Tag: "Haiti"

Don't just do something.  Stand there!

Don’t just do something. Stand there!

Should I stay or should I go?

An article in yesterday’s USA Today caught my attention.  In it, an emergency room doc, Scott Plantz, recounts his voluneteer experience in Haiti.  He describes it as working in a “chaotic hell” with  the presentation of patients with broken bones that were  “the worst injuries I have ever seen.”

He expresses his frustration at the lack of coordination between hospitals as a real problem.  Some faciltities have far too few of desperately needed neuro and vascular surgeons.  The facilities he worked at, Project Medishare and the University of Miami Global Institute Hospital, had four orthopedic surgeons.  Down the road, at another facility, patients with broken limbs were being turned away and told to return in two weeks due to a shortage of the orthopedic surgeons which his facility had too many.

This reminded me of “Woodall’s Axiom: There is no such thing as an adequate response to a catastrophe.”  One can not expect things to run smoothly after a horror like what Haiti experienced.  But, we only hope to get closer and closer to acceptable responses to the overwhelming challenges.

Of note, Dr. Plantz describes what I have seen many times,

“I flew down with a group of 200 college students with no association with Project Medishare- probably the most frustrating aspect. They came down to “help out,” each at a cost of $500.  They had no construction or medical skills.  When you realize that $500 will keep two Haitian children alive for a year, watching anyone arrive that is not trained is aggravating.  Funding the sending of carpenters or one bulldozer would have been 1,000 times more effective.”

There was a saying I remember from my medical training that seems absurd and counter-intuitive.  “Don’t just do something.  Stand there!”   This saying was meant to tell us to think carefully about what the most strategic and helpful intervention would be to help a patient.  We were asked to resist immediate actions based on our own emotional responses that might make us feel good because we are doing something,  but that would not really be in the patient’s best interest.

It boils down to a question a doctor is trained to ask themself: “Is my acting based on me trying to prove to myself I’m useful, or is it really in the best interest of the patient?”  The patient comes first, not my desire to feel helpful, or to calm my anxieties about how bad things are,  or prove to myself I have a life’s mission, or to launch a new phase of my life, or gain recognition for being a humanitarian.   These all get checked at the door.  The patient’s real needs come first.

Then, the sober analysis must begin as to how one can be of the most help.  Dr. Plantz felt that these 200 college students were treating their own desire to be seen as helpful, while likely being of very little actual help.  It is very likely that they consumed food that was not readily available, contributed to an already overloaded sewage capacity, took time and resources away from generous hosts who had to accomodate them.

It may be that such “missions” can have some positive effect.  But, there may have been 100 other interventions that would truly be more effective in helping many more people without burdening already broken systems.  Such modest interventions  might not allow for  a “life changing experience” for the person who wants to go to help.  But, it is not about the care giver having a life changing experience.  It is about actually helping those in need.

So, for now, it seems to me, that if you can help medically treat or nurse this child, find a way to go to Haiti, preferably by connecting to an agency that is established there to maximize your efficiency.

If you can provide a way to clean up sewage and treat water, by all means, get yourself to Haiti.  If not,  it is probably best you stay home and raise funds for those who can or provide material that is specfically requested by agencies on the ground in Haiti that have the means to distribute it.

If you can help to clear and rebuild this, consider going to Haiti.

There will come a time when the emergency phase of this calamity is over.  That will be a time for other types of services to be brought to Haiti in earnest.  That will be a time for non-specialists.  But, until the sewage and water systems are intact, until food is readily available, until basic accomodations are there for Haitians at the pre-earthquake levels, consider the strain you are putting on the system by trying to be of help.  Honestly ask if your personal input is more valuable then the strain your presence puts on these systems.

Be honest.

Wanting to help and being willing to sacrifice yourself to help are different than actually being helpful.  Your best intentions to help may best be fulfilled by not going and doing something here that benefits many there.  No one may know of your effort, but that is really the measure of who you are really going for.

If you would regret if no one knew you went to help, don’t go.

If you have no specific skills to render at this time, seriously consider not going.

If you have no systematic plan to be of help, seriously consider not going.

Be honest.

The Three Identities: Weakened, Rigid and Compassionate

The Three Identities: Weakened, Rigid and Compassionate

 


“What do we do for kids in the city?  Do we send them all to therapy?”  This was the question one of the Commissioners asked me as I sat with officials of the City of New York at City Hall shortly after 9/11.  They had asked me to help them think through how to respond to the tragedy.

“Absolutely not!” I said.    “To label them mentally ill brings up all kinds of problems.  First, the mental health system is barely able to handle its current load, let alone imagining what would happen if we flooded it with hundreds of thousands of new cases.  Second, the kids don’t see themselves as mentally ill.  They are scared, confused, angry and grieving, but these aren’t illnesses.  There are better ways to deal with these real issues outside of a health care system.  There are cultural and educational means to address them.  Third, if we were to describe the kids of the City  as needing mental health services, we create a sense of dependence.  A patient is weak and in need of a professional.  Just when we need to be mobilizing the population in a positive way, we would be telling kids they are sick and need to be dependent on a handful of professionals in understaffed and underfunded mental health care centers.   To be certain, some percentage of the kids of the city will need mental health care, maybe 15%.  But, these can be dealt with within the existing mental health care system.  What is needed instead, is a rapid and large scale public movement that mobilizes the best in ordinary people toward a common and uplifting goal.”

 

As with all great tragedies like 9/11, Katrina, Haiti or Tucson we are presented with a choice.The multiple crises affecting the country present us with significant challenges to our sense of who we are as individuals and a nation.  There is a choice that links the plight of those who are living through the catastrophes of the earthquakes in Haiti and Japan, the challenges facing the residents of Mississippi, New Orleans and Vermont since Hurricanes Katrina and Irene and all of us since the horror of September 11, 2001.In fact, it is the choice we all face when we are confronted with any crisis in our lives. It will confront us again if, God forbid, another catastrophe strikes our shores. Knowing what is involved in this choice can guide us through any past or future crisis we face individually or as a nation.

If we did this correctly, we could help these kids become role models of resilience instead of psychological casualties.  They could come out personally stronger and become agents to help make the country stronger and our democracy healthier.

I told them the issue the city faced had to do with the affect 9/11 had on the identity of everyone in the city, and the country for that matter, including the children.   These affects on our identity had far reaching influences on the way we see and relate to ourselves and each other.   I went on, “Generally speaking, there are three identities that result from a horrific event like this.  The first, I call a ‘Weakened Identity.’”

I explained that for some after such a horrific event, there is a corrosive effect on their sense of hope that anything good can happen in the world.   This is one effect of our natural instincts in times of threat to our safety.  Our perfectly natural instinctual survival responses cause us to filter all of our experiences through the lens of our survival emotions: feelings like fear and anger.  This is a necessary and very helpful survival mechanism to help us focus on dangers when our safety is threatened.  But, in social situations over the long term, these unthinking responses are nothing but damaging to our relationships and our ability to effecively solve problems.  The survival emotions of fear and anger help us while a crisis is occuring.  When it is over, we need other emotions and cognitive skills to keep our social and community life healthy.

These latter skills, however, do not come automatically like fear and anger do.  They require deliberate conscious cultivation, modelling and practice.  The problem the city faced was allowing these instinctual survival responses governed by fear and anger to morph into social expressions that would poison the climate for healthy community and effective democratic governance.

In the case of the survival emotion of fear, our perceptions become distorted to see threats everywhere, even where they do not exist.  For instance, when chased by a tiger, the survival emotion of fear plays an important function to help us focus on the threat to our lives and run away.  But over time and when the tiger is gone, if this feeling persists, we will misinterpret harmless movements as being threatening.  Our thinking, feeling and behavior are distorted, as is our motivation to engage in new behaviors and explore new forms of growth.  We become motivated to avoid new thoughts and experiences in life for fear of harm, not to engage them for the growth they may contain.

Other parts of our capacity to perceive, feel, think, exercise our will and behave need to kick in after the threat is gone.  This is so we can reflect objectively on the world as it is now, take allowance for the past threat, but not be caught up in the cognitive distortions caused by fear.  In order to grow and enjoy life, we need to know how to consciously over-ride our fear.

To calm our fear enough to reflect objectively on the current situation requires a conscious choice.  If this conscious choice is not made, the residue of lingering fear distorts our way of being.  This has an exhausting affect on our view of the world.  Over time, it becomes  harder to believe that what we have held to be true and good really amount to anything.   The resulting sense of powerlessness can feed a growing sense of despair in our personal effectivness.  So, with a diminished sense of a vision worth striving for, coupled with a weakening sense of personal capacity, a paralysis of the will sets in that is characterized by despair and disengegement with the big questions in our personal life and our role in the life of  society as a whole.  It is harder to be motivated to do anything positive since no goal seems particularly worthwhile.  As a result, we sabotage our growth by not striving for any worthy goal.

To deal with the pain of this erroneous conclusion that our lives are hopelessly fruitless, we can become caught up in the pursuit of anesthetizing distractions  and dysfunctional behaviors and relations.  When these forces play out in vast numbers of people, the citizenry is disengaged, distracted and disempowered. The tragedy is that this disengagement occurs just as the increasingly complex crises in the country continue to demand higher levels of focused, dispassionate and collaborative attention.

I warned that this fear of the future would show up in young people as truancy, poor school performance, a greater sense of nihilism and preoccupation with distracting and dysfunctional pursuits.  The lack of a believable vision they could adopt to direct their lives, coupled with a lost sense of capacity and competence to move their lives forward would lead to lost opportunity for personal growth and apathy for their personal advancement and the social responsibilities each generation must pick up to fulfill the social contract in a democracy.  I call this constellation of effects that result in a dimmed life’s vision, a diminished sense of personal capacity, the feeling of despair and withered motivation, a “Weakened Identity.”

Natural survival instincts can lead to despair or rigidity in times of crisis.

On the other extreme is a “Rigid Identity.”  Instead of being grounded in fear, however, the Rigid Identity arises from anger.   Fear has the cognitive and behavioral affect of directing us to avoidance of new ideas and others.  Anger, on the other hand, is mobilizing and directs us toward engagement, and unfortunately, engagement with perceived threats that may or may not be there.  Unlike a person with a Weakened Identity that has a dissipated will and difficulty holding a vision of any goal worth believing in, a Rigid Identity is very much the opposite.

A person with a Rigid Identity becomes intensely allied to a particular idea: a political party, a national, racial or ethnic identity, a religious belief, etc.  Unlike a person with a Weakened Identity who responds to the sense of powerlessness with diminished will, a person with a Rigid Identity has an intensifed sense of will.  They direct this will to the goals of an identity group that, to them, holds the ultimate answer to the experience of powerlessness over the real or imagined threats they perceive.  Everyone inside this group identity is considered good and principled and everyone outside is considered not just different, but evil, bad, stupid, or a potential threat.  Being more motivated by anger, these indviduals are far more outspoken and interested in organizing then their Weakened Identity counterparts, who  despite being a majority, have neither a well formulated social vision nor the motivation to be outspoken about one.

As an example, I pointed to how, since 9/11, the national discourse had become polarized with Americans calling other Americans “traitors” and “America haters” as examples of this rigidification of identity that occurs in parts of the population that predictably follows in some form after a frightening national event.

The danger, I explained, was that those with a nihilistic Weakened Identity would fall prey to those with a Rigid Identity either being blamed for the nations problems or becoming the objects of recruitment to their increasingly extremist views.   I further explained that the opposing Rigid Identities would battle each other.  This would increase social tension and polarize the social discourse exactly when unity of purpose and reasoned cooperation was most needed to deal with increasingly pressing, interrelated and complex problems.  Worse, the tendency of Rigid Identities to not tolerate the anxiety that comes with moral and social complexity would lead to simplistic, and therefore inadequate assessments of the real problems facing the country.  This would result in the forceful advocacy of inadequate solutions that were likely to make matters worse.

In neighborhoods, this Rigid Identity might appear in youth as increased racial, ethnic, religious or gang tension as groups demonize each other.  That would set the stage for community instability, the increasing inability to problem solve cooperatively and effectively, and create the social atmosphere for potential violence.

One of the city officials from the Department of Education looked at papers in her hands and noted that there had been an increase in incidents of gang violence in the months after 9/11. Everyone who watched the news had seen the name calling between increasingly strident Americans gripped by Rigid Identifications.

“What do we do?” was the question on everyone’s lips. “There is a third response,” I said, “a third identity.  I call it, ‘The Compassionate Identity.’ Unlike the Weakened and Rigid Identities, which arise instinctually as a result of neurologically wired unreflective and automatic survival responses to threats, the Compassionate Identity requires a mature conscious choice.  We come to see the roots of our common humanity in our common suffering.  This allows us to see the potential for united growth with each other when we face a crisis and not only see each other as sources of threat that lead to fearful despair or angry extremism.

But this requires the capacity to calm the survival emotions of fear and anger and reflect on the larger picture.  In the face of the emotional pressures of the immediate trauma, it is hard to learn this skill.  It would be much better to have a core segment of a community that has practiced this kind of response, that understands its features and can speak to its value so that it can be modelled to others in the aftermath of a crisis and give a workable alternative to those who despair and a way to calm the anger of potential extremists.”

Compassion must be chosen after great loss and suffering.

“How do we make that choice?” was the logical next question. “It begins with knowing these responses are there.  Kids need to know what to avoid when the Weakened and Rigid Identities arise in them, as they surely will.  They also need role models of effective applications of a Compassionate Identity that are more than bromides, something that can realistically capture the hopes of suffering and seemingly powerless people.  Compassion has to be seen as the engine of personal and community growth and strength and not a hollow moralizing platitude.  It has to be seen as the foundation of civil discourse and effective problem solving.  It has to be seen as the ground from which healthy democracy springs, the best of the American promise, our generation’s version of the ‘better angels of our nature.'”

“Then, every leader in the city has to state this choice over and over.  They have to be outspoken role models of this choice.  From the Mayor on down they have to steer people away from reflexive despair and extremism and state clearly that the lesson to be learned from this horrible event is that we are all in this together. We all have a role to play and there is no ‘them.’  There is only, ‘us.’  Then, we need to teach the kids the skills they need to live creatively and productively in that kind of community.”**

My experience has shown time and again that no matter how horrific the events we go through, we retain the crucial element of our humanity: our ability to choose our response to what happens to us. In this lies our personal hope.  In choosing a Compassionate Identity, our hope is linked to the hopes of others.  We unleash latent capacities and abilities in ourselves that can be directed to the welfare of all.  We minimize the likelihood of our actions adding to the disunity that paralyzes the national discourse and robs us of our chance to solve the complex and trans-partisan issues we face.

Our personal and national resilience must draw from this choice.  Before the national discourse becomes irretrievably caught up in the despair and disengement of the Weakened Identity and the country is left to those extremists on the Left and the Right with Rigid Identities who will lead us into an abyss of disunity, short sighted and impractical solutions to complex problems and a deepening national paralysis, we must act to vindicate before an increasingly hopeless and agitated citizenry that the best promise of America lies in a practical and effective system that sets free, through the united exercise of a Compassionate Identity, the better angels in each of us.  The Unity Project is one effort along these lines.

This site is an exploration of that choice and the potential it holds for every aspect of life.  This is what I mean by resilience.

Related Posts:

A wonderful story of the choice of a Compassionate Identity from the Balkans:  “Compassion, Fantastic Coffee and My Shock

The classic example of this choice in recent American history is Dr. Martin Luther King.  In this post, Dr. King’s Morehouse College roommate, Dr. Charles Willie, who worked with me at Harvard on the Resilient Responses to Social Crisis Interfaculty Working group, explains:  “Compassion, the Prize and the Price.”

This video demonstrates this choice among survivors of the civil war in Uganda:  “As a Family”

Post-Partisan America explains the tension we feel in the country.

Click here for Suffering Successfully.

All Rights Reserved, John Woodall, MD, copyright, 2011

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*Leaders of The Department of Youth and Community Development (DYCD) and the Department of Education of the City of New York were present.

**Right there on the spot, we created The Healing Arts Project as the way for the city to do this. This program was carried out over the next few years across the City of New York. That work, and the way it was subsequently refined in pilot schools and in New Orleans and Mississippi after Hurricane Katrina became the theory and methods of the Unity Project. This work was then presented to my colleagues for comment at the Resilient Responses to Social Crisis Interfaculty Working Group I convened at Harvard’s Mind Brain Behavior Interfaculty Initiative from 2002-2004.