The 2011 earthquake and tsumani in Japan:
One clue to what may be going on in the minds of many of the survivors there
A fairly recent imaging study [1] of the brains of earthquake survivors in China confirms what earlier psychological studies have
concluded: Many of the thousands affected by any quakes approaching the severity of that in Japan will carry with them emotional scars that they will
struggle with for many years afterward in the process of rebuilding their lives.
The study was performed on survivors of a 2008 earthquake in China which killed about
80,000 people, injured over 374,00, and directly affected 45 million. According to that study, the
trauma of a quake has long term effects on the brain that were not previously known:
An earthquake that involves the loss of limbs, livelihood, loved ones, and/or a home produces 'assaults' on these 5 parts of the brain. |
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Most of the locations in the animation have to do with processing emotions and this provides clues to the symptoms of Post-Traumatice Stress Syndrome (PTSD) which many survivors present [1]. Careful fMRI studies, specifically hi-field fMRI , indicate that these parts have a decrease in the connections indicated by the blue lines in the figure below -- decreased 'functional connectivity'. In other words, they have a decreased ability to 'talk' to each other or to 'coordinate' with each other to do the brain's 'work'.
This decreased ability was also seen in the 'default mode network' of the brains of many quake survivors; the default mode network is involved in monitoring internal thoughts and feelings [32], and other nebulous but typically-human behaviours. This network is often affected adversely in those with PTSD [31]:
The brain "at rest" or in "default (no-current-task) mode" also shows decreased connectivity.[1] |
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The Effects
"... [M]ost people function remarkably well in the midst of a crisis. It's only when the shaking or the shooting or the flooding stops that PTSD begins to appear. [28]" According to Haitian psychologist Dr. Guerda Nicolas:
'The psychological impact doesn't occur until several months later.... When things get quiet...you start to feel the impact and the sadness of the images you witnessed. Having come so close to death starts to set in. That "post" part of the post-traumatic reaction is what so often takes people by surprise. The brain, however, processes fear in a particularly lasting way and once lessons about danger are learned they're very hard to unlearn.' [28]
The invisible effects
Long term effects such as these have been borne out by many earthquake survivors just in the past 20 years, including after earthquakes in China [12,13], Pakistan [15], Marmara [10], Armenia [14], and other natural and man-made devastations. The effects of earthquakes specifically tend to produce hopelessness from loss of family members, home, and community, Post Traumatic Stress Disorder and Acute Stress Disorder [17,3], suicidality [14], and vertigo [8,2].
The awareness that these changes are occurring as early as 25 days after a major earthquake may help bring early treatment that "might reduce long-term psychological disability in trauma survivors" not just of earthquakes, but for all "national disasters, military conflict, and other causes of severe emotional distress." [1]
How many quake survivors are likely to be affected by this ?
"A population that has gone through something like an earthquake of [the magnitude in Haiti] will typically have about 10 percent of people with PTSD and 10 percent with depression, based on studies of Hurricane Katrina, 9/11, and other events .... But among those who lose their homes and loved ones in an event like [that quake], the rates can be more like 40 to 50 percent [26]."
The lessons from those who lost loved ones, livelihoods, and/or homes in the Asian Tsunami are this [30]:
Approximately 21% had PTSD
Approximately 13% had severe depression.
Approximately 30% had severe anxiety
Approximately 22% had somatic symptoms (or physical symptoms without an apparent medical explanation).
Most vulnerable are the oldest and the youngest, and particularly the females in each group
Up to 95% (!) of the youngest are vulnerable
Symptoms of PTSD are much more common in children after an earthquake [33] than in their parents, and this appears to be true of most natural disasters. A study of children that were affected by Hurricane Katrina "found that about half of the children experienced high levels of depression and post-traumatic stress symptoms." In general, "currently being separated from a caregiver, living in a trailer, having to stay in a shelter, younger age, being female, having previous loss or trauma, having had family members or friends killed ... seemed to increase risk for these symptoms [22]."
"A study of children affected by the Armenian earthquake of 1988, interviewing children 18 months after the event, and published in the British Journal of Psychiatry, concluded that catastrophic natural disaster can produce PTSD in children, reaching to as high as epidemic proportions and staying high for a long time [25]." 204.13.164.45"In a study conducted by the New York Academy of Medicine, researchers found that 95% of children [my emphasis] following [and most heavily affected by] the Armenian earthquake of 1988 suffered from PTSD. The study also found that women are more prone to PTSD than men [27]."
The oldest feel that it's just too late to rebuild a whole life
Loss of family members and/or ones home leaves them particularly vulnerable to despair, because they see themselves as too old to start building another life [12]. "Studies by psychologist Fran Norris at Dartmouth University have shown that adult disaster survivors who feel uncared for by others or who lack the capacity to manage stress are also at risk for PTSD[26]."
The study in China, after that country's 2008 quake, was particularly unique in terms of how soon after the quake the testing was done (25 days), and showed that the potential for long term effects (and thus the hope for minimizing them) shows up in a visible and quantifiable way, very soon after the quake. Not surprisingly, many quake survivors also suffer from 'compartment syndrome' [10].
At the very least, the psychological trauma hinders healing from the shorterm visible
injuries. People suffering from psychological trauma tend not to attend to the self-care that is
necessary for their physical injuries to heal [14], tending to have persistent
'avoidance' symptoms and irritableness [9], and this is especially true if they've lost
a limb [14], have been rendered paraplegic or have other spinal cord injuries
[15].
This underlies how important it is for the survivor to get psychological treatment as soon
as possible, and this benefits the surrounding community as well. The neurological effects start
early and last a long time [3,6]. The more time, energy, and money spent now to identify
and treat these problems will avoid a greater expenditure later [3,1].
Mental vs. physical
As the 2 brain images at the top show, the trauma of a natural disaster can have as physical an effect on the brains of the survivors as can objects which crush limbs and destroy homes, and treating a broken psyche is as essential to rebuilding a life as treating a broken limb.
I suspect many agencies receiving donations are wondering how they will make the money
stretch over the many many months that the survivors will be battling with these less-visible, but
still debilitating and long-term effects of living through an earthquake or tsunami or both.
Here are some agencies giving long-term support:
Huffington Post's page http://news.yahoo.com/s/huffpost/20100113/cm_huffpost/421014" target="_blank"
Raj Patel's page: http://rajpatel.org/2010/01/14/haiti-how-you-can-help/
Partners in Health: http://www.standwithhaiti.org/haiti
