Patricia Casey: 'Our culture could learn a lot from boys in Thai cave rescue'
Our "compo culture" is coming under enormous scrutiny as businesses are bankrupted and litigants' recovery is impeded by the process of litigation itself. 'Ambulance-chasing' solicitors are also being exposed.
Litigation culture plays a considerable role in causing and maintaining some psychiatric consequences. Most notably this applies to post-traumatic stress disorder (PTSD). While this is a very real condition, there are some cultures in which it is uncommon or absent, even in the face of life-threatening incidents.
Does anybody recall the Wild Boars in Thailand, the schoolboy football team trapped in a cave for more than two weeks this time last year? The story of their entrapment and heroic rescue by divers caught the world's attention. The rescue itself was a potentially fatal endeavour but had a happy ending. Experts made dire predictions about the mental well-being of these boys. But one should be cautious about predicting the future.
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The story of the rescue of the Wild Boars and of their life since the dramatic rescue is now emerging and I was privileged to have heard it a few days ago at the Royal College of Psychiatrists' annual International Congress in London. The man who recounted the up-to-date version is the Thai Education Minister Dr Teerakiat Jareonsettasin. He is also a British-trained psychiatrist. I wrote at the time that, "despite the trauma they have suffered you can see the joy in their eyes. Their resilience is shining through in spite of their young age and the terrifying ordeal they experienced". I was in a very small minority as the received wisdom was that they were destined to develop distressing mental health problems in the months ahead.
The psychological outcome as recounted by the minister is much more positive. He has met the boys and none of them suffers with PTSD or any other mental health condition. Neither do their parents or siblings and the divers have been utterly pragmatic about their wellbeing. Why have these boys seemingly escaped without any psychological injury? The explanation for their resilience is complex but is bound up with their culture, which focuses on caring for others as if they were caring for themselves. Their greatest concern was their guilt at not having told their parents where they were going. The first thing they did when they were reunited with them was to apologise for the suffering they had caused.
The boys described their time in the cave as one of friendship and feeling like a team. They described living in the moment and keeping a positive outlook. Their coach set up a structure for their day and taught them to meditate and to take turns digging a hole to try to escape. They would tell jokes if they felt sad or fearful. They agreed that those who lived farthest away should be rescued first, thinking that they would have to cycle home. Innocently, they did not realise that the world was looking on them and that their parents would be there to cradle them in love when they emerged.
For their part, the parents were protected from journalists and there were no lawyers on hand either. The parents acted in concert with worry for all the children rather than each being worried just for their own.
The authorities gave the go-ahead for a dramatic action to facilitate the rescue. In similar circumstances in a Western country, this would never happen because of fear of litigation. Each boy was given injections of ketamine by the divers, to sedate them during the six-hour journey out of the cave. In this way, panic or wriggling, a danger to the lives of the boys and the divers, was avoided. This was not disclosed to their parents at the time.
The boys are now well and all back at school. What can we in this culture learn about trauma and how to deal with it from this story? According to the minister, it shows that a rural life is beneficial. It allows them to accept the vagaries of nature, such as the torrential rain that trapped them, rather than being angry at their plight. There was no question of blame being heaped on the coach or on anybody else. Litigation has not been an issue. But Thailand is far away and the attitudes there are as different as night from day to those of most western and northern Europeans. So this happy story, unfortunately, has little relevance to us except to cause us to appreciate the difference in values between the cultures, and that the impact of this is real and tangible.
Patricia Casey is consultant psychiatrist in the Mater Hospital and Emeritus Professor of Psychiatry at UCD