Opinion

Coping with horror: The long game of recovery


Louise Stone


15/01/2020 12:44:53 PM

Once the devastating firefronts are gone, GPs will be called on to help their patients and communities deal with the ongoing trauma.

Burnt out tree
Disasters have a long tail and GPs are often needed to help pick up the pieces. (Image: AAP)

There is a moment in the life of seriously ill patients when they realise for the first time that a cure is not possible.
 
It is terrifying, isolating and profoundly destabilising.
 
To survive in this world, most of us carry a sense of security and safety by placing our trust in important institutions and people.
 
If I become seriously ill, we reason, the Royal Flying Doctor service will rescue me, the tertiary temple of St Elsewhere will fix my pain, the pharmaceutical industry will supply me with a cure.
 
There is a horror when we realise these institutions have limits and that we can be, in fact, alone in our suffering.
 
As one of my patients put it, ‘We all walk close to the edge of a cliff as human beings. We are all vulnerable. It’s just that now I notice the cliff is there, and I can’t help looking down’.
 
At the moment, there are many bushfire survivors who are looking down over that same cliff, feeling unsafe.
 
As we brace ourselves for the long tail of this trauma, it is helpful to reflect on the terror of vulnerability we all feel in the wake of something that is so far beyond our normal experience.
 
There may be fly-in fly-out trauma experts circulating the country at present, but we all know when those crisis services have been and gone the GPs in these regions will continue to support their patients in the months, years, and decades to come.
 
As GPs, we need to assist our patients with coping, reminding them of their strengths when their confidence and skills disintegrate in the wake of trauma.
 
We do this with seriously unwell patients all the time, but the scale of this disaster is unprecedented.
 
Coping theory suggests there are three mechanisms that assist.
 
The first is problem-focused coping, which is familiar and comfortable to us all. Helping patients deal with the problems in front of them, assisting them to access resources, reminding them of strategies to tackle their problems one step at a time and, of course, providing advice when their health is suffering.
 
The second coping strategy is emotion-focused. Listening, providing empathy, encouraging people to talk and share the burden of suffering. Again, this is core business for all of us.
 
However, it is the third major coping strategy that is the most difficult. When trauma is life-changing and severe, and it cannot be ‘fixed’ with problem-solving or soothed with emotional support.
 
We need to face the difficult existential questions.
 
Why do bad things happen to good people? Who am I in the wake of this trauma? Where were the people and institutions I trusted when I needed them the most, and how is it that I was facing this trauma alone and unprotected?
 
Recovery in this space is hard and I find the mnemonic CHIME helpful:
 
Connectedness
Many people have expressed a sense that there is a leadership vacuum at the moment. They feel unsupported and vulnerable.
 
GPs can help in this space by getting the community together to rebuild, providing caring one-on-one support, and encouraging people to reach out to others who need them.
 
We must not underestimate the power of the therapeutic relationship. When all of the trauma services leave, we will still be there mopping up the consequences.
 
Hope
Despair is common after this sort of devastation, and it is unsurprising that this impedes recovery. We can help by reminding people of their own strengths, encouraging community discussions about recovery and providing practical assistance to help patients regain the sense that a future is possible.
 
Identity
Natural disasters profoundly change the landscape in many ways. The pretty little town we love is now a wasteland, our possessions may have been destroyed and our financial stability and livelihood may be threatened.
 
By still being there, providing care and stability, GPs can remind patients of who they are under all of that trauma, and help re-establish their sense of identity. 
 
Meaning
In the longer term, natural disasters can make people question fundamental beliefs. What is the point of working hard when everything can be taken away from me in a heartbeat? I thought I was strong and capable, but am I just weak, vulnerable and helpless? Why did my faith not protect me?
 
It is not GPs’ role to become spiritual leaders, philosophers or psychoanalytic therapists, but we can listen as patients grapple with these issues. It is especially important when a loss of meaning and purpose leads to depression, severe anxiety or suicidal thinking.
 
Empowerment  
Helplessness can erode our capacity to recover. As GPs, it is important to demonstrate respect for every person, and remind them of what makes them important. Encouragement is critical when people have lost confidence. By encouraging community engagement, we can also help people rediscover their own coping skills.
 
Natural disasters not only cause physical and mental illness, they can also severely disrupt how we view ourselves and our sense of self-efficacy. As GPs, our important role includes leveraging the therapeutic relationship to help patients move towards recovery.
 
At the same time, we need to acknowledge our own needs and our own trauma. After all, we share the community with our patients.
 
There is no easy answer to this issue, and we rely on the acquired wisdom of years to cope with the emotional fallout. This is a time where collegiate support is critical, because the recovery from this devastation may impact our work and our own health for decades.
 
Resources for doctors who need support:

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