PTSD and MDD: The Aftermath of the 2010 Earthquake in Haiti: Psychological Studies & Critique
I’ve grown up on a cloud most of my life. Privileged, with commodities that protected my innocence, and my glass castle crumbled January 12th. Everything from my faith onward to my very existence was questioned. 10 years later and I am still asking.
As the anniversary peaked its head, I began attempting to avoid the idea. It only dawned on me at the end of the day, January 12, 2020, that many coping mechanisms later, the trauma was well ingrained within. I have in the months leading to January experienced many nightmares. They all dealt with personal, traumatic or triggering themes. One dream in particular, was reoccurring. It always ended in the scenery of a loved one under rubble, dead.
I have the privilege of simply dreaming as opposed to carrying that memory.
Whether a memory of a specific death, or the memory of the overwhelming uncertainty and fear; the earthquake impaired a lot of foundations, and some of them, are our mental.
There is not much data to account for the mental repercussions. There is however, a post-earthquake study, whIch found that Haitians who had lived through the earthquake had higher rates of PTSD and MDD than other countries who had survived similar events.
Below, I've shared an academic paper I've written which explains the general scope of the study with a critique.
In the last decade, Haiti has seen many country-altering disasters. From political unrests, government corruption, and coups, to natural disasters. Once they pass, most do not seem to hear much about them internationally, and a lot of the reports, only account for the material losses. Seldom does anyone stop to consider thoroughly the mental repercussions. This is fairly understandable, seeing as with our very poor access to health care, it is hard for health to be considered in its entity as muti-dimensional, rather than just the provision of material resources, and physical health. Provisions and physical health themselves are not always readily accessible, so mental health is very often forgotten in the conversation. Due to this, recount of Haiti’s vulnerability is not considered in its entirety.
Notably, one of its most traumatic events is the Earthquake of January 12, 2010. With a magnitude of 7.0 on the Ritcher scale, the damage was catastrophic with a death toll of approximately 200, 000, and 300,000 injured. There were over a million individuals displaced from their homes as a result. (Cerdá et al., 2012)
What we are to discuss is the first population-based study of collective mental health in Haiti after the Earthquake that shook the country in 2010. The two major mental disorders to be considered are Post Traumatic Stress Disorder and Major Depressive Disorder.
The foundation for mental Health in Haiti is seemingly nonexistent, which can be inferred by the numbers representing their socioeconomic status. Most of its individuals survive with less than two American dollars a day, which is the equivalent of approximately 97 Haitian monetary units, called Gourdes (HTG). Given that export in the country is low, these units are not widely represented enough to provide for the individual when possessed in such low quantity.
Already, the physical and material welfare is compromised. In addition other factors such as political unrest, and natural disasters influence the well-being of the average Haitian citizen, in ways that are often not considered. (Cerdá et al., 2012)
In their population-based approach, Cerda et al., (2012) conducted a study on the experiences of Haitian individuals following the earthquake. The study served to indicate how withstanding a catastrophic disaster, could on-set the prevalence of PTSD and Major Depressive Disorder on an already vulnerable population within a two to four month period. To do so, Cerdea et al based their study in the region of Nazon, in Port-au-Prince, the capital of Haiti.
Presented with a varied level of damage in that area, it allowed them to assess with proportion, the range or level to which material damage, injury and trauma would affect the prevalence of the two aforementioned mental disorders.
Having defined that the Haitian population is a vulnerable one on structural levels that relate to economic welfare standards, the study then used empirical evidence and standardized diagnostic criteria to define the past traumatic experiences and mental disorders which they were going to assess the effect and post prevalence of. In accordance with the time of its administration, this was defined by the DSM-IV and adjusted to socio-cultural factors, such as the known rates of common traumatic experiences in the area of study (for instance, kidnapping was found to be more common in this case, and a source of trauma more widespread in Haiti). This data was collected both through the methods of self report and collection of available data.
The prior traumas and disorders were then categorized accordingly by level, type and demographic, so as to make inferences more concise. (Cerdá et al., 2012)
The results of the study showed that the rates of PTSD and MDD were higher for the Haitian people than they were for other studies in other countries based on the same post-earthquake foundation, at (24.6%) and (28.3%) respectively, in comparison to the general range of 3.3 to 24.2%, and 20 to 30%, in that order. (Cerdá et al., 2012) Moreover citizens within the area, with reported and or recorded history of mental illness and past traumas showed more likely signs of Major Depressive Disorder and Post Traumatic Stress Disorder as defined by DSM-IV. That being said, levels of past traumatic experiences were higher than other studies, - so much so - that a third of the sample reported prior violent and traumatic experiences. This is of course in parallel to the discussed vulnerability of the Haitian people. It makes sense that weak infrastructure would result in interpersonal harm, in addition to structural oppression. This also coordinated well with the fact that the level of present injury presented itself as much higher, as it speaks to the systems in place for social welfare and health. (Cerdá et al., 2012)
The results were likely affected by the reliability of the data collected on prior mental disorders within both the official records and the self reports. While a general inference can be made on said data, it is important to consider the socio-cultural factors that will impact its reliability. The study did well in terms of considering variables in accordance with cultural norms and understandings, using standardized definitions, and translating them into more culturally appropriate interviews. (Cerdá et al., 2012)
However, the barrier is bigger than one from one language to another. It starts at perception of health and mental disorders within the community.
As mentioned in the discussion, there were no similar studies in Haiti to compare the results to, and the recorded cases of mental illness were significantly less than the number of the population that showed markers for PTSD and MDD in a way that could not be explained only by the earthquake, especially if the self reports were stating otherwise so drastically. (Cerdá et al., 2012)
Aside from a critique of the structures or lack thereof for overall health and more specifically mental health in Haiti, perhaps it is important to consider why this has not been a priority.
While Cerdá et al., (2012) gave detailed results with respect to conventional and established standards of mental health and wellness, if they were relating empirical evidence to collected data, and attempting with the resources at hand to best carry the information gathered across culture and language; this study’s importance should have highlighted with the help of documentation the cultural implications of mental health in Haiti.
While it may not have influenced the results greatly, it would have provided better insight on the self reports, and solidified the counting of events by Haitian individuals in their mother tongue. That way, perhaps certain recounted symptoms on members with mental illness would have been more clear, as there would be more material to open them to interpretation. For instance, in Haitian culture, part of the general consensus on health is the state of being functional, and of “well-being in connectedness” with one’s environment/community (Kirmayer, 2010, p. 9). The latter has the variable of religion, where it might also include connectedness to the spiritual. This connectedness, could also contain a variety of explanations, which may cause one individual to fall under “well” even if they are not. Specifically, things are more likely to be seen as consequences of action rather than to be considered as hereditary, or influenced by genetic components - which in turn influences actions and religious practices (Kirmayer, 2010, p. 9).
Kirmayer, (2010), even elaborates how this classification of illness is often largely reliant on the obvious environment or religious values. As a result, what may be a mental impairment manifesting physically, or vice-versa could be interpreted as magical or spiritual, and if decided non-acceptable, is dealt with inefficient spiritual measures, or not dealt with at all, as we have mentioned. This also ties with how a lot of Haiti’s religious beliefs, are also practices that affect various domains in life, including healing, physical and mental well being.
All of this may not have been properly communicated during the study as socio-cultural and historical context is not something one can grasp in full with little time, and with the barriers that may be posed by ethnocentrism, and other issues of perception and relativity.
This is why, when concluding the study, much was said about the restructuring of the institutions that are to cater to mental health, and in meticulous respect to gender, age and social inequalities; and while the dissociation of physical well being and mental well being was noted, - it was not emphasized how there needs to be a radical thought that considers culture, while not letting it overlap with the values that are harmful to the mental Health of Haitian individuals.
This is of course not an easy task, and it is in fact why studies such as this are important. However, they are simply the starting point. They have thoroughly assessed the consequences, and it is with the retracing of steps that the Haitian people will be able to lead themselves back to the problems in their foundational rhetoric, in order to create more efficient change.
WRITTEN BY DAISHA DORSAINVIL
Kirmayer, L. J. (2010). Culture and Mental Health in Haiti: A Literature Review. Department of Mental Health and Substance Abuse of the World Health Organization, 9-28. Retrieved from https://www.who.int/mental_health/emergencies/culture_mental_health_haiti_eng.pdf
National Institutes of Health, & U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES. (2012, November 1). Post-Traumatic Stress Disorder. Retrieved from https://www.nimh.nih.gov/health/publications/post-traumatic-stress-disorder-ptsd/index.shtml
Cerdá, M., Paczkowski, M., Galea, S., Nemethy, K., Péan, C., & Desvarieux, M. (2013). Psychopathology in the aftermath of the Haiti earthquake: a population-based study of posttraumatic stress disorder and major depression. Depression and anxiety, 30(5), 413–424. doi:10.1002/da.22007