Abstract: Natural disasters are more than physiologically disruptive. Social and psychological scars can have deep, long-lasting implications in the lives of survivors. While some communities are rebuilt and some individuals receive treatment, the majority of those directly affected carry an emotional burden for years beyond a disaster. I want to redesign the survivor experience to increase the availability of social and psychological aid.
An earthquake is disruptive to families, lives, and physical and social infrastructure. In the aftermath of a disaster, governments and non-governmental organizations (NGOs) often only address immediate physiological needs. What happens when aid dries up? How do people recover financially when job opportunities were scarce to begin with? How do individuals cope with the loss of loved ones and accumulated personal items that shaped their identity? How do communities rebuild their social infrastructure?
I’ve looked at case studies covering a range of post-earthquake relief scenarios. The best responses use the catastrophe as a force for social and infrastructure change. After the 2004 tsunami in Sri Lanka, the Sri Lankan government coordinated the efforts of NGOs to rebuild in less disaster prone areas. They focused resources on permanent communities with vistas reminding Sri Lankans of their livelihoods at sea. In one community, an NGO provided vocational training for construction, a field in which demand outstripped the labor supply. However, not all earthquakes displace 500,000 to 800,000 people and provide opportunities to completely rethink physical and social infrastructure. In Chile, over 1,500,000 were displaced, but infrastructure damage was not as severe.
On a smaller scale, the 1995 earthquake in Kobe, Japan offers an example of a well-organized physical and mental health response. The Japanese government worked with retailers to meet immediate physical needs. Japan’s centralized mental health system facilitated a rapid response for both adults and children. The media response that followed helped alleviate the social stigma of mental illness in Japan by demonstrating that causes for mental illness could be externally driven (versus demonstrating a personal defect).
The difference between a catastrophe and a disaster is rarely the magnitude of the earthquake but the quality of the physical (architectural) and social infrastructure in place before the quake. Compare the situation in Haiti to that of Chile from their respective 2010 earthquakes. In Haiti, many of the buildings were poorly constructed and the economy was poorly developed. The 7.0 Haitian earthquake decimated the island while the 8.8 earthquake in Chile resulted primarily in temporary displacement.
I am interested in the medium and long-term implications of a disaster. I want to pick up in stages where governments and NGOs often leave off. This requires planning and forethought before a disaster even occurs. Moreover, it requires a commitment to the social development of country and an understanding that well-being goes beyond minimal standards for survival.
We can frame the problem within the four psychological stages of a disaster. The Heroic Stage occurs immediately after the disaster and lasts up to one week. During this stage, emotions are intense and people respond altruistically, using resources on hand to help people in dire need. In the second stage, known as the Honeymoon, feelings of camaraderie are strong, as assistance is promised from the outside and hopes for recovery are at their highest. This phase lasts up to six months after the disaster. The third stage, Disillusionment, follows; people feel disappointed and angry about their situation, as promises of aid are unmet and hopes for recovery remain unfulfilled. The spirit of camaraderie fades and people become concerned with their own problems. In the final stage, Reconstruction, new movements for rebuilding based on resources within the community arise. This may last for several years following the disaster.
People’s needs vary throughout the disaster stages. At the same time, there are opportunities to enact lasting changes in social policies in the context of a disaster. Feelings of altruism can be extended if the proper expectations are set and supporting layers of social and information infrastructure are in place prior to the disaster. Post-Haiti, google set up an online search mechanism for people to identify and find lost relatives and friends. Can this sort of infrastructure be extended to create a non-monetary economic system that matches local aid to local needs while signaling a commitment to rebuilding the community? Can disillusionment be avoided altogether through realistic expectations and fulfilled promises? These questions form the basis for the socioeconomic issues on one end of the opportunity space.
On an individual level, people of all socioeconomic classes are temporarily equalized by the disaster. While I am fascinated by the broader issue of economic inequality, it is too much to tackle in the time allotted. Rather, I want to approach the post-disaster psychological issues from a needs perspective.
Maslow’s hierarchy of needs provides a useful framework. Maslow suggested that there are five need stages: physiological, safety, love/belonging, esteem, and self-actualization. Each lower level stage must be fulfilled before a person can move onto a higher one. Post-disaster, those directly affected are reduced to seeking physiological needs: first aid, food and shelter. Governments and NGOs are often capable of performing this task adequately. In stable countries, governments can usually restore physical safety through police or military control. However, a person’s psychological sense of safety often remains compromised for months. The death of loved ones and loss of personal possessions that form identity can leave a survivor with very little to look forward to. Add to this the displacement of being interned with only basic survival needs and you can see that post-disaster life isn’t much of a life at all. How can survivors fulfill higher level needs if the fabric of their identity and support systems is so severely torn?
In conversations with psychologists and art therapists, I’ve learned that people need to establish a mental sense of safety immediately following a disaster. Failure to do so can result in severe post-traumatic stress disorder (PTSD) which may include a loss of speech, persistent re-experiencing, and other significant disruptions to daily life. Stable routines can facilitate processing. Talking through, drawing, or acting out events can help a person accept loss. Immediately following a disaster, how can we quickly mobilize and extend the reach of psychologists in the dissemination of immediate aid? For those with lasting PTSD, can we develop resources for a more sustained response? Are there therapeutic objects that we can distribute to supplement or substitute for first-hand therapy? These questions identify the psychological issues on the other end of the opportunity space.
After acceptance, people need to find a positive meaning in the disaster to move forward with their lives. If people learn to place greater value on interpersonal relationships and communities, can the context of a disaster create opportunities to rebuild social structures? Can aid be channeled in ways that strengthen local economies? This is the community intersection between socioeconomic and psychological issues.
The Need to Redesign
Post-disaster aid is temporary and primarily addresses physiological needs. In most cases, the government delivers relief supplies, establishes military control of affected areas, and rebuilds physical infrastructure. NGOs might provide field hospitals, generators, telecom equipment, first aid supplies, water purifiers, temporary shelters, blankets, food, money, doctors, civil engineering experts, and rescue teams. Neither adequately tackle the social, psychological and community issues that arise from a disaster. In Haiti, many now have some food and shelter, but there are few schools or jobs. Rebuilding should create new opportunities.
In some post-disaster cases, psychologists throughout the world have mobilized to educate or work with local mental health practitioners. When adapted to the cultural context, these interventions can be effective. However, the scope and reach of these services is limited. Volunteer psychologists provide temporary group aid to few and identify those with additional needs but do not provide that extra counseling. The vast majority of those affected by a disaster do not receive any mental health treatment. Such interventions are analogous to doctors that fly in to treat AIDS patients in Africa when limited funds could be more cost-effectively used in education and prevention.
I plan to develop a culturally relevant system that extends the reach of social and psychological aid in Chile. This starts by recontextualizing the post-disaster user experience into a framework that sets realistic expectations and provides real hope for personal healing and social progress. The objective isn’t to solve all of the logistical issues pertaining to relief, but to leave as many people one step better off than they otherwise would have been. It is my hope that the accumulation of many small differences can make one big difference.
While I am starting locally, I believe my learnings can be scaled globally. In this sense, the project is not about Chile but about post-disaster relief in general. It is about helping the displaced in less obvious ways than food and shelter. It is about providing for higher level needs so that people can prosper in spite of the trauma. My project is about hope.