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14 January 2013, 6.38am EST

Natural disasters have unexpected impacts on mental health

Radical circumstances (bushfires and natural disasters) flush out the mental illness in society. Whenever there’s a disaster, there’s a rush on hospital admissions for psychiatric problems. But on the whole, the illness is already there. Emergencies naturally make fodder for delusions and the emergency…

Mndrmzrx-1357883608 — Bushfire affected property at Sommers Bay in Tasmania, Thursday, Jan. 10, 2013. Residents of the worst-hit town Dunalley in the Tasmanian bushfires returned on Friday to see the full extent of the devastation. AAP/David Beniuk

Emergencies naturally make fodder for delusions and the emergency efforts, for mania. Obviously, there are direct mental health consequences – a small rise in post-traumatic stress disorder inevitably follows disaster. This correlates with the severity of the consequences of the disaster (loss of family, friends, animals and property).

And there’s usually a big rethink, with about a third of those affected leaving the area permanently. But, for the most part, this isn’t driven by mental health issues, it results from the very real fears about whether living in a fire (or other disaster) zone is worth it.

Resilience and weakness

In terms of mental health, the real effect of disasters is surprising. When handled well (as they have been in the recent efforts), disasters are an opportunity for communities and people who are directly involved to galvanise, and this appears to inoculate against mental illness by strengthening social bonds, and feeding a sense of purpose and meaning.

Another surprise is the flipside – an inexplicable rise in the mental illnesses that affect the elderly. Those who are frail and can’t get involved may feel they are ultimately only a burden. Such people suffer terribly from mental illness as a result of disasters. The big rise in mental health admissions after a bushfire happens in this group – its first presentations of dementia and senile degeneration is many times higher than with any other mental illness.

The complexity of social, environmental and psychological dynamics during an emergency cannot be underestimated. With normalcy going with the first evacuees, the strength of “all that is good” becomes the new foundation. As the National Strategy for Disaster Resilience points out, the power of the community (people you never met before come out of the woodwork to help), and the abiding dedication of the emergency services can be truly inspiring. And this is just the thing for building physical and mental resilience.

A useful way to understand this effect is through a theory called salutogenics. The theory rests on a relative sense of coherence that’s built by fostering three things – manageability, comprehensibility and meaning. Conversely, the sense of coherence is depleted by anything that rattles your ability to cope – not only a lack of resources required to manage; a lack of knowledge needed to comprehend circumstances, or a lack of meaning in life, but more general forces like the entropy of age and time.

A man walks through waist deep water to a small community cut off by flooded roads from the rest of Gulfport, Miss., after the arrival of Hurricane Katrina on Monday 29 August 2005. EPA/DAN ANDERSON

While emergencies inevitably attack the ability to manage, they allow for meaning by providing clear answers to life’s big question – what are you here for? Getting involved in an emergency effort gives the answer – I’m not a parasite, I’m here to save people. I’m a contributor.

The formation of beliefs like these has been shown to assist in the widest gamut of health outcomes, not only in mental health. Recent research has also identified the effect of improved meaning and comprehensibility in conditions as diverse as heart disease and cancers. Surprising as it is, disasters can actually improve health if people find a way to get meaningfully involved in the disaster response effort.

Perceiving is believing

Reading this, you might think a bushfire is a wonderful thing. But there’s a big caveat – in emergencies, the perceptions of those involved are critical. Good interpersonal connections create meaning, but the lack of structure within emergency situations also provides opportunities for selfishness and even criminality. And these inevitably lend themselves to atrocious outcomes (consider Hurricane Katrina).

Good information improves comprehensibility, but in an emergency, information may be hard to come by and is frequently manipulated. What’s more, people might not have the heart to be honest when it matters most.

An under-promise allows low expectations to be exceeded, and this allows for a powerful message of hope and the belief that everything ultimately works out well. On the other hand, disappointment is easily taken as betrayal.

Disaster victims should be expected to make unreasonable demands. Victims may, for instance, extract promises that are difficult or impossible to keep. Who, after all, wants to deny someone who is desperate and might have his life in danger? Who wouldn’t prefer to lie and say, “don’t worry. Everything will be fine”?

But a hastily made guess that “someone will be there to help in a couple of hours” can start doing damage at 120 minutes and one second. The reason is because the promise suddenly becomes questionable, and at this point, comprehensibility collapses and meaning starts to erode. What could be more destructive mentally?

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11 Comments sorted by

Clare Mann

logged in via Facebook

As a psychologist I have worked with large numbers of people who show enormous variability in their ability to cope with change. Divorce, children leaving home, redundancy, ageing, death in the family etc present individuals with the opportunity to 'break through' or 'break down'. Natural disasters bring another layer of uncertainty and unpredictability on a collective level. One is reminded of one's vulnerability and mortality and where a close-knit community doesn't exist, people can feel the…
Read more

As a psychologist I have worked with large numbers of people who show enormous variability in their ability to cope with change. Divorce, children leaving home, redundancy, ageing, death in the family etc present individuals with the opportunity to 'break through' or 'break down'. Natural disasters bring another layer of uncertainty and unpredictability on a collective level. One is reminded of one's vulnerability and mortality and where a close-knit community doesn't exist, people can feel the futility and loneliness of their existence. Much of the fear and panic is existential in nature where a person is faced with their own mortality and finitude - they can be forced to look at what their life is about and its purpose and meaning. If one is unhappy or unfulfilled and has regrets, the possibility of endings reminds them that time is running out.

I lived in New Zealand where the Christchurch Earthquake saw a city decimated. My observation was that people who had social support and had placed importance on relationships used their already honed skills to rebuild their lives and communities. Those without those connections or commitments felt more alone and hopeless.

Natural disaster can mean 'break down' or 'break through' for an individual - the opportunity to review one's life and relationships exists at any time - natural disasters remind us that time is limited and we must be clear that we alone are responsible for our own life.

Clare Mann
www.communicate31.com

5 months ago report
Peter Ormonde

Peter Ormonde is a Friend of The Conversation.

Farmer

Environmental DETERMINANTS of mental health ... Big ask.

Anyway a very interesting piece.

Living in a teensy town the whole place operates on volunteerist communityism. And curiously the place and the people demonstrate a remarkable collective and individual resilience - that's an important notion here - at least in the face of a shared disaster or menace.

Far less so resilient when it comes to confronting the isolated personal grind of individual everyday life - particularly the males. DV, alcoholism, family breakdowns and depression - the place is awash with it. But that's another issue I guess. Maybe not.

But it is this collective participation and sense of value that drives the strange passion of the middle aged firebug at least in part. Odd huh?

5 months ago report
1. Jan Golembiewski
  
  Researcher in Environmental Determinants of Mental Health at University of Sydney
  
  In reply to Peter Ormonde
  
  I have often thought the middle-aged firebug might be 'using' the fires to personally bolster their sense of involvement and meaning. And while I think there might be a case for this twisted logic, I think there is a better one for another argument. But there's another argument. One I would have loved to have had space to write about in this article (but with 600 words?) and it is the environmental demands or 'affordances' a tinderbox landscape offers: such an environment says "light me". People with low frontal inhibition (either due to alcohol/drugs, organic brain damage or psychological problems) just cannot resist affordances (see my other articles like: http://www.academia.edu/1144070/All_common_psychotic_symptoms_can_be_explained_by_the_theory_of_ecological_perception).
  
  Thanks for your comment btw.
  
  J
  
  5 months ago report
2. Emma Anderson
  
  Artist and Science Junkie
  
  In reply to Jan Golembiewski
  
  Hi Jan
  
  I read your linked article which - correct me if I'm wrong - appears to be in a draft state and open for comment. So here's some comment.
  
  I like the concept you're working with, it has potential, although it needs work.
  
  Referring to your table, a person can have delusions without ever having hallucinations and vice versa. In schizophrenia, as both a diagnostic criteria to relate each concept may make sense (the content of a hallucination may reflect the content of a delusion) but…
  Read more
  
  Hi Jan
  
  I read your linked article which - correct me if I'm wrong - appears to be in a draft state and open for comment. So here's some comment.
  
  I like the concept you're working with, it has potential, although it needs work.
  
  Referring to your table, a person can have delusions without ever having hallucinations and vice versa. In schizophrenia, as both a diagnostic criteria to relate each concept may make sense (the content of a hallucination may reflect the content of a delusion) but to include it in a discussion that implies a more general application to psychiatric conditions is inaccurate. It doesn't apply to bipolar disorder, for example; hallucinations are not diagnostic criteria (it's a mood disorder, not a psychotic disorder although sometimes - but often not- mood disorders can lead to psychotic like symptoms). Linking delusions with hallucinations might apply to schizoaffective disorder though, so if you want to relate it to moods, this might be a bridge.
  
  You also need to be careful with symptoms that occur in psychotic illnesses but also occur in non-psychotic persons with other illnesses. For example, ataxia can occur in multiple sclerosis, parkinsons, epileptic and non epileptic seizures, hepatic failure - none of which necessitate psychosis (although it's possible for that to happen). Can these conditions be explained by ecological perception? Only if other parts of the brain or body are misinterpreting environmental stimuli (although we don't argue that the immune system for example, is perceptive...maybe we ought to) this would be interesting....do the frontal lobes regulate self-other perception in the immune system...I would love to know!!
  
  I would also caution - and this is a general comment to the psychological/psychiatric community, not just you- what we define as a delusion. Although some things are obviously delusional some things might appear to be delusional but are merely subjective and not understood, perhaps due to the communication issues that occur between patient/client and treaters/carers generally and especially in otherwise psychotic individuals. In particular, the so called delusion that other people make the world a bad place, is absolutely true to a person who has been severely and continuously traumatised to the point of the perceptual wiring in the brain/minds not having any other information. Their life experience - actual evidence - dictates this fact - and it is only that others have different experiences that mean their brains wire different information. Trauma history is quite common in people with psychiatric illnesses. And calling - however indirectly - their life experiences delusional is ineffective to treatment. First acknowledge their suffering, then, give them the space to learn that their perceptions, although based on evidence, is missing other kinds of evidence. The people that hurt them may have been bad, but they need to learn that those people are the exception, not the rule. Trust is important here, and the treater/carer may help challenge that belief by first becoming the exception to their rule and gradually introducing more exceptions. I don't think people usually trust people who don't trust them. So teasing out what is a delusion and what is not is not so simple and not always effective; if treater does not trust patient, patient does not trust treater.
  
  How does ecological perception relate to this?
  
  5 months ago report
3. Jan Golembiewski
  
  Researcher in Environmental Determinants of Mental Health at University of Sydney
  
  In reply to Emma Anderson
  
  I'm not exactly sure which of my articles you are commenting on - I've written many, but none of the material you are concerned by has been written up in The Conversation.
  
  You are right, not all hallucinations nor delusions can be explained by the ecological theory of perception. In a couple of my articles I make this more than clear - but I have to admit, that the Medical Hypotheses paper really only focus on the ETP and related psychoses. A much better paper is currently in press at Facilities…
  Read more
  
  I'm not exactly sure which of my articles you are commenting on - I've written many, but none of the material you are concerned by has been written up in The Conversation.
  
  You are right, not all hallucinations nor delusions can be explained by the ecological theory of perception. In a couple of my articles I make this more than clear - but I have to admit, that the Medical Hypotheses paper really only focus on the ETP and related psychoses. A much better paper is currently in press at Facilities Journal and will be published soon.
  
  In terms of hallucination, the ETP can only explain 'simple' hallucinations - those that are commonly experienced with organic brain deficiencies, bipolar type 1 disorder and people suffering substance abuse. (Psychosis is included in the diagnostic criteria for BPt1 and is reflected by the 5th digit of the DSM-IV recording procedure, with '4' meaning that there are no psychotic features, and '5' meaning that psychosis is very pronounced.)
  
  Unlike hallucinations, which are perceptual, delusions are rational. Delusions must be based on rationalisation of evidence - however sketchy. For the best part, this means perceptual input, but also includes cultural expectations and other familiar narrative schemata.
  
  Interestingly, schizophrenic patients show a deficit when it comes to rationalisation. To me, the reason for this is clear enough, but is complex and is the subject of another paper I have been unsuccessfully been trying to get published. Most significantly, rational processes employ an enquiring mindset which relies on a bottom-up perceptual process. This is used for perceiving aberrance and the unexpected. The ETP theory that you critique employs only the opposite, the top-down perceptual process (familiar schemata, intention, expectation and routinised behaviour).
  
  Schizophrenia is a disorder that debilitates the bottom-up perceptual process while overstimulating the top-down: all in all, it's the perfect combination to provide extremely vivid hallucinations and wild delusions. Other disorders tend to favour one perceptual process over another.
  
  I could go on and on - but perhaps it's better to do this for an academic journal rather than a blog attached to tangental newspaper article...
  
  5 months ago report
4. Emma Anderson
  
  Artist and Science Junkie
  
  In reply to Jan Golembiewski
  
  I was referring to http://www.academia.edu/1144070/All_common_psychotic_symptoms_can_be_explained_by_the_theory_of_ecological_perception
  
  I'm not in position to reflect and comment further on your reply as yet so just thanking you for sharing.
  
  5 months ago report
5. Ron Fletcher
  
  Psychosocial Care Coordinator
  
  In reply to Peter Ormonde
  
  I would agree that often the reason for lighting fires is often the desire to ignite the community spirit. However, having worked in the past, in a fire fighting position, with a firebug I would say that his motivating force was not a desire for collective participation (everyone had that within the team), his motivation seemed to be more of stature within the team (which could be the same thing). He basked in the imagined glory of always being the first on the scene; I say "imagined" because everyone knew it was him and his status was lowered massively because of it. His appeared to be a very distorted 'masculine' reason.
  Oh by the way, nothing could ever be proven but they got rid of him.
  
  3 months ago report
6. Jan Golembiewski
  
  Researcher in Environmental Determinants of Mental Health at University of Sydney
  
  In reply to Ron Fletcher
  
  It's hard to even touch the tip of the iceberg with a 700 word article. But for the best part, I agree with you too. Having said that, I think there are other reasons - the community spirit is one, delusions another and finally there's the ecological perception of it all. People light fires because they can. Fields of dry grass and mounds of dry leaves beg to be lit - in the same way that a candle 'wants' to be blown out, an apple to be eaten (even when you're not hungry), a cliff to be leapt off…
  Read more
  
  It's hard to even touch the tip of the iceberg with a 700 word article. But for the best part, I agree with you too. Having said that, I think there are other reasons - the community spirit is one, delusions another and finally there's the ecological perception of it all. People light fires because they can. Fields of dry grass and mounds of dry leaves beg to be lit - in the same way that a candle 'wants' to be blown out, an apple to be eaten (even when you're not hungry), a cliff to be leapt off. There is a powerful invitation in the knowledge that something that is possible - an entropy of sorts, that only doesn't turn to action when resisted with a healthy dose of inhibition. Children and adolescents have naturally low inhibition, people who are intoxicated do too, and also people with certain mental disorders (especially bipolar type 1 or those with organic frontal brain damage). There's a good argument that those people simply can't resist the temptation to light up a fire. (Please read my article "All common psychotic symptoms can be explained by the theory of ecological perception' on http://usyd.academia.edu/JanGolembiewski.) Someone I know is fully aware that she has borderline mental issues. She is also aware of how close she gets to being a fire-bug in high summer. She tells me that the sight of her old rain-tank, full of dry eucalyptus leaves is sometimes too tempting. She wants to throw a match in - and has to consciously resist the desire, because her own house will be the first to burn down.
  
  3 months ago report
Colin Kline

logged in via Facebook

-
#History Of (Australian) Fire Fighting Strategies#

Fire Fighting authorities (& Govts), on both sides of the Pacific, are frequently reported as obdurately pursuing policies that guarantee large numbers of people, animals, homes, forest will be regularly annihilated.

These catastrophes will repeat, and increase, with Global Warming.

Authorities have arrogantly (and provedly) refused to use better & more appropriate technologies, viz - replacing Miniscule Manpower and Piddling Planepower…
Read more

-
#History Of (Australian) Fire Fighting Strategies#

Fire Fighting authorities (& Govts), on both sides of the Pacific, are frequently reported as obdurately pursuing policies that guarantee large numbers of people, animals, homes, forest will be regularly annihilated.

These catastrophes will repeat, and increase, with Global Warming.

Authorities have arrogantly (and provedly) refused to use better & more appropriate technologies, viz - replacing Miniscule Manpower and Piddling Planepower with - proven Large Aerial Fire Tankers.

Australia has a deplorable history of ignoring this above option, indeed of ignoring an abysmal number of other recommendations, from so many Royal Commissions over several decades, back to the 1930’s.

Recent Royal Commissions, show no indication of having even considered, or investigated this option, despite several submissions from the public requesting that the idea of Large Aerial Fire Tankers be explored.

No matter how greatly the deaths and damage accumulate, the inertia and obstructionism of Fire Management and Politicians mounts even higher.

#Critiques & Rebuttals of Current Fire Suppression Practices#
Several facile counter-arguments have been touted by luddite authorities.
Rebuttals are below :

1. COSTS (of such equipment)

 1.1 Costs can be amortised annually over several Govt budgets, by sharing with other countries as scheduled & alternated each fire-season. 

1.2 Costs of fire losses should be properly assessed and weighed against cost of equipment. Fire-fighting authorities seem to have a quite different costing for human life as compared to that asserted by the general public. 

1.3 Costs & effectiveness of land-based fire communications should be weighed against aerial ‘eye-in-the-sky’ comms centres, mounted onboard with these tankers.

2. SALINATION 
2.1 Indeed there could be a measured assessment of the percentage increase in water & ground salinity, as measured by the quantity of salt-water delivered by these tankers, but this is a fraction of the annual rainfall delivered by nature. The costs of such degradation should be fairly weighed against the costs of fire losses. 

2.2 Increased corrosion of houses and other property could be likewise fairly weighed.

3. SMALL PLANES ARE BETTER

 3.1 What? Current small aerial fire fighting planes are grounded by safety regulations on windy days of extreme fire danger.

 3.2 Because of their small payload, these small planes need fire retardant added to their water load; this retardant is highly questionable from an epidemiological / carcinogenic basis.

4. MEN ADORE THEIR FIRE FIGHTING ACTIVITIES 

4.1 A very senior (Victorian) CFA administrator has defended current #manpowered technologies# with a statement that: “Men like to prove themselves by meeting fire face-to-face”.

This might be the epitome of the kind of incompetent planning and thinking that infects so much of obsolete fire authority management. It would appear that the weight of this manager’s testosterone outweighs any other reasonable opinion.

5. LARGE AERIAL TANKERS ARE NOT SUITABLE TO AUSTRALIAN CONDITIONS 

5.1 Where is the carefully investigated report, by qualified assessors, that supports these off-the-cuff denialist assertions, (frequently appearing from aged ex-fire-fighters contributing to Internet Blogs)?

There exists an excellent report on Aerial Firefighting, by M. PLUCINSKI, et. al., but this report refers ONLY to small airplanes. A superficial Oz State Govt test was implemented, but designed to MAKE the tanker-planes fail, in unspecified ways.

5.2 “… (a) 11,000-gallon tanker plane pours ‘too much water,’ officials say …” (American Forest Service).
What? The water delivery rate can be minutely controlled !

How can uneducated and unqualified officials be continually permitted to sacrifice so many lives and dollars, with no expertise other than their bombastic bluster?

See:

http://en.wikipedia.org/wiki/Aerial_firefighting

http://en.wikipedia.org/wiki/User:Akradecki/Sandbox5

http://en.wikipedia.org/wiki/DC-10_Air_Tanker

http://www.dse.vic.gov.au/fire-and-other-emergencies/wildfire-control-equipment-aircraft
[Note: There are NO large water tankers in the Australian fleet !!!]

http://www.agaservices.com.au/aerial_firefighting.htm

www.fs.fed.us/fire/aviation/airtanker_modernization_strategy.pdf

http://wattsupwiththat.com/2012/06/30/in-colorado-wildfires-worst-in-state-history-why-wont-the-forest-service-use-the-biggest-firefighting-tool-available/

http://www.huffingtonpost.com/2012/06/15/firefighting-tanker-planes-fleet_n_1597829.html

http://www.gizmag.com/evergreen-supertanker-the-worlds-largest-firefighting-aircraft/9565/

http://www.gizmodo.com.au/2011/06/aerial-super-tankers-drown-forest-fires-with-waterfalls-from-the-sky/

5 months ago report
Ron Fletcher

Psychosocial Care Coordinator

Is it possible that the negative effect experienced by older people is due to their inability to participate in the positive aspects of the work involved. When I was young everybody participated in bushfire emergencies, the CWA had production lines of sandwiches and older men helped around the CFA station, delivered food, etc. Nowadays it is only when a bushfire or other emergency becomes a 'disaster' that this community spirit is allowed to blossom. It is the sense of helplessness, loss of locus of control and unpredictability that causes trauma, if people are actively involved in the answer these things are, by definition, reduced.

3 months ago report
1. Jan Golembiewski
  
  Researcher in Environmental Determinants of Mental Health at University of Sydney
  
  In reply to Ron Fletcher
  
  True. This is a very real danger. The best 'treatment' appears to be engagement. I write all about why in a couple of articles:
  
  Golembiewski, Jan. (2012). Moving from theory to praxis on the fly; Introducing a salutogenic method to expedite mental healthcare provision. Australian Journal of Emergency Management, 27(1), 42-47.
  
  Golembiewski, Jan. (2012). Salutogenic design: The neural basis for health promoting environments. World Health Design Scientific Review, 5(4), 62-68.
  
  You can find these on: http://usyd.academia.edu/JanGolembiewski
  
  3 months ago report

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Natural disasters have unexpected impacts on mental health

Resilience and weakness

Perceiving is believing

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Clare Mann

Peter Ormonde

Peter Ormonde is a Friend of The Conversation.

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Emma Anderson

Jan Golembiewski

Emma Anderson

Ron Fletcher

Jan Golembiewski

Colin Kline

Ron Fletcher

Jan Golembiewski

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