Participants: Don Mckintosh (Host), Manjula Borge
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. 13:55 Have you found yourself wishing that you could 13:56 shed a few pounds? 13:57 Have you been on a diet for most of your life? 14:00 But not found anything that will really keep the weight off? 14:03 If you've answered yes to any of these questions, then we 14:06 have a solution for you that works. 14:08 Dr. Hans Diehl and Dr. Aileen Ludington 14:11 have written a marvelous booklet called 14:14 REVERSING OBESITY NATURALLY, and we'd like to 14:17 send it to you free of charge. 14:19 Here's a medically sound approach successfully used 14:21 by thousands who are able to eat more 14:24 and loose weight permanently without 14:26 feeling guilty or hungry through lifestyle medicine. 14:29 Dr. Diehl and Dr. Lundington have been featured on 3ABN 14:33 and in this booklet they present a sensible approach to eating, 14:36 nutrition, and lifestyle changes that can help you prevent 14:39 heart disease, diabetes, and even cancer. 14:42 Call or write today for your free copy: 14:44 and you could be on your way to a healtier, and happier you. 14:49 It is absolutely free of charge. So call or write today. 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. |
Revised 2014-12-17