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Int J Qual Stud Health Well-being. 2010; 5(3): 10.3402/qhw.v5i3.5323.
Published online 2010 October 14. doi:  10.3402/qhw.v5i3.5323
PMCID: PMC2956576

Out of the wave: The meaning of suffering and relief from suffering as described in autobiographies by survivors of the 2004 Indian Ocean tsunami

Åsa Roxberg, PhD,1,2 Jessica Sameby, RN,1 Sandra Brodin, RN,1 Bengt Fridlund, PhD,1,3 and António Barbosa da Silva, B.A., Professor4

Abstract

The aim of this study was to explore the meaning of suffering and relief from suffering as described in autobiographies by tourists who experienced the tsunami on 26 December 2004 and lost loved ones. A lifeworld approach, inspired by the French philosopher Merleau-Ponty's phenomenology of perception, was chosen for the theoretical framework. This catastrophe totally changed the survivors' world within a moment. In this new world, there were three main phases: the power of remaining focused, a life of despair, and the unbearable becoming bearable. Life turns into a matter of making the unbearable bearable. Such challenging experiences are discussed in terms of the philosophy of Weil, Jaspers, and Merleau-Ponty. The survivors of the tsunami catastrophe were facing a boundary situation and “le malheur,” the unthinkable misfortune. Even at this lowest level of misfortune, joy is possible to experience. This is part of the survivors' ambivalent experiences of their lifeworld. In this world of the uttermost despair there are also rays of hope, joy, and new life possibilities.

Keywords: Autobiographies, lifeworld, catastrophe, tsunami, suffering, relief from suffering, le malheur, boundary situation

Introduction

A catastrophe strikes suddenly, is unpredictable and out of our control, and its effects are long lasting (Dyregrov, 2002). The tsunami of December 2004 is one among a number of major catastrophes that has stricken humankind. Climate reports forecast that natural disasters will increase in number in the future (Danschutter, 2005). Suffering caused by disaster will thus be a frequent experience for a number of people in the world.

Scientists have assumed that reflections on a catastrophe and the victims' mourning process are intense during the first years after the event (Lundin, 1982; Michel, Lundin, & Otto, 2001). People have different ways of mourning. For some of the survivors of the tsunami catastrophe, a part of their mourning process included writing an autobiography. The autobiographies comprise reflections on what it was like to be exposed to a major and unexpected natural catastrophe, to be in the midst of the unthinkable. As Hardin (2003) has suggested, these autobiographies can convey the survivors' reflections on how their suffering was experienced. These accounts can deepen our understanding of how to encounter and care for people who have been exposed to minor or major catastrophes.

According to the American Psychiatric Association [APA] (2000, p. 463), a trauma is defined as “an extreme stressor involving direct personal experience of an event that involves actual or threatened death or serious injury, or other threats to one's physical integrity”. A catastrophe is characterized by the massive human suffering it causes as well as the vast amount of material damage and its threat to human identity, dignity, and security (Dyregrov, 2007). The risk for severe stress reactions increases if the situation that arises from the catastrophe is so vast and if there are limited possibilities for individuals to exert any influence (Michel et al., 2001). Two factors, in particular, may lead to acute severe reactions and physical problems after a catastrophe. Firstly, a sudden and unexpected loss of a loved one and secondly, exposure to a threat to one's own existence (Bergh-Johannesson et al., 2007). Job in the Old Testament (Holy Bible, 2004) encounters a similar threat. Job and people of today who have been exposed to a life-threatening event may also be affected by health problems if the threat has been extreme enough or has been going on for a long time. A post-traumatic crisis is generally characterized by a number of symptoms, such as fear of death, recollections of the trauma appearing in nightmares, survival guilt, emptiness, and sleeping disturbances (Deranieri, Clements, & Henry, 2002; Michel et al., 2001). These reactions normally disappear after some time (Michel et al., 2001) and most people do not develop an enduring post-traumatic stress disorder (PTSD) after trauma exposure (Connor, Foa, & Davidson, 2006). In order for PTSD to be diagnosed, the person must have been exposed to an extreme threatening event and the symptoms must have developed not more than 6 months after the trauma (Michel et al., 2001).

Psychosocial losses associated with the tsunami exposure, such as prolonged displacement, social losses, family losses, and mental health impairment among mothers, contributed to depressive and PTSD-symptoms in adolescents (Wickrama & Kaspar, 2006). If young people are not treated for their traumatic experiences and are exposed to stress later in life, they might then develop PTSD-symptoms (Goenjian et al., 2005). Adult survivors of the tsunami in Southern Thailand reported higher rates of anxiety and depression than PTSD-symptoms two months post-tsunami. Nine months after the disaster, the rates of these symptoms had decreased but not to normal levels (Van Griensven et al., 2006). Adult survivors in Sri Lanka experienced that their lives were in danger 20–21 months after the 2004 tsunami, which was strongly associated with symptoms and impairment (Hollifield et al., 2008). Adult females showed at least twice the risk of experiencing PTSD 6 months post-tsunami compared with males (Ranasinghe & Levy, 2007).

Pain and anxiety are dominating symptoms of a grief reaction. The goal of grief, however, is neither to forget about nor to “get over” the loss. Survivors of a catastrophe may recognize that they have completed the process when they are reinvesting in life again (Clements, DeRanieri, Vigil, & Benasutti, 2004). Grief is, however, a normal response in the early aftermath of a disaster, but is at the same time culturally specific. Most cultures have their own particular grief rituals/ceremonies, and these play an important role in the trauma recovery (Lundin, 1982; Pérez-Sales, Cervellón, Vázquez,Vidales, & Gaborit, 2005). Cultural norms in Sri Lanka dictated that the information that next of kin had been killed in the tsunami catastrophe was withheld from the relatives, thus preventing them from mourning (Nikapota, 2006). However, when screened for complicated grief nearly half of the project liberty service recipients showed symptoms of complicated grief 18 months after September 11. Complicated grief was also the strongest contributor to impairment (Shear, Jackson, Essock, Donahue, & Felton, 2006).

Consolation alleviates suffering by a change of focus from the suffering to something in between, which is described as communion, entailing a transformation of desolation into consolation (Rasmussen, Jansson, & Norberg, 2000; Talseth, Gilje, & Norberg, 2001). The in-between might also be understood as an experience of time and space in order to be able to suffer and to get a consoling interval in or from the suffering (Roxberg, 2005; Roxberg, Eriksson, Rehnsfeldt, & Fridlund, 2008; Öhlén & Holm, 2006). The key to getting well is to get resources and help (Ventegodt, Kandel, Neikrug, & Merrick, 2005). The spontaneous support of neighbors and friends is thus especially important in the initial phase after a catastrophe, while the advantage of professional support is its continuity when the spontaneous support may have disappeared (Nieminen-Kristofersson, 1998). The majority of adult survivors of the tsunami 2004 in Sri Lanka found their own strength, family and friends, a Western-style hospital, and their religious practice to be the most helpful coping aids (Hollifield et al., 2008). For people from the Western countries a revisit to the area of the disaster also contributed to the recovery of traumatized children and adults (Heir & Weisaeth, 2006).

How is it possible to research on suffering? Little research has been carried out that focuses on suffering and relief from suffering from a caring science perspective, which has its starting point in the suffering of the individual and views care as an art (Arman & Rehnsfeldt, 2006). The question is relevant for the present study being as it is assumed that the suffering after an unexpected catastrophe is a very overwhelming and complex experience. Is it then possible to carry out research on it when the rhythm of life is ruptured and life can no longer be taken for granted? To investigate this experience might mean going beyond what is taken for granted, seeking the rupture which could contain the profound experience of the tsunami disaster. The aim of the study was thus to explore the meaning of suffering and relief from suffering as described by survivors who on site experienced the tsunami catastrophe, 26 December 2004, and lost close relatives.

Methodology

Design and setting

An explorative study design using a lifeworld approach (Dahlberg, Dahlberg, & Nyström, 2008) was performed. The concept of lifeworld has its roots in phenomenology and means the everyday world as experienced by individuals themselves (Husserl 1999; Merleau-Ponty, 1962, 1968). Published autobiographies, written by survivors who experienced the catastrophe and lost close relatives as a consequence of it, were chosen as the data source.

Data collection and selection procedure

The main motive for the choice of data was that autobiographies may capture the reflected experiences of suffering and relief from suffering associated with the tsunami catastrophe in 2004. A procedure including reflection and distance means a shift of focus from the “what” to the “how.” In comparison with “traditional” interviews as well as TV and radio interviews, the writing of the autobiographies seemed to require a distancing from and a reflection on the traumatic event and the changed lifeworld (Dahlberg et al., 2008). Newspapers were initially also considered as a possible data source but were later excluded since the reports were brief and did not contain any disclosures of reflected experiences. The inclusion criteria were: (1) the autobiographies should pertain to the phenomenon suffering and relief from suffering associated with the tsunami catastrophe; (2) the autobiographies should contain personal experiences of the catastrophe at the place where it happened. The motive for emphasizing this was that it appears to be a significant distinction between having experienced the catastrophe on site compared with not having been there; and (3) the authors of the autobiographies should have lost at least one close relative in the tsunami catastrophe. It was assumed that it is a factor that influences the suffering and alleviation of suffering. No limitation concerning age and gender was set. All lifeworld research aiming at a general structure of any kind is dependent on a rich variation in data. It is thus generally important to include informants of different genders and ages (Dahlberg et al., 2008). Grief is a normal response in the early aftermath of a disaster, but is at the same time culturally specific (Nikapota, 2006; Pérez-Sales et al., 2005). Autobiographies from the Eastern part of the world would probably have contributed to greater variations in the data, which would have been an advantage to the study. The languages that we did not master were thus a limitation. Hence, the included autobiographies were written in languages the authors had a good command of, i.e. English, Swedish, and Norwegian.

The data collection began with searching for relevant autobiographies in relevant databases. Five autobiographies were found in Libris (websearch) and one autobiography in the British Library (websearch). Six autobiographies (cf.*) that pertained to the aim and criteria of the study were thus included. The authors of these autobiographies were five women and four men. Four of the autobiographies had two authors. Kyrkjebø and Kyrkjebø (2005) are a father and son author team. The first author of the autobiographies by Werkelin and Swanberg (2005) and Nemcova and Scovell (2005) are the survivors of the Indian Ocean tsunami. Olafsen and Dahl (2007) are a survivor/therapist author team. The piece written by Dahl as a therapist was excluded due to the text not corresponding with the inclusion criteria. The autobiographies were all written by tourists who were visitors when the Indian Ocean tsunami occurred in 2004. The authors' ages were 17–47, according to the autobiographies.

Data analysis

For this study, the latent level, the underlying meaning of the text, was searched, uncovered, and explicated, in order to reach a deeper understanding of the experienced suffering and relief from suffering associated with the tsunami catastrophe. The analysis focused primarily on what was written in the text and not on what the author may have meant, i.e., the unexpressed intention. It contributed to the ability of the autobiographies to highlight “the more” of suffering and relief from suffering of the tsunami (cf. Sayre & Halling, 2007).

There are some methodological issues to consider. Firstly, the problem of not being able to communicate with the author, in order for example to ask for clarifications, was a disadvantage in the study. This lack of communication became, however, at another level an advantage because the methodological problem of bridling one's pre-understanding in an interview situation was not an issue. The bridling of one's pre-understanding was instead transferred to the encounter with the text and to the text analysis. Secondly, autobiographies are constructed in a manner that temporally connects the past with the present, meaning that events from the past are linked with the purpose of the autobiography (Hardin, 2003). This temporal construction was a benefit to this study, because the link between the past and present implied a reflection on the event, i.e., the research phenomenon. Merleau-Ponty (1962) maintains that a person is a body-subject and the body is the vehicle for the human understanding of the world and of other people. The dialog between the embodied self and the world is understood as an intertwining (cf. Sayre & Halling, 2007). This dialogical intertwining might well add to the understanding of the research phenomenon. Thirdly, the manner in which individuals write their story might be a strategy in order to make secure that the work will be published. It is, however, assumed that the authors of these biographies had other reasons to tell their story, for example, to acknowledge the individual suffering associated with a major catastrophe, where the sufferers may remain anonymous, and to give vent to one's feelings.

The analysis started with several readings of the autobiographies in order to be acquainted with them and acquire a sense of the whole content. The next phase was to read the autobiographies with a critical attitude. When we live the everyday world our attitude is natural and unreflected, we just are “to the world” (Heidegger, 1996). However, as researchers we have to switch to a reflective attitude that is to be critical about how we experience the world, i.e. the research phenomenon (Dahlberg et al., 2008). The researchers' approach to the phenomenon was on the one hand open and on the other hand bridled, thus allowing the phenomenon to be what it is and not what it is supposed to be (Dahlberg & Dahlberg, 2004).

The third phase was to perform a thematic form of analysis. A theme is a kind of thread, a thread of meaning, which is expressed both in the parts (sub-themes) and in the wholes (themes) (Lindseth & Norberg, 2004). The text that corresponded with the aim of the study was divided into smaller units where each unit was described with a preliminary meaning, a meaning code. The meaning units were first coded in the autobiographies, and then imported to the text. The analysis entailed recognition of similarities and differences and attempts to cluster meaning codes containing similar meanings in so-called sub-themes. These sub-themes were then similarly clustered to form themes. The meaning that the themes formed was then critically reflected on in relation to the text, the first reading and the sub-themes. A complex pattern of ambiguous experiences of suffering and relief from suffering was revealed through the analysis. Finally, a comprehensive interpretation of the result was carried out, where the themes, sub-themes, the first reading of the text as well as the authors' pre-understanding was taken into consideration. This last phase of the analysis formed a new whole with a new meaning, which was reflected upon in the perspective of some well-known, and for the purpose of this study, relevant philosophers. The analysis thus entailed a movement between the different phases, for example, the final reflection meant returning to the text in order to validate the comprehensive understanding of the result.

Ethical considerations

Performing research where suffering is concerned always includes a risk of exploiting the vulnerability of one's fellow man. This risk was reduced throughout the research process by considering the risk of transgressing the integrity of the informant. The informants had published autobiographies about their experiences of the tsunami catastrophe revealing both names and other personal data. An objection can be raised that the informants had not agreed on participating in a research study. The authors discussed this ethical dilemma and reasoned that in qualitative studies the presumptive informants are often initially contacted by somebody already known, and that being contacted by a stranger might be experienced as a threat, which could provoke difficult memories. Research ethics in accordance with the Helsinki Declaration (2008) were thus followed. Although the authors have made a choice to publish the autobiographies, data that was considered as transgressing the integrity of the informant was left out. The Regional Research Ethics Committee at the University of Linköping has approved the study (Reg. nr Ö 158-07).

Findings

This presentation begins with a short summary of the survivors' situation at the time of the catastrophe. We have chosen to call the authors of the autobiographies “survivors,” and the deceased “victims,” “loved ones,” or “next of kin.” Each theme is introduced by a short summary of its content. The tsunami waves are mentioned in singular, the wave. The analysis revealed three phases: “The power of remaining focused,” “A world of despair,” and “The unbearable is made bearable.”

When the tsunami wave struck, Trisha Broadbridge and her husband were celebrating their honeymoon at Khao Lak. At the airport on the way back to Australia, Trisha got the message that her husband had been found dead. Pigge Werkelin was at Khao Lak with his family, his wife Ulrika and their two sons, Charlie 7 and Max 5 years old. Pigge went back to Sweden with his family in three sepulchral urns. Pigge Werkelin wrote his autobiography together with Katarina Swanberg. Steinar, Simen, and Ola Kyrkjebø, father and sons, were at Khao Lak by the swimming pool when the wave came. Heidi, wife and mother, was killed by the tsunami. When hit by the wave, Petra and her boyfriend were in their bungalow at Khao Lak. Petra received serious injuries and lost her boyfriend. Petra Nemcova wrote her autobiography together with Jane Scovell. Malin Sävestam lost her husband Mats and their children, Harald 12 and Elsa 9 years old, in the tsunami catastrophe at Khao Lak. Espen Olafsen was at Khao Lak with his wife and two children. He lost his wife Elfrid and 5-year old daughter Froya.

Early in the morning of Boxing Day, 26 December 2004, the authors of the autobiographies as well as thousands of other holiday-makers enjoyed their Christmas vacation at the place considered as “the paradise.” None of them could ever have foreseen that they would this day be victims of an immense wave, which indiscriminately killed their loved ones. The impression of the text as a whole (the autobiographies) was that the world that day at Khao Lak more or less completely turned around. In this altered lifeworld the taken-for-granted was replaced by nothing that could be taken for granted. In a few seconds the well-known world was swept away leaving an unknown and painful world behind. The time following the catastrophe was for the survivors a struggle to orientate them in the new world which never would be the same as the “old” world.

The power of remaining focused

In a moment the survivors' world was completely changed. The wave was chasing the people, who although frightened, managed mainly to remain focused. The powerful wave seemed determined to destroy the people as well as their paradise:

The water strikes me like a great slap against the whole of my body. It throws me against the wall … the sea is a mighty exterminator that is aiming to take me, torment me, destroy me, with a violent bite he swallows her. My beloved daughter. (Olafsen & Dahl, 2007, p. 23)

A discerning perspective

The survivors managed to discern the right thing to do, e.g., to foresee what to do, how to do it, and who to rescue. Their first instinct was to run for their lives and to help their next of kin:

I was completely focused on Ulrika and the children. (Werkelin & Swanberg, 2005, p. 78)

I look into her [the wife] eyes, it's a special moment … She is not afraid, only deeply focused. (Olafsen & Dahl, p. 25)

This instinct often entailed getting hold of something that could protect from the wave, “I caught sight of a pick-up, which strangely enough was in an upright position. This car, I must reach … or otherwise I will die” (Kyrkjebø & Kyrkjebø, 2005, p. 132). Many encounters between unknown and frightened people took place during the struggle to survive. In the encounter between three men (two of them are authors of the autobiographies in this study) the focus was on saving the life of the other, “Pigge turns up. He has lost his wife and his sons, but still he is able to lift and help to save Anders” (Olafsen & Dahl, 2007, p. 31). Encounters were also remarkably intense, capturing a couple's history in a one single moment, “We are looking at each other (man and wife), nothing else, and it is as our whole history together and all our love is caught in this encounter” (Olafsen & Dahl, 2007, p. 25). However, the water masses rose and ultimately their force were so strong that the victims were drawn under the water. The focus was to a great extent on the next of kin, “All the time I am thinking that I have to search for ‘mine’ [my family]: Heidi, Simen, and Ola, find them, help them” (Kyrkjebø & Kyrkjebø, 2005, p. 13). The survivors were exasperated and physical needs like resting or eating were not felt. If they had to take a rest it was because of their injuries. Nevertheless, the survivors continuously called out the names of their loved ones. In the middle of the chaos the survivors where surprisingly focused on concerns which did not immediately belong to the extreme situation, the battle between life and death, “My insides hurt, and even in all that chaos I wondered if I could still have children (Broadbridge, 2005, p. 19). When the immediate surroundings had been searched without finding their next of kin alive, the next alternative was to search among the dead.

To be cut off

After the tsunami had passed away the victims were living in their own world, isolated from the surroundings but still with a strong instinct and in hope of finding their relatives, alive or dead. Corpses covered with white linen were everywhere. The survivors also had to witness how corpses were caught in fishing nets. To be able to distance oneself from an inhuman situation was necessary, “You turn yourself into a machine in order to be able to search among the dead bodies, otherwise you wouldn't be able to manage it” (Broadbridge, 2005, p. 78). Hoping (and fearing) to find their next of kin dead made the survivors continue their search in the temple among hundreds of dead corpses. In the temple they had to look at every corpse:

If something could cause a person to break down it is walking among eight hundred dead persons searching for your son. (Werkelin & Swanberg, 2005, p. 113)

The survivors felt lonely and forsaken. The experience of being unreal as well as of an unreal situation was prominent, “This is not to happening us” (Sävstam, 2007, p. 92), “There was something unreal, empty, and desolated about the whole scene” (Olafsen & Dahl, 2007, p. 39). The trying situation evoked a state of complete exhaustion and of being divided into parts, entailing body, and person losing contact with each other, “I cannot manage anymore!!! My chest is burning, my thoughts are in a tumult. My body and I have parted from each other—are living separate lives” (Sävstam, 2007, p. 97). When struggling to survive the conception of time was changed, time as a linear construct vanished into a lived now. The experience of satiated moments, which embraced the eternity of a life-time, was described. It was no longer a matter of living one but several lives:

Every second is so satiated with action that the whole event appears to be an eternity, a whole life, even several lives. (Olafsen & Dahl, p. 32)

It is also a kind of “seeing.” The extreme situation was experienced as seeing oneself from the outside in a condensed moment of existential recognition. The physical injuries had normally been considered extensive. However, in this phase it seemed as though pain diverted pain. Many of the survivors, although being injured, were not feeling any pain at all during the hours following the catastrophe. They felt cut off from their painful bodies or the painful bodies were experienced as living their own lives. The pain was an existential experience:

Under these circumstances the painful wounds are something that co-exist, beside and behind the inconceivable loss of Ulrika (wife) and the boys (sons). (Werkelin & Swanberg, & Swanberg, 2005, p. 130)

A world of despair

Surviving the funeral and the time after was a matter of endurance on a day-to-day basis. The pain was burning on the inside and the thought of a future without the deceased unbearable, “Coming home to Australia from my honeymoon, without my husband, is the one of the hardest things I have ever had to do” (Broadbridge, 2005, p. 109).

A life of loose ends

When the corpses of the next of kin were found they were transported to be buried in the home country. The survivors' world was experienced as being unreal and filled with a great loneliness and emptiness.

“Is this really happening to me”? On the day of the funeral the survivors realized that this day was the end of their world. Never more they would hold the loved ones in their arms. Their silent cry was formulated in a question; Is it really true that I am to say good-bye to someone I love so much. When Sävstam (2007) received the message that her husband was dead, she described the experience as: “I am falling millions of kilometres headlong into an abyss screaming out my pain” (p. 64). The survivors had never felt so lonely and incapable of being together with other people, despite being together with other people; “I am surrounded by people. I am very lonely” (Werkelin & Swanberg, 2005, p. 53). The survivors' experienced themselves as separated from the whole, lacking a connection within themselves and with their context, “like taking part in a football game when most of the team is missing” (Sävstam, 2007, p. 181). The other half was gone and would never come back to make them whole again. The inside was empty and something was missing. The emptiness was experienced as a black hole, “Just thirty-three days after our wedding, I would be burying my husband. I felt absolutely empty that morning. It was as if all the life had been sucked from me and there was nothing left but a shell” (Broadbridge, 2005, p. 124). Some of the survivors frequently used metaphors to express their despair. The metaphors described a great feeling of being torn to pieces and completely vulnerable and bare:

I'm empty. Just skin and bone, two sad eyes. Everything around me is in black and white and has no colours. I'm looking and don't understand what I see. (Sävstam, 2007, p. 115)

The tormenting fear

The survivors experienced an enormous fear. The fear concerned how to manage to carry on living, a fear of having a breakdown, and a fear of not being able to distinguish the real from the unreal. The nightmares started as soon as the survivors closed their eyes and hearing a loud sound reminded them of the black wave. For some, the fear became unbearable and they had to seek professional help. One of the survivors had to be admitted for psychiatric care because of the risk for suicide. In order to cope with the first period after the catastrophe, the survivors surrounded themselves with relatives and friends day and night.

The provocative anger and guilt

The unbearable pain expressed itself in many different ways. To feel angry and to express the anger was one way of reducing the pain. The survivors were angry with the public authorities as well as with persons in authority who could not or did not dare to answer their questions, “Now I'm really angry and shout like a dog barking … Once again nothing is working. Absolutely nothing!” (Werkelin & Swanberg, p. 109). The anger was also directed toward the deceased. This anger concerned being left alone in a terrible life situation, “I kicked the water [in Thailand] with all my might, screaming, “Damn you! Damn you!” (Nemcova & Scovell, p. 194), “I am probable most angry at her because she is not alive” (Werkelin & Swanberg, 2005, p. 83). Ultimately the anger provoked feelings of guilt for being the one who had survived the catastrophe. The guilt involved why they, at that critical moment, had gone to that very place. The insight that a change of hotel or a left turn had had such devastating consequences provoked anger as well as guilt, “Again the feeling of guilt gets hold of me. It was me who took the initiative to spend the holiday in Thailand … (Kyrkjebø & Kyrkjebø, 2005, p. 66). The feeling of being unjustly stricken was also prominent and closely related to anger, “I can not help cursing my destiny, which is so unjust” (Sävstam, 2007, p. 97).

Missing the world as it was

The world of the survivors momentarily changed and life was no longer as it used to be. The persons they had loved and taken for granted and the every-day life they had had together was gone. Old “tracks” were wiped out and were to be replaced by new ones. The survivors missed the closeness they had had to the best friend, children, wife/husband/boyfriend, and mother. The grief was particularly painful on anniversaries:

Troy had always made my birthday so special and I missed him so much. That night I cried so much I vomited. I had turned twenty-four and my heart was breaking. (Broadbridge, 2005, p. 171)

The desire “to turn time back again” to the world as it was before initiated a negotiation with God:

If you give me one of the children back I will change my whole life. Everything will be different. If you give me back both my children you can have my whole life. (Sävstam, 2007, p. 30)

The unbearable is made bearable

A hard task for the survivors to face was to try to return to an ordinary life after the catastrophe. An ordinary life was hard to recreate in the survivors' altered lifeworld. It was a matter of enduring, trying to put the bits and pieces of a devastated life and world together. The survivors experienced an overwhelming loneliness. “I know there are hundreds out there who have begun the process of putting together their shattered lives in silence” (Broadbridge, 2005, Author's note).

Alleviation that conquers loneliness

When the survivors managed to get in contact with their relatives “at home,” the relatives started telephone networks in order to find the missed persons. Some relatives also came to the disaster area in order to assist the survivors, which to some extent alleviated their great sense of loneliness:

I am not alone any longer as I have come into contact with my siblings, the jungle drums have started up in Gotland [Swedish island]. (Werkelin & Swanberg, 2005, p. 56)

The survivors experienced many generous gestures, on site in the disaster area as well as in their home countries, in particular the Thai people displayed their concern and hospitality. The Thai people were capable of putting their own loss aside in order to pay full attention to the survivors. However, the generous gestures were discerned with a special perspicacity, “Those who have experienced a catastrophe are unbelievably sensitive for small gestures, both the well-meant and the mean” (Werkelin & Swanberg, 2005, p. 91).

The experience of kinship in the support groups meant a lot to the survivors. The support groups were even experienced as a better help than the professional support. For the first time after the catastrophe the survivors did not feel lonely. It was the atmosphere of warmth and love in the group which gradually helped the victims to return to a normal life. Furthermore, real friends were distinguished from others by being there, enduring and listening again and again to the survivors' stories. Another way to alleviate the suffering was to dwell on “the living memories,” in the form of photo albums, letters, and videos from the past years with the deceased; “I look forward to the future because, whatever happens, I bring to it beautiful memories of the wonderful man I lost” (Nemcova & Scovell, 2005, p. 194).

The phenomenon of transgressing boundaries was also described as something that alleviated the victims' deep experience of being left alone with their loss. The transgressing was like crossing a border and was something that could be learned and subsequently practiced, “I have to once again learn to keep walking longer on the right side of the fragile thread between love and grief-between the experience of being alive and being dead” (Sävstam, 2007, p. 164). Then, all of a sudden, it was possible to cross the border in order to reach the “life-part” they had longed for, “put a foot on the other side of the border into joy-love and to the life-part” (Sävstam, 2007, p. 155).

Activities that reassure

Physically exhausting sports were reassuring for some. Physical activity eased the frustration for a while:

Riding my motorbike gives me a sense of joy in my body, ‘I am free.’ For a short while I have the feeling of regaining control over my life again. (Werkelin & Swanberg, 2005, p. 170)

Other activities that gave relief from the suffering were to have dinner with friends, listen to music, to write one's story, and to remember the moments the survivors had had with the deceased. These activities worked as a kind of therapy and acted as an intermediary to a kind of joy, even if only for a short while.

A return that makes the suffering proceed

All the authors returned to the disaster area in order to say good-bye to the deceased. Many questions could only be answered at the place where the loved ones were lost. For many of the survivors it was the first time they could really take in what had happened. A special closeness to the deceased was felt in the disaster area, a closeness which was regarded as impossible to experience anywhere else in the world. To step into the same water that took their loved ones away was a very difficult thing to do but something that was necessary. This act seemed to work as a symbol of returning back to life again. To swim in the same sea that took their loved ones was therefore regarded as a healing experience. Paradoxically the sea that took was giving back with the same hand.

Life possibilities that conquer impossibilities

“How would you survive if your child died”? The night before the catastrophe was the answer to the question, “No, you do not survive” (Werkelin & Swanberg, 2005, pp. 34–35). However, the experience drawn from the loss was that a human being has unforeseen strength. No one is spared from catastrophes, but when it happens it is an opportunity to overcome human boundaries. The grief will not disappear, but it will be mitigated, “The first ray of hope appears—I am living, is the thought that comes for a second” (Broadbridge, 2005, p. 104).

Methodological implications

The methodological approach aimed to highlight the meaning of human suffering and relief from suffering from the tsunami catastrophe in Thailand, 2004. There are, however, several methodological considerations to reflect upon. The first concerns the choice of data source. According to Merleau-Ponty (1962), memories are embedded in the body and as such are memories of the present. The access to the world of suffering and relief from suffering associated with the tsunami catastrophe goes through reflection, because the experience of the tsunami wave has to be encapsulated in the survivors' way or mode of being-in-the-world (Heidegger, 1996). Thus, the two alternatives, an interview study more than 3 years after the tsunami and an autobiography study would probably generate different results. It is most likely that the first alternative would to a greater extent reveal a reflected experience while the second alternative would highlight “more” of the embedded experience of incorporating an altered lifeworld into the ordinary lifeworld. Secondly, the use of autobiographies as a data source entails dealing with edited and “mute” data. However, not being able to communicate with the author, e.g., to ask for clarification, can be frustrating. Variations in the data were searched for in order to counteract this problem. Thirdly, the autobiographies included in the present study contributed to its validity. These were of good quality, i.e., described in a balanced and well-expressed way the meaning of the research phenomenon. Fourthly, during the research process it became clear that we had to change our opinion as to what constitutes good data. The descriptions in the autobiographies were sometimes short, e.g., as notes in a diary, and somewhat unexpectedly, these short descriptions had a rich meaning content. We had to try to adapt to these short descriptions, compared with the large amount of data we usually have.

A fifth aspect concerns the question of transferability,that is, to what extent the findings can be transferred to other contexts (Polit & Beck, 2006). The level of transferability seems to be high since the results, although dealing with an abstract phenomenology, can be applicable to similar situations that is a disaster environment and disaster care (Dyregrov, 2002). An objection might be raised that bereavement is culturally specific. No autobiographies from the East were included in the study, which can bias the findings. Nevertheless, it seems as the findings point toward a more profound experience of loss, which has less in common with cultural differences and more in common with ontology, that is, what belongs to human existence as such. Finally, the question of how we dealt with our pre-understanding is an important issue. The first, second, and third researcher were responsible for the data collection and the analysis. The first author was also responsible for the interpretation of the findings and for the composition of the study. The fourth and fifth researcher added critical reflections to the study. The researchers' approach was to keep an open mind, asking the text if their expectations about the phenomenon were in any way dominating the analysis. When the researchers critically reflected upon the analysis and their pre-understanding they did it in terms of questioning their previous experiences in terms of their present ones (cf. Gadamer, 1960). The researchers' pre-understanding was thus made conscious both by, on the one hand, focusing on the understanding and on the other by not having any pre-understanding at all. By letting these two aspects of pre-understanding confront each other we could avoid making definite what is indefinite (Dahlberg & Dahlberg, 2004).

Philosophical reflections on the findings

The findings of this study reveal a picture, that is, neither colored in black nor white, but in both. What at first sight appears as either weakness or strength, later on appears as an intertwined web of both. This intertwining in dark and light colors is especially prominent in the sudden changes of the survivors' world, from the taken for granted world before the wave and to the “disaster world” where nothing can be taken for granted. Life, for the survivors, becomes a matter of making the unbearable bearable. These types of challenges are considered in terms of the philosophy of Weil, Jaspers, and Merleau-Ponty, whose work may be able to contribute to understanding the findings.

According to Weil (1963, 1994), only the person loved is adjudged full existence. The findings show that the survivors are making all possible efforts, including risking their own lives, in order to rescue their loved ones. The loved ones get all possible attention during their struggle to survive. In that sense they are adjudged to and loved to full existence. However, everything that is tied to oneself by rope can always be cut off (cf. Weil, 1994). The rope attached to the loved ones is cut off by the tsunami. In light of Merleau-Ponty's philosophy (1962), the cut means a rupture of the invisible threads to the individual's life and world. In light of Jaspers' existential philosophy (Jaspers, 1963), the survivors of the tsunami catastrophe are facing a boundary situation and according to Weil (Stenqvist, 1984), facing the “le malheur,” is the unthinkable misfortune.

A boundary experience is an external situation that presents the contradiction of life itself (Jaspers, 1963). By “le malheur” (Weil, 1963, 1994) is meant the innocent suffering experienced at the border of existence, such as death, a pure chance happening, guilt, and the unreliability of the world (Jaspers, 1963). In the findings of this study the suffering provoked by the tsunami can be understood as such a boundary experience. Man's life is impossible and only a misfortune (le malheur) can make him or her experience the impossibility. The uttermost misfortune is to lose the ability to love (Weil, 1963, 1994). The findings show that some of the experiences of guilt concerned being the one who survived. “Le malheur” can provoke experiences of guilt and of being tainted. The experience of guilt associated with the tsunami catastrophe can be interpreted as fear of losing the ability to love the deceased as well as fear of being tainted as unlovable.

According to Weil (1963, 1994), the misfortune (le malheur) makes the soul hard and desperate. Those who suffer are therefore quietly pleading to be given words to convey their suffering with. This silent cry is only heard in the inner of the soul, because the sufferers do not have the strength to cry out anymore (Weil, 1994). The survivors' experience of a great loneliness is congruent with this silent cry. The cry is to be likened with a dark night in which the survivors try to find a way to reach some kind of life and world to feel at home in. It is also congruent with Weil's (1963, 1994) thinking about emptiness as an inner tension to which nothing external can respond. The survivors are trying to adapt to their new lifeworld but are incapable since some parts of the whole have been removed, “is like taking part in a football game when most of the team is missing.” This lack of wholeness makes the survivors become alienated from themselves as well as from others. Hence, the suffering is a double suffering (Younger, 1995).

The survivors were very sensitive to other peoples' approaches, “…both the well-meant and the mean.” In benevolence the sufferers are given foreign words because those who have chosen the words are foreign to the misfortune (le malheur) they are interpreting (Weil, 1994). According to Levinas (1969), we are responsible for the other. This responsibility is evoked by the other's vulnerability which in turn evokes one's own vulnerability. The survivors' experience of being at home is the togetherness with the world they belonged to before the catastrophe. However, the invisible threads to that world are broken. The survivors' vulnerability and brokenness has to be met by someone who dares to enter their world of homelessness and lack of context (cf. Dahlberg, 2007). This courage can only be found within the consoler (Roxberg, 2005; Roxberg et al., 2008), for example the nurse, being as the meeting with the other at another level is a meeting with oneself (Levinas, 1969).

Another aspect of the findings is that in the midst of the catastrophe the power of remaining focused is outstanding. Time is encapsulated in a lived now, described as encompassing not only one but several lives as well as the entire eternity. An understanding is developed of the intense encounters in the findings and the experiences of seeing oneself from outside in a condensed moment of existential recognition. Instead of being stiffened by despair, humans can use the despair to reach deeper insights (Weil, 1963). It seems as the survivors are, in a symbolical way, crossing a border in order to reach “the real.” A test of what is real is that it is hard and rough, and joy is to be found in it, not pleasure (Weil, 1963). Man's holiness is non-personal, meaning that the non-personal cannot be violated. “The real” cannot be transgressed, since it is non-personal (Weil, 1994). “The real” is not “working” on the superficial level of the suffering but right in the hard and tough struggle to survive. It may be likened with a consoling interval right in the “midst of the unthinkable” (cf. Roxberg et al., 2008; Roxberg, Burman, Guldbrand, Fridlund, & Barbosa da Silva, 2010; Roxberg, Dahlberg, Stolt, & Fridlund, 2009; Öhlén & Holm, 2006). However, this “real consolation” is neither soothing nor reducing the suffering. It is evident when the survivors “once again learn to keep walking on the right side of the fragile thread between love and grief, between being alive and being dead.” This experience has nothing in common with “the cream on the cake” pleasure. Instead it is in the struggle where the real joy all of a sudden appears as a possibility to “put a foot on the other side of the border into joy-love and to the life-part.” Hence, “the real” is something which is not possible to transgress, i.e. to reduce, which shows similarities with a caring consolation (Roxberg, 2005; Roxberg et al., 2008). This interpretation of the findings points toward an innovative care aiming at assisting the victims' to experience “the real.” To experience “the real” is to know what suffering means. Furthermore it does not reduce but transgress the victims' suffering into “the life-part.”

The findings reveal experiences of being separated from the body. The body is a lived body that encapsulates time and place. The experience of an extreme situation can be interpreted as a rupture of memories that are embedded in the body and as such memories of the present. Hence, the understanding of a painful body in a devastated life situation, like the tsunami catastrophe, can be interpreted as an experience of a rupture in the lived now (Husserl, 1999). The world of the individual and the individual in the world of the tsunami belongs to the same devastated world (cf. Dahlberg, 2006).

Furthermore, the findings reveal an alleviation that reassures. Physically exhausting sports eased the suffering and riding a motorbike was a way of taking control over life again. The misfortune (le malheur), as the tsunami catastrophe, is a life situation in which man is losing his/her footing and is experiencing a threat of the impossible. The loss is compensated by illusions, which are figments of imagination in order to keep the suffering at a distance. To keep the suffering at a distance is part of the process of making the unbearable bearable. Weil (1963, 1994) finds that the process is more of a way of enduring than a path to healing. In a boundary situation man is either falling or driven (Stenqvist, 1984). To be driven is to make use of the experienced emptiness inside. It is interpreted as when the survivors dare to face the existential challenge the suffering starts to free itself (cf. Weil, 1963, 1994). How can a nurse then assist survivors in being led into the process of encountering the inner experience of emptiness without reducing it? The findings of this study are congruent with Job's suffering in The Old Testament of the Bible. Job suffers from “le malheur,” which ruptures the connection to his lifeworld. He suffers from a great loneliness that is part of not being understood. Job's friends try to console him with a set of explanations to why he has to suffer (Holy Bible, 2004). To explain the misfortune (le malheur) is to excuse the suffering, which is to escape reality (Stenqvist, 1984). Roxberg et al. (2008), inspired by Weil (Stenqvist, 1984), describes a reducing consolation. The reducing consolation deprives humans of the potential to suffer and is a non-caring consolation. The struggle with suffering thus becomes a struggle for consolation, an attempt to be in contact with one's innermost core, one's true self (Roxberg, 2005). The utter and complete is non-personal (Weil, 1994) and at the bottom level of the accident is the essence of joy. The catastrophe area is described as an unreal, empty, and desolated scene. The survivors are experiencing immense emptiness, as a shell that covers an empty hole inside. Ambivalent feelings are also part of the survivors' lifeworld. These are described as crossing the border into joy-love and to the “life-part” of life. In these feelings uttermost despair is sharing room with rays of hope, joy, and new life possibilities. It also sheds light on the question on, “How to research suffering?” (Arman & Rehnsfeldt, 2006). There is little research that views PTSD from an existential and philosophical perspective (Isovaara, Arman, & Rehnsfeldt, 2006). For further research the findings of this study and other studies with an existential–philosophical perspective (Råholm, Arman, & Rehnsfeldt, 2008; Roxberg et al., 2009, 2010) can deepen the understanding of the complex world of human suffering from a major catastrophe and how that suffering can be relieved.

Conclusion

The present study shows that for the survivors of the Indian Ocean tsunami the new world presents itself in three complex phases. The complexity of the experience is to remain focused right in the midst of chaos and to share room with uttermost despair in which rays of hope and joy also are to be found. The unbearable emptiness is made bearable by facing the suffering without compensating it with anything else. The survivors are, for example, facing their suffering by returning to the catastrophe area. When facing the fear of stepping into the water that took their loved ones they are struggling with their suffering and struggling for consolation. The fear of encountering the “le malheur” (the misfortune) which ruptured the survivors' connecting threads to what they valued most in life and to their taken for granted world may be seen as an encounter between the “fulfilled” love of the previous world and the emptiness of the new world. This act seems to have the capacity of loosening the suffering without replacing it with a substitute. It is to face the nothing in the empty hole inside in order to “keep walking longer on the right side of the fragile thread between love and grief—between the experience of being alive and being dead.”

Conflict of interest and funding

This study was supported by grants from the Swedish Order of St John, Lars Hierta's Foundation, and the South of Sweden Nursing Home.

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