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Watch for our nation's post-traumatic reactions

September 18, 2017

Our nation has been in the eye of two hurricanes—literally and figuratively—punctuated by the exclamation point of the 16th anniversary of 9/11. One way or another, nearly everybody has been affected emotionally.

Post-traumatic stress disorders (PTSD) are likely to be common in those whose lives were directly damaged by Hurricanes Harvey and Irma. In the aftermath of Hurricane Katrina in 2005, it was about a third of the impacted population who showed signs of PTSD, but the timetable for emergence of symptoms can range from immediate to years later. Additionally, the storms and the 9/11 anniversary may trigger painful memories of similar, unrelated traumas for others.

Some populations are particularly vulnerable. One group is children, especially if they have to move from their flooded home that doesn’t even look like their home anymore. Indeed, that is the primary reason why hurricanes become the worst natural disaster for them.

Other more vulnerable groups are the poor and the mentally ill, categories that are often combined. Those with symptoms of anxiety or paranoia, and without enough resources, will need more of our help.

Survivor guilt

There are also many other emotional reactions possible that are less well-known, which can not only affect our patients and the public, but ourselves as clinicians. One less-often recognized reaction is survivor guilt. Survivor guilt is the fairly common reaction, conscious or unconscious, of feeling bad because you escaped a trauma and others didn’t.  

I previously lived in Houston, so it was no surprise to me that I was anxious for my prior neighbors during Hurricane Harvey. I experienced some grief at the losses that occurred for friends and the damage to places that I loved. Like many people who were glued to the media’s non-stop coverage, that in itself made me more anxious and sad. I had to stop watching.

What I didn’t anticipate, though I should have as a psychiatrist, was survivor guilt. Surely, our former home, located in a flooded area where there were boat rescues, would have been severely damaged, and we would have been devastated if we had still lived there.

On top of that, the hurricanes happened while I was on vacation in Canada. I could have decided to stop and volunteer for disaster psychiatry, but I didn't. I was relieved to some extent because more psychiatrists volunteered than were needed. Besides, what seems to help mental healing the most is not necessarily individual psychological first aid, but community psychological first aid that replenishes as many of the social and economic resources as possible.

What to do

There is also the seeming paradox in which research indicates that there is a “sweet spot” for treatment of major trauma: not too little and not too much. It seems that people who have been through at least two major traumas, but not more than six, end up with higher well-being scores with support. What enhances that outcome are supportive loved ones and adequate community resources.

All of this suggests several things we can do:

  • Monitor our own personal reactions to these traumas so that we can still be at our best for our patients;
  • Educate the public about these emotional reactions whenever we have the opportunity, including teachers and children at schools, as well as inviting people to also come in for an assessment if they continue to feel worse in any way;
  • Assess the reactions of our patients no matter where they live; and
  • Remember that most mental health professions have an ethical principle to address and societal conditions that worsen mental health.

Of course, as citizens, we can also try to contribute. That would include political inputs to enhance future resilience in such traumas. That also might include advocating for addressing the climate change that many believe could have enhanced the magnitude of Harvey and Irma.

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