Welcome to University of Iowa Health Care Today. It is hard to believe it has almost been a month since the flooding. The damage is breathtaking and estimates so far total in the tens of billions of dollars. If you are one of many people affected by flooding, you know it is more than the issue of cleaning up. There is real emotional loss that people are also dealing with. Those who have never experienced a traumatic situation or who have never dealt with depression and anxiety may underestimate the seriousness of mental illnesses. Dr. Janeta Tansey joins me now by phone to speak to us about signs we should look for in ourselves and our neighbors dealing with loss. Dr. Tansey is an associate professor and psychiatrist at University of Iowa Hospitals and Clinics. Dr. Tansey,
For anyone who experienced the recent flooding, what sort of emotional responses are expected?
We see a lot of wide-ranging emotional responses when people go through a disaster of any kind, including the flooding of our community. On the one hand, we can see a lot of very frightening emotions, strong fear, anxiety, sadness, and even anger. We also see people sometimes really feel positive emotions as they look around and see the tragedy and they want to help. They have feelings of compassion for others; strong, caring feelings. They may even feel grateful that they didn’t have the severity of response that they see around their neighborhood. It’s really common for patients to feel a lot of different emotions from hour to hour, or even become really overwhelmed and feel a little shocked or numb and withdrawn.
Short-term, what can people do to cope with the overwhelming sense of loss for their home, property, and possessions?
Well, this is a very important time for persons to acknowledge that there are a lot of different losses happening in our community. For some, certainly it’s the loss of home and property and possessions. But for others, it may be a loss of security about one’s neighborhood or dramatic changes in one’s way of life. Or it can be a time of losing a sense of what the future is going to hold. Many people have invested in various things that they hoped would really be with them for the long-term and are watching those slip away. So coping with loss first requires understanding that there are lots of different kinds of losses, and then giving one’s self permission to grieve about those losses. It’s very easy to keep so busy that no time is taken to stop and take stock of one’s feelings and one’s grief. But this is a sad time for many in our community and it’s really important to acknowledge this.
Can persons experience the same kind of traumatic event, such as the flooding and evacuation events of our community, but have different responses?
Oh definitely! Every one of us has such different personalities, and histories, and support systems; we have different kinds of losses that we sustained. The persons with personal or family histories of anxiety or depression can have much more severe emotional responses to trauma. We need to see every person kind of as their own individual whose emotional needs will be different. One thing that’s important to notice is that there have been some very good studies looking at how traumatic events, natural disasters, and flooding can trigger psychological problems. Certain traumas are especially worrisome, so when we know someone who has lost a friend or relative or they’ve had serious injury to themselves or to someone that they love; if their life was in danger or they experienced extreme panic or horror during the disaster; also loss of property, separation from your family, and displacement from home are all traumas that we know are much more likely to cause psychological problems. There’s been a very interesting study that has been published in the Archives ofGeneral Psychiatry in 2007 looking at the Katrina metropolitan area, in which 90 percent of the folks that were there experienced a very severe trauma of these kinds that I just listed; and five to seven months after the storm when they’re interviewed, anywhere from 30 to 50 percent developed significant psychological problems with mood and anxiety.
How common are anxiety disorders in a community like ours after a natural disaster?
Well, one would expect it to be very common. We’re already seeing fair amounts of anxiety and depression that happened in the acute incidents and also in the aftermath. Not all anxiety is bad anxiety. Anxiety is the human being’s natural response to stressful situations and the flooding and the displacement of persons and possessions have certainly caused anxiety. But for some people the anxiety can really start to become a problem, so that it interferes with their ability to respond to the urgent issues or to spend time with friends and family. And these are the persons we really want to know that treatments are available to help them decrease their anxiety so that they can feel better and function better.
How can we know whether the anxiety is normal or excessive?
Well, when we see anxiety that’s started to interfere with someone’s ability to function on a day-to-day basis, including just trouble taking care of themselves, trouble taking care of their family and their responsibilities, that’s when we know that their anxiety is no longer in the normal range but it’s started to become a problem. Anxiety of this kind can take a lot of different forms; they may look like panic attacks, they may show up with people who feel very agitated, unable to rest or calm down. People with anxiety can start developing insomnia and nightmares. For others, anxiety can include a lot of fearful thoughts, or memories, or imaginings that one can’t stop from playing over and over in one’s mind. Another thing we worry about is that anxiety can lead people to use alcohol or other drugs to try to calm down, and this is definitely a sign that the anxiety has become a problem and needs medical attention.
A term we hear a lot about, but might not think it applies to us, is Post Traumatic Stress Syndrome or PTSD. Explain what is PTSD.
You bet. So for some people who have experienced trauma in which death or serious injury happened or was a possibility, they experienced intense fear, helplessness, and horror. In some of these cases a very serious condition can develop that we call Post Traumatic Stress Disorder. This is an illness that includes a variety of anxiety, mood, and personality changes; including having very vivid recollections or dreams of the horror of the trauma. Folks may have changes in the way they are feeling with irritability and sadness; they may have problems with sleep; and often they start avoiding any situation that triggers memory of the trauma. Not everybody with these symptoms has the Post Traumatic Stress Disorder form of it. It’s very common in the immediate aftermath of a disaster like this flooding, that people have some of these symptoms for a period of days to weeks, and then gradually get better. If the symptoms last just for a few weeks, we usually call this a diagnosis of Acute Stress Disorder. But if the symptoms keep lasting for a month or more, the person is very easily developing Post Traumatic Stress Disorder.
Are we likely to see Acute Stress Disorder and Post Traumatic Stress Disorder in our community?
Yes, definitely. We know from other disasters and shared kinds of trauma that persons of all ages can develop anxiety disorders of many different kinds, including these. It’s important to remember our children, as well. We have many children who, even if they weren’t actually displaced, may have seen a lot of images on TV or talked to friends and family. So it’s important to think of all ages when we’re looking for anxiety disorders.
What other mental health disorders can be caused or worsened by traumatic events?
Yes, persons who have a history of emotional or mental health problems often find that their symptoms may recur or worsen during times of severe stress and trauma. For example, persons with a history of depression may be more likely to develop another episode of depression during this time after a trauma. It’s very important for persons with mental health concerns to take especially good care of themselves during this time and have good follow-up with their health care providers. And then, even persons without a history of mental health problems will want to be aware. This is a very stressful time and very high risk time for the onset of depression and anxiety.
At what point should someone consider seeing a mental health provider for care and treatment?
Whenever someone finds that strong emotions or thoughts or personality changes are starting to interfere with their ability to function each day, to take care of themselves, to take care of their responsibilities, they should talk to their support persons about how they are doing. This friend or grief counselor might urge them to go and talk to their primary care provider or a mental health provider. Certainly, if persons are having suicidal thoughts, as can definitely happen when people become overwhelmed by a crisis, this is a psychiatric emergency and this is a person who should be brought immediately to the emergency room. If people are unsure if they might benefit from mental health care, they should talk to their primary care doctor—or also our crisis lines here in town are wonderful resources for talking through what options are available for mental health care.
What would your advice be to people who are right now in the process of cleaning up after the flooding to help them mentally?
Well this is a really critical time for taking care of one’s physical health and making sure that you’re paying attention to your emotional health. It’s so easy to become overwhelmed and busy that people stop following their routines. They stop eating healthily or getting sleep or exercise. Returning to those routines or starting new routines to make sure you are sleeping, exercising, and talking to friends with stress management is just as important for taking care of one’s emotions as it is for taking care of one’s physical health. And there’s certainly never been a more important time to reach out to your neighbor; to share each other’s grief and fears and hopes for the future. Taking time to talk with one another can really be helpful, and it’s important not to be afraid to ask for help. |
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