Disasters Archive - Susan Pease Banitt, LCSW

Archive for the ‘Disasters’ Category

The Second Pandemic: PTSD

It has been a little over one year since COVID 19 made its world debut. In that time we have all seen reports of horrendous deaths from the disease, the toll it has taken on our healthcare professionals and the tremendous changes it has brought to every society in the world:

constant mask wearing
hypervigilance around health and contagion
decreased movement around our communities and world
elimination of cultural group activities from rock concerts to political events to pubs
the constant background fear of death or long term disability

In addition to these profoundly stressful changes in our lives, we have seen brutal killings on live TV by people who are supposed to protect us, as well as by mass murderers; social and political uprisings, the polarization of politics and the death of cooperation between political parties. These changes have left people all over the world uncertain about their future, about their safety, and about their financial survival.

Many people understand that they are chronically traumatized. And many deny that these events affect them, even while acting out their fears and angers on their loved ones and those around them (itself a trauma symptom).

In the current Diagnostics and Statistical Manual on PTSD we have a list of criteria that apply to our collective experience of COVID and mass unrest. I have paraphrased some of these criteria; the ones that are verbatim from the DSM are in quotes.

1. “Exposure to actual or threatened death” by one of these four means: “directly experience the traumatic event(s)”, “witnessing in person, the traumatic event(s) as it occurred to to others, “learning that the traumatic event(s) occurred to a close family member or friend, and/or experiencing repeated or “extreme exposure to aversive details about the event(s)” as part of one’s work.

Check. We would have to be very isolated indeed to not have experienced at least one of these criteria. As for the fourth criteria, that is officially listed as being “part of one’s work”, I disagree as a trauma therapist. Exposure is exposure. Just because the DSM says your exposure doesn’t count because you were not ‘on the job’ doesn’t mean that you were not traumatized. There is research showing that repeated viewings of traumas on TV or other media create a trauma response in viewers. I believe this criteria may be changed in future versions of the DSM.

2. Presence of one or more of these disturbing intrusive symptoms: uncontrollable recurrent memories and perseverations around the event(s); nightmares related to either the content of the event or the emotions around the event (loss, sickness, contagion, fear of the future etc.); flashbacks, or other dissociative reactions around the event(s), which for children can include repetitive play of the trauma or event; “intense or prolonged psychological distress at exposure to internal [your own memories] or external [in the environment] that symbolize or resemble an aspect of the traumatic event.

Translation: You cannot stop thinking about COVID, COVID related losses (school, travel, etc.) or other traumatic events related to COVID or social unrest. You cannot stop the feels that keep coming, and you feel depleted because of this. It is hard to focus on daily routines and feel ‘normal’ again. You may take extraordinary precautions that are not strictly necessary or none at all as a rebellion to these feelings. You may have insomnia as the mind unconsciously avoids dream content related to COVID or social unrest and pops us out of sleep as we approach REM phase, where memories are processed.

3. Avoiding anything that reminds you of the traumatic event(s) in one or two of these ways: “Avoidance of or efforts to avoid distressing memories, thoughts, or feelings about or closely associated with the traumatic event(s) and/or “ [making] efforts to avoid external reminders (people, places, conversations, activities, objects, situations) that arouse distressing memories, thoughts, or feelings about or closely associated with the traumatic event(s)”.

In other words, you don’t want to think about it and you don’t want to talk about it anymore. Even reading this blog may be a trigger. (Did you make it this far?) You may avoid shows about: illness, contagion, disasters etc. that you previously enjoyed. Or you may avoid discussing COVID with friends and family, or avoid talking about your feelings about it. Denial is another way our minds practice PTSD-related avoidance. We may minimize COVID or say we are not at risk, or refuse to take precautionary measures. All of these are trauma responses, in other words, our mind unconsciously and automatically protects us through avoidance.

Some of these behaviors make other people very angry and are themselves a stimulation of the trauma. You may be very reactive to people who minimize the risk of COVID to themselves and others. Both of these reactions are traumatic in nature. We do not, necessarily, choose our defense (which is a whole other blog topic). Some people intellectualize and want to learn everything about the event; others want to know nothing or deny reality. Both groups are avoiding their feelings, although intellectualization is preferable to denial. Avoiding feelings, in general, is a traumatic response, as well as a cultural one (some cultures value feelings more than others).

4. Negative alterations in cognitions and mood associated with the traumatic event(s), as evidenced by two (or more) of the following:

Loss of memory around the event(s) [one of the more extreme reactions]
“Persistent and exaggerated negative beliefs or expectations about oneself, others, or the world”
“Persistent, distorted cognitions about the cause or consequences of the traumatic event(s) that lead the individual to blame himself/herself or others.”
“Persistent negative emotional state (e.g., fear, horror, anger, guilt, or shame).”
“ Markedly diminished interest or participation in significant activities.”
“Feelings of detachment or estrangement from others.”
“ Persistent inability to experience positive emotions (e.g., inability to experience happiness, satisfaction, or loving feelings).”

What strikes me about this section is how real it is socially, except for the loss of memory bit.

(Also how much the word “persistent” is used.)

“Persistent exaggerated negative beliefs or expectations about oneself, others or the world” Check.

“…lead the individual to blame himself/herself or others”

Check.

“Persistant negative emotional state”

Check. It’s like a nightmare we cannot get out of, which then becomes a trigger for all of our other unresolved traumas from this (and other, if you believe in that) lifetimes.

“Markedly diminished interest or participation in significant activities”.

Check. But in a weird way. COVID prevents us from participation and maintaining interest. Double check.

“Persistent inability to experience positive emotions”.

Check and Checkmate. We all feel depressed. We are all grieving. It is hard enough to maintain hope in the persistence of COVID, never mind the persistence of our collective trauma around COVID. Ugh.

5. Unpleasant behavioral changes as a result of the event that include two or more of the following: Insomnia or other sleep disturbance, inappropriate emotional outbursts that are out of character, hypervigilance, exaggerated startle response, and/or difficulty focusing and/or concentrating.

Well, yes. Most of these for most folks. One only has to venture online to see the reactivity happening. Nearly everyone I know either as a friend or patient has struggled with sleep this year. You can check in with yourself as to whether you are still washing your hands 10 times/day or wearing your mask when you really do not need to (hypervigilance), or if you jump when someone comes up behind you unexpectedly.

Many people came into this period of time with PTSD, either diagnosed or not. They have been suffering tremendously because their systems were already sensitive to traumatic stress. The rest of humanity may now suffer some level of PTSD. I say “level” because although PTSD is by definition a very unpleasant condition, it can have levels of severity beyond baseline. If you are having dissociative symptoms such as depersonalization (“feeling as though one were in a dream; feeling a sense of unreality of self or body or of time moving slowly”) or derealization (the world around you feels “unreal, dreamlike, distant, or distorted”) you may have a more severe situation that needs attention. Technically it is called PTSD with dissociative symptoms.

Oh yes. And these symptoms need to have gone on for more than one month.

Check.

Please, dear reader, remember: I would not write this blog if I did not feel you or your loved ones could be helped. There are many resources available to help you heal from PTSD. My book, The Trauma Tool Kit: Healing PTSD From the Inside Out is available in libraries all over the world, and has a rating of 4.6/5 stars on Amazon where it is available on Kindle and Audible (in my own voice).

Be well and stay safe, Susan PB

American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders: DSM-5 E-Kindle Book 5th Edition (p. 308). Indephent. Kindle Edition.

Helping Kids Deal With The Moore Tornado and other Disasters

Children can be particularly vulnerable to distressing weather and events. Even children that were not directly affected will be deeply disturbed by these community wide disasters. Most parents have not been taught to look for signs that children are under stress, or even intense stress. This blog, by request, will give you some tips on helping your children recover from the devastating tornadoes in the midwest.

First know that your child is stressed. Some signs that children are stressed include:

– repetitive talk about the event
– repetitive drawing of the event
– unusually irritable
– unusually withdrawn
– needy and clingy
– more forgetful than usual
– having trouble regulating emotions: laughing silly “highs” crash into sullen “lows”
– hair-pulling (trichotillomania)
– disturbed eating
– disturbed sleep

We forget what it is like to be a child. Under 14 years of age, children have some awareness that they cannot survive without adult assistance; this is especially true for very young children. Children watch their parents very carefully and take their cues from them about whether they should be upset or not. In addition children have losses in the storm that adults may trivialize or not realize the depth of the loss. For instance, a parent may not know that a stuffed animal was more like a best friend, or that a destroyed work of their art has taken away a precious sense of self. Because parents are suffering their own losses and in survival mode they may not feel like children are dealing with anything significant, but, of course, they are.

Here are some ways to help your child heal in the aftermath:

1) Limit media exposure of the event. Adults tend to watch traumatic events obsessively but we know from 9/11 that this can create traumas in kids who may not understand that they are seeing the same event repeated rather than several different events. TV may make them think the world is ending

2) Set some “processing” time aside every day for your kids where they can express their feelings. Young children (3yrs-8yrs) might be encouraged to color, draw a picture, or engage in puppet play. 8-12 years olds might want more information about storms, or just to spend time playing games. (Experienced child therapists know that most kids need to be occupied with a game or activity in order to talk about their feelings.) Teenagers may be able to sit and talk if they are mature, and are invited to participate in a judgment free zone. Also, ball throwing and basketball hoop shooting are excellent ways to get kids to open up. During this time turn off your phone and your own agendas and create a lot of space to just listen or answer questions.

3) Try to keep a normal rhythm to the day, even if you are in a shelter. Have regular mealtimes, structured activities and a bed time.

4) Speaking of bedtime, be aware that sleep may be difficult at first. Kids may be having unpleasant dreams processing the storm. Be patient and non-judgmental about this, while helping maintain a schedule.

5) Monitor your own reactions. Calm yourself down as much as possible. Do not share horrible new stories with your kids or in earshot of them. They will be alarmed but will not tell you.

6) Understand that quiet kids may not be OK. Invite them to play with you or help you with simple chores. Reinforce any sharing with your attention and love.

7) Provide lots of hugs and affection. Take time for yourself and for them. You both need the contact!

8) If your child has a pronounced behavioral change reach out for professional help ASAP. Red Cross will have referrals for free and low-income therapy professionals.

9) Be active in reassuring your children that life will get better. Hold the optimism for them, even if you are feeling discouraged. This is kind and wise parenting.

10) Lastly, cultivate patience! Be patient with your kids and be patient with the city and be patient with yourself. Stop and breathe as needed. Practice self-care and stay aware of your own needs! Then you won’t resist the children’s needs when they are up.

Know that there are so many of us pulling for all of you and your kids. Our hearts go out to yours. Be well and be safe!

The Root of Violence: Solutions for a Beleaguered World

When I was in high school and the world’s population was at about 4 billion, I saw a video about an experiment in rat overcrowding. The researchers showed very clearly that up until a certain population the rats were civil, harmonious and happy. When they became overcrowded, the rats turned on each other and a cycle of violence began. I remembered wondering where that tipping point was for humanity.

Today the world’s population stands at about 7 billion, ready to top 8 billion in the next decade. I cannot help but wonder if the world is getting too crowded to maintain civil societies. At least in the old models.

Fortunately, we are not rats. We are human beings with a plethora of ingenious human tools at our disposal, the foremost being a thinking, self-reflective brain. We can not only reshape our environment, we can also reshape our bodies, personalities and even our own brains.

Clearly, it is time to evolve.

What would it take to stop the violence?

Currently it is popular to blame religion for violence. But I don’t buy it. Historically, nationalism was blamed for wars. But we didn’t abolish nations, nor could we. Anymore than we can abolish religion. The search for God and religion seems to be hardwired into the very fabric of humanity. And that’s potentially a good thing. Innumerable hospitals, orphanages, and other charitable endeavors have been supported by large religious bodies.

Look, I’m a therapist. I’ve spent a lifetime peering into the hidden mechanisms of human consciousness. I’ve worked with victims and perpetrators of violence, religious, atheist, you name it.

And the root of violence is pretty simple. The recipe is this: take a human ego, prone to intense biological impulses like sex and aggression, add a dose of rejection, violence, or trauma and withhold empathy, attachment and kindness. Don’t forget to add the testosterone, or all that violence will turn inwards. This is the basic formula; there are of course endless ways to “spice” things up. Anything that disinhibits a human helps: drugs, a charismatic leader, any kind of reward real or imagined, spiritual or material. You get the picture.

When the world becomes an overall less kinder place to be, when governments exist to punish and control rather than support, when adults are too busy trying to survive than to connect, when children are subjected to all manner of abuse growing up, when basic needs are withheld (food, shelter, education), then we can be sure the rise of violence is around the corner.
My little piece of contribution centers around psychological trauma. Like the tipping point for rat populations, I believe that there is a tipping point for the number of citizens with untreated abuse and trauma issues that starts to unravel societies and the fabric of civilization gets weak, gauzy and prone to tears.

That is why I wrote The Trauma Tool Kit: Healing PTSD From the Inside Out. But one book is not enough to stem the tide.

If we want to turn this around we need the biggest investment in our humanity the world has ever seen.

Our healthcare system is broke.
Out educational system is broke.
Our national aggression is disproportionately funded.
PTSD is a national (and global) epidemic.
Our TV and media is a wasteland of violence, sex and empty, puerile stories aimed at the basest nature of humans.
Adults can’t find meaningful work or time to connect.
Children can’t get their emotional needs met so they are turning to early sex, drugs, computers and violent videogames.

Like the global climate crisis we are in, we are in a crisis of our own humanity.

We need to ask ourselves: what does it mean to be human? Are we living lifestyles that are in alignment with our values and ideals, or have we given up?

The answers are simple. Accomplishing them requires insight, wisdom and the will of the people.

1) Convert from a permanent wartime economy to a peace economy. Stop trying to control the world and get back to taking care of American citizens.
2) Reinstate the important status of mothers in the world by funding them to stay home with their children as needed. Working mothers is a redundant, and obnoxious term. We need to recognize that all mothers are, by definition, working.
3) Stop projecting our own internal demons onto other groups: immigrants, “terrorists”, “dirty hippies”, whatever. And affirm the dignity of all human beings, the vast majority of whom merely seek to be happy.
4) Reign in the vast greed industries and interests in Washington.
5) Recognize that only people are people. Corporations are sociopathic entities.
6) Fund a single payer healthcare system and come into the 21st century.
7) Throw out the educational dictates of the last 20 years and create sound educational ideas that really engage students and teachers in learning in the new millennium.
8) Turn off your TV. Or at least have enforced rules about usage .
9) Heal your traumas. Help yourself.
10) Recognize that your children, friends and neighbors may be struggling quietly and desperately in need of help. Help them.
11) Spend more time with your kids. Quality is not enough. Quantity is also required for healthy kids. Don’t let computers and TV parent.
12) Create community events for connection. Host a potluck once/month. Get involved. Talk to your neighbors. Get over your fear of the ‘other’.
13) MEDITATE. Rats can’t meditate, we can. If we all just calmed down and healed our own brains, it would be enough.

OK, then. We do have choices. It’s either us or no one. We can cower in fear waiting for the next attack, the next screw gone loose, or we can start changing our communities here and now.

I vote for now. I’ll go meditate on it, and then I will act.

Sandy Update 3: Top Five Reasons You’re Eligible to Apply for SBA Disaster Assistance | SBA.gov

If you have property destruction from Sandy, please read this very important article. You don’t have to be a business owner or to have insurance to apply for a low interest loan from the Small Business Administration. You might also be able to apply even if you live in a Coastal Barrier Zone. Most loans are made at four percent! The remainder are at six percent. Read the article for complete details.

Helping Kids Recover From Hurricane Sandy

Children can be particularly vulnerable to distressing weather and events. Most parents have not been taught to look for signs that children are under stress, or even intense stress. This blog, by request, will give you some tips on helping your children recover from Sandy.