Katrina Survisors and PTSD - The Pain Continues
Only 18 months ago, Americans were glued to their television sets, watching in horror, as the devastation to our neighbors played out in the Gulf Region of the United States. People and institutions from around the globe demonstrated their care and concern. Throughout the country, our people opened their homes, schools, shelters, and resources to assist those victimized by an unprecedented natural disaster.
As the governor of Arizona reiterated, This is not a sprint, but a marathon! Our new neighbors will continue to need ongoing assistance in the form of food, clothing, and hope for a new future. Like most horrific events that people experience (whether natural or not), the survivors will need time to process the trauma of this event.
One image portrayed on television still replays in my mind. I can still see the courageous rescuers cruising through the waters of a downtown New Orleans street. They approach a house which has a water level just below the stairway to the front door. A man greets the rescuers, declines assistance from them, and proceeds to take a dust broom and sweep off the steps of his entry way.
That image, from the streets of New Orleans, characterizes the very nature of posttraumatic stress disorder. This poor man was continuing to play out his life like nothing had happened. Psychic numbing and denial had a firm grip on this victim, and he wasnt about to leave the only possession he had his home.
Although necessary, no amount of money and aid will make this pain go away for the grieving victims of the Gulf Region disaster. Only through time, and emotional support, will the painful reality of this trauma diminish. Many of the evacuees from this tragedy will need psychological assistance in order to be in a position to move forward with their lives. Is this country prepared to provide the support needed for the healing of our people?
In the years to come, we can expect to be faced with monumental emotional fallout from this natural disaster affecting our people. In order to assist those who experience PTSD, one must understand the features of the disorder. Here is a general overview of the symptoms:
An initial response of psychic numbing and denial.
An experience which involves the threat of serious injury or harm.
An experience of intense fear, vulnerability, and horror.
A persistent reexperiencing of the traumatic event within.
Avoidance of stimuli associated with the event.
Persistent symptoms of hypervigilence, a startle/arousal response.
Increased agitation, anxiety, depression, and anger.
Emotional withdrawal and social detachment.
Reliance on a pattern of self-medicating through alcohol and other substances.
We know that some of the Gulf Region evacuees were suffering from mental disorders prior to Hurricane Katrina. These people need urgent psychological intervention to make sure that they are getting the necessary medications and counseling support for their disorders. Others, who have been overwhelmed by the emotional trauma of this catastrophic event, will also need psychological support. Various states and local municipalities housing evacuees will need to coordinate mental health efforts through a myriad of support agencies. Volunteers will need to be recruited and trained so that they can assist those who are experiencing the pain of Posttraumatic Stress disorder. If we do not address the mental health needs resulting from our neighbors grief and despair, there will be no moving forward for the many that were touched by the power of Hurricane Katrina. Now that the initial shock of this traumatic event has come and gone, it is time for all of us to re-commit ourselves to doing what is necessary to help our neighbors in need.
People are not easily going to rebound and resume their lives as usual like the pace of other disasters all dwarf in comparison to Katrina, including 9/11. More than a million people have been displaced and more than 400,000 have lost their jobs. We have parents and children still separated from each other. Young children are asked, Whats your mothers name and they respond with mommy. As of the end of May 2006, there were still 1,753 children under the age of 18, the youngest a three-week old infant, who were still separated from their family.
Health care providers assume many roles in the midst of a natural disaster caregiver, leader, comforter, and information source. As health care providers mobilize to help, we should be mindful of the losses experienced by those under our care. Interviewing with sensitivity is essential, and is the first step in assessing specific needs. The CAPS test (Clinician Administered - PTSD Scale) may be administered at some point to gauge the level of stress and determine where PTSD is symptomatic of the victims emotional state.
Studies have found that the longer and more intense the threat to a persons life, the greater the likelihood of developing features of PTSD. The disorder is more common among people who are socially isolated, those with a history of psychological and physical trauma, and people with preexisting mental health problems, including depression and anxiety. Children who got out of the disaster early on will fare better than those who watched dead bodies float through the water, and who saw their parents lose control, or witnessed violence.
Providers can promote mental health by creating and sustaining an environment of safety, calm, connectedness to others, self-empowerment, and hopefulness. Workers should:
Help people meet their basic needs.
Provide simple, accurate information on how to obtain services.
Listen to people who wish to share their stories.
Be friendly and compassionate, even with difficult people.
Help people contact friends and loved ones.
Keep families together.
Give practical suggestions that steer people toward helping themselves.
Avoid doing such things as:
Forcing people to share their stories with you.
Telling people what you think they should be feeling, thinking or doing.
Making promises that may not be kept.
Criticizing existing services or relief efforts.
PTSD is not a condition that is merely in peoples heads. We know from research that the response to danger or threats, the so-called fight or flight response malfunctions in people with PTSD, leaving them unable to switch off the intense emotional and physical sensations. They feel that they are in danger even after the threat has long passed.
The good news is that researchers, supported by the National Institute of Mental Health, the Department of Veterans Affairs, and other agencies, have developed effective treatments for PTSD. These include medications and cognitive-behavioral treatments talk therapies that teach people how to manage upsetting and unwanted thoughts as well as physical symptoms. There is a lot of work to be done. It is through the efforts willing volunteers that we will reach the goal of healing our people from this horrific event.
James P. Krehbiel, Ed.S., LPC, CCBT is an author, freelance writer and cognitive-behavioral therapist practicing in Scottsdale, Arizona. His personal growth book, Stepping Out of the Bubble is available at http://www.booklocker.com James can be reached at http://www.krehbielcounseling.com
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