The Great California Shakeout drill is happening Thursday at 10:20 a.m., looking to help us all prepare for the Big One. If you live in the Golden State, you know the possibility of a major earthquake is always a factor. What does that sometimes distant fear do to the psychology of Californians?
Dr. Anand Pandya is associate professor of clinical psychiatry at USC and co-founder of the group Disaster Psychiatry Outreach, which offers psychiatric services and education following acute disasters to help treat the invisible wounds of psychological trauma. He talked with KPCC about how people respond to disaster — and how we can prepare ourselves.
On disasters his outreach group has responded to:
We started in 1998, so we've responded to plane crashes. Our largest response to date has been after September 11th, where we coordinate the volunteer psychiatrists in New York City, but we've also responded to the Indian Ocean tsunami, we did education in both New Orleans and Baton Rouge after Katrina, and more recently we've worked with survivors of the hurricane in the Philippines.
Since childhood, we've been taught that the Big One is just around the corner, but somehow we go about our days like nothing's wrong. Is there a certain amount of denial involved when you live in a place with the possibility of a devastating natural disaster?
There is a certain amount of denial. There's also just the human way we deal with risks in every day life. We stay conscious of new risks; we don't stay conscious of chronic risks. So how aware we are of the risk is not proportional to how great the risk is, but whether it's new or not. So the risk of crossing a street may be greater than the risk of being attacked by terrorists, but because the risk of terrorists are new, we are much more conscious of that than we are of the risk of being hit by a car.
Do we not prepare for earthquakes the way we would to a new risk?
It means that we are accustomed to it and we don't have a new plan for it. That doesn't meant that we can't consciously overcome that bias, and we should overcome that bias. It's the way our brain is naturally include to work — that doesn't mean it's the most productive and successful way for our brain to work."
We have the Great California Shakeout drill Wednesday, but we don't want to freak people out. Is there a way people can prepare for a disaster without becoming overwhelmed by anxiety?
With every drill, we are focused on people's specific role as members of the general public, or members of a first response group. And so the good news is that, as a member of the general republic, there's very concrete things that we should be doing: Having our file documents photocopied and in a place where we can access them, having a to-go kit with medications.
All of this is easily obtained on the internet, a list of things you can do to be prepared for a disaster. And a lot of these things are good things to do no matter what kind of disaster may strike, or even if it's just an individual catastrophe like a house fire. Having these things ready can be very helpful. So you don't have to think about what if everything goes wrong, there's already a lot of guidance on what you can do to be ready for what's most likely to go wrong.
Is it best to focus on preparation to cope with dealing with anxiety?
It works for a lot of people. It works for me. I definitely feel, if I can do something about something, it is less overwhelming, and that's been the experience of many people that I've spoken to and worked with over the years.
How do people respond after living through a serious disaster/attack/etc.?
First of all, there's a range of different psychiatric problems that we see. First, most people are resilient. Most people do not develop a psychiatric diagnosis. Even in the worst traumas, the worst disasters that we've responded to, it's only a minority that develop psychiatric disorders.
The people who do develop psychiatric disasters most commonly develop post-traumatic stress disorder, but almost as high a number suffer from major depressive disorder, and a very high percentage also experience relapse of addictions or exacerbations of addictions. So those are the kinds of clinical problems that we tend to focus on when we are working with survivors of disasters, or first responders — people who are responding to the disaster.
We know who is most likely to develop these kinds of problems. We know that women are at higher risk for post-traumatic stress disorder and major depressive disorder than men, and that men are more at higher risk for addiction than women.
We know that people who've been exposed for longer periods of time to the disaster are at higher risk. We know that people who have had prior exposure to trauma are at higher risk, where people who've had prior depression or addiction are at higher risk for subsequently developing post-traumatic stress disorder.
So there's a lot of things we can look at, as well as the severity of the trauma itself, to figure out who we need to spend more time with and keep an extra eye on, because they are more likely to have problems in the long run.
What is the prognosis when someone is dealing with post-traumatic stress from, say, a large earthquake?
Moving on with your life can be defined very individually, and I've worked with many people who've had a lot of success moving on with their lives. That doesn't mean that they're symptom free, and one of the important things that we do in disaster psychiatry outreach is helping people understand that, after a disaster, you're not going back to the same state of mind that you were in before.
You will be forever changed, but that doesn't mean that you're going to be forever dysfunctional, and there is a new kind of state of equilibrium that people reach where they remain aware of the possibility of trauma in their life, and they can continue to mourn losses that they've had, but they are able to function again. And recovering some or all of your function is a very realistic goal for people who have psychiatric problems after a disaster, so I tend to be pretty optimistic when I start treatment with an individual.
On what to expect after a disaster, and how to prepare:
I do think we tend to prepare based on worst-case scenarios. That is, when we are exposed to a disaster, we sometimes expect people to be very traumatized, and if you create that expectation, then people will feel like they're supposed to be dysfunctional, and they're supposed to be traumatized. So really appreciating that most people are resilient, and most people will do OK after a disaster, is very important.
The other thing I'd like to emphasize is there's a growing body of research that being really connected with other people in a community helps you be more resilient after a disaster. So anything that ties you in to friends, family, neighbors is probably helping you prepare for a disaster.