Discover Trauma Clearance Concept of PTSD from the Victims Involving in Volunteers Help Disaster Victims Avoid from PTSD by Volunteering ()
1. Introduction
This paper collected a lot of experiences from Tzu Chi Foundation’s domestic and international relief activities of the victims who took part in volunteers in diverse big scale disasters. From them, we discover Trauma Clearance Concept of PTSD.
Post-traumatic Stress Disorder (PTSD) is a psychological disorder that can affect victims after a disaster. Once PTSD occurs, it is not easy to complete recovery and it may cause a negative burden on the victim and people around him (SAMHSA, 2014) . People have different physical and mental reactions to the disaster. Once these reactions or syndromes reach a certain level, they will form disorders such as Adjustment Disorders, Pathological grief, Obsessive-compulsive disorder (OCD), depression or anxiety. The critical mental reconstruction period is the first month after the disaster (Neria et al., 2008: pp. 467-480) . It is better to have psychological aid as early as possible; however, saving lives is always the first priority, and dealing with mental conditions comes second. After this critical one-month period and the onset of PTSD, it always takes a long time to treat the PTSD. Tzu Chi has got many experiences from domestic and international disaster relief activities and discovered the best strategy of avoiding PTSD for the victim. The strategy is “Victims becoming volunteer and participating the disaster recovery will make them be easier to overcome from disaster trauma”. During their volunteering, a new valuable life experience will cover up their trauma of disaster experience and the trauma will gradually be cleared following the time going on.
After a disaster, many things must be done—help the victims recover from their physical injuries and build shelters for them—and care for their mental health. Post-traumatic Stress Disorder (PTSD) is a psychological disorder that can affect victims after a disaster. Once PTSD occurs, it is not easy to complete recovery; it may develop to a negative stress on the victims. People have different physical and mental reactions to disaster; once these reactions or syndromes reach a certain level, they will form disorders such as Adjustment Disorders, Pathological grief, Obsessive-compulsive disorder (OCD), depression or anxiety (including PTSD) or even mental illness. Other than this, disaster experience may also worsen a victim’s existing psychological condition. The critical mental reconstruction period is the first month after the disaster (Andrews, Brewin, &, Rose, 2003) . It is better to have psychological aid as early as possible (PFA); however, saving lives is always the first priority, and caring for mental conditions comes second. After this critical one-month period and the onset of PTSD, it takes a long time to treat the disorder.
Why do we invite the victims volunteering? After a huge natural disaster, the victims felt that the life was greatly threatened and feared, and even felt desperate. Whenever the pouring rain comes, they often fear the earth and stone rushing during the typhoon. After the huge earthquake, the victims always fear the continuous aftershock will bring further damage that feels dizzy and sky spinning and earth shaking every day. Everyone who suffers such huge disaster always gets great pressure both physical and mental and gradually becomes a trauma. Such trauma is always very painful and fearful. In a short period of time, the victim often thinks of traumatic event, and has the nightmares and serious anxiety. They are afraid that the incident will come again and are afraid of sleep and rest. As time passes, most people can gradually get rid of stress and fear if they are well self-adjusted. However, if these symptoms are not properly guided and resolved at an early date, they will continue to deteriorate. After months or even years, it interferes with daily work and social functions and is likely to suffer from Post-Traumatic Stress Disorder. Meanwhile, Disaster relief personnel may also suffer from post-traumatic syndrome due to the large number of victims and the horrors of various disasters. Normally, Cognitive Behavioral Therapy (CBT) is currently the effective form of psychotherapy for Post-Traumatic Stress Disorder syndrome (Wright, 2006: pp. 173-178) . During this treatment, the case is discussed through an interview with a physician or therapist to explore the patient’s over-worry and find alternative ideas. Then, through psychological education, cognitive reconstruction, anxiety management, etc., the case can be gradually improved, take the emotional and gradual way to actively overcome the fear, learn to overcome the fear, let the patient get out of the symptoms and build confidence to achieve recovery.
As to the main discussion of this paper, we want to make a new point. According to the observation and practical disaster rescue actions of Tzu Chi Foundation, “inviting victims to be the volunteer” is a positive improving strategy. It is not only a kind of group support, the members of the NGO are just like friends but also makes the victims not worry or remain in their negative emotions and revert their mood to be a helper and worthy ‘person. It will be explained hereinafter in detail.
2. Method and Material
2.1. Method
This study collected a lot of experiences from Tzu Chi Foundation’s domestic and international relief activities of the victims who took part in volunteers in diverse big scale disasters. And from those actual examples, this study discovers Trauma Clearance Concept of PTSD. The author has taken so many big disasters and accumulated a lot of examples of victim volunteers who have overcome the invasion of PTSD through involvement in volunteering. This study discovers that victims who engage in volunteer will get more opportunities to take part in society and interact with more people. Meanwhile, they will get the new valuable experience with delight. These experiences will cover up and gradually clear the trauma experience. The victims in a disaster take part in the volunteers that will convert the victims’ attention in some more worthwhile matters. They care for the needy and devote themselves to disaster recovery that will give them a feeling of a worthwhile and valuable life.
2.2. Material
Tzu Chi foundation has a lot of relief activities both in domestic and international. And there are diverse experiences of inspiring disaster victims to become volunteers. The examples include 921 Taiwan Chi-Chi earthquake in 1999, Indian Ocean earthquake and tsunami in 2004, Sichuan (Wenchuan) earthquake in Chinese Mainland in 2008, Morake typhoon of southern Taiwan in 2009, Typhoon Haiyan of Philippine in 2013. We accumulated some examples of victim volunteers how they quit the invasion of PTSD through the involve of volunteering, such as that Tzu Chi invited the victims to participate the disaster recovery through cleaning the home and community by “cash relief for work”, being volunteer of the free clinic, cooking hot meal for the victims, interpreters, forming the youth service team to console the aged victims, promoting community environmental protection and resources recycling as well as to be the interpreter.
3. Practice—A Lot of Actual Examples of Victims’ Volunteer Quit from PTSD
1) To get the experience of mental problem of 921 earthquake in Taiwan
When 921 (Sep. 21, 1999 Chi-Chi 7.2 earthquake on the Richter scale) earthquake struck in Taiwan, I, the author, together with the Tzu Chi International Medical Association (TIMA) arrived in Zhongliao Township of Nantou county by 2 pm. We were the first medical team to arrive. We found 70% of the buildings of Zhongliao Township had collapsed, including classrooms of Zhongliao elementary school. The school ground was full of all sorts of tents. Once TIMA set up a free clinic station in a corner of the school grounds, victims flooded in to seek medical aid. We heard victims describe the terrifying experience of the earthquake. They described that the ground was shaking up and down like ocean waves, victims couldn’t stand still and got hurt if they tried to grasp anything. A mother took her two children to the free clinic; she told us that, when the earthquake struck, her husband had escaped from the house originally. But he wanted to drive the family to Taichung city, so he returned to their house to fetch the car key and money. At that moment, a big aftershock came, the house collapsed, and her husband had never returned. She could not stop weeping, and her two children held her hand and stayed very close to her, as nowhere was safe. After dinner time, TIMA volunteers went into the tents area and had conversation with victims. The victims all told stories of how they had escaped their homes; seeing the horrified eyes of the children and hearing their nightmares were something hard to forget. When walking on the street, victims would sleep on the roadside, because aftershocks continued, and everyone was too frightened to go home. TIMA stayed in Nantou disaster area for 35 days and encountered countless victims. Some of them would stop in the middle of conversation and asked: “Is it an earthquake again? Did you feel that? Did you?” But, in fact, there was no aftershock. This imaginary earthquake was caused by the post-trauma fear, which may linger for a period of time to the victims. Thirty days after the quake, psychiatrists of Hualien Tzu Chi hospital arrived. They held counseling sessions for the victims. Through drawing therapy, it was obvious to see that children had post-traumatic syndrome as their drawings showed angels with broken wings and a dark sky.
Tzu Chi found that some victims were Tzu Chi volunteers themselves. Instead of worrying or staying in their negative emotions, they immediately went out to help care for their neighbors, cook hot meals, assist in free clinics, etc. These actions of giving and devoting gave them a sense of valuable and seemed to free them from fear. As they did a lot worthwhile work for the victims, this phenomenon gave Tzu-Chi a precious experience in victims’ disaster mental rebuilding.
2) The Experience of getting rid of PTSD in Hambantota Sri Lanka
Right after the 2004 South Asia Tsunami in Ache, Tzu Chi had the relief activity in Hambantota, Sri Lanka. The language barrier was one of the big issues there, because the victims were not everyone who could speak English. Hence, Tzu Chi tried to recruit interpreter volunteers from local people. A lady came to a Tzu Chi Medical station one day; she was full of grief when she arrived.
During the conversation, she said that her husband and two children had died during the tsunami. Tzu Chi volunteer found out that this lady could speak fluent English; so Tzu Chi people asked if she would willing to volunteer as an interpreter. She suddenly opened her eyes wide and agreed to assist. Day by day, this lady followed the Tzu Chi relief team and interpreted when necessary; through the volunteer work, she seemed happier and smiled much more. The lady said that she realized her life was not at its end and that she had found her life value by serving others. Actually, there were a lot of local residents who took part in the volunteers. They were always smiling to do all the assistant work in the free clinic. When Tzu Chi gave them the wage, almost everyone wanted to donate the wage back to Tzu Chi. After the insisting of Tzu Chi group and explaining that they had a huge disaster, they did need this money to have their further livelihood. They receive the wage at last. We saw their delightful and enthusiastic mood in the free clinic site. After the victims moved into the temporary housing, this lady who lost husband and two children continued carrying out the service for others. She originally had encountered the biggest tragedy of her life ( American Psychiatric Association, 2013 , DSM-5, persistent complex bereavement disorder); but, through volunteering, she found her new life value and direction. There were also other victims who recovered from sorrow through volunteering and helping others. When Tzu Chi gave them relief money, some of them willingly donated the money back to help others in need, as they already felt grateful and content with what they had. These enlightening experiences gave Tzu Chi stronger confidence in a concept that is “To be the volunteer is the best way to avoid from the PTSD.” We believe to be the volunteer can transfer the mood of the victims, and meanwhile could prevent and reduce the occurrence of PTSD (See Picture 1).
3) The Experience of earthquake in Sichuan
I was the member of first Tzu Chi relief assessment team right after 2008 Sichuan earthquake. Since access to the hardest area of the earthquake was restricted, Tzu Chi conducted its relief work in the secondary disaster-affected
Picture 1. The victims took part in the volunteers as the interpreters and assistants at the Tzu Chi medical station in Hampantota that presented their delightful smile naturally. One of those ladies lost her husband and two children in the big Tsunami.
areas. When Tzu Chi volunteers went to the tent area originally, most of the victims were sitting inside of the tents lifelessly. The volunteers had set up a hot meal station and started preparing dinner. We then invited children from the tent area for group activity, sign language song learning and performances which is a characteristic of Tzu Chi; soon they were all delightful and getting involved in the games. The volunteers taught them to sing; if there were elderly people sitting listlessly in the tent, Tzu Chi volunteers would ask the children sing for the elderly. When the old people saw this group of children start to sing for them, their surprise soon turned to joy. Then, the dinner was ready; all the victims queued in line for their first hot meal since earthquake. Many said that it had been a long time since the earthquake that they had no chance to enjoy a hot meal. When the night had come, we were wrapping up equipment at the hot meal station; we invited those women from the tent area to come back again the next morning to prepare the meal and to cook together, and they all happily agreed. The next morning, even before we arrived at the hot meal station, those women of victims were already starting to wash and chop the vegetables and fruits that we had stored in the station. Everyone seemed much happier; through cooking, they felt like a big family having a meal together. Above all, they felt that could serve other people like Tzu Chi volunteers.
At this time, the free clinic station encountered problems in communicating with the old people and the dialect of Sichuan accent was very strong. Hence, we recruited children to interpret as volunteers for us; most of the children can speak fluent Mandarin. Since most of the schools had collapsed, the students could not go to school, so they took turns to help. These kids not only assisted us in interpreting, but also formed in groups and performance singing, sign language for the old people and helping other victims to clean up their living area. Their parents were surprised that their children had become so happy and enthusiastic. Out of curiosity, they come to Tzu Chi service station to explore the reason. After the explanation of Tzu Chi volunteer, they also participated in Tzu Chi’s activities or helped cook meals. We see all the victims experienced the spirit of “service outlook on life.”
More and more people joined volunteer work and felt happier. As the result, this tent area had become so lively. Tzu Chi also promoted resources recycling and the concept of environmental protection to the victims. This systematic way of leading victims to join volunteer work had formed a close bond between Tzu Chi volunteers and victims; through the recycling, they also learnt the importance of protecting our environment for our next generation. Local people could be seen riding their carrier tricycles to pick up recycling items throughout the disaster area; their actions also promoted the recycling concept. The victims no longer suffered from the fear of disaster; instead, they received valuable feeling from volunteering works. This fact illustrates what we said above: “the critical mental reconstructing period is better to have psychological aid as early as possible”, and “to be the volunteer can transfer the mood of the victims, and meanwhile could prevent and reduce the occurrence of PTSD”. It helped the victims clear their mental trauma experience through the valuable experience of helping others.
4) Typhoon Haiyan of Philippine in 2013
In disaster areas, it takes time for the healing process—slow and painstaking disaster recovery. People not only have no jobs but also no money for purchasing daily necessities and rebuilding their houses. The victims’ homes are in a terrible mess. Livelihood and socio-economic problems are waited to be solved. Therefore, the victim will fall into desperation.
Having participated in international disaster relief for years in many countries, Tzu Chi realizes that providing materials and helping victims to regain their confidence and hope should be considered a priority during the healing process. Therefore, Tzu Chi offers “Relief work with Cash” to the victims in the beginning so that they not only receive relief money but also help victims rebuild their homeland very soon. Through relief work, the survivors can devote themselves to the physical recovery of their community. Besides, they can solve their financial problems so as to revive the local economy.
When the powerful and deadly Typhoon Haiyan hit the central area of Philippines on November 8, 2013, this relief-work model worked in the best way. During the typhoon, Leyte and Samar were damaged the most. Tzu Chi volunteers in Philippines entered the disaster areas on November 13 and saw that the areas were almost completely destroyed. The homes of government officers and their staff were ruined as well. Therefore, it was hard to find people working in the Government office. When Tzu Chi volunteers explored the disaster areas, they felt that victims seemed to feel desperate and didn’t know how to deal with what had happened. Because of experience gathered for years in disaster relief, Tzu Chi volunteers immediately launched a relief-work project in Tacloban, Leyte. Paid work was offered to the victims for the disaster recovery. For 29 days, more than 280,000 survivors took part in the “Relief work with Cash” to help rebuild their own towns themselves. Meanwhile, Tzu Chi offered them warm meals, free clinics, daily necessities. Besides, Tzu Chi also built prefabricated classrooms for school children to use. Through all these efforts, the city gradually came back to live.
The “Relief-work with Cash” project of Tzu Chi aimed to help victims rebuild their hometowns with their own hands (See Picture 2). The money offered for their work has multiple meanings: payment, consolation, encouragement and reviving the local economy. Taking all the meanings into account, the payment must be more than local normal wage so that the victims and the society can ride out the storm. Although Tzu Chi still distributed many other materials, the relief work not only brought hope to victims but also encouraged them to rebuild their homes by themselves. After the relief-work project in the disaster area, many victims were encouraged because of receiving work payment; therefore, the local economy also revived gradually. This is the practice of compassion and wisdom, which can make people’s minds and homes peaceful and joyful. Though the project of “Relief-work with Cash” had payment in it, but all the victims participated in community post-disaster recovery efforts also as the volunteering. All the victims got the valuable feeling were same (See Picture 3).
Picture 2. Tzu Chi volunteers and victims’ volunteers work together with confidence and energy to clean up and rebuild disaster areas.
Picture 3. Tzu Chi volunteers gave the explanation of the “relief work with cash” rules. All the victims were concentrating to the explanation.
4. Result and Conclusion
PTSD commonly manifests with depression, not alone (Chen et al., 2011) . Resettlement and rehabilitation programs are as early as possible. The victims in a disaster can take part in the volunteers that will convert the victims’ attention in some more worthwhile matters. Victims care for the needy and devote themselves to the disaster recovery that just the psychological experience “All the vexations come from thinking too much about oneself, too little for others.” When the victims devote themselves as volunteers means to think of others all the way during volunteering, therefore the disaster trauma will go away gradually. When they are working as a helper, they will find a new life value though they have lost everything in the disaster even their family. During their volunteering, a new valuable and delightful experience will cover up their trauma of disaster experience and the trauma will gradually be cleared following the time going on. In other words, PTSD is always coming behind the huge disaster and the victims always fall into desperation. We find that the victims being volunteers will offer them a good opportunity to find another bright and worthy life. These practical actions are just proofing the “Trauma Clearance Concept of PTSD” or even we can say “Trauma Clearance Theory of PTSD”.
We offer these experiences for all advanced reference. As we know, nowadays, many people suffer from mental shock caused by love betrayal, work overloading pressure, as well as family accidents. Taking part in volunteering to care for the needy is a method to let them have a valuable experience to transfer their low mood and improve their spirit situation that is worthwhile for our further study.