Q: Beyond machismo, what might be some other barriers to their recovery?
A: [Lack of proper psychotherapy.] You have to understand, I’m trained as a psychotherapist and I live in New York — therapy is like breathing. In our culture, people have therapists and there’s nothing surprising about it. But these people are poor miners, so therapy is anathema to them: only “crazy” people go to therapy. To them, therapy is probably an institution without home’s supports. It’s a very scary, foreign thing.
Q: If you were leading a trauma recovery effort in Chile, how would you approach it?
A: I would provide psychoeducation — explaining symptoms, triggers — to spouses, parents and children. I would let them know that time won’t make things better. I really want to stress that. Trauma is timeless — you could have a sudden-onset physical response to a trigger months and years after the event.
The best way to do international trauma outreach, the way you help communities, is psychosocial intervention, which is using the resources of the community. Rather than me and a whole crew of psychotherapists coming in, you put in place a network of care that’s based on what is already there. What do the community use during difficult times? Who are the people they turn to? There might be the priest in the church, but there isn’t necessarily a mental health center. (More on Time.com: See the top 10 miraculous rescues)
I did trauma training in Indonesia in Yogyakarta after earthquakes. A lot of the people had died in the community. There was a sense that you had to enlist the support of the local elder as the authority, but also that we had to provide education to children, parents and teachers.
The goal is, you want to normalize the experience of trauma. You don’t want someone to think that they are crazy. So you stress to them and their community that their reaction is normal because something abnormal happened to them.
Studies show that for people recovering from addiction, the people who fare better have perceived social support. They feel that people care about them and understand them, that they’re not isolated and not all alone.
Another part of the education is to stress that some people will be more affected than others. A solid 10% will go on to develop a trauma response. (Read more: Sear of the spotlight awaits miners)
Q: What is a trauma response?
A: There are three distinct aspects of it: the first is re-experiencing the event — something triggers the sensation of the trauma. Your mind is trying to save you, so you go back to the “fight or flight” mentality. Another is avoidance. For example, some people who went through 9/11 won’t get on a plane anymore. So if some of the miners go into other work, that could be an example of avoidance. And the third is hyperarousal, a state of being easily startled, easily reactive to noises or experiences in an excessive way.
A lot of people have an acute response, an acute stress disorder. The first couple of days, it’s to be expected that people will experience some of the signs. Really anywhere between one week to one month, that’s acute trauma response. When you start going longer with symptoms, that can be posttraumatic stress disorder or another more chronic, long-term condition.
Q: So symptoms lasting longer than a month would be considered PTSD or something similar?
A: I hate to put a time frame on it, and certainly you can have an acute response for longer. But, yes, after a month it’s time to evaluate.
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