Trauma, including one-time, multiple, or long-lasting repetitive events, affects everyone differently. While some individuals may clearly display symptoms associated with post-traumatic stress disorder (PTSD) immediately, many others may not, as the impact of trauma can be subtle and insidious. A recent event that may help illustrate the effects of trauma on mental health is the current circumstances of the residents of Puerto Rico after almost two years of rebuilding following Hurricane Maria.
Physicians and public health officials advise that returning to a routine is the most important step towards overcoming trauma, yet logistical barriers like scarce water and electricity make that nearly impossible. Instead, Dr. Domingo Marquez, director of clinical psychology at Albizu University, suggests that Puerto Ricans should adjust their definition of normalcy in order to function: “It’s ‘I survived. My family didn’t die.’ That’s the new definition of O.K.” However, I would make the argument that this line of thinking, only strengthens the feelings associated with trauma as the situation is no longer only about surviving, but maintaining.
This is particularly true for those who had mental illnesses before the storm. An example would be 39-year-old, Laura Rodriguez, who managed her borderline personality disorder without medication by adhering to a strict routine: Early morning CrossFit workouts, long hours at work as an interior designer, going to bed early and never having guests at home. But since Maria hit, Laura’s gym had been closed, her therapist has not been working, and Laura is now out of a job. “I’m constantly anxious. I get these urges to be violent and I can’t control it.”
Memories of the storm also tormented her as flashbacks of being trapped in her apartment for two days with her boyfriend, mother and her mother’s cat creep into her mind every now and then. She remembers the fear of being forced to use plastic tarps, towels, bedsheets and pieces of wood to try to plug the windows where rain water was surging through. Without access to any of the balms that she typically relied on to stabilize her mood, she worried about resorting to self-harm, an impulse that she had struggled to control since she was 8 years old.
Even for those without an illness, the lack of a stable daily routine has greatly affected their mental health as anxieties bubble below the surface. Dr. Carlos del Toro Ortiz, a clinical psychologist treating individuals in San Juan, has illustrated how many residents of the island feel by stating, “When it starts raining, they have episodes of anxiety because they think their house is going to flood again. They have heart palpitations, sweating, catastrophic thoughts. They think, ‘I’m going to drown,’ ‘I’m going to die,’ ‘I’m going to lose everything.’”
Dr. John Velazquez, the only physician on the eastern part of the island who was able to treat those with physical injuries during the first few days of the hurricane, has witnessed the shift of those previous patients now coming to see him due to psychological ailments. “They say, ‘Doctor, I don’t want to live like this. This is terrible for me, I need to move, but I don’t know where I’m going. My family wants to move to the States but I don’t know English, I don’t have an education.’”
Dr. Velazquez further stated that many of the people in Puerto Rico are very poor with limited education. The lack of opportunity for work and a way to rebuild their lives in the wake of Maria has been extremely hard to deal with, and has bred constant fear. Due to this, suicide rates have increased to more than 29% in 2017 in the aftermath of Maria, and they remain high as people struggle with limitations on work opportunities and confusion around U.S. Federal Emergency Management Agency (FEMA) funding applications.
But the population that has been most affected by storm are the children of Puerto Rico.
Months-long school closures left children isolated while the unsafe conditions kept them indoors. More than half of the youth had a friend or family member leave the island. Subsequently, a large number of parents have reported that their child has not spoken since the storm, or that they cry inconsolably when it rains. Other children have reacted by regressing (which is a child’s typical reaction to stress) by wetting their beds again or being unable to sleep alone.
To understand just how much the storm has affected Puerto Rico’s youth, one of the largest attempts in US history to survey young people after a major natural disaster took place. From February 1st to June 29, 2018, 100,000 to 226,800 Puerto Rican students (the largest sample ever of Hispanic youth impacted by disaster) were surveyed. The study found that:
- 5% of children’s homes were damaged, while 83.9% of children saw damaged homes
- 24% helped rescue people
- 5% were forced to evacuate
- 32% experienced shortages of food and water
- 7% still did not have electricity five to nine months after the storm
- Overall, about 6,900 students, 7.2%, reported ‘clinically significant’ symptoms of PTSD.
Further exacerbating the trauma for these children is that about 4% of the population (130,000 people) left the island after Hurricane Maria, according to the 2018 US census. The majority of these individuals were children who did not move with their parents, but instead went to live with family members already based on the mainland. While this was meant to protect children, the distance between them and their immediate family members has caused more stress and anxiety for this group. According to Erica Vera, a social worker in a New York state school district who has evaluated a lot of these children, the distress is coming from ‘a fear that this will happen again’- a fear so strong, that it’s causing many to have nightmares. In some cases, children as young as 8 have begun contemplating suicide after the storm because “they were completely desperate and worried about what their family was going through.”
Vera went on further to say: “What really hurt me was the concern of these young kids who are seven to eight years old, them being so scared for their uncles and grandmothers. I think it’s a feeling that the family is not safe over there. The feeling of loss and concern of these young kids for the safety and resources of the family members they left behind haunts them.”
Trauma is more significant over the long term. As Puerto Rico’s recovery is slow, its residents are being re-traumatized repeatedly. With media coverage of the island’s conditions lessened (and the President’s downplay of the catastrophic circumstances of Puerto Rico’s residents), most of us on the mainland are unaware of the island’s situation. I hope this piece helps promote conversations on the American mental health crisis that is Puerto Rico.
Ways to Help:
- Donate to Maria Fund, where 100% of monies raised support grassroots community initiatives impacting immediate relief needs
- Help with United for Puerto Rico, with their goal of facilitating recovery for individuals and small businesses by helping meet housing, food and health needs
- Aid the nonprofit Hispanic Federation, with their UNIDOS Disaster Relief and Recovery Program aimed at serving the immediate and long-term needs of PR families and communities
- Support UNICEF’s efforts, who has been mobilizing teams to aid children and mothers in PR
- Make a donation to the American Red Cross for disaster relief
– Barr, Jennifer. Mental health crisis grips Puerto Rico as rebuilding efforts stumble a year after hurricane. CBC News. 2018.
– Dickerson, Caitlin. After Hurricane, Signs of a Mental Health Crisis Haunt Puerto Rico. The New York Times. 2017
– Holpuch, Amanda and Kilani, Hazar. Hurricane Maria’s lasting impact on Puerto Rico’s children revealed in report. The Guardian. 2019.
– Lybarger, Jeremy. Mental Health in Puerto Rico. American Psycholocial Association. May 2018, Vol 29, No. 5
– Wyss, Jim. Puerto Rico’s suicide rates spiked after Maria. And the mental health crisis isn’t over. Miami Herald. 2017.