Life on the edge

In the aftermath of Saturday's earthquake, Christchurch clinical psychologist FRAN VERTUE looks at the psychological toll and how best to cope.

Everyone in Christchurch experienced an extremely traumatic event this past weekend.

However, our experiences have ranged from fairly mild to extremely severe, and our reactions to these experiences depend, to some extent, on our past experiences and our personalities. We will all have to make sense of the traumatic events so we can go on living productive lives that are not limited by the psychological results of the trauma.

The human brain has very specific ways of dealing with unpredictable experiences of this kind. Our brains go through two critical processes - immediately evaluating the risk, and instantaneously finding ways to avoid being destroyed.

However, once the danger is past, we have to find ways to integrate the memories of the events into our understanding of how the world works.

Most of us will not have been in a life-threatening situation before, and so our memory networks inform us the world is generally safe and we, or the people around us, will not suddenly die.

Because they have taken our own lifetimes to reach their current state, these memory networks are slow to change.

So for a period of time, the memories of our traumatic events "float" around before they can be built into a restructured memory system. It takes a while for us to reconcile a life-threatening event, such as the earthquake, with our existing beliefs about the world being generally safe. This change process can take weeks, and in the meantime, we struggle with the experiences that are commonly associated with post-traumatic stress disorder (PTSD).

However, a diagnosis of PTSD requires that a month should have passed since the traumatic event. In our case, it is only five days since September 4, so we talk of acute stress disorder, where the disturbances in our thinking, feelings and behaviour have lasted for a minimum of 48 hours.

Common experiences of acute stress disorder are a sense of numbness, "being in a daze", disrupted sleep, being very easily startled, feeling irritable, struggling to settle down to work, feeling disconnected from the real world, and having recurrent distressing images and thoughts of the event. These experiences are likely to continue until each of us, in our own way, makes sense of the events and knits the new memories into the fabric of our existing memory networks.

Over a period of time, we will isolate our individual memory fragments about the earthquake, and work out just how much each fragment changes our general perception of the world as a safe place. For example, you might remember being at home, in your bed, when the earthquake struck.

You need to build this memory fragment into your existing knowledge about how safe you are in your bed. Over time, you will build this memory fragment into your general understanding of your safety in bed, and as you build up many more safe nights in bed, your anxiety about going to bed will fade. Additionally, you will integrate your memories of coping with the danger, and your resilience will be strengthened because you know that you have survived this terrible event.

Given the differences between adults and children in terms of an appreciation of death and a capacity to see "the big picture", there may be significant differences in the ways that adults and children cope with the earthquake and its associated events. For example, children may seem to recover more quickly from the trauma, and may be distracted more easily than adults from thoughts of the event.

The fact is that they may be relatively unaware of the life- threatening danger involved in extremely unusual events such as an earthquake.

Critically, children look to the adults around them for indications of their own safety. When adults express fear or distress, children get the message that they, too, are in danger.

Importantly, children receive most of their information through non-verbal channels - it's not always what you say to your children that impresses them, but the tone and volume of your voice, your posture and your facial expression.

Just like adults, children rely on predictability to feel safe. So parents can support their children's adjustment to a traumatic event by ensuring that routines are adhered to as far as possible, that they stay close to their children, and that they are available to answer questions.

Remember children do best when their questions are answered briefly. Children can only process relatively small pieces of information at a time, so they can become overwhelmed if they are given comprehensive answers to simple questions. For example, the question, "Will there be another earthquake, Dad?" does not require any kind of seismological answer. A simple response, such as, "I don't know, but we did good with this one, so we'll do good if there's another one" would do nicely.

Children primarily want to know that they are safe, and this is best accomplished by simple parental reassurances that the adults are taking care of business, and that they (the children) can concentrate on more age- appropriate pursuits.

Remember, too, that children vary enormously in their tolerance for threat. Some children are hardy creatures, who bounce back from danger almost effortlessly. Others have a lower tolerance, becoming anxious quickly and remaining so longer.

It is vital parents understand their child's temperament to know how best to facilitate their adjustment to this changed world. If a child experiences high levels of anxiety over a period of time, it may be helpful to get specialist assistance, because, be in no doubt, our inner worlds will be changed forever by this earth- shattering experience.

Dr Fran Vertue is a clinical psychologist and part-time university lecturer. For more about her or her work, see christchurchpsychology.co.nz

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