| In
the aftermath of Hurricane Sandy, opinions—some
reliable, some misleading— about the storm’s
potential mental health impact have proliferated.
When media channels act responsibly they engage
experienced experts as spokespeople; when that
does not happen, wrong information adds to the
public’s anxiety and can foster inappropriate
clinical interventions and waste resources.
In the latter category, perhaps
the greatest myths I have heard are:
• Post-traumatic stress
disorder (PTSD) can appear in the immediate
wake of a disaster.
• Watching television can cause PTSD.
• The highly common psychic distress in
the wake of a disaster is a mental illness.
Here are some facts:
Psychic distress after a disaster, which can
be highly prevalent and last up to a month,
generally is a normal reaction to an abnormal
situation. This is known as an acute stress
disorder (ASD).
Many people experience ASD
after exposure to a traumatic event in which
they felt intense fear, helplessness or horror.
A person who experiences it is deeply shaken
and cannot stop thinking about the event, he
or she may have difficulty sleeping and may
be jumpy or irritable or cry easily. Taking
care of everyday business is hard and socializing
is no longer fun. The person may smoke or drink
more and withdraw from others.
These symptoms can impair
functioning at school or work and within the
family.
For a diagnosis of ASD to
be made, the condition must come on within four
weeks of a trauma and last more than a couple
of days. If significant symptoms persist for
longer than a month, it is likely that the ASD
has progressed to PTSD (see below).
Watching television ceaselessly
can aggravate a person’s distress, so
people should limit their television viewing
so that they remain informed but not compound
their worries. Parents should monitor what their
children watch. They should also provide them
reassurance and hope since children do well
when they feel protected and comforted by those
they depend upon and trust.
PTSD is a more persistent
and severe response to trauma than ASD, which
always precedes it. Symptoms of PTSD include
re-experiencing of the traumatic event, avoiding
cues of the trauma, emotional numbing that can
become consuming, and persistent symptoms of
heightened arousal. PTSD can only be diagnosed
if it has been at least a month since the catastrophe.
There are other conditions
besides PTSD that commonly emerge in the days,
weeks and months after a disaster. These include
depression; anxiety disorders, other than PTSD,
such as generalized anxiety and agoraphobia;
alcohol, tobacco and drug overuse and abuse;
and worsening of pre-existing mental and addictive
disorders.
A singular focus on identifying
PTSD is apt to miss these other serious and
potentially disabling conditions, which can
exist independent or occur alongside the disorder.
The more life threatening
and ghastly the disaster, as well as the degree
of what is called “exposure,”—when
a person experiences direct and continuous visual,
olfactory, and auditory sensations after the
disaster—the more likely a traumatic state
will ensue.
Direct victims of a disaster
are at greatest risk of developing post-traumatic
emotional problems followed by rescue workers,
followed by some of the general public. Once
PTSD sets in there is evidence that it can and
does persist, especially for those with early
onset of the symptoms.
No definitive psychological
profile characterizes those who are apt to do
poorly after a disaster, except for those who
already had poor coping skills. People with
active or past mental disorders or who have
been previously traumatized are also at greater
risk. Yet not everyone exposed to a severe traumatic
event will develop ASD or PTSD. In fact, most
will not.
Perhaps the safest and most
effective disaster mental health approach that
has evolved from experience emphasizes careful
listening to assess a person’s response,
assessment of an individual’s capacity
to cope and their risk of self-destructive behavior,
non-judgmental education to help a person appreciate
that their response may indeed be a “normal
response to an abnormal situation,” and
urging people to seek support from those they
can trust. Practical coping strategies, such
as getting sleep, not being alone and not abusing
alcohol and drugs, coupled with the realistic
provision of hope are also essential.
Psychological first aid, which
employs many of these approaches, is becoming
a standard of care for trauma victims. Individuals
can benefit from being in a calm setting and
a supportive environment and, when possible,
psychological first aid is delivered in the
affected community, making use of its local
constituents to establish trust and ensure cultural
and linguistic competence. Healthcare workers
are tasked with first making sure that those
they see are physically and psychologically
safe. Individuals showing extreme reactions
are identified and referred to professional
treatment when possible.
Seeking assistance need not
be shameful and should be encouraged to do so
by public authorities and others.
Because post-disaster disorders
like depression, anxiety, PTSD and abuse of
alcohol and drugs can emerge many months after
an event, public messages can be very useful
when maintained over time.
After 9/11 the effort to get
first responders—uniformed personnel,
including fire fighters, police, emergency medical
technicians and other healthcare workers—mental
health services included a powerful ad campaign
with the message “Even Heroes Need to
Talk.” It is only over time that first
responders may begin to suffer problems and
need communication about how to seek help for
themselves.
Perhaps the greatest lesson
we have learned from natural and human-made
disasters is how resilient most people can be.
But one should not go it alone in the face of
disaster, whether an individual, community,
city or nation.
A disaster experience can
be indelible in a person’s memory and
can put lives on a very different trajectory,
but that does not mean one’s response
is an illness. We know that the more we support
one another and understand and respond to family
needs and the needs of our neighbors and community,
the more likely we will be able to manage trauma,
with unfortunate distress but without disorder.
For immediate assistance,
people with psychic distress that exceeds what
family and friends can provide have many places
to turn. The American Red Cross is on-site and
familiar with the emotional aftermath of a disaster.
Family physicians, clergy and local mental health
clinics are also important resources for people
who need further assistance. Information and
referral services are also promptly and capably
available in New York City, 24 hours a day,
from LIFENET [1-800-LIFENET]. Other impacted
communities can turn to the National Suicide
Prevention Lifeline [1-800-273-TALK (8255) www.suicidepreventionlifeline.org],
whose services extend far beyond suicide prevention.
REFERENCES:
Galea S, Nandi A, Vlahov D
(2005). The epidemiology of post-traumatic stress
disorder after disasters. Epidemiological Reviews
27, 78–91.
Sederer LI, Lanzara CB, Essock
SM, Donahue SA, Stone JL, Galea S (2011) Lessons
learned from the New York State mental health
response to the September 11, 2001 terrorist
attacks. Psychiatric Services 62, 1085–1089.
Photo: A soldier assists a
family displaced by Hurricane Sandy in Hoboken,
N.J., Oct. 31, 2012. The soldier is assigned
to the New Jersey National Guard. U.S. Army
photo by Spc. Joseph Davis.
Edited by Elaine Meyer
Author Bio:
Dr. Sederer is adjunct professor
at Columbia University’s Mailman School
of Public Health, medical director for the New
York State Office of Mental Health, and medical
editor of Mental Health for the Huffington Post/AOL.
His website is www.askdrlloyd.com.
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