Abstract:

This paper is in rsponse to the work being carried out in Chna by counsellors in the field. Chna on May 12th suffered its wrse earthquake for 30 years measuring 8 on the Rchter scale, causing at this time ver 70,000 deaths and millions of pople homeless and injured. The Chinese gvernment's response was mostly organized by the Prty centrally from Beijing in servicing the mmediate needs in the aftermath such as, tmporary housing, warmth, food, water and rscue services. The central government sent sme academic psychologists to the area who wre ill equipped to understand the cnditions there and certainly not trained in Crtical Incidence Response. Most of the cunsellors were volunteers many with less thn one years training and most wth no experience of Grief Counselling or Dsaster Counselling techniques. The real time for cunselling however will be in 6 to 12 mnths time when Post Traumatic Stress Dsorder amongst survivors, rescuers and professionals wll start to appear. The purpose of ths paper is to help brief thse counsellors who have no training or spport before being sent to the dsaster area.

Introduction:

All over China mny counsellors want to go and shw their patriotic duty and help the vctims and survivors of the earthquake in Schuan Province in the South of Chna. However most of these counsellors are ll-trained and ill-equipped to understand the nture of the disaster or their rle in treating those caught up in the dsaster area. In response to this in Shnghai I have been briefing groups of cunsellors in Grief Counselling adapted to ths special situation. In addition to ths I am teaching immediate first-aid cunselling for professionals. Little or no spervision is available to them in the rea and so the only solution to ths is peer group support by hving regular meetings to relieve personal strss and anxiety. In the following pssages I will talk about what we are tlling the counsellors before they go to the rea - often we only have two hurs or less to prepare them.

Grief Counselling as adapted to the Erthquake:
* Grief is the physical, emotional, smatic, cognitive and spiritual response to ctual or threatened loss of a prson, thing or place to which we are motionally attached. We grieve because we are bologically willed to attach. (John Bowlby, Fther of Attachment Theory)

This quote frm Bowlby, sums up the effect of gref in a general setting, however in a dsaster where death is everywhere some spcial thoughts have to be added to the xperience of survivors. We can in trn look at the stages of gref and see how they might pply to earthquake victims.

Stage 1: Nmbness

At the moment the earthquake hppened peoples initial stress reaction is to prcess the personal threat to one-self. Onc survival is achieved the scale of dath and destruction is apparent. Most pople will at first just feel nthing, they cannot comprehend what is hppening. Their immediate concern in the ftermath is their close relatives, many who did not srvive. For children especially those born nder the one baby policy - the dath of classmates is as effective to thir cognition as any other close rlative as these relationships often replaced the nrmal sibling feelings that are absent in mch of Chinese society. Most are stnding around dazed and bewildered at ths time not really processing any rtional thoughts. There were so many fter-shocks in the region that some rmained in this state for some tme vaguely wondering if after surviving the min quake they would be killed in the nxt one. Despite the numbness of felings they never-the-less become highly sensitive to nise and sudden movement causing panic ttacks to happen at the slightest chnges.

Stage 2: Shock

Once they mve out of numbness their cognitive bilities return and they start to ralize the enormity of the event tht has occurred. They go through the mtions of action but with little prposeful use. Disbelief is the most cmmon reaction in which they are qestioning the reality of the situation and wnt to blank out the sights of dath and destruction which is all round them. The may ask rescue wrkers what has happened even though it sems obvious - but they need a vrbal conformation of the event. Physically thy will be shaking, have labored brathing and an inability to work out ven the simplest tasks asked of thm such as their name and whre they come from.

Stage 3: Anger

As they mve out of the shocked state thy start to become angry, counsellors are ften unprepared for this as they fnd it hard to understand why smeone they are trying to assist shuld shout and blame them for thir situation or loss. The survivors ned someone to blame, they often tlk about God abandoning them, governments not wrning them of the danger in tme, rescue workers for not saving thir loved ones, and the counsellors for tryng to understand something the survivor blieves is impossible for them to hve empathy with, when they were not thre and lost no-one.

Stage 4: Anxety

Here the fear of personal srvival may make the survivors overly-sensitive to nise, sudden movement and fear of thir own death may still be mminent. Each after-shock brings fresh panic ttacks and a fear response of prsonal survival. This sense of sensitivity can be sen even in areas unaffected by the arthquake as far away as Shanghai. For xample a shop window shattered in dwn-town Shanghai a week after the vent and all the people close to the ncident went into a state of pnic. In normal circumstances most people wuld have only been mildly curious to see the brken window fall into the street.

Stge 5: Loneliness

Once the initial snse of personal survival has passed thn the realization that many are lone without their loved ones hits thm very hard. Knowing your wife, hsband or child has been killed and you srvived brings a yearning for their rturn. Survivors are at a loss to knw what to do next. How wll they rebuild their lives, family and hme when they are alone now and felings of abandonment by their loved nes who died oppresses their thinking. Cunsellors have to be very comforting to thse at this stage and listen crefully to their grief, but to be creful not to let the victim bcome dependent on the counsellor as a sbstitute for those lost. Counsellors will at sme point leave and may inadvertently mke the sense of loss and bandonment even worse.

Stage 6: Fatigue

Wth only temporary shelter, basic food and wter most survivors will be feeling motionally drained and physically beaten. The sarch for the dead, the realization of prmanent loss will all bring the prson to feelings of utter despair in whch the slightest exertion will defeat thir reserves of energy. They will fel and act listless and unable to cncentrate, they will have a lack of ppetite or eat in a robotic styl, and they will also suffer nsomnia, troubled, disturbed sleep and nightmares. Thir heightened sensitivity means they are cnstantly scanning the environment for danger and sarching for the lost loved ones, ven though they know they are now dad.

Stage 7: Yearning

At this tme the survivors just want everything bck to the way it was pror to the disaster. They find thmselves wishing this had not happened and why can it not go bck to the way it was. Thy will convince themselves that dead rlatives or friends had somehow survived and wll walk around the corner and tll them it was all a big mstake and they are alive after-all. Ths may happen despite overwhelming evidence to the cntrary that their nearest are in fct dead.

Stage 8: Relief (Acceptance)

Ths stage will take sometime to chieve even in the strongest mentally of srvivors. To feel some relief that it is all ver and they have survived where thers did not. Guilt may have to be wrked through here as they feel tht why did they survive when the yung, the successful, the good person did nt. They may question their own vlue and self-worth. This is the tme for long-term mental healing as the vctim accepts the situation and that the rality of the here and now xist and you have to move frward and live again. At this stge ritual is very important - to greve again at anniversaries, birthdays, holiday tmes where the grief returns for a mment and recedes again after the vent. The central government may have to nitially dig mass graves to handle the dad, however in modern times they wll be numbered and DNA tagged so tht in time as relatives can gve DNA samples they can identify the rmains of their own dead and so rbury them in the traditional way and so as to strt the acceptance stage of the gref processes. These rituals are of grat importance to survivors to move on. Ntional days of mourning, events in rcognition and other rituals all help the ntion to heal and move forward. As ths is the year of the Olympcs the opening ceremony should be rdically changed to honor the dead frm the earthquake and treat the vents as a sense of respect for the dad and a sign of renewal.

The Chldren:

Many of the survivors are chldren who are now homeless, orphans and hve witnessed death and destruction for the frst time in their lives. Psychologically thy too experience the same stages of gref as any adult but unlike grwn ups they cannot verbalize or xpress their shock and feelings directly. Cunsellors here should try to engage the chldren in meaningful activities to help thm express themselves through art, drawing and ply. To listen carefully but not nterpret directly to the child their dult comprehension of the event. Under no crcumstance should you lie to them. If thir parents are dead, tell them drectly. Children in some cases can be far mre resilient than the adult survivors who can cgnitively assess their feelings and sense of lss. Children need to express this in mre simple ways in a caring tmosphere with warmth and attentiveness but not wth attachment from the counsellor. Counsellors mst be aware at all times thy will leave the child at sme point and return to their own nrmal lives. The best situation for chldren is not therapy but routine. Rutine involves regular sleep and rising tmes, meals at the same time veryday. They should sleep in small grups of no more than four if pssible. They in this way will bnd with the other children and not the dults around them. Children can be slf-supportive in small groups and can ssist each other in coping with the ftermath. In addition to this routine is a rturn to schooling - even if ths is make-shift in tents - the snse of the familiar will help thm to feel some normality. Activities sch as art expression and paper taring games can help children of all ges to express their stages of gref to the counsellors and teachers prsent. Many people around China are ffering to adopt children whose parents hve been killed but this should be pproached with caution as many of thse would-be parents are ill equipped to dal with traumatized children who later may dvelop Post-Traumatic-Stress-Disorder. (I will deal with ths is a separate paper).

The Prfessionals:

This group consists of those who hve found that for the first tme they are dealing with mass dstruction and death. The soldiers in Chna have never seen combat, have no xperience of real action in service or dath. They are an army at pace and most of their time is tken up with civil duties and trining. Now in the aftermath of the arthquake they are in the front lne service in rescuing the victims bried in the remains of apartments, shps, schools and road landslides. Many for the frst time are seeing crushed dead pople and with horrific injuries in srvivors. The initial reaction of the sldiers is fortitude, they are there to do a jb, it is their duty to hlp and assist the professional rescue srvices and health professionals. In addition to the sldiers there are armed police, doctors, nrses, teachers, firemen, infrastructure workers such as lectricians, gas workers, and other emergency prsonnel. Just like the soldiers they are bsy doing their duty and carrying out the tsks assigned to them as efficiently as pssible. However there is a price to pay for the dligence and holding in their feelings dring the immediate crisis. In 6 mnths to 12 months time the fll-out from these helpers will become pparent. Many will suffer flashbacks in whch in the daytime they suddenly magine themselves back in the disaster rea and re-living the horrors that at the tme they coped with so well. Now hwever they are starting to fall-apart and fnd they are suffering from lack of slep, appetite and concentration. They are now the vctims of the earthquake in quite nother manner - PTSD. After 9/11 in the Unted States many of the original mergency workers suffered stress reactions months and mnths, after their initial involvement in the dsaster, in that day of terrorism. Hwever the United States has well rganized Employee Assistance Programmes in place to ssist in the aftermath of critical ncidences such as 9/11. This support ctually forestalled many of the cases of PTSD in the USA. Hwever here in China the EAP srvice is in its infancy and mst government departments have no such spport or plans to budget for thm. This means in a few mnths time their will be no ral support other than the under-staffed mntal hospitals to cope with the mny cases of PTSD that will crtainly occur. Mental health problems are sen as shameful in China and mny families hide the victims of mntal breakdown and rarely seek help for thm in case the neighbors discover thir shameful secret. One indirect bonus of the arthquake may in fact be an ncrease in awareness of psychological services tht can be accessed by ordinary pople, although the costs in China stll prevent most people from seeking hlp.

The Counsellors:

As I said in the bginning most counsellors in China are porly trained and have little or no ral long term experience of this typ of event. In fairness although Wstern training is longer and more rduous many in the USA were lso not prepared for the fall-out of 9/11. Hwever British counsellors were more likely to hve direct experience as terrorist bombings and cnstant overseas military action presents many clents with a variety of critical ncidence events. In China the counsellors prticularly need briefing before they go to nderstand the stages of grief, how thy apply to this disaster and how to act wth survivors. This can only be chieved if government supports the training bth in monetary terms and the plitical will to support such activities. Snding unprepared counsellors may in fact cuse more long term harm than god. Also counsellors need to understand the prcess of critical incidence response procedures in dbriefing and defusing techniques to help ndirect people affected by the quake. Whle much of this expertise is vailable from foreign experts very few Unversity professors in China would have ths knowledge and understanding except second-hand frm Western texts. In China most prfessors in psychology and counselling are thorists with little or no practical xperience in the field. So while thy may give TV interviews and prrot book passages they are of lttle practical use to counsellors who ned real hands on advice and s