"We are running from the wave, and we can see the water right behind us. We run toward the other side of the island. When we get about halfway across, we meet people running and screaming from the other direction. Then we see the water in front of us too. The waves meet, and we are underwater."

American psychologist Ben Weinstein, PhD, repeatedly heard accounts such as this one from survivors of the Southeast Asia tsunami. Weinstein, who lives inland in Bangkok, was on the scene in badly hit Phuket, Thailand, on Dec. 27--a day after the earthquake-spurred tsunami killed nearly 200,000 people and destroyed the homes and livelihoods of millions in Southeast Asia and parts of Africa.

While on the ground in Phuket, Weinstein spoke with survivors in Hebrew, English and French, and listened to parents recall how the churning sea pulled their children from them.

"They literally could not stop asking themselves why they couldn't hold on to their child," he recalls. "I have never felt an emotion as intense or raw as the sheer despair and anguish of the parents who did not know what happened to their child in that wave, or what to do next."

On hearing of the tsunami, Weinstein immediately began calling agencies asking how he could help. He traveled to Phuket with the Thai Ministry of Public Health on Dec. 27 and 28 to help survivors in the waves' aftermath. Since the situation was so chaotic, Weinstein went back to Bangkok for two days to look for an organized way to help. He returned to Phuket on Dec. 31 to help the British Embassy command post by talking with survivors and supporting its relief staff, who were themselves at risk for trauma in assisting at a disaster scene.

Weinstein, a U.S.-trained clinical psychologist, moved to Thailand about a year ago with his wife, who is the director of a Thai nonprofit organization that helps refugees and displaced people. Since then, Weinstein has been teaching psychology and establishing a clinical practice. After the tsunami hit, he drew on specialized training he received in trauma counseling and disaster mental health services following the 9/11 terrorist attacks. That training consisted of American Red Cross workshops on disaster mental health and critical incident stress-management training. And he credits it with being invaluable in his tsunami relief work.

In the middle of chaos

Weinstein describes the scene on Dec. 27 in Phuket as "chaotic" with "crowds of people wandering around," unsure of what to do and where to go.

To help bring order to the situation, he directed people to basic care, such as food, shelter and clothing. He smiled and offered supportive words to survivors, striving to help those who may have still been in shock to re-establish a human connection. Weinstein also tried to normalize what survivors were feeling by reassuring them the shock and disbelief they felt was normal.

Despite the bleak circumstances, many survivors demonstrated resilience by moving into survival mode by searching for food and shelter, Weinstein says. To assist them, Weinstein set up a buddy system, in which he linked people doing well with people of the same nationality who he identified as struggling. The pairs then went to eat or find shelter together.

Such assistance can be more effective than providing counseling or psychotherapy immediately following a disaster, Weinstein says.

"The risks of providing therapy too soon after the disaster outweigh the benefits, especially since most people will heal on their own," Weinstein maintains. The most common response to disaster trauma is resiliency, he explains: Back in the safety of their homes with their families and friends, most people will slowly return to normal.

As for others, "psychotherapy comes later," he says.

Helping to train Thai psychologists

Back in Bangkok, Weinstein has teamed with Thai psychologists and mental health professionals in the Thai Department of Mental Health to charge ahead with training psychologists, social workers, educators, health-care professionals and community volunteers in disaster response. Since Dec. 26, he's applied his background on disaster mental health to a series of Bangkok workshops that prime Thai mental health workers to assist tsunami survivors.

As of Jan. 31, the workshops had trained 150 mental health professionals in trauma response. In turn, these professionals will train other Thai mental health personnel creating a "multiplier effect," Weinstein says.

"Trauma and other mental health impacts of disaster on individuals, families and communities are not well understood here," he adds. "In fact, the task is not so much one of public education about trauma as of raising awareness that there is a natural mental health impact of disaster."

In Thailand and all over the Indian Ocean, people are still at risk for developing trauma from the event, he notes.

"They are safe, but their communities, families and livelihoods have been shattered," he adds. "In order to hope for good mental health outcomes, we need to help them rebuild their communities and social networks."

Further Reading

Psychologists with experience in disaster mental health or community interventions who are interested in traveling to Thailand or assisting in other ways may contact Weinstein.

APA provides psychological information on trauma

In its response to the Southeast Asia tsunami, APA is providing the public and affected countries with psychologists' expertise on trauma, coping and resilience following natural disasters. To stay updated to APA's tsunami relief efforts and for information on disaster mental health, visit the APA homepage and the APA Help Center.