the aftermath of Hurricane Sandy, opinions—some
reliable, some misleading— about the storm’s
potential mental health impact have proliferated.
When media channels act responsibly they engage
experienced experts as spokespeople; when that
does not happen, wrong information adds to the
public’s anxiety and can foster inappropriate
clinical interventions and waste resources.
In the latter
category, perhaps the greatest myths I have
stress disorder (PTSD) can appear in the immediate
wake of a disaster.
• Watching television can cause PTSD.
• The highly common psychic distress in
the wake of a disaster is a mental illness.
are some facts:
Psychic distress after a disaster, which can
be highly prevalent and last up to a month,
generally is a normal reaction to an abnormal
situation. This is known as an acute stress
experience ASD after exposure to a traumatic
event in which they felt intense fear, helplessness
or horror. A person who experiences it is deeply
shaken and cannot stop thinking about the event,
he or she may have difficulty sleeping and may
be jumpy or irritable or cry easily. Taking
care of everyday business is hard and socializing
is no longer fun. The person may smoke or drink
more and withdraw from others.
can impair functioning at school or work and
within the family.
For a diagnosis
of ASD to be made, the condition must come on
within four weeks of a trauma and last more
than a couple of days. If significant symptoms
persist for longer than a month, it is likely
that the ASD has progressed to PTSD (see below).
ceaselessly can aggravate a person’s distress,
so people should limit their television viewing
so that they remain informed but not compound
their worries. Parents should monitor what their
children watch. They should also provide them
reassurance and hope since children do well
when they feel protected and comforted by those
they depend upon and trust.
PTSD is a more
persistent and severe response to trauma than
ASD, which always precedes it. Symptoms of PTSD
include re-experiencing of the traumatic event,
avoiding cues of the trauma, emotional numbing
that can become consuming, and persistent symptoms
of heightened arousal. PTSD can only be diagnosed
if it has been at least a month since the catastrophe.
There are other
conditions besides PTSD that commonly emerge
in the days, weeks and months after a disaster.
These include depression; anxiety disorders,
other than PTSD, such as generalized anxiety
and agoraphobia; alcohol, tobacco and drug overuse
and abuse; and worsening of pre-existing mental
and addictive disorders.
focus on identifying PTSD is apt to miss these
other serious and potentially disabling conditions,
which can exist independent or occur alongside
The more life
threatening and ghastly the disaster, as well
as the degree of what is called “exposure,”—when
a person experiences direct and continuous visual,
olfactory, and auditory sensations after the
disaster—the more likely a traumatic state
of a disaster are at greatest risk of developing
post-traumatic emotional problems followed by
rescue workers, followed by some of the general
public. Once PTSD sets in there is evidence
that it can and does persist, especially for
those with early onset of the symptoms.
psychological profile characterizes those who
are apt to do poorly after a disaster, except
for those who already had poor coping skills.
People with active or past mental disorders
or who have been previously traumatized are
also at greater risk. Yet not everyone exposed
to a severe traumatic event will develop ASD
or PTSD. In fact, most will not.
safest and most effective disaster mental health
approach that has evolved from experience emphasizes
careful listening to assess a person’s
response, assessment of an individual’s
capacity to cope and their risk of self-destructive
behavior, non-judgmental education to help a
person appreciate that their response may indeed
be a “normal response to an abnormal situation,”
and urging people to seek support from those
they can trust. Practical coping strategies,
such as getting sleep, not being alone and not
abusing alcohol and drugs, coupled with the
realistic provision of hope are also essential.
first aid, which employs many of these approaches,
is becoming a standard of care for trauma victims.
Individuals can benefit from being in a calm
setting and a supportive environment and, when
possible, psychological first aid is delivered
in the affected community, making use of its
local constituents to establish trust and ensure
cultural and linguistic competence. Healthcare
workers are tasked with first making sure that
those they see are physically and psychologically
safe. Individuals showing extreme reactions
are identified and referred to professional
treatment when possible.
need not be shameful and should be encouraged
to do so by public authorities and others.
disorders like depression, anxiety, PTSD and
abuse of alcohol and drugs can emerge many months
after an event, public messages can be very
useful when maintained over time.
the effort to get first responders—uniformed
personnel, including fire fighters, police,
emergency medical technicians and other healthcare
workers—mental health services included
a powerful ad campaign with the message “Even
Heroes Need to Talk.” It is only over
time that first responders may begin to suffer
problems and need communication about how to
seek help for themselves.
greatest lesson we have learned from natural
and human-made disasters is how resilient most
people can be. But one should not go it alone
in the face of disaster, whether an individual,
community, city or nation.
experience can be indelible in a person’s
memory and can put lives on a very different
trajectory, but that does not mean one’s
response is an illness. We know that the more
we support one another and understand and respond
to family needs and the needs of our neighbors
and community, the more likely we will be able
to manage trauma, with unfortunate distress
but without disorder.
assistance, people with psychic distress that
exceeds what family and friends can provide
have many places to turn. The American Red Cross
is on-site and familiar with the emotional aftermath
of a disaster. Family physicians, clergy and
local mental health clinics are also important
resources for people who need further assistance.
Information and referral services are also promptly
and capably available in New York City, 24 hours
a day, from LIFENET [1-800-LIFENET]. Other impacted
communities can turn to the National Suicide
Prevention Lifeline [1-800-273-TALK (8255) www.suicidepreventionlifeline.org],
whose services extend far beyond suicide prevention.
Galea S, Nandi
A, Vlahov D (2005). The epidemiology of post-traumatic
stress disorder after disasters. Epidemiological
Reviews 27, 78–91.
Lanzara CB, Essock SM, Donahue SA, Stone JL,
Galea S (2011) Lessons learned from the New
York State mental health response to the September
11, 2001 terrorist attacks. Psychiatric Services
Photo: A soldier
assists a family displaced by Hurricane Sandy
in Hoboken, N.J., Oct. 31, 2012. The soldier
is assigned to the New Jersey National Guard.
U.S. Army photo by Spc. Joseph Davis.
Edited by Elaine
is adjunct professor at Columbia University’s
Mailman School of Public Health, medical director
for the New York State Office of Mental Health,
and medical editor of Mental Health for the
Huffington Post/AOL. His website is www.askdrlloyd.com.