San Diego Fires 2007

The Santa Ana winds created significant havoc in the early part of fire season this year. Greater than 1000 homes destroyed, 2 deaths, many injuries and hundreds of thousands of evacuations. Living 8 blocks from the ocean I felt fairly secure, although we do live next to a lagoon and the authorities asked us to leave on Monday AM because of the potential for fire spread. My colleague Dr. Eric Drimmer was at greater risk as he lives more inland than I do. I pray that his home is alright as he and everyone else don't deserve to lose their homes.

A reporter asked me my thoughts about the effect of the fire and upheaval on people's mental health. I did my best to answer cogently. It is interesting that the idea of stress was first noted by a Canadian researcher named Hans Selye in 1936. It is hard to imagine that his original idea of stress affecting our physical health was originally met with skepticism. Anyway, the first effect on people is to feel anxious or tense with increased heart rate and rapid breathing. The desire to escape is significant which serves to protect us and is helped by these physiological changes. If the stress does not abate, exhaustion follows. Exhaustion is a politically correct term for depression.

What people need immediately after a life threatening stress is shelter, food and a secure place to recover with lot's of human contact. Anger, sadness and fear are common feelings and should not be denied. At the same time, acting out anger al;ways makes things worse. Walking off that feeling off is always the best approach. Any injuries or medical problems need to be addressed quickly also.

The feeling of loss of control after an out of the ordinary event is significant also. My feeling is to ask people what they would like so that the feeling of some control is returned. Making decisions is a form of control. Reassurance that they are safe and every effort will be made to help them is important. The mayor of San Diego (Larry Sanders) and Governor Arnold Schwarzenegger did an excellent job of mobilizing help and also providing for people's basic needs.

Representative Duncan Hunter was very informative in his description of being more prepared next time. The reassurance of dong more next time is important in helping others feel more safe living here. He described hitting the next fire hard initially, so that things don't get out of control. Considering the military presence and capacity in San Diego, Mr. Hunter talked about being more prepared with helicopters, fixed wing water bombers and overcoming the bureaucracy which can slow things down.

Speaking of bureaucracy, one of my patients called me in the middle of this disaster to say that her pharmacy would not refill her prescription that she has taken for at least a year, without a written doctors prescription. It is another example of how a mental health problem is always treated as less important than medical problems. Would they have been so difficult with this woman if she needed her insulin or hypertension medication? I can't tell you which pharmacy it was, as I would need to hear their side of the story. Still, it sounded officious, unhelpful and bureaucratic to me. I would assume the pharmacist would be aware that we were in an emergency situation in the county.

Duncan Hunter went on to say that Governor Schwarzenegger was an example of a hands on leader and someone who insists on getting things done quickly. I have loved Arnold since his earliest career as a weight lifter and he seems to get better with age. One person that he spoke to said she was mostly struck by how much he cared. It's too bad that more of our politicians aren't like him and Duncan Hunter.

Children should be reassured and kept close. Constant re-exposre to the trauma by watching TV is not a good idea for children and adults. Especially when they show the same pictures and tell the same story over and over. I must say that I was more impressed by the local TV than the national coverage. Keeping family and friends close, apart from providing for basic needs, is really the best we can do to help. As time goes by, the need for more mental health help is probably wise, depending on each and every case. Early trauma counseling probably does more harm than good according to studies after 9-11. Still the risk of emerging Post Traumatic Stress disorder or depression is not insignificant. Getting enough sleep, starting to rebuild and recognizing that the worst off people lost family, friends or pets is a good start. Houses can be rebuilt, people can't.

This is my view at least. In general, I was impressed by how much help was made available. As Dr. Selye remarked years ago, helping others is very good for both your physical and mental health. I try to never forget that one of the best exercises for the heart is to reach down and help someone up. Let me know what you think and take care.

What Is PsychOptChat?

There are 3 factors to this name. I am a psychiatrist first. My career in this branch of medicine has been rewarding and at this point lengthy. 22 years of listening to and assisting people with mental health problems. My discovery while working and reading led me to the second part of my title. The majority of people with depression and anxiety are hard working, conscientious and performance oriented. These people are optimal performers, our finest citizens in fact. Chat is the final part of my title. My hope with this blog is to reach out to everyone interested in mental health and it's vicissitudes. Psychiatrist's, psychologists, other health care professionals, patients and people in general can let me know what they think. I have learned more in my career from the countless views offered, and my hope is this blog will expand this learning. My private practice is in Rancho Santa Fe if one needs to speak to me in person.