pietergrdevilliers: Trauma, geweld en mistagogie.
Die foto's is aan die einde van die blog. Nie vir sensitiewe kykers nie.
Ek het die onderstaande koerantberig oor die gevolge van die 9/11 aanval op New York se World Trade Centre op slagoffers vanuit 'n spiritualiteitshoek en vanuit pastorale of mistagogiese begeleiding waardevol gevind.
As ‘n mens die artikel goed en deeglik lees, kry ‘n mens insigte ook in hoe die mistagogiese gesprek oor ander sake en met ander mense kan of moet verloop of hoe ‘n mens ander wat ly aan traumatiese ervaringe kan ondersteun as hulle daarmee worstel in hul geestelike reis.
Die artikel help ‘n mens om ook op ander gebiede en in ander omstandighede op te let as iemand, sonder dat hulle dit self weet, getraumatiseer is, gevoelens van waardeloosheid koester of ‘n neiging tot self-vernietiging het (bv. wanneer hulle tuis mishandel word of wanneer hulle skuldig voel oor iets waaraan hulle nie regtig skuld het nie).
Die artikel help ‘n mens ook om te besef hoe belangrik dit is dat mense, wanneer hulle geestelik bygestaan word, ook holisties en veral ook professioneel behandel moet word (o.a. deur medisinale ingryping). Daar is nie altyd net bloot eenvoudige antwoorde uit die Bybel of op geestelike vlak nie.
In spiritualiteit is daar altyd ‘n begrip vir die feit dat ‘n mens ook liggaamlik gedeformeer kan word en dat die liggaamlike juis by tye ‘n sterk invloed op mens se geestelike welsyn kan hê. Sommige mense kan nie herstel van trauma voordat hulle nie klinies of deur medisinale ingryping gestabiliseer word nie.
Ek het die berig ook waardevol gevind omdat dit so eerlik is oor die probleme wat dit uitwys. 'n Mens kan byvoorbeeld, waarsku die berig, post-traumatiese stres verkeerd verstaan of selfs verkeerd diagnoseer. Die berig debateer openhartig hoe ‘n mens trauma nie moet verwar met sekere minder ernstige ervarings van mense nie.
Tog is die berig vir my belangrik omdat dit sekere basiese dinge weer helder illustreer. Dit wys hoe geweld ‘n durende, vernietigende uitwerking op mense se lewens het. Die uitwerking is nie net fisiek nie. Geweld is in vele gevalle juis meer vernietigend oor die geestelike gevolge. In vele gevalle is die gevolge van geweld onomkeerbaar. Daarvoor moet ‘n mens net na flieks kyk oor die soldate wat na die Viëtnamese oorlog teruggekeer het en in familie-geweld hulle eie mense en hulleself om die lewe gebring het of totaal verwoes het.
Wat my opval in die berig is hoe mense jare na die tyd vernietig word deur ‘n insident wat hulle bloot net gesien het en waarby hulle nie noodwendig direk betrokke was nie.
Dit is ook opvallend hoe hierdie vernietigende effek homself wegsteek. Mense besef nie hoe geweld hulle lewens tot niet gemaak het nie.
Wat hier dramaties uitgebeeld word omdat dit gaan om die val van die Torings in New York as een van die mees skouspelagtige dade van geweld in moderne geskiedenis, voltrek hom natuurlik elke dag op kleiner skaal in vele mense se lewens en in baie huise. En dit is op hierdie punt dat gelowige mense ver van New York veel uit die berig kan put.
Huishoudelike geweld in die kleinste dorpie van ons land kan dieselfde uitwerking op mense se lewens hê. Dit kwel my dat geestelike leiers so min oor sulke geweld praat en preek. Daar is nie dikwels plek hiervoor op die sondelys wat gelowiges uitspel nie.
Geweld wat mense aangedoen word deurdat hulle verneder, geboelie, onregverdig behandel word, verskel word (in huise, in skole, in kantore, ook in preke!), kan lewenslange gevolge hê. En hierdie gevolge steek hulle self dikwels so weg dat die slagoffers nie eers besef wat regtig die oorsaak van hul lyding is nie.
Dit kwel my ook hoe mense die oorsake van trauma kan onderskat. Dikwels kan die dood van ‘n familie-lid of bekende of, soos die berig hier onder meld, selfs net die nuus oor dood, trauma tot gevolg hê. Juis daarom moet gelowige mense sensitief wees vir mense wat sulke nuus nie kan verwerk nie.
Maar kyk nou hoe waardevol is hierdie berig deur die twee, versteekte opmerkings oor hoe mense hul post-traumatiese stress hanteer:
1. Die een is hoedat innerlike stilte deur meditasie mense kan heel maak. Maar, dit kan nie sommer net gebeur nie. Mense moet geleer word om te mediteer. In ‘n kerklike konteks is hier dus groot moontlikhede om pastors en mense wat omgee vir ander, te bekragtig deurdat hulle vermoëns ontwikkel om ander in meditasie te help genesing vind.
2. Ook boeiend, uit hierdie berig, is die verwysing na blootstellingsterapie (exposure therapy). Dit is, interessant genoeg, in spiritualiteit ‘n belangrike mistagogiese benadering. Deur oor trauma te skryf, roep ‘n mens die negatiewe weer in herinnering. Op ‘n bykans mistieke manier verloor sulke neergeskryfde herinneringe in hierdie herroeping en die beskrywing daarvan, hul houvas op ‘n mens. Ook hieroor sou ‘n mens kon oorweeg dat mistagoë bemagtigingskursusse uitwerk sodat hulle ander kan help om hul lyding te oorkom. Nouwen skryf hieroor in sy Dagboek nogal interessante opmerkings. Uiteraard kan ‘n mens gaan sit en skryf – en sal dit goeie gevolge hê. Maar dit sal goed wees as mense begelei word met opmerkings hoe en waaroor om te skryf. Maar waarom kan ‘n predikant nie hieroor doodgewoon ‘n slag preek nie. In ‘n sekere sin kan ‘n mens die Nuwe Testament as teks deur volgelinge van die gekruisigde Jesus sinvol vanuit hierdie mistagogiese hoek bedink.
Hier is die berig in vanoggend se New York Times:
In interviews over the last several months, Dr. Dessau and others revealed a wide-ranging but consistent body of symptoms. They cannot sleep. They replay the disaster in their minds, or in their nightmares. They have trouble concentrating. They are jittery and overreact to alarms or loud noises. They feel helpless, hopeless, guilty and cut off from the people who are close to them. They avoid anything that reminds them of that terrible day.
Millions of dollars will be spent treating them over the next few years through the James Zadroga 9/11 Health and Compensation Act, passed by Congress in December, which provides $4.3 billion to compensate and treat people with 9/11-related illnesses.
Some are emergency responders and others who vainly searched the debris for survivors. But some were residents, commuters and office workers caught in the dust cloud. And others were passive witnesses with no direct connection to the attack other than proximity.
Charles Figley, professor of disaster mental health at Tulane University’s School of Social Work and a former Marine, advanced the concept of PTSD in a 1978 book on Vietnam War veterans. He said one reason the trauma had been so hard to shake was that it ripped at the most ordinary fabric of daily life.
The landmark is not a distant hill in Afghanistan that one will never see again. “It’s the places you see every day, where you proposed to your wife, where you remember getting the news that you got promoted, where your young children played,” Dr. Figley said.
Ancient but Evolving Illness
“The Iliad” described warriors consumed by feelings of guilt, rage and grief. World War I had “shell shock,” and World War II had “combat fatigue.” PTSD has been found in survivors of Nazi concentration camps, fires and railway accidents. But it was not until 1980, after the Vietnam War, that post-traumatic stress disorder was added to the psychiatric bible, the Diagnostic and Statistical Manual of Mental Disorders.
The current manual, the DSM-IV, says PTSD can develop through a range of exposures to death or injury: direct personal involvement, witnessing it or, if it concerns someone close, just learning about it. Almost no other psychiatric diagnosis has generated as much controversy, according to Dr. Robert L. Spitzer, a retired psychiatry professor from Columbia University and an expert in mental disorder classifications. It has become so vague that stressed-out college students and people who watched horror movies could fit the profile, he and two other experts wrote in a professional journal article.
“It’s a way of saying something terrible has happened to me and I’ve been damaged in some way, but that doesn’t necessarily mean it’s an illness,” Dr. Spitzer, who advocates tightening the criteria, said in an interview.
Some experts have been skeptical of studies finding that people suffered the disorder from watching television coverage of the Sept. 11 attacks. (Congress effectively excluded TV watchers from its treatment program by requiring that victims had lived or worked within certain geographic boundaries.)
Amy Cushing-Savvi, a social worker at Mount Sinai Medical Center, which runs the largest program, said a frequent topic at staff meetings was, “What’s 9/11 and what isn’t?” — in other words, the exquisitely vexing question of how to separate the effects of 9/11 from the traumas of everyday life.
“Taxpayers could end up paying for psychotherapy for Woody Allen and half of Manhattan,” Theodore H. Frank, a fellow at the Manhattan Institute, testified before the House Judiciary Committee in April 2008, when he was a fellow at the conservative American Enterprise Institute.
Ultimately, federal financing for PTSD treatment was limited to firefighters, police officers, employees of the New York City medical examiner’s office who handled body parts, and other rescue, recovery, cleanup and support workers at ground zero, on the barges that carried debris and at the Staten Island landfill where the twin towers rubble was entombed; responders at the attack sites at the Pentagon and Shanksville, Pa.; and people exposed to 9/11 dust when the buildings collapsed or who lived, worked or attended school south of Houston Street in Manhattan and in parts of Downtown Brooklyn where the dust may have extended.
Dr. John Howard, who oversees 9/11 programs as the director of the National Institute for Occupational Safety and Health, said in an interview that he was willing to give people the benefit of the doubt about PTSD, even if they had other stresses. “Collapsing 220 stories of a lot of material in one of the most densely populated cities in the world is a very unique event,” Dr. Howard said.
“In mental health you have to treat the whole person, and you can’t really separate out some of these other influences, personal stressors, economic issues. People are living their lives.”
“It sounds squishy,” he added, “but it really isn’t squishy.”
Her World Collapses
For Dr. Dessau, who is now 64, listening to the tapes she made during therapy conquered her fears for a while, “like cod liver oil,” she said. But in 2009, her sense of tragedy was compounded when her husband, Bob Wheeler, died just four months after being told he had lung cancer.
Dr. Dessau, a youthful, athletic blonde with blue-rimmed green eyes, still lives in the same airy loft on Greenwich Street, decorated with souvenirs of 35 years of travel with Mr. Wheeler — shells arranged in bowls, a child-size winged Hermes, a many-limb stone goddess, a terra cotta Chinese statue of a man. There is also a green plastic box containing her husband’s ashes.
Mr. Wheeler, a lawyer, never smoked, so Dr. Dessau, a pulmonologist, suspected that his disease was related to his exposure to the falling buildings. His quick death revived the sense of helplessness she had felt watching people jump from the towers. “As a doctor you always think you can fix it,” she said.
She lost 20 pounds. She stopped seeing friends. She was “on red alert,” sure that something bad would happen at any second. She avoids looking at the skyline outside her window, though her reaction is not as bad since buildings have begun to fill in the space where the World Trade Center used to be.
A city fund set up before the Zadroga Act was enacted provided $9,000 to Dr. Dessau to cover therapy expenses not handled by her insurance. The city sent a letter encouraging her to seek further treatment through a public program that would allow the Zadroga money to cover her out-of-pocket expenses, but she prefers her own therapist.
That sense of 9/11 as a catalyst is common. In June, Stanley Mieses, 58, a freelance writer and editor, lined up with other psychiatric patients at the city-run Elmhurst Hospital Center under a sign that said, as if testing his sanity: New atient Registrati n.
During a screening, he circled the maximum, “nearly every day,” to a question about how often he had been “feeling bad about yourself — or that you are a failure or have let yourself or your family down.”
Mr. Mieses, who is receiving treatment under the Zadroga Act, lived six and a half blocks from the trade center and watched the buildings collapse. The police evacuated him, but he returned every few days to feed his cats. “Dead people were blowing into my apartment off the windowsills,” he said, remembering the ash, “because the landlord was too cheap to clean it.”
For a while he sublimated his anxiety, filing reports for NPR from his stunned neighborhood. But in short order, his mother, a World War II German refugee with what he said were her own PTSD issues, died; his girlfriend left him; work dried up; and he was forced by his finances to move to Jackson Heights, Queens.
These psychic blows led, he said, to “a change in my attitude, a change in my — I don’t know — joie de vivre.”
His pulmonologist at Elmhurst says his shortness of breath could be from the dust, or the 20 years he smoked. The origins of his mental wounds are also ambiguous. “I tend to think of 9/11 as the trapdoor that opened up,” Mr. Mieses said. “Whatever else I’m doing past that, is climbing back up.”
It is impossible to say how many people have 9/11-related PTSD. The city’s three official programs do not count people, like Dr. Dessau, who use private physicians — or those who have not been treated at all.
Extrapolating from a registry of people exposed to the attack, the city’s health department has estimated that 61,000 of the 409,000 in the disaster area experienced “probable” PTSD within six years of 9/11. But these numbers were produced by institutions and a city government with two main goals: to make as many people as possible feel better, and to try to persuade Congress to provide a steady stream of treatment money. The city’s 9/11 health programs have created a huge intake system that screens every patient for mental as well as physical illness, and the public hospitals reached out to New Yorkers with subway advertisements that said: “Lived there? Worked there? You deserve care.”
No one can say exactly how many people were exposed to the attack, and how many will eventually become physically or mentally sick. The federal government will allow the Mount Sinai and public hospitals programs to grow by 25,000 patients each over the next five years. It will be up to each program to decide who qualifies for treatment, but they will have to use uniform criteria approved by the government. Therapy can cost $135 for a 45-minute weekly session with a psychologist or $165 with a psychiatrist.
If the government finds a link between 9/11 dust and cancer, there is some concern about running out of money, though the Zadroga fund is to be a secondary payment source, covering what insurance and workers’ compensation do not.
Dr. Howard, the federal 9/11 health administrator, said the government “will treat people as they come in to the extent possible.”
Alarms, Over and Over
Patients at Mount Sinai find a busy warren of rooms where they are divided into three categories: green (no further assessment needed), yellow (potentially symptomatic) and red (symptoms so severe that they might be suicidal). They begin the screening at home, filling out an 11-page questionnaire that asks about their level of energy, how often they feel “calm and peaceful,” and about recent life experiences like losing a job or having a relationship break up. In a section called “Reminders of 9/11,” they are asked whether they have recurring thoughts of the disaster and whether they feel emotionally cut off from those close to them.
In an interview with a clinician, they are asked whether “you often believe it would be better if you were dead,” “you feel worthless” or “you feel guilty even though you didn’t deserve to feel that way.”
If they have PTSD, patients are usually given a combination of psychotherapy and pills, typically antidepressants, and sometimes sleeping pills. Many patients are encouraged to make recordings of their memories, as Dr. Dessau did, or to write about them until the memories lose their power. This is called exposure therapy.
“I kept the list” of the missing, he said.
Two months after the attacks, he responded to the crash of American Airlines Flight 587 in Belle Harbor, Queens.
He started shutting himself in his bedroom, refusing to talk to his wife and children. He spent hours staring at photographs of the burning rubble and had flashbacks of responding to murders during the 1980s crack epidemic.
Mr. Holland’s diagnosis of PTSD was made in 2009 through a Mount Sinai outreach program, and his costs will be covered by the Zadroga Act.
He has recovered enough that he hopes to return to work, but not on the front lines. “I don’t know if I’ll go to the memorial any time soon,” he said.
“I look at that kind of as closure, if I’m able to do that.”
Posted by Pieter G R de Villiers at 9:40 PM