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
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...
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.
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.
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
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
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?
strongest predictor of who will develop problems after trauma is if an
individual has a prior history of psychiatric problems.
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?
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
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?
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.
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
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.
people struggle with the urge to "fix it" for their traumatized loved
ones. Again, the best "fix" is non-judgmental listening.