The following is a transcript of a recent interview conducted with psychologist Al Siebert, a PTSD expert who has worked with Vietnam veterans, Native American tribes, and the World Trade Center 9/11 Survivors Network.
What will be the psychological effects of Katrina, Rita and other hurricanes on the survivors?
Al Siebert: Most people will go through months of grief and loss. A few will not be deeply effected, while others will have Post-Traumatic Stress Disorder -- PTSD.
What is PTSD?
AS: PTSD symptoms include:
- Insomnia, nightmares, and flashbacks. The person is vulnerable to suddenly feeling back in the experience, is not able to stop thinking about it, and has moments of fear and panic.
- Constant hyper-vigilance. They expect that the same experience could happen to them again and try to avoid situations with the remote possibility that it might happen.
- Physical problems may include stomach distress, high blood pressure, heart irregularities, and asthma.
- It is a lasting patterns of symptoms found in normal people who have experienced extreme psychological and physical trauma. It is not a mental illness.
Will everyone in the hurricane area have PTSD?
AS: No. Only about five to ten percent. Symptoms generally appear shortly following a traumatic event, however, it is common for symptoms to appear months later.
What makes the difference? Who is least likely and who is most likely to get PTSD?
AS: The least vulnerable to PTSD are experienced, well-trained, emergency response teams such as fire and rescue personnel, medical teams, experienced war veterans, old sailors, mountain climbers--anyone who has learned to cope with extreme, adverse outdoor experiences. Although those working day after day with extremely distressed people my get “by-stander” PTSD.
Other less vulnerable people are the ones who listened to the warnings, left the area, and avoided being injured by the hurricane.
Most vulnerable are the people who stayed in their homes on the Gulf Coast, went through the full brunt of the storm, and have had little experience in extreme outdoor survival situations.
Why would they get PTSD?
AS: PTSD comes from living though the extreme shock of having the world you've always known explode around you, being physically pounded by extreme wind and rain, and feeling “I could die!” The likelihood of PTSD is even higher in people who heard and saw people screaming and dying during or after the storm.
Can people recover from PTSD?
AS: Yes. It takes a lot of work, but it can be done.
Doesn't it go away as time passes?
AS: No. The images of seeing dead people and the physical and visual memories of the terrifying experience are a deeply imbedded neuro-chemical pattern that won't go away. It doesn't work to try to suppress the memories, or to numb one's self with alcohol or drugs, or to relieve symptoms with medications. Some Vietnam veterans still had PTSD twenty years after the war as strong as it was their first year back.
Is there no hope then?
AS: Just the opposite. There is more than hope. The proven way to recover from PTSD is to talk and write about the experience over and over. The goal is not to make the memories go away, but to gain control over them and integrate them into your larger life story.
An extreme, traumatic experience divides your life into two parts. Life before and life after. Many people never overcome the experience and remain psychological casualties for the rest of their lives. Such folks allow the experience to become their primary identity and they often need help from others to get through daily life.
The resilient survivors take on the heroic inner journey to get a good life back again. They talk and write about what they went through until they can choose when they will bring up the memories. By choosing to bring the memories back, you gain the ability to not allow them to become active.
What has fascinated me for many years is that a few people not only fully recover from PTSD, but they discover that the recovery struggle transforms them. They become better than they were before and may start telling others about positive aspects of their experience. For them, life after is better than their life before.
How can such a devastating tragedy be seen in a positive light?
AS: We humans can have two sets of feelings about the same experience. We can recall and feel many distressing, negative feelings and the put those aside to talk about the valuable, positive aspects of going through the experience and recovering from it. In two to three years, some Katrina survivors will write books about how going through the storm and losing everything was the best thing that ever happened to them.
Why did some people ignore the warnings and not evacuate?
AS: There are many different reasons:
First, are people in mild denial who shrug off warnings. They don't believe anything truly bad will happen and do not feel at serious risk. Local officials are seen as overstating the dangers for political reasons.
Second, are folks who are slow to comprehend the world around them and are challenged by ordinary life. The dangerousness of the approaching storm didn't register with them and even if they sensed some danger they didn't have the coping skills or personal resources to get to a safer place.
Third are the large number of poor people and others who need public assistance to live during ordinary times. This includes low-income elderly, handicapped, infirmed, and bed-ridden people who had no means for getting transportation or arranging for a place to go.
Fourth, are fiercely independent, government-defiant individuals. Whatever any government official says they should do, they will do the opposite. They actively defy government intrusion into their lives. Proving they can't be controlled by government becomes more important than the specific situation.
Fifth, are hardy survivalists. They build survival shelters and feel confident they can personally face up to any storm and survive it.
Sixth, are thrill seekers attracted to the excitement of the action. They want to fully immerse themselves in the wild forces of nature. Fire fighters and police must always set up barriers at big fires or disaster areas to keep thrill seekers out. CNN ran some video shots taken by a man from California who flew to New Orleans and rented a room at an ocean front hotel to be able to find out what it was like to experience a hurricane.
What about the people who don't get PTSD? Won't they feel loss and grief?
AS: Yes, of course. Most people will. These are normal human emotions. Some people will feel the loss and grief longer and more deeply, others will not be affected as long or as much. Some people whose homes were filled with objects rich with meaning, photographs, and precious reminders of their past experiences, are experiencing agonizing grief over all the losses. At the other extreme are a few people who are glad to be alive, but feel detached from material possessions. They feel brief sadness, then focus on finding a new place to live.
What we can predict is that the main focus of energy for most people will be to dig out, clean up, and rebuild their homes and communities. This will be emergency, non-stop work to re-establish their lives. Then at some point about six to eight months from now, after a certain level of recovery has been achieved, the person can let down. When they are more open to fully experience the impact and meaning of their losses and the losses of others, they will feel grief and mild depression. This is normal and healthy, not something to be avoided or treated for.
Why don't they feel grief and loss now?
AS: Many people are, but mostly those who don't have essential work that must be done. In emergency situations stopping to grieve and feel depressed is a non-survival reaction. Highly resilient survivors can postpone dealing with their feelings until an appropriate time later.
We also know that a good sign of emotional intelligence is being able to verbalize and process feelings about past experiences in order to defuse and assimilate the emotional aspects of the experience. People who never allow themselves to re-experience distressing feelings from the past are emotionally fragile. They lack emotional flexibility and waste psychological energy trying to avoid feelings they don't want.
What about Critical Incident Stress Debriefing?
AS: CISD or CID is not proving to be as helpful as first believed. Psychotherapists of various kinds thought that people who carried painful memories of a traumatic experience for many years would have avoided the lasting effects if they'd talked with a mental health professional immediately after the experience. But such efforts have not proven to be very effective. It is best for each person to decide when they are ready to delve into their feelings and start the healing process. It is only just now, four years after the 9/11 terrorist attack on the World Trade Center in New York City, that some survivors are deciding they must do something about the memories, nightmares, and pain that won't go away.
You seem optimistic about people's ability to cope with losing everything.
AS: It's more than optimism, I know that most of the people in the Gulf area will recover and rebuild good lives for themselves. We humans are good at surviving natural disasters. It's in our DNA. We've had thousands of years of experience surviving and recovering from one disaster after another-- earthquakes, floods, forest fires, famines, plagues, wars, and so forth.
But these were relatively temporary events in between long periods of relative calm and peace. Much of my professional work today is trying to inform people that they will shorten their lives, however, if they live month after month as though they are working to survive a natural disaster. Working in an emergency survival mode suppresses the immune system and depletes our bodies. If not stopped, we get heart attacks, strokes, cardio-vascular diseases, ulcers, are sick more often, and eventually die. One's daily life should not be lived as though a disaster was happening. Nature arranges for those.
Al Siebert is an ex-paratrooper with a PhD in clinical psychology. More information is available in his books The Survivor Personality and The Resiliency Advantage (see Chapter 12, "Mastering Extreme Resiliency Challenges"). Related articles and survivor resiliency guidelines are available at www.THRIVEnet.com