Are disasters becoming part of the new normal? Or have disasters become our new (ab)normal?
Disasters are extraordinarily varied in their nature, ranging from accidents (from local motor vehicle accidents to major train or plane crashes); natural catastrophes (like the recent floods in Oklahoma and Texas, hurricanes like Katrina and Sandy, and earthquakes, fires and tsunami); and acts of terrorism (including school and mall mass murders, the Boston bombing and 9/11). Their settings are also diverse, from dense urban to rural, isolated areas.
Yet one thing disasters have in common is that stress and distress are ubiquitous and inescapable in their wake. In our lifetimes, very few of us will be spared the direct impact of a disaster. Facing the probability of disaster for most and the inevitability for others we will be well served to understand what to expect, what we can do to master our human responses, both immediate and ongoing, and what help is available in the aftermath of a catastrophe.
Here are seven things to know that can help you and your family if and when disaster strikes:
1. Distress is a predictable response to the overwhelming experience of a disaster. It is a normal reaction to an abnormal situation. Distress includes feeling anxious, overwhelmed or depleted; being on-edge, irritable, tearful and unable to sleep; having difficulty concentrating; and drinking and smoking more than usual. Expect to feel distress and to appreciate that it is not abnormal under the circumstances you are experiencing.
2. The vast predominance of people who experience distress in the wake of a disaster improve in days to weeks. They are resilient. Resilience is helped by connection to other people; attention to coping skills, including getting needed rest and sleep; not abusing alcohol or drugs; sustaining hope; and having faith. Simple breathing techniques and other natural calming activities are readily learned and effective in quieting distress until it passes.
Common sense plays an important role in responding to the emotional impact of a disaster. We all need to appreciate and attend to what gives us, and our loved ones, a sense of (realistic) safety and calm. We also need to find ways to be helpful to family and community, and in so doing experience a sense of competence, sometimes called "self-efficacy." And we are best not going it alone; being connected to others, either family or those also impacted, is more helpful than being alone.
3. The emotional states of children and other dependent family members (like the elderly and disabled) typically reflect that of their parents or caregivers. So grownups and caregivers need to achieve their own comfort and confidence and then reassure those who depend upon them. Think of putting the oxygen mask on yourself before you put it on your child.
4. The persistence of significant distress for weeks is called an Acute Stress Disorder (ASD). Those people with previous trauma or mental health problems are at greater risk for developing this condition. ASD is not a disease; and it is not Post-Traumatic Stress Disorder (PTSD). ASD usually abates within weeks with good self-care and support.
5. Disaster mental health has become a specialty, and is now a standard part of all major disaster response efforts. Trained community workers mobilized by local, state or Federal government agencies in the wake of a disaster provide Crisis Counseling or Psychological First Aid. These brief, supportive, problem-solving interventions can be very helpful to people with significant or persistent distress. These workers are also able to link you to professional services if needed. Welcome these community (field) workers to your community and engage their help if you are impacted.
6. However, as many as 1/3 of people exposed to a disaster are apt to develop a (or have a worsening of a pre-existing) mental health disorder. These conditions include PTSD, which has a delayed onset of at least one month, often longer; bereavement (grief) from loss of a loved one(s); clinical depression; substance use (alcohol and legal and illicit drugs); generalized anxiety; and dissociative experiences (e.g., feeling cut off, separate, unreal). Domestic violence is also sadly all too common. In addition, worsening of existing medical conditions (including heart and lung diseases, diabetes, pain syndromes, arthritis, and other common illnesses) frequently occurs. Early detection and proper professional treatment of mental and physical conditions increases the likelihood of their successful resolution or control.
For those people whose mental health response is characteristic of a disorder rather than distress, evidence-based short-term therapies have been developed and have been proven effective. These can help those who experience the new onset or worsening of conditions like clinical depression, grief, trauma, anxiety and substance use disorders. These therapies are delivered by trained professionals; they generally employ Cognitive Behavioral Therapy (CBT) and trauma treatment techniques. Medications also can offer significant, prompt relief of symptoms and enable impacted individuals to return to normal patterns of sleep and functioning.
If you think you or a loved one has developed a mental disorder seek help from licensed mental health clinicians and programs, and insist that you receive a treatment plan that is specific to and known to work for the condition you (or a loved one) have developed (which is called evidence-based care).
7. You also may be reassured to know that for over 15 years, especially from lessons learned from 9/11 and other terrorist acts; Hurricanes Katrina and Sandy; floods and tornadoes; heartbreaking school and community shootings; major transportation accidents; and other natural and human-made disasters, a broad network of governmental, community and faith based organizations specialized in disaster mental health have developed. They stand ready and have the capacity to respond rapidly, effectively and in a coordinated manner to the mental health problems that are an inevitable result of a disaster. These agencies are mobilized in a crisis and authorized to provide services and relief in catastrophic situations.
Perhaps the greatest lesson we have learned from natural and human-made disasters is how resilient most people can be. But that does not mean you should go it alone, as an individual, family, community, city or nation.
When we support one another, and understand and effectively respond to our own needs as well as that of family, neighbors and community, the more likely we will successfully manage disaster-related stress and trauma and be able to bear the misfortunes of catastrophe without lasting pain, suffering and disorder.
Additional References:
Sederer, LI, Lanzara, CB, Essock, SM, Donahue, SA, Stone, JL, Galea, S. Lessons learned from the New York State mental health response to the September 11, 2001 terrorist attacks. Psychiatric Services 62:1085-1089, 2011
Sederer LI. Mental Health and Hurricane Sandy: What can we expect, what can we do? The Columbia University Mailman School of Public Health. November 5, 2012, http://the2x2project.org/mental-health-and-hurricane-sandy/
North, CS, Pfefferbaum, B: Mental Health Response to Community Disasters - A Systematic Review, J. American Medical Assn, JAMA. 2013;310(5):507-518. doi:10.1001/jama.2013.107799
US Dept of Veteran's Affairs, National Center for PTSD: Effects of Traumatic Stress after Mass Violence, Terror, or Disaster, http://www.ptsd.va.gov/professional/trauma/disaster-terrorism/stress-mv-t-dhtml.asp
Galea, S., Brewin, C. R., Gruber, M., Jones, R. T., King, D. W., King, L. A., et al. (2007). Exposure to hurricane-related stressors and mental illness after Hurricane Katrina. Archives of General Psychiatry, 64, 1427-1434
Sederer, LI. FEMA Approves $8.2 Million for Post-Sandy Mental Health Outreach, TheAtlantic.com, November 19, 2012