In the U.S., in event of a natural disaster like a hurricane or an earthquake, there's usually an assumption that the official response will have to include some sort of mental health therapy. And yet, another of one the surprising elements of your story is the suggestion that after a natural disaster that inflicts broad trauma, a blanket offer of Western-style mental health therapy may not always be appropriate in other cultures. Was it appropriate in the areas you visited? Why or why not? Was it effective?

A big part of the problem is that there's not a lot of good research on what is, in fact, the best response for disaster survivors in terms of mental health. That is especially true in developing countries. A lot of the psychosocial response to the tsunami has been based on good intentions rather than solid research. Many of the NGOs have been doing very good work, but there have been problems in the psychosocial relief effort.

For example, some foreign groups arrived to counsel tsunami survivors, or train local people to do counseling, but they didn't speak the local language. In Sri Lanka, I talked to a psychiatrist who complained that some foreign groups had prevented people from carrying out local customs-particularly with regard to burying the dead-that normally help people grieve and recover. In his view, these customs are important for coping, and should have been strengthened, not pushed aside. The World Health Organization and others also complained that many NGOs were too focused on post-traumatic stress disorder and certain types of trauma counseling that haven't been shown to be effective. There seems to be an emerging consensus that PTSD is just one of many ways people react to disasters. People with symptoms of depression or anxiety disorders other than PTSD get overlooked when the aid effort is too focused on PTSD.

At the same time, there were some groups who did very good, culturally
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11-Aug-2005