Why do I keep harping on the psychology of disaster? Why do I keep bringing up this principle of good self care as part of preparing for an emergency? Because I believe it’s important. Gosh, why is this so important? Dr. J. M. Schultz, of the DEEP Center (Disaster and Extreme Event Preparedness Center) at the University of Miami has this to say, “In a disaster, the size of the psychological ‘footprint’ will greatly exceed the size of the medical ‘footprint.’ “1 He goes on to say, “The psychological fallout from a disaster can be widespread and pervasive.”2 The implications for psychological impact will exceed the physical and medical impact. Every time.
Is that right? Can the mental and emotional fallout exceed the medical impact? You bet.
Let’s take a look at an event from recent memory ̶ long enough ago that we(hopefully) won’t traumatize anyone by bringing it up again, but recent enough so that we have solid and reliable data. Let’s consider the 1995 Subway Sarin Incident in Tokyo. Members of a terrorist group released Sarin gas (a nerve agent) in the subway system. A dozen people were killed, dozens more required critical care and several hundred sustained injuries that required emergency treatment or hospitalization.
All told there were 1,053 victims in the medical footprint: 12 dead, 63 critically injured , 978 other injuries. Within hours of the event 4,023 people walked into emergencies rooms all over the city complaining of symptoms of Sarin exposure. Each and every one of these individuals was examined and then released – none of the 4,023 had actually been exposed. Yet, they walked into ER’s all over Tokyo nearly overwhelming already taxed resources.
When we consider the psychological footprint of an event on the healthcare system, let’s consider how an event would be perceived by a single hospital. It could be a hospital that is one of several similar institutions in a city, or it could be a single hospital that serves a far-flung rural area. Their map of impacted persons demonstrates the potential pervasiveness of the psychological impact.3
As you can see, hospitals must be prepared to deal with a great number of people who were psychologically impacted by an event ̶ regardless of whether they were present at the time of the event, or not. Beyond the medical casualties, there will be people who are psychological casualties, people who break down, people who suffer panic or anxiety attacks, people with mental illness whose challenges are exacerbated by the event. Hospital will also have to deal with: families of the victims, families searching for missing loved ones, aid workers who are injured or distressed, media, hospital volunteers, bystanders, patients who were already in the hospital whose services are impacted by the event, families of existing patients who are inconvenienced by the event (or by not being able to enter or leave the hospital because of the event), and distressed staff (whose distress may range from frustration at being forced to work longer hours to concern about their family outside of the hospital). The potential psychological impact is far reaching.
Now, even if you aren’t one of the directly impacted, and you don’t find yourself in or near a hospital after a disaster, you should still understand how far reaching the impact can be – because you’ll be dealing with people who have been impacted. And in your dealings with them, it will help you if you have at least some understanding of what they’re facing.
What does psychological impact mean to you personally? A number of things. If you are directly involved in an event, you could be personally traumatized by it. This is not a forgone conclusion. Many people seem to “weather the storm” without suffering negative long term effects. Others, however, are traumatized by their experiences. Unable to cope with what they have been through, they develop post traumatic stress disorder and their response to what happened to them is no longer a one-time event ̶ it becomes chronic.
There is also the phenomena of vicarious trauma. According to the Vicarious Trauma Institute, vicarious trauma is the result of negative changes that can occur from empathic engagement with victims and their suffering and needs. 4 You can be personally overwhelmed by what others have been through. This is especially true when you are in direct contact with victims and survivors.
Long term traumatization, both direct and indirect, can lead to a condition known as compassion fatigue. The Compassion Fatigue Awareness Project defines compassion fatigue this way, “[It] is also sometimes called Secondary Traumatic Stress Disorder. It is a lessening of one’s ability to feel compassion toward others, a desensitization to the suffering of other beings.” 5 In form and function, it is much the same animal as Post Traumatic Stress Disorder, but it results from repeated engagement with the trauma of others. In Secondary Traumatic Stress Disorder you become numb to the suffering of others.
So, what makes an event traumatic as opposed to just stressful? Researchers have discovered that humans seem to respond better to disasters and emergencies when they’re “natural” ̶ tornadoes, floods, earthquakes, etc. People seem to be able to rationalize these things more effectively. These things are obviously beyond our control. Ironically, this seems to make it easier to deal with.
When disasters are manmade (like the BP oil spill, the aftermath of hurricane Katrina, the Three Mile Island incident) they have greater potential for psychological trauma. When the disaster is caused by human error or laziness, its traumatic potential is greater.
Greater yet in traumatic potential yet are terrorist events.
There are certain factors in any event which can increase an events potential for psychological trauma. If an event is unexpected and many people die (especially children), or if it lasts a long time, the potential increases. If the causes is unknown the potential for mental distress increases. This is one of the reasons that authorities often rush to get out reports about an event. Even when the early reports are contradicted by later information, the goal is to give people some assurances and mitigate a little of that psychological impact. It’s also well known that excessive conflicting reports can have the opposite effect. Events that are poignant or meaningful (say, for example, it occurs on the anniversary of another disaster or on an important holiday) can be especially traumatic ̶ as can events that cover a large area.
Individuals also have their own personal factors which can increase the psychological impact of an event. The impact has the potential to be greater if the person has some personal involvement with the event ̶ if, say, they worked in the same building where the event took place, or if they knew someone who worked there. Having a history of previous mental health issues increases risk ̶ as do previous significant loss (like a death in the family), social isolation (like older people living alone), and poverty.
What’s the solution? How do you mitigate the potential psychological impact of an event? You guessed it, it begins with the good self care we discussed in the previous post.
If you’re not already practicing good self care, the time to start is now. Now is the time to build the knowledge you need. Now is the time to “get right with God” or the Great Pumpkin, or whatever helps you understand your place in the scheme of things. Now is the time to start getting enough rest and eating right. Now is the time to start getting some exercise. Now is the time to reinforce those support relationships that are so critical to you emotional and mental well being – let your friends and loved one know how you feel. Now is the time to build the skills and stock the supplies to help you feel in control and in command of your problem solving faculties. Now is the time to do these things to build your personal resilience.
Remember: pre-existing resiliency is the best predictor of how you will fare in a disaster.
As always, thanks for reading.
1 Schultz, J.M. 2010. “Psychological footprints.” Disaster and Extreme Event Preparedness Center, University of Miami. Retrieved from: www.deep.med.miami.edu/…/(2_0)%20SFA09%20BRIEF_ DISASTER%20BEHAVIORAL%20HEALTH.pdf
3 Carlson, Nancy. “Psychological First Aid.” Minnesota Department of Health.
4 Vicarious Trauma Institute. 2009. “What is Vicarious Trauma.” Retrieved from: http://www.vicarioustrauma.com/
5 Compassion Fatigue Awareness Project. “What is compassion fatigue.” Retrieved from: http://www.compassionfatigue.org/