Will we keep on sharing?

Two people embrace after the February 22 earthquake.
Two people embrace after the February 22 earthquake.

Christchurch has become many things post-quake - that includes being the ideal human laboratory on how people respond to and cope with such a natural disaster. PHILIP MATTHEWS reports.

City of sadness, city of sorrow, city of sharing? This one certainly grabbed our attention just before Christmas.

A press release from the Canterbury District Health Board announced a new general manager of its Specialist Mental Health Services. That was possibly interesting in itself, but I was more intrigued by comments attributed to that new manager, Toni Gutschlag.

Drawing on more than 20 years' experience working in mental health in Canterbury, Gutschlag said the Christchurch earthquakes had helped to break down some of the stigma that surrounds mental illness. Mental health had become more of a talking point since the quakes, and there is a greater awareness of the importance of mental health and wellbeing.

Chalk that one up as a positive. A few weeks into the new job, Gutschlag is able to talk about this story a little more.

"What we've seen within our services, but also what I and many others have seen just as members of the community, is that we're much more aware of the importance of mental health and the impact of stress and it's able to be spoken about in a much more open way," she says.

"The stress and anxiety and worry and pressure that we've all experienced to different degrees since the earthquakes have meant that mental health is now something that can be spoken about without needing to whisper. The sense of shame or embarrassment that might have been there before is not so prevalent. I think that's got to be a good thing."

The question as we approach the second anniversary of the worst quake is: will this endure? It has been often observed that the post-quake period in Christchurch resulted in an increase in community spirit, however you define that. In the midst of disaster you can get, as writer Rebecca Solnit has put it, a "paradise built in hell". This openness about our mental health and sensitivity to others is one small version of that paradise.

"My personal view is, of course, it's not the same as when we were in the acute response and in shock, but there is still a genuine interest from a community perspective," Gutschlag says.

"If you go the supermarket, people still ask questions about repairs and how people are progressing, how's your family and how are people doing at school, and it is still easier to speak with people that you don't even know well about those areas or points of stress. I think we are still a much more cohesive community than we were pre-quake.

"We heard reports of people who maybe weren't working and had been very unwell for periods of time, they took on roles within their neighbourhood looking after neighbours, and became known by people, and were and still are valued members of the community. Maybe before they had really kept to themselves."

As for its peaks and troughs, there were "increases across primary care" after the February 2011 quake and "now we're seeing some decline in the specialist end". Demand has eased off, but predictions have been difficult. It's commonplace that you often see a delayed effect, with mental-health effects surfacing 18 months to two years after a traumatic event. But, Gutschlag wonders, when do we count from? The September 2010 event? The February one? Or do we start with your repair and insurance challenges?

In general terms, both mental health and Relationships Aotearoa have had increased resources.

You don't have to go very far into the literature about mental health after a disaster to come across references to "perceived benefit". In 1997, a paper appeared in the Journal of Consulting and Clinical Psychology in the United States, produced by three academics at the University of Washington. It proposed that "the study of growth and perceived benefit after traumatic events has been hailed as one of the most promising directions for stress research".

Three disasters were compared. There was a tornado in Florida in 1988 that killed four, injured 17 and cut a path almost two kilometres wide and 19km long right through the town of Madison. There was an air force jet that crashed into a hotel in Indianapolis in 1987, killing 10 people, nine of whom were hotel staff. There was a shooting in a cafe in Texas in 1991 in which 24 people, including the gunman, were killed.

In each case, survivors were interviewed four to six weeks after the event and then re-interviewed three years later. They were asked, "Sometimes even the most awful events have their good outcomes, at least in part. Can you think of anything positive that came about as a result of this event?"

They found that those who perceived benefits soon after the event were less likely to have post- traumatic stress disorder three years later. Those with high exposure who perceived benefit tended to have the best recovery, while those with high exposure who did not perceive benefit tended to have the worst.

Yet "it remains premature to suggest a causal benefit between perceived benefit and adjustment". Perhaps those who are predisposed to optimism, open to new experiences, who have what the jargon calls "cognitively complex self-representations" and hardy personalities are most likely to perceive benefit and cope effectively. But the same study found that "a higher number of pre-incident mental-health diagnoses predicted perceived benefit". Put simply, those whose lives were in the worst shape before the disaster might have the most to gain.

There were also differences in perceived benefits across the three American locations. Essentially, the smaller the town, the greater the benefit.

Again, there are various possibilities. Are smaller communities more able to rally to the aid of victims? Is there something in the corporate response from affected companies? Survivors of the cafe shooting were more positive about their employer's response than hotel staff. Perhaps people are more comfortable in offering aid after a natural disaster than after criminal or technological disasters. Perhaps tangible aid, such as housing and food, is easier to provide than emotional assistance.

Of course, there is also an enormous amount of subjectivity in all this.

"I guess what you're saying is a disaster puts things into perspective for us," Gutschlag says. "It does really crystallise what's important and what is not."

Some big decisions about our lives were taken out of our hands in the immediate weeks afterwards, she remembers.

"It's relationships that matter, it's taking care of ourselves and our families and the people that are close to us."

In Christchurch terms, we might also take a positive from the immediate response of most of our services. There was a feeling that society worked as it should. Gutschlag: "I was very proud to work in the DHB vulnerable young persons team."

What this really tells you is that people in post-disaster environments are an ideal human laboratory. Study follows study. Many relate to ways of coping.

In December, Chris Sibley and Joseph Bulbulia's paper, Faith after an Earthquake: A Longitudinal Study of Religion and Perceived Health before and after the 2011 Christchurch New Zealand Earthquake, was picked up by the media because it found secular people might turn to religion after a disaster.

A more interesting part of their research was less discussed. They looked at whether having a religion made a difference to "subjective ratings of personal health". Is religion a kind of panacea? Not really, but "among those affected by the earthquake, a loss of faith was associated with significant subjective health declines".

Those who lost faith elsewhere in New Zealand did not experience similar health declines. In short, "religious conversion after a natural disaster is unlikely to improve subjective wellbeing, yet upholding faith might be an important step on the road to recovery". Or, if you lose your faith, you will feel worse than if you never had it.

Sibley is from the University of Auckland and Bulbulia is at Victoria University in Wellington. If you read the paper, you see that its authors got lucky. The earthquakes hit between the 2009 and 2011 waves of the New Zealand Attitudes and Values Study, which assesses change and stability in values nationwide.

"The timing of the earthquakes between two survey points afforded the unprecedented opportunity to examine how a natural disaster of this magnitude affects deeply held religious commitments and global ratings of personal health."

As was reported, religious conversion in Canterbury bucked the usual trend of ongoing, gradual decline, with the proportion of believers growing from 35.5 per cent of the sample in 2009 to 39.5 per cent in 2011.

"Thus, in the region where the church spires had fallen, faith soared," say the authors.

But the study also argued against the so-called "superior buffering hypothesis", which says that the religious will feel subjectively better than the non- religious. The "comfort model" is not as straightforward as it seems, as religious conversion is a complicated thing, yet although "faith eroded elsewhere in New Zealand, there was a significant upturn in religious faith among those who experienced the misery of New Zealand's most lethal natural disaster in 80 years".

This brought the authors to a fairly provocative conclusion. "Whether religious or secular, those who want to foster healing in the aftermath of a devastating earthquake should consider joining arms in rebuilding the broken churches, for those who have faith."

Other studies tell us other things about life in the human laboratory. This month, University of Canterbury masters student Sarah Yanicki presented a study called East Side Stories: Cases of Quake Related Innovation. The idea was to compare quake responses in Aranui and Sumner.

Again, the quake was "a unique opportunity" for a sociologist. One suburb is wealthy, one is poorer and both are in the east. Did any of this make a difference?

Yanicki found that, in Aranui, groups remain focused on tackling social issues that follow earthquake disruption, while, in Sumner, they have moved on to restoring and even improving the suburb. But, in each case, the wisdom of local groups was invaluable straight after the quakes, and they moved more quickly than Government or Civil Defence. In Aranui's case, this response came from groups already in the community, such as the Aranui Community Trust. In Sumner, new groups emerged.

Initially, both suburbs were dealing with the same things - food, water, accommodation. But, as time went on, the focus changed, with Sumner getting into rebuild mode more quickly.

Beyond the University of Canterbury's better-known input in areas like engineering and geology, there are also further contributions from sociology and psychology. Masters student and trainee child psychologist Ellen Sole is researching post-quake anxiety in children.

In a media release last month, Sole talked of the strain on family life post-quake that includes behavioural and psychological issues.

"Parents often have to be close to their child for them to go to sleep," Sole says. "The child may experience separation anxiety when away from the parents making childcare difficult. They may try to avoid places making family outings or visits to the shops more difficult, there may be financial impact if the parent is trying numerous avenues to help their child.

"Parents can be stressed and tired themselves because they find it hard to help their child and see them unhappy. Sibling relationships can also be affected when a child is anxious. Certainly Christchurch children have had to cope with much more than a lot of children do, so we would expect that some of these children will struggle."

The study looks at whether micronutrients can help these anxious children. Sole expects final answers later in 2013.

What else have researchers been looking at? Last year, University of Canterbury health science graduate Mohamud Osman led a study that found former refugees living in Christchurch "coped well" with the earthquakes, even though more than 80 per cent of them got no help or support from the Christchurch City Council or Earthquake Commission and more than 60 per cent found it hard to access help and information.

Osman found that religion and spirituality helped his group, who were from Afghanistan, Kurdistan, Ethiopia, Somalia and Bhutan.

But, for many in the quake- damaged city, church was online, according to a senior lecturer in management, Ekant Veer, who looked at social media's function. His research found that Facebook and Twitter became the "place" where people could share stories, comfort each other and find solace. As we communicated with each other, we also updated the world.

Education lecturer Veronica O'Toole has been looking at the emotional impact of the earthquakes on Christchurch teachers, exploring the idea that, as in New York after 9/11, teachers were the unsung heroes.

In psychology, associate professor Neville Blampied has looked at the quake's effects on academic performance, towards a chapter in a book titled Forces of Nature and Cultural Responses. There was also a report on "post- earthquake psychological functioning in adults with Attention-Deficit/Hyperactivity Disorder".

An associate professor in social and political sciences, Kate van Heugten, measured stress and exhaustion in frontline workers and managers. The result: burnouts increased. That might seem obvious, but there were nuances, including a message for employers.

"Research has shown that it is factors in the organisation, rather than in the person, that lead to burnout," van Heugten said in a media release. "Factors that are implicated are not just high workloads. Workers are more likely to burn out in organisations where they experience lack of control over how they work, unreasonably tight regulations, and where they don't feel the organisation treats them with fairness and respect, or they feel disillusioned about the organisation's values."

She warns that people's capacity for work will be reduced after "an ongoing major community crisis" while demands may increase. Organisations need to be aware of that and offer "practical support, coupled with respectful empathic communication".

Last June, an entire conference at Canterbury was focused on earthquake-related research, drawing on everything from journalism to law to psychology to biological experiences. The open- air laboratory is on the university's back door.

Some of what is found out may seem self-evident to the stressed populations who have lived through the past two years. But, at the same time, it must be reassuring to think that, next time a disaster like this hits a major urban area, that community will be able to take guidance and maybe even comfort from reading about what has happened to us.

The Press