The Role of Psychiatrists in Disasters
Human suffering comes in many forms and shapes.
Working with inter-personal violence and man-made trauma is something that psychiatrists encounter on a regular basis, and many of them seem to have the tools, confidence and expertise to engage survivors in meaningful and effective interventions.
With the global scare over the Coronavirus (COVID-19) pandemic and similar large-scale natural disasters, psychiatrists now have a unique opportunity to explore new territories and play a vital role in helping the general public cope and heal.
Natural disasters come at a heavy psychosocial price, the invisible wounds and mental scars of such experiences can go unnoticed, leading to long-term dysfunctions and at times trans-generational transmission of the impacts of trauma. The suffering might extend beyond classical psychiatric symptoms to include somatic, academic, vocational, and relational struggles.
Disasters usually strike the least prepared of areas and communities, but like the COVID-19 had proven, industrialized societies are not immune. Disasters tend to overwhelm the existing local resources, and hence the need to rely on extra sources of assistance.
The mental health consequences of trauma are more than “just PTSD”. And even though most people who survive disasters usually completely recover, some will have difficult time coping.
As a psychiatrist, I can either regress, react in fear, anger, or despair, and be part of the problem, or can choose resilience and become an active part of the solution. But what can psychiatrists really and realistically do in response to incidents of such magnitude?
Taking the example of the COVID-19 crisis, I would offer here few suggestions that can help psychiatrists participate in healing themselves and others.
Psychiatrists don’t live in a vacuum or behind the walls of fortresses, they are part of their communities, and they are in the frontlines of response, starting from their families and expanding to their neighborhoods, schools, community centers, and places of worship.
Psycho-education is very important in the aftermath of disasters, survivors need to know that most of the symptoms they experience are normal responses to an abnormal situation. Triage is also needed in order to maximize benefit and wisely allocate the sparse resources. Mental health expertise is needed to differentiate medical and psychiatric symptoms. Psychiatrists can help first responders and liaise with the multiple agencies involved. Psycho-therapeutic skills can come handy like active listening, calm and non-judgmental approach, building trust, establishing rapport, compassion, teaching coping skills and grounding techniques, in addition to assessing risky behaviors like unhealthy coping habits including the use of alcohol and drugs, and suicidal or violent thoughts or behaviors. In certain cases, comfort could be brought to grieving families through the ease with which psychiatrists talk about the issues of death and dying. And in rare circumstances there might need be a limited and judicious use of psychotropics and referral to specialized services.
Psychiatrists who work with trauma survivors should show the utmost level of sensitivity and tenderness.
Time to recovery after disasters varies, not only to communities as they try to rebuild, but also to individuals and families as they try to piece together what happened and make a meaning out of their trauma stories. Recurrence of symptoms is possible at times of high stress; survivors therefore will be served well if educated and equipped in advance.
Trauma shatters and confuses the core beliefs that the world is a safe place and that others are to be trusted. In the aftermath of disasters therefore it is vital to regain the sense of safety, establish routine, structure and semi-normal state in order for survivors to feel that they are back in control. One example of community response are the random acts of beauty and kindness shown to strangers like offering to babysit for those working in hospitals, grocery-shop for the elderly, and share whatever limited resources with neighbors.
Pointing survivors to their inner strength and the available psychosocial resources in the community is of utmost importance, as is linking them to their support networks and their belief system and spirituality.
Taking care of the caretaker is a topic that needs to be emphasized in order to prevent or at least reduce the risk of vicarious trauma, provider burnout and compassion fatigue.
A word about social distancing: one protective measure that is in place to reduce the spread of the Coronavirus is referred to as social distancing, to have a safe physical distance between oneself and people who have symptoms suggestive of the infection. Some people with high risk of contracting the virus are encouraged to self-quarantine, even in my inpatient psychiatric unit we place folks on isolation precautions and limit staff contact. Social distancing however doesn’t mean to cut the therapeutic alliance and the human bonding, I am a strong believer that the best treatment for human suffering is human connection, to be in isolation is a very lonely experience, having the virus should not be a social death sentence, we need to support rather than alienate, we need to reach out to our patients, co-workers and neighbors. Also, these trying times can offer a golden opportunity to reconnect with our families and loved ones through spending quality times together to open channels of communication and build bridges of trust. Yes, these are hard times, but they get a little easier when we make the decision to go through them together.
Working with inter-personal violence and man-made trauma is something that psychiatrists encounter on a regular basis, and many of them seem to have the tools, confidence and expertise to engage survivors in meaningful and effective interventions.
With the global scare over the Coronavirus (COVID-19) pandemic and similar large-scale natural disasters, psychiatrists now have a unique opportunity to explore new territories and play a vital role in helping the general public cope and heal.
Natural disasters come at a heavy psychosocial price, the invisible wounds and mental scars of such experiences can go unnoticed, leading to long-term dysfunctions and at times trans-generational transmission of the impacts of trauma. The suffering might extend beyond classical psychiatric symptoms to include somatic, academic, vocational, and relational struggles.
Disasters usually strike the least prepared of areas and communities, but like the COVID-19 had proven, industrialized societies are not immune. Disasters tend to overwhelm the existing local resources, and hence the need to rely on extra sources of assistance.
The mental health consequences of trauma are more than “just PTSD”. And even though most people who survive disasters usually completely recover, some will have difficult time coping.
As a psychiatrist, I can either regress, react in fear, anger, or despair, and be part of the problem, or can choose resilience and become an active part of the solution. But what can psychiatrists really and realistically do in response to incidents of such magnitude?
Taking the example of the COVID-19 crisis, I would offer here few suggestions that can help psychiatrists participate in healing themselves and others.
Psychiatrists don’t live in a vacuum or behind the walls of fortresses, they are part of their communities, and they are in the frontlines of response, starting from their families and expanding to their neighborhoods, schools, community centers, and places of worship.
Psycho-education is very important in the aftermath of disasters, survivors need to know that most of the symptoms they experience are normal responses to an abnormal situation. Triage is also needed in order to maximize benefit and wisely allocate the sparse resources. Mental health expertise is needed to differentiate medical and psychiatric symptoms. Psychiatrists can help first responders and liaise with the multiple agencies involved. Psycho-therapeutic skills can come handy like active listening, calm and non-judgmental approach, building trust, establishing rapport, compassion, teaching coping skills and grounding techniques, in addition to assessing risky behaviors like unhealthy coping habits including the use of alcohol and drugs, and suicidal or violent thoughts or behaviors. In certain cases, comfort could be brought to grieving families through the ease with which psychiatrists talk about the issues of death and dying. And in rare circumstances there might need be a limited and judicious use of psychotropics and referral to specialized services.
Psychiatrists who work with trauma survivors should show the utmost level of sensitivity and tenderness.
Time to recovery after disasters varies, not only to communities as they try to rebuild, but also to individuals and families as they try to piece together what happened and make a meaning out of their trauma stories. Recurrence of symptoms is possible at times of high stress; survivors therefore will be served well if educated and equipped in advance.
Trauma shatters and confuses the core beliefs that the world is a safe place and that others are to be trusted. In the aftermath of disasters therefore it is vital to regain the sense of safety, establish routine, structure and semi-normal state in order for survivors to feel that they are back in control. One example of community response are the random acts of beauty and kindness shown to strangers like offering to babysit for those working in hospitals, grocery-shop for the elderly, and share whatever limited resources with neighbors.
Pointing survivors to their inner strength and the available psychosocial resources in the community is of utmost importance, as is linking them to their support networks and their belief system and spirituality.
Taking care of the caretaker is a topic that needs to be emphasized in order to prevent or at least reduce the risk of vicarious trauma, provider burnout and compassion fatigue.
A word about social distancing: one protective measure that is in place to reduce the spread of the Coronavirus is referred to as social distancing, to have a safe physical distance between oneself and people who have symptoms suggestive of the infection. Some people with high risk of contracting the virus are encouraged to self-quarantine, even in my inpatient psychiatric unit we place folks on isolation precautions and limit staff contact. Social distancing however doesn’t mean to cut the therapeutic alliance and the human bonding, I am a strong believer that the best treatment for human suffering is human connection, to be in isolation is a very lonely experience, having the virus should not be a social death sentence, we need to support rather than alienate, we need to reach out to our patients, co-workers and neighbors. Also, these trying times can offer a golden opportunity to reconnect with our families and loved ones through spending quality times together to open channels of communication and build bridges of trust. Yes, these are hard times, but they get a little easier when we make the decision to go through them together.
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