I recently attended a conference on Preparing for Dirty Bombs, Nuclear Disaster and Other Radiological Emergencies. Scary stuff. A subject that is about the last thing we want to consider -- yet in the "new normal" it has become inescapable.
Disaster, especially terrorism, notwithstanding its horrific initial impact on lives and property, takes its greatest toll, over time, by destabilizing the emotional -- and thus economic -- fabric of a community, state or nation.
New York Congressman Chris Gibson, MPA, Ph.D., a retired Marine colonel, opened the meeting appreciating that mental health and mental illnesses are not "static." In other words, how we respond individually and collectively will influence the trajectory of human distress and disorder. He understood that those people who learn to turn and face a challenge, a danger, will suffer less and be more successful over time. Mental health professionals understand this as overcoming avoidance, a natural, even instinctual, response that may transiently reduce anxiety but offers no lasting mastery.
Experts on radiological events, often armed with chilling photos of nuclear disasters, as well as our federal government now, assert that an IND (Improvised Nuclear Device) could be assembled using contraband uranium by rogue dictators or organized terror groups. An IND can fit in a car or van and have the destructive capability of the Hiroshima and Nagasaki bombs. Beyond the incomprehensible horror of the blast, or the contamination dispersed by winds or other natural means, the footprint of the psychological terror unleashed would extend well beyond the boundaries of a bomb. The emotional blast from a nuclear event has no definable limits.
How people react determines more than anything the outcomes of a disaster. Radiation is a terribly feared hazard, sharing top billing with biological weapons of destruction. The particular evil of radiation, and how it spawns such intense alarm and dread, is that it is invisible, silent and odorless. We have almost no ways to know the danger (unless we have Geiger Counters). Moreover, psychogenic symptoms, like rash, fatigue and gastrointestinal problems, are common and confound understanding who has been truly exposed. Perhaps worst of all is that we are apt to turn away from, or against, our fellow human beings (including emergency workers) as well as places and products from the disaster zone because they represent potential dangers to our health.
Disaster experts have learned from too many such events that trustworthy information, promptly delivered, is the most effective "anxiolytic" (remedy for anxiety). Responsible officials can, and must, impart information about what is known, what is not known, and dispel misinformation to build trust and assist a fearful public.
What survivors of a nuclear event will need to know, god forbid that should happen, is what to do to avoid harm. The main message is "Go inside, stay inside, and stay tuned." Remarkably, we just witnessed this message in Boston for a very different threat: The city was told "Go inside, stay inside, and stay tuned" -- also known as "Shelter in place."
From every disaster, including 9/11, Katrina, Hurricane Sandy, Boston, Texas, and the massacres that have darkened the lives of families in Newtown, Aurora, Columbine, Virginia Tech and too many other sites, we know that people are resilient. We also know that people are "pro-social," namely they tend to turn to each other both to help and to seek help. We all need encouragement and support to heal.
Now is the time to build a stockpile of information, messages and communication plans about what to do, how, and by whom. Now is also the time to identify and train a core group of people who can carry the message and "just in time" train others for when the next disaster strikes. This is called readiness. Not preparing, not building readiness, exposes our communities and potential victims and responders to its disturbing alternative, a lack of critical knowledge about how to respond. Readiness is how to help protect the public from not taking the self protective actions that can keep immediate disaster from becoming sustained catastrophe.
I didn't sleep well the night after the conference. I suspect others who attended did not as well. But I felt better knowing that federal-, state- and community-based organizations were taking Congressman Gibson's words to heart and turning toward the challenge, with eyes wide open and minds restless to build readiness.
Dr. Sederer is the author of The Family Guide to Mental Health Care and Adjunct Professor at the Columbia/Mailman School of Public Health.
The opinions expressed here are solely mine as a psychiatrist and public health advocate. I receive no support from any pharmaceutical or device company.
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