How does being one of 33 men cut off from families and the world in a relatively small space affect your mental state?
The Following was originally posted to Psychiatry Talk.
I recently had a phone call from a reporter from the LA Times asking me if I had opinions about the psychological issues that miners trapped in Chile might be having in view of the fact they might be there for another 3 months.
I hadn’t previously thought about this issue and was glad to offer certain possibilities. After the phone call I kept reflecting on this issue. 33 men cut off from their families and the world in a relatively small space. Except for telephone communication and thin tube which could bring them food and water as well as whatever small items could fit through the small opening, they were isolated captives. I don’t know what trauma they experienced at the time of mine collapse and whether they had some moments where they felt their life was in immediate damage. We also don’t know whether they still continually fearful for their lives and safety. After all, they are miners and they know the potential pitfalls of the rescue mission being undertaken.
An Event Outside The Usual Human Experience
When people experience a traumatic event that is out of the usual human experience, especially when it is life threatening to themselves or others, that is the major ingredient for developing a post traumatic stress disorder. If they are trained as to what to expect and how to protect themselves, that may help mitigate the trauma. However, as our soldiers have learned, there is no way to guarantee immunity from post traumatic stress. Sensory and sleep deprivation can intensify their response to trauma . The continued presence of the threat to themselves will also exacerbate the psychological symptoms as will the reintroduction of the trauma or something that reminds the person of the trauma.
While the isolation in a mine for this long duration of time appears to be unprecedented, there are certain situations where observations have been made on people isolated for long periods of time even with the ability to communicate to the outside world.
Space Travel Provides Model of Prolonged Isolation
The Space program comes immediately to mind where astronauts and cosmonauts were isolated on space stations for long periods of time. Several years ago after one such space trip a Russian cosmonaut wryly remarked, “All the conditions necessary for murder are met if you shut two men in a cabin measuring 5 meters by 6 and leave them together for two months.” With a larger group there is less likely to be intense reactions between two individuals but it certainly can happen. One report divided the various psychological responses during prolonged periods in space into three phases. During the first, which usually lasted about two months, people were busy adapting, usually successfully, to their new environment. In the second phase, there were clear signs of fatigue and low motivation. In the final phase the people could become hypersensitive, nervous and irritable. In discussing the anticipated expedition to Mars experts have been concerned the ever-present possibility of death by small breach of the space ship by a meteorite or sun flare and how that will effect them. As mentioned above, the trapped miners may very well be attuned to the possibility of some dangerous event where no help could be offered to them
Life on Submerged Submarine or in the Antarctica for Long Periods
Other examples of people being isolated for prolonged periods of time are life aboard a submarine which is on a mission requiring prolonged submersion or life in a remote scientific camp in the Antarctica. The psychological problems which have been noted in these environments include concerns about a limited amount of resources, the unchanging social group, social isolation, limited communication with the outside world, a self-contained ecosystem, the constant sense of danger, physical confinement, lack of privacy, lack of separation between work and non-work, limited opportunity for variety and change, limited sensory deprivation, and dependence on machine-dominated environment. This pretty well defines the anticipated psychological challenges facing the trapped minors. One big difference with those people isolated in the Antarctica — if one member of an Antarctica team got annoyed with another, he or she would have the whole continent to walk away and be separate for a while. Astronauts and the trapped miners, however, would be very confined with no escape from each other, and they would be very worried about the supply of air and water.
Provide Basic Necessities Plus a Little Extra and More if Possible
The first rule for treating people who may be potentially traumatized is to give them the basic necessities of life plus a little extra when possible. This means food, water, warm dry clothes (or in this case since it is warm down there, dry comfortable cool clothes). The next things that they need are information and communication. They have to have confidence in the people talking to them and know they are receiving honest information. People in a crisis, whether it is on a airliner having difficulty, being in a flood, hurricane or the target of an ongoing terrorist attack all want to know what is going on and what is planned for the immediate and near term future. While they will respond best to truthful information, sometimes it doesn’t help them to give bad news if there is nothing they can do about it. So for example, sometimes the death of family members is withheld if practical, from a trapped or isolated person until they are rescued. It goes without saying that speaking to loved ones during separation or during an ordeal is usually quite supportive. If a telephone line or radio signal is available a video link usually can be set up. Providing music, tv shows and broadcasts of sporting events or other entertainment can be psychologically healthy for them also . I understand that some computer games, which are very small and can fit in the small opening, are also being provided. A particular social environment naturally develops with certain people becoming leaders. A 63 year old miner among those down there has become the spiritual leader according to reports that I read. Recommendations can be made to the miners, which may be helpful. For example it is very important that they maintain a regular sleep cycle, which will be based on the clock rather than on seeing daylight outside. Another recommendation that I heard was being given to them to help maintain their civility and sociability is that they wait before starting their meals until the food for all the miners has been lowered.
Psychological Help During and After Being Trapped in the Mine
It will be feasible for the miners to have individual or group counseling session with mental health experts even while they are in the mine through the communication set up. If needed, psychotropic medications can be prescribed for various individuals and lowered into the mine. Regular chats with mental health professional while they trapped underground even if informal and brief will allow assessment of potential problems, which might require more intensive discussions or medication. I have read about the development of technology to help determine when someone on a phone line is in psychological distress just by their voice characteristics For example, computers can now discern the emotional inflection in a person’s voice to look for signs of emotional trouble. If the computer does find that someone is in need of help, it is programmed to suggest ways to alleviate the problem, such as recommending extra rest, extra food, or possibly medications or the live counselor could do so at that point. Unexpected crisis situations may occur and will have to be dealt with as they occur. One situation, which occurred recently in the Chile mine incident, was similar to situations I have occasionally seen when someone was unexpectedly brought to the hospital. A worried spouse and a girl friend meet each other for the first time as they rushed to the bedside (or in this case to the site of the mine collapse).
It is difficult to anticipate which members of the trapped group of miners will have more psychological issues than the others, both while in the mine and in the aftermath. Perhaps the best indication is whether they have had previous traumas and how they have dealt with them. This is certainly no guaranteed predictor of the future. Even the presence of severe mental illness doesn’t predict problems in this situation. During World War II in Europe there was a diminished amount of exacerbation of existing mental disease as compared to during peacetime. One of the almost universal responses to an overwhelming trauma is to try to block it out, either by isolating the emotional reactions and/or the memory of traumatic event. People in the midst of traumatic event will report that it seemed as if it were happening to someone else. The degree to which they keep these memories and feelings out of their consciousness can be related to subsequent symptoms, which they may have. Most prominent among post traumatic symptoms are flashback, nightmares, being easily reminded of the trauma with reoccurring feelings or going out of the way to avoid such reminders. Some people resort to alcohol or drugs to try to avoid such painful feelings. Suicidal behavior is sometimes seen in people who feel overwhelmed by their experience and see no way for improvement. These problems when they do occur can be very brief and transient. They may not occur until after a period of weeks or several month from the time of rescue. They can persist for several months or even a lifetime if not treated.
CBT ( Cognitive Behavior Therapy ) has been used successfully in treating PTSD. This is a therapy which consists of correcting negative misperceptions about the experience but also teaching the patient various relaxation techniques at the same time as they mentally re-experience some of their traumatic memories. Other patients will benefit from therapy, which helps them explore the psychological meaning of this experience as well as deal with relationship issues and any resultant drug or alcohol problems.
Resiliency and The Joy of Being Alive
A few years ago I put together a conference of leading experts in psychological trauma and then edited a book with chapters by them on various aspects of disaster. Independently, in each of their presentations and in their book chapter they all made a point of discussing the resiliency that most people have in dealing with traumatic events. Although many victims of such events greatly benefit by treatment and may have lingering symptoms, the major of of people in such a situation will have the resiliency, to put this event into some perspective and return to their previous functioning.
Despite clinical experience that mental health professionals might have with people who have been through other traumatic situations, it is still hard to really imagine or empathize how these people are feeling. When I worked as consultant to a burn unit we would sometimes arrange a visit to a patient with a severe burn by a someone who had survived the ordeal that they had been through.
Just this week a Uruguayan rugby player who survived more than two months of isolation in the Andes with 15 others after a 1971 plane crash brought a message of hope for the miners. This survivor, Jose Luis Inciarte said, “They are in the process of discovering the joy of being alive and the will to survive.”