Exploring the Role of Psychiatrists in Disasters

Human suffering comes in many forms and shapes.

Working with interpersonal violence and man-made trauma is something that we as psychiatrists encounter on a regular basis, and we have the tools, confidence, and expertise to engage survivors in meaningful and effective interventions.

With the global scare over the COVID-19 pandemic and similar large-scale natural disasters, we have a unique opportunity to explore new territories and play vital roles in helping the public cope and heal.

The mental health consequences of trauma are more than “just PTSD,” and natural disasters come at a heavy psychosocial price. The invisible wounds and mental scars of such experiences can go unnoticed and lead to long-term dysfunction and, at times, transgenerational transmission of trauma.

The suffering might extend beyond classical psychiatric symptoms to include somatic, academic, vocational, and relational struggles. And although most people who survive disasters usually completely recover, there are some that will have a persistent difficult time.

Disasters usually strike the least prepared areas and communities, but, as COVID-19 has proven, industrialized societies are not immune. Disasters tend to overwhelm the existing local resources and there is usually a need to find additional sources of assistance.

As psychiatrists, we can either regress, react in fear, anger, or despair and be part of the problem, or we 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?

Things we can do

Using the COVID-19 crisis as an example, here are a few suggestions that can magnify our potential to help and heal ourselves and others.

Take the lead. Psychiatrists do not live in vacuum or behind fortress walls; we are part of communities and we need to be in the frontlines in responding. We should start with our families and expand to neighborhoods, schools, community centers, and places of worship.

Leverage our knowledge. Psycho-education is very important in the aftermath of disasters. Survivors need to know that most of their symptoms are normal responses to an abnormal situation. Triage is also needed to maximize benefit and wisely allocate sparse resources. Psychiatrists can help first responders in differentiating medical and psychiatric symptoms. Psychotherapeutic skills-active listening, calm and non-judgmental approaches, trust-building, establishing rapport, compassion, coping skills, and grounding techniques-also can come in handy. Those skills may help in assessing risky behaviors and addressing unhealthy coping habits, including the use of alcohol and drugs and suicidal or violent thoughts or behaviors. As needed, comfort could be brought to grieving families through the ease with which psychiatrists talk about death and dying. And, in rare circumstances, psychiatrists can judiciously prescribe the use of psychotropics and referral to specialized services.

Discuss recurring impact. Recovery time varies, not only among communities as they try to rebuild, but also among individuals 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; it is important to help survivors understand this so they can be better prepared to deal with symptom recurrences.

Promote safety and community. Trauma shatters and confuses the core beliefs that the world is a safe place and that others can be trusted. In the aftermath of disasters, therefore, it is vital to regain the sense of safety and to establish routine, structure, and a semi-normal state so survivors feel they have some control. For example, random acts of beauty and kindness include offering to babysit for those working in hospitals and grocery shop for the elderly as well as sharing limited resources with neighbors. Similarly, helping survivors find their inner strength and pointing out available psychosocial resources, support networks, and their belief system and spirituality is of utmost importance.

Care for the caretakers. To prevent or at least reduce the risk of vicarious trauma, provider burnout, and compassion fatigue, it is essential that we take care of ourselves and encourage other caregivers to do the same.
Social distancing

To reduce the spread of COVID-19, we have been encouraged to use social distancing; even in our inpatient psychiatric unit we place folks on isolation precautions and limit staff contact. Social distancing, however, does not mean cutting the therapeutic alliance and human bonds. I am a strong believer that:

- The treatment of choice for human suffering is human connection;
- Being in isolation is a very lonely experience;
- Having the virus should not be a social death sentence;
- We need to support rather than alienate; and
- We need to reach out to our patients, co-workers and neighbors. 

These trying times can offer a golden opportunity to reconnect with our families and loved ones through quality time spent together, opening channels of communication, and building bridges of trust.

Yes, these are hard times, but they get a little easier when we make the decision to unite and go through them together.

Dr Reda is a psychiatrist at Providence Health & Services, Portland, OR.

Have more COVID concerns and clinical tips? Email us at PTEditor@mmhgroup.com. We may share your stories, queries, or thoughts in a future editorial or even as a standalone piece. Check out our COVID-19 Resource Page for Psychiatrists.