STEVE INSKEEP, host:
The earthquake did more than shatter homes and bodies. Haitians are also struggling emotionally and the emotional wounds are no less serious for being invisible. Alix Spiegel�has this story about the role of mental health professionals.
ALIX SPIEGEL: They came after Oklahoma City and flooded Sri Lanka in the wake of the South Asian tsunami. They came in droves to New York after 9/11. And according to Richard Mollica, a professor at Harvard who spent his life researching mental health responses to natural and man-made disasters, mental health professionals will soon come to Haiti as well.
Dr. RICHARD MOLLICA (Harvard University): Theres going to be many, many, many, many hundreds and hundreds of organizations - big, little and small doing mental health work in Haiti. And they all have their own agenda and their own donors and their own goals.
SPIEGEL: There is no doubt, Mollica says, that all come with the best of intentions. But, he says, the work of a mental health professional in the aftermath of a major disaster isnt always clear.
Mr. MOLLICA: Mental health has had a hard time figuring out how to fit in with the medical response.
SPIEGEL: Apparently, while mending a broken leg is pretty straight forward process, mending a broken heart is much more fraught. In fact, according to Sandro Galea, former director of the Center for Global Health, organized mental health responses to major disasters are really relatively new.
Mr. SANDRO GALEA (Director, Center for Global Health, Former): The big shift in the field came after the Vietnam War.
SPIEGEL: Is he it was only after Vietnam that American psychiatry came up with a formal definition of Post Traumatic Stress Disorder. But once PTSD was firmly established, the mental health community actively embraced it.
Mr. GALEA: Scientific and the therapeutic community really coalesced around providing services for people who are experiencing traumatic events.
SPIEGEL: But unfortunately, though they was a clear definition, initially, mental health professionals didnt have clarity at all about what should be done to prevent PTSD. One big idea though, that did became popular through the 80s and 90s, was this idea that professionals should encourage victims to talk in a very, very detailed way about what has happened to them, within days of a traumatic event. Richard Mollica says people just assumed that this would help.
Mr. MOLLICA: At the time of the tragedy, sharing that story with people and going through it point-by-point, would sort of discharge any emotional upset that you might stir up, and that might come back to haunt you six months from now.
SPIEGEL: And so, after Okalahoma City, and 9/11, and Katrina, mental health professionals rushed in to help. But in 2007, according to Sandro Galea, two big research reviews came to a very clear conclusion about this practice, known as debriefing.
Mr. GALEA: The body of evidence suggests that it actually might harm people and that people who actually do undergo debriefing probably do worse in the long term and in the short term.
SPIEGEL: This doesnt mean to both Galea and Mollica that its always harmful to discuss your experience. Its just that those kinds of discussions are probably better left till months later, when there is time to teach people who have been traumatized how to master or counter their feelings. So these days, says Mollica, the new approach of the mental health community is something called psychological first aid.
Mr. MOLLICA: Its kind of the bible now of how to approach survivors, psychologically, in the acute phase.
SPIEGEL: The funny thing about psychological first aid is that theres really very little thats particularly psychological about it. Mollica says its mostly very practical, basic social work.
Mr. MOLLICA: You cant find your son. Well, this is who you need to talk to at the Red Cross to find your son. You dont have enough of water for tonight. This is who you need to work with, you know, to get water for yourself.
SPIEGEL: By clearing a path for people in this way, Mollica says, you reduce the stress on them, which ultimately helps them to avoid more serious psychological repercussions down the road.
Alix Spiegel, NPR News, Washington.
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