Tuesday, August 2, 2016

Catastrophic Thinking About Catastrophes

A storm rolls into Minneapolis - photo by Eduardo Colón, MD

Like most psychiatrists, I have spent a lot of time listening to anxieties about hypotheticals.  Are people judging me when I am out in public?  Will I fail an examination?  Will I end up penniless and homeless?  Am I really dying of something that the doctors can't diagnose? Am I going to lose control and drive off a bridge on the way in to work?  Now that my relationship is over will I ever find another person who will love me?  The human mind is set up to obsess about the improbable and if you have the predisposition to create a hypervigilant approach to this anxious stream of consciousness it will lead to much less sleep and a number of physical symptoms.  Many  people have had these patterns of thoughts for years or decades before they decide to see a psychiatrist or a psychotherapist.  This kind of anxiety can be disabling even without any panic attacks or significant physical manifestations.  It is an outstanding example of how emotion impacts decisions - in this case the decision to worry about something that is recognized as illogical.   One of my standard questions of the anxious person involves catastrophizing or jumping to the worst possible conclusion.  It is also a universal human experience.  The best example is assuming the worst if a family member is late when driving over to your place.  Are they in a ditch?  Are they in the emergency room?  Have they been in an accident?  Are they dead?  Common thoughts that various people get in that situation.  When it comes to real catastrophes, the thought patterns change significantly.

I have always been interested in catastrophes - ever since I read a book as a kid about a meteor hitting earth.  In those days we used to have to go to a bookmobile stop, get on a large recreational vehicle that functioned as a mobile library and borrow books to read every week.  That book caught my eye, because it had a picture of the collision on the cover and a detailed description of events on the inside.  At the time, the real risk of massive destruction was a standoff between the US and the USSR in the Cuban missile blockade and a decision by a Soviet submarine commander - but taxpayers are always the last to know.  We were worried plenty about that real crisis, but at about the same time - I was reading my first 400 page novel on a meteor hitting earth and all of the destruction that would involve.  Over the years it has lead to a focus on how to survive, the unsurvivable,  I have referred to myself as a survivalist at times but realize the I am half joking.  Real survivalists tend to see catastrophic events as impacting on the food supply.  I have heard the credo that "We are only 5 meals away from chaos."  The associated strategies are food hoarding, secure locations, and plenty of firearms if necessary.  I think it is logical to think that the food supply may be constrained, in quantity and volume - but I think that is also logical to take an approach that involves that maximizes the survival of the human race - from anything just short of the destruction of the planet.

My personal involvement with disaster planning peaked about 8-10 years ago.  At that time I was involved in 2 avian influenza task forces - one localized to the hospital where I was working and the other metro and statewide.  An influenza pandemic is a very lethal event that can result in tens of millions of deaths.  The last time the world population was subjected to a highly lethal strain in 1918, people were going to work in the morning and dropping dead in the streets on the way home in the evening.  My participation in these task forces was highly instructive on a number of issues.  I was involved in teaching psychological first aid (PFA).  The theory was fairly simple.  Most people who suffer the psychological trauma of a mass event like an epidemic will recover psychologically.  The focus is reassurance, providing information, and preventing surges of activity in hospitals and emergency departments that would overwhelm resources.  That theory was based on what happened after the concern about anthrax being sent to the US Capitol building occurred.  In that event emergency department (ED) services were immediately overwhelmed by people who thought they were exposed to anthrax.  To prevent that - trained PFA staff would be in ED areas to assist with keeping people moving.  The unfortunate reality was that the real infrastructure, ventilators and isolation rooms would be almost immediately overwhelmed even with the appropriate surge protection.   Nobody had adequate infrastructure to treat high numbers of people with respiratory failure who were infected with a highly virulent strains of influenza virus.  Nobody was interested in building that infrastructure.  Nobody was interested in HVAC (heating, ventilating, air conditioning) systems that did more than isolate a few infected people.  There was an interest in getting oseltamivir phosphate (Tamiflu ®) to whoever needed it.  I saw a slide several times of large pallets of boxed oseltamivir sitting in a large government hangar somewhere and being told that it was ready to be shipped to whoever might need it.  There was also an interest in what to do with large numbers of dead bodies and fairly specific plans for that detail.  In the end, the only logical conclusion was that the planners of this event were fairly hopeless about the outcome and trying to quell either the expected mass hysteria, the inability to marshall any realistic resources, or both.  From what I have seen, I would not expect a better outcome than 1918, unless there are effective vaccines immediately available.    

Non-Biological catastrophes are broader in scope and potentially more devastating.  The recent overview by Julia Rosen in Science (1) illustrates the possibilities.  An interesting aspect of the non-biological catastrophes is that they necessary need some kind of a hard fix.  There needs to be a basic shelter or someone has to figure out how to go out into space and either destroy or displace that asteroid hurtling toward the Earth.  There is no imaginary hospital bed capacity like with a biological epidemic.  If you don't have a real shelter or a real intercept device - all or part of the human race perishes. According to Rosen,  even these scientists are subjected to a "pervasive giggle factor".  Many do not see the study and prevention of catastrophes as mainstream science.

The body of Rosen's article discusses natural events that can decimate the infrastructure and other that could lead to the extinction of humans.  An example of an event that is probably not directly harmful to humans is a coronal mass ejection (CME) from the sun.  High energy particles are ejected from the sun and into the Earth's magnetic field.  The particles can destroy power grids and other electrical transmission gear.  CME events have occurred on Earth, one of the largest in 1859 called the Carrington Event.  Any similar event today might place power transformers at risk and create widespread havoc with the power grid resulting in large section of continents going dark for as long as years.

Near-Earth Objects (NEOs) are a more clear danger and probably have the most scientific investigation.  The Spaceguard survey by NASA identified 90% of the NEOs larger than 1 kilometer by 2010.  They are currently working on identifying 90% of the NEOs greater than 140 meters by 2020.  No NEO identified so far is on a colleion course with Earth.  The article contains a graph of Damage/Fatalities versus Recurrence Period in Years for Volcanoes, Impacts, Earthquakes, Floods and Tsunamis.  According to that graphic - a global catastrophe from an NEO impact recurs about once in 100,000 years.  From the graphic below, that event would have been the eruption of Mt. Toba in Indonesia about 74.000 years ago.  That may have killed most humans and led to a bottleneck event in human evolution where climate change led to a rapid paring of certain populations and more rapid adaptive changes.  Interestingly some fossil evidence suggests that native people in the vicinity of the eruption survived it and adapted to it.  The 1980 Mt. St. Helen's eruption is shown for relative scale.  That event killed 57 people and covered 22,000 square miles.  At 10 miles the ash was 10 inches thick.         

Graphic From US Geological Survey - Public Domain

I took the above events and tried to order them chronologically in the following graph.  For comparison with human evolution the first ancient humans (Homo erectus, Homo heidelbergensis) started out in East Africa about 200,000 years ago and started to migrate north.  The evolutionary changes necessary for modern humans happened about 50,000-75,000 years ago - sometime after the Mt Toba eruption.  The fossil evidence from Mt. Toba suggests that a supervolcano eruption in Yellowstone is survivable.  The critical question is how?  Various scenario have suggested that the sulfur dioxide content in the air will lead to climate change and a much higher prevalence of pulmonary illness.  Climate change will likely be a problem.  Fossil evidence suggests that there was a decade long period of cooler drier weather after the Mt. Toba eruption.    Computer simulations of the ash distribution from a Yellowstone supervolcano event would cover most of a triangular area from Los Angeles to Chicago to Calgary would be covered in ash varying in depth from 40 inches or more at the center to about an inch at the periphery.  With volcanos there is also a significant environmental impact from both the direct blast and and toxic gases like sulfur dioxide.

Whenever I discuss some of the issues with friends or coworkers - I get the same nervous laughter mentioned in the Science article. People can't seem to believe that there is anyone out there thinking about these things. The endpoints of the spectrum include: "You are nuts!" at one end to "I am just going to run outside and stand under the mushroom cloud. I would rather be dead than living in my basement for a year." at the other.   These sentiments were captured by Cormac McCarthy in his post-apocalyptic novel The Road. In the novel a boy and his father wander a dangerous post-catastrophe countryside. The actual event is never specified but there is widespread famine, climate change, and primitive behaviors including constant confrontations about food and cannibalism. There are flashbacks about the wife and mother of this dyad and we learn that she was not able to cope with the new reality and committed suicide. At one point they encounter an old man along the road who wants some of their food. There is tension between the father and son - the father wants to move on and the son is still altruistic and wants to help the old man. At some point there is a conversation and the old man sums up the situation when asked if he tried to "get ready for it":

"What would you do?....Even if you knew what to do you wouldn't know what to do. You wouldn't know if you wanted to do it or not. Suppose you were the last one left? Suppose you did that to yourself?" (p168-169).

McCarthy does a masterful job of capturing the attitudes of the resilient, the hopeless, and the altruistic after a catastrophe. He also illustrates that in truly catastrophic conditions nihilism may be a logical conclusion, but hope still lives on in the minds of others.  I have encountered all of these attitudes in discussing the prospects for survival, but my anecdotal experience is that most of the people planning to survive seem to be planning on confrontations and shoot outs that are directly out of The Road.

I think the outcome can be much more positive, survival enhancing and optimal when it comes to the survival of the human race.  It does take a more enlightened approach to food and shelter. It requires generations of planning. It requires multidisciplinary planning to gradually change the infrastructure. I was not able to get a critical reference to complete this post that was listed in the Rosen article (5). This book has been widely reviewed as a possible solution when food storage is not possible. Their suggested food sources would be useful in any sun blocking catastrophe like a supervolcano, nuclear winter or high speed impact by an NEO where vegetation could not be grown. Gradual but large scale changes to the infrastructure could also result in permanent dwellings designed to provide fresh food and water to the occupants as well as waste disposal and HVAC systems that would function in a highly adverse environment and supply clean air in the absence of any major power disruptions.

Encouraging gradual change with these goals in mind is a much better position to take than preventing post catastrophe panic. As a psychiatrist who has been involved in disaster planning - having a real solution is always superior to meaningless reassurance. That would never work in one-to-one psychotherapy. Why would anyone expect it to work for agitated crowds?

George Dawson, MD, DFAPA


1: Rosen J. Thinking the Unthinkable. Science. 2016 Jul 15;353(6296):232-7. doi: 10.1126/science.353.6296.232. PubMed PMID: 27418500.

2: United States Geological Survey (USGS). Yellowstone Volcano Observatory. Questions about supervolcanoes. Accessed August 2016.

3: United States Geological Survey (USGS). Fact Sheet 2005-3024. Steam Explosions, Earthquakes, and Volcanic Eruptions—What’s in Yellowstone’s Future? Accessed August 2016.

4: Cormac McCarthy. The Road. Vintage Books, New York, 2006. 287pp.

5: David Denkenberger and Joshua Pearce. Feeding Everybody No Matter What: Managing Food Security After Global Catastrophe, First Edition. Academic Press, 2014

Appendix 1: Estimated ash distribution from a Yellowstone supervolcano event.

From United States Geological Survey - Public Domain

Appendix 2:

I wrote a brief science fiction piece about psychiatric treatment after a supervolcano eruption in both original and annotated forms.