Geriatric Mental Health Disaster and Emergency Preparedness

302 Geriatric Mental Health Disaster and Emergency Preparedness
and efforts to divert it fail. Attempts to assuage the anger can be perceived
as arguments supporting authority. Under the influence of anger,
the subject confuses attempts at explanation with justification. The caregiver
who tries to give a reason for the disaster is readily thought to be
giving an excuse. If the disaster was the result of a human attack, then
any discussion of the motives of the attackers can be seen as defending
their actions.
In some cases, anger can give rise to litigation, as will be discussed
later.
Depression
This prolonged stage of grief is similar to the melancholic type of clinical
depression and manifests as weight loss, insomnia, and self-neglect. Recurrent
thoughts of the loss pervade each day. There is a risk of suicide.
The similarities and differences are well described by Freud in his 1917
paper cited earlier. More recent studies, using sophisticated modern statistical
techniques, have mostly confirmed what Freud said. The only
clear distinction between the symptoms of clinical depression and those
of grief is the fact of bereavement (Kendler, Myers, & Zisook, 2008).
Delusional guilt feelings distinguish depression from normal grief,
but in disaster situations this diagnostic point may be obscured by survivor’s
guilt. Yet a further complication is that the survivor’s guilt may not
be entirely irrational.
These subtle phenomenological differences may test the skills of
even experienced mental health professionals. The differentiation between
grief and clinical depression is often made intuitively on the basis
of what has been lost. Severe symptoms following the loss of a pet or
photographs are more readily assigned to mental illness than those following
the loss of a child. As we shall discuss, however, this can be deceptive.
Antidepressant Medication
Given the similarities of grief to a type of depression that often responds
well to organic treatments, the question arises of whether antidepressant
medications can help. Three open-label and one randomized controlled
trials of such treatment have been reported (National Cancer Institute,
2009). Medications found helpful are desipramine, nortriptyline, and
bupropion.