05/19/2024 – 16:55
Psychologist specializing in trauma and post-traumatic stress, Christian Haag Kristensen explains the impacts of the floods in RS on mental health and how people and communities can strengthen themselves to face the moment. When the water swept away houses and claimed lives in Rio Grande do Sul , when it rose to the ceiling and prevented people from working or enjoying the safety of their homes, it also had profound impacts on mental health. Many people saw their affectionate memories and the fruits of years of effort disappear in a few days. Thousands are displaced or homeless, not knowing when they will be able to return to their homes and, often, without resources to start over.
“For some people, it is much more than something material, it is as if it were a representation of their life. It’s as if my life, my material memories, the memories of my children, my births, everything had been taken away; and everything was, somehow, taken away”, says psychologist Christian Haag Kristensen, coordinator of the Center for Studies and Research in Trauma and Stress at the Pontifical Catholic University of Rio Grande do Sul (NEPTE/PUC-RS).
The group trains and guides volunteers who provide psychological first aid to flood victims in different shelters in the city of Porto Alegre and the metropolitan region.
To varying degrees, the catastrophe touched all Gauchos, who are now dealing with feelings of anxiety, impotence and anguish.
In an interview, Kristensen explains the impacts of the tragedy on mental health, the dimensions of a collective trauma, and how people and communities can strengthen themselves to face the moment.
DW: What effects on mental health can traumatic stress at the level of the floods in Rio Grande do Sul cause?
In the short term, we have a major stressful event considered primary: the threat to life, being swept away by the current, the injury, being without water, without light, without food. Later on, there is a second impact, a secondary stressor, which is the person wanting to return home, but no longer having a home, no longer having a job. In the dynamics of extreme climate stressors, one adds to the other.
What we saw in people in these first weeks were acute stress reactions that are even expected, like intense emotional reactions; cognitive reactions such as mental confusion and difficulty making decisions; intense physical reactions such as tiredness, fatigue, muscle tension, in addition to an impact on interpersonal relationships. These reactions, which are, let’s say, normal for the moment, will diminish over time for most people, who will gradually recover their healthy functioning. Most people will not get sick.
What emotions or symptoms, if not given due care, can worsen or transform into chronic conditions?
Some people will maintain very intense reactions for a long time. And then we may already be talking about signs and symptoms that will constitute mental disorders later on. What is more common in the medium term – approximately 12 months from now – is an increase in anxiety and anxiety disorders.
Furthermore, some people are already in need of a specialized level of mental health care because they are experiencing psychotic conditions, dissociative conditions – which is when the person has a certain break with reality –, or because they are starting to use substances such as alcohol to deal with and alleviate the stressor, which can become a chronic problem.
It is important to remember that a very large proportion of people already had previous psychological problems that have now worsened. This can even happen to those who were not directly affected by the floods, but are in contact with the news and the suffering of others.
What trauma coping strategies can people use? Both those who directly experienced the impacts of the floods and those who have friends who are in this critical situation?
The first step is to normalize the response. It is understanding that I went through, or my friend went through, something very serious, which represented a risk to life, to physical integrity, which is already causing immense damage from a structural point of view. So, it is normal that, when faced with a threat, I may have nightmares, intrusive thoughts; I may feel anxious when it starts to rain, for example, as it triggers a painful memory. All of this is expected. It’s important to say, even to yourself: look, I understand you, it’s okay to feel this way, most people feel this way right now.
Another important point would be to be able to have a routine – if it’s not your routine before, some routine. And also, little by little, being able to have some physical activity. Additionally, it is essential to reconnect with your support group: family, circle of friends, church group, community leader, etc. It is also beneficial not to be overexposed to news and social media, viewing images of the flood. The memory that remains of the traumatic situation does not need to be reactivated all the time, especially outside of a therapeutic context.
And how to deal with the feeling of uncertainty, since many people are in shelters and don’t know how long they will have to stay there?
The person who goes through a situation of this type has an increased need for security. And she looks for certainty, and sometimes she looks for it in the relationship with the volunteer or rescuer. One of the worst things you can do in an attempt to help someone else is to promise something that you can’t fulfill, because you don’t know what will actually happen.
Little by little the uncertainties will decrease – and for those that don’t decrease, you need to learn to tolerate uncertainty. We already practice this constantly in our lives. Our mind works with ideas of the future that we don’t know if they will actually occur.
But it is also important to emphasize that we need to work towards hope: because things will, to some degree, gradually improve. To some degree, we will have reconstruction. To some degree, we will have a return to normal situations.
And the feeling of impotence, of wanting to do something and feeling like you can’t help, how to deal with the anguish that can come from this?
I think there are three things: anguish, a sense of impotence, and guilt. Anguish, to some degree, moves us. And to a very high degree, it paralyzes us. Having this anxiety of wanting to help, which is in the same direction as a desire to help others, is one of the most important things at this moment.
So what can I do? Maybe I won’t go to Rio Grande do Sul to get into the water to help people, but what can I do? A donation? Can I do this remotely? Can I help disseminate good quality information? Can I call my friend who is in the state and ask how he is doing? Then we have to deal with each other’s limits, and not feel guilty because they are not contributing in a certain way.
It is worth highlighting that we are living in an acute phase of the catastrophe. We will have a long way to go and many months to be able to help.
How does a community deal with collective trauma?
A very relevant aspect is that there is a “protective factor” in this collective. Traumas of an interpersonal nature – the damage that one person does to another – tend to cause greater damage from the point of view of mental health. Traumatic situations like the one we are experiencing are very impactful, but the idea that I am not the only one affected by this, that this did not happen because of something I did or didn’t do, is a great protective factor.
I think that this sense of community is the basis on which reconstruction and overcoming, including psychologically, of this trauma that touched everyone will take place. The perspective of overcoming is also collective.
It is the groups that will reorganize, the community leaders, the health agents who know each of those people. And they, from a public mental health management perspective, will be decisive.
There are many losses and mourning. In communities that were truly devastated, how do we deal with the loss of references, memory, and identity?
We have very different scenarios. There will be that community where people will, little by little, return to their homes, clean them. This will be a long process, but your house is there, the store where you worked is there, the health center is there. But some communities were devastated, leaving only rubble. There should be much greater attention to mental health.
For some people, it is much more than something material, it is as if it were a representation of their life. It’s as if my life, my material memories, the memories of my children, my births, everything had been taken away; and everything was somehow taken away.
In these cases that are very extreme – and there are many –, we will need to give a new meaning to what is being built, so that it can represent, to some degree, overcoming, individual and collective effort. A major reframing effort will be necessary.
As we already had a serious rain tragedy in the state in 2023, there are reports of children panicking when it starts to rain. How to help little ones deal with these triggers?
Firstly, it is important for the child to be in a safe context. And many shelters are very well organized to provide children with some leisure. Another important aspect is being able to explain that to the child, saying: “Look, the rain, like the sun, is part of it.” But when the child becomes too activated, you can even use an active distraction technique, shifting the child’s attention to another stimulus. And, eventually, even some relaxation techniques, such as breathing exercises, adapted in a playful way.
Historically, Rio Grande do Sul is the state with the highest suicide rate in Brazil. According to a 2020 survey, this number was 12.4 deaths per 100,000 inhabitants, double the national average. What measures will be needed to take care of mental health in the state?
At this moment we have the centralization of this care in the National SUS Force, which is working together with the State Department of Health and the regional coordinators of the most affected areas, training the technical staff from a mental health point of view and already having volunteers – who are SUS health professionals – to be located in those regions. This is already underway, which is a very positive thing. The big challenge, in my opinion, is not so much now, but in the long term. How do we rebuild mental health devices in the most affected communities? This will be fundamental.
Some of these post-traumatic stress and depressive disorders are closely associated with the risk of suicide. Something that contributes to both ideation and attempted suicide is hopelessness. So it’s a time to be aware and tell people that we can have hope, that many of these negative emotional experiences are temporary.
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