As an indicator of how devastating Hurricane Sandy was, CNN writes that it is also known as “Superstorm Sandy.” Between October 22 and 29, 2012, Sandy killed 147 people across the Northeast United States, eastern Canada, and the Caribbean. In New York, 48 people died; in New Jersey, 12; in Connecticut, 5; in Pennsylvania, 2; and five spread out across other states. On October 26, Sandy was officially designated a Category 1 hurricane, reaching wind speeds of 80 mph. Force winds extended 175 miles out from the center of the hurricane, rendering Sandy much larger than other, similar storms.
The Journal of the American Medical Association quotes figures from The New York Times that estimate 60 million people across 24 states were affected by storm-force winds, rains, floods, coastal surges, and blizzards. Damage estimates released by the National Weather Services found that the cost of Sandy’s destruction was $75 billion, with $71.4 billion worth of destruction taking place in the United States alone.
Post-Traumatic Stress Disorder
Notwithstanding the unfathomable devastation caused by Hurricane Sandy, The Huffington Post warns that the psychological harm in the wake of the storm may account for the effects that last the longest and may even be the most painful to deal with.
Natural disasters are an obvious source of trauma for a lot of people. Even with plenty of advance warning, the sheer power unleashed by natural forces is hard to comprehend, let alone survive. In the aftermath of an event like Hurricane Sandy, survivors are left without homes, jobs, and sometimes family members or close friends. The loss of a childhood home or items of sentimental value can be a source of deep pain, as such mementos can never be replaced.
A lot of people are able to pick the pieces of their lives back up and move on. They still carry some scars of the disaster, but with the help of friends and family (and maybe some professional help), and the passage of time, they are able to process their losses.
PTSD does not only affect people who were caught directly in the path of Hurricane Sandy or any other natural disaster. The “trauma” of post-traumatic stress disorder can be an uncontrollable response to an event that scared a person so much, they are genuinely afraid of death or injury to themselves, people close to them, or even people they see suffering in news coverage. It is a case of “personal vulnerability,” according to Psychology Today., 
For example, a mother who is cut off from her children during a natural disaster and cannot contact them (due to power outages) may suffer from post-traumatic stress disorder, even if the mother herself is physically safe and unharmed. The fear of (potential) loss and the inability to get information about her children’s wellbeing can accumulate to the point where the mother’s mind cannot cope with the stress. Her children may be fine, but the close familial bond, the “personal vulnerability,” Psychology Today spoke of, could lead to the mother developing symptoms of post-traumatic stress disorder, even though she could have been hundreds of miles away from the danger (which, in its own way, could contribute to the feelings of helplessness and despair).
The idea of personal vulnerability may be exceptionally strong among children who are often defenseless and powerless as a matter of nature. Because children lack the experience and maturity to process traumatic events on their own, they are at a higher risk for developing PTSD or a related anxiety disorder.
Media Coverage as a Risk Factor
A study suggested that kids with clinical anxiety may be more likely to develop PTSD by being exposed to images and videos of the devastation caused by Sandy, confirming the findings of previous research that found a connection between watching distressing events on TV and later showing symptoms consistent with those of PTSD.
A professor of psychology at the University of New Orleans worked with 141 children who were living in areas that had been hit by Hurricane Katrina, one of the deadliest natural disasters in American history. The professor looked at the kids’ PTSD symptoms 24 months, and then 30 months, after Katrina made landfall in 2005. After Hurricane Gustav made its own landfall in 2008, the research team asked the same children about their television-watching habits, as they related to media coverage about Gustav’s impact. The researchers discovered that children who were diagnosed with post-traumatic stress disorder before Gustav experienced their symptoms anew with the media coverage of Gustav that they consumed.
The worst thing parents can do is avoid talking to their kids about a situation.
Commenting on the study, the psychology professor said that children with anxiety diagnoses and histories are at risk for experiencing PTSD even by witnessing the event on television. Their firsthand experience with the effects of a hurricane – and then seeing real-time, graphic, and dramatic media coverage of another hurricane – primed them for a PTSD relapse.
One possible solution to protect vulnerable children might be for their parents to talk to them about what they’re seeing, while also limiting media exposure. Kids need to be listened to, and they need their fears to be acknowledged. Being told of contingency plans, and being reminded that they are safer now than they were in the aftermath of the hurricane, will help them control their fear responses.
Long-term Emotional Damage
The psychological and emotional vulnerability of children was a point made in a Psychology Today article that talked about the long-term traumatic effects in the aftermath of a natural disaster. A study by the University of Miami looked at 384 children who experienced Hurricane Charley, a Category 4 hurricane that slammed into Florida’s Charlotte County in 2004. Thirty-five people died as a result of the weather effects of the hurricane, and the damage expense went as high as $16.3 billion.
Of the 384 children involved in the study, 35 percent of them showed signs of moderate to very severe post-traumatic stress disorder nine months after the event, and 29 percent reported having comparable levels of PTSD 21 months after the event.
Children being children, their emotional vulnerability to other stressful events (such as parents’ separation or health issues in the family) caused a “cascading effect,” which intensified the stress experiences directly attributed to Hurricane Charley. The lead researcher called this a significant finding, because there had been no previous scientific literature on the subject of hurricane-related stressors contributing to the stress caused by other major life events.
As the CBS News report suggested, communicating with peers and family members about psychological and emotional shock brought about by violent natural disasters was found to be “extremely helpful” in creating a barrier of protection around children. Kids who have firsthand experience with the destruction and terror of hurricane, earthquakes, tsunamis, and volcanoes should stay in contact with their friends, so as to develop a shield against the negative thoughts that develop as a result.
Being able to verbally process what they are going through will help children build up their resilience to the symptoms of post-traumatic stress disorder and improve their life adjustment after the event.
When Do People Look for Help?
The idea of talking about the devastating effects of natural disasters, and in particular Hurricane Sandy, came up in an interview the Press of Atlantic City conducted with two Sandy survivors. One of them, a man named Ken Turner, became increasingly anxious and fearful, going day to day with a constant state of dread, even months after Sandy finally dissipated. Turner recalled to the Press of how he was in a neighbor’s home, watching water rush through his Mystic Island home. It’s an image that he couldn’t get out of his head, no matter how hard he tried.
In time, his short-term memory started to fade, and he developed a speech impediment. He jokingly attributed the symptoms to “post-traumatic Sandy disorder.”
Turner and his wife Suzanne both struggled with health problems before Sandy struck. They each underwent major surgeries, which rendered them unable to work for several months. After watching their home get destroyed, the Turners were thrown into a protracted battle with their insurance company over the rebuilding of their home, a process that placed a great deal of stress on both of them. To complete the deterioration, Ken was laid off from his job.
A senior scientist and clinical director, who has studied post-traumatic stress disorder for three decades, told the Press of Atlantic City that people who develop PTSD tend to have other mental health concerns before the traumatic event. The health and financial issues the Turners faced would place a great amount of stress on anyone; Hurricane Sandy taking away their homes and their livelihoods was “the last cable that snaps.”
With so much going on – and with so much going wrong – talking about the problem can be the last thing many people want to do, even though it is the healthiest way of dealing with the psychological damage. The medical director for a behavioral health clinic notes that in the aftermath of widespread traumatic events, the use of mental health rehabilitation services declines. Residents of Ocean, Monmouth, and Atlantic counties were all severely affected, losing homes and jobs. Many people moved out, leaving waiting rooms at outpatient clinics empty.
The medical director acknowledged that amid all the stress, depression, and anxiety, “it’s somewhat normative that people are not looking for help,” even though the time spent without mental health treatment can lead to the development of PTSD, like a physical wound going untended.
It takes about 6-8 weeks for the dust to finally settle for most people, at which point they turn their attention to their mental and emotional states.
From Devastation to Devastation
In addition to watching homes literally get blown and washed away, the process of looking for emergency accommodation and then returning to the neighborhood to commence the rebuilding process can be a source of chronic trauma in itself. Seeing what was once a place of family and community reduced to debris and rubble can make it very difficult for survivors to put their grief and loss behind them and focus on moving forward.
Anniversaries of the event are bad times for disaster survivors, as reminders can trigger a relapse. The first year is usually the hardest, and experts advise that the people who lived through a natural disaster avoid television and media coverage, especially if the event caused issues of anxiety and depression.
Other people can watch news coverage without any ill effects but may still be put on edge during times of bad weather or power outages, as such occurrences will be vividly, and chronically, reminiscent of the traumatic experience.
One woman recounted how she had to leave her Mystic Island home because of Hurricane Sandy and went north to Ortley Beach. The move offered no respite, as that community had been similarly leveled by the storm. After leaving devastation “to go live among more devastation,” she was diagnosed with post-traumatic stress disorder and has resigned herself to having to learn to live with the panic and anxiety of the unknown.
Further complicating the situation is that natural disasters tend to be unpredictable. Even when they can be anticipated (to a degree), the scope of the devastation, as well as the varied aftereffects (like the combined tsunami and nuclear accidents following the 2011 Tōhoku earthquake in Japan), present unique and daunting challenges – and opportunities – to the mental health treatment community.
Brain Regions and Disaster-Influenced PTSD
The Tōhoku earthquake and tsunami off the coast of Japan in 2011 was one of the most devastating and powerful natural disasters in human history, claiming almost 16,000 lives and costing up to $235 billion in economic damage, making it the most financially ruinous natural disaster in history. The earthquake that struck Japan’s northeastern shore caused flooding that ripped coastal towns and villages apart, and even five years afterwards, 100,000 residents were forced to live as evacuees due to extensive damage to the Fukushima Daiichi Nuclear Power Plant.
In 2012, Sciencemagazine wrote that the earthquake presented Japanese scientists with a unique chance to study patterns of post-traumatic stress disorder cause and effect in people. Among survivors of the 2011 disaster, neuroscientists found that the size of a particular brain region “seems to predict susceptibility to PTSD symptoms.” Another region was found to reduce in size for people who had the most symptoms.
Prior research had found that the part of the brain responsible for regulating emotions — the pregenual anterior cingulate cortex – is smaller in people who develop PTSD after experiencing or witnessing a traumatic event. The lead scientist in the Japanese study suggested that this presents a “vulnerability factor” for patients, in that patients who have smaller pregenual anterior cingulate cortex are more likely to display diagnosable symptoms of PTSD for six months or more after an event than people whose relevant region is of a standard size.
Another region of the brain, the orbitofrontal cortex, showed signs of a change in size as a result of the trauma itself. Test participants who showed a small orbitofrontal cortex, compared with scans taken of their brains before the earthquake, had higher scores on tests that determined the presence of PTSD symptoms. The orbitofrontal cortex is responsible for eliminating memories related to fearful experiences, suggesting that since it is smaller in PTSD-positive patients, they tend to have more intense post-traumatic stress symptoms.
The 2011 Tōhoku earthquake and tsunami claimed almost 16,000 lives and caused $235 billion in economic damage
Implications for Protecting against PTSD
A psychiatrist at Harvard Medical School in Boston told Science that the research conducted by the Japanese neuroscientists speaks to the sensitivity of the brain, especially when confronted by natural disasters that present a direct threat to life and personal safety. While the findings presented no immediate insights into how to better treat clients with PTSD, they do raise the possibility of developing “neuroprotective drugs” for the areas of the brain that might be responsible for the increased vulnerability to PTSD.
However, such a step would be most beneficial for individuals who can be reasonably expected to face trauma, like a soldier or firefighter. Most of the people living in areas that are prone to natural disasters – on an oceanic coastline or a seismic fault line – don’t sign up for the possibility of their lives being permanently altered by an unpredictable event.
That said, Current Psychology offers a list of some general behaviors and practices to increase psychological resilience, such that the development of post-traumatic stress symptoms can be controlled or reduced. Mental health exercises and checklists, like problem-solving and emotional regulation, can teach people how they can face their fears; physical exercise boosts mood and health; having a positive outlook can decrease pessimism and stress; and social support can encourage active coping strategies, reduce loneliness, and help to develop a healthy framework to process problems.
The Importance of Communal Support
A study out of Rowan University in Glassboro, New Jersey, on Hurricane Sandy’s mental health effects on older adults found that strong relationships with people in the local neighborhood and community “reduced the incidence of symptoms of PTSD” among senior citizens. Older adults accounted for 65 percent of the fatalities caused by Hurricane Sandy, but those who survived were able to use the pre-existing social support of their families and friends, which was already critical to their wellbeing.
Resilience is an easy word to use to describe the phenomenon, but it goes beyond a case of character. Resilience is based on available resources and the nature of the exposure to disaster, but also on the relationships to the neighborhoods in which people live. The Rowan University researchers suggested that having strong communal ties not only makes quality of life for older adults better; it can also make a huge difference in mental health when natural disasters occur.