In a natural or man-made disaster, the challenges will certainly be demanding from a physical standpoint. The ultimate factor, however, could have more to do with how the survivor, their family or their community handles the mental aspects of the situation.
The stability of a survival community is dependent on the stability of its members. In the aftermath of a catastrophe, extreme stress will cause epidemics of depression and anxiety. Living off the grid with limited supplies is, for the average person, an emotional roller coaster. The lack of bushcraft skills will mean that every aspect of survival is part of a learning curve; even simple tasks can be emotionally and physically brutal.
As a result, the effective group medic will have to be able to identify those who need help and do everything possible to support them.
Clinical depression, sometimes called “major depression,” has to do with abnormal levels of chemicals in the brain called “neurotransmitters.” Scientists believe that some of these, such as serotonin, norepinephrine and dopamine, are low in the chronically depressed. Clinical depression can occur due to genetic traits, hormonal issues, family history and other factors.
In normal times, 5 percent of the population has signs of clinical depression. In a survival scenario, however, everyone will be prone to what is called “situational depression.” Situational depression, also known as “stress response disorder,” occurs in otherwise normal people who are exposed to extreme stress. Some examples include the death of a loved one, divorce, a cancer diagnosis or the loss of a job. In survival settings, lack of resources, hostile encounters and fear will be common triggers.
The classic symptoms of depression include:
- Feelings of hopelessness or inadequacy
- Changes in appetite that lead to weight loss or gain
- Irritability (especially common in men)
- Reckless behavior
- Difficulty concentrating on tasks
- Aches and pains without clear physical cause
The symptoms above can be seen in both situational and clinical depression. Although they are similar, the medic can often identify the survivors with situational depression versus those who might be predisposed to clinical depression.
The differences are mostly related to the number, onset, duration and severity of symptoms.
Number: In chronic clinical depression, five or more symptoms are often present simultaneously.
Onset: In situational depression, a trigger event is often present, such as an apocalyptic natural disaster or other stress-inducing event. Trigger events might be hard to define in those with clinical depression.
Duration: In situational depression, the symptoms improve once the stressful event is resolved. Clinically depressed patients might continue to experience symptoms long after things improve.
Severity: In clinical depression, symptoms often completely incapacitate the individual. In addition, some with major depression might become delusional, experience hallucinations or have thoughts of suicide. These symptoms are rarely seen in situational depression.
Progression From Situational to Clinical Depression
In situations where the stressors become long-term issues, some with situational depression might become clinically depressed. Here are some signs that situational depression has progressed to clinical depression:
- Multiple symptoms such as apathy, irritability, reckless behavior, difficulty concentrating on tasks or topics, exhaustion, hopelessness
- Trigger events are less clear in those with major depression compared to situational depression
- Failure to improve once the stressful event resolves
- Severe symptoms such as delusions, hallucinations and suicidal thoughts
In survival scenarios, depression often exists simultaneously with anxiety. It is a rare individual who would not experience significant anxiety when confronted with the challenges that exist when things go south.
Even in normal times, anxious people think catastrophically; that is, they are always assuming the worst. In many cases, things are rarely as bad as they seem, but their concerns could be completely realistic after a disaster. Anxiety is similar to constantly experiencing a “fight or flight” response, despite no immediate danger present.
Anxiety is more than just an uneasy mind, however, and one sufferer might present to the medic quite differently from another. The symptoms can be mostly emotional, mostly physical or some combination of both.
The anxious individual often experiences one or more of the following:
- Irrational fear
- Difficulty concentrating; jumpiness
- Extreme pessimism; irritability
- Mental “paralysis” or inability to act
- Inability to stand still
- Shortness of breath
- Palpitations (rapid pulse)
- Upset stomach/diarrhea; tremors/tics/twitches
- Tense muscles
The Medic’s Role
In normal times, medical professionals freely use a wide array of “psychotropic” drugs to treat depression and anxiety. A psychotropic drug is any medication capable of affecting the mind, emotions and behavior.
Some common anti-depressant drugs (U.S. brand names/generic names) include Prozac (Fluoxetine), Zoloft (Sertraline), Paxil (Paroxetine) and Elavil (Amitriptyline). Some common anti-anxiety drugs (U.S. brand names/generic names) include Xanax (Alprazolam), Ativan (Lorazepam), BuSpar (Buspirone) and Valium (Diazepam).
Although these tools exist for modern medical professionals, the off-the-grid medic who won’t have access to them must construct a different strategy that doesn’t include pharmaceuticals. But given the likelihood that many in the survival community will need support in the aftermath of a catastrophe, what options are available?
Consider some natural alternatives that might have a beneficial effect on mental well-being. Vitamin supplements such as B12, folic acid, tryptophan and Omega-3 antioxidants can be effective in some sufferers. St. John’s Wort has been used with some success and has even been called “herbal Prozac,” but it shouldn’t be used on pregnant women or children.
Before and After
Before a disaster happens, the medic should assess the probable issues that would cause the onset of depression. Making sure that group members stockpile adequate food, for example, could assuage hunger. Assuring good nutrition will prevent many problems, both physical and mental, in survival settings. Reducing use of certain substances (such as nicotine, caffeine and alcohol) among group members will prevent issues with withdrawal once these items become unavailable. Encouraging exercise and constructive activities to prepare for disasters will also be beneficial.
After a disaster occurs, careful attention to each member of the community is warranted to prevent situational depression from decreasing work efficiency and destroying morale. The increased physical exertion involved in daily activities of survival will present a problem, so promote rest breaks and good sleep habits. Sleep deprivation will lead not only to depression, but also to lapses in judgment that will lead to worse problems. And maintaining good hygiene will decrease infectious diseases that could sap the resiliency of survivors.
Some medics might doubt their effectiveness, but certain relaxation techniques might also be helpful to maintain good mental health in disasters. Instituting relaxation methods such as meditation, massage and deep breathing might be a good strategy to keep group members on an even keel.
In addition, it will be especially important to make sure the survival group cultivates supportive relationships with each other. People who are depressed often feel very alone. The medic must work to foster a sense of community; this will provide strength to emotionally weakened members in times of trouble.
In order to be effective as a medical provider in austere settings, it’s important to realize the importance of counseling skills. Listen with a sympathetic ear to the concerns of depressed and anxious survivors. The medic should make sure to accentuate the positive aspects of every situation (if there are any). Encourage each member of the group to share their feelings with the others. Group meetings for this purpose will encourage communication and bonding in the survival group. Incorporate these meetings as a regular event.
Post-Traumatic Stress Disorder
Sometimes, the circumstances related to a true disaster, especially an apocalyptic one, are so extreme that group members might exhibit what is called “Post-Traumatic Stress Disorder” (PTSD).
PTSD is a type of severe psychological disorder caused when a person is exposed to an overwhelmingly traumatic event during which they felt extreme fear, horror and helplessness. Everyone experiences a range of emotions in this situation. And although some might recover relatively quickly afterwards, many carry scars that could affect their ability to function in the aftermath of such an event. It’s thought that seven or eight out of every 100 people will suffer with PTSD at some point in their lives.
Although post-traumatic stress is a problem that has been mostly associated with the rigors of combat in our veterans, anyone can have it. The unexpected death of a loved one, for example, might trigger PTSD. Children might even show symptoms of the disorder.
Symptoms of PTSD could occur soon after the event or might be first noted years later. To diagnose a case of PTSD, the following symptoms should be catalogued for a one-month period:
- “Re-experiencing” episodes: Flashbacks might occur during which the person appears to relive the traumatic event. These patients often have physical symptoms such as a rapid heartbeat or profuse sweating. The flashback might be experienced in a nightmare or while awake. Sometimes, a trigger such as a similar situation, an object or conversation could precipitate the “re-experience.”
- Avoidance reactions: A strong effort to avoid places, objects, thoughts or conversations relating to the traumatic event.
- Arousal and reactivity symptoms: These could include being easily startled, having difficulty sleeping, tenseness or experiencing frequent angry outbursts.
- Cognition/mood symptoms: PTSD sufferers might lose interest in previously enjoyable activities. They might also have problems dealing with feelings of blame, guilt or other negative feelings about themselves. In addition, they could be “foggy,” even about the event that caused the disorder.
The Medic’s Response
Although many with PTSD will show symptoms of anxiety, anti-depressant medications seem to have the most beneficial effects. These medications will be unavailable in survival settings, so the best option for the medic might be “talk therapy.”
Talk therapy helps people make sense of their bad memories and allows them to work through feelings of guilt related to the event. Some benefit might exist by exposing them to triggers in a safe environment.
Mental issues such as depression, anxiety and post-traumatic stress will be encountered by the medic in a survival setting more frequently than gunfights at the OK Corral. Paying attention to the mental—as well as the physical—well-being of group members will greatly increase the success of the group.
Editor’s note: A version of this article first appeared in the March 2017 print issue of American Survival Guide.