The Many Faces of Disaster Psychiatry: A Resident’s Journey of Resilience and Recovery

The COVID-19 pandemic began in the spring of my fourth year of medical school, and I soon graduated early to work on one of the COVID units in our hospital, where I worked for two months prior to my move for residency. My plans for the last few months of my schooling and postgraduation were abandoned. I have vivid memories of helping loved ones say goodbye to their family members over FaceTime, then biking home through an empty Times Square alone in my thoughts. It was grueling, devastating work. I began my intern year—a time that is supposed to be one of excitement in addition to anxiety about one’s new responsibilities—burdened by the trauma of what I had experienced, with few tools to manage my fears. I was alone in a new city, unable to form meaningful connections with anyone due to the strictures of the quarantine. As a current PGY-4, the COVID pandemic has colored my entire residency experience, and it is increasingly obvious that things will never quite return to the way they were before COVID.

When I first learned about disaster psychiatry, I imagined it referred to psychiatry in response to disasters such as war, earthquakes, and hurricanes. Perhaps because by then I had become so numbed to the horrors wrought by the COVID pandemic, I did not immediately think about the disaster that has been unfolding worldwide over the past three years. But the truth is that I have seen the trauma of the COVID pandemic everywhere during my residency. A 20-something who lost several family members to COVID and developed anxiety and depression attempted suicide after being asked to work from home in isolation. A middle-aged man with chronic schizophrenia who had been stable for years and had been regularly attending a day program decompensated without his support systems and regular contact with his psychiatrist. These are the kinds of cases that characterized my first year in residency.

Even further, I certainly did not consider the effect that the COVID disaster had on me or my colleagues. Yet how could there not be an effect, given that we were the frontline workforce during a worldwide pandemic characterized by terrible suffering, grueling working conditions, and an increasing distrust and even hatred of those in our field of work? I watched as my friends from medical school slowly withdrew and eventually dropped off the map, overwhelmed by the extraordinary pressures of the work. Studies show that there were increased rates of depression, anxiety, and burnout among house staff during the COVID pandemic.

My work on the APA Committee on Psychiatric Dimensions of Disaster has introduced me to concepts that can be used to counteract the effects of the COVID pandemic both in my patients and for me and my colleagues, as well as during future disasters. Through the committee I have learned about psychological first aid, which recommends ideas such as helping people meet basic safety needs and encouraging calming, connectedness, self-efficacy, and hopefulness in the aftermath of disaster to mitigate immediate and future psychological sequelae. These are valuable tools, and ones I wish I had learned about earlier in my training.

Psychiatric response to disasters should be a part of residency curricula, either as lectures or grand rounds, to expose residents to these ideas while still in training. It might also inspire residents to join in the volunteer responses to disasters. Not only can the training improve the care we deliver to our patients in times of turmoil and fear, but also it can help us understand our own responses to disaster and better equip us to safeguard our own mental well-being as we care for our patients. ■

Alison Liss, M.D., is a PGY-4 and chief resident at Temple University Hospital in Philadelphia. She is an APA/APAF Public Psychiatry Fellow.