Tanzina Vega: This week on the show, we've been talking about how natural disasters can affect mental health. This past Sunday marked the third anniversary of Hurricane Maria's devastating impact on the island of Puerto Rico. Since then, Puerto Rico has struggled to recover and there have been crises upon crises. Last year, the island's governor stepped down after sustained protests called for his resignation. In recent years, we've seen rising rates of femicide and violence against women in Puerto Rico.

With me again is Karen Martinez, the chair in the Department of Psychiatry at the University of Puerto Rico and director of the Center for the Study and Treatment of Fear and Anxiety.

Karen Martinez: Unfortunately, many traumatic events have occurred because even though maybe it isn't directly traumatic like the political unrest, it does cause stress. There has been real trauma and there have been these very stressful situations that we have gone through during these past three years. Right now, the state of mental health is one of helplessness and not having hope. That's the main thing I'm working with my patients.

How do you have hope when everything seems so bleak and when we have a disaster, stressful event, disaster, stressful event, one after another? We're seeing more of depressive-like symptoms related to that helplessness and hopelessness. That's the main thing that at least as mental health conditions we're working right now. How do you create hope when you really know that a lot of people have just gone through so much?

Right now with the pandemic, the most difficult thing here is just the economic instability. A lot of people has lost their jobs. A lot of businesses has had to close. We're very worried about the effect that that's going to have on people's mental health when it's already so fragile. I think one of the things that has [unintelligible 00:02:07], we haven't seen a spike in suicides which was something that really worried the mental health community and it's because there is a sense of community here that helps us, that is something protective.

Culturally, we take care of each other and that's really what helped us get through Maria, but after Maria, with all the political unrest, people are really feeling like you can't count on the government. One of the good things is that a lot of communities are coming together and are trying to help each other in terms of mental health. I think that's probably something that will need to happen more now with the pandemic.

Tanzina: Your research is working with women who were pregnant and postpartum during Maria, what are you finding that these women are experiencing three years later?

Karen: There's still high symptoms of depression. High symptoms of post-traumatic stress disorder and there's this feeling of not having enough help, of not knowing where to go to get help, especially if they're women who have children who are already in school age. What has happened here in Puerto Rico with schools, it's terrible. Schools were closed for three to four months after Hurricane Maria and then with the earthquakes, school were again closed and then the pandemic happen.

We have kids in the southern part of Puerto Rico who have not had barely any schooling in the last three years. For moms, there's no childcare, there's no formal school and it's just another added stressor to what already has happened. These moms, what we're seeing is that they had that severe exposure to Hurricane Maria, but then they haven't been able to get their mental health stabilized just because things continue to happen.

Tanzina: We had a reporter about a month and a half ago, who had done reporting on domestic violence on the island and how the number had spiked post-Maria. Now, one of the concerns with the pandemic with quarantining is that that would exacerbate that problem. Are you seeing that Karen, among women, that they are either in intimate partner violence situations that they can't get out of or that those instances have increased?

Karen: Yes. As always, the problem is having the data to actually be able to know how much it has increased, but just this week, we had two instances of partners killing a woman and then committing suicide. That two events in one week is definitely a red flag. We do know it's really difficult for women to talk about domestic violence and abuse. Right now, when they're at home, they're not necessarily having the social context or going to the places where they're going. It's even more difficult for them to be able to talk to someone and get help. We don't necessarily have the data to know how much it has increased, but at least clinically, we are seeing women talking about their partners getting more violent and we have seen very severe cases where it ends up in a tragedy. We need to have a plan on how we are going to address that.

Tanzina: Karen, this is a crisis for Puerto Ricans, for Puerto Rican children, for Puerto Rican women, and even for Puerto Rican men. Where do you see there being any-- You mentioned community resources coming together, but there needs to be more.

Karen: There needs to be a government plan on how to address it and I know--

Tanzina: A federal government or a Puerto Rican government?

Karen: A Puerto Rican government, at least as a start. [chuckles] The local government and all the different entities that have been working with this problem of violence in women, they have been pleading for a national plan to be established on how we're going to work on this and it just hasn't been done. We need--

Tanzina: Even under Wanda Vázquez?

Karen: Even under Wanda Vázquez, yes. Right now, we're in a state where the elections are very near. Wanda Vázquez is not going up for re-election. We're right now in this state where nothing really has happened at the state government level. Usually, things start-- In a new government, things start happening in January. We cannot wait until January to have this plan. There's a lot of non-for-profits and women group and other associations like the Psychology Association, the Social Workers Association. We are trying to get people in the government to notice this problem and we need to do something, but it's just been really hard to get the attention on this problem in the middle of a pandemic.

Tanzina: Karen Martinez is the chair of the Department of Psychiatry at the University of Puerto Rico and director of the Center for the Study and Treatment of Fear and Anxiety. Karen, thanks so much.

Karen: Thank you.

Tanzina: You've been telling us how living through disasters like hurricanes or wildfires has affected your mental health.

Christina: This is Christina from Seal beach. I went through a hurricane called Hortense in 1996 on the West end of Puerto Rico. It was scary overnight when it hit the island. Driving around the next day and seeing what nature had done gave me a sense of being so small in a powerful and natural world. I helped people who needed it. It left me with a positive and empowered feeling like it was a wonder to witness and experience and survive.

I lost my house to a fire in 2007. As I was away from my house, what precipitated my awareness of it was a phone call from a friend. To this day, I get a horrible feeling in my stomach when I get a phone call and the person's voice sounds even a bit grave. That's just one PTSD effect of that loss. From both experiences, I feel that disconnection from what I own and what I can create, it can be gone any day and it's okay. I accumulate new things quickly and appallingly. What I crave is meaning each day and meaningful connections to those who are important to me, which is obviously my friends and family, but really the entire world.

Tanzina: You can keep sharing your thoughts with us by calling 877-869-8253. That's 877-MY-TAKE

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