Expert Opinion
As the whole world is facing its greatest existential threat due to the coronavirus pandemic, there are major mental health problems that are staring at people. The prolonged lockdowns and “social distancing” have resulted in trauma for millions of people. In India, millions of migrant workers, daily wage earners, workers in the unorganized sectors and their families have been the worst affected as they have become displaced persons stranded in urban centres with no source of income and facing hunger till the government came in. These traumatic experiences have a telling effect on their mental wellbeing. After every disaster, personal, natural or man-made victims experience trauma manifesting as depression, fear, anger, anxiety, hypertension, blaming / complaining, domestic violence and even suicidal thoughts.
Once the scourge of the coronavirus is over, sooner than later, the emotional impact of the trauma people have faced would need help from mental health professionals. We have such help and interventions available from our government mental health institutions, non- government initiatives and psychiatrists. They have varied procedures, practices and therapies and research in the field add to these from time to time. One such initiative is e-CPR pioneered by two recovering mental health professionals from the United States, noted psychiatrist Dr. Daniel. B. Fisher, MD. Ph. D executive director and CEO of National Empowerment Center, international speaker, activist and trainer and Lauren Spiro, a Master’s in clinical / community psychology and an author. They co-founded e-CPR as, yet another effective help for people with mental health problems and those recovering from trauma.
My friend and long- time associate Suneel Vatsyayan, founder - Director Navjyoti, Delhi Police Foundation’s Deaddiction and Rehabilitation Center, who later founded Nada India Foundation. Early this year he invited me for a programme introducing Emotional CPR conducted by Lauren Spiro. Though I could not attend the training programme, I was fascinated and was inquisitive about e-PCR, another innovative tool to help people in crises and their trauma. So Vatsyayan briefed me thoroughly about what it is and sent me plenty of background material. That prompted me to interview Dr. Fisher and Lauren and they were happy to answer my questions mailed to them.
Let’s know in detail about how e-CPR can help people to renew life after coronavirus trauma from Dr. Fisher and Lauren.
Q. Most people know what CPR is in medical terms as an emergency life- saving procedure when someone has a heart attack. Why have you prefixed ‘Emotional’ with CPR as the name?
“We believe that in a manner analogous to our circulatory heart we each possess an emotional heart. We use the term emotional CPR to call attention to the need for many people to restart their emotional heart after trauma. We believe that trauma causes our emotional heart to lose strength or to build a protective wall around the heart and that the emotional presence of another person may be as necessary as for emotional heart failure as application of CPR is for someone whose physical heart has been interrupted. Interesting to note that in the cardiology world, e-CPR means extracorporeal CPR, which is when a heart-lung machine is used to restore the function of a persons' own hearts and lungs”.
Q. Can you explain what e-CPR is?
“e-CPR describes a way of being with a person in distress which enables both persons an opportunity to grow emotionally. E-CPR is also a way of being with oneself and others at any time. In contrast to conventional counselling, e-CPR emphasizes the importance of connecting through feelings first, words second. The C of e-CPR is for connecting at a deeper than usual level, through increasing awareness of the nonverbal dimensions of communication. We underline the importance of sharing some of one’s own feelings when assisting a person in distress. This means being deeply authentic which gives the person in distress a sense of greater safety. We facilitate ‘emPowerment’, which is what the P stands for. Rather than trying to empower the person, we urge people to enter into the relationship as an equal through being with rather than doing for.
We also equalize the relationship by accepting that we do not know what is best for the other person, and by accepting that together we will explore the unknown. This mutual exploration is also based on another quality of equality, namely that we are sure that each person has the power to heal. Then when we connect in an empowering fashion, our emotional hearts resonate and can engage in emotional dialogue which is mutually healing. The combination of emotional connection and emotional empowerment nourish our deeper self and make us feel more alive, more expressive, more creative and more optimistic. The pure life force energy begins to fully flow again as the person emerges from their crisis state. We call this process Revitalization which gives us the R of e-CPR”.
Q. Can e-CPR help coronavirus victims to overcome trauma?
“It is more important than ever that people be able to connect at an emotional level. Many people have not learned to make these sorts of relationships. Therefore, we feel that crisis is an opportunity to teach ways of being together which will serve them the rest of their life. It has taken a disaster such as this to show people the importance of social connections”.
Q . Seeking professional help about mental health problems is not popular in India. There are also different approaches and therapies. How will the e-CPR model, which is new work in India?
“e-CPR is not a form of psychotherapy. Rather it is a way of being in one's life and in the lives of those we care for. It is a good complement to therapy and indeed I and other therapists find that it enhances our capacity to carry our therapy. In many ways it draws on some of the aspects of therapy proposed by the humanistic school of Carl Rogers and Fritz Perls. By highlighting the emotional dimensions of relating we are reinforcing the task of therapy. Furthermore, e-CPR training gives clients and their families suggested tasks to do between sessions. Finally, e-CPR can be thought of as primary prevention in mental health. Before an issue becomes a full-blown diagnosable condition, friends and family can support a person in such a manner that they will release their capacity to self-heal”.
Q. In India there are taboos, superstitions and misgivings when someone has a mental health problem. Anyone affected is branded as 'MAD'. Using ECPR how can we overcome this kind of prejudice?
“Though it may appear a bit radical, the invitation when practicing e-CPR is to enter the relationship with a neutral mind and an open heart. Judgements, labels or diagnoses, make assumptions about a person’s emotional state that may create a barrier resulting in misunderstanding what the person’s heart is trying to communicate. It is important to recognize that the person in emotional crisis is trying as best they can to communicate the help they need. Therefore, the task of the supporter is to use their deepest listening skills (using one’s heart, one’s body and all sensing organs of perception) and curious inquiry to understand the meaning of their experience. When we react – and label someone as being “the problem” we are creating misunderstanding which typically adds more hurt and trauma to the person. eCPR invites us to look together and come to understand the deeper meaning to one’s emotional experience and the behaviour they express. As I shared in the e- CPR training, it took me (Lauren) many years to realize that there was never anything wrong with me; I had a spiritual emergency and no one at the time really understood what I needed. No one knew how to support me in moving from monologue (being stuck in my head) to dialogue (creating a mutually meaningful verbal exchange with another). Asking too many questions of the person in distress may reinforce a power imbalance. It might also feel like an interrogation which of course we don’t want. Instead, it is useful to sometimes use open ended prompts such as tell me more or what has helped in the past as long as the questions are not closed (yes/no) and not too probing. As appropriate, we encourage supporters to express how the expressions of feelings by the person in distress make them feel. Once the person in distress feels more equality and connection, a few open-ended questions may assist their process of what, for example, to plan for their future, beyond the e-CPR session”.
Q . There is a spurt in cases of depression after the onslaught of the coronavirus scourge. Same is the case with suicidal tendencies and similar other issues. What is the e-CPR approach to tackle these problems?
“The e-CPR approach is universal. it can be used with any crisis or distress anywhere as it directly assists to alleviate some of the central causes of depression such as powerlessness and disconnection from friends and family. The e-CPR process helps people regain a sense of hope, of meaning and purpose in life, a sense of urgency and power, and to get a clearer understanding of how they want to move forward towards their goals and dreams based on their personal values and circumstances. It helps people think more clearly about their life and how to more successfully navigate turbulent times including how to gather and organize the support they need. Practicing the e-CPR process helps the person live in a manner that is more aligned with their deeper values and vision of what their life can be. This is not an easy process. In fact it is hard work and that is why it is important to build the community of e-CPR practitioners, so they can continually enhance their learning of how to use e-CPR as a process to assist people to move more intentionally towards the life and the relationships they want to create”.
Q. You have been in India and trained some professionals and social activists in e-CPR in collaboration with Nada India Foundation. What has been your experience and do you think e-CPR can become popular here?
“I was very impressed with the wisdom and the breadth of experience of the e-CPR training participants. It is our great desire to have the new trainees more deeply understand and practice e-CPR so that they enhance their ability to share the process in India. Worldwide, we find that when a core group of local e-CPR practitioners understand it well and have the time and resources to share it, it spreads”.
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