. Before we finish in mid-afternoon, another, older priest calls the Bishop from the next diocese. It turns out he would like us to come there.
More soon about another workshop, this time with the Haitian Red Cross staff and volunteers . . .
We keep our sessions as simple and clear as we can: an introduction to fight-or-flight, stress, and trauma, answers to their questions, and three lessons.
Here they are:
1. Slow deep breathing with the belly soft. This, we explain, is the antidote to the flight or flight and stress response that the earthquake has inscribed in the kids’ minds and bodies. Soft belly will quiet their physiology, slow their racing thoughts, give them a little perspective on the flashbacks of dead bodies, the horror of loss and the ambush of fearful anticipation. Knowing—feeling—that they can breathe deeply and relax, they will have a small but important sense of control in world where so much—whether or not they can concentrate or sleep, where they live and how they will make a living—is, or feels, beyond their power to affect.
You can experience a relaxing guided Soft Belly meditation here, at The Center for Mind-Body Medicine’s website.
2. Later we do some shaking and dancing so they can let go of fixed patterns of physical tension and mental preoccupation; can feel their bodies moving freely; can raise their energy, lift their mood, and lower their anxiety. They clap and laugh and shout and afterwards, flop happily onto their hard seats.
3. We also explain the value of sharing here in the classroom, at home, or with a friend, the pain they feel and the fears and concerns that arise.
Many of the kids would like us to do more, to tell them where they can go to practice the techniques and talk to others. For now, I say, “you have each other and your families. We are giving you these techniques, written in French. Practice them at home and we will come back to your school. Soon we will be training many people, including some of your teachers, to do this with you.”
The story of how CMBM’s model helped Andre, a Haitian boy, overcome feelings of grief and guilt, coming soon . . .