ROCKY MOUNTAIN REGION DISASTER MENTAL HEALTH NEWSLETTER

Learning From The Past and Planning For The Future


MENTAL HEALTH MOMENT
February 8, 2002

"A problem is a chance for you to do your best."
- Duke Ellington
							
				
				
				
				
		
			
				

				
					
LINKS AND SHORT TOPICS

				
				


FLASH FLOODS KILL NINE IN SOUTH-WESTERN IRAN

Devastating flash floods in south-western Iran have left nine people
dead, 49 injured and dozens homeless. Heavy rains, which began on Jan
11, caused the flooding in the provinces of Booshehr, Khozestan,
Ghazvin, Chaharmahal, Bakhtiyari and Fars.

The Iranian Red Crescent immediately mobilized some 250 relief workers,
as well as boats, helicopters and heavy equipment, to evacuate people
trapped by rising waters and to clear roads. They also provided first
aid and transported eight of the most severely injured people to
hospital.

More at: http://www.ifrc.org/docs/news/02/011701/

VANUATU: RED CROSS PREPARES FOR POSSIBLE VOLCANIC ERUPTION

Peter Tamara dropped his phone and ran out of the building when an
earthquake measuring what he later guessed was "five to six" on the
Richter scale jolted his office in Vanuatu's capital, Port Vila, on
January 15. More than 400 tremors have hit the south Pacific nation
since January 3, when a 7.2-scale earthquake rocked the city's
residents, causing widespread damage to infrastructure but claiming no
casualties or serious injuries.

Similar quakes shake Port Vila every day, says Mr Tamara, acting CEO
and disaster response coordinator with the Vanuatu Red Cross.

More at: http://www.ifrc.org/docs/news/02/011602/

TEA AND CHOCOLATE BENEFICIAL FOR HEART HEALTH

A Penn State-led review of the available evidence from 66 published studies 
supports the view that consuming flavonoid-rich tea and/or chocolate, in moderation, 
can be associated with reduced risk for cardiovascular disease. Penny Kris-Etherton, 
distinguished professor of nutrition and lead author of the review, says, "Since tea, 
without milk or sugar, contains no calories, it's an ideal way to add antioxidant 
flavonoids to your diet without increasing your weight. Having a chocolate cookie 
that also contains fruit and nuts along with the tea, if consumed in moderation, can be 
a heart healthy snack."
http://www.psu.edu/ur/2002/teaandchocolate.html

				
				

				

				

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SOME EXAMPLES OF DISASTER RELATED EMOTIONAL PROBLEMS


Frequently among workers, questions are raised about the types of emotional distress to be expected with disaster victims. 
There is also interest expressed about learning ways in which these problems can best be handled by workers in the field.

Workers should realize that they are not expected to become instant experts in the diagnosis and treatment
of mental disorders. The worker's role is first to identify those in need of help and then to offer
verbal support, information, and advice when requested. Sometimes physical assistance, such as
moving a victim's belongings or helping to repair damage to homes and property, is most helpful in
overcoming emotional distress.

Following are some case illustrations of the more typical types of disaster-related emotional distress
along with a brief discussion of ways the situation might be handled.

Depression

A worker finds a middle-aged man pacing up and down in front of his flood-ravaged home. Some of the water
-soaked furniture has been dragged out into the yard to let the sun dry it out. However, the man has
apparently abandoned further attempts to salvage his furnishings and is now walking about aimlessly in what
remains of the front yard, wringing his hands.

This illustration of depression differs somewhat from the usual picture of the individual suffering from
apathy and withdrawal, with no interest in what is going on around him. The example demonstrates that
depression is frequently masked by, or expressed in, agitated activity which is aimless or nonproductive.
Unless the depression in this phase is recognized and helped, it may readily progress to more serious mental
and physical problems.

Help for the depressed person in this instance might take the form of verbal help, such as reassurance,
encouragement, giving information about where and how to get help, and offers of physical assistance in
salvaging belongings, making sure he has had something to eat recently, and providing hot coffee or tea while
conversing.

Grief

A man appears in a one-stop relief center in a small western city severely damaged by an earthquake. He
asks for help in acquiring a set of mechanic's tools. He needs the tools because his set was lost with his
house and all the rest of his possessions in the earthquake. While giving the required information to
the disaster worker, he mentions in passing that his son was killed in the earthquake.

This man appears to be in complete control of his emotions. He seems to be going about the business of
re-establishing his life in a well-organized fashion. However, such behavior would be considered healthy and
desirable only after a suitable period of mourning or "working through" the grief reactions to the death
of his son. In this instance, there had been no time for mourning. The father was busying himself with
constructive tasks that actually served to screen the emotional pain in order to avoid dealing directly with
his loss. One doesn't have to be a specialist in human behavior to anticipate that the father would probably
at some point experience the flooding of emotions he was now damming up and that he would be overwhelmed by
them.

What could be done in such a case? It would seem presumptuous and perhaps ill-advised to confront this
man directly with his loss and to challenge his defense of suppressing his emotions under these
circumstances. Perhaps a brief, gentle comment on his loss is all that can be done at this time. Such a
comment might permit the beginning of the experience of grief. The bereaved father has thus felt the touch
of gentle understanding and in a sense has received permission to deal directly with his loss. The worker
would want to alert relatives or close friends to the probability that the father might need help in the
future in dealing with his grief.

Depending on the situation, there are many approaches which might be appropriate for assisting those
suffering grief. It often might be desirable to convey empathy through those close to the victim rather than
directly. Again, depending on the circumstances, it might be more suitable to offer direct assistance in
the form of making arrangements, notifying relatives, or dealing with insurance matters.

Anger

A rural valley with many small farms was devastated when a newly finished man-made dam gave way and
flooded the area below it. Some citizens who had suffered losses in the flood were seen throwing rocks
at trucks belonging to the construction company that had built the dam. Anger was also expressed by local
relief workers whose efforts were hampered by bureaucratic red tape. Victims exhibited anger toward
relief workers both for interfering with their lives and for not doing enough to help those in need.

Anger is one of the natural and expected reactions to adversity. The degree of anger felt and ways in which
it is expressed are related to many things, some of which are external, as in the case of negligence which
caused or contributed to the catastrophe; and some of which are a reflection of the individual's experience
of helplessness and frustration in the disaster itself.

In dealing with anger in disaster victims, it is important for the worker to be aware of the value
of "ventilation" as a means of reducing the excess emotion which interferes with constructive handling of
the causes. That is, it is important that the angry victim be permitted to express his/her anger verbally.
It is generally not desirable to take direct action while in the grips of such strong feelings. On the
other hand, an understanding listener should not try to exhibit anxiety while listening to the angry
outbursts and recitals and not try to "talk him out of" being angry, nor express disapproval or other
guilt-inducing reactions. Many people find it uncomfortable and difficult to listen to angry
reactions of others. If one is aware of its therapeutic value and is sufficiently motivated,
however, this important service becomes easier with practice.

Guilt

A woman whose home miraculously escaped damage in the flood, while the home of a close friend and neighbor
was completely destroyed, appears at the local health center with various physical symptoms such as stomach
cramps, loss of appetite, and severe headaches. Medical examination provides no apparent basis for the
complaints. It was concluded that the patient was experiencing a severe anxiety attack. Consultation
with a mental health professional revealed that the woman was suffering an overwhelming sense of guilt
because she was spared the tragic loss suffered by her friend. Counseling helped her to accept the
unpredictable nature of the disaster which ruined one person and spared the next. The woman was able to
overcome her guilt and to offer welcome assistance to her neighbor in coping with her losses.

Guilt is a frequent occurrence among survivors of a disaster. We all experience to some degree the
uneasiness which accompanies sudden and unexplainable good fortune. Our own sense of worthwhileness is
called into question. Why have we been spared misfortune when others have suffered? We are glad to
have been so favored, of course, but at the same time feelings of guilt arise because secretly we are
relieved that the losses occurred to someone else instead of us. The opportunity to talk about and
confront directly these natural human reactions with someone who is understanding and shares the same
weaknesses is of great value. The knowledge that such feelings occur with most people provides a sense of
acceptance and belonging which permits one to go on and to do what can be done to help others who have
been less fortunate.

Apathy

An elderly man owned and operated a small private fishing lake and boat rental concession at his
homesite. A flood destroyed his boats and equipment and completely filled the lake with mud. The old man,
who lived alone, was discovered by neighbors several weeks later. He had taken to his bed, neglecting to
eat or care for himself. At the time he was found, his weight and physical condition had deteriorated to the
point where he was almost dead. At first he refused assistance. However, as a result of patient and
persistent efforts by the neighbors, he was persuaded to allow himself to be taken to the hospital. Although
he initially regained his health he did not survive long after being placed in a residence for the elderly.

In this case, the old man felt he could never regain what he had lost in the flood. There simply was not
enough time or opportunity. He had little left to live for.

In disasters, apathy is frequently found in the elderly who have suffered significant losses of
possessions, their homes, friends, and neighbors. There is a feeling, often all too real, that they will
not again be able to recover or replace these losses. Assistance must take very concrete and immediate forms
if it is to be of any value. Relatives or friends must be located if possible.  Physical relocation should be
as near as possible to what is familiar for the older person. Readjustment to new surroundings and strangers
is often an overwhelming and sometimes impossible effort, as in the case illustrated above. As many
people as possible should be involved, especially other elderly people who have gone through the same
experience.
When apathy is encountered in the middle-aged person
or in the adolescent, emphasis should be on immediate and active attempts to recover and replace the losses,
to become involved in community rehabilitation, and to participate in social activities. The last mentioned
is of particular importance for the adolescent.

Fears

An otherwise normal 6-year-old girl who has experienced an earthquake becomes terrified and cries
when a heavy truck passes by the house, causing a slight vibration. A 4-year-old boy, who was suddenly
evacuated just before the flood destroyed his home, develops the habit of sleeping with all his clothes on
and his remaining belongings packed in a suitcase kept at the foot of his bed in the mobile home he and his
family now occupy. A 7-year-old boy, who survived a flood caused by torrential rain, is found crying and
crouched under a stairwell when a light rain starts to fall.

These persisting fears are often found among young children and sometimes among adolescents and adults
following a disaster. They are referred to technically as "traumatic neuroses". With most otherwise healthy
persons such persistent fears tend to subside as time passes. If they continue to appear some months after
the disaster it is apparent that the intervention of a mental health specialist is needed. Much can be done,
however, in the immediate post-disaster period to relieve these symptoms and prevent their continued
self-reinforcement.

With children it is essential that the child be given additional warm affection and understanding when
experiencing the recurrence. Above all, the child should not be scolded or punished for exhibiting these
fears. Talking with the child in a gentle and reassuring manner is helpful. Permitting or
encouraging the child to talk about what is frightening him is also important. For adolescents and
adults who display recurrent fear symptoms, permitting the victim to relive the experience verbally, to
become actively involved in recovery efforts, and to learn more about the causes and means of possible
protection from future disasters are particularly useful.

The "Burn-out" Syndrome

Two police officers are on duty at a checkpoint for autos entering the disaster area. It is their job to
permit entry only to those who have homes or businesses in the area or who are involved in relief
activities. There is a constant stream of vehicles lined up in both directions. The officers must inspect
identification and passes, answer questions about disaster recovery activities, reassure anxious
homeowners, and placate angry citizens frustrated at the delay. The officers have had 12-hour duty days for
the past week, with only brief periods of relief. Their faces show fatigue. Their efficiency is at a low
ebb. One officer describes his concern about his family to a relief worker. Another officer is anxious
about all the work that needs to be done at his house. His wife is upset at his absence during this critical
period. He feels the accumulating frustrations and anger of the people he is trying to assist. His work
requires him to ignore his personal priorities. There are not enough replacements to permit him to attend to
his family responsibilities.

The man is exhibiting excessive fatigue, irritability, anxiety, impatience, and all symptoms of the beginning
of the "burn-out" syndrome. Front-line workers typically overextend themselves in disasters. This
most often occurs when there are not enough relief workers, and the ones available want to help as much
as possible. Sometimes, however, even when replacements are available, workers refuse relief and
push themselves beyond their effective limits. Such action might seem altruistic and commendable. In
reality, the tired and inefficient relief worker can be more of a liability than an asset in rescue and
recovery activities. The workers during and immediately following the disaster need all the
strength and energy they can gather. They must have clear heads to make critical and sometimes life-saving
decisions. They must be able to cope not only with the physical consequences of the disaster itself but with
the fears, anger, and physical and emotional suffering of the victims.

It is essential, therefore, that the worker is not overtired or weak from lack of food or rest. Often the
worker fails to recognize these signs in him/herself although they are obvious to others. Those responsible
for supervision of front-line relief workers must do everything possible to forestall the occurrence of
the "burn-out" syndrome.


Bizarre Behavior

A man whose entire herd of cattle was lost in a flood is apprehended while shooting his neighbor's surviving
cattle. The man can offer no rational explanation for his behavior.

Sometimes the effects of the disaster can prove to be an overwhelming experience for victims. The excessive
stress causes a breakdown of usually effective coping mechanisms. The individual exhibits irrational and
bizarre behavior. He may temporarily "go crazy".

Contrary to popular misconception, this is an unusual rather than a usual occurrence during disasters. Most
frequently, individuals who suffer emotional breakdowns are those who have had previous histories
of breakdown and likely have had to be hospitalized for mental health treatment in the past. There are
generally a few people in any community with histories of emotional breakdown. It is valuable for local
mental health professionals to be aware of those who are more likely than most to suffer serious mental
disturbance as a consequence of the disaster. Immediate assistance is required in the form of
admittance to a hospital or emergency professional attention when the victim shows behavior which could
be harmful to himself or others.

Suicide
  
A woman who lives alone is found dead of a self-inflicted gunshot wound following a flood which
devastated the community where she lived.

As with mental breakdowns, suicide is not a common occurrence among disaster victims. The seriousness of
this tragic aftermath is such that mental health and other relief workers need to be alert to those
individuals who might be likely to react to excessive stress in this way. It has been found that those who
do commit suicide usually have some previous history of attempts or communications to others about their
intent to do away with themselves. Awareness of who in the community is susceptible to this sort of self-
destruction is one of the vital roles the local mental health workers can play in alleviating the emotional
suffering which accompanies all disasters.