What Does Haiti Need Most?

February 14, 2010 at 10:54 am 13 comments

“The most urgent need … is not food and water which is temporary. The most urgent need is for psychiatrists.” — From an AP article in the Monterey Herald

Ah yes, food and water are temporary. Psychiatry is forever. Who can forget the great Thorazine famine of Ireland or the poor little Ethiopians with no Zyprexa in their bellies?

As many as one in five Haiti earthquake victims has suffered trauma so great with the multiple shock of lost homes, jobs and loved ones that they won’t be able to cope without professional help, doctors say.

The people of Haiti are grieving. They have every reason to grieve. It’s not an illness. Who are doctors to ascertain who will cope without psychiatric intervention or even to declare that coping is mandatory? No nation that has ever rebuilt itself from ashes and rubble or the widespread damage of war and political land grabbing has psychiatry to thank for their renewal. It has never been a drug induced haze of vague acceptance that spurs people to rebuild but the knowledge that action is required and genuine help from people in a position to offer it. We should be providing the true necessities of survival and the tools necessary to rebuild as they determine the direction of their own nation, not assuming as we have here that we know someone’s needs better than they do and there is a pill for every hardship that’s been thrust upon us. By all means, let’s offer our emotional support but let’s let them determine their needs and act as friends, not crusaders. God help us if our response to grief and loss in every suffering country is the expansion of the lucrative, western and drug-centered psych industry with all of its ills — but then again maybe we can offer a little bit of the peace and happiness synonymous with being a psychiatric patient.


Entry filed under: Psychiatry. Tags: , , , , , , , , .

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  • 1. Tammy Simon  |  February 14, 2010 at 1:24 pm

    “Jones, a veteran of natural disasters and wars from Bosnia to Indonesia, is teaching front-line doctors how to identify “disabling fear” and, quite literally, hold people’s hands and listen.”

    Why do we {we meaning our culture, not us per se…} equate holding hands and listening with psychiatric care?

    “It’s about assisting mourning. People cannot recover if their social needs are not met.”

    Can you imagine our surprise if a psychiatrist was to attempt to hold our hands or, dare I say, listen?

    The story has been removed but I have a cached copy. Oddly Facebook will not allow me to send the link. If anyone would like a copy of the original article, please let me know.

    It seems the reporter, or whoever provided her with information, is confusing normal disaster behavior with psychiatric symptoms.

    Great writing, Aaron!

  • 2. abellve  |  February 14, 2010 at 1:37 pm

    Thanks, Tammy. I’ve updated the link. Somebody let me know if it fails again.

  • 3. Nina Snowden  |  February 14, 2010 at 4:11 pm

    Yes, their grief is situational as opposed to a chemical imbalance. But when one is sad, the person has the chemical state of a depressed person and antidepressants can and will help them through some very tough times.

  • 4. abellve  |  February 14, 2010 at 7:08 pm

    “when one is sad, the person has the chemical state of a depressed person and antidepressants can and will help…”

    Chemical state? I (and millions of others) would love to see some evidence of that. It’s a convenient theory and it sells a lot of drugs but it’s just a theory and the evidence is piling up against it. I don’t think our calling to help our neighbors means we should bottle up theories and ship them to people short on options.

  • 5. markps2  |  February 14, 2010 at 9:37 pm

    Nina Snowden “the chemical state of a depressed person”
    Selling legal drugs is not medicine. Emotions are not diseases.

    Only those who refuse to eat ( in grief ) might need “help” if they can not move on.

  • 6. Marian  |  February 15, 2010 at 7:03 pm

    How did mankind survive the first 199,750 years without psychiatry???

  • 7. KHorn  |  February 17, 2010 at 11:33 am

    I have to say, I think this post was a bit dishonest. I read your post, and I had no trouble believing there was someone advocating the positions you imply in the post, but when I read the actual article, I don’t think your worst insinuations have any merit. Yes, I will admit the “most urgent need” quote is very stupid, but let’s look at some other quotes from the article:

    — “It’s not about immediate psychological counseling,” said Dr. Lynne Jones, a senior medical adviser for the International Medical Corps. “It’s about assisting mourning. People cannot recover if their social needs are not met.”

    That seems reasonable. They are not advocating immediate intensive psychological counseling, but over the long term helping people to recover in a social sense.

    — Jones, a veteran of natural disasters and wars from Bosnia to Indonesia, is teaching front-line doctors how to identify “disabling fear” and, quite literally, hold people’s hands and listen.

    Advocating docto’s listen to people and give them more personal attention. And it turns out…

    — “The doctors in such situations tend only to hand out tranquilizers,” Jones said. “We don’t want them to do that.”

    This is being advocated in order to decrease use of medication. You should be all about that.

    — ” He tore the cast off his leg last week. For days after he arrived two weeks ago, he only let the hospital director feed him; he claimed everyone else was trying to poison him. ”

    — ” Many sit quietly in corners, staring blankly into space. Others cadge handouts or wait in line for tranquilizers.”

    — “Palpitatations — rapid, fluttering or pounding heartbeats — are rampant among them, doctors say. ”

    I think dismissing this by saying “The people of Haiti are grieving”, grossly underestimates the suffering and mental trauma the Haitians are going through.

    There clearly is a need for mental health professionals in Haiti, and for the primary care doctors in Haiti to be more aware of the types of mental issues their patients are having. As the article points out, absent those things all the doctors can do is hand out tranquilizers. The call for mental health experts here is in fact an attempt to lessen to use of drugs.

    It is disappointing to see (both in the post and in the comments) this story get so twisted so as to fit with a “psychiatry/psychology is invariable and absolutely bad” world view. Yes psychiatry and the use of psychiatric drugs is abused, but that does not mean any mention of mental health is bad without exception.

  • 8. abellve  |  February 17, 2010 at 12:47 pm

    I really don’t think this post was dishonest. Narrowly sliced perhaps but not dishonest — and not because I was trying to be deceptive but because I was reacting to two statements that jumped out at me, not just from this article but from a chorus of responses to a terrible event.
    And yes, I’m all for something better than passing out tranquilizers, but not if they just switch it to antipsychotics which, right now, is the tendency in psychiatry. Psychiatry now is almost exclusively based on theories within the medical model, far from hand-holding and listening. That’s a lot closer to psychology and I think psychology and emotional support fields have far more merit than current psychiatry. I see psychiatry and psychology as vastly different, not two branches of the same field.
    Yes “grieving” is an understatement. Frankly, anything one could say about the state of Haiti right now is likely to be a gross understatement. I think there are problems that need to be addressed in practical, spiritual and emotional terms but I don’t think a very singularly focused scope such as current psychiatry is beneficial to many people. There a huge business in psychiatry inseparable from a huge business in psych meds and I don’t think we should export and expand those businesses when more direct, human and whole-minded approaches are needed. I’m not opposed to all mention of mental heaalth but psychiatry is theory. They/we don’t need theories but for people to just act as people and offer real help.

  • 9. KHorn  |  February 17, 2010 at 1:13 pm

    My point being, the article does not give you any reason to believe the call for help addressing mental health issues in Haiti will be drug based. It’s an assumption you are making. A knee-jerk reaction to hearing about a mental health professional. I agree that flooding Haiti with psych meds is not what is needed. I just don’t think, based on that article, I have cause for concern about it happening. I would also point out that, as you mention, psych meds are huge business, so why would they try to expanded into Haiti? There’s no money in it for them. The reason psych meds are so overused in this country is because pharmaceutical companies are greedy and make money by selling these drugs. Why would they ever want to give them away to people who can’t afford to buy them.

  • 10. Marian  |  February 17, 2010 at 1:48 pm

    What I find deeply disturbing about this article is that on the one side it states, very much to the point, that what people need is someone to hold their hand and listen, and on the other psychiatrists. I totally agree with Aaron when he says “They/we don’t need theories but for people to just act as people and offer real help.” Psychiatry is all about theories (and drugs), and approximately zero about people acting as people and offering real help. A two-minute-stay at any psych prison will do to convince anybody of this.

    The article admits this itself when it is said that Dr. Lynne Jones “is teaching front-line doctors how to identify “disabling fear” and, quite literally, hold people’s hands and listen.” If these doctors have to be taught to hold people’s hand and listen, that means they are not able to figure out how to do this, and act as people, by themselves. And that’s about as true as it can get when it comes to psychiatrists – not every single one of them, but the vast majority. Usually, people don’t become mental health professionals, and especially not psychiatrists, because they truly want to help people in distress. They become professionals because they’re frightened out of their wits by both their own and others’ humanity, including extreme emotions, and because professionalism is an excellent means to keep this humanity at arm’s length and under control, by labelling it “sick”, and suppressing it chemically, electrically, and also psychologically (CBT, psycho-“education” – make that psycho-seduction).

    What Haiti needs on a psychological, spiritual, etc. level are human beings who are not afraid to be human beings, and who are not afraid of allowing others to be human beings. With a very few exceptions, psychiatrists are about the last people in this world who meet these criteria.

    • 11. KHorn  |  February 17, 2010 at 3:04 pm

      The doctors that Dr. Jones is teaching hold people’s hands and listen are the primary care physicians and surgeons, not psychiatrists.

      As for your generalizations about psychiatrists (you were very clearly expressing opinions on psychiatrists – not psychiatry) all I can say is wow. Way to make some very nasty over generalizations. I dare you to rewrite any one of those sentences and replace “psychiatrist” with the ethnicity of your choice.

  • 12. Marian  |  February 17, 2010 at 3:44 pm

    Well, that only tells a lot about primary care physicians’ and surgeons’ ability to embrace their humanity, and that of others, and act as people. Probably humanity as a whole has never been more afraid of itself, and consequently at war with itself, than today. However, it is psychiatry that ultimately institutionalizes this war.

    It’s not a generalization. I pointed out that there are in fact exceptions. Although they are few. If this wasn’t so, the mh system would look quite different from what it does.

  • 13. abellve  |  February 17, 2010 at 7:15 pm

    It was never my intention to paraphrase or re-report the tone of the article — only to point out some pretty asinine and presumptuous things that were said. It could have been an article about anything and if someone said those things they would still be worth addressing on their own.
    I didn’t take a call to address mental health issues in general as meaning drug based but rather a remark specifically about calling in psychiatrists. In the current paradigm psychiatry is closely tied to psychotropic drugs. I don’t think I’m being overly cynical when I point out that connection. Psychiatrists in general have made a point of making that connection which is why so-called dissident psychiatrists are the ones that steer away from drugs and toward broader approaches. All of this said, you may be right about whether or not it poses a real concern at the moment. I didn’t see this post so much as addressing an immediate threat but a wildly ridiculous and even offensive remark. Whether it’s the start of a movement or not, some people are worth shouting down.
    As to pharmaceutical interests in poor and developing countries, Haitians would not necessarily have to pay for it. A great amount of drugs in our own country are bought with third party reimbursement. Pharmaceutical companies could certainly go for a piece of the aid money offered through organizations like Medecins Sans Frontieres (Doctors Without Borders) that offer mental health services in addition to any potential government aid offerings. Kashmir got an ECT machine through MSF. I don’t consider that the kind of care we need and certainly not the kind we should be sending down to Haiti. I’m not saying all of this is a given in Haiti but a possibility worth acknowledging.



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