A Wall of Silence

Páll Ásgeirsson, Department of Psychiatry The University Hospital at Reykjavík, Reykjavik, Iceland

In 1995 two snow avalanches took over 30 homes in two villages on the west coast of Iceland. In contrast to other disasters that have previously taken place in Iceland, these two villages received considerable psychiatric assistance and the Icelandic public became quite conscious of the benefit of such help. After the second incident, an outcry for help came from a small town on the east coast that had been struck by an avalanche 21 years previously, resulting in a toll of 12 dead and a nearly total destruction of its industry. True to their professional opinion that it is never too late to work through a traumatic experience, a team of two experienced professionals from the University Hospital in Reykjavik (a psychiatrist and a psychologist) reacted and started work with those people who wanted help.

The work consisted of eight visits to the community that previously has never had any organized psychiatric service. On every visit there were group sessions and individual sessions. Several meetings were arranged with local health authorities and other organizing bodies. A community session was open to everybody. In addition we held other individual and family sessions at our home base in Reykjavik. This organized approach was terminated after 15 months, but several of the clients still have contact for some infrequent assistance.

The village where this took place is an isolated, prosperous community with 1,700 inhabitants that build their economy mainly on fishing and fish processing. It is located in an area under a mountain slope and practically the whole area is now considered to be very dangerous because of possible avalanches. Before a recent danger evaluation of many such villages, locals and the Icelandic community have been remarkably unaware of the life threat that has persisted through the ages, which has in this century lead to a great deal of questionable town planning.

One of the conclusions of our local treatment group has been that a "wall of silence" was built around everything concerning the avalanche, a wall that they felt had been a serious barrier against the rehabilitation of individuals, as well as the community as a whole. The very situation in 1974 where the existence of the whole village was threatened put all attention on the rebuilding of its industry and left no space for work around emotional issues.

In the course of this therapeutic progress, we had contact with about 100 people, who got very different services ranging from one large group session to short-term individual psychotherapy. Several of our clients gave indication that our participation initiated remarkable progress in their personal lives and others had their chronicity acknowledged, which gave them different opportunities to organize their lives. They also expressed the opinion that the afterwaves of our participation influenced the community as a whole by making the 1974 disaster a part of reality for everybody. It might be a realistic evaluation that the fact that this work took place made development possible on other levels of the community as well.

Before our work started, there were some doubts whether this initiative would only reawaken sorrow that we would not have a chance to address adequately. The sorrow and pain was certainly reawakened, but it seems that this initiated considerable constructive rebuilding and mobilization of dormant possibilities.