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In Sri Lanka, family and friends help ease mental pain

This painting, done by a student of the Batheegam middle school in Sri Lanka, depicts the devastating tsunami that swept across the coastal regions of the island in 2004.
This painting, done by a student of the Batheegam middle school in Sri Lanka, depicts the devastating tsunami that swept across the coastal regions of the island in 2004. SUN HERALD

Iresha Susanthi was playing on the beach with friends in the southern Sri Lankan village of Batheegama when the tsunami came in late 2004.

She was 8 years old at the time, but said recently she remembers well the cries: "The sea is coming! The sea is coming!"

Susanthi took off running with friends and made it up a nearby hill. The moment everything seemed safe she descended and ran home. She said it took another two days to find her mother's body.

For a while, things were bad for Susanthi. She said she was sad and afraid of the water. Yet she got better. She said she moved in with her married sister and talked often with others about her mom, about the terror they all faced that day.

With a shy smile she said she loves the water again, and will play by it and in it regularly.

"I see the sea always," said Susanthi through a translator. "It always goes back."

Interviews and conversations with more than a dozen Sri Lankans who survived the tsunami reveal a similar pattern: They were terrified when it hit. They were depressed when thinking about what happened for a brief time. They talked about it a lot with family and friends. They feel better today.

While there are exceptions, few mental health professionals in Sri Lanka agree with the widely held belief that as many as one-third of all disaster survivors require professional mental health help. In Sri Lanka, they say, just about everyone has moved past the trauma of the tsunami already.

"It looks as if some of these people, many of them, dealt with their problems on their own," said Dr. Nalaka Mendis, one of only a few dozen practicing psychiatrists in Sri Lanka with hundreds of patients. "I don't know of anybody who left work or said I'm going to do this (terrible thing) because of the tsunami."

One theory put forth as to why Sri Lankans did well post-tsunami is that their 25-year ongoing civil war between the Tamil Tigers and majority Sinhalese government has hardened the population. As recently as July 11, four people were killed in a terrorist gun attack on a public bus and, since the war's inception in 1983, estimates of civilian casualties alone range as high as 65,000.

This is too easy an explanation for most locals. Also, psychiatrists generally agree that each trauma is something new. What normally happens is that each new trauma triggers undealt-with emotions from previous traumas, rather than making it easier for the next one to come.

Another explanation for the mental health recovery is that foreign aid actually worked and reached everyone. (By the way, both that and the hardened population theory are similar to sentiments offered by Pearlington residents, who say their longtime isolated go-it-alone struggle in poorer circumstances made them better able to handle Katrina's destruction. They also credit the unending cycle of volunteers for their current well-being.)

Yet it is easy to find skeptics to both of those explanations inside and outside the country. The only thing that everyone agrees most likely contributed to the general mental well-being of Sri Lankans after the tsunami is that, like nearly all of the developing world, it is hard to get some alone time.

"It's due to the collectivism," said Chrishara Paranawithana, a program officer with the World Health Organization's mental health initiative in Sri Lanka. "It's a collectivistic society. Each and everyone is close. You have a network of family and friends. You are closer to your neighbors and more able to respond to others' needs. It think it helped quite a lot."

There are exceptions to the majority who are doing well, of course. Inuka Thilkwaeda, a 15-year-old who lives in Madiha on the southern coast, was praying in a Buddhist temple about a half-mile from the beach when the tsunami hit. He ran and was so far ahead of the waves he did not actually see them when he turned around. Yet he claimed in a recent interview to see the ghosts of people who died in the tsunami by the beach.

Thilkwaeda, however, may not suffer long. As he told this story, his monk and some Red Cross workers expressed shock and promised to talk with him about his issues at the appropriate moment.

Across Sri Lanka, expressions of anxiety, stress or depression are quickly met with open arms and ears.

Champika Liyanaarachchi, editor of the Daily Mirror, Sri Lanka's largest independent daily newspaper, said none of her reporters, who saw unimaginably horrible things and sometimes lost their own homes after the tsunami, did poorly mentally after the storm.

"They were traumatized," Liyanaarachchi said. "But what we did was we always discussed things. If you can just talk with somebody, I think that's therapeutic."

The series

Post-disaster mental health, like mental health in general, is a dark art. While there is a lot of research and many years of practice in both, there is no guaranteed, positive way to handle post-disaster mental heath issues like there is, say, a broken bone or a cut.

The general agreement among American professionals is that disasters necessitate some sort of mass public mental health intervention. However, figuring out exactly who will be affected and how they are affected exactly is still anyone's guess.

This three-part series examines what has happened in Sri Lanka since the tsunami in terms of mental health issues through the lens of the post-Katrina experience.

Sunday: The Sun Herald looks at the response itself. There was a troupe of organizations that rushed in to lend a hand, to rebuild homes and rebuild allegedly fragile psyches. What did they do? What did they offer?

Monday: The Sun Herald looks at how individual Sri Lankans are recovering today. About 30,000 people died in the tsunami in Sri Lanka, so nearly everyone either lost someone they knew, or knew someone who lost someone they knew. At the same time, the population is dealing with an ongoing 25-year civil war and has dealt with large-scale trauma repeatedly. Prior to the tsunami, Sri Lanka had one of the highest suicide rates in the world. What kind of effect did that have on their mental health recovery from the tsunami, if at all?

Tuesday: The Sun Herald looks at what Sri Lankans have to say to their Gulf Coast counterparts as they glimpse into the future of disaster mental health. Mentally, why and how did the Sri Lankans get to where they are today?

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