Mental health crisis descends on Puerto Rico’s working class

By Ali Abu Elhassan

9 March 2018

As the six-month anniversary of Hurricane María approaches, a deadly mental health crisis has emerged on the island of Puerto Rico. Health officials are reporting endemic levels of trauma related emotional disorders. Many Puerto Ricans are showing symptoms of post-traumatic stress disorder (PTSD), experiencing extreme anxiety and depression for the first time in their lives. The severity of the crisis is most sharply expressed in the rise in suicides, which has seen a disturbing 30 percent spike since the storm made landfall.

The reports of PTSD are a testament to the reality of life for the working class in Puerto Rico as the disorder is most popularly associated with soldiers who experience trauma in war zones. The sudden and long-term loss of access to basic necessities of life such as running water and electricity, homes left destroyed and roofless with residents still occupying the structures, the covering up of a massive death toll, the destruction of public utilities, school buildings, education and jobs, as well as an increase in policing has had a traumatic impact on the island’s population.

Thousands of people with preexisting mental health problems have been unable to obtain their needed medications and therapy, causing marked deteriorations in their conditions, especially among the elderly who are particularly vulnerable. Storms and rain produce anxiety and paranoia in children and adults who become worried that there will be more flooding.

Symptoms of PTSD include irritability, mood swings, anxiety, depression, repeated and vivid memories of the event, which lead to physical reactions, confusion or difficulty making decisions, sleep or eating disorders, fear of the event being repeated, an increase in conflict or a more withdrawn and avoidant personality, and physical symptoms such as headaches, nausea, and chest pain. These responses can vary widely depending on the individual, the environment, and the event.

The only suicide hotline in Puerto Rico, Linea PAS, has been dealing with a surge in calls, up nearly 70 percent, from people contemplating suicide.

In an interview with Univision Noticias, the director of Linea PAS, Monserrate Allende Santos, relayed that between the months of October and December 2017 the program received 9,000 suicidal phone calls; 6,733 calls were from callers with suicidal thoughts, while 2,206 were from people who had actually attempted suicide.

A member of the hotline’s call-taking staff told the New York Times, “Sometimes I cannot find the words. Because how can I tell someone to keep calm when they don't have a place to sleep.”

Linea PAS’ staff, many of whom have experienced their own hardships, patiently try to console, reassure, and talk suicidal hurricane survivors who have lost all hope out of ending their lives. Another staff member is heard in a Times video telling a caller, “the situation of not having light in your house, the situation of being dark, of not having resources, this is temporary.” For some, however, it is not certain that this assertion is true.

How many Puerto Ricans will die due to criminal government indifference?

In an interview with Newsweek, Kenira Thompson, who heads mental health services at the Ponce Health Sciences University, stated that for the people in rural areas, “It’s as if the storm hit last week.”

“Mental health issues will not stop,” Thompson explained, “if you think about the next hurricane season will start again [soon]. We will have chaos when the first storm is announced on the news. Hopefully, it’s not another storm like María.”

When María made landfall on the island in September, it descended upon a population already in the grip of extreme poverty and depressed living standards. Having been in recession since 2006, half the population stood below the official poverty rate while the official unemployment rate stood at 16 percent. A staggering 60 percent of eligible workers did not participate in the labor force, instead relying on food stamps or working in the “underground economy.”

In the wake of the hurricane this already precarious situation dramatically worsened. Hundreds of people perished or died in the aftermath from lack of basic necessities. Hundreds of thousands of homes and basic infrastructure have been destroyed, leaving, to this day, 150,000 homes and businesses without electricity and much of the island in ruin.

While it’s common for people to experience stress in the immediate aftermath of such an event, the American Psychological Association (APA) stresses that recovery is dependent on one’s ability to resume functioning as they did prior to the disaster and to engage in healthy behaviors, such as a healthy diet, establishing routines, and seeking getting help from a licensed mental health professional.

Healthy behaviors cannot develop when countless homes remain destroyed, when people are trying to live without roofs or are forced to join relatives in overcrowded, unsafe conditions. The establishment of routines is not a possibility in circumstances where people are chronically living without electricity, are struggling to find food and clean water and are unable to travel on closed roads to frequent, or work, in closed businesses and attend closed schools.

The Federal Emergency Management Agency has provided a paltry $3 million for the mental health division of the Puerto Rican Health Department. The failures and crimes of FEMA, and the US government more generally, against the working class of Puerto Rico are innumerable.

In the immediate aftermath of the storm, ports that import about 85 percent of the island’s food supply were shut down under the draconian hundred-year-old Jones Act, which the government only reluctantly lifted weeks later. Another outrageous episode was when Tribute Contracting LLC, awarded a $156 million contract to deliver 30 million meals, only managed to deliver 50,000. The criminality of the US government is best exemplified, however, by the efforts to undermine and ultimately privatize the island’s resources and infrastructure, currently the education system and the public electric power company.

This inadequate provision of social and psychological services by the government has compelled universities to send teams of students, social workers and other volunteers out in a piecemeal effort to meet the needs of the population. These students and workers have made their way to the worst hit areas inland, which have become isolated and hard to reach due to the poor recovery efforts. They go door to door and visit emergency shelters where the newly homeless are crowded in order to conduct physical and psychological screenings and deliver food and water.

Observers and health experts have drawn parallels between the aftermaths of hurricanes Katrina and María: From the physical and social devastation they visited upon New Orleans and Puerto Rico, respectively, to the inadequate governmental response marked by gross negligence and arrogance, the long term physical and psychological trauma their victims are suffering, and the fact that these are both climate-change related catastrophes.

In a report published last year titled, “Mental Health and Our Changing Climate: Impacts, Implications, and Guidance,” psychologists with the APA found that 12 years after Hurricane Katrina, survivors developed mood disorders, saw rates of suicide and suicidal thoughts double, and one in six met the diagnostic criteria for PTSD. Psychiatrists have since stressed the importance of immediate access to mental health care for the victims of natural disasters to help mitigate these types of outbreaks.

At the 10-year mark of Hurricane Katrina, the WSWS published an analysis of the source of the catastrophe that is no less apt at describing the one facing Puerto Rico today: “The sudden shock of Hurricane Katrina exposed the rot at the heart of American capitalism. Decades of social neglect, the staggering growth of social inequality, the putrefaction of American democracy, and the domination of every facet of social life by a narrow and parasitic layer of financial speculators was laid bare before a shocked American and world public. For millions of people around the world, already horrified by American imperialism’s criminal adventure in Iraq, Katrina demonstrated that the American ruling class was no less hostile towards its own working class.

“This rot has spread geometrically in the years since then. Since the onset of the 2008 recession, the attitude of the ruling elite towards Katrina, which saw it as an opportunity to open up further opportunities for profit, has been replicated in every facet of American life. Instead of responding to the recession with a public works program or other measures to alleviate the distress of the working class, American, and, indeed, world capitalism, with Obama at the head, has responded with a fundamental restructuring of class relations, aimed at nothing less than the dismantling of every gain made by the working class in over a century of bitter struggle.”

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