After the Floods – Social Connectedness - transcript

Alexandra (Alex) Howard: First couple of questions I’ll direct to Linda and Connie. I think you have both very interesting perspectives in the roles that you have in terms of problematic anger after disaster. So, Linda, you’re currently really still in the thick of it there in in South Australia helping people in their recovery. So, can you share some of the experiences that Red Cross frontline workers have had with anger or problematic anger, and you’re working after disaster at different phases of recovery?

Linda McCabe: Yes definitely.  I’d like to also start by saying that I’m speaking to you from the traditional lands of the Narungga people. So, my role and the role of over 50 recovery officers in Red Cross supporting the Black Summer fires is very much on the ground and we do see and at times are the branch of anger within the community.

So, to follow on from David’s presentation there are a lot of peaks and troughs, the adrenaline fuelled few weeks and months and then that cortisol or that longer term potential presentation of anger. But it is also can be seen in different events. So, when there is a major event such as the Black Summer fires, the first sort of one to seven days is that intense life preservation activities with the front line of first responders and they are often the brunt of anger.

We’ve seen many in the mainstream media, sort of quite volatile angry videos of those who are desperate to save their homes, their families, their pets, and anger is lashed out occasionally physically, very occasionally, but it is often directed to not so many individuals but in organizations. So by the time the longer term recovery agencies step in it’s usually around about that sort of one to seven days when there’s an official activation from the state authorities and it is safe to go in and start that initial recovery. So, the next step is usually the evacuation centre provision, and where Red Cross comes in is that we are part of a multidisciplinary team of recovery agencies. So, if anyone has ever been into an evacuation centre it’s incredibly frenetic, it’s busy and it’s very, very loud.

So the type of potential anger issues come from what happened sort of the week before, the month before the event. So those situations of family and domestic violence where you have community and family members coming together extremely overwhelmed and potentially can create some volatile situations.

We also have, and again it doesn’t happen very often, but I think it is important to highlight that those who have substance abuse or perhaps have medications, where the lack of being able to get the medications because of emergency evacuations, can potentially exacerbate the issues of anger or their behaviours. Fortunately, that doesn’t happen very often and it is usually quickly addressed with support. And those people will get additional clinical support.

Most of the anger that we see in that situation is directed at organisations. ‘Why didn’t the council clear the land? The council cleared too much land. Why aren’t we able to gain extra support from different government agencies?’ And certainly, Red Cross from the Black Summer fires came into that where the ground funds, there was a lot of aggression directed at volunteers and staff.

So as the recovery journey moves forward, we see this sort of three to four to six months where that adrenaline phase has dropped down, we see the community coming together. So, so many of those dysfunctional relationships that are just I guess the norm in communities, are pushed aside. But as that, as that community collegiate approach disperses, we will often see an increase in anger and targeted, aggressive behaviour directed at individuals. And so that’s something of a concern because that’s often something that we’re having to deal with in our community setting.

As the journey continues, you’re looking at anniversaries which are quite often triggers for an anger response. So, for example those who haven’t had extensive damage, able to move forward very confidently, versus those who are still very much struggling financially, their careers, there may have been an injury or death in the family, and many of the general community actually move on. We forget others trauma. And so, there is that situation of having to support people who feel they’ve been forgotten and they’re quite angry with that, and we’re coming into the third year.

Alex: I was just going to say, I might even just get you to pause there and just maybe Connie, just to bring you into the conversation. How does what Linda’s described and also what David has described, fit with the research and kind of what you’ve learned from working with communities and yes then maybe Linda you can kind of comment again to see if that fits?

Dr Connie Kellett: Thanks for that Alex. Hi everyone, such a pleasure to be here today and I too would like to acknowledge the traditional owners of the lands upon which we meet today and pay my respect to elders past and present.

My research is qualitative research Beyond Bushfires, and I’ve also as a social worker work with disaster impacted communities for many years particularly with the Commonwealth Government.

So, when working with and researching with these communities what I found is very much in line with what David’s been saying which is that anger is very diverse it can have adaptive functions, it can be productive and protective, associated with fight or flight and provide the ability to protect self and others during that you know, initial threat period with disasters. In line with what emotion theorists describe I’ve often heard about how it can be motivational. In this case fuelling that long and arduous journey of recovery from disaster so, I’m sure most of the people listening today can identify the enormous, sort of myriad of recovery tasks that people have. There’s rebuilding, gaining council permits, applying for grants, finding new schools, dealing with all those things like day care and employment, etc.  And anger can become the fuel that will lead people through this labyrinth beyond what they would normally be able to adapt to, physically and emotionally.

On the other hand, anger was also described as harmful and impacting resilience and recovery. Again, as David has talked about. It can become linked in with other emotions such as shame, blame and guilt. And I found in my research, people really talked about how those emotions really came together to create this really demanding and debilitating emotional experience that can impact their mental health.

Community members most commonly seem to identify the way services are provided, and those hoops and barriers to services post-disaster to be the most common (cause of) their anger. That’s what they remember from the long-term recovery process, is that its health service provision that made them angry.

And importantly, while community agree that their anger was presenting differently, as David said, more intense immediate and frequent, and people used words like ‘I was really short-fused’ and ‘I went from naught to 100 in zero seconds’. But they also felt it was still very much justified because of what triggered the anger. So, I think you know, particularly for practitioners, to see that difference between the presentation of the anger and what triggered the anger is really critical for communities.

So, you know as practitioners we often fear or avoid or dismiss anger because we’re not really well trained on how to deal with it ourselves, as David is very much a sort of it’s something that we’ve not learnt well or thought about a lot. The community want us to find out what triggered it and provide them with the support addressing this because for them that’s what’s meaningful. They want to maintain power and control over their recovery, for services to come in under them and support them until they can operate independently again rather than being shunted aside.

And I might just finish this with a quote from my research, where someone said, ‘when understood, anger can motivate change, when misinterpreted and allocated to some other cause, then act as the breath’, so anger becomes an impermissible emotion after a while because of the way it might be interpreted. And I think that succinctly describes that excess point with anger where it can go one way or another depending on what kind of response you give.

Alex: Yeah and I think it is really important to acknowledge those different sides of anger: the motivating, the problematic side as well and I think that leads nicely because I think you linked nicely with what Linda was saying around directed at services offered, and then thinking about what does it mean for practitioners, what does it mean for services and organizations, and I guess this is where I’m going to throw to you Carmel, thinking about what does this mean kind of in your role and in Bushfire Recovery Victoria or other roles, how do you or your organization see and consider anger in your response to the Black Summer bushfires in Victoria?

Carmel Flynn: Yes, thanks Alex, I too would like to acknowledge the traditional owners of the lands in which we all meet. And for me it’s the people of the Bunurong nations.

So, and I firstly like to say that I do concur with Linda and Connie’s observations about anger and what might trigger it and taking the perspective of my organisation which is Bushfire Recovery Victoria which is a state agency leading recovery from those 2019-20 fires. From a recovery system perspective, the recovery system doesn’t treat the anger of people and communities directly, rather as Connie has pointed out, we like to deal with the causes of the anger, to reduce those multiple triggers that lead people to escalating what might be a legitimate level of anger and often is, but by preventing them from escalating from that legitimate and healthy level of anger to an unhealthy level. So I guess to give people and communities the best opportunity to recover well, the disaster recovery system has got policy and practices in place that look to support individuals, but also to empower communities. And this notion of dignity is really important David, not just for individuals but for communities and we also use the words of empathy and community care and compassion. How recovery is worked through with affected individuals and communities is as important as what services are delivered.  We want to make sure that we tailor what’s needed and when it’s needed, for when people and communities tell us.

So at the individual level for example, a really important service, very practical service is what we call recovery case support, directly linking individuals to what supports they need for their own circumstances. Information about health services, rebuilding grants and so on. At the community level we use this notion of community-led recovery which is at the heart of how we approach, how we approach recovery. So, in the case of the Black Summer bushfires, Bushfire Recovery Victoria worked with local governments to establish 20 community recovery committees that were comprised of local leaders. And these community recovery committees were critical to advising authorities both in a proactive sense how to plan for local recovery that is tailored to the needs of each community, but also to be very responsive and have this direct voice into authorities to say these are some issues that are exacerbating anger, and here are some solutions that we need you as authorities to deal with in a very efficient way.

So this sort of governance arrangement putting individuals and communities at the centre and giving communities a voice, and leadership at the local level and direct agency into authorities, we found it’s been really, really critical in how we approach recovery.

Alex: Yes and I think that’s partly responding to one of the questions I’ve seen come up about what can organizations do to, I guess reduce those triggers for anger and I think it’s a really interesting point that it starts at kind of the way organisations are set up from their, you know, from when the governance structure is formed.  That’s a really critical, critical point. So we’ll zoom, we’ve kind of gone organization, I’m going to get Tony to zoom in with his practitioner hat on or you could have your practitioner and researcher hat on and think about at an individual level, what do you think healthcare workers need to be mindful of when working with people with problematic anger in this disaster context that we’ve been talking about. It can be in terms of recognizing it or any thoughts on addressing it, because I know people have made the point a few times that it’s not necessarily something that gets a lot of airplay during now training to be clinicians, practitioners and professionals in that space.

Tony McHugh: Thanks Alex, really good question. I’m going to speak to the individual particulars but I just want to emphasize that well operating systems of care are so important and while I’m talking to the individual, those systems play an enormous role.

So signs of problematic anger, very quickly, predominance of anger, frequency, intensity and duration, David’s spoken to those, or to what you all, however the concept of anger as a camouflage, it surplaces other emotions and doesn’t allow people to be with their anxiety, fears, worries, their horror, etc.

Another important sign is disproportionate anger where there are either no palpable causes or where there are causes the reaction is extreme. Ruminative thinking, going over and over and over aspects of the traumatic experience particularly related for example to injustice or the failure to act with justice. And dysfunctional anger which David has alluded to.

I’ll talk a little bit to the importance of optimism and treatment. Our data really clearly shows through what we call systematic reviews and meta-analyses, that trauma treatment, anger and trauma treatment works, and this is really, really important. This has to be conveyed to people, because often people don’t not only want to be angry but they’re guilty and ashamed of being angry and they think that there’s no way out. It is simply not true, provided people are given evidence-based effective treatment. It’s a critical message.

There is recovery and I, I talk about transferring beyond the event so useful explanatory theories exist. There’s theories by Berkowitz, Novaco, learning theory by the famous Albert Bandura and a very interesting theory called survivor mode by a fellow called For Chemtob, where he talks about friends becoming foes because of tendencies to interpret everything as related to survival. So if you’re not totally with me, you’re again me. And we’ve all heard stories of people who have disconnected from their friends and actually turned into enemies post disasters.

Very briefly about myths. People are not born angry. That is a conception that is out there and it has a long lineage. There’s evidence clearly, that anger grows in families. There’s another myth that is that trauma creates new people, that’s also not supported in evidence. There is clear evidence that trauma amplifies latent vulnerabilities. We’ve got before trauma, during trauma and post trauma factors and we often tend to think these days, as opposed to the past, that the post-trauma support factor is so, so important being individual or systemic another really important myth to counter is that catharsis works it does not. Brad Bushman here talks about how it’s the worst possible thing people can do in interpersonal relationships.

And finally to emphasise that to be angry is not to be monstrous. Famous paper 1983, American psychologist studies on anger and aggression by Averill really kind of ground breaking paper just like the Hobfoll paper where he basically said ‘nice people get angry and they get angry every month, sometimes every week, and sometimes twice a week’.

So we don’t want people to think that because they’re struggling with anger individually in a family communally that there’s something inherently wrong. There are evidence-based methods, cognitive work, behavioural work, very interesting papers around relaxation in the veteran world some few years ago, slowness something I talk with people all the time, when angry people or people suffering with anger more correctly are bombarded by thoughts particularly the repetitive type they doubt their sanity and to get them to work really, really, slowly and that can mean many things and working with sometimes personality styles, where people have a fixation on justice through something like an obsessional personality style, field leaders got to follow them, one of us, one of them spoke to us today David Forbes, Ray Novaco is another field leader, Leonard Berkowitz, Brad Bushman, all have great ideas.

It’s great that there’s so many people here today but I have to say as Reina Vargo said 35 years ago, anger is the most talked about but least researched affect and for every paper written on anger there’s seven on depression and ten on anxiety. Go figure. I’ll stop there Alex.

Alex: Know that there’s a lot there for us to digest definitely, and I think the message of optimism around, if you’re working with someone who is experiencing problematic anger is a really important one as and  hopefully I might grab some of  those resources that you’ve mentioned off you after here to be able to share with the audience because I know that there were some people thinking about where do they go to look for short-term interventions for anger.

But I think you’re very clear that there are options it’s just about knowing what those are we’ve also had a question and this one I’ll direct to Connie and then to David and I, and I can see from the question that there are some people kind of trying to get their head around how family violence or violence more generally, might fit in the discussion that we’re having around anger after disaster. And I know this has been the focus of your work Connie so could you, yes, kind of share your thoughts around that and then David happy for you to kind of pick up and add anything to Connie there.

Connie: Yes, I’ve been working as an executive in the Victorian government during this period of the Royal Commission into Family Violence and trying to implement changes post that. I think one thing that we all know from the last two years is that family violence increases post-emergencies or disaster. COVID certainly has shown us that.  And you know in terms of the experience of violence as David was saying, we previously haven’t had a lot of data and evidence. But as David was saying that in the Beyond Bushfires research we found that women in low impacted areas of women sorry, in high impacted areas, experience at least four times the amount of violence that women in low impacted areas do. There’s not a big, nearly as larger change for men and we would assume that that is caused by family violence that that increase in imbalance experience because that is primarily the violence that women experience so, and keeping in mind of course that 95 percent of perpetrators of family violence are men, and most of the victim survivors are women, but that not that anyone could be positioned in either of those roles, so you know look at everyone, don’t just look at women survivors.

What’s seen in the community following disaster is this jump back to more traditional roles by men who might be risking their lives fighting fires or cleaning up debris, women with a loss of services like child care end up back in the role, at the role of you know the domestic sphere as carer. And what I heard from men from my research was that they are often experiencing extreme distress and yet a high reluctance to seek psychosocial support so women are providing all of the emotional support and this is where we see the increase of risk of family violence where women are in the home trying to provide support with men who are extraordinarily distressed and may end up experiencing overwhelming anger as a result of their experience, assisting communities to recover, and then that may in some cases manifest as that’s family violence.

But it’s really important to say here that most people who have that experience of anger don’t use violence. Violence is not something that automatically happens as a result of trauma and is absolutely as David said, a choice. It’s a really very important thing for us to remember as practitioners. And of course, then what we have is women who’ve experienced family violence who don’t want to call the police because it’s their traumatized loved one who has acted in a violent manner and then we have women who have this double trauma where they’ve had disaster experience plus family violence and research would tell us that that has a compounding effect for men.

So really important for practitioners to keep in mind is – talk about anger and the possibility of anger in every environment you can post disaster and become really skilled in how to identify family violence and how you get people in to provide supports because you’re going to see it more often and it’s already seen an enormous amount in our communities.

Alex: Thank you. David any kind of things to add to that?

David: Oh look it’s a delight to be able to go after Connie because that was absolutely, that was kind of a terrific kind of description of really the key issues. Agree with absolutely everything that Connie had said you know, really important, as we do discriminate between kind of anger and violence. They’re not connected together and they can often get blurred, particularly in the mind of service providers either or clinicians or other community providers.

We talk about kind of anger aggression and violence as though they are one thing sometimes. It’s really important to disaggregate those and where anger, where poor regulation of anger, has resulted in the triggering of aggression, really important that that’s identified by providers and being able to address as a first priority.  And being used to being able to ask questions bravely and honestly, asking questions about it, because often it’s you know what we find is that clinicians who are nervous about asking questions about this and can walk on eggshells around the topic are really important to be able to be open, and have conversations about identification of risk and to be able to lean accordingly.

Alex: Thank you.

David: And being alert to other factors along the way, knowing that the increasing financial stress increases the risk in substance use, the gambling, all of these things we know increased risk. Being alert for what might be softer indicators for asking questions, asking questions regardless, but also know that these other factors increase the risk.

Alex: Thank you and I think, yes, I think it’s important that we do try and differentiate there. So thinking now, I’ve got some, we’ve been answering these questions as we’ve been chatting anyway but I might kind of push two questions together if I may, just being aware of the time, and start with Linda and Carmel just if you could consider you know what people might want to walk away with today. What the key message is particularly if that relates to things from an organizational level what some of the things that we’ve been trying to talk about is the idea that there are these triggers for anger that you know a system approach can be helpful with. So yes, Carmel and maybe Carmel and then Linda, what are your kind of take-home points around that?

Carmel:  Look I guess firstly, disaster recovery is long, and it’s complex. I can say it’s a marathon not a sprint although what happens in that first part of the journey after, in those early days, after an event absolutely does matter for the long-term outcomes. But I think that the key takeaway is yes let communities and people know, as if you’re part of the recovery system that you are there with them for the long term. That people and communities are at the centre, that they have agency and they have a voice and that our job in the recovery sector is to partner with them in a coherent coordinated and joined up way to make recovery as seamless as possible to not exacerbate the trauma and trigger, triggering any more than is necessary. Thank you, and Linda did you have anything to add to that before I’ll unfortunately have to rough up the panel.

Linda:  yeah just briefly, if those who are listening in can really have a look at where the cycle of your community is. There are definite events, definite triggers for that adrenaline and then that cortisol phase and that will impact on how your community is reacting. And also be aware that as well as having the largest disaster event we also have the pandemic on top of that, and that has really come in to disrupt that natural healing process after a disaster. For those who can, I would really encourage everyone of your front-facing staff whether it be on the phone or face-to-face to undertake a short course in psychological first aid whether it be through Phoenix, Red Cross, it was a number of agencies. It really does help you understand what you can do right across that two, three-year space. And it gives you that confidence to deal with situations such as anger.

Alex: Yes, thank you.

David: Can I sneak in one last comment?

Alex: Of course you can, final reflections.

David: No, no, well it may be a little less sophisticated than that. But one thing I just really want to mention, I think that we haven’t mentioned so far, is the organizational support for the supporters so really, really, important particularly as Linda described in the first instance really. Which is the first responders and community workers are often at the coal face of the engagement. I agree absolutely with what Linda was saying about psychological first aid in terms of training but the other issue is the organizational supports for the support workers themselves. We know that you know their trauma load their impact is significant. I mean being able to support them provide them with the training and support they need, to maintain their mind to health and wellbeing in the context of not only the onslaught of the disaster but also sometimes the onslaught of community anger. So really critical that we don’t lose sight of how to support the supporters.

Alex: Yes, I think that’s a really a great note to end on given that the hub is really a resource targeted for helping the helpers.