Geriatric Mental Health Disaster and Emergency Preparedness

Chapter 15 Bereavement and Grief 301
the dead person as more well formed and vivid. When hallucinations are
auditory, they assume the voice of the lost and are felt to be genuine. The
hearer insists the dead person is talking to them.
Such voices may be thought of as evidence of mental illness by an observer,
but they differ from the auditory hallucinations of schizophrenia
in their phenomenology. Multiple voices are not heard, and the hearer,
although he or she insists on the validity of the experience, does not expect
others to be able to share it. Thus, it is necessary sometimes to reassure
both hearers and caregivers that this manifestation is part of the
grieving process. It may be suggested that such hallucinations can be
comforting. In some cases, of course, such hallucinations readily fit in
with cultural or religious beliefs about an afterlife.
Panic Attacks and Phobias
Panic attacks and severe anxiety are especially common when the grieved
death was sudden and unexpected as occurs in disasters. In cases where
the bereaved person shared in the disaster, other features of PTSD can
be present. Questions of whether to start benzodiazepines — a type of
medication typically prescribed for anxiety and phobia —and how and
when to stop such treatment often arise . Several recent reviews, such
as the American Psychiatric Association’s “Practice Guidelines” (2004),
cover the topic of the management of PTSD.
In many cases, the circumstances of a disaster will give rise to a phobia
of things connected with it, which can be treated by the usual methods
for treating phobias. In some cases, this may require instruction by
a mental health professional using behavior therapy or hypnosis, but
return to everyday living may be sufficient. For example, following an
automobile accident in which there were deaths, the survivors, at least
in rural and suburban America, often remain phobic for about 6 months.
The daily necessity of driving produces a deconditioning by the end of
that time.
Anger
Anger is often the most difficult emotion for helpers to deal with, especially
because caregivers may find themselves as the objects of anger.
Caregivers from an outside agency may be regarded as agents of those responsible
for the disaster. The bereaved may convince themselves the disaster
was avoidable. Their anger builds up like a liquid under pressure.
Once it flows in a particular direction, the stream becomes unstoppable