San Antonio Express-News: Commentary: After the storm, a focus on meeting basic needs

By Drs. Barbara Robles-Ramamurthy and Jessica Sandoval, submitted to the San Antonio Express-News as an opinion piece and published on Feb. 26, 2021.

Our community has been torn with stress and uncertainty in the past 12 months. A global, deadly pandemic. An awakening to racial injustice present for centuries. And now a deadly winter storm, placing millions of Texans in freezing temperatures inside their homes, without the ability to secure basic needs such as food, or medical needs such as individualized therapies, electrical medical equipment and clean water to take medications.

We all felt the fear of not knowing when it would end. Would the power go out again? Is my child safe inside our freezing home? Can I stock up on groceries? Necessities were gone overnight. And now, even as we get back to “normal,” many of us are still feeling fatigued and distracted.

As psychiatrists who serve families with significant foundational safety and health needs, we noticed changes to the way our own brains processed the situation. These experiences remind us of the feelings we had at the beginning of the pandemic but also shine a light on the experiences we hear from so many of the families we serve.

In our medical world, we define this as a trauma or stress response.

When confronted by a direct threat, our brains go into “crisis” mode, gearing up neuropsychological processes that help us survive by focusing on preparing for the next “disaster” and to ensure our family’s safety. This is a normal response that has served humans well throughout generations. Stress and worry are not bad, but if present for long periods or at unhealthy levels, these can affect our overall health and functioning.

When these processes are prolonged or are turned on repeatedly, we may struggle to make the best use of these normal functions. If our worries and inability to think clearly go unchecked for too long, we may overestimate the level of preparation needed and find our attention and concentration may not be as sharp. Emotional numbing may result from incessant signals of danger. Many of us felt vulnerable, and in the days that follow may continue to experience these feelings as we adjust back to safety.

However, for many families in poverty in our city, this is just a daily part of life rather than an inconvenience driven by a seasonal fluke. Clinically, we see families who find themselves constantly “putting out fires” that are out of their control and preparing for the next threat. The worries about whether there is a safe place to live with drinkable water, available food and power needed to survive the elements are ever-present. This state of being negatively impacts our physical health — such as blood pressure — and relationships, which can impact our ability to advocate for ourselves.

As we continue on “survival mode,” what can we do?

Awareness: Label your experience and feelings. Try to use objective descriptions — “we went without power for 36 hours” — instead of a negative judgment such as “this was terrible.” Acknowledging negative feelings is part of a normal human experience.

Find support: When we objectively describe our situation, we can then acknowledge our needs. Ask for the help you need and offer support where you can.

Remind yourself of what’s known and real: All of us have been through challenging situations. Remind yourself that you will get through this and you are safe. Today is a better day.

Remember this experience: Take a moment to truly notice what this experience of “not knowing” and fearing for your safety and well-being feels like. The humility of learning from the voices of those struggling at baseline, and not just those when natural disaster meets structural inadequacies, will benefit us all.

Advocate: Be an advocate. Advocate to reduce poverty and improve public services that we benefited from during this shared trauma, as families will continue to be in need. Share more compassion to those who may not have the same privileges and resources.

Just as parents forget the arduous nights spent with their crying babies, most of us will forget the challenges seen during the snowstorm. With our families warm and safe, with clear running water and stocked-up fridges, our brains can recognize we are no longer under threat, but let it not be lost that there are those for whom it is not so simple. May we find new perspectives, new approaches and possible solutions for a future where not a single San Antonio resident goes without basic human needs.

Drs. Barbara Robles-Ramamurthy and Jessica Sandoval are faculty psychiatrists at the Long School of Medicine at UT Health San Antonio.

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