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Trauma, especially after a fire disaster, can remain dormant for a very long time because people first have to focus on rebuilding instead of on their mental health needs.
Nightmares, trigger responses and the effects of PTSD, can then show up weeks, months and sometimes years later, usually when the individual thinks everything is OK.
“This is very important for us to know in mental health, but it’s also very confusing,” said Dr. Norman Blumenthal, a nationally recognized expert in trauma, during a Jan. 29 presentation at the Malibu Civic Theater.
The presentation about trauma, coordinated by Dr. Juliette Boewe, school psychologist for the Santa Monica-Malibu Unified School District, was given to mental health providers providing services for Malibu residents and staff after the Woolsey Fire.
Blumenthal, who also is director of trauma, bereavement and crisis intervention at OHEL Children’s Home and Family Services in New York, joined Tzivy Reiter, director of children’s services at OHEL, for the presentation.
Blumenthal, Reiter and their team of trauma interveners have responded to local and national crises ranging from the Sept. 11 attacks in New York, Hurricanes Sandy and Harvey, and the Pennsylvania synagogue shooting.
Blumenthal began the presentation with a discussion about what trauma is, and said the way people function is based on the notion that everything is going to be the way it always was.
Every once in a while, something like a disaster derails us and takes away that core assumption of safety and security.
“A trauma reaction is not a mental illness,” he said. “A trauma reaction is how normal people respond to trauma. It’s about being human.”
Blumenthal said residents in Malibu live, for the most part, a beautiful and normal, predictable life. But, he said, many victims of disasters in high-risk areas are always anticipating when the next disaster is going to happen.
“So, we can’t say to the victim that you have nothing to worry about; they do have something to worry about,” he said. “On the other hand, we can’t take them out of the situation for practical reasons. So, how do we help this subset, which I think is the focus here.”
He emphasized that people whose homes have been destroyed could be living in a new home and seemingly dealing with things fine, but then images of watching the old house burn can come back.
“You don’t want to remember that and yet, in a strange way, the brain will bring you back there,” Blumenthal said.
He noted that after residential fires, it’s often the smell of smoke, the sensation of heat, seeing flames, or hearing sirens that can bring people back, and that often happens because people had to deal with pragmatic matters first after the disaster rather than seeking help.
“If there’s a trauma that requires having to deal with the government, having to rebuild a home, having to find someplace to live, the body remarkably takes the emotional piece and parks it, files it away,” he explained. “So, you’re very often with this kind of trauma, where there’s so much destruction of property and there’s so much need to rebuild afterwards, you’re going to have a longer dormant period.”
Blumenthal said this kind of response happened very dramatically with Holocaust survivors. Though the Holocaust was over in 1945, survivors who needed psychiatric help only started showing up in mental health professionals’ offices in the 1950s because their first priority was rebuilding their lives.
Blumenthal highlighted a study that included forest fires in California, which found rates of PTSD and other psychiatric diagnoses much higher than those from other natural disasters.
He noted that seeing destruction of the landscape is very traumatic for survivors, especially if it’s in a wooded area, which is often very tranquil and associated with peace.
Trauma can be exacerbated after a disaster when the culprit gets away with it or the wrong wasn’t righted, he said.
Blumenthal also said an issue related to trauma is the reaction to those who are supposed to help victims recover, whether it’s government agencies or rescuers.
“The interesting thing that I have found, and you can tell me if it’s true here as well, is that it’s very polarized,” he said. “People are either idealized or resented. Then you got to deal with bureaucracies and others, and you get a lot of extreme reactions — and that has a lot of lingering effect.”
He said doing productive things, as well as practicing self-care and routines, are important for survivors of trauma, because it reaffirms that life for the most part is predictable.
Reestablishing a sense of community when so many have been displaced, and welcoming people back and making them feel wanted, also are very important.
Reiter said one of the most important things mental health care providers can do is let victims and survivors talk about the trauma, because “speaking about it takes it from something that is out of control and makes it in control.”
Reiter said the resilience of communities after disasters has been very powerful to see. One disabled woman she met after Hurricane Sandy lost everything, but vowed to not let the disaster ruin her, she recalled.
“I thought that was very profound, and that is really what the crux of this work is: working with people and helping them sort of find their inner strength, tap into their coping skills, and really come out stronger on the other side,” Reiter said.
Reiter said the OHEL group has donated resiliency workbooks for every elementary school student at Malibu schools. The books were personalized for fire recovery, and include the most up-to-date information on resiliency building.
For those helping children deal with trauma, Reiter recommended visiting the National Child Traumatic Stress Network at www.nctsn.org/resources/help-kids-cope.