Dr Robert London

PTSD and the Gulf Oil Spill

Clinical Psychiatry News -Volume 38; Issue 7; Page 10, 2010

Awareness and treatment strategies for posttraumatic stress disorder should be at the forefront of mental health care in the Gulf states. After all, the Gulf oil spill is now ranked as the greatest man-made disaster this country has ever seen.

Usually, PTSD occurs as a result of a severe emotional trauma from an event that is life threatening. It often occurs in the wake of military combat, violent personal assault, kidnapping, torture, incarceration, and/or man-made or natural disasters. PTSD often leads to a combination of symptoms, including depression, suicidal thoughts, homicidal thoughts, anger, irritability, severe generalized anxiety, and sleep disturbance. It’s clear that for the residents of the Gulf, the BP oil spill qualifies as such an event.

The ecological disaster has turned upside down the lives of thousands people in Louisiana, Alabama, Mississippi, and Florida. We’ve watched countless television interviews with resilient, hardy residents of these states—who have tearfully described the devastating impact of the spill. For some charter boat owners, fishermen, shrimpers, hotel workers and owners, individuals in the tourist industry, and even owners of jet ski rentals, this calamity will be a turning point in their lives. The reality, of course, is that the spill will have a ripple effect across the entire economy. People are losing their livelihoods.

With a loss of livelihood often comes a loss of mental health. I worry that this traumatic experience—especially just a few short years after Hurricanes Katrina and Rita, will lead to PTSD—not only among the vulnerable, but among those without any previous mental health issues.

A few months ago, I wrote a column focusing on the mental health effects of the earthquake that upended the lives of the people of Haiti (“Mental Health and Haiti,” April 2010, p. 7). Certainly, PTSD, as well as other mental disorders, is commonly seen after a disaster as enormous as the Haitian earthquake. As one study of the Sept. 11, 2001, World Trade Center attacks shows, the resulting trauma often lasts long after the event (J. Clin. Psychiatry 2005;66:231-7).

Unlike Haiti, we do have a well-developed mental health system in the United States. That means we should be prepared to offer strategic mental health care as a national priority for those who might be suffering and at risk. However, as in Haiti, there is a rich and distinct culture in the Gulf area. Just as mental health professionals must be careful to respect Haitian culture while delivering services, we must do the same in the Gulf as we educate people about and treat PTSD.

Not only are Gulf residents at risk of developing PTSD, but all too often, survivors of these kinds of disasters fall into alcohol and substance abuse, which end up exacerbating the mental problems.

PTSD has some obvious signs and symptoms, but sometimes it can be hidden. What appears to be depressive disorder and generalized anxiety disorder may actually be subthreshold or subclinical variations of PTSD (“PTSD: Another Great Masquerader,” The Psychiatrist’s Toolbox, May 2009, p. 23).

Individuals in the Gulf states who are experiencing business loss, bankruptcy, and living from week to week on a paycheck that suddenly disappears are at risk for mental disorders, especially PTSD and including subthreshold/subclinical variations that masquerade as other disorders.

Educational seminars, group therapy, and medication management all have been shown to be valuable in treating the PTSD. However, in my experience, the use of relaxation techniques, reciprocal inhibition, guided imagery, and systematic desensitization have been the most effective short-term treatments.

Another successful short-term successful approach has been the use of virtual reality. This technique, which uses a head-mounted device replaying traumatic events in an ascending order in order to desensitize a person from a traumatic event, (a high-tech version of in vitro desensitization), has been used by the military and certain medical centers across the country.

It is important that psychiatrists, psychologists, and other mental health professionals not only learn the proper diagnoses seen in subtle variations of PTSD that might masquerade as other disorders. We also must focus on codified short-term treatment strategies that have demonstrated the most success in treating PTSD. By doing so, we offer the most efficient strategies to help the potentially large numbers of people who might be experiencing signs and symptoms of this disorder. It is important to avoid traditional open-ended talk therapies that are not the first-line of care in PTSD.

In addition to these psychiatric/psychological interventions fir PTSD prevention and treatments, some social and economic interventions might stave off serious emotional problems such as PTSD. Just as we recently bailed out the banks and a large part of the auto industry, it would seem more than reasonable that the culprits of this disaster assist thousands of hardworking people with more than just their actual losses. They must also be mindful of the psychiatric/psychological toll that has occurred and will likely occur in many people.

Just as compensation for physical and economic losses should be prompt, fair, and adequate, so, too, should such awards aimed at providing compensation for the fallout from emotional problems and losses, such as PTSD. While not a bailout in terms of what the government did for our banks, such assistance—which is owed—would help some hold back the emotional disasters likely to occur from a fracture within the identities of many Gulf state residents. The $20 billion escrow account set up by BP for claims associated with the catastrophe is a step in the right direction.

Organized psychiatry should gear up, and offer educational and treatment strategies that would help our fellow citizens in this current disaster.