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.
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.
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.
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.
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.