January 27, 2005
In the Tsunami’s Wake: Risk for Post-Traumatic Stress Disorder
The devastation from the Indian Ocean tsunamis that have claimed as many as 250,000 lives and destroyed countless homes and villages did not end when the waters receded. In the coming months and years, many survivors will have to deal with the disaster’s effects on their mental health.
In fact, the conditions left in the wake of a major disaster--one's house destroyed, the social fabric of one's existence torn away--are often more damaging to the psyche than the disaster itself, according to Cheryl Person, MD. And, she says, the psychological disorder that most often befalls such survivors is post-traumatic stress disorder (PTSD).
Earl Wall, MS, for instance, who spent from Dec. 28 to Jan. 12 assessing health care needs in Aceh Province, Indonesia, asserts that the challenge of a corpse-strewn landscape is more psychological than physiological. "The real problem is it's just terribly inhuman to see people everywhere who have died suddenly and violently..." Wall, a research associate in International Health from the Center for Refugee and Disaster Response, is responsible for program development. He goes on to say, "Even two weeks after the event there were still many, many bodies in need of burial. And the process of removing the debris and recovering the last of the bodies is probably going to take months."
Post-traumatic stress disorder, long known to be caused by battlefield combat, has in the past been called "soldier's heart" (during the American Civil War), "shell shock" (World War I) and "battle fatigue" (World War II). Today, however, we know that combat veterans are by no means the only ones who can suffer from PTSD. Survivors of the Holocaust, rape, domestic violence, child abuse, serious accidents and natural disasters are all susceptible to the flashbacks and nightmares, the suppression of feelings and the emotional numbing that mark PTSD.
"What PTSD sufferers have in common," explains Howard Chilcoat, PhD, an associate professor of Mental Health, "is that they have all experienced an event outside the range of normal human experience, one that involves actual injury or threatened death, either to themselves or to others." No one can be diagnosed with PTSD who has not actually lived through a traumatic experience, he notes.
According to Chilcoat, symptoms of PTSD can be grouped into three categories:
- re-experiencing the trauma via intrusive thoughts and memories, nightmares, vivid flashbacks or daytime fantasies;
- avoidance and numbing, whereby the victim attempts to avoid situations that prompt memories of the trauma or suppress painful emotions;
- a condition of hyperarousal with insomnia, an exaggerated startle reflex, irritability and hypervigilance.
PTSD is often linked with depression, too, but in ways that are still unclear, according to Person, a postdoctoral fellow in the Department of Mental Health. Thus, 10-30 percent of people will develop depression after a disaster, and major depressive disorder is another risk factor for PTSD after a trauma.
The World Health Organization recommends some very basic mental health services should be made available during the first days of a disaster's aftermath, such as setting up recreational activities for children and tracing family members for unaccompanied children and other vulnerable people.
"Typically, many people will experience some PTSD symptoms right after a disaster, but only those whose symptoms last longer than a month will actually have PTSD," says Person. That is why, she stresses, educational programs must be launched right after a disaster to let survivors know that their sleeping troubles, loss of appetite, crying spells and feelings of shock are perfectly normal.
She says rebuilding the shattered infrastructure as soon as possible "is absolutely the biggest thing that can be done after a disaster. Getting people back to a routine as soon as possible should be the number-one priority of relief workers."
Unfortunately, recovery from the almost mythical damage done by the December 26 tsunamis will not come quickly. --Rod Grahampaffairs@jhsph.edu.