Post-Traumatic Stress Disorder After a Hurricane

Introduction

Posttraumatic stress disorder also known as PTSD is a psychological and emotional response to a traumatic event. Not everyone who went through a disaster or emergency situation develops PTSD. It is also difficult to diagnose PTSD if health workers and volunteers are not aware of the symptoms. It requires a level of expertise to determine the extent of the problem. The failure to diagnose PTSD can lead to frustrations when it comes to dealing with symptoms. In the aftermath of a disaster it is crucial to reduce the impact of traumatic events and at the same time develop a program to help those suffering from PTSD.

Hurricane Katrina

A perfect example of a traumatic event that not only provides the necessary elements needed to develop PTSD but also creates an environment that makes it difficult to deal with PTSD is Hurricane Katrina. Here is an overview of the nightmare:

On 29 August 2005, a category 4 hurricane struck the Mississippi Gulf Coast and southeast Louisiana, with winds in excess of 190km/h and torrential rain. The winds, tsunami-like waves, and high tides literally erased several Mississippi Gulf Coast and Mississippi River Delta communities in southern Louisiana from the map. More than 1 million inhabitants were forced to evacuate their homes (Winslow, 2007, p. 1759).

It is important to point out that most of the victims of the category 4 hurricane were people who are struggling with poverty. This is the reason why many chose to live in high-risk zones and exacerbated the effects of Hurricane Katrina. Many of them are of African-American descent who decided to stay even when the government already issued warnings for them to evacuate New Orleans.

In order to deal effectively with the aftermath of the hurricane, health workers must realize the factors that can either aid or hinder their efforts and these are a) Religion; b) Age; c) Gender; d) Literacy; e) Health; g) Politics; h) Social equality and equity; i) Traditional values; j) Customs/Traditions; and k) Culture (Pyles & Harding, 2011, p. 23). New Orleans had to be rebuilt. But not only the physical structures but also the psychological and emotional as well (Pyles & Harding, 2011, p. 23).

There are groups of people that are more vulnerable because of their race and the social and political implications of their ethnicity (Forgette, King, & Dettrey, 2011, p. 671). It has to be pointed out that socioeconomic status is the direct result of education and income.

The failure of emergency response and recovery operations in New Orleans cannot be simply analyzed as the failure of the respective emergency response teams responsible for that area (Gomez & Wilson, 2011, p.633). Without a doubt, it can be stated that “The government response to Hurricane Katrina was widely perceived to be flawed and inadequate” (Gomez & Wilson, 2011, p.633). However, there were social factors that have to be considered as well. This must be incorporated in any intervention program.

What is PTSD

The problem with PTSD was first discovered in relation to combating veterans. As a result, it was only in the latter part of the 20th century when a formal diagnosis was made. Nevertheless, scientists agree that this anxiety disorder may have existed since ancient times when human beings first encountered traumatic events. It may have been called with different names but the symptoms are the same.

It is an anxiety disorder that can occur after someone has been through a traumatic event. A traumatic event is further defined as, “…something horrible and scary that you see or that happens to you” and that during this type of event, “…you think that your life or other’s lives are in danger” (Kazak et al., 2004, p.211). Thus, anyone who has gone through a life-threatening event is prone to develop this type of mental illness (Blake et al., 1995, p.15). A more technical definition can be gleaned through this report: “Experiencing, witnessing or confronting events that involve actual or threatened death or serious injury, or a threat to the physical integrity of self or others” can lead to the traumatization of the individual (Kazak et al., 2004, p. 212).

It is important to clarify the meaning of trauma. According to experts, the term trauma should be used to describe the “subjective response of an individual, not the quality of an event” (Hart, Nijenhuis, & Steele, 2005, p.2). This is a crucial piece of information because this would enable the emergency response team not to assume that a person is traumatized simply because he or she is in the middle of an extraordinary event. Thus, not everyone who went through the harrowing experience of dealing with Hurricane Katrina should be expected to develop symptoms consistent with a traumatized person.

Thus, experts in dealing with PTSD and other related problems has this to say, “we consider only those who have developed at least substantial symptoms of trauma-related disorders over the course of their lives to be traumatized … traumatization involves a loss of the pretraumatic personality structure in adults and interferes with the development of a cohesive and coherent personality structure in children” (Hart, Nijenhuis, & Steele, 2005, p.2). It can also be the aftereffects of deep-seated anxiety (Mueller et al., 2009, p.184).

It is important to seek the help of a professional trained to correctly diagnose the implication of the following symptoms: “The alternation between and coexistence of reexperiencing traumatizing events and avoidance of the trauma are the hallmarks of posttraumatic stress disorder” (Hart, Nijenhuis, & Steele, 2005, p.2). An easier understanding of the definition of the symptoms of PTSD is as follows: “intrusive thoughts or re-experiencing aspects of the traumatic event, avoidance of reminders of the event or a numbing of emotions, and hypervigilance or increased physiological arousal” (Manne et al., 2002, p.608). The events that can lead to PTSD are listed as follows:

• Combat or military exposure;
• Child sexual or physical abuse;
• Terrorist attacks;
• Sexual or physical assault;
• Serious accidents; and
• Natural disasters such as hurricanes and earthquakes (Husain, Allwood & Bell, 2008, p. 52).

It is important to correctly diagnose PTSD because the failure of doing so can easily impede treatment (Husain, Allwood & Bell, 2008, p. 53). However, it is easy to commit errors when it comes to dealing with PTSD. One of the main reasons for misdiagnosis is ignorance about the nature of the problem because the symptoms can easily point to another stress-induced disorder. For instance, those who suffer from this malady can manifest it through deviant behavior such as substance abuse and hyper-arousal, irritability and anger. It is also difficult for PTSD patients to acknowledge that they have problems and need help.

Social Aspect

If given the chance to develop an ideal treatment protocol emphasis must be given to preparedness. One example is to prepare better communication plans between members of the community – among friends and family (Vasterling, 2008, p. 27). But in the case of a catastrophic disaster like Hurricane Katrina, it is extremely difficult to prepare for the aftermath. According to a professional who volunteered to help people cope with the disaster, “The very asset – community-based social support networks – that could have helped people through the adversity of the storm were ironically also casualties of disaster” (Vasterling, 2008, p. 27). Nevertheless, dealing with the aftermath of a Category 4 storm requires resourcefulness and ingenuity in order to use whatever resources are available.

It has been well documented that “neighborhood organizations can be superior to large bureaucracies in igniting recovery efforts … strong community bonds can be used as effective tools in many different respects” (Vasterling, 2008, p. 27). It has to be made clear though that this intervention strategy is focused on reducing the incidence of PTSD. As discussed earlier, people react differently to a traumatic event. It is therefore important to reduce their exposure time to a stressful situation. It has to be highlighted that “Research on postdisaster situations has demonstrated that in the aftermath of crisis situations, individuals embedded in stronger networks have more resources, both emotional and material, with which to rebuild their lives (Aldrich & Crook, 2008, p. 379). It is imperative to reduce the impact of the traumatizing event.

The use of social networks is not only to access resources such as food and clothing but also to find someone that they can talk to. The ability to reconnect with someone that they know can understand what they are going through is a major step when it comes to dealing with negative emotions regarding the event. This is also the reason why counselors and health workers need to realize the importance of being sensitive to age, gender, and ethnicity. The best intentions are useless if the recipient does not understand the message that the rescue team and volunteers are trying to get across.

The next step of the process is to evaluate, train, and equip volunteers. These volunteers can come from the field of health workers, psychiatrists, psychologists, and professional counselors and they must have the necessary credentials to deal with traumatic stress. Key personnel must undergo rigorous training making sure that those who would take part in the intervention program are well aware of current trends when it comes to dealing with PTSD.

There must be a culture of preparedness developed before and after the incident. Looking back at the aftermath of Hurricane Katrina it should have been made clear that the cycle of emergency preparedness and response does not end in the diffusion of a tense situation but it must continue days, weeks and even months after the event. After dealing with the physical needs such as food, shelter and clothing, the psychological aspect must be dealt with immediately.

The Critical Incident Stress Debriefing is part of the major arsenal of weapons used to combat the effects of trauma in a very stressful situation (Vasterling, 2008, p. 22). The related tools that accompany CISD are the following: pre-crisis intervention; defusing; one-on-one crisis counseling or support; family crisis intervention and organizational consultation and; follow-up and referral mechanisms for assessment (Schechter, 2008, p. 38). This process must be applied to both the victims of the disaster as well as the emergency responders.

When it comes to the emergency responders, CISD is ideally done in a group setting where the members in the active response group are able to verbalize the previous events. It is widely believed to be helpful to the participants and also provides feedback for the emergency plan that was put in place before the disaster took place (Kazak et al., 2004, p. 211). It is of utmost importance that a psychiatrist or a psychologist is present in these sessions. The professional will be able to determine if the emergency responder could no longer handle further exposure and suggest removal from the scene. Most importantly the psychiatrist can immediately fast-track the processes required to initiate treatment and therefore prevent the situation from deteriorating. In this example, rapid response is not only focused on the physical aspect of a traumatic event but also the mental and emotional aspects as well.

When it comes to determining PTSD, it is imperative that mental health experts are able to pinpoint the symptoms and one way to do that is to use a structured interview that would reveal the frequency and intensity of each symptom (Blake et al., 1995, p. 15). Mental health experts must use everything at their disposal to prevent a misdiagnosis of the problem. A correct diagnosis paves the way for an effective intervention program.

Cognitive Aspect

The explanation as to why others develop PTSD while others do not develop any kind of symptoms remains unclear. However, there are those who suggested that cognitive and social processing are two important factors that are linked to PTSD. “Cognitive processing refers to how the individual comes to understand the implications of the event, in both cognitive and emotional terms, and social processing refers to the way that the experience is talked about and dealt with in the individuals’ social network” (Manne et al., 2002, p. 608).

If cognitive and social processing is linked to the development of PTSD, then it can also be argued that the treatment procedure must also be established using the same process, building it around cognitive and social components of the behavior of the patient. For instance, “talking with others may facilitate recovery through discharging of emotions, learning to tolerate aversive feelings, and receiving support and encouragement of effective coping” (Manne et al., 2002, p. 608). In fact, it has been documented that “supportive responses are associated with lower levels of PTSD symptoms, while negative responses are associated with higher levels of symptoms” (Manne et al., 2002, p. 608).

An example of dealing with the cognitive aspect of the problem is the realization that the person suffering from PTSD has to learn to forgive himself or herself in relation to the traumatic event that was experienced (Thompson & Waltz, 2008, p. 556). The mental health practitioner must be aware of the internal processes going inside the mind of the person suffering from PTSD.

The treatment has to come in stages. It is also important to remember that it is the job of the health professional to strengthen the patient’s ability to “function in daily life, and commonly implies overcoming reciprocal fear and avoidance of different dissociative parts, and the related phobias of attachment, separation, loss, traumatic memories, and change (Hart, Nijenhuis, & Steele, 2005, p. 11). In other words, treatment must not be confined to the four walls of a clinic or counseling room it has to be extended into the real world.

Discussion of Treatment Protocols

There are so many things that have to be considered when it comes to dealing with PTSD. The first thing that has to be understood in the context of the source of trauma. A volunteer or mental health professional cannot directly use coping strategies without knowing the root cause of the problem. In the case of a disaster, the emergency responders must assess the situation determining the extent of the damage in order to develop an appropriate strategy.

The reason for knowing the context of a traumatic event is not only to develop an atmosphere of effective communication but also to understand the available resources that can be used to enhance the coping strategies that would be implemented later on. It has been made clear that the social network of the individual is the best tool that can reduce the incidence of PTSD as well as help that person deal with the effects of the traumatizing event.

The second important thing to remember is that the event can be the trigger but it does not guarantee the emergence of PTSD. Two people can go through a similar event and one develops PTSD while the other person can go through it unscathed. Emergency responders must not assume that the quality of the event is the precursor for this particular anxiety disorder.

The third important thing to consider is that PTSD can be easily misdiagnosed. A counselor can look at the symptoms and say that the person requires anger counseling. Another one would prescribe drug rehabilitation. There are those who would suggest that counseling can help the person cope with his or her negative view of the world and all of it can be rooted in good intentions but it does not solve the root cause of the problem.

The fourth important thing to remember when it comes to PTSD – as the result of a disaster like Hurricane Katrina – is that an intervention strategy cannot be implemented without considering the socioeconomic status of the victims. The first obstacle is the communication process. At the same time, it must be made clearer that gender and ethnicity play a major role when it comes to the manifestation of PTSD (Parson, 1996, p. 911). This is especially true when it comes to volunteers and health experts coming in from outside the state. They can use a standardized approach but they would never be able to gain the trust of the people that they are trying to help. The intervention process must be suited to the socioeconomic status and other cultural factors that are in play.

The fifth most important thing to consider is the need to look at the cognitive aspects of PTSD. This is the reason why psychologists can play a major role in dealing with PTSD (Schechter, 2008, p.38). There must be a way to understand the internal processes that are going on in the minds of the person suffering from PTSD. There must be a way to access what he or she is thinking when confronted with memories and other things that remind them of the event. In this regard, a clinician-administered interview process is needed. In this way, the mental health professional and counselors are able to understand the depth of the problem and the consistency of the symptoms.

The sixth most important thing to remember when it comes to PTSD is that not only the residents of a particular area are prone to it. The emergency responders that went there to help are also prone to developing PTSD. They are also exposed to a traumatic event. It is therefore important that their team includes a psychiatrist and psychologist who are able to determine if the emergency responders are already showing signs of PTSD. When the diagnosis is complete the health experts should be able to advise the removal of the emergency responders from the stressful environment.

Dealing with PTSD should be done in stages. In an ideal setting, the community must be well prepared for an incoming catastrophic event. This is why New Orleans is a perfect case study because the impact of Hurricane Katrina has proven many of the theoretical underpinnings found in most emergency disaster management protocols. The importance of readiness has been made clear precisely because no one was ready for Hurricane Katrina. There was a basic realization that comes with the knowledge of a category 4 hurricane but no one anticipated that there would be many poverty-stricken families that we’re unable to evacuate and make wise decisions regarding their lives.

In an ideal setting, the cycle of preparedness should have been on a high level but this was not the case. Therefore only a few people were able to deal with the aftermath. One of the consequences was PTSD. There were only a few people who are aware of the symptoms and what must be done to the person suffering from PTSD. There was no clear program to deal with the physical needs of the people, therefore it can be argued that no one paid much attention to their mental health needs as well.

The high level of preparedness should have been completed days before the hurricane blasted New Orleans. Volunteers and mental health experts should have prepared a team of emergency responders able to diagnose PTSD. They should have trained a team of volunteers who are able to coordinate the movement of people so that a social network can be rebuilt in the shelters. Family and friends should have been reunited immediately after the event in order to provide them the ability to verbalize what happened.

At the same time counselors, psychologists and psychiatrists should have been deployed to use scientific tools to pinpoint those that have PTSD and those that do not have PTSD. The scientific process should be able to distinguish those who are upset and those that are clearly demonstrating the signs of someone with PTSD. The faster the diagnosis can be made the faster the intervention program can be implemented. Without clear diagnosis counselors and health workers would only be dealing with the symptoms and yet unable to help the patient deal with the anxiety disorder.

Conclusion

PTSD can be easily misdiagnosed especially in the aftermath of a disaster where the primary goal is the physical needs of the person. In the commotion and desperation of the displaced families, it is easy to ignore the symptoms. It is therefore important to diagnose correctly and at the same time to use available resources to reduce the impact of PTSD on the person and the community. The intervention program must consider the social and cognitive aspects of PTSD. The language of the intervention program must be sensitive to the socioeconomic status of the victims. These things have to be clearly understood to develop an intervention program that works.

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