Health for a Lifetime

Children's Mental Health After A Natural Disaster

Three Angels Broadcasting Network

Program transcript

Participants: Don Mckintosh (Host), Manjula Borge

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Series Code: HFAL

Program Code: HFAL000169


00:50 Hello and welcome to HEALTH FOR A LIFE TIME
00:51 I'm your host, Don Mackintosh,
00:53 and we're glad that you've joined us today, and I
00:55 think today's program is going to be especially
00:57 helpful to many people.
00:59 Over the last number of months there have been all kinds of
01:03 natural disasters and these have a big effect on our health
01:07 both physically and mentally.
01:09 Today to talk to us about that problem and some solutions
01:14 is a physiatrist from Pittsburgh, Pennsylvania.
01:19 Manjula Borge and we're glad that you're here with us doctor.
01:25 Thank you for having me.
01:26 You have gone through a residency now in adult
01:31 psychiatry and you're now working on another fellowship
01:35 it's called in child and adolescent psychiatry
01:39 in Pittsburgh.
01:40 Yes, that's right.
01:42 So you've had a lot of experience talking with people
01:44 and you told me before the program that you were very
01:47 interested in doing this program because you felt like you
01:51 wanted to give something more than just a donation,
01:55 you want to help people who have gone through the trauma.
01:58 Yes, I was interested especially after the resent hurricanes that
02:02 we have experienced here in the United States - Katrina, Wilma.
02:06 The natural disasters overseas, the earthquakes in India and
02:10 Pakistan and other natural disasters that have been
02:14 occurring and on the increase, actually.
02:16 So, I was just interested to find out what kind of
02:20 mental illnesses one can experience after this natural
02:23 disasters and what we can do as professionals and as
02:28 lay people to help individuals who have been traumatized.
02:32 Yes, and as we've gone through some of this material
02:34 beforehand, I know it's going to be very useful,
02:36 you may want to get a pen or a pencil and write down
02:39 some of these thoughts.
02:40 I think you'll really enjoy the material.
02:42 I guess the first thing we need to talk about is how to define
02:47 a disaster or a trauma.
02:51 What is the definition for a disaster or trauma?
02:55 Well, after any person who has experienced or witnessed any
03:02 event such as combat, rape, torture, natural disasters,
03:09 accidents in which the physical integrity of them or others
03:16 was threatened, has experienced what is called a
03:20 traumatic stress reaction.
03:22 So they can experience it or they can even witness an event
03:28 where death was involved or physical injury to
03:33 themselves or others.
03:35 So September 11 would have been a traumatic thing for the
03:38 entire country.
03:39 Absolutely.
03:40 Watching some television programs might be that as well.
03:42 It could be for some people depending on how a person
03:45 reacts if you see other people in a dying or experiencing very
03:51 horrible events where their life was threatened can experience
03:57 traumatic stress reaction.
03:59 But we're talking about these huge hurricanes and different
04:02 things whither it be Sumatra, where some people may be
04:06 watching, or where ever they are, these are called
04:11 traumatic events.
04:12 What are some normal reactions to a traumatic stressor?
04:18 Before we go into the normal reactions I also like to talk
04:21 of some other experiences where people can have...
04:24 where they can experience trauma.
04:27 For example if a person is EMT worker or policeman or a fire
04:34 worker or a person who is taking care of a medical personnel
04:42 working in burn units or trauma units where the stress level
04:47 is very high and mortality is high, they also have
04:50 experienced what we call as trauma.
04:54 So this is a wide spectrum of people that could be
04:57 impacted in what you're going to be sharing to
05:00 help all these groups.
05:01 Sure, it can be people who go to help out and help in the
05:05 trauma after a disaster that they also can experience it
05:09 after seeing injury or death.
05:12 So what are some normal responses to traumatic events?
05:17 Well, some normal responses we can talk about some
05:21 emotional things that people can go through.
05:23 Emotional reaction is shock.
05:26 People are very shocked like, how could this be
05:29 happening to them? Is this real?
05:31 This could have never been happen, they may have felt
05:34 secure in whatever situation they were in and now that's all
05:39 shattered and they feel very shocked and they go through
05:43 what's sometimes called denial that this is not happening
05:47 to them, or it can't be happening, this is unreal
05:50 it would never have happened to me so
05:53 they can go through denial or
05:54 they can go through a lot of anger.
05:56 Anger that this has happened to them or why when things were
06:01 going ok, how come this can happen?
06:03 You know something making it worse, a lot of resentment,
06:07 a lot of hate towards authorities or towards people
06:15 who are maybe not necessarily responsible towards of people
06:19 they think could have done a better job.
06:21 They have a lot of hatred involved with that.
06:24 Sometimes they could have a lot of guilt that how they
06:28 could have done something better or they could have
06:31 gone away from the trauma sooner or they could have
06:36 called someone or they could have done something.
06:39 They feel a lot of guilt involved with the trauma.
06:45 This is certainly what we heard as we listened to people going
06:48 through these natural disasters. Listen
06:50 to the interviews on television or reading about it.
06:53 Those are exactly the things that are being said.
06:55 Absolutely.
06:56 They feel a lot of guilt that they were not able to evacuate
07:02 maybe earlier or didn't think earlier,
07:07 and they also could go through a lot of fear.
07:10 Fear is very... it's a normal reaction.
07:13 It's normal to be fearful after what has happened.
07:16 Fear can bring a lot of anxiety, anxiety about
07:21 feelings of whatever is going on around, whatever the chaos
07:28 around that can...
07:30 These are all normal.
07:32 If these are happening that's healthy?
07:33 Yes.
07:34 What about physical things?
07:35 Are there other physical things?
07:37 Yes, they can go through a lot of physical problems.
07:39 They can have a lot of tension, muscular tension.
07:42 And that's normal.
07:43 Yes.
07:44 Fatigue, people can get tired very soon.
07:47 They can have a lot of somatic complaints, abdominal pain,
07:51 nausea, feeling distressed, diarrhea.
07:55 They can have sweating.
07:58 They can be anxious.
08:00 They can have what we call paresthesia or difficulty in
08:06 sensations for the extremities.
08:08 They can have paraesthesia or numbness.
08:09 And that's normal?
08:10 Yes, this is normal.
08:12 So the person might be wondering what are they going
08:17 through? Why are they feeling this way?
08:18 They just need to realize that after seeing a devastating
08:22 event or events that they can experience these
08:26 physical symptoms.
08:27 They can have head aches.
08:29 They can have dizziness.
08:31 They can have some emotional cognitive problems
08:37 What about inter-personally?
08:39 Inter-personally they can have a lot of relationship issues.
08:43 They can have a lot of relationship problems
08:48 with their spouses, with their families, with their children
08:51 because of their stress.
08:53 For example, middle aged men they might feel that they need
08:57 to take care of their family or should have been there and
09:01 they feel this overwhelming stress now that things have
09:05 fallen out of control.
09:08 They feel loss of control, and this makes them very angry,
09:12 and makes them probably more argumentative with
09:16 their spouse or more edgy with their children and with
09:20 their other family relatives.
09:22 They can also have a lot of depression.
09:25 Depression can be there, and people can feel
09:33 hopeless, very hopeless, very shameful, shameful of
09:37 what has been happened, what is going on.
09:41 They can feel hopeless.
09:43 They can feel helpless.
09:44 They can feel lonely.
09:45 They can feel abandoned.
09:47 And these are all normal things.
09:49 Yes, absolutely.
09:50 What about spiritually?
09:51 Are there some spiritual things that happen?
09:53 Spiritually, yes, people can wonder... some people get angry
09:58 with God and wonder why this happened to them.
10:02 They might blame God and say, "Why did You did You let this
10:05 happen to us?"
10:06 "Why did my child have to die?"
10:08 "Why did this natural disaster have to take place and my family
10:12 was lost?"
10:15 So they can have a lot of anger towards God, a lot of hatred,
10:18 a lot of resentment towards God, a lot of questioning
10:22 God like, Why are you doing this?
10:24 Some people might feel guilty that they did something, they
10:30 lived bad lives and then this is their punishment
10:33 received from God, but I think
10:36 there is another spiritual aspect also after
10:38 natural disasters that can happen is some peoples'
10:41 relationship with God can get closer.
10:43 They might look at it as a sign to get closer to God and they
10:50 might think that their lives were not good enough
10:51 and God is giving them a sign to improve their lives.
10:55 They might start going more to church, become more spiritual,
10:59 start praying more.
11:01 So that's a good thing.
11:03 Yes, absolutely.
11:04 These are just normal reactions. What are
11:06 the risk factors when going through a traumatic event?
11:10 Several risk factors that when you have the loss of a
11:15 neighborhood or community or family that...
11:18 That describes Katrina doesn't it?
11:20 Definitely, absolutely, yes.
11:21 One time you'll be near a child and the next thing you might
11:27 not be able to see your child or family.
11:29 That's very devastating to somebody.
11:31 So loss of community's support from family.
11:38 Loss of property is another risk factor.
11:41 If you come and see your house just totally gone...
11:44 Yes, I heard these people saying, "Look this house has
11:46 been in our family for 400 years and now it's gone.
11:49 When you see something that was a place of security or a
11:53 place of attachment for you and then you see it in shambles
11:57 it's very devastating to have some kind of illness after
12:03 a trauma.
12:04 So those are some of the things.
12:07 You could also feel if there is a risk to the health of the
12:13 person from the environment.
12:16 It could be like loss of water supply or shelter.
12:21 That can be also another factor.
12:24 You said some of the other things were fear for safety?
12:27 Yes.
12:29 Fear of death?
12:30 Absolutely.
12:31 Or injury?
12:32 Sure.
12:33 Seeing a dead body, seeing people being injured, not
12:35 knowing that if you can get out from here without being injured
12:39 is definitely a risk factor for developing trauma afterwards.
12:45 Bringing up old traumas that were pre-existing?
12:48 Sure, previous history of traumatic experience is another
12:53 risk factor for developing up another trauma.
12:56 So history of traumatic experiences, having medical
13:01 conditions before that can be exacerbated so your health
13:06 conditions can worsen, psychological distress...
13:10 What about relationally - divorce, job loss, separation?
13:13 Absolutely.
13:14 If someone has had experienced that before, a divorce or job
13:18 loss, that is a risk factor for developing mental illness after
13:23 trauma.
13:24 We're talking with Dr. Manjula Borge.
13:27 She is trained in psychiatry both in adult and now a
13:31 fellowship in child and adolescent psychiatry.
13:34 When we come back we're going to talk about what the impact of
13:37 trauma can be on children and what we can do now to help
13:41 with these situations.
13:43 This is a very important program and I know it's going to get a
13:46 great help to many people.
13:48 You may want to give someone a call and have them tune in
13:51 right now and join us when we come back.
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14:55 Welcome back.
14:56 We're talking with Dr. Manjula Borge.
14:59 She's a psychiatrist from Pittsburg, Pennsylvania.
15:03 And we're talking about natural disasters and mental health.
15:06 We're talking about what can happen, the trauma that can
15:09 come to people.
15:10 And, Doctor, we were saying that this trauma can really
15:12 effect in many different ways.
15:14 There's some natural things that come up and those things are
15:17 happening you described that that's good.
15:19 Those are good signs.
15:20 That means you're not blocking it.
15:22 You pay a cost at some time but you're really
15:26 addressing those things,
15:27 and then secondly, you went through some of the negative
15:30 things that can happen.
15:32 It's very important to keep in mind that a person can
15:36 experience these normal reactions after a traumatic
15:40 event.
15:41 If they're going through it they might feel that what is
15:45 happening to them.
15:47 The trauma is probably like clearing or getting better but
15:50 they're loosing it or going crazy but one should be aware
15:54 that there are certain natural and normal reactions
15:58 after a huge, traumatic event.
16:00 And some of those were eye-opening like numbness in
16:04 the extremities and not feeling them.
16:05 And some people think, "What is that?" but that's
16:07 normal.
16:08 And what about children and trauma?
16:10 Are there specific things for children in trauma that
16:13 you want to share?
16:14 As you can imagine children are very vulnerable to trauma
16:18 after disasters.
16:20 And according to the
16:21 American Psychological Association between 14-43%
16:25 of children have experienced at least one traumatic
16:29 event in their life time.
16:31 Wow, that's a lot.
16:32 Yes, yes.
16:33 Is that up from before?
16:34 I'm sure it's on the rise especially after these
16:37 natural events that we're witnessing.
16:40 So the way children experience their trauma can be a little bit
16:45 different from how adults experience them and we need
16:48 to be aware of that - parents, teachers, those who are working
16:53 with children definitely need to be aware of that.
16:56 Let's click through some of those real quick so we can
16:57 put it on the mind what we need to be aware of.
16:59 What should we look for?
17:00 Sure, children might not want to do their homework.
17:04 That sounds like something they don't want to do anyway.
17:07 Could be true to some point, but if a child has been
17:12 previously going to school doing their homework and
17:16 then you start noticing that the child is not interested.
17:20 The child might not express that they are afraid
17:23 after the trauma.
17:24 They might even say that, you know, "I'm not afraid. " But you
17:28 can notice other differences going on for example
17:30 like not doing their homework, not wanting to go to school.
17:34 You can see what's called separation anxiety - children
17:38 don't want to leave their parents.
17:39 Because they want to be together.
17:40 Absolutely, yes, you can see that.
17:42 Sometimes we called what we call avoidance.
17:46 They might not want to talk to people or be in places or have
17:50 conversations - anything that reminds them of the trauma
17:53 they might want to avoid them.
17:55 And the way children show that could be very subtle.
18:01 Adults might not definitely recognize it.
18:04 For example, a child who has corn flakes for breakfast
18:08 might not want to eat corn flakes any more.
18:11 So this might be taken as... for an adult it might be seen as
18:17 "Why is this child not eating breakfast?"
18:19 It might be looked at as nothing related to the trauma whereas
18:25 the child is showing his or her anxiety through that way.
18:29 Another example is a child who has been through,
18:32 let's say fires,
18:33 and after that event of the fire they might want to set fires.
18:39 Actually physical fires?
18:41 Yes.
18:42 Better keep on top of that!
18:43 Yes, absolutely, and one needs to be aware that they're not
18:46 trying to worsen the situation or they're not trying to make
18:51 things worse but this is their way of reenacting the trauma.
18:56 This is the child's way of reenacting the trauma.
18:58 For example after a hurricane a child might come home
19:01 and might start twirling, play as twirling around,
19:06 or hiding under furniture. So this is the way
19:11 a child is expressing what they understand
19:15 of the trauma.
19:16 Your definition of trauma can be from television programs and
19:20 other things and especially probably the younger the child
19:23 the less able they are to see whither or not that's real
19:27 or not.
19:28 So it's very dangerous, maybe would you say, to have kids be
19:31 watching television when they're young?
19:34 Absolutely, you know I think parents need to be aware
19:39 of what their children are watching, and they
19:41 need to be aware of how much their child can handle
19:45 watching on television.
19:47 If your child is very sensitive, very vulnerable to things that
19:53 are distressing, the parents need to be aware of that
19:57 and not show those kind of things to their child.
19:59 Have them watch 3ABN.
20:01 Yes, that's a good idea.
20:02 You said also there were different ages and different
20:05 categories where they respond a little differently.
20:08 Yes, children for example, younger children let's say
20:11 lesser than 5 years old, might regress and they can regress
20:16 in ways such as if they were toilet trained they might start
20:21 bed wetting again.
20:23 So that's important to keep in mind because parents should
20:26 not be very critical about it or anxious about it.
20:30 They should be supportive to the child and realize that the
20:34 child is going through a period of distress and anxiety.
20:39 That's why they're feeling and they're doing this.
20:42 Another thing that the child might do is become very clingy,
20:46 very needy, very helpless, become very child-like.
20:50 Age 0-5?
20:51 Yes.
20:52 And then the next category up, older than 5, elementary school.
20:54 Elementary school kids might not recall memories of what
21:00 happened of the event.
21:01 They might just block it out.
21:04 This is not that they are going through... it just might
21:10 be that they don't remember certain aspects of the trauma.
21:13 They're not able to recall certain aspects.
21:16 They might also go through they might not want to do their
21:21 homework, like I mentioned earlier.
21:23 They might also become very aggressive.
21:27 These are adolescents now?
21:28 Yes.
21:30 They might become aggressive.
21:31 They might also become very "spacey," they start staring,
21:36 and start getting blank spells.
21:38 That could be one of them.
21:39 Anybody think of suicide?
21:41 Adolescents, definitely yes.
21:43 They might think of suicide.
21:44 They might become depressed and suicidal.
21:48 They might start using drugs and alcohol to deal with their
21:51 anxiety, and like I
21:53 mentioned, they might also become very argumentative
21:55 and aggressive - that's the adolescent.
22:00 So Dr. Borge, we've talked about the signs and symptoms.
22:03 We've talked about what can happen.
22:04 Look, I'm listening here and I'm saying, "That's exactly
22:07 what's been happening. "
22:08 I've seen it in my congregations as a pastor.
22:10 I've heard about it and seen it on television.
22:12 This is exactly what people are going through.
22:14 Now, we've focused more on children.
22:18 We maybe can do another segment together focusing on
22:20 adults, but we focused on the kids.
22:22 What can we do to help them?
22:24 What's the treatment in our last 5 minutes?
22:27 It's very important to educate the children and let them know
22:31 what has been happening, what is going on, tell them about the
22:36 disaster, so that they are not in the blind, they're not
22:40 feeling that they are in the dark.
22:44 So children can pick up anxiety by adults very quickly.
22:49 And I think if a person is anxious and nervous and tries
22:54 to minimize the situation, I think that is not a good idea.
22:59 You need to express to the child what is going on, educate
23:02 the child and also need to give them hope that, "Well this has
23:06 happened but this is what we're trying to do
23:08 to get things better. "
23:10 So that's a very important part.
23:12 Getting them in normal routine is very healthy.
23:16 That gives them sort of a structure in their life.
23:19 For example, school is a good example taking the children
23:23 back to school and letting them do their regular
23:27 school work is important.
23:29 Educating the teachers is important.
23:31 If a child has been through a trauma, they might be more
23:34 anxious or might be more irritable and teachers...
23:38 Somebody might start a fire, like you said.
23:40 A school need to be aware of that so that they can
23:45 understand the child's reactions a little bit more.
23:49 Another way of giving control to the kids is to allow them to
23:53 pick up their clothes.
23:54 Allow them to choose the menu for their meals.
23:58 That gives them a sense of control.
24:01 If a child starts to cry, that's ok.
24:03 Allow them to cry and express what is going on.
24:07 Just be sympathetic and understanding.
24:10 What adults can do also is help themselves.
24:15 Studies have shown that if a close adult to the child is
24:20 very anxious and nervous and hopeless there's more chance
24:26 for the child to feel the same way.
24:29 Whereas, if the adult is more in control, hopeful and positive
24:34 the child is also going to feel that way.
24:36 So what adults can do is take care of themselves.
24:38 They can exercise.
24:40 They can take care of their health, get into a better
24:43 routine so that they will not transmit this anxiety, fear,
24:48 and more trauma to the child who has already been
24:51 traumatized with whatever is going on.
24:53 So give them a sense of safety.
24:55 Absolutely, safety is very important.
24:57 Safety is first.
24:58 You have to protect the child from any further trauma.
25:02 What about the person that's watching that says, "That
25:05 sounds easy, go out and exercise, take care of my
25:07 health and nutrition, but I don't have a house.
25:09 I don't have a grocery store.
25:10 I don't have this, I don't have that. "
25:12 What do you say to that person that's going through
25:14 that right now?
25:15 Well, it's important to get in touch with your family, with the
25:19 community and with the resources that are available.
25:23 That is key.
25:24 Find out, and get the source of information.
25:26 Find out what is going on and what they need to do to help
25:31 themselves.
25:32 You know if you feel hopeless and if you feel that I can't
25:35 do anything, then chances are for you to recover
25:39 are more difficult.
25:41 But if you go out there and get the resources that are available
25:45 you're helping yourself, helping the people around you.
25:49 That's very important.
25:52 So be hopeful going out and looking for the resources
25:56 and getting that is very important.
25:59 Now you talked earlier about different ages of children.
26:03 Is there a different way to educate a 0-5 year old
26:07 vs. an elementary school vs. an adolescent?
26:09 Are there different ways to go about that?
26:11 Or is it pretty much the same for every age?
26:14 I think different ages the requirements are different.
26:18 For example for a child 0-5 years might not necessarily
26:21 need to know what is going on around them or what is the
26:25 impact of the situation in detail compared to
26:28 an adolescent.
26:29 So you can still explain to a younger child what is going on
26:33 but in simpler terms, in terms that they can understand.
26:38 You can allow them to draw to express what is going on.
26:42 Draw something that has happened like if it's a
26:45 hurricane or something.
26:46 You know, explain to the child in simpler terms.
26:49 They understand pictures much better.
26:51 You can have what they call at schools now they're having
26:56 "After Katrina. "
26:58 They gave the teachers Katrina handbooks so that the
27:02 children can draw and color in that,
27:05 so that they can learn that way.
27:07 Whereas, for adolescents they might not be interested in that,
27:11 and I think they might want to talk to you and find out more
27:14 of what is going on.
27:15 So you can explain to them things a little bit better
27:18 in detail.
27:19 Are there any spiritual resources that those who have
27:23 been through trauma should consider?
27:25 Absolutely.
27:26 I think prayer is very important - prayer with your
27:30 family, with your community.
27:31 If you do that with the school, you need to increase the time
27:35 that you do this so that you will feel strengthened.
27:37 The normal routine and just drawing strength from your
27:40 normal rituals?
27:41 Absolutely.
27:42 Thank you so much, Doctor, for being with us.
27:44 This has been very useful and we appreciate it.
27:47 And thank you for joining us on Health for a Lifetime.
27:50 Hey, if you've been through trauma, we're praying for you.
27:54 We hope this program has been helpful.


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Revised 2014-12-17