Figure 5.1 The author, Anie Kalayjian, in a classroom set up in an army tent, assisting Armenian adolescents in expressing their experiences and feelings following displacement from the earthquake. (Personal photo of the author, taken in Leninakan, now Gurnei, Armenia, January 1989.)
Coping Through Meaning: The Community Response to the Earthquake in Armenia
Bereavement is the reaction to the death of a loved one; collective bereavement, therefore, is the reaction of the community to a massive loss. This chapter describes the collective bereavement and coping of a community in the Republic of Armenia after the devastating earthquake of 1988. It reviews bereavement patterns and systematic responses to the disaster, discusses research, and presents logotherapeutic perspectives as therapeutic modalities.
THE DAY THE LAND MOVED: DECEMBER 7, 1988
On Wednesday, December 7, 1988, at 11:41 a.m., a devastating earthquake shook the Republic of Armenia (Soviet Armenia at that time) for 40 seconds. This catastrophic destruction occurred in a zone where several plates of the earth’s surface converge. The quake did not come as a total surprise to American and Soviet experts in the field, according to the Director of the Geological Institute in Frankfurt (Sullivan, 1988). But, due to gross unpreparedness and lack of emergency and evacuation plans, the Armenian community experienced the quake as a total nightmare.
Measuring 6.9 on the Richter scale, the 1988 quake occurred in an area highly vulnerable to seismic activity. It destroyed two thirds of Leninakan, Armenia’s second-largest city (now Gumri, population about 300,000) and half of Kirovakan (population 150,000), and heavily damaged some 56 of 150 villages and towns in the northwest corner of Armenia, near the Turkish border. Spitak, a town of about 30,000, lay at the epicenter of the quake and was obliterated.
Earthquakes have been part of Armenian history. In 893 AD, a quake in the same general area of Armenia caused 20,000 deaths. In 1667, another earthquake in that general region claimed 80,000 lives, and, in the late 1800s, yet another devastating quake had taken place in the same general vicinity (Sullivan, 1988). The 1988 earthquake, however, was an order of magnitude beyond these tragedies. “I have Chernobyl behind me, but I have never seen anything like this,” Yevgeny I. Chazov, the Soviet Health Minister, told the government newspaper Izvestia after visiting the scene with fellow physicians (Fein, 1988, p. 23).
Initial reports of casualties spoke of “thousands,” which then became “tens of thousands” and went on to climb day-by-day to 130,000, even though the official death toll was announced as 25,000. In the end, there were approximatley 500,000 people handicapped, approximately 500,000 children orphaned, and over 500,000 (one sixth of Armenia’s population) left homeless. A more accurate count of human loss was very difficult to determine for several reasons: the uncertain number of refugees from the February 1988 massacres in the Azeri cities of Baku and Sumgait; the poor record-keeping procedures; and, finally, the Soviet government’s covert style of operation. Therefore, the above estimates, or any estimates from this incident, are only provisional. Proportional losses in the United States would have amounted to six million dead and 40 million homeless. The physical damage was estimated at $20 billion (U.S.) (Kalayjian, 1995).
All hospitals, schools, churches, and community centers were severely damaged or destroyed, unlike the Mexican quake of 1986, the San Francisco quake of 1989, and the Los Angeles quake of 1994. Survivors were forced to head for the capital, Yerevan, 90 miles southeast of the epicenter, to receive emergency medical care. This meant traveling 4 to 6 hours, instead of the usual 2 hours, due to the extremely crowded conditions and roads that were partially destroyed by the quake. The delay caused additional casualties. “My only brother, 10 years old, died in my arms in the car going to Yerevan,” stated Nayiri, a 16-year-old female Armenian survivor from Spitak.
In the earthquake region, survivors had no services or buildings left intact in their community in which to seek support or refuge. In turn, this made relocation for all survivors a necessity and created additional stress and trauma. Further trauma was caused by the Soviet government when it decided to relocate women and children to Yerevan and other Soviet Republics while keeping the traumatized men in the earthquake zone to help “clean up” (Kalayjian, 1995). According to Terr (1989), families cope better if they remain together after a trauma. Therefore, these relocations and separations further aggravated the trauma by shattering and displacing family units.
Assistance from all over the world poured into Armenia. Within the first 10 days, $50 million worth of goods, food, and supplies were delivered to Yerevan’s airport from around the world, overwhelming the damaged distribution system. This airlift marked the first time since World War II that the Soviet government had accepted disaster assistance from the United States. In all, the American government spent about $4 million, and U.S. Air Force and National Guard planes were used to fly in the relief supplies. Private contributions from Americans in the first 4 weeks following the earthquake reached about $34 million. The grand total given by all countries outside the Soviet Union reached $106 million (Simon, 1989). According to U.S. Senator Paul Simon, what the United States did as a nation was not that impressive in view of the fact that the United States represents 20% of the world’s economy. However, aid sent by the U.S. government to the Soviet Union and the Soviets’ acceptance of it were unprecedented. When the Marshall Plan was announced in 1948, the Soviets would accept no American aid whatsoever. Therefore, the fact that aid was given and received was a healthy sign of collaboration (Simon).
Survivor Characteristics in Armenia
Who were the survivors of the 1988 earthquake in Armenia? They were intelligent, hard-working, peaceful, religious, family-oriented, and hospitable people (Jordan, 1978). The Republic of Armenia is geographically the smallest of the former Soviet Republics (11,500 sq. mi.), with a population of approximately 4 million, and is the most entrepreneurial and the economically fastest-growing republic (Walker, 1991). An Armenian presence in the general region of Asia Minor and the Caucasus dates back over three millennia (Ishkanian, 1989). Armenia’s history through the centuries is one of enduring oppression, war, relocation, and survival. From the end of the 14th century until 1991, Armenia had only 2 years of independence (1918–1920); yet its people, culture, and language survived. On September 23, 1991, Armenia once again declared independence. For the first time in 71 years, the Armenian people freely elected a president and representatives to the Republic’s Parliament, the Supreme Soviet, from a slate of candidates representing a variety of political movements and organizations.
In discussing their history, Armenians mention three things: their religion, language, and survival. Religion is a point of great pride since Armenia became the first nation to adopt Christianity as its national religion in 301 AD. The Armenian language is a distinct branch of the Indo-European family of languages, with a unique 38-character alphabet. Lastly, they mention their survival of the Ottoman-Turkish Genocide. From 1895 to 1923, the Armenian nation was brought to the brink of annihilation as almost 2 million Armenians, more than half the Armenian population, were massacred by the Ottoman-Turkish rulers. To this day, the Genocide is denied by the current Turkish government. This denial causes tremendous anger and resentment, with no reparation or resolution in sight (Kalayjian, Shahinian, Gergerian, & Saraydarian, 1996).
During World War II and for over 70 years under Communism, Armenians experienced yet more pain and suffering. The Soviet system relied on the oppression of individual needs for the sake of the party, and any attempt at independence could lead to one’s disappearance (Kalayjian, in press-b). Pain and suffering continued in the postindependence era, due to territorial conflict with Azerbaijan (East of Armenia) over Nagorno-Karabagh, a 4,000-square kilometer enclave (at the southeast border) mostly populated by Armenians and locally ruled by Armenians until 1923, when Josef Stalin gave it to Soviet Azerbaijan. Adding to the suffering has been the Azeri blockade of Armenia. This blockade began in 1988, preventing 80% of goods destined to Armenia from entering that country. As of late 1996, this crippling blockade had yet to be lifted.
The literacy rate is comparatively high in Armenia. Virtually all Armenian children attend school for 8–10 years from age 6 to 16. People are industrious yet poor, as the economy has been decimated by decades of Soviet rule, further exacerbated by the Azeri blockade. As in many third world countries, an insurance industry is nonexistent. Per Soviet design, healthcare is free in Armenia, but the quality and availability vary greatly.
Sociopolitical and Economic Climate at the Time of the Disaster
During the 10 months preceding the quake, Armenia was experiencing sociopolitical tension and was economically drained. This was due to the conflict with neighboring Azerbaijan over Nagorno-Karabagh, a historically Armenian area, given to Soviet Azerbaijan by Stalin to ensure instability in the region. For over 50 years, Armenians in Nagorno-Karabagh were oppressed by the Azeris: they were forbidden to speak their mother tongue or practice their religion, and were forced to adhere to Azeri Muslim traditions. In early 1988, Armenia challenged Gorbachev and put “Glasnost” and “Perestroika” to their first true test; the challenge failed. As a result, in 1988, over 200,000 Armenian refugees from Azerbaijan came to already overcrowded Armenia. In February 1988, there was a yet another massacre in Sumgait, Azerbaijan, where dozens of Armenians were killed, houses were burned, and women were raped and set on fire (Kalayjian, 1991b).
Seismologists described the quake area as a “structural knot,” engendered by the interaction of several rigid plates (Sullivan, 1988). Ironically, this paralleled the sociopolitical and emotional situation: political agitation, tension, anger, resentment, disappointment, and mistrust, due, at least partly, to rigid attitudes.
Bereavement
In the early 1930s, researchers began to describe stages of the bereavement process (Parkes, 1975; Pollack, 1961). Later, researchers distinguished the differing affects and intensities of feelings in each phase (Erikson, 1976; Glick, Weiss, & Parkes, 1974; Smith, 1971). In light of research in three countries following natural disasters, this author found more similarities than differences across cultures in the sequential nature and symptomatology of the bereavement process (Kalayjian, in press-a). The two generally accepted phases are the acute and the chronic. The acute phase includes the following stages: the initial feeling of shock, fear, numbness, disbelief, and denial; followed by sadness, weeping, generalized anxiety, helplessness, frustration, emptiness, and meaninglessness. Unique to the earthquake in Armenia were expressions of feelings of anger. The chronic phase may include attempts toward reintegration, moving towards acceptance of the loss, and finding meaning in trauma and bereavement.
These phases do not prescribe how a community should respond to a massive loss; instead, they attempt to summarize and organize the reactions often observed by mental health professionals. They attempt to shed some light onto the dynamics of massive loss. Coping and adaptation to massive, often unexpected natural disasters (e.g., an earthquake) are complex emotional phenomena. The conceptual framework presented in this chapter is only a guide for professionals, the community leaders, and the surviving community in their attempt to make sense of the chaotic and to manage the unmanageable.
General Systems Theory
Natural disasters, no matter what the degree, intensity, or kind, subject the surviving community to a wide range of disruptions and stressors. It is useful to look at the impact of a natural disaster on a community from a general systems perspective, that is, to view the general science of “wholeness” irrespective of the nature of the entities. Part of this view includes seeing the community as an “open system,” a living organism that maintains itself in a continuous inflow and outflow, in a building up and breaking down of components (von Bertalanffy, 1968).
Disasters and mass trauma affect an existing community social system, with its unique historical background, predisaster characteristics and experiences, traditional rituals, cultural practices, religious beliefs, and psychosocial responses. Any event that affects one part of the system will affect the whole system, directly or indirectly. One system influences the other and is in turn influenced by it. The parts of a living system cooperate not just with each other but with the whole, and are homeotelic, seeking order and stability (Goldsmith, 1993). Therefore, although two thirds of the Republic of Armenia were directly affected by the earthquake, the entire country was affected to some degree.
Disaster Research
Scientists often place emphasis and focus their research and discussions on the here and now, on the disaster itself and its immediate impact on the community. It is as if the disaster has occurred in a vacuum, as if the clock stopped at the time of the disaster, as if the community did not have a past or future. According to Bolin (1989), however, predisaster characteristics are important in determining the degree of vulnerability to the trauma as well as the impact and the psychosocial response to it.
Predisaster characteristics, socioeconomic climate, and psychosocial responses to any disaster are important areas to assess. According to Quarantelli (1985), distinguishing between disaster-produced stress and response-generated demands is essential in gauging the types of mental health services necessary to assist the surviving community. Bolin (1985) suggests that survivor characteristics, event characteristics, and psychosocial responses are the three categories for preassessment of the community. But three additional categories are necessary (Kalayjian, 1995): issues during the disaster relief; sociopolitical and economic climate before, during, and after the disaster; and resistance to change.
Current disaster research suggests that traumatic experiences may result in posttraumatic stress disorder (PTSD) in survivors. According to DSM-IV (American Psychiatric Association, 1994), PTSD is categorized as an anxiety disorder with the following symptoms experienced for over 1 month of duration following exposure to a traumatic event: persistent reexperiencing of the event, persistent avoidance of the stimuli associated with the trauma, and clinically significant decrease in the individual’s ability to function.
Not all traumas cause psychopathology, and not all psychopathology resulting from a massive trauma can be diagnosed as PTSD. Expert clinicians are necessary to make the differential diagnoses and to meet the mental health needs of a community following disasters.
Logotheory
Logotheory is based on spiritual and existential principles, placing emphasis on meanings instead of feelings as a means of understanding and resolving spiritual conflicts. Logotherapy, as a form of individual and group psychotherapy, was introduced by Frankl (1969). Logotherapy is the third Viennese school of psychotherapy, the predecessors being the Freudian and Adlerian schools.
There is wide misconception that Frankl introduced his theory as a longtime prisoner of the Nazi concentration camps; in fact, he had introduced the core concepts of logotherapy before his imprisonment. But, in the concentration camps, he was first able to put his theory to use. Although his entire family except his sister died in the camps, Frankl was not only able to find meaning in his suffering, he was able to help many other prisoners to exercise their will to freedom. When all is taken away, due to humanmade or natural disasters, Frankl tells us to focus on “the last of human freedoms—the ability to choose one’s attitude in a given set of circumstances” (1969, p. 73). This ultimate freedom is what we can exercise in any given situation, even in the worst conceivable one.
Frankl is well known as the author of Man’s Search for Meaning (1962/1984), which outlines his pioneering work pertaining to treatment of PTSD and other existential crises. In logotherapy, or existential analysis, the human will to give meaning is the core for most behavior. In his writings, Frankl (1969, 1978) consistently points out that human beings readily sacrifice safety, security, and sexual needs for things that are meaningful to them. According to Frankl (1978), being human means being always directed and pointed to something or someone other than oneself: to a meaning to fulfill or another human being to encounter, a cause to serve or a person to love. Only to the extent that one is living out this self-transcendence of human existence is one truly human.
For Frankl (1978), each life situation is unique, and therefore the meaning of each situation must be unique. He asserts that therapists can never define what is or is not meaningful for individuals; meaning is often found in a self-transcendent encounter with the world. Just as people differ in their perceptions of trauma and in the ways that they cope with it, they also differ in the meanings they attribute to the same situation. Frankl (1962/1984) points out that meanings and meaning potentials are reactive to trauma and thus can be clouded, covered, and/or repressed. Such meaning repression will ultimately lead to a meaning vacuum or existential vacuum. This vacuum is then filled by the development of anxiety, depression, phobias, compulsive sexual behavior, or self-medicating practices, as in the case of substance abuse.
Frankl was the first psychiatrist to recognize the positive outcomes from traumatic situations. The role of the therapist within logotherapy is to help the trauma survivor discover a unique personal meaning, thereby transforming the trauma-related pain and suffering into meaningful awareness or a rediscovery of meaning in one’s own existence.
Several other theorists have expressed ideas on meaning. Jung (1972) stated that finding meaning in life was a difficult task, and he believed that most of us were not forced to answer the extraordinary question of the meaning of life. Adler (1980) stated that every human being had assigned a meaning to life by the age of 5 and that this meaning, although unconscious, objectively existed.
Frankl (1962/1984) maintained that, as long as we are breathing, our life has meaning, whether we believe it or not, whether we have discovered it or not, and whether we admit it or not. Tolstoy, in his book My Confession, reinforced Frankl’s assertion that life has meaning and that we must have the mental capacity to understand it (Leontiev, 1992). Traumas, whether humanmade or natural, have the ability to challenge previously held assumptions about the meaning of life and to force the discovery or rediscovery of a new meaning, one that incorporates the new experience and the the trauma and that integrates one’s personal perception.
PSYCHOSOCIAL RESPONSE OF THE ARMENIAN COMMUNITY
The Acute Phase
Four to 6 weeks after the earthquake, I interviewed survivors at five shelters located in Soviet Armenia (N = 60). Survivors in this study ranged from 22 to 65 years of age, with a majority (75%) being between the ages of 30 and 60. Half of all respondents were male. A majority (68%) were college educated (which is consistent with the general population). Over 62% were married. The overwhelming majority (98%) had lost their jobs as a result of the earthquake and had been forced to relocate. All had incurred physical and monetary losses (Kalayjian, 1996).
In this initial phase, immediately after the trauma, the following stages were detected:
1 Feelings of intense fear, shock, numbness, and disbelief. Several different subpopulations of the community were observed in their natural environments, for example, school-age children and adolescents in their classrooms and during recess, in hospitals, shelters, or in their homes. Adults and older adults were observed at their workplaces (if they were still employed), in hospitals, at government shelters, or in their homes.
Feelings of fear (98%), shock (98%), disbelief (62%), and numbness (58%) were often expressed. This was consistent with research findings in bereavement as well as in disaster research. Survivors repeatedly stated: “I am really scared; I try not to think about it (the quake), but it is still in front of my eyes.” “I can’t believe this, I am in shock,” and “If they had told me that there was a horror movie such as this (quake), I would not have believed it.” There were piles of steel, chunks of concrete, leveled buildings, and the stench of corpses everywhere. People wearing inadequate clothing wandered about, their eyes filled with tears of sadness, shock, and disbelief. This was compounded by the terror of impending aftershocks and the decreasing hope of finding loved ones.
In this acute phase, it is essential for mental health caregivers to assess the community’s psychosocial needs effectively, focusing on target groups. The most vulnerable groups affected by the earthquake as well as any other natural disasters are: the very young, adolescents, and the very old, due to their concurrent developmental challenges. Other vulnerable groups, due to the weight of responsibilities in key positions are: governmental officers, administrators, clergy, media, educators, disaster relief workers, and healthcare providers.
2 Sadness and generalized anxiety. These feelings generally followed for the majority of survivors once feelings of disbelief and denial were, as survivors later reported, found to be ineffective. A deep, enduring sadness prevailed in Armenia as a whole, even in areas that were not directly affected by the earth-quake, i.e., where there were no physical damages, nor any financial losses or casualties. It was a collective sadness, connected to their identity as Armenians and how they felt about their country and their land.
This was inconsistent with the feelings expressed to this author by American survivors of the 1994 earthquake in Southern California and Hurricane Andrew in Southern Florida. Earthquake survivors in Armenia talked about their land as “holy,” “unique,” and “one and only.” They expressed spiritual and emotional connectedness to “Mother Armenia,” unlike survivors of Hurricane Andrew or the 1994 earthquake in California, who expressed plans to move to another state or another part of the country, with little emotional difficulty expressed.
3 Uncertainty. In addition to fear, uncertainty pertaining to their connectedness to the earth, to the “Motherland,” was expressed frequently (by 75% of respondents). Violent aftershocks continued for 2 months after the initial quake, and, with each aftershock, the sense of uncertainty was exacerbated. Every bull-dozer or truck passing by caused a minor tremor that would jolt survivors, disconnecting them from their beliefs regarding the safety and security of the Motherland. But the majority of the survivors expressed in a heroic manner: “This is the land of our great-great-great-grandparents; our roots are here.” “We have been here for over three millennia, we’re not going to leave no matter what” (Kalayjian, 1994).
Other uncertainties caused by the quake and by the Soviet regime overwhelmed many survivors. “What’s going to happen to my home?” “Are they [the Soviet government] going to provide us with food?” asked survivors, focusing on their basic needs for shelter and food. Some survivors were more pessimistic and fatalistic in their expressions: “Nothing is certain when the earth itself moves under your feet” and “If this quake could destroy our country in 40 seconds, what is the use of all the everyday planning we do in life—all for nothing!”
Uncertainty coupled with fear overwhelmed many survivors and influenced all aspects of their lives as well as their decision making. In a previous research study conducted by the present author with spouses of cancer patients, uncertainty was also one of the major coping difficulties expressed (Kalayjian, 1989). Cancer, as a chronic illness, caused the spouses to anticipate the loss, prepare for grieving, and raise issues concerning their mortality. Earthquake survivors also challenged their feelings of immortality and experienced emotional uncertainties regarding the self, death, and dying. They feared the death of loved ones (62%); they reported that they behaved more protectively (58%).
4 Anger. Anger was expressed very frequently. This is contrary to previous research in this area, where natural disasters are referred to as “acts of God,” a label that automatically eliminated human involvement and left no clear target of resentment and anger (Sorensen et al., 1987). Feelings of anger co-existed with the previously mentioned feelings of sadness and uncertainty.
Anger was expressed toward others: the Azeris and the Turks (87%), the Soviet regime (85%), the builders and the engineers (83%), the Soviet Armenian caregivers and “doctors” (80%), the Soviet Government (76%), “our bad luck and fate” (70%), and God or the Creator (11%).
Anger at oneself was also expressed in the form of feelings of guilt. There was guilt for surviving (61%): “They’re lucky and fortunate [those who died in the quake]”; guilt for not being able to rescue a loved one (28%): “I could hear him yelling for help, and I couldn’t do anything about it, I can still hear him today”; and guilt for expressing anger toward the Creator (6%), for this challenged their religious beliefs. Anger toward the deceased, which is a common phenomenon in Western research in death and dying, was not expressed because this is culturally unacceptable. Survivors talked about the deceased as being perfect, placing them on a pedestal. The deceased boys were “the smartest, top of their class”; meanwhile the deceased girls were “the most beautiful, kind, caring and sensitive, living saints.” This is indicative of cultural, traditional, gender-specific values. Anger toward the deceased was displaced onto other survivors: siblings, friends, and neighbors. As Levinson (1989) has pointed out, the deceased are usually stripped of their human and sometimes imperfect qualities, thus inhibiting the grief process.
5 Helplessness and frustration. Feelings of helplessness were expressed over 50% of the time. Survivors repeatedly stated, “There is nothing I can do,” especially referring to the Soviet regime, the hierarchy of the decision making, and the constant pressure from Moscow. Some survivors did not even feel that they could make decisions and take actions regarding personal issues such as housing, food, and other family matters because all the decisions had to be made in Moscow.
6 Emptiness and meaninglessness. Although Frankl asserted that meaning is available under any condition, even the worst conceivable one, it was very difficult for most Armenians to find meaning immediately after such a devastating earthquake. It was enlightening, therefore, to see that one fifth of those interviewed had discovered positive meanings in their traumatic experiences.
Survivors were asked an open-ended question to elicit the meaning they had attributed to the earthquake. Twenty percent attributed a positive value and meaning to their experiences surrounding the disaster (Kalayjian, 1991b). This is congruent with Quarantelli’s (1985) notion and with Frankl’s central assertion that disaster survivors are primarily attempting to cope with the meaning of the trauma. This observation is somewhat contrary to Figley’s (1985) belief that one of the fundamental questions a victim needs to answer in order to become a survivor is “Why did it happen?” This type of question forces a survivor to remain in the past, in the role of a victim, a dependent, without a rational and satisfactory answer. It also leaves the survivor filled with feelings of self-induced guilt and, therefore, trapped in a cycle of destructive behavior. Frankl labeled this type of “why” question as the “wrong question” (personal communication, June 29, 1989). Any question that begins with a “why” has a built-in presumption that there is someone responsible for the incident or that there is a particular predetermined reason for the event.
Those survivors who were preoccupied with “why did this happen?” were dissatisfied with the scientific answer that the plates moved, pressure built up, and finally the tension was released. They continued maintaining, “But why? Why us? Why me?” One “why” question led to yet another “why,” like a vicious circle, moving the survivor around and around without a satisfactory end. These “why” questions implied that trauma and disaster happen to bad, sinful, or unworthy people, attributing a negative meaning to the disaster experience. In addition, these questions helped maintain an external focus, in comparison with questions such as: “What can I do about it now?” or “How can I deal with my experiences?” This latter type of question focuses on our internal powers and keeps us engaged and active, instead of feeling passive and reactive to external forces. Armenian survivors who were preoccupied with the questions of “why?” remained helpless, more depressed, and showed higher scores on the PTSD Reaction Index Scale (Frederick, 1977).
Survivors who attributed a positive meaning to the trauma focused instead on the present moment and the meaningful experiences they had gained by helping or receiving help from one another and from the world. As one survivor stated, “Look at how the world has come to help us [the Armenians], the closed Soviet system has opened its doors, there is more communication, caring, and sharing.” It should be noted, however, that Frankl (1969) emphasizes the importance of trauma survivors expressing sadness, terror and rage, and going through these stages of grief and bereavement before prematurely becoming involved in a self-transcendence activity to find a positive meaning in their trauma experiences.
Therapeutic interventions utilized by mental health volunteers in Armenia in this acute phase included: art therapy, group therapy, play therapy, biofeedback and stress inoculation training, expressive art training, eye movement desensitization and reprocessing, symbolic expressive theory, pharmacotherapy, and psychotherapy. No single clinical intervention alone would have been successful to treat the surviving community and all postdisaster symptomatology (Kalayjian, 1995).
The Chronic Phase
The chronic phase immediately follows the acute phase. This phase involves the long-term rehabilitation of the community. The chronic phase includes the following stages: integration of loss into the psyche, acceptance of loss, and finding meaning in trauma experiences. Education is essential to help the community through these stages. Community education is not only the responsibility of educators, but of mental health professionals as well. Educators in Armenia, being survivors themselves, experienced difficulties in simultaneously going through their own bereavement and being sympathetic to their pupils’ experiences. Mental health volunteers, as part of the program called Mental Health Outreach for Armenia, cofounded and coordinated by the present author, were extremely instrumental in helping educators, parents, and government leaders in this arena. Through television and radio programs and through written materials, mental health volunteers were able to educate the community regarding the phases and stages of bereavement, signs of PTSD, and other symptomatology requiring further professional interventions.
Media experts, journalists, and government leaders also have a responsibility to help the community by collaborating with mental health professionals and volunteers. This collaboration can result in a community that can grieve appropriately and move beyond grief toward acceptance, integration, and meaning.
The chronic phase also includes finding meaning in this massive loss. Principles of logotherapy are very useful in helping the community integrate trauma psychically and noogenically and in discovering or recovering a new meaning in bereavement experiences. There are two levels of bereavement. The first level is the personal level: bereavement over one’s own personal losses. These losses could be human losses, material losses, and losses of social and economic status (Kalayjian et al., 1996). The second level is the collective loss: loss of community, land, and collective identity as well the loss of the sense of safety, security, and certainty (Kalayjian, 1995). Mental health professionals need to assess the type of loss and the reaction to it in order to assist the surviving community toward integration and resolution.
In Armenia, 20% of those interviewed were able to achieve a positive meaning in their disaster experiences through what Frankl (1986) has called “dereflection.” Dereflection means turning one’s attention away from self and one’s own particular situation, as opposed to hyperreflection, which directs focus toward oneself. According to Goldsmith (1993), dereflective behavior requires the involvement of our instincts, emotions, and values, all of which must be mediated at the primitive level.
This 20% attributed meaning to reaching beyond themselves and volunteering to work with and help other survivors. They revealed that caring and ministering to others and helping one another were the real meanings they had attributed to the quake. They not only expressed valuing what they had learned from their experiences, but using this insight to help other survivors. These respondents also found meaning through acceptance of what was beyond their control: “We could not have prevented it [the quake].” They then went on to modify their attitudes: “I am changing the way I look at things; although I’ve lost everything, everything material, I have myself and I have this moment with you on this Earth; no one or no disaster can take that away from me” and “We live in a mountainous region, where seismic activity is not uncommon. If you read our history, you’ll notice that a devastating quake had struck this area some 100 years ago; we rebuilt then and we’ll do the same now—even better!”
They also reiterated convictions such as: “I am stronger now” and “We [the Armenians] are an indomitable nation; we dealt with the Ottoman-Turkish Genocide when over 2 million Armenians were killed; we dealt with the 70 years of Stalinist regime, losing many more lives; we dealt with the Azeri blockade and more massacres and oppression, yet losing more lives—and now we deal with this devastation. We can deal with anything!” (Kalayjian, 1996).
They were convinced that they were indomitable, echoing the words of Nietzsche (1956), who said, “That which does not kill me makes me stronger.”
According to systems theory, a community is more than the sum of its parts. Therefore, although we can assess individual survivor responses, it is a challenge to evaluate effectively the community response and to address the community needs after a devastating natural disaster. Expeditious, careful, and comprehensive assessment of several layers of the community is essential to diagnose and meet the bereaved community’s needs.
Disasters create enormous tensions in a community: physical, psychological, and spiritual, on one level, and social, political, and economic on the other. These tensions can create challenges in the soma, psyche, and spirit of community members, in addition to sociopolitical and economic challenges. Although there are unique individual responses to any massive loss, we need to recognize also the many similarities in the grieving process.
The community response is influenced by several factors, among which are: event and survivor characteristics; the sociopolitical and economic climate before, during, and after; rescue efforts, and leadership and media attitudes and practices. The role of media and government leadership is very important in helping the community grieve effectively, moving them away from victimhood and dependence to acceptance, empowerment, and positive meaning. Because media experts and many leaders were unable to recognize the importance of their role in the community’s grieving process, mental health professionals took the initiative to instruct, guide, and empower them.
Mental health professionals are in key positions to empower individual leaders and, therefore, the entire community by helping them uncover, discover, or recover their responsibility. We can empower them and help them become free but yet connected to their emotions, environment, and soul. We can help them build skills to help free themselves from moral conflicts, guilt, and self-destructive behaviors, and from conflicts of conscience which, according to Frankl, can lead to an existential neurosis.
Pain and suffering caused by massive losses after natural or human-induced disasters may cause a fruitful tension, making the community aware of what could be, appreciate what it is, and prevent what ought not to be. These tensions may help the community to come together and act responsibly and collectively. Massive traumatic losses not only create a crisis in the community; they create opportunities for survivors to understand their obligations to one another and to the earth, and also help the community feel such obligation. Above all, crises carry the potential to help community members care for each other and exhibit this caring in a humanistic way. It may well be a paradox that traumatic disasters that disrupt the way of life of a community may lead to spiritual evolution as long as the community can learn from and find positive meaning in a communal crisis.
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