Given recent events, Elizabeth Johnson and I were both curious about the mental health effects of natural disasters. How does someone even begin to rebuild his or her life after it has been so thoroughly destroyed? Linda McCauley, RN, PhD, FAAN, FAAOHN and Dean of the Woodruff School of nursing, explained the nature of resilience. Find out what that means by listening to our podcast!

Transcript:

 

[sounds of sirens]

 

LM: We know the cascade of events that are gonna happen. So there are gonna be coastal communities that go away. There are going to be thousands of homes destroyed in mudslides and wildfires and tornadoes. If we put on the brakes tomorrow, it’s gonna take a while before the car is gonna stop.

 

EJ: Climate change is a huge issue for the planet and for human health. That includes mental health. I’m Elizabeth Johnson –

 

DA: And I’m Deanna Altomara.

 

EJ: We talked to Linda McCauley –

 

LM: I’m a dean and professor of nursing here at Emory University.

 

DA: to find out more.

 

LM: When you think about climate change, there’s gradual changes that are happening to our planet around, extinction of species, and changes in growing seasons. But one of the major areas that’s linked to mental health are the more dramatic, emergency extreme weather events. And that’s just a hugely acute stressor.

 

DA: And stress can sometimes trigger crippling mental health issues. These things are tough to address, and it can take years for someone to find their path to healing and recovery.

 

DA: One of the hardest things about mental illness and treating it is that, like you said, everyone is so different, it’s hard to know how to treat them and given them what they need to heal. So how do you even begin to approach that in a large-scale community event, like what happened to Puerto Rico or in Hurricane Katrina?
LM: One of the things we’re really focusing on is building resiliency before the event happens. For some reason, we don’t fully understand it, some communities are more resilient, and some individuals are more resilient. What are those key things that some people can come out of a disaster better than before it happened? We need to work on having more people be on the positive resilience side.

 

DA: Some people definitely have better reactions to disasters than others.

LM: We need to be studying not mental illness, per se, and what causes it, but what

helped the person be resilient. What are those key things that some people can come out of a disaster better than before it happened?

 

DA: What if we could help teach skills like resiliency and build support systems before disaster strikes? That would save a huge amount of time during a crisis.

 

LM: You have to teach people to be in touch with their feelings, so if something makes you cry, if you’re in resiliency training, you develop this kind of mindful sense of what is making me feel sad. It’s really just becoming aware of yourself. That’s hard work. We believe that resilient communities have a critical number of people who can channel helplessness into a sense of recovery. And it’s a really important area to study because if you can build more resiliency there’s more people to hold up the ones that are devastated.

 

EJ: So during different points in our interview, resiliency was defined as picking a safe place to live, as sort of a meditative thing of being aware of your own emotions in your body, and prevention and preparation before a disaster strikes. There’s not really a clear-cut definition. There was a lot of discussion of resiliency as access to resources, access to information, access to nicer, safer housing.

 

LM: People can choose not to live in the tornado belt in homes without basements. A resilient family, if they are looking for a home in Nashville, won’t buy a home without a basement, because you can’t protect your family when something happens.

EJ: It sounds like access to information is a part of that also.

LM: Oh, that’s a good point.

EJ: Because it seems like this is influencing a group that has less education, less resources and fewer options to buy a house.

LM: Yeah, yeah.

 

EJ: It kind of came down to being just a huge social class thing, so upper class, educated people are considered more resilient than poor people with less access to information. And I think that that’s kind of a limited view.

 

DA: Yeah, I think resiliency has a lot of factors that go into it. And it’s really confusing as to what exactly makes up those factors, so we decided to ask what she thinks resilience is.

 

LM: Being able to withstand more than the average person is resilient.

 

DA: Which is a bit of a hazy definition, since we discussed there’s no such thing as normal or average grief.

 

LM: There’s not such a thing such as normal grief. Things that would devastate you, I could cope with. Things that wouldn’t bother you could devastate me. There’s not a normal response to grief.

 

DA: Everyone is different, and no one really feels things the same way.

 

EJ: But, see, there’s still a difference between someone feeling grief and suffering from depression.

 

EJ: Talking about the mental health consequences, when you’re doing research how do you tell the difference between someone who might have a mental illness kind of triggered by stress versus someone who’s just having a normal response to losing their livelihood or losing their home?

LM: That’s a good question, and I don’t think we try to tell them apart. We don’t spend a lot of time trying to…remember I had said that it doesn’t really matter whether it is the loss of life or the loss of your home, the physiological effect on you is you become depressed. And depression is depression.

 

EJ: The issue, with that, though, is that sometimes things that are symptoms of clinical depression can be a normal human response. Like, if out of the blue, I just lose interest in all of the enjoyable activities in my life, that’s probably a sign of depression. But if my home got blown away in a hurricane, then it’s probably normal for me to not be interested in the activities I’m involved in. It’s normal in some situations to feel that kind of hopelessness. And I think if we come in and medicalize everything, I think that’s kind of a loss of part of the human experience.

 

DA: It doesn’t really matter if you’re experiencing depression caused by biochemical stuff happening in your brain or if you’re having depression because something really bad has happened to you. If you are feeling hopeless and worthless, and can’t pull yourself out of that place by yourself, then you have depression. You deserve help.

 

EJ: It does make a difference in the way someone is treated by their community. People who are experiencing grief from losing something, they kind of tend to get embraced by their community and supported by their community, where there’s a lot of research that tells us that someone who comes in and says “oh, I have a biochemical disorder” – the reaction of the community is a lot more stigmatizing. So to diagnose people, it could potentially lead to some negative social repercussions that make it harder to recover in the long run. We conflate diagnosis with treatment. When I asked Dean McCauley about diagnosis:

 

EJ: So what role do you think would mental health diagnosis play in a resilient community? Because –

LM: They have to have services. We don’t have enough services for mental health, so people can’t even get help.

 

EJ: So the assumption is when I ask about diagnosis, I’m asking about access to mental health services. Which aren’t the same thing. It’s important to provide services, and it’s also important to be sensitive to the needs of the community.

 

DA: Yeah, I would love to look into the cultural implications of this, because I feel like there are so many different variations of values and approaches that people take to natural disasters. And if we could harness those and implement them into resiliency training, and fit each culture to what it needs most when a natural disaster strikes, I think it would be so much more effective than just Westerners coming in and telling people “rebuild this,” “do that.”

 

EJ: Yeah, and it’s important to consider also that some of these cultures have had to face much more substantial, much more frequent disasters than we have in our world, so it’s a little bit arrogant of us to then come in and assume that we know the best way of rebuilding after a disaster.

 

DA: I feel like there’s different ways you can be resilient. Not all mental illnesses require Western medicine or antidepressants. Traditional practices, religion, all those things can really help people going through mental illness.

 

EJ: I think that we’re still at a point where those sorts of things are considered as inferior alternatives to Westernized psychiatry rather than just, you know, a different way of approaching mental health.

 

DA: We’ve seen that this is a really thorny issue and that there’s a lot of work to be done, no matter how you approach it. We just have to keep working forward and learning more about what’s going on and how to help each other.

 

EJ: I mean, no matter how we decide to approach this issue, we have to approach it. Because we’ve already seen a lot of really extreme events caused by climate change, and we’re only going to see more in the future.

 

EJ: Elizabeth Johnson.

 

DA: Deanna Altomara.

 

EJ: From Emory University.

 

Sources:

Apocalyptic Disaster Fire Horror [Photograph found in Pexels]. (n.d.). Retrieved May 7, 2018, from https://www.pexels.com/photo/apocalyptic-disaster-fire-horror-266516/ (Originally photographed 2016, March 18)

Drewkelly. (2011). SIRENS. Retrieved May 6, 2018, from https://freesound.org/people/drewkelly/sounds/117181/

McCauley, Linda, and Deanna Altomara, Elizabeth Johnson. “Resilience.” 12 Apr. 2017.

 

 

Recommended further reading on the issue of depression and diagnosis in non-Western cultures:

Horwitz, A. V., & Wakefield, J. C. (2007). The loss of sadness: How psychiatry transformed normal sorrow into depressive disorder. Oxford University Press. Watters, E. (2010).

Crazy like us: The globalization of the American psyche. Simon and Schuster.