Science / Medicine : Nightmares...
For weeks after Hurricane Hugo pounded the coast of South Carolina, an unexpected gust of wind would cause rescue workers to freeze in their tracks.
A month after the devastating Bay Area earthquake, reporter Lee Quarnstrom said the rumble from a truck outside his Santa Cruz home would make him jump and poise himself to run to the front door.
And three years after a plane crash devastated her Cerritos neighborhood, the sound of a jet overhead causes Maria Santiago instinctively to look to see if the aircraft is headed up--or down.
The psychological trauma on individuals and community lingers long after a tornado or a raging flood weaves a path of destruction. And because of the emergence of the new field of psychological trauma treatment, a clearer picture is developing of the effects of disasters.
Although the post-disaster effects on individuals are remarkably similar, recent disasters have helped catastrophic trauma researchers detect subtle behavioral difference among people who have experienced large-scale disasters. Among the findings reported by researchers are:
* Widespread violence involving multiple murders is the most traumatic type of disaster.
* Any catastrophe involving children may have long-term psychological effects, especially among rescue workers.
* Technological disasters, such as plane crashes, are more traumatic than natural disasters, such as earthquakes.
* Disasters that occur around holidays, such as the recent mass murder at the University of Montreal, become indelibly linked to the holiday.
* Personal vulnerability factors, such as whether someone has been the victim of a violent attack, often determine the extent of the trauma on individuals during disasters.
Researchers agree that the extent of trauma after a disaster depends on who or what triggered the catastrophe.
“What you find is that the differences depend on whether it was God-sent event versus a technological or man-made disaster,” said Jeffery Mitchell, assistant professor of emergency services at the University of Maryland. “People in a technological disaster, like an air crash, tend to be angrier and tend to suffer longer because it gives them someone to blame, and they can question why it happened. But when they don’t find the answers, the result is tremendous frustration. It’s tougher to be angry at God or some supreme being for causing an earthquake.”
Researchers believe that nearly all rescue workers or residents who are exposed to a catastrophic event will suffer some form of post-traumatic stress. Generally, they become anxious, hyper-alert and fearful and may have nightmares. They may experience guilt feelings about their own survival, suffer lapses in concentration or suppress all emotions relating to the event. Some may take refuge in alcohol or drugs, and others will become depressed and withdraw from their families and friends.
The depth of their reactions usually coincides with their proximity to the disaster. Those closest to the death and destruction are the most vulnerable.
“Disaster teaches us the most common lesson in life--that we are not in control,” said Mory Framer, a co-founder of the Barrington Psychiatric Center in West Los Angeles. “All of a sudden you realize that you’re not omnipotent and the basic patterns of your life have been ripped to shreds.”
So despite the commonly held perception that Hurricane Hugo victims were less traumatized than Bay Area residents because South Carolinians had time to prepare for the onslaught, psychologists said very little difference exists between the trauma rendered by the two events--except that earthquake survivors had to deal with frightening aftershocks for weeks.
Yet each disaster offers different potential psychological tremors to those closest to it. Framer, a member of the growing field of emergency trauma counseling, said that after the PSA plane crash in San Luis Obispo last year, rescue workers faced a grim task of searching a huge area for body parts. But the most disturbing finds, he said, were items like teddy bears and suitcases filled with clothing.
He said those discoveries were especially upsetting because they forced rescue workers to imagine who might have owned the belongings and reminded rescue workers of the vulnerability of their own families.
“Some disasters are definitely more stressful, especially for rescue workers,” said Charles Figley, director of the psychosocial stress research program at Florida State University in Tallahassee. “When children are involved, it is much worse, and when their own lives are touched by the event, the effects are more profound.
“If you work in a business where there is loss of life all the time, you become hardened to it. But if children are involved, 99% of the time (their deaths) are not their fault. The sense of a wasted life is much greater then.”
The destruction of a community can also trigger harrowing emotions. Quarnstrom, a reporter and columnist for the San Jose Mercury News, lives and works in Santa Cruz, one of the areas hardest hit by the Oct. 17 earthquake. His office in the Pacific Garden Mall was destroyed in the temblor, and several people were killed in shops and restaurants just yards from where he worked.
“I’ve been through hundreds of earthquakes, but I will never again trust the solidity of the ground,” said Quarnstrom, whose home was damaged in the quake. “No one here is anywhere close to being over it, and everybody here knows Santa Cruz will never be the same.
“The strangest thing to realize was that I was both a reporter working on the story and a victim at the same time. I worked as hard as I could, partly just so I didn’t have think about all the crap that was broken on the floor of my house.”
The large number of disasters in recent years has led to the emergence of a field known as critical incidence briefing, where teams of psychologists and social workers are sent to counsel rescue workers. Counseling teams are commonplace at nearly every major disaster, and even local fire and police crews, such as the Los Angeles County Fire Department, have their own emergency trauma networks to deal with employees exposed to catastrophes like the Cerritos air crash.
Mitchell, who has counseled workers and victims at numerous disasters, said emergency workers are extremely vulnerable to post-traumatic stress “because they’re so caught up in recovery operations they don’t put much emphasis on how they are reacting to it.”
Psychologists say the counseling is critical because if not treated immediately, the trauma can result in long-term behavioral disorders such as the type experienced by Vietnam War veterans.
“It’s extremely hard to cure, and it can lead to (physical) illness, dysfunction, all sorts of things,” Mitchell said. “It has nothing to do with previous training, rank or experience. Traumatic stress doesn’t respect any of those things. It’s an equal opportunity problem that can hit anybody at any time.”
Framer, who has led counseling teams to San Francisco and Charleston this year, said that even the psychologists must debrief one another after visiting a disaster scene. This year, he said, he has already reached his limit and has removed himself from involvement in any further catastrophe.
To reduce the stress on rescue workers, Christine Dunning, associate professor of governmental affairs at the University of Wisconsin, is preparing a study on the experience of emergency crews at the Lockerbie, Scotland, air crash last December in which 259 passengers and crew were killed. Because the crash was caused by a bomb explosion in midair, human body parts and personal belongings were scattered over an 850-square-mile area. Emergency workers were still searching for human remains nine months later.
Dunning said the vast sweep of the recovery operation overwhelmed rescue workers, and she said preliminary results of her study indicate that rescue teams should be limited to a very finite search area at a disaster to give them a “sense of closure.”
“What happened was that some of the workers dreamed for a long time that they were unable to find any bodies, and it was very disturbing for them,” Dunning said. “One of the recommendations that I made is that (rescue workers) do a matrix search where they actually use poles to mark off their search area. That way people are only responsible for a certain section so that they are not overwhelmed by the enormity of the disaster.”
Framer said one of the main problems therapists must deal with in treating disaster victims is an inherent myth that people should be strong enough to handle any tragedy.
“We have a tremendous myth that we’re all going to be Rambo, especially a lot of the rescue workers who want to be tough and strong,” he said. “But heroism always has a price. You can be incredibly tough, but you’re still going to be affected by the gruesome things that you see.”
