Page 222 - Creating Spiritual and Psychological Resilience

Rituals, Routines, and Resilience 191

The answer to this, at the least, is because psychiatry stands to benefit
from becoming involved, or at least aware, of activities like rituals that fos-
ter meaning when life seems to have lost meaning and purpose. Under any
circumstances, one of the hardest things to do as a psychiatrist is to lend a
patient passion and purpose. After disasters, this is an especially daunting
challenge. I am still haunted by my memory of the words of a survivor of
the 2004 tsunami who I met in a rural northeastern region of Sri Lanka: “I
lost my wife, my daughter, my boat for fishing, and even, literally, the shirt
off of my back. I have no spirit. Life has lost its meaning. What is there?”
Considering prescribing this clearly and understandably depressed man
antidepressant medication seemed especially disproportionate to these
existential concerns.
We know that the “avoidant” symptoms of PTSD, in particular, are
often harbingers of a poor prognosis, being among the most enduring
of all PTSD symptoms even when treatment has been beneficial. These
include feeling painfully detached from life, experiencing less emotional
depth and having a tenuous connection to one’s future. Insofar as rituals
have an apparent function of fostering meaning, they may constitute an
important tool in a range of interventions psychiatrists recommend to a
disaster survivor.
Psychiatry may well have something to offer to ritualistic practices
as well. There can be a collective dialogue about what constitutes the
purpose, in psychological and spiritual terms, of rituals. This naturally
involves studying how to capture, as exactly as is possible, what it is about
rituals that is effective. Next, we can investigate what factors contribute to
this effectiveness. These may include factors as far ranging as the size of
ceremonies, their location relative to the disaster site, their timing relative
to the event, and even their frequency. Ultimately, it should then be pos-
sible to generate guidelines, borne of collaboration between the spiritual
and mental health care realms, for when and how to initiate postdisas-
ter rituals. Indeed, it is perhaps time to generate these guidelines through
joint dialogue, while we await whatever further answers clinical science
can offer on the subject.

Conclusion

Rituals are a central aspect of spiritual practice but far afield from the
practice of psychiatry. The examples from survivors of Auschwitz, Pol
Pot’s killing fields, Hiroshima, and 9/11 reflect how rituals appear to play