After an earthquake, we're left with striking images of devastation among buildings and landscapes. But what's often ignored is the lingering mental devastation.
Imagine losing a child, your home, your livelihood, and your community - all in one day. When a major earthquake hits a populated area, thousands find themselves coping with the emotions of sudden and severe loss.
It's grieving on a massive scale. “Disaster by definition is a tragic event, and tragedies precipitate emotional issues,” says Dr. Craig Van Dyke, professor of psychiatry at the University of California – San Francisco.
Dr. Van Dyke told dailyRx that disasters leave entire populations vulnerable to mental illnesses such as depression, post-traumatic stress disorder, and anxiety. A person who might not otherwise be diagnosed with a mental illness is at greater risk, simply by experiencing this large-scale traumatic event.
Dr. Van Dyke said that what separates a mental illness from grieving is the length of time. What defines the degree of trauma, he added, is how prepared a region is for disaster.
“There are earthquakes and then there are earthquakes, in the sense of size and magnitude and what they trigger,” he said. The devastation and loss of life that they trigger can be controlled by how well buildings are built.
“Earthquakes in the US tend to cause fewer fatalities because buildings are stronger,” said Dr. Van Dyke. But a similar earthquake in China may cause massive loss of life because buildings aren't built to withstand an earthquake.
He gave the example of the earthquake that hit China's Sichuan province in 2008. “They had shoddy construction, particularly in schools. The walls fell outwards and the cement beams came crashing down. It led to serious injuries and fatalities, and many were killed in massive landslides. The US, by and large, has never had that kind of thing.”
Adding to the feeling of loss was China's one child policy. Many people lost their only child in the rubble of their school.
Massive landslides wiped out entire landscapes. For many, there was no home to return to.
These events, combined with China's lack of mental health services at the time, combined to create a large-scale mental health problem. People with mental health issues find it difficult to sleep, difficult to work, and many turn to drinking.
“They frequently have lost friends and community, they're relocated to temporary housing living next to strangers, and they're demoralized because they've lost their child,” said Dr. Van Dyke.
That results in a less productive population. Dr. Van Dyke says that China saw the earthquake as a wake-up call to begin building up their mental health services.
Despite the growing awareness of the after-effects of earthquakes, there is no tried-and-true model for how to handle mental illness on such a massive scale. Dr. Van Dyke said that scientists are now beginning to try and understand the true impact of disaster on mental health, and how to treat it.
So far, few studies have looked at psychological reactions from the general population after a major disaster. One of the first was recently conducted on the population that survived the 2011 Japanese earthquake. The March 11th earthquake set off a massive tsunami, which in turn triggered the Fukushima I nuclear power plant meltdown.
In this disaster, more fatalities were due to the tsunami than the earthquake, because Japan has strong buildings that are designed to withstand earthquakes. The nuclear power plant meltdown added a human element to the compounded disaster, and the researchers wanted to know if natural disasters or man-made disasters are more mentally scarring.
They focused on post-traumatic stress, also called general stress. It's that feeling you have when you are distressed by having little control over a situation.
Interestingly, there's also the opportunity for positive psychological reactions. Post-traumatic growth (PTG) is what happens when a traumatic event brings appreciation of life, the idea of new opportunities, and improved personal relationships.
They surveyed the Japanese population three months after the disasters, using an online survey company. They took into account how close they were to the disasters. Nearly 3,500 people responded.
They found that post-traumatic stress from the natural disasters – the earthquake and tsunami – was greater than post-traumatic stress tied to the nuclear crisis. The reason behind that may be that natural disasters have a great impact while a technological disaster, such as the nuclear meltdown, is more likely to be felt as chronic stress.
Post-traumatic stress was higher among people in the affected area. But they found that mental stress was the great equalizer, affecting people regardless of gender or class.
Post-traumatic growth sometimes came out of post-traumatic stress, but it did not alleviate the initial negative impacts. In other words, most people have to go through periods of stress and depression before they come out on the other side with personal growth and a higher quality of life.
So how can health care services help large populations cope with mental problems after an earthquake? That's still an open question.
Some communities have used individual case management after a natural disaster, assigning a social worker to each person and identifying the problems they're dealing with. There are many mental health resources that a person suddenly thrown into depression may not be aware of.
According to Dr. Van Dyke, mental recovery is tied to physical recovery. It's hard to piece your life back together when your community is still in ruins.
“You can't do therapy or medications if they don't have a job, and their family is scattered. It has to be part of a larger plan,” he said. “The question is how to coordinate a human-centered approach.”
If you've recently been through a natural disaster and are experiencing symptoms of mental problems, seek help among your family, friends, and mental health professionals. In the wake of a disaster, there are many options open to you, depending on where you live.
Basic recovery techniques include:
- Reaching out to friends
- Staying physically active
- Maintaining a regular sleep schedule
- Reflecting on the good things in life
- Find ways that you can be productive
- Eat regular and healthy meals
- Be patient with your own pace of recovery
The most important thing to remember is that you're not alone going through the experience of an earthquake. Your entire community has been affected, and your friends and neighbors are in the same situation.
“In the past, there was a sense that [those who became depressed after an earthquake] were weak and vulnerable people, but all of us are vulnerable to becoming symptomatic,” said Dr. Van Dyke. “This is part of human nature.”