For a PTSD sufferer, distressing experiences are divorced from time or place and out of sync with the person’s life story. “Once these memories are activated, usually the interpretation of the brain of what’s happening is that there’s a danger right now, because the brain is not really aware that it’s just a memory,” Neuner points out. “We want to nail down this vivid emotional representation. We want to bring it where it belongs and connect it with your life history.”
Accordingly, refugee therapists spent six weeks learning to help patients shape their lives into a coherent story, incorporating major traumas into the narrative. The strategy worked. Seventy percent of those who received the therapy no longer displayed significant PTSD symptoms at a nine-month follow-up assessment compared to a 37 percent recovery rate among a group of untreated refugees.
In Rawalpindi, a largely rural district of Pakistan, nearly 30 percent of new mothers become depressed—about twice the rate in the developed world. In addition to its toll on mothers, postpartum depression can harm babies’ emotional and, in South Asia, physical development. Most of these women consider their symptoms the fate of poor folk or believe that they are caused by tawiz, or black magic. Many are anxious about talking about their problems and being labeled as ill. What is more, Rawalpindi has only three psychiatrists for its more than 3.5 million residents.
To get around such stigmas and barriers, Rahman and his colleagues recruited government employees known as lady health workers to integrate mental health therapy into their home visits to mothers. Ordinarily, these workers visit homes 16 times a year to give advice on infant nutrition and child rearing.
A two-day course enabled these health workers to add mental health to their curriculum. Rahman’s approach is based on cognitive-behavior therapy, in which a counselor tries to correct distorted and negative ways of thinking either by discussing them openly or by suggesting more adaptive behaviors. If a mother said she could not afford to feed her baby healthful food, for example, the lady health worker would question that assumption and suggest incremental improvements to the baby’s diet. A year after giving birth, mothers given this psychologically sensitive advice showed half the rate of major depression of those who received traditional health visits. The strategy worked by empowering the women to solve problems, Rahman believes.
More efforts to bring psychiatry to the poor are under way, such as a trial in Pakistan in which community health workers help to ensure that schizophrenics take their medications. But the biggest hurdle is scaling up these treatments to meet the great need.
Note: This article was originally printed with the title, "Psychotherapy for the Poor".
This article was originally published with the title Psychotherapy for the Poor.