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“To Do No Harm” Spiritual Care and Ethnomedical Competence 175

trauma recovery work? The Seven Project Steps (Box 6), four IPR cases in
South Asia, and the overall IPR framework are responses to this first ques-
tion. And then, what constitutes “appropriateness” vis-à-vis the diversity
of psychological, social, and medical tasks that need to be accomplished in
disaster relief? Boxes 1, 2, 3, 4, and 7 are responses to this second question.
Among the ethnomedical components of integrative medicine, spiritual
care is no less valid than modern psychiatry; it only needs to be deployed
in a way that ensures EC. Mental health practitioners who work within
the psychosocial model are increasingly looking to local culture for clues
and strengths for appropriate blends. And often, spiritual care and mental
health are housed in the same practitioner or program. Such integration
frequently gives rise to important hybrids of practice that will be exceed-
ingly relevant to EC and IPR.
There are both good indicators and unclear signs regarding spiritual
care and retooling religious traditions. In Sri Lanka, in conjunction with
an NGO named Sarvodaya, a U.S.-based colleague, Gaea Logan (personal
communication, July 6, 2008), evaluated subjective outcomes among
a group of women who had participated in Psycho–Spiritual Healing
Project, which included therapeutic play, physical activity, group discus-
sion, experientials, and meditation. The consensus was that meditation
had been “the most useful and most calming.” In the Pakistani and Indian
cases above, I solicited feedback from trainees and most people gave the
trainings glowing reviews. From a scientific evidence point-of-view, how-
ever, post hoc analysis of such feedback will not go very far. In my cases,
even with great urging, no one provided negative feedback—a skew that
may be a function of the goodwill created between trainers and trainees.
The “appropriateness” question may be solved by a complicated cost-
benefit calculation that recognizes intangibles and involves diverse
stakeholders. Experience shows that an overly biopsychiatric approach
predicated on generalizability misses important cultural specificity and
angers some stakeholders. Experience also shows that psychosocial inter-
ventions with multiple therapeutic mechanisms given by well-meaning
cultural relativists tend to produce positive feedback but no scientifically
convincing measurements of effectiveness. Improving our knowledge on
both sides of this equation is crucial. Collaborations with disaster-affected
stakeholders and disinterested researchers together will advance our field
of work. Gradual approximations with EC will help to unpack the many
layers of complexities involved with people’s trauma and the interventions
that we develop to support recovery.