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The Better Healthcast brought to you by the Better Health Channel at betterhealth.vic.gov.au
Please be advised this episode discusses events surrounding the 2009 Victorian bushfires. Our content may be distressing or triggering for some people. If you need support speak to family and friends, your GP or contact Lifeline on 131 114.
Welcome to the Better Healthcast. Today’s Podcast is on recovering from long-term trauma. I’m Hayden Nicholls.
In early 2009 Victoria experienced the worst bushfires in our nation’s recent history. Up to 400 individual fires burned across 450,000 hectares of land. There were over 3,500 buildings destroyed, many of them were people’s homes. 173 died as a result of the fires and many more were injured.
This episode of the Better Healthcast we’re talking about how these disasters affect people’s whole lives and what the journey of recovery after a traumatic event involves.
With me I have Dr Rob Gordon, a Psychologist who specialises in trauma, and Anne Leadbeater OAM who led the recovery effort for the Kinglake Ranges in the wake of the 2009 Victorian bushfires. She now uses her experience to support National Policy Development and Training for emergency management staff and volunteers.
Q: Rob, can you tell us a bit about yourself first?
Rob: Yes, I’ve been a Clinical Psychologist working in the area of disasters since 1983, the Ash Wednesday Fires, and for about 25 years I’ve been a consultant to the Department of Health and Human Services and that’s given me a role in working with almost everything that’s happened in Victoria, and I’ve done a lot of work throughout Australia and New Zealand in various events.
Q: Anne, yourself as well?
Anne: Yes, I live in Kinglake and my background is Local Government and State Government. I’ve been working in emergency management now for 10 years and I run my own consultancy consulting on disaster recovery and working with disaster in [02:29 unclear] communities here and in New Zealand.
Q: Let’s start with you Anne. Tell us a bit about your experiences in 2009.
Anne: We live in Kinglake and we were home on the day of the fires; with family members we fought the fires at our house and then in the days and weeks following I was working on behalf of Local Government to help coordinate the recovery of our community and the communities in our area. That involved working with emergency services and recovery agencies, DHS, all sorts of different people, and just trying to coordinate the information, support and resources that the community would need.
Q: When did you get involved in 2009 Rob?
Rob: Well I live in the Yarra Valley and on that day our town was completely surrounded by fire and luckily for me as a spot fire approached our property the wind changed and blew it away, but it was very much touch and go at the time, and then in the aftermath I began working with various communities and providing training and orientation to many of the people working in the fire affected areas.
Q: During an event such as a bushfire or other life-threatening situations, what are people likely to be experiencing and when does an upsetting or negative experience become a more serious traumatic episode?
Rob: I guess the first thing to realise is that when we’re presented with a threatening situation we go into our adrenaline mode and that means we get very focused on what we need to do to survive and that often means in the first instance we actually put aside our emotions and go into action mode, and people usually don’t have a very clear sense of what’s going on inside them at that time at all, they often don’t feel hungry, tired or thirsty or even pain as long as the urgency is on them. And as time passes they come out of that, they recognise the losses, their own or other people’s, and then a whole lot of emotional reactions start to kick in and there’s often quite a protracted period of movement back and forth between these moments of emotional response and then going back into action mode. Then that really keeps going until some kind of routine or order is established, for those who lose their houses that will often mean multiple rapid changes of where they have to live, buying a whole lot of things, talking to the insurance company and so on, but then there’s a certain point where they are in new accommodation and things start to settle and then they see, everyone in the community sees this huge long road ahead, and then they shift gear from the acute stress of the adrenalin to the chronic stress of the cortisol – cortisol is the chemical that helps us survive that – and then starts a long dogged grinding slog as people work their way through and that will often go for quite some years. Then as they come out of that, they’ve got their new house, etc, they start to feel ‘I’m coming out the other side’ and they’re often very surprised that it’s actually when everything is over and they’ve moved into the new house now they start to feel really sad and a lot of the feelings come through. For other people in the community who didn’t lose their houses they’re somehow caught up in it again and they find it’s several years down the track before they’re really starting to feel it, and it’s really only when you then work through a lot of those emotional responses that you actually have to start thinking about, ‘Well okay, who am I now? How do my previous life goals still fit or do I need to change them?’ and really one of the defining characters of an event like this is that it irreversibly changes your sense of what life is about, your values, your priorities, what’s important, and often the people who didn’t go through it with you can’t understand why you’re different. So that’s another stage and I would say as we are coming up to the 10 year anniversary people are coming out of this stage now, some are probably still working with it, but many people are coming out and now in a very important position of being able to look back and reflect so that they can start to think of this as part of their history, put it into a big picture.
Q: Rob just mentioned at the start there the not feeling but just going straight into action mode. You were up there in the middle of things and from once you’d defended your place you were straight out amongst what was left of Kinglake to see what the damage was, how did you feel in those moments, situation?
Anne: Yeah I think what Rob is highlighting is absolutely the way the situation unfolds. The overwhelming sense is one of disbelief, the evidence is in front of you, you’ve seen the damage or hearing about what’s happened, you’re trying to make sense of the enormity of this event and you just keep saying to yourself, ‘I can’t believe it, I can’t believe this has happened’ so then it’s this painful process of actually piecing together a picture of the whole story of what’s occurred, what’s been lost, the people that have been lost, but all the time trying to do that in a sense of absolute uncertainty about what comes next. So you’re really, I describe it as being off the map, in terms of the way your life has worked up to this point, the sorts of things that you have used to guide your passage through your day-to-day life, at least temporarily disrupted or swept away, so you’ve got to try and piece together some way forward and it is quit overwhelming, and it’s quite exhausting too initially, and for a long time.
Rob: In regard to the question about when does it become traumatic, I think this is a really important point. The word ‘trauma’ in medicine means a wound or injury and I think a psychological trauma is when my ability to process, adapt, come to terms with it has been damaged and I can’t do that. So in other words the experience doesn’t fade into sadness as normally happens with serious losses, every possible thing reminds me and takes me back, I don’t just remember - that reminds me of Black Saturday - I’m there feeling it, smelling it, frightened, quivering, sobbing, whatever, again and again and again, and so we could say that a traumatic event occurs when a person’s most fundamental beliefs and assumptions are shattered, and described how this sense of disbelief is a challenge but people can stretch and say, ‘Okay, I’m getting used to it, I’m accepting it’, but if you just can’t, if that disbelief is accompanied by severe life threat or loss of loved ones around you and so on, all sorts of horrible things, then this is something that the person often just can’t process. One of the things that we could hope is that now by reflecting back after 10 years they can begin to get a perspective on it even though it’s very painful.
Q: Can a big anniversary like a 10th anniversary that is coming up assist things often in that sense, or can it just keep the status quo?
Rob: I think actually both can happen, so one of the things I emphasise to people coming up for anniversaries is have a think about what this means for you and what you want to do with it, because if you can make a plan about how you will reflect and commemorate this very, very important event in your life it will give you a greater sense of control, and it will give you a sense of history, of survival, etc. If you haven’t prepared for it then it comes upon you in ways that you don’t feel in control of; the risk is it will trigger you back into it, you will feel very distressed and you will feel as though 10 years haven’t passed at all, and I think a very important part of it is this planning and preparation and so some people might like to come down to the official process, other people might like to go to the local event, other people might like to just have a barbecue in the back yard with their close friends and that’s fine, everything is right, there is no right way except what the person wants.
Anne: The interesting thing about this time of year as well is that as the anniversary approaches the conditions in the landscape replicate what was going on at that time as well, so that’s often a subconscious reminder of all that has happened and all the time that’s passed. The sun will shine through the clouds in a certain way or the wind will pick up the leaves and blow them across the yard in a certain way and those things are very powerful reminders of that time and what was going on at that time, so you not only have the red date on the calendar as a reminder of the time but also all of these physical reminders in the natural environment too.
Q: Are there specific signs to indicate that someone has been traumatised, and is it always obvious to the victim themselves?
Rob: That’s a very good question. The answer to the second part is no, it’s not always obvious to the victim, but the real hallmark of traumatic event is the re experiencing, the involuntary intrusive re experiencing, so the sorts of associations or the circumstances that Anne described are likely to – we popularly use the word ‘trigger’ – trigger the reappearance of so-to-speak unprocessed memories that still carry all the emotions and the person finds themselves reliving rather than remembering. When I remember something I remember that I was very sad or frightened. When I relive it I feel very sad or frightened. That would be one sign, the other sign is that if that threatens to happen people can shut it down but when they do that it’s very likely they will shut down all of their spontaneity and their emotions and they will become a kind of slightly disconnected kind of person and that’s the big where they mightn’t recognise they’ve done it but those people around them will say “Well Rob seems to be pretty disconnected and off the planet, I don’t know why he’s not laughing and he doesn’t want to come out or do anything, he’s just sitting at home, hopefully not with a beer bottle, but just trying to space out.” I think what’s important is I don’t think we help people by saying, “Hey, you must be traumatised, come and talk about the fire” because by definition they’re saying, “I don’t want to go there” but I think just being warm and friendly and engaging with them so they relax is very supportive. The third sign to look for is some indication of constant heightened arousal, now that adrenaline process, and that means your nervous system is keyed up and overactive, more active than it should be. Now that can happen by: You’re jumping at little sounds and getting anxious, getting upset if someone beeps the horn behind you, or getting irritable and impatient with your kids or your family when you didn’t feel like it, or wouldn’t normally do it, or having difficulty sleeping or concentrating, people often say they can’t read the way they used to and they haven’t got that concentration span. So this sense that your mind is really busy all the time but unproductive, this is a sign you’re really revved up and I think if a person is experiencing any of those three it’s really important to think about, wait a second, what’s going on here? It would be a great advantage to me to do a bit of processing here, talk about it with my friends and family or go to the GP and get some advice.
Q: I suppose we’ve touched on it just then but does trauma affect people differently?
Rob: Yeah, you know there are some people who will try to push the trauma away by being active and we did notice that there were people who didn’t come forward for support with their traumatic reactions for three or four years afterwards, often they were farmers and so on who were busy building fences and so on.
Q: Sort of bury yourself in the work kind of thing?
Rob: That’s right. Their wives often were meeting with other women and talking and processing things, but the husbands are out doing work often by themselves, so they’re not talking about it and when they do meet they’re tired and they don’t talk about the experience so much. So that’s one way I think that people react to it. Another way is I think people just get very strong emotions of fearfulness, apprehension, which then will actually spread beyond the kind of reminders of bushfires to sense of danger and so they are liable to become much more anxious and insecure, they might be anxious about their loved ones being away or things like that. Now we know that if people recognise that and rebuild their confidence they will start to recover, but I think probably one of the constructive ways of doing it is, as often as it comes into your mind talking through what’s happened with other people and in those environments as you would say Anne, there was lots and lots of talk in the street, in meetings and so on, as people slowly worked their way through this whole experience and that’s a very constructive way. Some people can’t bear it and don’t want to hear about it, and they do it in their own way, and we have to respect that too.
Q: When you mentioned speaking to people, you mentioned earlier that people who weren’t involved, folks who are suffering from trauma might be feeling like ‘You couldn’t understand because you weren’t there’ so is it better to speak to people who were also in that situation or still useful to speak to other people about their experiences?
Anne: Yeah, I think it’s interesting because in one way in the immediate aftermath it was a blessing to talk to people from outside the area because they could just listen, you didn’t have to exchange stories, so you didn’t have to hear about their sad experience in order to share your own, however there’s also an enormous comfort in talking to people who had a similar experience because you don’t have to explain what it was like or what it sounded like, how you might have felt, because they’re there with you and they understand straight away, but I think the important thing as Rob was saying, is to actually talk about the experiences in as many ways and to as many different people as you can because you can feel a sense of control returning; the more you understand about the experience the more you’re able to explain it to other people, the more in control you end up feeling yourself. So I think talking – we used to have a bit of a joke in Kinglake, we’d say ‘It didn’t matter what we started talking about, we would end up talking about the fire’ because it’s such an all-consuming experience, it touches every aspect of your life, so there’s not one bit of your day-to-day life that’s kind of immune from that larger experience.
Q: How did the physical impacts of emergencies like loss of loved ones or possessions, or coming close to losing loved ones or possessions, how do they impact on recovery?
Rob: Often people who have survived, their house has survived, feel a tremendous burden of guilt when the houses on either side have burnt down for apparently no reason – I mean no reason why their house hasn’t burnt too but it didn’t and there they are alone – I’ve talked to many people – find themselves sitting alone and it’s a terrible feeling to be suddenly in a suburb that used to be filled with your friends in the street and they’re all gone even if they haven’t died, and these people also don’t feel entitled to put their hand up and say, ‘Hey, I’m really hurting; I’ve lost my whole community’ because they didn’t actually lose material objects, and I think it’s very, very easy in the aftermath to align our understanding of the effects with the physical effects, but by no means are all of the most severely affected people the most physically affected people, it doesn’t align that way at all. As Anne said, we really just have to be very sensitive to what does it mean for a particular individual? There was one other point I wanted to add about this question of talking and talking to people outside. I think as Anne described the benefit of talking to the affected community is that they get it, but the disadvantage of that is, I’ve got to take theirs as well and in the end we’re also sick of talking to each other that the risk is we drive each other mad; on the other side we support each other. So therefore I think that the talk to the people you’re with and the talk to the people who are outside that are your old friends and family are complementary, I think they each provide different facets of the recovery process, but we really need to do is to educate the outside family and friends to keep listening a lot longer than they want to because from the point of view of someone who wasn’t there it gets boring to hear the same story over and over again, and you want them to move on. There’s a woman who has recently written a book about her disaster experience called “Aren’t you over it yet?” and that’s a cry that often comes back, “Aren’t you over it yet? You should, it’s six months already”. In six months I haven’t even hit the ground yet, three years, five years, whatever. I think if we go back to that sort of timetable I sketched out before, there are a whole lot of things that probably are still going on for a lot of people and what the greatest gift you can give to your affected loved ones and friends is just listen, and when I talk to people about that I say, “I know that a lot of it is the same but when you listen, listen carefully to what are they saying now that they haven’t said before, and what are they not saying that they used to say?” and that might only be 10% but that’s where the movement is, isn’t it?
Q: That’s where it’s starting to process.
Rob: I’ve let go of some things and now I’m actually starting to process something else and if you listen from that you could see that people slowly – even though they’re repeating the whole core of it – they’re slowly working their way through it.
Anne: Because the important thing to understand there is that the person who is telling the story doesn’t know how long this is going to take either. You tell them and you go, “Okay, I’ve got my head around that now, I understand what my experience has been” and then you might speak to someone else and you get a difference insight into what happened for you or what happened for them, and so you don’t have any sense at the beginning. I remember being given a note in the early days after the fires and it said that one of the large hardware firms wanted to bring up some plants and I’ve got the note, I wrote on the bottom, ‘Tell them to call back in two weeks’, and in my naivety I actually thought that we would be ready to talk about plants in two weeks. Of course two weeks went by in a blink and we were no more prepared to talk about those sorts of things than we were the day of the event, but what that helped me understand was that I had no more sense of how long this would all take than anyone else, and we have to actually get much better at understanding that this is such a long process, and that’s okay. It doesn’t mean you’re doing it badly because it’s taking a long time, it just means that it’s a lot to take in.
Q: What about people that are not traumatised, what ways might they be affected still if at all by events?
Rob: I think there are three major impacts of disasters, the first one is the trauma and that’s usually defined by the threat that the person felt on the day to begin with, but the second one is loss, and I mean by that loss of whatever you lost; it could be you lost your neighbours, or you lost all your property or you lost loved ones or animals, or lifestyle and the psychological process whereby we come to terms with loss we call grief, so grief is a really important part of recovery, grief is a process of adjusting to something I’ve lost that was a part of me, a part of my life, that I can’t bring back. The third one is disruption, and as Anne mentioned, the event affects every part of a person’s life and when you’re in a community the whole routine of the community is completely swept away and replaced with often a very frenetic routine around very simple high priority survival needs, and if you go through the consequences of, you don’t even have to lose your house you just need to be involved in extensive repairs, or you saw the same thing in Queensland after cyclones when the roof has been swept off, the time that these things take and all the argumentation with agencies and insurance companies and so on which maybe goes on for potentially years, means that you can’t go back to your normal routine. What I’ve learnt over the years by watching communities and listening to people and following their lives through, is that if you think about it the routines that we form we do deliberately, we put our pyjamas in the same drawer, we put our toothbrush in the same place, we put the butter in the same place, and isn’t it annoying when somebody puts it in the wrong place, you have to go through the cupboards and look for it.
Q: Yeah, that’s right. It makes life easier right?
Rob: Absolutely, because actually once we’re in a routine we only have to use part of our mind, an automatic part, to deal with routine, therefore the important creative part is free to reflect, make plans, process what happened yesterday, come to terms with emotional issues, and really get control of our life. All you need to lose that is some idiot puts the butter into the wrong place and I take five minutes to find it, and multiply that by a hundred details, and that means then people often go through a period during this disrupted period where they’re improvising their lives every day for several years and they lose this ability to take a perspective, and I think this is often why we have the dog year idea that I’m living seven years in one year, sort of thing, because I’m so busy processing trivia and I can’t give my attention to the really profound implications of this. Now what I’ve learnt is that if you’re not careful when you lose a routine you lose the values and purposes that created that routine, for instance if you sat with your partner routinely after the kids were in bed and had a cup of tea and talked about your day and you did that, maybe not every night but several times a week, then that’s a time to be intimate, it maybe is a time to actually talk about the kids and their problems and what we should do about it and be parents. Now all you need for people to lose that is too many tasks to do for tomorrow and who’s going to talk to the insurance company and Telstra and so on and so forth, how do we get the documentation for our marriage certificate, etc, etc?
Q: So much life minutia that there’s no way of getting out of it.
Rob: That’s right. So they don’t realise they’ve actually lost a routine element that actually allowed them to feel connected on the same page working together and they don’t realise they’ve lost that because they didn’t realise they had it, it just worked. Then you take them down several years and they just don’t feel connected anymore or the kids don’t feel the parents have got them in mind.
Q: How might these anniversaries provide opportunities to challenge the disruption experienced after emergencies and re establish some of those important routines?
Rob: It becomes very, very important and I think this is where anniversaries help people stop and say, “Where are we?” a question I suggest that people ask themselves even in the early stages, “What was really important in my life before the event? What really gave me a sense of value in life and quality of life? And am I still doing it? And if not, what have I replaced it with?” and if you haven’t replaced it with something better then it would be really important to start creating circumstances to bring these things back in, even at the expense of how quickly you get your house up; there’s no point getting your house up and then being unhappy in it. So I think this disruption element is very widespread and unacknowledged because we’re in the midst of it. Then the loss I think, coming back to the loss and the grief, I think people cycle in and out of that, they have to put it aside to get on with their problems so people are often surprised, ‘Why am I feeling sad now two or three years later?’ It’s very common when people move into their new house that they grieve for the things they lost. Everyone has got things of sentimental importance, wedding presents that you only use once a year or something.
Q: Photo album or something.
Rob: Yeah. Now when you’re in temporary accommodation and you’re trying to negotiate all these things you’re not thinking about that wedding present that Auntie Mabel who died 10 years ago gave you, but when you have moved into your new house and you’re going to have some friends for afternoon tea and you want to take out those special teaspoons and you go to the cupboard and they’re not there, and that’s the point where it’s as though people have to take an emotional inventory of their losses, and it’s not helped by their friends saying, “Geez, I wish I had a new house.”
Anne: Or, “Don’t worry, it was only stuff, it’s just stuff”, yes but it’s your stuff, it’s the stuff you choose to [cross-talking].
Rob: It’s our histories embedded in our stuff. Now it is only stuff but we should say “It is stuff and it’s the stuff of our lives, and we can let it go but we have to let it go” and so you just can’t shortcut that process, it comes up when it comes up and it will often only start getting processed when everything else has been dealt with. So again the anniversaries are a marker, how have we got to, where have we got to, what’s going on? The chance to review, “Am I holding the quality of life that I value?”
Q: Can people do anything to be more resilient to traumatic events or reduce their impact?
Anne: Yeah I think in terms of reducing the impact of trauma, I think one of the things we need to be mindful of is allowing people to be active contributors to their own recovery, so actually being able to maintain some sense of control over what happens. You can have a terribly traumatic experience but that doesn’t mean that you’re incapable of then knowing what you might need or being able to anticipate what’s going to help, and so I think the idea that we need to come in and completely rescue people after a disaster is probably a bit problematic. I think we need to actually tap into that existing resilience that people have and that communities have. Sometimes despite our best intentions we actually undermine that resilience because we feel that we need to do everything for people, we need to pre empt what we think they need and so therefore we’re taking away that self-determination which I think is so important in terms of getting back into the driver’s seat and being able to have control over what happens in your future.
Rob: If we go back to that idea that a trauma is an experience that doesn’t fit your assumptions about the world and therefore you can’t process it, and it shatters them, and then you don’t know what to expect. I think we can prepare ourselves by being in a way more realistic about what can happen. We drive every day with the illusion that we’re doing something safe but actually we’re not because we only have partial control, we can’t control what another driver will do, so I think challenging your expectations would be the first thing to do. Another thing we can do would be to ensure that we have very good connections and we put a lot of energy into the connections we have in our community. Very often the traumatised person feels very alone and if we’ve cultivated the kind of relationships where we can call on people and connect with them.
Q: What happens if trauma goes without being diagnosed or treated?
Rob: This often happens for the people that I mentioned earlier who are strong enough to just lock it and shut it down, particularly if they can translate that into activity like building fences or rushing around and helping other people or whatever; what you will get is a person will build a shell around the trauma and go on with their routine of their life and keeping that immobilised often absorbs a lot of energy so often they will show up feeling some exhaustion or maybe what we call ‘psychosomatic complaints’, that is physical complaints that are a consequence of psychological tension, headaches, digestive problems, skin complaints and so on, and these are very, very common after disasters for everybody because everyone is under so much pressure, but very often the person who is carrying trauma will often have poorer health, lowered immunity and so on. They will often show that they are really having trouble dealing with minor emotional things, that trivial problems are extremely upsetting to them because they just don’t have the energy to deal with it and it all just feels absolutely overwhelming, these kinds of reactions. And I think all of these things are signals that perhaps the person is carrying something that they are not even clear about themselves and often this takes a bit of time to unravel and people, to begin with they need to first of all understand – we often have to begin by helping people understand what’s happening to them and then help them to feel safe and to understand the process of reflecting and talking about what happened, and then usually there’s a point where they will say, “Yes, I think I’m ready to do this” and then we can do it and we can often do it in little bite size chunks and process it with them, and you will see them just feel so much more relaxed and relieved afterwards.
Q: What does the research show about the best way to tackle existing traumas? I guess we’ve spoken to this a little bit.
Rob: Look I think it’s really important to be clear about this and that is that the effect of the trauma is this imprint of a lived experience and we know that that is absorbed in a particular part of the brain, the receptive part of the brain, and that’s not the part that helps us process it. We’ve got to move it into the expressive part of the brain and this is why it’s so important for people to express themselves, talk about it, but they could also write about it, paint it, act it, whatever way is helpful for them actually represent, tell the story, put it out there, “This is what I went through” and the sooner they can begin to do that - this is why I think it’s so helpful that we have a community perspective that we create environments where everybody can get together and talk, often though what’s important is that people will favour the most disturbing elements, they’ll keep remembering how something terrible happened and they nearly died and what they really need to be asked is, “Why didn’t you die? What did you do? Why did you do that? Oh, so you had plans and you exercised them or you had experience and you made good decisions and that’s why you survived?” and that’s the package that has to be put together otherwise they’ll go around that loop of thinking they nearly died all the time and not remembering why they didn’t.
Q: How does storytelling help people to break that loop?
Rob: It’s really in the telling of the story that you have the chance to put all those details together and it’s actually telling that story as often as you need to and gradually putting all the details and filling it in that is so valuable and we know from a lot of research that the earlier people can start doing that and the better they can do it, the sooner they start processing it, but they need to do it in an environment where they feel safe and secure, and they probably need to do it once they’ve achieved that sense of initial safety, so we don’t want to rush up to people who have just staggered out of the fire and say, “Tell me what you’ve been through”, but we need to help them understand that as soon as they have settled and calm they need to just take the opportunity to tell their story.
Anne: And it’s really helpful if people’s friends and family and the people that they are surrounded by understand how helpful that is to talk about your story, because sometimes what you get is, “Look, don’t talk about this, it just upsets you, or it makes me upset, it upsets the kids, let’s not actually talk about this” and so the thing that you need to do most is sometimes the hardest thing to actually do because there isn’t an environment for you to do that in, or there’s not the people who can hear that story.
Q: So it sounds like the expression of emotion is a positive part of the recovery journey?
Rob: I think that touches on a very general point for everybody, not just the people suffering from trauma but the people suffering from loss, and that is to remember that expressed emotion is never the problem, it’s unexpressed emotion, suppressed, displaced, detached, that doesn’t go anywhere, it doesn’t change and it absorbs energy. Expressed emotion never lasts that long. You know if people cry it’s very unusual for somebody to cry without stopping for half an hour, some people do but they’re probably going to stop before an hour or before an hour and a half, and they will feel very, very different because we know that the physical process of expressing emotions creates a whole change in the energy in our bodies and the chemicals in our brain and so on, and we’ll be in a different position and we want the helpers and the supporters to have the confidence to just go through it with them and stay with them, calm them down, give them tissues, make a cup of tea and say, “How are you now? How do you see it now after you’ve had the emotion?” Whereas what we often get even amongst health practitioners is, “Oh my goodness the person is crying, we’d better get a counsellor in”, no they’re crying with you because you’ve created the space where they can connect with the experience; they need you just be with them.
Q: Be with them a bit longer, yeah.
Rob: And as Anne mentioned, I think a major mental health intervention, a major mental health technique is listening, just listening, not saying anything, just listening, and we want people to be confident, if I listen I’ll do a lot of good, I don’t have to be an expert.
Q: How can someone help a friend or loved one if they believe they’ve experienced a traumatic event or episode?
Rob: One of the first things I would suggest is, you can show them that you understand by offering them practical help, practical simple help. We know how much people appreciate when they’ve had a sudden bereavement that friends just bring a casserole around and they just don’t have to cook meals for the first week or something. In the case of disasters really just doing things like sitting on the phone to Telstra or whatever and chugging through that procedure of actually getting some problems sorted out, or negotiating with the insurance companies or maybe Coroners’ Courts or other agencies that just those very simple practical, that can allow the person just a bit of a breather and I think sensitively keeping them company, and I say ‘sensitively’ because there may be times they want to be by themselves but giving them a sense that you’re doing it their way and you’re going to keep them company.
Anne: Yeah I think just as Rob said, being willing to move through the experience at the pace that’s right for the person who is having it, not feeling like we need to rush them to some point of being able to be okay, and that’s hard because watching someone else’s grief, particularly if you might be upset yourself is a really hard thing to do and our natural response is to say, “Don’t be sad, this is all going to be okay, let’s not think about this anymore” but in actual fact that’s not what we need, we need people who can sit with that pain and grief and walk alongside the person as they experience it, not steer them particularly one way or the other but just to be with them and be with them in that time. I think one of the things that we talked about in our daily meetings after the fires that we would have in the community was that if someone asked you how you were feeling you had to really tell them, you weren’t allowed to just go “Oh I’m fine”, like let’s actually unpack this a bit and talk with a degree of honesty about how things are going and what’s working and what’s not. I think families and the individuals can do that for each other but I think whole communities can do it as well, and so just being really open and honest as much as you can about what’s hard, but also the other thing that we used to say is if someone has said something to you that made you feel better be sure to say it to somebody else because likely if it’s worked for you it might work for them too, so collectively we can raise the resilience and the capacity in the community by sharing those things.
Rob: There’s one other thing that I think can be very helpful and that is that particularly in the early phases people are inclined to make decisions around the heat of the moment, the pain, the feeling they can’t see how they’re going to get through this, and they may sometimes make decisions that are probably not the best and they may come to regret, so I think something that a friend or family member can do is help them stop and think it right through, and also really ask the question “Do you need to make this decision now?” I think it’s very important not to make decisions until you need to because they will be better and you’ll be more confident. People throw away the stuff that has survived because they think “I’ve just got to get rid of everything” and then later they feel “I didn’t need to lose that.”
Q: How can people seek help? Where can they find more information about this type of thing?
Rob: A good first point if people have got any concerns about their health, a first point of contact is GPs, quite a lot of effort goes into ensuring they’ve got access to information and training and they will be networked with other services, psychologists or counsellors, and often the GP is somebody who knows them or their family and has known them hopefully for a long time and has a perspective, but I think there’s a huge amount of information online, not the least of which is of course the Better Health Channel. I’m sure people can use the internet to get an enormous amount of written information available on that and links but I would be saying in the first instance, if you’re in a place where an event has occurred then through Local Government and through the recovery agencies there in the recovery offices they will have access to all sorts of services, but your GP or the health agencies in the area.
Q: Great. I think we’ve covered everything. Thank you both so much for talking to us today.
Rob: It’s been a pleasure.
For those of you wanting more information you can visit the Better Health Channel at www.betterhealth.vic.gov.au or vic.gov.au/2009-bushfires. If this episode has brought up strong feelings for you there are many ways you can get support, speak with family and friends, see your GP or call Lifeline on 13 11 14.
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