On the heels of publishing his latest book, Psychosocial Capacity Building in Response to Disasters, Josh Miller, professor of social work—whose career has included counseling people around the world after devastating crises—experienced his own life-threatening crisis earlier this year while riding a motorcycle in Thailand. After an accident, while recovering from multiple injuries, Miller gained a new perspective that would inform his work.
I don’t remember the first 45 minutes after the accident but became aware of what was going on as I arrived in the emergency room of a small provincial hospital in Pai, in Northern Thailand. I realized that I probably had broken ribs and was bleeding in many places, but felt surprisingly detached and vague about what was happening—as if I was watching another person as the nurses cleaned up my wounds. I was then taken by ambulance on twisting roads at breakneck speeds to a larger hospital in Chiang Mai, where I was treated in the emergency room and kept in the Intensive Care Unit over night. A nurse named Noh, who spoke little English, kept a vigil outside my room and cared for me in my helpless and fragile state. In the morning, a doctor explained to me that I had suffered a concussion, broken ribs, and a pnuemothorax. As it turns out, none of my injuries were life-threatening, although I had to stay in Thailand for an extra two weeks because it was unsafe to fly with a punctured lung.
I was traveling in Thailand with my wife—ironically, after teaching a course in Beijing about how to help people and communities who had encountered disasters. About midway through our trip, I remember riding on a motorbike on a country road when an elderly couple stepped in front of us, causing me to swerve to avoid hitting them, which involved ditching the motorbike. Fortunately, we avoided the couple and my wife was fine.
Over the past dozen years, I have responded to local tragedies—such as a homicide or fatal car accident—as well as major disasters (e.g. 9/11/01 and Hurricane Katrina). Increasingly my work was international (e.g. Sri Lanka after the Tsunami, Haiti after the earthquake and, with my colleague Joanne Corbin, Northern Uganda in the wake of a long-standing armed conflict). After the Wenchuan Earthquake in Sichuan Province, China, I met many Chinese colleagues at a post-earthquake conference in Chengdu. Since then we have become friends and have collaborated on research and articles, and I regularly co-teach courses about disasters at the School for Public Policy and Social Administration at Beijing Normal University.
Like most people in the helping professions, I get satisfaction from helping others. After a disaster, survivors have lost a great deal and are often in a very emotionally open and exposed space; leading to many deep and meaningful relationships and interactions. It is an honor to be able to help people at a time of such great need and I feel privileged and have gained a great deal from doing this kind of work. But of course, I have experienced these disasters as the person coming in from the outside, who has not sustained losses, whose body and spirit is intact, and although I have absorbed many sorrows from others, they did not stem from my injuries or losses. Being in a dependent position and requiring help from others was a new experience.
I realized that dependency required surrendering the illusion that I was in control of my life. For example, I initially resisted my Thai doctor’s advice about not flying. I was adamant that I needed to return as scheduled to the U.S. My mother in New York City was failing and this added to my sense of urgency. In retrospect, I feel as if I was culturally disrespectful to the doctor, who seemed disappointed with my reaction but unwilling to argue forcefully with me. After emailing some medical friends in the U.S., I was told that my Thai doctor was absolutely correct and that flying with a pnuemothorax would be dangerous. When I returned to the hospital and apologized to the doctor, he seemed to open up and became a more active collaborator in my rehabilitation and recovery, explaining to me how much air my pneumothorax had let in, pointing out which of my four ribs were broken and in how many places, reassuring me that I would eventually be able to sleep without pain and even swim and run again.
I could not dress myself and needed my wife’s help. She also cleaned my wounds multiple times a day. At first I could barely walk but would take tuk-tuks [Thailand's open-air taxis] to one of Chiang Mai’s many Buddhist Temples. I found peace sitting in their courtyards, meditating or reflecting on what had happened, the thin line between mortality and survival, and feeling the pain but not fighting it. I found that by yielding to my vulnerability and lack of control life seemed less threatening and more meaningful and resonant.
I had to rely on the benevolence of strangers. Why would they want to care for me—carry things, open doors, drive me to places, ask me how I was doing, share stories about their own mishaps, in essence be kind to me and not exploit my fragility? People were interested in my story and it was helpful for me to tell it; the telling and re-telling gave me different perspectives about what had happened, helped me to integrate the experience, and pointed me toward a hopeful future. I realized that there was a social trust that was part of what helped Thai society to cohere and that I needed to allow myself to accept and rely on this—an act of faith in a country anchored by its Buddhist convictions. I slowed down and savored every interaction, every act of kindness—coveting every smile. While I initially found it hard to accept the graciousness of the hotel staff, waiters and waitresses, taxi and tuk-tuk drivers, and strangers passing me on the street and greeting me, over time I came to see how they genuinely wanted to care for me because I was a human being and that it was okay to accept their kindness.
As I reflected on this encounter, I realized that I had a taste of what people might feel when I had responded to them after a disaster. I had not lost family or friends and my community was intact, but I had experienced something life-threatening and in a place without my usual support systems or cultural signposts. I was initially disoriented and confused. I lost control over the narrative that I had anticipated for myself. The depth of connection that I felt with strangers and the faith that was necessary for being in such a dependent position helped me to understand in a visceral and spiritual way what it means to rely on others who are committed to helping you. I had grasped this intellectually in the past, but this was a new level of understanding.
In the end, this was a good experience—something special had happened to me. It made me feel more connected with people and more in touch with how dangerous and caring the world can be. It was also helpful that I was able return to the U.S. in time to see my mother before she died. Closure helps us to heal.
Intellectually, it has helped me to tie together some disparate threads in my academic life: my antiracism and disaster response work; my participation in the Evil Symposium for the Kahn Institute, with the notion of social trust, what it is, how it is sustained, what happens when it breaks down, and how it is similar or different in a range of societies and historical periods; scholarly work that I plan to pursue.
But on a more personal level, when I look at some of the scars on my knee and hand, or at my ring that was dented during the accident and which I still wear, I feel a bond with the living world, knowing that death and destruction are always lurking in the shadows; I feel less fearful of this.
And through this experience, I had a glimpse of the knowledge and insights that my clients had often shared with me after experiencing disasters, which I now cherish all the more.