Thursday, January 9, 2020

Healing the wounds from the Puerto Rico Earthquakes: Components of Community based Psychosocial Support (CBPSS)

Joseph O. Prewitt Diaz, PhD
Disaster Mental Health Advisor
National Capitol region
Washington, DC

Disasters, whether natural events or human generated, wound the geographic location that they impact, and wounds the emotional fabric of the survivors.  The physical wounds, can be seen, treated and will heal, with appropriate treatment in a short period of time. The emotional wounds, are not seen, and because they go unnoticed, they linger on in the psyche and the memories of those affected. Community-base Psychosocial Support (CBPSS) supports affected people to share their history, visualize their experiences, and  through community walks beginning to transform loss into a re-establishment of place, a new beginning, and feelings of resilience.

A healthy seed cannot grow into a plant without fertile soil, light and water, and yet we resist to recognize the importance of the environment in our life.  It is important to consider how place molds our behavior and optic when facing a problem such as the destructive earthquakes in Puerto Rico. 
Place is important for human beings right from the beginning. The greatest need that the affected people  have right now, is the ability to control their own experiences. Whether we are happy or sad, is related with the place where we decide to spend our lives.  Our actions, thoughts, and feelings are shaped not only by our physical or psychological make-up, but by our place. The residents of Puerto Rico are dealing with the destruction of their emotional ecosystem, their livelihood, and their loss of safety and security. Our body-social memory has been disrupted. 
The population has lost their places. Places are thus both personal and social, made of human and non-human lives. Through making and maintaining places, individuals sustain the mazeways and enacted assemblages created through personal, bodily, social, and material worlds. Ecological characteristics provide structure for individuals and social groups, and may include places of worship, schools, marketplaces, and parks. Social institutions that are located throughout places and neighborhoods offer regular activities and rhythms for local and social communities. 

There are three pillars that interact in a dynamic movement of affected people and resources in place

First, the welfare and recovery of the affected people depends upon a dynamic process of interactions between the affected people's needs and resources in place. To determine the needs of the affected people  the CBPSS personnel conduct on-site interviews with survivors, explore historical images, elicit maps of the place, and displays photos with scenes of destruction. Rather than treat the audience as spectators, they are called upon to be guests and resident experts, to perceive the disaster destroyed geographical location  as an inhabited place. In this matter, slowly, the affected people begin to unfold and open-ended pathways of memory that generate possibilities of shared belongings in a re-established place. The affected people, through psychosocial support activities accept the new reality, engage in the difficult process of mourning, begin a process of emotional transformation of the self, and as a group visualize and develop a new community. The dialectic of loss is reframed into a path of development, where we can discard the old and embrace a new beginning, a re-established place. 

Several factors interact, playing an equally important role in the growth and welfare of a person. We can classically distinguish the various factors as geographical (space, ecological factors), physical (food, shelter, protection, medical care), psychological, (attachment, affection, self-esteem), spiritual (belief system, identity, and values) and social (family, friends, sense of place to which one belongs). A person is not an isolated individual but one who belongs and interacts in a given time and space with the community where he/she finds him/herself, whether it is the original or an adopted community. Therefore, to facilitate recovery and reconstruction and enhance resilience and well being, we must  act on various levels: individual, family, place, or community.  

Second, we must consider a holistic approach to recovery of the earthquake affected communities. The holistic approach of mobilization takes into consideration the results of an assessment of needs and resources of the affected place, in time, and assist the affected people to identify the geographical, psychological and social capital available to them, and at the same time, identify interventions that will enhance the well being. A deeper appreciation of the lived, place-based experiences of the affected people would enable the stakeholders to consider more ethical and sustainable forms of community action.  

Sharing stories and experiences  from the past (e.g. has this happened here before? or how did your elders cope with the situation?), will revive lessons, in the affected people that will evolve into creative practices in re-establishing place. The affected people will think differently about the new possibilities in at least three ways. First, inclusion of all affected creates the feeling of being visible to partners and external stakeholders. Through their narratives and performances in community theaters, affected people documented their presence (how they used, moved through, and made their place, neighborhood, and community).  The affected people are able to assert the right to be a part of the recovery (healing process) of their place, neighborhood, and community. Second, they communicated and enacted their experiences of place as inhabited, an understanding based upon psychological attachments, bodily and social memories, and fragile social ecologies. Affected people, as they consider the tensions of acceptance of the loss of everyday life in their place, are encouraged through CBPSS to remember life in an otherwise previously part of an affected neighborhood and community. 

If the earthquake affected people are understood as having been wounded by prevention activities after Hurricane Maria, or lack thereof, and the devastating power of the disaster itself, other images of place might focus attention on why places, peoples, groups, and environments, have been injured.  

Finally. the  active metaphor of  “wounded place” is operational in the psychosocial realm.  If the affected people, their place, and neighborhood are wounded through displacement, material devastation, and emotional raections, so too is the whole community and its inhabitants. 

Disaster wounds uncover old wounds, be those tied to the particular histories of the affected people in the place, processes, and traumas of displacement. The un-wrapping of old wounds and common stories about place, are important in terms of intergenerational relations and silences, and the affected individual, families and neighborhood  capacity to repair. CBPSS may offer possibilities of place-based mourning and care across generations that build self-worth, collective security, and social capacity. Materially, CBPSS activities motivate the creation of social capital, provides a range of memorialization activities, creates new forms of public memory, and is committed to intergenerational education and social outreach.

The third  pillar stresses the rights based ethic of care of a psychosocial intervention which lies in the complex interaction between the individual, the natural and made environment, and the social configuration of the affected place.   A CBPSS will address basic needs (food, shelter, protection and health) that will provide safety and security and increase comfort. Promote self-esteem and a sense of belonging to place (resilience). Value and use the resources of the person, the place and the community. Foster the reconstruction of the significant children and adults in their lives, family, group, and  social fabric. Increase social access through the school, place and community. Celebrate traditional, religious, and cultural aspects that promote growth in their place.

The psychosocial activities that are recommended to alleviate fear and promote well being are:
  • ‘Caring about’ someone or something helps individuals to recognize need in others, thereby resulting in attentiveness. Here I would include ‘caring about places’ as a type of care that encourages attentiveness in the ways that places are both deeply personal as well as socially shared. 
  • 'Taking care of’ someone or something in the affected areas and surrounding communities.  Place-based caring can be as simple as picking up trash on the beach to hosting a neighborhood potluck to organizing political protest actions; such feelings and actions produce responsibility to oneself, to others, and to places, neighborhoods, and social communities. 
  • ‘Giving care’ means that the feeling of responsibility for doing the work of caring for oneself and getting that work done produces competence in caring work. For example, in working in several affected communities after Hurricane Maria, I observed that, individuals may gain self-confidence, leadership skills, and social respect when collaborating over several months, and successfully creating a neighborhood community garden, planting trees, and fixing the “caminos” in the neighborhoods.
  • ‘Receiving care’ means that one makes sure the care work has been done and it has made things better; such a commitment produces responsiveness. This fourth type of care is not only the most difficult; receiving care also means that one must allow others to share in the responsibility of caring for oneself. To do this means to recognize the ‘other’ as different than the self in ways that might allow for inclusiveness and openness, including also listening to others, enhancing one’s own sense of self- worth, and crafting new social shells.

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