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Trauma Below and Above Ground

By Garry Cooper

It’s been more than a year since the 33 Chilean miners, trapped for over a month half a mile underground, emerged to worldwide celebration. But despite everyone’s best wishes and many efforts to help them, by all accounts, they’re doing poorly. It’s been reported that 29 of the 33 continue to suffer from such disabling symptoms that they’ve been unable to resume normal lives.

“They’re taking uppers, downers, and mood stabilizers,” says Jean Romagnoli, a physician who’s been involved with the miners since the rescue operation began. “They’re overprescribed. They don’t understand why they’re taking them, but they’re fed up with the pills.” Several are still having flashbacks. One miner, for reasons he can’t explain, has built a wall around his house. Raised in a culture that values toughness, several had predicted they’d go back to work in the mines, but only two have been able to return. One of them tried walking into a mine months after their rescue, and could last only two minutes. When Jonathan Franklin, a British journalist whose book 33 Men relates their ordeal from the initial cave-in to their post-rescue struggles, accompanied another to the mine entrance, the man started crying. Franklin asked him why, pointing out that he’d survived. “Yes,” the former miner replied, “but my happiness is still inside there.” Considering that mining is the only work most of them have ever done, and that they live in a poverty-stricken region where virtually no other work is available, most of the rescued miners have been reduced to poverty. Their monthly disability checks of $500 are about half of what they earned previously.

Despite all that’s been learned about PTSD and helping people recover from ordeals like those the miners experienced, how can so many of them still be in such bad shape? It’s been 30 years since PTSD was first recognized as a distinct diagnostic category and made it into DSM-III. Since then, millions of dollars and hundreds of studies have focused on how to treat it, and the miners have received six months worth of treatment, courtesy of the Chilean government.

Actually, recent research on PTSD provides a possible answer to why the miners are continuing to experience such difficulties. Increasingly, researchers are coming to realize that PTSD can be somewhat of an umbrella term, like depression. It’s not a single condition and, therefore, no one treatment is likely to be universally effective. In the January 2009 issue of Psychological Trauma: Theory, Research, Practice and Policy, Christine Courtois and Steven Gold explain the different kinds of traumatic reactions, some of which, like “betrayal-trauma,” are triggered by factors beyond the immediate trauma itself. For at least some of the miners, the experience of betrayal may be part of their ongoing problems.

The most common type of betrayal-trauma is abuse by a relative, but betrayal can be perpetrated by organizations as well. While there was massive support for the miners during the rescue operation, the explosion itself resulted from unsafe working conditions and unenforced safeguards that the mining company and government supervisors had overlooked. This may well have put the miners into a psychologically untenable conflict: the ones who victimized them are also the ones who rescued them—and celebrated their rescue.

An example of the unenforced safeguards is shown in the fact that the rescue chamber to which the miners struggled immediately after the explosion—that was supposed to be fully stocked to help in just such an emergency—contained only a two-day supply of food and water. Therefore, until the rescue shaft was opened wide enough to send down supplies 17 days later, each miner subsisted on two spoonfuls of tuna, a sip of milk, a bite of a cracker, and a small piece of peach every other day.

Trauma undermines a victim’s fundamental sense of safety and basic assumption that the world is orderly, fair, and secure, and much of the psychological healing that must take place necessitates restoring people’s sense of control and safety. “These guys have been on several roller coasters,” says Gold, adding his own powerful metaphor. “The ground’s been constantly shifting beneath their feet.” They went from believing they’d all die—they’d actually considered eating whoever died first—to being rescued. They went from the terrible, dark isolation of being trapped underground to the glare of worldwide attention. They were taken care of for six months, and then the psychological services were eased out. Increasingly they’ve gone from heroes to becoming objects of scorn: people who celebrated their rescue have since booed them, saying they’re greedy ingrates for attempting to sue the government. The President of Chile even publicly opined that “It’s time for them to return to their normal lives.”

The roller coaster likely has another wrenching twist ahead, adds Gold: the movie rights to their ordeal have just been sold, and a sudden infusion of cash will likely make things better for a while. But whatever the financial windfall, the emotional up-swell is likely to be short-lived, and they’ll still be struggling to make sense of what happened to them and trying to find a way to go on with their lives.

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