Orlando, Florida-based therapist Janera Echevarría was not surprised to see an upsurge in the number of Hurricane Maria refugees arriving from the island seeking treatment for anxiety, depression, and stress. After any disaster, the counselor explained, it’s par for the course. In the area, groups and agencies are helping provide services to those who fled the monster storm and its devastating aftermath.
“Even if you were unharmed and your house was okay, living an experience like this is emotionally traumatizing,” said Echevarría of the hurricane that hit Puerto Rico on September 20th. “In one way or another, after a disaster — manmade or natural — it is expected that people will suffer some kind of post traumatic stress.”
However, what has alarmed Echevarría, a twenty year veteran in the field of mental health, is how deeply the hurricane’s aftermath has hit islanders who live outside of Puerto Rico. “I have a client, a 60-year-old grandmother, who stopped eating because she feels guilty that members of her family might be going hungry,” Echevarría said. “I have another client, a woman in her 40’s, who is sleeping on the floor because she says that her sisters lost everything so she is in some form of solidarity with them. She has a perfectly comfortable bed but prefers to suffer and sleep on the cold concrete floor –it’s a form of flagellation.” These reactions may seem illogical to some, but for people who are not mentally resilient, it’s the only way they know how to cope with stress. Technically it’s a form of survivor’s guilt, she explained.
Nearly sixty days after the category five storm landed, millions are still without electricity and desperate for basic necessities such as warm food, water, and shelter. In Echevarría’s downtown Orlando practice, she has begun seeing the toll such images are taking on the mental health of Central Floridians.
Echevarría, who was born and raised in the western Puerto Rican town of San Germán, has seen the strain in her inner circle. Discussions around the dinner table revolve around the latest news from the island. Family members and friends discuss having trouble sleeping, experiencing fears about the future of the island, sadness, and some, say they are unable to fully focus as they watch the latest news and hear from family members having a rough time.
The most vulnerable populations after disasters are children, who don’t have the capacity to understand the scope of the devastation. Echevarría also sees it in women, mostly mothers and grandmothers, who suffer doubly because they are not on the island to do what Puerto Rican mothers do best — nurture their loved ones.
Brain experts say that even witnessing images destruction from afar, such as scenes of strangers’ lives ruined, wound the brain. But if it’s extended family, the wound is deeper.
Nancy Rosado is a veteran of disasters. She was in charge of a mental health unit helping NYPD officers cope with the aftermath of 911. She was already in Florida when the Pulse nightclub massacre happened. During the massacre, Rosado said she that she helped provide culturally competent training for local officials. Everyone grieves and mourns differently and Puerto Ricans are no exception. “It was important to let officials understand that culturally, we see loss and grieve in a unique way. Our language is different, even the forms of mourning expressions are unique,” she explained.
This time around, Rosado said she took a step back from the disaster, because she said that “even those trained to help others are also affected.”
Experts say that directly helping others is one of the ways to cope with stress. Another way is to take a break from the news cycle, as images do cause harm and humans are not built to take in so much suffering at once.
One of the most important ways to handle stress is to talk about it. “For Puerto Ricans, therapy is not the norm,” the mental health professional explained. “We are used to staying in the family. But this is something catastrophic and we have to be able to open up. My suggestion is that if you feel like you can’t handle seeing so much loss, to get help from a culturally competent professional.”
“It’s important for anyone suffering from afar to now that they are not alone,” said Rosado. “Others are feeling the same way.”
Read more on NBCNews.com