Garth Rattray | Mental-health challenges after Hurricane Melissa

Although Hurricane Melissa tore a destructive path through the west of Jamaica and caused disruption across most of the island, every Jamaican - here and in the diaspora - was badly affected by its passage. Those within the path of the monster were directly traumatised. Jamaicans just outside the most powerful winds and rainfall were also directly affected, but less so. However, the rest of us were vicariously traumatised because we knew the horrors that our fellow citizens endured … the loss of property and lives.

Psychiatric specialists will tell you that mental-health problems may not be visible and, therefore, not readily discernible to most people, but they are just as real, ‘painful’. and, perhaps, more disabling than many physical problems. I have had patients heal from broken bones in six to eight weeks, but the mental trauma of the accident or crash that caused the broken bones can last years or for their entire lifetime.

Because mental issues reside deep within the recesses of our minds and may be [purposefully] hidden away from others, they cannot be readily seen, observed, or measured with imaging or blood tests. It sometimes takes a cooperative patient/victim to submit to the sessions and/or probing investigations of trained mental-health professionals to reveal them. Once revealed, the healing/repair may commence.

Sometimes we see individuals reeling from psychological trauma, and counselling, or therapy, or medication is unable to treat them adequately because they may need water, food, clothes, money, a job, or somewhere to live. Sometimes people [just] need affection. In fact, if a husband or wife knowingly and wilfully withholds affection, the affected partner may use that as grounds for divorce because it is akin to mental abuse.

HIERARCHY OF NEEDS

American psychologist, Abraham Maslow (1908 – 1970) became famous for his ‘Hierarchy of Needs’ (his theory of human motivation). He listed our psychological needs in order of priority: (1) physiological needs - water, food, shelter, sleep, health; (2) safety needs – employment, financial security, law and order, protection from harm; (3) love and belonging – friendship, intimacy, family, sense of belonging; (4) esteem needs – self-respect, recognition, achievement, status; (5) self-actualisation (personal fulfilment) – pursuing passions, creative expression, personal growth, contributing to society.

Our fellow citizens who were in the direct path of that category 5 weather phenomenon had everything stripped away from them. Their only thought was of survival, second by second, minute by minute, hour by hour, then day by day, and now, week by week. They may recover physically and materially, but they will never recover mentally. Even the most mentally resilient among them will experience post-traumatic stress disorder (PTSD).

Such an absolutely terrifying experience will result in – reliving the traumatic event, nightmares, flashbacks, intrusive/disruptive thoughts, stressful memories, the attempt to avoid people and places that remind them of the hurricane, jumpiness, insomnia, inability to focus at times, mood swings, dark thoughts, and sadness. Added to that, hundreds of thousands have lost most or everything that they have - access to water and food, clothes, shelter, loved ones, employment, and communication.

Everybody who has seen the devastation first hand has warned that the social media videos and news accounts do not come near to adequately representing the reality of what happened. The visual and olfactory experience is shocking and extremely disturbing even to those who visit. It must be heartrending to those caught up in the real-life experience.

OVERWHELMING TASK

I can’t begin to imagine the overwhelming task ahead of the Government. The physical recovery process is daunting because of the widespread and horrific annihilation of infrastructure in innumerable places, homes, businesses, medical facilities, and public places. People need psychological first aid … immediate emotional support and [short-term] crisis counselling. They will need the setting up of community support groups along with social activities and cultural events to entertain and distract them from their intrusive, negative memories, and thoughts.

Over the long term, badly affected citizens will need access to professional mental-health services (therapy, counselling, and perhaps medication). Networks of support groups for individuals and communities, programmes to promote coping skills (for stress management and emotional release) will be needed. Ongoing support will be necessary. The emotional damage from Hurricane Melissa will never go away totally.

Physical recovery is a behemoth that must be tackled quickly and efficiently, but, on the other hand, and equally as important, mental recovery must also be addressed ASAP. There are several stumbling blocks in the path to mental recovery. People abhor the very idea of mental-health problems. It is so taboo that they tend to use euphemistic words and terms for the reactive anxiety and depression from Hurricane Melissa. People will say that they are “stressed out” (instead of saying “anxious”) and “frassed” (meaning tired, physically or mentally exhausted, frustrated, annoyed, or emotionally drained or depleted).

A huge hurdle is to demystify, and destigmatise mental disease/mental issues/mental problems. Unfortunately, many Jamaicans view psychiatrists, psychologists, and [sometimes] counsellors as professionals who treat ‘mad people’ (a very derogatory term for people with schizophrenia). Although this is far from the truth, it will be very difficult to convince citizens that they have a mental problem (reactive stress and/or depression) and that they need help.

Sir William Hamilton is said to have coined the phrase, “On earth there is nothing great but man; in man there is nothing great but mind”. Until we repair (heal) the minds of our citizens, as a nation, we will not heal from Hurricane Melissa.

Garth Rattray is a medical doctor with a family practice, and author of ‘The Long and Short of Thick and Thin’. Send feedback to columns@gleanerjm.com and garthrattray@gmail.com