Suchitra is a psychiatrist from Indonesia. Heriari is a psychologist from Thailand. Both know the toll a disaster can take on the psyche. So they sit in the middle of a small room at Penn’s Center for the Treatment and Study of Anxiety, playing the roles of therapist and patient.
“I’m 25 years old, and the water swept my parents away in the sea in the morning when the tsunami happened,” Heriari says. “The water comes to my house again and again.”
“What are your symptoms?” Suchitra asks her.
“The government built a new home, but I don’t want to be there. I cannot sleep. I always have nightmares.” She goes on to describe her headaches and sweating hands, and how she avoids newspapers and friends—anything that might remind her of the tsunami.
Suchitra tells her that she seems to be suffering from post-traumatic stress disorder (PTSD). “Some people cannot forget the trauma, because they avoid thinking about it—like you avoid going to the sea,” she adds gently. “You don’t want to talk about it, and the more you try to forget it, the more you remember it.”
They, along with seven other mental-health professionals from Thailand and Indonesia, spent two weeks at Penn in October learning how to train others to treat PTSD using prolonged exposure therapy. Developed by Dr. Edna Foa, professor of psychology in Penn Medicine’s psychiatry department and director of the center, the treatment has proven effective in about 80 percent of cases.
It works by teaching patients to describe their traumatic memories repeatedly in a way that helps put them into perspective so they can move on with their lives. It also helps patients to gradually confront situations that cause them anxiety, which for a tsunami survivor could range from watching the TV news to sitting on the beach. “There are people [for whom] getting water from the dispenser is very frightening,” Foa explains.
The tsunami poses special challenges for PTSD treatments because of the way it destroyed entire communities. “Even if you take care of their fears, you still have the losses to take care of,” she says. “I think in a way that New Orleans was another example of a disaster that went beyond individuals losing their homes or seeing horrific things or feeling their life was in danger.”
Foa and her colleagues aren’t the only Penn educators who have been helping people rebuild their lives after the tsunami. Last summer Dr. Kathy Schultz GEd’91 Gr’91, associate professor at the Graduate School of Education, led a small team of scholars from Penn and Swarthmore to Banda Aceh, Indonesia, to train 100 master teachers there in educational psychology as well as “child-centered” methods for teaching literacy, math, and science. Those teachers went on to train 4,500 more teachers to replace thousands who were lost in the tsunami.
Schultz incorporated techniques from her own elementary literacy-methods class at Penn, showing how to teach writing through making children’s books. “There was not a tradition of teaching reading or writing through children’s literature as far as I could tell,” she says.
Schultz had the classes start with oral storytelling, explaining the history of their own names and sharing traditional tales. Next they looked at children’s books from the United States, such as Maurice Sendak’s Where the Wild Things Are, and created stories based on the illustrations. Finally, they wrote their own stories and made books using Japanese binding. “They made these beautiful, elaborate pictures and read the stories to each other,” Schultz says. There were animal fables with moral lessons, stories connected to the Koran, and accounts of the tsunami that spoke of devastation—“38 people in my family died”—as well as hope.
“I said, ‘So now you’re authors.’ In each class there was this silence, and then they all clapped. One person said, ‘I’d like copies of all the books.’” Schultz made a trip to the photocopy machine, and each teacher left with 100 books for their classrooms.
While books were teaching tools in the literacy classes, they also symbolized the healing process in Foa’s therapy training.
“It’s like a book,” Suchitra tells her patient, as a way to explain PTSD. “When you open a book and see something that’s bad and you don’t want to read anymore. Then you close the book. But if you read from the beginning to the end and see the context of the story, then maybe you’re not afraid anymore. Afterward you can close the book and get on with whatever you’re going to do.”
—S.F.
