Coping With Anxiety From the Quake : Mental Health: San Francisco’s devasting temblor raised emotional aftershocks--in the rest of the nation as well as in California.

The San Francisco earthquake was disturbing--and not just for Californians. We have seen several patients in our practice in the last few days because of anxiety precipitated by the quake.

In addition, many of my patients have become significantly more anxious and depressed since the disaster, which killed so many and devastated the lives of thousands. I was initially amazed as to how important discussion of the California quake was to my patients. What was even more puzzling was that their focus on this event continued rather than diminished as the days went by.

I polled several practitioners and they reported similar reactions with their patients. Interested to see if this was limited to people who were already in therapy, I asked several of my friends and family to informally monitor and report back to me what they observed with their friends and associates. Although far from qualifying as a scientific survey, their reports were unanimous: about 25% of the people they observed seemed to have a higher level of anxiety and depression associated with the California earthquake. What is the basis for their anxiety--particularly in Baltimore, Md., 3,000 miles from the disaster?

Perceived control over our lives is the most important factor which predicts our emotional and physical health as well as our longevity. Most of us spend the majority of our energy to secure what we want and need and to increase the predictability of life. When we feel that our control over day-to-day existence is reduced, our anxiety and fear grow proportionately.

But worldwide disasters are commonplace. All we have to do any day of the week is turn on the TV and there we have it--instant disaster. So why should the California temblor shake us to our foundation and create so many emotional aftershocks, including increased anxiety, panic attacks, insomnia and depression, and physical problems, such as headaches, gastrointestinal distress and fatigue? There appear to be several conditions that came together to reduce our sense of perceived control over our lives to extremely low levels and, in turn, resulted in severe and continued reactions to the earthquake.

First, within the month preceding the quake we had Hurricane Hugo. Each night, we tracked the hurricane on the evening news. At the onset we saw it east of Puerto Rico, and then each day we carefully plotted its course. We knew exactly where it was, what islands were in its path, how large it was, and how strong were its winds. Yet in spite of all that information, we watched on television while it destroyed the life’s work of tens of thousands of people in South Carolina. We had complete information and yet were helpless--totally lacking control over preventing its disastrous consequences.

In addition, because of instantaneous reporting on television, our capacity to closely identify with the people who were devastated was heightened to levels beyond that which we normally experience. This unique combination of “seeing it coming” and being unable to “stop it” increased our sense of helplessness and fear.

With the devastation of Hugo still fresh in memory, along comes the earthquake. Not in Tibet or Peru, but on home territory, in San Francisco, a city most Americans associate with the height of civilization and sophistication.

So the one-two punch of Hugo and the quake has caused the nation’s anxiety to soar.

But why doesn’t everyone experience problems? And what can we do about it if we are suffering such upset?

We all have, whether we realize it or not, what I call a “sense-of-control quotient.” Some of us feel more in control of our lives than do others. For example, at one end of the continuum of perceived control is the person who, after falling out of an airplane without a parachute, is relatively confident that he will be able to hit the ground in such a fashion as to minimize his injuries. At the other end is the individual who, while seemingly secure in his cozy living room, is anxiety-ridden over the possibility of an out-of-control airplane crashing into his house. Fortunately, most of us reside somewhere in between these two extremes.

However, where we reside appears to be the result of two factors. The first is subtle and often hard-to-identify learned behaviors in our childhood that, at critical times in our development, teach us how much control we “perceive” having over our lives. I must emphasize that what we grow to expect in terms of control over our life and how much control we actually have are not necessarily related. Some of us grow up expecting to rule the world and others grow up with a desire to dig a hole and hide, no matter what our life’s experiences.

In addition to our childhood experiences are those in our adult life. If we have been plagued by events such as losing our job unexpectedly, our spouse running away with the next-door neighbor, the unexpected and untimely death of a loved one, a chronic illness--these combine with our learned expectations from childhood to produce a particular “sense of control quotient.” The lower our quotient, the more susceptible we are to developing emotional and physical problems from events like Hugo and the earthquake.

So what can we do to enhance our quotient and to reduce our distress?

First, we can use our intelligence like a tool to reshape our emotional reactions. Understanding the meaning and implications of the serenity “prayer” can be a major first step in this regard. “God give me the strength to change the things I can, the serenity to accept the things I cannot change, and the wisdom to know the difference.”

We spend so much of our emotional energy focusing upon that which we cannot change that we have none left to expend on those circumstances that we could alter. As a result of not taking charge over that which we can control--we feel even more out of control and our “quotient” drops even lower.

Although most of us have experienced tragic events in our lives that have been totally outside of our control, in fact these account for a very small percentage of events and situations in our lives. In spite of this fact, so many people spend so much of their time worrying about things they can’t change and do little to shape the outcome of their own lives.