JOSH FEDER: Welcome to The Carlat Psychiatry Podcast. I am your host, Dr. Josh Feder, the editor-in-chief of The Carlat Child Psychiatry Report and co-author of The Child Medication Fact Book for Psychiatric Practice, Second Edition (2023), and one of my side jobs, as Mara knows, is that I'm co-chair of the Disaster and Trauma Issues Committee of the American Academy of Child and Adolescent Psychiatry. 

MARA GOVERMAN: And I'm Mara Goverman, a licensed clinical social worker in Southern California with a private practice, and an avid reader of The Carlat Psychiatry Reports. Thanks so much for joining us. These topics come up often, unfortunately, especially after disasters that displace families and strain support systems. We see responses unfold in waves. 

JOSH FEDER: My byline is Ready or not, these things are coming for all of us, and we all need to be ready. In the early days after a flooding that we've just had, we hear a lot about food, shelter, water, but mental and emotional responses are happening right away also.  

MARA GOVERMAN: For kids, that response may show through behavior more than words. They might act more dependent, withdraw, show irritability, or even have trouble sleeping. 

JOSH FEDER: So, we've been displaced by fires a couple of times here in Southern California, and I remember with my own family how disruptive that was. You get your go bag, you jump in the car, you don't know if your house is going to be there. The kids are unsure, right? And the animals are all a twitter. Even today, I was telling Mara before we started today, I was out sheep herding with my sheep dog, and the sheep are very distressed, and I'm wondering, are they expecting something like an earthquake, or who knows? That was just a fire warning that came in on my phone as we spoke. I'm going to just check that. So, I'm on my watch duty app for fires here, even though we're talking about floods today, and we've got a 0.5-acre fire a little bit far from us, and the winds are going well, they're going in the other direction. So, that's the good news, but even so, we're watching for these things all the time in Southern Cal for fires, and we hope everybody has good and better warning systems moving forward as well. So, let's talk about how psychiatric teams can support families during and after things like the Texas floods, and the Carolinas had flooding too, with some deaths. The first focus is stabilization, safety, sleep, and access to medications. 

MARA GOVERMAN: And checking in on the caregivers, parents often feel like they have to hold it together, but they're dealing with their stress responses, including loss of housing, jobs, and routines. 

JOSH FEDER: Sometimes, there's mobile clinics or telepsychiatry for areas where there is no possibility of in-person care, even short check-ins with families can help them stay stable... 

MARA GOVERMAN: And connected. Keep those sessions flexible. Maybe 10 minutes at first. Focus on sleep, hydration, irritability, or reactivity, which tells us how a person's nervous system is holding up. 

JOSH FEDER: Right. And again, as a disaster psychiatrist, one of my hats... How often do I run across the country to a disaster? Not very often. For me, it's mostly within my community where I end up doing some of these things, but what we do for our colleagues is we stay in touch. So, at ACAP, we have kind of a phone tree, right? So, we've got colleagues all over the country and globally all over the world. And every time there's a disaster, whether manmade, like a mass shooting or a new war, or there's a natural disaster, a flood, tornadoes, hurricanes, things like that. We reach out to those areas, to our mental health colleagues, to remind them of just these kinds of things we're talking about to today, so they can remind their colleagues to be paying attention to these things. And then what we also do is we take time to spend with them to listen to their stories, to let them decompress so that they can stay steady, so they can help their colleagues stay steady. So those colleagues can help families and parents stay steady, so they can help the children to get through this okay. After a death, especially of a parent or caregiver, children may have deep emotional shifts, even if they don't express it outwardly. 

MARA GOVERMAN: We often tell caregivers there's no one right way to grieve. Each child brings their understanding, their questions. And they won't always come forward on their own. 

JOSH FEDER: One thing that's helped many families is simply naming that it's okay to talk, that you're available even if you don't have all the answers. That message alone can give a child permission to begin expressing what's going on side to you or to somebody else. I mean, mental health clinicians are stretched thin, and a lot of times, what we're doing is we're helping parents to be able to withstand hearing some of the things from their kids if we're not able to be there all the time for them. 

MARA GOVERMAN: Some kids won't say a word about it for weeks. Others ask the same question again and again. That's normal. It's how they're trying to understand something that changed their world forever. 

JOSH FEDER: And it's helpful to remember that children might carry fears that they don't speak about, whether the surviving caregiver will die too, or whether they'll forget the parent who passed, or whether they blame themselves for the death of that parent, even though it's irrational. A lot of kids do that. We did an interview with Julian Ford a couple of years ago for The Carlat Child Psychiatry Report, and he talked a lot about developmental trauma where you're in a disaster, and that's bad enough, but then you lose a caregiver, someone who you really depend on to be able to stay steady. These kinds of losses are more than doubly worse than just being through the disaster itself. 

MARA GOVERMAN: As well as the unexpected nature of what has happened to them, which creates so much fear and anxiety. Remember, grief isn't only sadness. It can be fear, guilt, and even numbness, and it helps to let kids hold onto familiar things while also starting new routines that feel safe and stable. 

JOSH FEDER: If you're a caregiver, your presence matters more than any perfect conversation. Being consistent, showing warmth, letting them ask questions, that's really where the healing starts. 

MARA GOVERMAN: Let's talk about something we're seeing increasingly, children exposed to frightening news or events, floods, shootings, war earthquakes. Even just hearing about a classmate's loss, they absorb more than we think. 

JOSH FEDER: Even if they don't have the language for it, kids pick up on tension, and fear, and disruption. Helping them to make sense of what they've seen or heard can reduce anxiety and confusion. 

MARA GOVERMAN: As a starting point, you might say something like, Is there something you saw or heard that you want to talk about? It's a gentle way to open the door without pushing to get kids to talk. 

JOSH FEDER: Adults sometimes give too much information or too little, but kids don't need every detail. They need enough to understand the situation in a way that makes sense for their age. 

MARA GOVERMAN: An age-appropriate explanation, keep it simple. And they need honesty, false reassurance, like saying Everything's fine when it's not, backfires. It can make kids worry even more or feel like they're on the feel like they're on their own or that you're not telling them the truth. 

JOSH FEDER: Right. It's also about how we say things. For example, instead of saying Someone went away, we say They died. It's clearer. It avoids confusion. 

MARA GOVERMAN: And it's okay to visit these topics more than once, in fact, we encourage it. Kids process in stages and hear things in stages. One conversation probably won't be enough. 

JOSH FEDER: We also model if we say, This makes me feel sad, but I talk to people when I feel this way. We're showing that emotions aren't problems to hide. 

MARA GOVERMAN: And for younger kids, physical comfort is powerful. Sometimes a hug says more than a sentence, especially in moments when the words feel too big. 

JOSH FEDER: For older kids and teens, it's also worth guiding them toward accurate sources of information. Misinformation online can make fears worse. 

MARA GOVERMAN: And don't hesitate to ask for help. These conversations are heavy, and you don't have to hold them alone. 

JOSH FEDER: As clinicians, we may focus on the family or the individual, but grief and trauma also ripple through communities, and this is where leadership, both formal and informal, shapes how people begin to recover. 

MARA GOVERMAN: Leaders are often the ones who help people feel grounded again, that includes not just elected officials, but school principals, pastors, local business owners, and anyone people look to for guidance. 

JOSH FEDER: After a disaster or tragedy. People want someone who can name what happened and help them make sense of it, not with perfect answers, but with clarity, calm, and presence. 

MARA GOVERMAN: And a plan. And one message that helps is simply, We are in this together. That doesn't take away the grief, but it can help people feel less alone inside it. 

JOSH FEDER: As doctors, what we discourage people from doing is jumping into the fray and saying, I'm going to just go to a disaster scene and help. We don't want you to do that, but call the Red Cross, they'll figure out how to use you. Usually, it's the Red Cross in the US, sometimes it's other organizations in other countries. But we as clinicians are often leaders in our community, and we have to kind of know what we're doing. 

MARA GOVERMAN: And know where you are needed. 

JOSH FEDER: Right? And so, one of our roles sometimes is to be behind the community leaders who we might know and helping them just stay calm and keep their messaging clear and helpful, in the early days after a traumatic loss there are often waves of sadness, intrusive thoughts, or a lot of people withdraw. So, leaders who show up visibly and emotionally help the community regulate. And we're talking about emotional, but not overwhelmed, emotional, right? So that's why we help them stay steady. 

MARA GOVERMAN: As we noted, we can take different forms. For some, it's delayed. For others, it's quiet. And some people avoid anything that reminds them of the event. 

JOSH FEDER: And that's why communication matters. Keep it simple, repeat key points, acknowledge what's known and what's not known, and that builds trust and helps reduce confusion and rumors. Although we always have anger, we always have rumors. I mean, first people pull together typically, and then people get angry after a few days, and it's a, it's a really long process. Communities are impacted for years. In Texas, it happened 10 years ago, and of course, everybody's pointing fingers now, about what do we should have done and why did we make or not make these decisions? You know what, right now it's time to save people and to try to help people recover, and yeah, I mean, I think everybody wants a better warning system, but let's try to do this together rather than ripping each other apart. 

MARA GOVERMAN: And it helps to use more than one communication channel. Whether it's a press briefing or someone talking at the PTA meeting, or grocery store. 

JOSH FEDER: Leaders can also support healing by organizing memorials, attending services. And again, just showing emotion publicly, that humanizes the grief and gives others permission to do the same. 

MARA GOVERMAN: And in recovery, the leader shifts toward the future. Reopening schools, restoring rituals, setting goals. They don't have to fix everything, but they create the environment for people to reengage and have a plan.

JOSH FEDER: A community begins healing when it feels safe to move forward, and leadership plays a big role in setting that tone, especially when families are already navigating loss, trauma, and change at home. And we should just mention that there's cultural aspects here too, right? With the Hawaii fires a couple of years ago, there was a lot of mistrust of the outside coming in, like the Red Cross felt like an outside group that didn't know the community, trying to come in and help, and the recovery process is complicated by that, but it is always complicated. I was in conversations daily, then weekly with the psychiatry leadership out in Hawaii, I'm still in touch with them periodically because it's a continuing process even a couple years later. 

MARA GOVERMAN: We've talked a lot about how to support children after personal loss or frightening events, but it's also true that caregivers are holding so much right now. 

JOSH FEDER: Over the past few years, we've seen pandemic stress, racial violence, discrimination, and economic instability. These aren't just abstract issues. They show up in our homes and bodies in both how we parent and how we cope. 

MARA GOVERMAN: That's why one of the most grounding things that we can say is, You are allowed to feel hurt. You may not be showing up in the same way you used to. That doesn't mean you're failing. It means you're human. 

JOSH FEDER: And for many caregivers, trauma isn't just current. It's layered with personal or historical pain. When a new event echoes a past one, it can feel like everything's happening at once. We just saw that with October 7th, right? People felt like it was the holocaust happening all over again for people who were survivors, and then being victimized, traumatized, raped, just horrible, and that can happen even when it's not as direct, right? So, think about Texas. I mean, it happened 10 years ago. Any trauma that was still there from before can get reawakened. So, it's a real problem, and it's also intergenerational. These things do get passed down in stories, but also with the control systems for your genetics that make you at risk to be more hypervigilant and more likely to react. 

MARA GOVERMAN: One helpful framework is pause, reset, nourish, or PRN. Start with a pause. What am I feeling? Where is this showing up in my body? Then reset What might help me to feel a little steadier, and then nourish What helps me to feel connected again to myself, to my people, and to the moment that I'm in. 

JOSH FEDER: And identities matter when parts of you are being targeted. That creates a different kind of exhaustion. It can make the world feel unsafe, even in quiet moments. 

MARA GOVERMAN: So, connection is healing, whether that's family, faith, community groups, or identity-affirming spaces, reach out to the people who help you feel seen and offer the same to others. A simple check-in can carry a lot of power. 

JOSH FEDER: And let's not forget, kids watch how we respond when we model acknowledging emotion, asking for help, or creating routines. We're not just coping; we're teaching them how to cope too. 

MARA GOVERMAN: Parents can even talk about injustice in a way that builds strength. What's happening isn't okay, and here are some things that we can do that could be joining a group, writing a letter, or helping someone at school feel supported. 

JOSH FEDER: And don't forget, it's okay to limit media. You don't have to carry the world's pain 24/7 to care deeply. Stepping away can help you stay regulated enough to support the people around you, and what I tell some of my families is that pilots can only fly for a certain amount of time policemen and fire department people, they only stay on duty a certain amount of time, and it's the same for you. You've got to put yourself off duty and not watching that stuff all the time, or you won't be able to function, and for your kids, really limiting it is so important because they get overwhelmed. They get flooded. That's the word. 

MARA GOVERMAN: Lastly, ask for help. There are community resources, crisis lines, and trusted people in your circles. You don't need to wait until you feel broken. Support is part of resilience, not the opposite of it. 

JOSH FEDER: We've talked a lot about how kids respond to disasters and grief, how to support them emotionally, how communities recover, and how caregivers manage collective trauma. 

MARA GOVERMAN: The through line is, simple connection heals. Whether it's in a one-on-one conversation, a shared meal, a team huddle, or a community vigil, being there makes a difference. 

JOSH FEDER: One note on that, we don't force people to talk. We found that increases rates of PTSD. We make the opportunities, but we don't force the ball there. So, we want to open it up. We want to model it, but don't pressure people necessarily to do that, and be vigilant for people who might not be doing well. So that you can focus and target them for additional help. Look, we've included resources in the show notes from helping children to cope with grief, to supporting caregivers, to managing identity-based stress. We will also put something in there about making your go bag, and use them when you need them, and share them with someone else who might. 

MARA GOVERMAN: And if you're listening today feeling tired, stressed, or unsure, that's okay. Take a moment. Take a breath. You are not alone. 

JOSH FEDER: Everything from Carlat Publishing is independently researched and produced. There's no funding from the pharmaceutical industry. 

MARA GOVERMAN: Yes, the newsletters and books that we produce depend entirely on reader support. There are no ads, and our authors do not receive industry funding, that helps us to bring you unbiased information that you can trust. 

JOSH FEDER: I hope this conversation helps our listeners make informed choices and do the things they need to do to care for themselves and their communities. If you found this discussion helpful, subscribe for more episodes on mental health and psychiatric care, and please share it with others who may need to hear this message, and remember, when we look for good things, more good can follow.  

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