Phases of Traumatic Stress Reactions in a Disaster
Disasters and terrorist attacks are often widespread with many
people who directly experience the event and many more who may
witness or be indirectly impacted. Many people may encounter
behavioral and emotional readjustment problems. Many posttraumatic
stress symptoms are normal responses to overwhelming stressors.
Exposure to these overwhelming stressors may change our assumptions
about life and create distress, but the intensity of this distress
will subside with time. Experts agree that the amount of time it
takes people to recover depends both on what happened to them and
on what meaning they give to those events.
Terroristic acts may result in a whole society questioning the
fundamental view of the world as a predictable, just, and
meaningful place to live. This questioning is amplified by the fact
that organized violence is intentional; it often has a political
agenda; and it is meant to create terror, destroy, and hurt.
Studies have shown that deliberate violence creates longer lasting
mental-health effects than natural disasters or accidents. The
consequences for individuals and the community are long lasting and
survivors often feel that injustice has been done to them. This can
lead to anger, frustration, helplessness, fear, and a desire for
revenge. Reestablishing meaningful patterns of interactions in the
community after a trauma may facilitate reconstruction of a sense
of meaning and purpose. Prior research into terroristic events and
disasters has shown that reactions to these events may be
categorized into different phases.
Impact phase
Most people respond appropriately during the impact of a
disaster and react to protect their own lives and the lives of
others. This is a natural and basic reaction. A range of such
behaviors can occur, and these may also need to be dealt with and
understood in the postdisaster period. After the fact, people may
judge their actions during the disaster as not having fulfilled
their own or others' expectations of themselves.
During the impact phase, some people respond in a way that is
disorganized and stunned, and they may not be able to respond
appropriately to protect themselves. Such disorganized or apathetic
behavior may be transient or may extend into the postdisaster
period, so that people may be found wandering helpless in the
devastation afterwards. These reactions may reflect cognitive
distortions in response to the severe disaster stressors and may
for some indicate a level of dissociation.
Several stressors may occur during impact, which may
subsequently have consequences for the person:
Feeling responsible (e.g., feeling as though could have done
more)
Inescapable horror (e.g., being trapped or tortured)
Human malevolence (It is particularly difficult to cope with
a disaster if it is seen as the result of deliberate human
actions.)
Immediate postdisaster phase: recoil and rescue
This is the phase where there is recoil from the impact and the
initial rescue activities commence. Initial mental-health effects
may appear (e.g., people show confusion, are stunned, or
demonstrate high anxiety levels). Emotional reactions will be
variable and depend on the individual's perceptions and experience
of the different stressor elements noted earlier. Necessary
activities of the rescue phase may delay these reactions, and they
may appear more as the recovery processes get under way. Reactions
may include:
Numbness
Denial or shock
Flashbacks and nightmares
Grief reactions to loss
Anger
Despair
Sadness
Hopelessness
Conversely, relief and survival may lead to feelings of elation,
which may be difficult to accept in the face of the destruction the
disaster has wrought.
Recovery phase
The recovery phase is the prolonged period of adjustment or
return to equilibrium that the community and individuals must go
through. It commences as rescue is completed and individuals and
communities face the task of bringing their lives and activities
back to normal. Much will depend on the extent of devastation and
destruction that has occurred as well as injuries and lives lost
(Raphael, 1993).
This period may be associated with a honeymoon phase deriving
from the altruistic and therapeutic community response immediately
following the disaster. A disillusionment phase may soon follow
when the disaster is no longer on the front pages of newspapers,
organized support starts to be withdrawn, and the realities of
losses, bureaucratic constraints, and the changes wrought by the
disaster must be faced and resolved (Raphael, 1986).
During the stage of acute danger the priority for all is basic
safety and survival. Once this is relatively secured, other needs
emerge that are both existential and psychological. And once
manifest, these needs are typically left frustrated and unfulfilled
for a prolonged period of time. Many times, through the media,
retribution, or continued violence, the community in question is
exposed to further traumatic events.
It is particularly important to remember that emotional needs
may be very significant, especially for those who have been
severely affected. They may only start to appear during this phase.
People may also be hesitant to express distress, concern, or
dissatisfaction, feeling they should be grateful for the aid given
or because they have suffered less than others have. It should be
noted that sometimes emotional reactions may present as physical
health symptoms, such as sleep disturbance, indigestion, and
fatigue, or they may present as social effects such as relationship
or work difficulties.
Excerpted from Raphael, Disaster Mental Health Response
Handbook, NSW Health, 2000
Copies available from:
The NSW Institute of Psychiatry
Telephone: (02) 9840 3833
Fax: (02) 9840 3838