Floridian hurricane survivors could be suffering from PTSD—but recovery is possible

Clearing the streets from debris, fixing broken bridges, or putting new drywall into a house are all familiar steps in how communities recover from hurricanes. But mental health experts warn that in the aftermath of a storm we need to pay more attention to the invisible damage hurricanes can cause to our mental health, and the “rebuilding” it takes to recover.

Post-traumatic stress disorder (PTSD) can affect about 30 percent of people who lived through a hurricane, according to research following Hurricane Katrina in 2005.

In an interview with the Miami Herald’s climate team, Dr. Isobel Rosenthal, co-founder of the virtual PTSD and trauma recovery platform Nema Health, speaks about recognizing the symptoms, finding the right treatment, and how to help family and friends. The interview was lightly edited for clarity and brevity. You can find the full video recording here.

What exactly is PTSD?

Rosenthal: It can look slightly different for different people, but when we’re making a diagnosis of PTSD, the first thing we think about is what’s considered a Criterion A trauma, or a clinical trauma. And in order to have that Criterion A trauma, essentially a person needs to be exposed to death, threatened death, actual or threatened serious injury, or threatened sexual violence, or actual sexual violence.

When we talk about the impact of hurricanes like Milton in Florida, many people you know might have witnessed stuff or were in situations that were very life threatening, and those are considered traumas as well. So I think it’s important when we talk about sort of what is a clinical trauma, that we remind people that it’s actually broad, that there are lots of different events that fall into this category.

What are the symptoms?

Rosenthal: There are a couple buckets of symptoms. The first big bucket is symptoms of intrusion. You’re not trying to think about it, but it keeps coming back into your head. The other thing that’s important is avoidance, and this can be both physical and psychological avoidance, meaning you try not to think about the event and what happened, or you were in a car crash, and suddenly you don’t drive anymore because driving reminds you of what happened. Or if you were the victim of a horrible hurricane, maybe you move states because you don’t want to think about sort of what happened. The other big bucket of symptoms is symptoms around arousal, meaning that people often become sort of like hyper vigilant, feeling always on edge, like something bad is going to happen because of the trauma that they experienced. And the last big bucket of symptoms is negative alterations in cognition.

So this can affect people who rode out the storm and survived it, but also people who weren’t directly hit or who had to evacuate.

Rosenthal: It could be people who witnessed horrific events that happened to others on their way to evacuate the storm, or it could be people who were directly affected themselves.

When should people consider seeking treatment?

Rosenthal: We think of post traumatic stress disorder as occurring a month after the events have happened. It’s important to think about is it possible to develop symptoms related to this trauma. So if you notice that the symptoms are continuing and not going away, then it’s really important to get professional help. And I think in general, after trauma has happened, it’s so important to invest in your community and social network, and that can often be very helpful for people.

What does treatment generally look like? Because it is something that people can recover from within a relatively short period of time.

Rosenthal: That is one of the really incredible things to know about PTSD treatment -- you can recover. So there are sort of three PTSD therapies that we think about in terms of a really effective treatment that have years of data behind them.

The first is cognitive processing therapy, which is what we focus on in Nema. The second is a therapy called prolonged exposure, and the third is a therapy called EMDR. They’re all excellent. The reason we focus on cognitive processing therapy is it really is the therapy that we find both had the years and years of data to back up its practice. You see a therapist for an intake appointment, evaluate whether you have PTSD, and if you do, then you start therapy right away. And it’s on average about 12 sessions where you address your thoughts, feelings and behaviors related to the trauma, and you start to change those things in psychotherapy. Essentially, 82% of our patients have completely recovered from PTSD by the end of treatment.

Whenever there’s a hurricane, there are lots of funny memes and viral clips, people joking about it. How do these reactions fit into something that is otherwise so serious and life threatening?

Rosenthal: The human instinct is to always kind of make light of very serious, difficult times, to cope. I don’t know if we have great data about that, but I think it is reasonable to think that for some people who have really serious mental health symptoms related to a trauma, it could be hard to see people making light of something that seriously affected them and their mental health. And I imagine that would be really challenging, but I also, on the other hand, understand the impulse to use comedy as a way to cope with really serious issues.

Are there other ways to help family or friends, neighbors, co-workers deal with it, or maybe recognize that maybe they might be dealing with some form of PTSD?

Rosenthal: It’s really important to validate how people are feeling and also not to downplay what they’re going through, because you don’t want someone to feel like they need to hide their symptoms or feel ashamed that they’re still struggling with symptoms, maybe related to the hurricane while they’ve seen others move on. The best thing you can always do is be like really open and honest with loved ones and friends and ask them how they’re doing. And then to let them know that there are treatments available. Provide that information to a loved one or friend and can say, “Hey, I heard about this program. I think it’d be super helpful for you. Here’s their number.” That’s always a great way to support someone.

The best medicine is supposed to be prevention, but I’d imagine that that’s pretty hard when it comes to PTSD.

Rosenthal: There isn’t really great data to show that there are ways to prevent yourself from developing PTSD. We know there are some protective factors, just like with other mental health disorders, illnesses, and some of that includes social support, access to mental health professionals, and sort of the ability and space to really connect with others, to share what’s going on with you, so that they can help you get into treatment.

Most Americans will be exposed to some sort of trauma in their lifetime, and there isn’t necessarily a way to prevent someone from going on to developing PTSD. That being said, most people will recover after a trauma. I think it’s the best we can do is really build these support systems and also know that there is treatment and that a diagnosis like this doesn’t have to go untreated, and you can be connected to the right treatment and really learn to recover from your symptoms. Just because you have these symptoms, it doesn’t mean it needs to be a lifelong struggle -- so I hope to install that message of hope as well.

This climate report is funded by Florida International University, the John S. and James L. Knight Foundation and the David and Christina Martin Family Foundation in partnership with Journalism Funding Partners. The Miami Herald retains editorial control of all content.