On Wednesday night, as the world watched, the last of the 33 trapped Chilean miners made it safely to the surface. After having spent more than two months underground in a collapsed mine, the men emerged remarkably physically healthy and robust, Chilean health officials said. One man had enough energy to literally jump around after his rescue, hugging the gathered crowd and cheering.
The miners were evaluated and treated for some health complications at Copiapo Hospital immediately after rescue. But from here on out, it will be the miners’ psychological well-being that will likely be the focus of their after care. Will they be able to handle the stress of sudden celebrity? Will they have proper social and psychological support going forward? As Mario Sepulveda, the second miner to be rescued, said: “The only thing I ask, personally, is that you please not treat us like celebrities. … I want to continue being treated like Mario Antonio Sepulveda Espinace, the worker, the miner. I love that, and I think that in some shape, way or form I want to continue working.” (More on Time.com: Photos of the rescue: all 33 miners brought to safety).
Trauma experts say a return to normal life is indeed crucial to recovery after a disaster. For more clarity on the emotional difficulties the rescued miners may face, TIME Healthland spoke with Dr. Carol Tosone, a trauma expert at NYU’s Silver School of Social Work and author of the Feel Free to Feel Better: FEMA Trauma Training manual. Tosone has provided crisis support to earthquake survivors in Indonesia and to 9/11 witnesses in New York City. It is important to note that she has not counseled the Chilean miners personally.
Q: How do you think such a large group of miners was able to succeed to this point psychologically, without any fighting or destructive antisocial behavior underground?
A: One thing that was very helpful for them was the sense of camaraderie — there was a critical mass of them, and they are all men from similar backgrounds. In this Hispanic culture, [of machismo] they could provide each other with a kind of shared bravado as well as having companionship.
I think what could have made this trauma easier was that it was a bonding experience. Studies show that even if people are competitive, when they have an external threat they no longer perceive each other that way. So having the group of them, that’s a plus.
Q: Now that they are no longer together in a group, how will they cope with re-entry to normal life?
A: First of all, it’s not just their own traumatic reaction, it’s their families’ reaction to them as well. There will be a lot of focus on them as heroes — there will be this external expectation for them to be O.K. In other words, if they are having a negative reaction, that won’t be acceptable to people. Culturally, it will be hard for them to focus on what could be perceived as weakness.
In Hispanic culture, there’s usually a very strong sense of the familia — a tight-knit group and a sense of getting through things together, and that takes over for a lot of the mental health profession. But usually, mental health considerations are still important — they may have flashbacks or other symptoms [that the family doesn’t understand]. It will be interesting to see how many of them will go back to mining versus taking another profession.
But coupled with that is the pressure to move on — the community wants everything to be okay. Remember Sully, the pilot who landed safely in the Hudson? He retired right after. And when you talk with the flight attendants [onboard], there was one in particular who was significantly traumatized. She talked about how everyone else was celebrating while she still had nightmares.
Q: Can you describe the process of recovery after trauma?
A: We now know that when trauma occurs, it’s more of a right-brain activity, which provides a “fight or flight” response. It’s like the reptilian side of the brain. When you experience trauma, the left side basically shuts down, and that’s the body saying you are in survival mode. After a period of crisis, the left brain starts to kick in, functioning to understand the meaning of what’s happened. (More on Time.com: Photos: Venezuela Cracks Down on Illegal Mining)
Even if healing occurs, there will always be receptivity for trauma. For example, New Yorkers who went through 9/11, when a plane is flying low overhead, they may be the first to look up. I was there and I look up. So the miners might experience that — triggers when they see something or feel closed in.
But the key is to integrate the trauma and grow from the trauma. There’s a phenomenon called post-traumatic growth, which is the expectation that you grow after a trauma. After a traumatic event, you’ll hear people say: “It makes me realize how precious life is,” or “It made me realize how important my family is.” When something like this happens, you get the sense of limited time, which is harder to appreciate without [an event], so that’s one of the positives that comes with it.
Q: You mentioned that families will be a support system, but is there also a risk of trouble in interpersonal relationships — with spouses or children?
A: Oh, yes, absolutely. There’s the quintessential example that we all know from war [veterans]. It’s really hard to become intimate with somebody, when you’ve had to spend so much of your day totally on alert.
Similarly, here, the miners might feel uncomfortable and not really sure what to do or say. They might keep things to themselves, especially given that they were all men down there. It’s a macho culture and that’s part of the problem. So it’s kind of like, “You can handle it” — that makes it really difficult to express problems.
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.
More on Time.com: