Published on Apr 18, 2017

15 March 2017

Dr Gordon has been involved in disaster psychology for many years, from the bush fires in Australia through to the earthquakes in Christchurch and lately North Canterbury. He has identified some common issues that crop up in the recovery period no matter what the disaster is. Everyone is different, but our bio-systems are the same.

Sometimes the effects of the long periods of stress or trauma are not apparent until four or five years later. He has had patients who come to him four or five year's after they have been an emergency because they can't concentrate, they are not confident, they don't enjoy doing things like they used to and have not retained that ability to enjoy their lives. His advice is to tune into these symptoms earlier and seek help.

When disasters strike, there are natural processes which enable us to survive, but these can come at a cost. Finding the balance between the stress agenda and holding on to what is important to us is difficult.

There are three basic responses

1. Trauma – damage: the ability to come to terms with what has happened. Of course the aftershocks with earthquakes makes this even worse as it reawakens the memories, and we have "intrusive re-experiences" where we go back into the state we were at the time of the earthquake. The aftershocks can result in us being on constant alert, like when a truck goes past, and we think truck or earthquake, truck or earthquake? Dr Gordon likened this to a digestive process, if we are still feeling like we are digesting the experience a long time after it has happened, there is something wrong. If it keeps coming back, this isn't a good thing. The longer you recycle it you hold that memory in place. The trick is to recognise it and work with it. Can we learn to recognise it is "just" a truck quicker?

2. Loss – not just of life and history but a loss of a project or a plan, financial loss or material loss. No one has the right to judge another person's loss. It is insensitive to rank losses and try to resist scaling them, ie "your house was only damaged a little bit, whereas this person's house was totally destroyed." If you are dealing with someone, resist this, as it may mean that a communication opportunity gets missed. A sensitive and understanding conversation helps other people digest and recover. It will take time to each understand the impact of the experiences on others.

Dr Gordon said we are embarking on a long complicated process, and we need to understand that and accept it. We also need to recognise that others outside the area may not understand what we are going through. This means that it is often more healing to talk to those who do understand but this can lead to social systems getting overloaded. Someone in a similar situation can be more understanding but it will also mean a shift in relationships. Seek out those who understand. Talk informally, allow people to talk, give them opportunities to talk (ie community gatherings).

Grief and sadness are appropriate ways of understanding loss and we will gradually accept it. Allow yourselves to grieve and you will start to accept it. Remember what you had and hold on to those memories. Tell the stories, talk about what you had. Be aware that sometimes you may not even realise your loss until some time afterwards (ie not realising you had lost your favourite piece of china until some months afterwards.). The important thing is to have situations where you can talk to someone who understands and listens.

3. The broader impact, disruption. When the emergency happens, you drop everything and you focus on the practical problems. It means a lot of normal patterns of life are disrupted. For instance a family with young children lose the routines that children find important. Our routines are important as we don't have to think about them to make them happen. This can include time with your partner, you may have had a routine time where you would have that catch up or one on one time but during or after an emergency, this disappears, as something else becomes more important. If you are tired and grumpy, you may miss this routine without even noticing until it starts to affect the relationship. Roles can get muddled and divide, you may start to miss the routines where you talk, or do something you enjoy (ie playing a musical instrument, sport). By losing some of your routines, you are in danger of losing your social network and even your sense of value. Disasters narrow your focus down and can result in your losing track of what you have lost, such as your creativity or relationships.

States of Mind

In a stressful situation you go into an adrenalin state, which increases your ability to survive. People don't feel pain or fatigue when they are in this state. You have a very narrow focus on the threat and as long as you are in that heightened state, you can't retain the normal broad base spectrum. Your mind is contracted and focused on the state of emergency, not the bigger picture.

In an emergency, you have to deal with unfamiliar systems and that keeps your arousal up so you stay in emergency mode, and use your right side of your brain (visual) more than your left side which is the logical and language side. There are times that you have to do things like read and try to understand your insurance policy when you are in this emergency mode, and you will struggle, and end up having multiple experiences of feeling incompetent. If you are not aware of this, and do not recognise that you are still in the adrenalin state, this can quickly escalate to feeling frustrated and angry and also lead to depression.

Your expectations are all mucked up, which leads to frustration. The trick is to recognise this, and get your brain back into your comfort zone. Do this by focusing on the present. Don't tell yourself to 'pull yourself together' but instead recognise that you are in emergency mode and try to disengage with the emergency, even if for a short time.

Pace yourself, this recovery from these earthquakes is a marathon, not a sprint. Don't allow yourself to run dry, and be careful of relying on your normal feedback systems, as you won't feel tired until it is too late and you are in a chronic stressed state.

Rest and recreation is therefore important, even if we don't feel like doing it. Sit and do nothing, that's OK. Sit and do nothing until it makes you feel uncomfortable. Sit and do nothing and feel what is around you, the noise, the smell, the feel of the chair rather than think about what you think you should be doing.

Chronic stress is when you are trying to deal with a long term problem in an adrenalin state rather than in endurance mode.

Cortisol State

Another important chemical to our physical wellbeing and state of mind is cortisol. Our bodies use it in stressful situations, drawing energy from tissue, with physiological changes that are at the cost of our long term health. In a state of high arousal you can't use all your faculties.

In the cortisol state you tend to be judgmental, grumpy, and your judgment black and white, you are biased to seeing only problems. You will be alert but not very expressive ('wired but tired'), you lose the natural fluctuation of emotions, but instead go to each extreme. You will find yourself being forgetful and have trouble remembering information. Recognise this as being in the cortisol state.

There are a lot of complicated problems to deal with after any emergency. It requires an endurance focus rather than a sprint focus. You may be tempted to avoid getting that information back to your insurance company, or bank, and revert to what seems like a routine task for you (ie fixing the fence), but that means you haven't reduced the source of stress at all as that information is now overdue.

You need to move from the cortisol brain as you can't plan, prioritise or remember when you are in that state. It's not that you are wrong, or incompetent, it is just that you can't do it in the cortisol state. You won't make your best decisions in this state and be careful that you don't convert a recoverable loss to an irretrievable one.

Dr Gordon gave the example of a farmer who was going to shoot his herd of cows as the bridges had been destroyed on his property and he couldn't see how he could get them more feed or to market and he was running out of feed. Luckily his neighbour intervened, and offered to cut the boundary fence and bring the cattle through his property. The farmer hadn't even thought of that – he couldn't as he was in the cortisol state and couldn't think clearly. Be aware of this cortisol state and recognise when you are there.

One of the ways of helping get out of this state is by talking to people. Look after yourself. Put off those important decisions. Self awareness is lost in the stressed state and that is not the best state to make a plan. Your first priority should be to get yourself in the right mind to make a plan, and make decisions. For some it may require time away, or time with family, or some form of time out. For others it may be talking about it with your friends and those in your social networks.

When you are in the right mind to make a plan, don't rush to identify the problems but think about what you stand for, what you value. If your goal or values have changed, you might not realise it and keep on the wrong road. You have to know where you are going at crucial times and think about what is important to you. Recovery has to be the foundation for the future, not recreating the past.

Dr Gordon emphasised the importance of time to think – he encouraged everyone to replenish their energy banks.

Stage four of the recovery can be a profound state of exhaustion, both emotional and physical, where you don't want to do anything. There are times when you just need to be alone, and need to have your own time out. If you feel like this, break up what you need to do and take regular time out. Remember recovery is a marathon and you may need more breaks that you would normally need.

Stay aware of your state. If you work too hard for too long you can go into spasms, back into adrenalin or cortisol state, and not be able to get out of this cycle, degrading your life.

If you have children, Dr Gordon advises it is best to protect them from your moments of being upset, or if it has happened, then apologise and frame it for them. Listen to them rather than confronting them, and if they ask unusual questions, you could ask them 'what made you think about that' to help understand where they are coming from. Don't focus on their emotions, as they are the end product. Teach children that we can all survive grief, just be with us, don't try to fix or change. Crying and being emotional can be important to change the state they are in. Acknowledge that they (and we) do have to be miserable from time to time, as long as you give yourself permission to take time out in these situations. Also, it is a natural tendency for children to fall back a bit on their development when they have been through an emergency situation. Regression can be helpful for children as it doesn't put as much pressure on them, they fall back to what they know they can do. When things settle down again, they will leap forward and be where they would have been without the disaster.

Dr Gordon also recommended avoiding the bad news or other disasters – all so accessible now. Limit yourself to knowing it has happened, but don't get into all the detail. Listen, don't watch. Avoid the videos or photos. By converting images into words, ie describe what it looks like but not how you feel about it is a useful thing to do as language is the digestive juices of the mind and it will help you digest what has happened.

Prioritise some free time to talk and get your experiences into a narrative or a story. But the most important message Dr Gordon had was to BE AWARE and recognise the various states you will go through as a result of having been through emergency situations!

Here are some of Dr Rob's tips for coping with the on-going effects of a disaster

1. A fast recovery is not necessarily a good recovery. Pace yourself and focus on things that give your life value and meaning e.g. relationships, family, recreational activities, your health or your career.
   
   
2. Take time to assess your energy levels. If you are feeling tired or stressed consider ways you can recharge your battery. Maybe you could get away for a weekend or take a walk, listen to music or, talk to friends - you decide how best to take care of yourself.
   
   
3. Ensure you maintain control of your own recovery by identifying, and focusing, on the things you can control. It's ok to acknowledge things beyond your control but try not to focus on them.
   
   
4. Ask yourself: "What am I not doing that I used to do? How do I maintain the quality of my life during this long and, at times, difficult recovery period?"
   
   
5. Maintain your established daily or weekly routines, or, if necessary create temporary ones during the recovery period. Established routines protect us from uncertainty and constant change.
   
   
6. Deal with small problems before they become bigger. Don't let things slip, or postpone them till after it is all 'back to normal'. Recovery means finding a new normal and it needs to include what is valuable and important to you.

More resources are available on these links, and a video of his talk will be made available on the NZ Red Cross page.

http://www.dhs.vic.gov.au/for-individuals/crisis-and-emergency/emergency-assistance/travelling-the-road-to-recovery-video-series

https://www.mentalhealth.org.nz/home/ways-to-wellbeing/

http://www.healthychristchurch.org.nz/news/earthquake/2017/3/recovery-expert-suggests-taking-time-to-stop-and-reflect

http://www.allright.org.nz/