The Psychology of Disaster Recovery
RadioEd is a biweekly podcast created by the DU Newsroom that taps into the University of Denver’s deep pool of bright brains to explore new takes on today’s top stories. See below for a transcript of this episode.
Across the globe, disaster can strike at a moments notice. While news headlines often focus on the death toll or economic cost, there's another hidden expense when natural disasters wreck havoc – the mental health of those who survive.
The 7.8 magnitude earthquake that struck along the border of Turkey and Syria has killed more than 50,000 and caused billions in damage for two countries ill-equipped to handle such devastation. As the region struggles to find its footing, hundreds of thousands are homeless and many are battling with trauma from the event. People are sleeping in streets out of fear that more buildings will collapse. First responders are pulling friends and neighbors from rubble.
In this episode of RadioEd, Matt talks with Dr. Tiamo Katsonga-Phiri, a licensed Clinical Psychologist in the State of Colorado and professor at the University of Denver, about the psychological effects of natural disasters and the many ways people cope with the trauma that comes from those life-altering events.
Tiamo Katsonga-Phiri, Ph.D. is a Licensed Clinical Psychologist in the State of Colorado. She received her doctorate degree in Clinical-Child Psychology from DePaul University in Chicago Illinois. Dr. Katsonga-Phiri currently works as a clinical supervisor at the Trauma Disaster Recovery Clinic training students in working with Survivors of Torture along with teaching several graduate level classes. Prior to that, she completed her post-doc at the Aurora Mental Health Center’s Colorado Refugee Wellness Center and Asian Pacific Development Center working with refugees and immigrants from all over the world. She received her prior clinical training in working with Survivors of Torture at Chicago’s Marjorie Kovler Center starting in August 2017. Prior to joining the Kovler Center, she worked as a therapist-in-training in multiple settings including one year of supervised clinical work at University of Chicago Counselling Services and Chicago Children’s Advocacy Center where she worked in collaboration with the Department of Child and Family Services (DCFS), and Chicago Police Department and at DePaul Family Community Services Center.
Trauma & Disaster Recovery Clinic: https://psychology.du.edu/clinics/trauma-disaster-recovery-clinic
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Matt Meyer (00:01):
Hey folks, it's Matt with RadioEd. Before we get into this, we want to warn you that this episode covers multiple instances of death and destruction on a massive scale, and the psychological damage such events inflict. This conversation also covers suicidal ideation and other traumatic events. Discussing natural disasters in the follow is never easy, but we recognize that it can be particularly unsettling for some people. Also, we're not really an avenue for calls to action, but there are dozens of reputable charitable organizations donating money and resources to help the people of Turkey and eventually Syria. If you of the means and feel called to help, consider donating to these organizations. Thanks, all. And now let's head into the episode.
Emma Atkinson (00:43):
You are listening to RadioEd.
Matt Meyer (00:45):
University of Denver podcast,
Emma Atkinson (00:47):
We’re your hosts, Emma Atkinson
Matt Meyer (00:48):
And Matt Meyer.
Damage inflicted by the 7.8 magnitude earthquake that struck Turkey in Syria earlier this month is immense. It's the strongest earthquake to ever strike the Middle East, and it could be felt roughly 700 miles away, in Egypt. The likely underreported death toll is past 50,000 people. More than hundred thousand people were injured, and hundreds of thousands more have lost shelter. Families are separated, pets lost, and the area is still reeling, with a 6.3 magnitude aftershock striking just last week. It killed six more people and injured an additional 294. It's a humanitarian crisis on an epic scale. Not all those who were buried under the rubble died immediately. Many suffered hypothermia and perished in freezing temperatures as rescuers mounted recovery efforts. Some have criticized the response by government agencies in Turkey, and the global community watched a serious struggle to organize a response at all. The economic cost in two countries already struggling is estimated to be between twenty billion and eighty four billion, with experts saying a full recovery is likely not possible until 2024,
at the absolute earliest. On this episode of RadioEd, we dig into the human cost of massive natural disasters. What happens to survivors? How does a big natural disaster affect not only those fighting to live but first responders? We'll chat with Tiamo Katsonga-Phiri, director of the Trauma Disaster Recovery Clinic at the University of Denver, and a professor in the International Disaster Psychology Program at the Graduate School of Professional Psychology. There's also one key distinction to know about trauma: there's interpersonal trauma, trauma inflicted on one person by another person; and environmental trauma, acts of nature through which traumas inflicted on a person. Katsonga-Phiri lays out the immediate and long-term effects of environmental trauma.
Tiamo Katsonga-Phiri (02:29):
I think primarily it's the shock that comes with it to start with. I think of one of the things that's going to be important to note is that, you know, we have what we call interpersonal trauma and then what's not interpersonal trauma. So this is not perpetrated by another individual. It's natural. Disasters have that aspect of not being interpersonally motivated, so to speak. So there's just a general shock, what you might call, realization that the use space is not as stable and as safe as you would want or hope. So a lot of times you're just dealing with the immediate crisis of trying to deal with the physical loss of the things in your surrounding, you know, dealing with figuring out where family members are. So a lot of the initial minutes, hours, days, really could just be a state of shock and just trying to find your footing, essentially.
Matt Meyer (03:16):
And then what about the long-term effects?
Tiamo Katsonga-Phiri (3:19):
Yeah, so this depends, you know, a lot of disasters affect different people differently. I think also thinking about all the various things, you know, as some of the news has been noting quite as well is that the Turkish population versus the Syrian population, they might be responding to this very differently because the people in the Syrian depression, this is a trauma on top of a trauma, what we would call complex trauma, right? Because the being kind of chronically in a traumatized state coming out of war, persecution, and all these things in their home countries, traveling, be being in a status of refugees, is on its own, kind of a very destabilizing and kind of sometimes traumatic process. And then putting this natural disaster on top of that, it's going to look really different for different people.
But generally you have, you know, what we would call within the first month or so, kind of acute traumatic distress. A lot of people will experience nightmares, re-experiencing, literally feeling like it's happening again in the moment. They might be avoidance of certain places or certain things that are either near where that happened or remind them of where that happened, things like that. So that's usually really normal. A startle response that's really exaggerated what we would call hypervigilance. So always kind of being very aware of your surroundings, in terms of a natural disaster, the way the earth is feeling, the way things are around you, you're kind of just always looking for something to go wrong, which is what the hypervigilance is about. And then just being jumpy, you might hear a loud sound, a rumble, these things will startle you.
So all of those things will happen. Nightmares, inability to sleep, just worry. You know, for most people, you know, maybe 80% of people who might experience that will have acute traumatic distress first days, first weeks. Usually, most people tend to get some kind of footing following that first month. Actually, the majority of people really recover. I think you know this in the lower percentages, maybe 20-30%, that end up having more long-term effects. And again, these statistics, they change and shift depending on what population you're reading about, what locations you're reading about, what traumas you're reading about. But generally, most people tend to recover, especially if they're able to restabilize, which I think is going to be easier, maybe, for some of the people who- that's their home. Maybe that's Turkey, for the people who are living literally in refugee situations or camps or more unstable housing,
it might take longer, it might be harder. But when we talk about psychological first aid, that people would practice in this situation, the first steps are always looking at how can we make sure these people get their families reunited. First of all, they get the resources they need, a place to sleep, food to eat, all of the things that would be normal. Lifestyles are the important things we look at first. So those things are able to be established quickly and reliably, a lot of times after the first month or so, people can kind of settle down and feel a lot better. Over time, some people might have those persisting longer-term symptoms, right? That are- whether it's nightmares, continual vigilance that goes on, continual startle responses, and things like that. It also depends on a person's preexisting psychological stability, right? How they end up showing up after that.
Matt Meyer (06:24):
You touched on this a little bit, but obviously there's no one roadmap to recovery, but broadly speaking, what kind of treatments go into helping those who have been affected by a natural disaster?
Tiamo Katsonga-Phiri (06:35):
I would say the first and foremost important thing is that physical stability. I don't know if you've heard of Maslow's Hierarchy of needs, but you definitely want to deal with the physical needs, shelter, you know, safety. You know, one of the things I heard was that some of the people who suffered this earthquake are literally sleeping in the middle of roads so that they're not in buildings, you know, so they're not at risk of being crushed. And that's one of those things that again, goes to that fear of re-experiencing. I mean, it was shattering to hear that they had more earthquakes two weeks later- or was it a week later? This is not good for recovery, right? Because it's this idea that you now start to realize your literal surroundings cannot be trusted, the earth cannot be trusted, and it's really that trust factor that is a really huge player in trauma that people don't often talk about, right?
It's this idea that like when you experience the trauma, you learn that, you know, the world around you can't be trusted, you can't be trusted. Individuals, and again, this is not depending if it's interpersonal, but if it's interpersonal in nature, you end up not being able to trust yourself and others. But now it's very much like the earth around me can't be trusted. And that's reinforced if a week later you have another earthquake, right? So that's going to be really bad for recovery. It's going to be longer. It's going to be harder because of that, because now it's- you would think these are once in a decade, you know, situations are going to happen. But when you find out that it actually doesn't take that long, it's definitely hard. But yes, I would say the stabilization factors that I mentioned, physically, are the first and most important things.
Reuniting people with family. And then I would say kind of getting people to some kind of coping supports. So we can talk about this in terms of self-soothing, distraction. You know, these are your typical things that we would tell people to do, just kind of spending time recuperating, you know, whether it's relaxing, whatever that might look like for you, listening to music, trying to get back to a normal routine. Routine is very important for coping. Trying to get back to normal routines, whether that's going back to school or work, trying to get back in your social settings, and the social rhythms of your life. Trying to do things as well that do relax you, whether it's exercise or, you know, whatever the things are that are what would call your coping strategies. They can be really fu fu too, like, you know, having a warm bath, and things like that.
Having a favorite snack. These are all different forms of coping and distraction- Can be things like watching television and engaging in different things. So I would say the base level, you want to get people to cope so that they can emotionally regulate. So let's say they're experiencing anxiety, they might be experiencing some depression. Maybe there's grief, since a lot of people have lost loved ones. So whatever rituals are a part of your grieving process, culturally, are very important to engage in. The thing about the destabilization of a natural disaster as well, or even war disaster, is that it kind of upsets some of those natural systems of grief processing, right? So these rituals- hospitals are now damaged, so they may not be doing the things that are required to prepare bodies for burial and things like that, or other ritualistic practices become logistically difficult when the space around you just isn't set up for it anymore.
But if you can do those things, I would say one of the next things is really, if you do need it- because most people, like I mentioned, a good 60-80%, might see a large improvement just from the re-stabilization and the coping factors alone, right? The few people who have persistent symptoms, I would definitely recommend more specialized psychotherapeutic interventions, therapies, things like that, in which you can learn more things. Maybe you might do something more purposeful. Because one thing we really discourage is at the beginning, historically in the old days when people did psychological first aid, they did this a lot. They would try to get people to talk about what happened immediately. And actually research has found that this does not help actually makes things much worse. But once a person is so much more stable, time has passed- time being key- they can now revisit that and maybe do what we might think of as more purposeful and intentional exposure therapy. So in that exposure therapy, what's really happening is you're talking about what happened, you're exploring it, you're getting through your stuck points, all the things that might be more triggering for you and processing those in a more structured environment, in a more safe and stable environment, which allows you to be able to kind of heal from that better and actually target some of those persisting long-term PTSD symptoms, whether it's lack of sleep, or nightmares, or something else like that.
Matt Meyer (10:40):
It's important to note some of the historical significance of natural disasters and specifically earthquakes in the area. That part of the world is home to a triple junction between the Anatolian, Arabian, and African plates. The East Anatolian Fault is a major strike slip fault zone running near the southeastern border of Turkey, and it is extremely active, with three of the five deadliest historical earthquakes of all time having happened near the border of Turkey and Syria. Antioch now overtaken by the modern city of Antakya, Turkey, saw massive earthquakes in 115 and 225 AD. It's hard to pin down exactly how many people died, but historians and scientists put the death toll of both quakes right around 250 thousand people in each event. An earthquake in 1138 struck further south in Aleppo, Syria, during the height of the fourth crusade, killing an estimated 230 thousand people and disrupting international trade for years. To Katsonga-Phiri, it's important to note the religious impact of the region as well. According to the governments of the respective countries, 99% of Turks and 87% of Syrians are at least registered as Muslims, if not actively practicing.
Tiamo Katsonga-Phiri (11:41):
You know, a lot of this part of the world is heavily Islamic, and thinking about all the things that come into play for that- a lot of what the healing's going to have to consist of as well is, you know, dealing with people's belief systems about why things happen. Do things happen for a reason? These are going to be a huge part of people’s healing. What kind of conversations are going to happen for them around this? What kind of encouragement will they be- maybe from spiritual leaders and different things that look at the ways that people are affected essentially. So I think there's a lot of things to consider. I wish I knew more and could speak in a more informed way about these particular parts of the world, but I do think that cultural and religious practices are going to be a big part of what comes into play in terms of what people are able to practice and what people are not.
Can they no longer gather because their mosque, you know, broke down in the earthquake? Can they no longer undergo the various, you know, burial rituals that they would normally do? You know, all of those things because they're inhibited, and you can't do what your religion will call or ask you to, you now come into these kind of internal battles that you're having with yourself about what you are and are not able to do to properly execute what's expected of you. So this becomes a whole other layer because now you're experiencing anxiety about what you can't do, maybe guilt, maybe , and things like that that end up being piled onto what is already a pretty traumatizing situation.
Matt Meyer (13:01):
And then the impact can spread beyond those who have just survived a natural disaster. First responders, police, EMS, firefighters, and more have been found to have some of the highest rates of suicide among studied professionals. They're also some of the least likely to seek help themselves. How can helping others during these events impact a person? And even if they themselves weren't impacted initially, what are some keys to getting those folks help?
Tiamo Katsonga-Phiri (13:22):
Yeah, this is so important. I think all of the organizations that employ people that are first responders really need to have systems, levels, approaches to helping these people. Whether it means checking in with people, helping them, creating space for them to process, creating the supports that they need, giving them time off – all the things that are required should be really at a systems space, right? We should be able to make sure that that is already embedded in the way we do things. Should they keep away from doing some of this work for a little while after? Should they have, you know, some time, some purposeful, you know, required maybe journaling or something that you give people the option that they can process their kind of trauma, or at least their secondary trauma that they're being exposed to vicarious trauma, we might call it as well, because they're seeing these things, especially if you're coming in right afterwards, you are maybe witness to, you know, whether I be aftershocks, you might see things falling, you're pulling people out of, you know, the rubble.
You know, you might be witnessing death happening in front of you or pulling down dead bodies. So all of these things are traumatizing within themselves. Seeing a dead body is a traumatic experience, right? And if you live anywhere near there, right? That's going to be something where you could have, like, this could have been me. The “you could have- this could have been me” element is actually a huge part of vicarious trauma. So being able to have seen yourself potentially being in those steps and being in that place is very, very difficult and is likely to cause people to be a little bit more affected. So I think it's really important to make sure that we're doing what we need to do within our organizations to make sure that these people get the help that they need when these things happen. And again, even families that are far away, you know, this might be people here, we have a student in our department actually who's Turkish, and the first thing I did was check in with her and say, how's your family?
How are they doing? You know, fortunately they weren't in this, in the area that experienced the earthquake, but, you know, it's one of these things where people from far as well end up feeling a vicarious sense of trauma because of their family members being hurt or maybe unfortunately passing away within those circumstances. So those things do happen. So I would say definitely having a systems level approach and then also just creating opportunities for people to go out and seek help if they're not in the system already. If you're far away and you're a family member and things like that, doing what you need to do to take care of yourself, whether that means going to therapy, gathering with other people from home, from similar backgrounds, to process what's happening, doing some kind of ritual as a group, as a community, that can help you figure out how to help. Some of them want to do something like volunteer, send resources, send money.
Although those things can be healing within themselves, right? The idea- you know, one of the main things that's a huge aspect of trauma is the helplessness of it, right? So this is happening to me, that's a huge part of what's happening with trauma. And one thing you want to be able to do with people is help empower. And I think a lot of ways, sometimes when you're far away, you're so much more effective because you feel even more helpless. So being able to do something that's helpful, that's going to be impactful is going to be so important in helping people feel empowered, like they're doing something that they're a part of a positive effect or part of the healing process, this can be really effective. So I would say being able to create spaces for people to cope and then making sure that people feel empowered to kind of take care of each other and of themselves is going to be really key as well.
Matt Meyer (16:25):
And then while the earthquake was a natural disaster without incidental cause or warnings, studies show that were already experiencing an increased rate of climate change related disasters. Often this topic is centered around the economic impact. But from a psychological standpoint, what are some of the key points regarding the treatment of those affected and the potential impact on psychologists and their patients?
Tiamo Katsonga-Phiri (16:45):
Oh my gosh, this is a very good question, and it's definitely a growing field. There's actually a new theory kind of expanding now. I think it's called climate anxiety which is the fact that like we realize these things are happening more and more, and for some people more than others, just the anxiety of the earth. You know, some people are really indifferent. Really indifferent, right? Then there's those of us who are like, I'm going to recycle. It's going to make the earth better. I'm not going to do, you know, I'm not going to fly on planes or, you know, we try to do our part, but there is some people who really do experience a level of high-end anxiety looking at the dangers and the potential disasters that could and do happen. So this is something that's increasing, it's an increasing area. I'm not as, you know, well-versed in it as I would like to be, but it's definitely a reality that people are experiencing a type of anxiety.
And now we might have a climate induced trauma- might be a new area that I'm just making up now as we speak. But I think it's an important thing to really look at and think about the fact that these are going to be ongoing things, even more so and more so. I usually don't go into this, but like thinking about gun violence and how that's become an epidemic in America, right? It's this consistent state of being where we just never feel safe. And this is going to be something that is going to affect people everywhere, right? Whether it's interpersonal disasters, like what I just mentioned, or it's natural with disasters. And so what's going to end up happening, what I think is either we'll become accustomed and desensitized to just like, well, we're just leave in a dangerous world and we just have to go about our lives and that's it.
But it could be something that does cause an increasing sense of just unease and, you know, hyper vigilance in all of us in on an ongoing basis. So I think we are going to have to adapt. I think, you know, mental health professionals are going to continue to be busy and they're going to continue to have work fortunately or unfortunately, but we're going to have to figure out ways, how do we teach and work with people to learn to exist in a state of almost constantly being under threat, right? And a big part of this, again, really brings me back to a soapbox I often stand on, which is the complex PTSD, right? A lot of times, I don't know how much you know about the history of PTSD, but it was theorized as a post-traumatic stress situation because the prototype client that they were working with was a man – man is important here – who had gone to war and had fought the good fight on the front lines and then had come back home.
And upon coming back home was experiencing all these things. But what was great about that, the war was far away. He was way over there. He's, you know, not here anymore. Like all these different things. And then it was like a, usually a one-time thing, unless you deployed multiple times, but it was this one-time event that you could isolate. Now what's happening with traumatic events is that they're closer, they're consistent, they're repetitive. So there really is no post that exists anymore. So, you know, the term when you're talking about complex or chronic PTSD, I think we should just take the P out essentially. You know, we're just talking about complex traumatic stress, right? And so what's going to happen is I think we're going to have more occurrences of this. We're going to see more people.
And I think one of the key factors that's, you know, a little bit different to regular PTSD and complex trauma is this idea of just not trusting ourselves, the world, the spaces around us. So we're going to have to figure out ways to target this specifically, in such a way that we don't always feel like we're in looming danger, because I think that is what is happening now. You know, even when we think about the things that are happening in the world, we just always feel like they might be some kind of danger around the corner, and I think a lot of times when we think about the way the disasters are and are increasing it's going to be that. It's going to be that we are always not, you know, feeling firm. I mean, hopefully there's structural engineering processes that take place where we are building our buildings differently and we're setting ourselves up and preparing ourselves for these types of dangers. Hopefully that takes place. But assuming that we're not able to necessarily get it to that stage, we are going to be dealing with people who are chronically anxious and chronically traumatized by the environment.
Matt Meyer (20:34):
And then for the last question here, are there any important points we might have missed in this discussion? Be they associated with international disaster psychology or just this specific earthquake in Turkey and Syria?
Tiamo Katsonga-Phiri (20:47):
I think there's a lot of ways in which I want there to be a psychological aspect to this, but I do think a lot of this is going to come down to policy and what we're doing as a society and as governments. I think that we've even talked about this, that there was a lot of things that are now being targeted about the way buildings were built in Turkey, right? And now people are being talked to. I think there's going to be a lot of work that needs to be done on a policy level to make sure that all kinds of disasters are being dealt with manmade and otherwise, right? So being able to make sure that we're, you know, ethical in our buildings of working on buildings, in our tendencies, we're ethical in our interactions.
I think these are going to be a big part of protecting the populations. I think that when we think about psychologically, I fear and I worry that it's going to become a bunch of maintenance, right? A lot of times in mental health, there's a lot of things we can treat, and the people really recover, and they get better. And there's then very few what we call SPMI, significant and persistent mental illnesses that people experience. But if we find ourselves in this situation, I don't want to be the bringer of doom, but we're going to, you know, I worry that we'll find ourselves in a situation where we're just chronically trying to maintain people's mental health only. I mean, again, mental health exists on a spectrum. All of us should, everything we do should be maintaining some level of mental health- interacting with people, getting our exercise in, finding time to meditate, finding time to do all these things. We're maintaining, right,
Mental wellness. But I worry that we're going to get into a space where we're going to be maintaining mental illness and just trying to not go overboard. Does that make sense? And so, I think that just keeping in mind that like, you know, we can do a lot to reinforce ourselves and to make sure that when things like this that are overwhelming come, we are strong and we're resilient, and some of that means that we're always taking care of ourselves. We're always doing the things that we need to do to cope. We're always trying to keep our stress levels as low as possible so that we can be more resilient should something really, you know, huge happen.
Matt Meyer (22:45):
That's it for our episode of RadioEd this week. Thanks to Tiamo Katsonga-Phiri for her expertise on the subject matter. The Graduate School of Professional Psychology in the Trauma Disaster Relief Clinic have two programs running as they work trained more inclusive and accessible clinicians for the state of Colorado and beyond. The first is a grief and loss trauma group, which encompasses the loss of people, but also of environments and surroundings. Their clinic has also opened to Afghan refugees who arrived in the city in 2021, for individual and group services. The clinic can be reached by emailing firstname.lastname@example.org, and we've included a direct link to their website in our Show Notes. Tamara Chapman is our managing editor, and Debora Rocha is our production assistant. James Swearingen arranged our theme. I'm Matt Meyer and this is RadioEd.