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Emotional care vital

Emotional care must be an integral part of the massive response to Hurricane Katrina, urged responders.

BY SUSAN KIM | BALTIMORE | September 2, 2005

"It takes your brain a little while to accept the reality."

—Cheryl Tyiska

Emotional care must be an integral part of the massive response to Hurricane Katrina, urged responders.

“Emotional support services are not offered in an vacuum,” said Cheryl Tyiska, deputy director of the National Organization for Victim Assistance (NOVA). “For example, whenever people are given a cup of coffee, the person providing them a cup of coffee, can, if they’re trained, also provide them with emotional support. Wherever that person turns for help, people will know the right things to say - or when it’s better to shut up and just listen.”

NOVA’s trained crisis response teams were en route to hurricane-affected areas. NOVA is one of many voluntary and faith-based agencies that will offer emotional and spiritual care to thousands of people affected by the hurricane.

NOVA teams work with chaplains and clergy, and also with other groups that are members of National Voluntary Organizations Active in Disaster (VOAD). Spiritual care has become an integral part of response within the VOAD system, particularly over the last decade, as responders have been developing spiritual care guidelines that can be used by people from a variety of faith groups.

The first emotional stage people go through is shock, explained Tyiska. “That’s when you find people walking around dazed. They can’t believe what they’re seeing. Their brain cannot take in the enormity of this.”

At that point, trained teams don’t do talk counseling, she said. “We hold their hand. That’s when you give hugs. It takes your brain a little while to accept the reality. Your brain can say my house is gone, everything is gone - my high school year books, my momma’s old wedding ring, and you just can’t believe it.”

After a few days - or a week - some of that shock does begin to subside, she said. Then, people will be overwhelmed with emotion.

Often, that’s when anger - at the Federal Emergency Management Agency, at relief groups, at God - begins.

“Some people are going to be angry at themselves,” she said. “There will be a lot of second guessing. Some people couldn’t leave. They’ll be angry because they were so poor - angry at responders, angry at officials. They’ll be angry at God, and they’ll think, ‘I’ve been a good believer for years, how could you let this happen?’ ”

Mental health workers are also expecting to see a tremendous amount of fear. “Think about the little kids,” she said. “You’re afraid when you start to hear the wind again.”

This is a new experience not only for hurricane refugees but also responders, said Tyiska. “Very few of us in this country know what it’s like to lose everything,” she said. “Here are people completely at the mercy of a system. They have fear about their future - anger, fear, frustration, confusion. That can lead to hopelessness and despair.”

Crisis intervention is going to be vitally important during the relief process, Tyiska said.

“We don’t want to stop people from having those reactions because they’re healthy reactions. People will be having these emotional reactions for a long, long time. It’s okay to articulate your anger. It’s okay to cry. It’s okay to stomp your foot and shout at God. But you can’t do it in a way that hurts yourself or other people.”

Some hurricane survivors might feel guilt or shame about being in the situation they’re in, she said. “Also, imagine people who have pre-existing mental illnesses who are not getting their medications.”

But within what seems like a bleak picture, there is hope, said Tyiska, because the majority of people do come to a psychological accommodation. “That new reality can be healthy or it can be awful. Some people will develop some disorders - they may develop depression, clinical depression, phobic disorders. Some might have symptoms of post-traumatic stress disorder (PTSD) or full-blown PTSD.”

But most people are resilient, she added. “Most people have the ability to pick themselves up, and say, ‘I went through this awful experience and it’s part of my life story. Some people will walk away from that feeling a certain amount of pride in their strength.”

Crisis intervention needs to be undertaken by highly trained people - but the process itself is very benign, said Tyiska.

“We provide emotional support and help people find their resiliency. We try to ask them: what is it going to take to get through this day? We help people take baby steps. Some of those people are going to need to have referrals to more intensive therapy. We can then be the bridge to help them find mental health therapy without stigma. We try to put that in the context of normalcy.”

The most important thing to give hurricane survivors right now, she said, is a sense of hope.

“We try to walk away from an encounter with a person having some sense of hope. There are going to be some people who may not pull themselves out of this. But there are other people who will say: who do I want to be?”

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