The Psychological Damage From Superstorm Sandy

As the East Coast struggles in the wake of superstorm Sandy, Tell Me More focuses on the psychological damage that natural disasters can cause. Host Michel Martin speaks with psychiatrist Dr. Carl Bell about who is most at risk, and how people can help each other survive the emotional trauma of disasters.

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MICHEL MARTIN, HOST:

I'm Michel Martin, and this is TELL ME MORE, from NPR News. Coming up, NPR has a new poll out on the presidential race, so we decided to talk a little bit about the science and business of polling and why so many polls conflict with each other. That's in just a few minutes.

But first, we want to talk a bit about that storm, Sandy, that lashed the East Coast this week. It is estimated that at least 15 people have died as a result of the storm. That's in the U.S. alone. NPR will continue to follow it as events warrant. And, of course, the most immediate concern is safety of people's property and families, of course.

But we wanted to talk about the toll that this storm and other natural disasters can take on mental health. For that conversation, we've called once again on psychiatrist Dr. Carl Bell. He is a professor of psychiatry at the University of Illinois at Chicago. He's also director of the Institute for Juvenile Research there, and joins us on many occasions to talk about mental health issues.

Dr. Bell, welcome back. Thanks for joining us once again.

CARL BELL: Thank you.

MARTIN: Dr. Bell, we often talk with you about - if I can call it that - man-made disasters, you know, violence and terrorism and the effect that that has on people and how to cope with those kinds of things. Do natural disasters affect people's psyches differently, or is it the same?

BELL: Well, you know, if someone does something, creates a man-made disaster, that's a choice they make. So some people actually believe because people make those choices, it has more impact on people's psyche because it's an act that the person chooses to do. And you start asking yourself: Why, you know, why did that person do this?

Natural disasters, on the other hand, are natural. They're acts of nature. And so they're a little bit different in terms of cause and volition. But in terms of being in the middle of something horrible, you're just in the middle of something horrible and you've got to do the best you can to make the best of it.

MARTIN: Are there certain people who react worse than others in these kinds of situations, who are more vulnerable - let me put it that way - in these kinds of situations?

BELL: Oh, yeah. Yeah, for sure. You know, people who are already mentally ill, who have schizophrenia, depression, bipolar disorder, panic disorder, people who are very scary and afraid, of course, are more vulnerable. Also people who have been previously harmed or traumatized or, in this case, if you're talking about humans victimized, they're more anxious, a lot of times.

But at the same time, those same people might actually be more resilient because they're a little more prepared for these kinds of things to happen. They may have, as a result of their previous trauma, developed a bit more faith and an understanding that life is kind of rough sometimes, and so you might as well expect it.

MARTIN: But what about the opposite side, people who seem kind of almost giddy when something like this happens?

BELL: Well, you know, people are strange creatures by nature, and so anything that hooks them, that stimulates that amygdala, that rollercoaster fear kind of a thing, it attracts people.

MARTIN: What about kids? I mean, you work with a lot of kids and...

BELL: Yeah.

MARTIN: ...I think that a lot of parents have already noted that, you know, things like lightning and thunder are kind of organically frightening to kids, anyway.

BELL: Sure.

MARTIN: Do you have any thoughts about that? Or how parents could be handling this or should handle these kinds of things?

BELL: You know, the best example of that comes from Anna Freud, who wrote about the bombing in London. And her observation - which has been shown to be true through research - is that if the parents are OK, if the parents are calm, if the parents have hope, if the parents are exuding a sense that we can keep you safe, if the parents seem like they know what they're doing, that's extraordinarily protective of children.

If, on the other hand, the parents are losing it and, you know, going off, then that's not good for the kids.

MARTIN: As in any disaster, you know, one home can be perfectly fine while the one next door is flooded or destroyed...

BELL: Yeah.

MARTIN: ...or something like that, or - and, you know, you see that a lot. You know, the tree falls on this house.

BELL: Yeah, yeah.

MARTIN: The house next to it is perfectly fine. Does that do something to your psyche, particularly if you're the person whose house is fine?

BELL: Oh, sure. People - any time anything bad happens to anybody, mostly the first question that comes up is: Why me? You know, what did I do? Why me? And people have to grapple with that. Most people are trying to figure out the best way to be in life, and, of course, there's no answer.

People often turn to spiritual books or to gurus or counselors to try to find that answer out. The truth is that if you read those books or go to those people, they don't really have your answer. You've got to find your answer for yourself and dig it out. So it's always a challenge.

MARTIN: If you're just joining us, this is TELL ME MORE, from NPR News. I'm Michel Martin. We're talking about the mental health effects of disasters like the storm Sandy, which has hit the East Coast. I'm joined by Dr. Carl Bell. He's a psychiatrist and a professor of psychiatry at the University of Illinois at Chicago. And we turn to him frequently for discussions of mental health issues.

Dr. Bell, the other thing I was wondering is if sometimes people get through an even just fine, right...

BELL: Yeah.

MARTIN: ...the actual event itself. But then they find themselves experiencing something, you know, days, weeks later.

BELL: Yes. Yes.

MARTIN: Is that common? And why is that?

BELL: Well, yeah, it is common. Because when you're in something, you're in it and you're sort of shocked. You're surprised. You're unprepared - depending, again, on your life's experiences. And some people it takes time for them to process fully what they're in. That's why they call it post-traumatic stress disorder.

There's also acute stress disorder, and they used to actually think that if you were in a disaster and you were suffering from an acute stress disorder, that you would be more vulnerable for post-traumatic stress disorder. That turns out not to be true. In fact, the more that people catastrophize(ph) - you know, oh, my God, I'll never survive - the more likely they have PTSD.

And the less people have a sense of self-efficacy, a sense of can-do, the more at risk they are to get PTSD.

MARTIN: So your attitude going in really does make a difference. So your attitude throughout really makes a difference?

BELL: Oh, yeah. Your culture makes a difference, too. Eastern cultures are frequently based on the notion that everything changes, and they're much more observant of the cycle of life and how things wax and wane. And so they're a little more comfortable culturally with the notion that they're going to be wiped out, uplifted, wiped out, uplifted.

In America, where we tend to be a bit more materialistic and transactional, we tend to think we can control everything. And so when we can't, it kind of shakes our confidence in our ability to do things.

MARTIN: Now that you've had these insights and that people have heard these insights, what should they be thinking about? I mean, we often talk about in terms of preparations, you know, get your batteries, get your flashlights, get your plywood. Get your sandbags.

BELL: Right.

MARTIN: Are there emotional and mental health preparations that you think people cold be making in advance of a disaster?

BELL: Prepare. Take a break. If you can, change the outside. And if you can't, change the inside, how you respond to that trauma or situation. So that's one sort of general thing. The other thing in terms of preparation is there is something that finally, after years and years and years, is out, and that's psychological first aid.

It's almost like the physical first aid that people do. When someone's choking, they know to get behind them and squeeze their lungs. Psychological first aid comes out of the National Child Traumatic Stress Center and is available on the Internet. People also have developed other renditions, like mental health first aid.

I think the Red Cross has a psychological first aid intervention. So being prepared like that is helpful, especially if you've got kids, because the psychological first aid is designed to help children deal with all kinds of problems. I mean, it's not only hurricanes, it's terrorism. It's death. It's violence.

So we all need to be prepared for - you know, what's the saying? Prepare for the worst, but hope for the best.

MARTIN: What do you recommend now that the worst of the storm seems to be over? I mean, obviously now there's the cleanup for people who are particularly affected by it.

BELL: Yeah.

MARTIN: What do you recommend that people be looking out for, either in themselves or in their friends and family members?

BELL: Well, you know, if you're jumpy, easily startled, having sleep loss, sad, distraught, can't concentrate, those kinds of things, those are all symptoms. Now, you know, there's a difference between stress, distress, and traumatic stress. Stress is your usual, you know, you don't sleep a couple hours at night after something bad happens.

Distress, like a parent dies, well, you might be messed up for six, nine months and be messed up forever every time their birthday comes around. Traumatic stress is the kind of stress that actually breaks you psychologically. It just destroys your ability to be whole and human. The other issue that people frequently do that's extraordinarily helpful - it's not the trauma that causes the problem. It's the helplessness in the face of trauma.

So that if you can change or shift that helplessness and do what some people refer to as learned helpfulness, you actually have a far better outcome. And again, that goes to research on self-efficacy and the notion that if you're in a disaster and you actually - you don't even have to do something that's constructive.

If you just feel like you can do something constructive and make a difference, then you come out better psychologically. And by virtue of being charitable to someone else and helping somebody else when they're in trouble, you actually feel better.

MARTIN: Before we let you go, do you recommend that people fake it until they make it?

(LAUGHTER)

MARTIN: You feel lousy. You're really, like bent out of shape. You're like oh, man...

BELL: I hear you.

MARTIN: ...I've got to pump out the basement again?

BELL: Yeah.

MARTIN: Trees are down. I don't have money for this. Ugh.

BELL: Yeah.

MARTIN: What do you recommend? In fact, you know, one of the things we didn't mention is there are a lot of people who are without jobs and whose financial resources...

BELL: Oh, yeah.

MARTIN: ...are already strained.

BELL: Yeah. Yeah.

MARTIN: Who are probably feeling, you know, additional strain.

BELL: It's hard. It's hard. You know, the fake it till you make it is a strategy for sure. When people come to me and they lack motivation I tell them, look, just start doing something and the motivation will come. But it takes a certain amount of discipline. It takes a certain amount of experience in life.

If you've got social support systems around you that can help you get up and go, that's very, very helpful. Music helps people. Those are all helpful strategies.

MARTIN: Dr. Carl Bell is a professor of psychiatry at the University of Illinois at Chicago and director of the Institute for Juvenile Research at that campus. And he was kind enough to join us from member station WBEZ in Chicago. Dr. Bell, always good to talk to you.

BELL: You too, Michel.

(SOUNDBITE OF MUSIC)

MARTIN: Coming up, if you tuned into NPR this morning you might have heard about our latest poll in the presidential race.

MARA LIASSON, BYLINE: Nationally, Romney is ahead by a hair but the president has a four point lead in the 12 states where the candidates are spending their time and money.

MARTIN: But you might have heard some other polls saying different things. So what gives? We'll try to find out. That's just ahead on TELL ME MORE from NPR News. I'm Michel Martin.

(SOUNDBITE OF SONG, "TAKE FIVE")

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