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Is Recovery Truly Possible? The Hidden Effects of Mental Health & Why We Need to Focus on Long-Term Improvements

After Hurricane Maria struck Puerto Rico, the island had many concerns that were revealed by the physical damages. Not only was the formal infrastructure of the island falling apart, but the social structure of the people began to change. Even with a renewed sense of community, one cannot deny the ways in which Maria’s damages harmed these social structures. With this in mind, we must question how we define recovery, and if recovery is truly possible. If recovery is returning to the way that things were before, then the island remains with the same systems that were hurting them even before the hurricane. But if recovery is a complete remodeling of systems to benefit all, is it possible for that to be sustainable in the long-term when psychological effects may transcend multiple generations? 

“I think the lesson for treatment of mental health conditions is don’t think it’s over after a year. It isn’t… They’ve been disrupted from their friends and their families. The whole fabric of their lives has really been changed.” – Paxson, Princeton University

In challenging our definition of recovery, we must also consider how we define resilience. Does resilience equal survival? Is it an individual’s ability to remain unaffected by an event? Is one resilient when they must ignore their internal suffering for the sake of moving forward? Many individuals were not able to even put language to their emotions, as the increased stress levels did not allow for space in which they could truly process these experiences. When physical survival takes precedence, it is difficult to emphasize the internal experiences. 

Marco Hernandez, a local pastor acting as guide for a Red Cross team visiting the Comerio region of Puerto Rico, comforts Felix Rodriguez with a long hug on Thursday, Nov. 9, 2017.

These mental health issues have been deemed a living emergency and psychological fallout, as the day to day impact has aggravated, and continues to aggravate, negative emotions and stress. This has caused increased risks through spikes in suicide rates, drug use, domestic violence, increased diagnoses of mental health disorder, and increased needs for new or stronger medications. 

The months following showed an increase of mental health concerns in addition to the physical damages. The Department of Health in Puerto Rico saw a 246% increase in calls of people reporting attempted suicides in a period of only three months. A report from the Commission for Suicide Prevention released a report on 2017, detailing how 253 suicides occurred, with 20 occurring in December alone. 

A survey from the Kaiser Family Foundation found that a small percentage of individuals were able to actually receive mental health services pertaining to Maria, yet almost double that number of people felt that they needed them and did not receive them. While the total percentage of individuals in need of mental health individuals is only around ⅕ of the population, a majority are still lacking access to proper resources, and therefore not receiving necessary aid.

This context and lack of available resources is particularly impactful for younger, school-aged children. Children, in healthy and normative development, require a strong social context in order to understand their position within the world around them. Their social environments were destroyed due to the lack of physical space in which they could come together, as most schools needed to be used as shelters for extended periods of time.

Heydee Perez, age 29, and her son, Yenel Calera, age 4 have not received any aid one week after Hurricane Maria. The roof of their home is gone and they have very little to eat.
A mother and her son have not received any aid one week after Hurricane Maria. The roof of their home is gone and they have very little to eat, from Time.

Furthermore, even contexts at home were conditions of sometimes extreme poverty. Many children experienced homelessness, food insecurity, and lack of health care access in addition to a weak school environment. The American Psychological Association has found that children experiencing these conditions are at greater risk for behavioral, emotional, and even physical health problems. While greater risk does not ensure that a child will have these conditions, the increased stress placed on a vulnerable child exacerbates existing issues and places them at risk in a setting where there is already limited access to resources. 

This psyche from a disaster period carries with them into adulthood, and in the context of surviving a disaster, the mentality of a disaster period may carry into future generations, even after the recovery period has ended. Some have described these individuals as the “Maria Generation,” as seen in this video from CNN.

We have already seen the long-term effects of mental health in the survivors of Hurricane Katrina in New Orleans. A study from Princeton, published in 2012, seven years after the impact of Katrina, they found that on average, many people did not return to their own mental health condition prior to the disaster. 

Other studies have shown that there was an increase in generalized anxiety disorder that included short-term memory loss and cognitive impairments. They called this condition “Katrina Brain” as its origins were pinpointed to the effects of the storm. Keep in mind, this post-disaster anxiety is separate from the increased rates of PTSD, and separate even from the overall degradation of mental health that had occurred. 

We have seen from the past that mental health presents as a long-standing issue even after “recovery” has been achieved. If people are still suffering from the conditions brought about by disaster— can we even call it that? 

It is a necessity to emphasize mental health in our interventions, as mental health and the psyche of the people is what carries on the ability to be resilient, and the ability to continue growth and rebuilding. Mental health is more than just a diagnosis. Mental health is the internal well-being of individuals, and of a collective.

Shaina kisses her son Keydiel in the yard of the school he attends in Yabucoa, Puerto Rico. This image was taken by the Guardian after the mother and son were saved from being trapped in their home.

It requires multiple areas of assistance to come together, and improve the conditions of the island in order to create a sustainable, safe environment in which individuals can place focus on the internal needs rather than exclusively the external needs. Even when external needs such as food, shelter, water, and electricity are met, the remnants of disaster can still affect one’s ability to continue their process of internal rebuilding. There can still be fear and anxiety that carries on and prolongs the effects of disaster.

A retirement community has volunteers who work with the elderly, and help them learn to cope with emotional stress, from NPR.

To create sustainable solutions, a multi-disciplinary approach is needed to address both the systematic and personal degradation of mental health. Quality of life must be improved for individuals, particularly those in vulnerable populations, through support in providing basic needs, such as food and shelter. This must be integrated with support from mental health professionals who go into the communities and offer spaces in which individuals can come and address their concerns and emotions surrounding their current state. These spaces should be ongoing rather than only in reaction to immediate disaster, and support mental health education in which individuals can recognize signs in order to offer support to each other within the community.

A Reminder of Hope: One Puerto Rican Woman’s Outlook & Her Experience of Maria

Monica Donaldson, a 51-year old woman living in Luquillo with her husband and children, shared her story with me about what it was like to experience Puerto Rico after Hurricane Maria. Her account showcased an amazing resilience— not only in her ability to help friends and family, but also her outlook towards the events. 

“Once the Hurricane is here, it’s actually kind of exciting. We get to experience nature at its worst, but also in its awesomeness. Maria was really intense— it didn’t rain much, but the winds were really bad. During the storm, my husband had to hold down a door that was blowing away. My daughter’s window was buckling in from the pressure. But the sound is incredible, like being next to the engine of an airplane.”

Monica had mentioned that the hurricane itself was an opportunity to experience the full capabilities of nature— you get to recognize the power that the Earth holds. The preparation, although intense, was a process that she and her family were familiar with. It was the after-effects of Maria that surprised everyone. 

Like many Puerto Ricans, Monica and her family experienced a lack of electricity for months, food shortages, and property loss. She described how her family stayed within their home for five days before they were able to leave. Their home, just outside of El Yunque national rainforest, remained intact. The same could not be said for their other property investments, rentals on AirBnB, that they utilized as a source of income.

Her neighbor’s house, which she had never seen before due to the forest’s usually dense foliage, had its roof ripped away by the strong winds.
Heading to a friend’s house. The road has been covered by
fallen trees.

The destruction of their property and a source of income was not all that was lost. Her husband could no longer work his job at the Wyndham hotel due to the building’s destruction. Her daughter could not complete her education while her school was being used as a shelter, and they needed to make the decision to send her to the States in order to complete high school.

Once they did leave the property, they quickly worked to help save their neighbors, many of whom were elderly, from being trapped within their homes from fallen trees— particularly her son due to his physical ability. A chainsaw became a unique necessity for them.

Her local grocery store had almost no food available. People were limited in the amount they were able to purchase.


The community shared their perishable food items before they could go bad, but after 2 weeks, things began to look grim as the food supply slowly became smaller and smaller. She described how her family missed having fresh vegetables to eat, and to give that up was difficult due to it being such a staple, and everyday part of their lifestyle.

Monica’s story of community represents the strength of the community of the Puerto Rican people, in that they utilized their own resilience and ability to stand together in order to survive. It was necessary for them to help each other, as they were not receiving help from other government agencies— even two years later. The Trump administration continues to deny Puerto Ricans their aid via food stamps. Yet, Jennifer Lopez, famed celebrity of Puerto Rican background, offered up $1 million in aid through a NY State Aid program in the immediate recovery efforts.

Monica had even mentioned how some in her neighborhood are still using tarps because they cannot afford to fix their property. She explained how FEMA requires that the individual must own the property, and many who rent or have the property under a family member’s name were not able to receive those funds. From our own readings, we have found that many who applied for FEMA assistance were provided with a denied application due to the strict, and often times unfair, qualifications required to receive that funding. Furthermore, many were not able to apply because of the little assistance provided from FEMA agents within the island.

Even while the condition of her surroundings seemed grim, Monica was able to keep a cheery demeanor and even joked about how she had to get creative in the kitchen— “I’m gonna make a cookbook about how to cook during a hurricane. I’ve been really creative with how to make meals… a lot of beans. I thought I did good,” she laughed.

She possessed a positive outlook for every hardship they faced. Even the loss of electricity became a way in which her family became closer. She felt that this was vital in their ability to adapt and remain resilient, as they were able to be open about their experiences.

Even the loss of electricity became a way in which her family became closer. She felt that this was vital in their ability to adapt and remain resilient, as they were able to be open about their experiences.

Monica and her daughter, taking a hike through the rainforest to check on a friend.

“The lack of electricity ended up being such a blessing because we were together. We weren’t interrupted by our phones or TV. When the electricity did come back, it was kind of like, ‘I’m going to miss those times of connecting and talking.’”

Monica even described how her son seemed to be empowered by the whole experience. He was able to serve his community, and recognized his own ability to survive.

When I asked her about what her life is like now, 2 years later, compared to the initial impact back in 2017, she responded by emphasizing the way in which it is both necessary, and natural, to adapt to the situation as a whole. Her positive outlook was not an easy thing to maintain— she found it hard to assimilate back into her community, as many individuals were still distraught. She understood their pain, but could not be like that herself. Her positivity was her own way of adapting, and creating an environment for her and her children that allowed them to grow rather than fall apart.

“I have children. You have to keep it together. You have to make this a learning experience. You have to make this positive. You have children looking up to you who need guidance. How do I want my children to be affected? I can change their outlook in an instant. Yeah this sucks, but are we going to wallow? Let’s make this fun. They’re going to remember this from the rest of their lives, but now in a positive way.”

Monica’s resilience is a powerful message for us all. She and her family were able to see the good that the hurricane created in their lives. While she recognizes that it was in fact a terrible situation for people to be in, she also recognizes that she had a greater power to make the best of it all. Her story, experience, and outlook, are all vital when we consider the way that we choose to represent victims. While it is important to recognize the bad that they experience, to look at a group of people only as victims rather than survivors as well, undermines and limits their resilience.

The Silence on Maria in the U.S.— 2nd Anniversary Reflection

When Hurricane Maria devastated Puerto Rico, I felt as if I had only heard about its arrival, but never about what it left behind. There were pockets of information here and there about the damage that Maria created, but I didn’t truly know what this damage entailed. Growing up in an area without a strong Puerto Rican community before moving to New York City, I had very little connection to the island besides my few years of living in Luquillo as a child.

Me, around the age of 5, standing on the shoreline of San Juan.
PR Beach 2
2017, an image of the damaged San Juan shoreline from the Miami Herald.

I found no way to conceptualize the severity of damages, and all I knew was that people were suffering. Even the images I was seeing from my childhood conjured up some type of disconnection. It had been so long since I lived there. I could barely remember what it was like.

But why was I part of the silence surrounding Puerto Rico’s suffering? Was there something blocking public consciousness of the event? It seemed that there was an unintended silence, as people lacked awareness of the issues unfolding in Puerto Rico. 

Similar to other hurricanes I had experienced from living in Florida, the shock and preparation for the initial disaster was a giant headline everywhere I turned. People frantically prepared themselves for the worst, but we continued on our daily lives. We were used to hurricanes occurring each year, and so it was never a state of panic in the community. I had never realized, or even considered, the damages following these disasters until one of my friend’s house flooded due to the rain and rising water levels from the storm. Her entire neighborhood was trying to salvage as much as they could, losing important documents, family photos, and in some cases, losing their entire home to the damages. There was no news coverage about this in my town. The storm had passed, and so had the public’s eye. 

This example showcases a scaled-down version of the lack of awareness that exists on such issues such as Hurricane Maria. The lack of conversation alone gives us an alarming view as to the ways in which the public eye seems to be looking away. Interestingly enough, when looking at Google’s trending list from 2017, Hurricane Irma was the top Google search and top in global news. Both hurricanes were Category 5, both occurring within the same 2-week period, and both affecting similar areas of the Caribbean. So why is it that Irma has taken a number one spot in global news, yet Maria cannot be found on this list at all? This may be due to Irma’s effect on Florida, a part of the global power that is the United States, while Maria only affected Caribbean islands. This is further supported when looking at Google Trends in the United States. 

This first graph shows a comparison web searches from 2017 on Hurricane Irma (in blue) and Hurricane Maria (in red). There is a drastic and clear distinction between the number of searches. I took a step further, and looked into the following two years.

In 2018, it was clear that Hurricane Maria began to gain more traction in regards to its web searches. People became more interested in the topic, spiking around the anniversary, yet Irma still came out on top with higher numbers of searches.

The graph from 2019 shows similar results, but with less and less interest forming (except a small peak around the anniversary), but even this interest in Hurricane Maria seems to be diminished by the interest in Hurricane Irma.

It seemed that one narrative was competing against others— the focus or emphasis of one issue seemed to overshadow other issues that existed. Irma seemed to reside in the spotlight, with Hurricane Maria hiding in the background. And when we consider some of the reasons that Puerto Rico suffered, and how their conditions prior to the storm itself created that, it creates a more alarming understanding with the rich political history that contributed to these damages. The ongoing debt crisis, colonial systems involving political identity, corrupt government, coal ash pollution… these factors were only some of the things that contributed to the disaster that was Hurricane Maria.

We cannot blame individuals of the public though, as there was a spread of misinformation from people of authority. Most notably, President Donald Trump claimed that there were few numbers of deaths, far below one hundred, from Hurricane Maria in September of 2018. He denied the actual death toll of 3,000 people for both hurricanes, although Maria alone was responsible for an approximated 2,975 storm-related deaths

I realized that if I denied myself an opportunity to learn more about this event, I was no different than those who turned a blind eye to what truly happened. By pushing myself to become better educated on the topic, I dismantled my own unintended ignorance that contributed to the inability of these individuals to receive justice for reparations.

The lack of general public attention to the victims of Hurricane Maria showcases the way in which media manipulates what we are able to see. The constant, daily intake of new media makes it difficult to focus on one event— but this does not mean that something like the recovery of Puerto Rico from Hurricane Maria should be put on the back burner.

It is possible to discuss multiple events at once, and we must be conscious of how we may unintentionally contribute to the silence, and how we are influenced by our intake (or lack thereof) of news and media. It is important to demand transparency, ask our own questions, and be aware of what knowledge we lack. In order to shed light on issues such as this, we cannot stand idly by and allow it to happen.

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