Each year, disasters and traumas are an all-too-common part of life for millions throughout the world. The World Health Organization estimates that from 1900-1988, hurricanes left 1.2 million people without homes and directly affected the lives of 3.5 million people. Floods afflicted 339 million people and left 36 million homeless. Earthquakes, typhoons, and cyclones affected another 26 million people each and rendered 10 million homeless. The year 1995 was the most expensive year for disaster internationally--$150 billion dollars was lost primarily in developed countries.
Sadly, those least prepared to deal with disaster often suffer the most: the less developed an area is economically, the greater the number of deaths, injuries and amount of damage its population sustains in a disaster--especially in more densely populated areas. Cities, states, and nations often lack the resources and insurance coverage they need to help people living in impoverished areas. However, as the 1995 earthquake in Kobe, Japan, illustrated (6,000 dead; 30,000 injured; 300,000 homeless), even industrialized countries with extensive disaster preparation are not immune.
Disasters at Home...
In 1996 alone, the American Red Cross responded to 236 major disasters in 48 states, spending a total of $216 million in assistance. The Red Cross noted that virtually every community across the nation was affected by disaster. For example, during one weekend in April 1996, 70 tornadoes hit 10 midwestern and southern states. Forest fires destroyed hundreds of homes in California, New Mexico, Arizona, and Alaska. There was widespread flooding in the eastern U.S. due to a rapid spring meltdown of snow. There also were two major aviation disasters in 1996: the ValuJet and TWA Flight 800 crashes.
In addition to natural disasters, people today are exposed to a wide range of other traumas: industrial accidents, airplane crashes, and acts of violence as well as more common traumatic events such as house fires, motor vehicle accidents, and physical assaults. In total, each year 3.6 million Americans sustain severe or life-threatening injuries in motor vehicle collisions and other accidents.
Estimates tell us that almost 40 percent of Americans will be exposed to a traumatic event during their lifetimes. While the physical dangers inherent in disasters are obvious, these events are a grave threat to mental health as well.
The Psychological Effects of Disaster
Many people survive disasters without developing significant psychological symptoms. Others, however, may have a difficult time "getting over it." Survivors of trauma have reported a wide range of psychiatric problems, including depression, alcohol and drug abuse, lingering symptoms of fear and anxiety that make it hard to work or go to school, family stress, and marital conflicts. Post-Traumatic Stress Disorder (PTSD) and Acute Stress Disorder (ASD) are probably the best known psychiatric disorders following a traumatic event. People suffering with PTSD or ASD often have persistent nightmares or "flashbacks" of the trauma. They may avoid reminders of the trauma or "feel numb" and have difficulty responding normally to average life situations. They may be on edge, have trouble sleeping, have angry outbursts, or seem excessively watchful. They may become badly depressed and begin to abuse drugs and/or alcohol as a way of medicating their painful feelings. This substance abuse can become active addiction.
The effects of trauma are not limited to those affected directly by the events. Others may also suffer indirect effects from trauma-- referred to as "vicarious" or "secondary" traumatization. Those at risk include spouses and loved ones of trauma victims, people who try to help victims, such as police or firemen, and health care professionals who treat trauma victims, such as therapists and emergency room personnel, as well as journalists.
Who will develop problems after trauma?
The strongest predictor of who will develop problems after trauma is if an individual has a prior history of psychiatric problems.
Research into the effects of trauma have shown that, in general, the more devastating and terrifying the trauma is, the more likely it is that a person exposed to it will develop psychiatric symptoms. Aspects of the disaster or trauma which increase the likelihood of psychiatric distress include a lack of warning about the event, injury during the trauma, death of a loved one, exposure to the grotesque (e.g., maimed bodies), darkness, experiencing the trauma alone, torture, and the possibility of recurrence. However, it should be emphasized that it is not necessary to experience torture or to see bodies and blood in order to develop psychiatric problems after trauma. Researchers are less sure, at this time, what factors protect some people from psychiatric illness following exposure to trauma.
What treatments can help a traumatized person?
It is important that a person who has been exposed to a disaster understand that he or she will probably have some of the symptoms described above as a normal response to an abnormal situation. These symptoms usually resolve over time. However, if they persist or interfere with the person's ability to function normally, professional help should be sought. Talk about suicide, excessive guilt or anxiety, and substance abuse are warning signals that require immediate professional attention.
Psychiatrists and other mental health professionals use a variety of effective treatments for disaster-related disorders. Talking treatments--such as individual, couples, family or group therapy--can be very helpful. Psychiatric medications can also provide relief for the symptoms of depression, anxiety, and sleep disturbances. It is very important for a psychiatrist or other mental health professional to evaluate persistent symptoms to develop a comprehensive treatment program.
How can friends, family and co-workers help?
One of the most important things a friend, family member, or co-worker can do for someone who's been in a disaster or other trauma is to be a supportive, active listener.
Listen patiently and nonjudgmentally as the person tells his or her story.
Avoid offering direct advice other than encouraging him or her to find healthy ways--such as exercise--to cope with stress.
Discourage such damaging ways of coping as excessive use of alcohol.
It is also important to realize that it takes weeks, months, and sometimes years before a survivor of trauma is able to put the disaster behind him or her. At times people who have resolved their symptoms following the trauma have a recurrence of traumatic symptoms during stressful times in their lives, such as retirement, divorce, or loss of a loved one.
While it is common for loved ones to become impatient and puzzled over the traumatized person's inability to get on with life, it is especially important at these times to persevere and continue to listen patiently.
Many people struggle with the urge to "fix it" for their traumatized loved ones. Again, the best "fix" is non-judgmental listening.
American Academy of Child and Adolescent Psychiatry, Facts for Families: Helping Children After A Disaster. Washington, DC, AACAP, 1993. (Free)
American Psychiatric Association, Let's Talk Facts about Post-traumatic Stress Disorder and Let's Talk Facts About Substance Abuse. Washington, DC, American Psychiatric Press, 1993. (Free)
Austin LS (ed.): Responding to Disaster. Washington, DC, American Psychiatric Press, Inc., 1992.
Davidson JRT, Foa EB (eds.): Post-traumatic Stress Disorder: DSM-IV and Beyond. Washington, DC, American Psychiatric Press, Inc., 1993.
Fullerton CS, Ursano RJ (eds.): Posttraumatic Stress Disorder: Acute and Long-Term Responses to Trauma and Disaster. Washington, DC, American Psychiatric Press, Inc., 1997.
Giller EL (ed.): Biological Assessment and Treatment of Post-traumatic Stress Disorders. Washington, DC, American Psychiatric Press, Inc., 1990.
Hodgkinson PE, Stewart M: Coping with Catastrophe: A Handbook of Disaster Management. New York, Routledge, 1991.
Lystad M (ed.): Innovations in Service to Disaster Victims, in National Institute of Mental Health, Disaster and Mental Health. Washington, DC, American Psychiatric Press, Inc., 1986, pp. 229-397
National Institute of Mental Health: Prevention and Control of Stress Among Emergency Workers (DDHS Publication No. ADM 88-1496). Washington, DC, Alcohol, Drug Abuse, and Mental Health Administration, 1987.
Mental Health America, Understanding Post-traumatic Stress Disorder. Alexandria, VA: Mental Health America, 1991. (Free)
Noji EK (ed.): The Public Health Consequences of Disaster. New York, Oxford Press, 1997.
Pynoos RS, Nader K: Issues in the Treament of Post-traumatic Stress in Children and Adolescents, in International Handbook of Traumatic Stress Syndromes. Edited by Wilson JP, Raphael B. New York, Plenum Press, 1992, pp. 535-549.
Ursano RJ, McCaughey B, Fullerton CS (eds.): Individual and Community Responses to Trauma and Disaster: The Structure of Human Chaos. London, Cambridge University Press, 1993.
Van der Kolk BA, McFarlane AC, Weisaeth L (eds.): Traumatic Stress: the Effects of Overwhelming Experience on Mind, Body, and Society. New York, Guilford Press, 1996.
Wilson JP, Raphael B (eds.): International Handbook of Traumatic Stress Syndromes. New York, Plenum Press, 1993.
Wolf ME, Mosnaim AD (eds.): Post-traumatic Stress Disorder: Etiology, Phenomenology, and Treatment.Washington, DC, American Psychiatric Press, Inc., 1990.
American Red Cross
(contact your local chapter)
National Institute of Mental Health
5600 Fishers Lane
Rockville, Maryland 20857
National Organization for Victim Assistance
1757 Park Road, N.W.
Washington, D.C. 20010
U.S. Veterans Administration
Mental Health and Behavioral Sciences Services
810 Vermont Avenue, N.W., Room 915
Washington, DC 20410