As Hurricane Floodwaters Recede, Anxiety Rises

EDITOR’S NOTE: As the floodwaters caused by Hurricanes Irma and Harvey recede, anxiety is expected to rise as residents in impacted cities and states recover. Some even could experience post-traumatic stress syndrome (PTSD). During the past two weeks, H. Steven Moffic, a former resident of Houston, has been closely monitoring the unfolding events in both his former home state and in Florida. ICD10monitor publisher Chuck Buck conducted an interview with Dr. Moffic recently, and excerpts from that interview follow.

BUCK: In the aftermath of Hurricanes Irma and Harvey, one of the long-term consequences could be folks suffering from PTSD. Is there evidence that supports this assumption?

MOFFIC: Chuck, as I received your first question it is Friday, Sept. 8, and I am on vacation in Canada, pretty far away from the devastating storms that have been hitting the southern parts of the United States and the various Caribbean Islands. Hurricane Irma is approaching Florida. 

It would be easy to answer your question in a simple, scholarly manner. That answer would be yes, there is evidence that many folks will suffer the long-term consequences of PTSD. But that doesn’t convey the emotionality of the human stories. 

Now, here I am, safe and sound in a hotel room. I can’t imagine that there is any possibility for me to get PTSD from these storms. And yet, I am experiencing some mild PTSD reactions as I watch the news: flashbacks to outrun a hurricane as we drove from Houston to move to Milwaukee in August 1989, as well as memories of past traumas of all kinds, including the secondary trauma I felt from the lives of my patients.

I also have some survivor guilt. Though our old house flooded in Houston, we were gone. We could have decided to stay. Or I could have cut this vacation short to volunteer in Houston. I trust I will not develop a smidgen of schadenfreude, that is, joy from the bad fortune of others. So in some sense, if I am any example, most of us will be affected to some extent by these storms.

But anything I am experiencing pales before what others in the path of the storms are experiencing. In the Canadian newspaper I read of Gloria Cethaf, a mother of six, from the destroyed island of Barbuda:

“I’ve lost everything. My home has been torn apart. Everything is gone,” she said.

Or Rosi Ramirez, who went through Hurricane Andrew in Florida as a child, and now says as she awaits Irma:

“I don’t want my kids to go through that traumatic experience. I hadn’t thought about Andrew in a while. But now I am seeing flashes of what we went through. It is all coming back.”

Will these people get full-blown diagnostic PTSD? That all depends on some of these various factors:

• Directly experiencing the storm, with a sense of terror;
• A history of similar trauma;
• Poor coping skills;
• Limited resilience;
• Having to leave one’s home;
• Feeling the trauma was at least partially manmade, as in climate instability; and
• Possibly a genetic predisposition.

About a third of people who were in New Orleans in 2005 got PTSD from Hurricane Katrina, but that was the case for less than 10 percent in Manhattan after 9/11.

BUCK: Could the effects of PTSD manifest themselves in physical conditions?

MOFFIC: Well, sort of. After the trauma elicits the adrenaline of the fight-or-flight response, there is a letdown of overall energy. Later, increased blood pressure is the most common symptom, but there is increased vulnerability to a variety of stress-related illnesses.

BUCK: Is PTSD more likely to exacerbate preexisting conditions, specifically behavioral health issues?

MOFFIC: Yes, it will for some conditions. One is substance abuse, which can worsen in an attempt to self-medicate to relieve the emotional suffering. Another is agoraphobia, the intense anxiety of leaving home, which will intensify if one has to evacuate. In general, any anxiety or depressive condition is likely to worsen.

BUCK: Is PTSD more likely to impact the poor than those in the middle and upper income ranges?

MOFFIC: Unfortunately, yes, due to less resources as well as a likely history of more losses and trauma. Consider the message of being told you are “crazy” (that stigmatizing term) if you don’t evacuate certain areas, as reflected in this example from the Canadian paper:

Judy McRae, who sheltered from Hurricane Harvey in her Texas mobile home, told the BBC, “I had some problems getting out of town, a little broke and stuff, so I had to come home and you know, tough it out. We’re the ones who go to the restaurants and wait on you and pick up your trash and do all that work. We don’t have a lot of money.”

A commentator in Texas said:

“There were few around here who stockpiled food and drinking water to wait out the storm, because stockpiling requires extra cash, and extra cash is not a luxury they have.”

BUCK: When are the symptoms of PTSD likely to be evident?

MOFFIC: This is the most tricky aspect of PTSD. They can be right after the trauma, but also could not become evident for weeks, months, or even years. We don’t know why, but the public needs to understand this possibility. Often, some future event will trigger the traumatic memories to reemerge into consciousness.

BUCK: What are some of the issues that will most likely trigger PTSD?

MOFFIC: In general, any situation that is life-threatening, or perceived to be life-threatening. Of course, the most well-known is war, but there are many civilian situations, ranging from accidents to storms.

BUCK: What advice would you offer primary care providers in treating those who present with physical conditions?

MOFFIC: Well, the most important thing is to recognize PTSD. Then, generally refer to a mental healthcare clinician, because there is no reliable medication that will help, and the psychotherapy needs expertise. PTSD can be treated well, but it is very challenging.

BUCK: Is there something good that can come out of this trauma?

MOFFIC: Indeed, there is, Chuck. It is called posttraumatic growth. Religions have always recognized this possibility, and in mythology it is portrayed as a heroic journey. Now that is confirmed by psychological research. The growth can be in new opportunities, new relationships, a greater appreciation of life’s value, and a new sense of self (“If I lived through this, I can face anything.”) What helps to achieve this for some? Exactly the same things: resources to recover to get new opportunities; supportive relationships; confirmation of spiritual beliefs and an appreciation for what life can still offer; and a new sense of personal strength. Also, add the appropriate grieving for what is lost. I’m sure we will hear those stories later, too. Even so, such trauma is not necessarily to be desired or sought.

Life will send us some of these challenges and traumas no matter what.

About Dr. Moffic
Steven Moffic, MD, is an award-winning author whose fifth book, “The Ethical Way: Challenges & Solutions for Managed Behavioral Health,” is considered a seminal study on healthcare ethics. Always in demand as a writer, Dr. Moffic has attracted a national audience with his three blogs: Psychiatry Times, Behavior Healthcare, and Over 65. Dr. Moffic, who is also a popular guest on Talk-Ten-Tuesdays, recently received the Administrative Psychiatry Award from the American Psychiatric Association (APA) and the American Association of Psychiatrist Administrators (AAPA).