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Ultimate Stressors: A Complete Upheaval

minamisanrikuThe unexpected convergence of catastrophic events that generated widespread damage, loss and destruction in Japan readily meets the dictionary’s definition of disaster. The common characteristics underlying natural disasters such as earthquakes, tsunamis, hurricanes, and man-made ones such as terrorist attacks or nuclear accidents are the virtually total lack of anticipation, limited preventive planning and, subsequently, the drama of human vulnerability.

A few typical phases of disaster are readily discernible, regardless of the type of disaster or its location: an initial impact characterized by shock, fear, and anxiety; an heroic phase, characterized by survivors reaching out in concerted effort to prevent further loss of life and property; a honeymoon phase, within 2 weeks to 2 months after the disaster, when survivors are buoyed up by an outpouring of support, services and supplies. Later, a disillusionment phase may follow, when hopeful expectations give way to resentment as promises of substantial help are broken or snarled by red tape. Finally, a reconstruction phase, which may last several years, characterized by the affected communities’ efforts to rebuild and by individuals coming to grips with their personal losses.

japan-nuclear-reactor-meltdownThe goal of stress reduction and trauma management programs is to help survivors achieve their pre-disaster level of functioning. The majority of individuals exposed to a mass disaster will experience acute stress that may be short-lived and does not develop into a clinically diagnosable disorder, especially if rescue is rapid and effective (as in the recent case of the trapped Chilean miners) and reconstruction or restoration can happen in a relatively short time. However, a substantial portion of individuals exposed to traumatic events will experience clinically significant stress and subsequent mental health problems. These include Acute Stress Disorder, Posttraumatic Stress Disorder (PTSD), depression, chemical abuse and dependence, and anxiety disorders. In the Japanese situation, the rebuilding of families, homes and businesses may turn out to be painfully slow due to the obliteration of entire communities by the tsunami, which increases the likelihood of significant mental health consequences. On the other hand, the Banda Aceh, Indonesia experience shows that even after a near-total erasure of structures by the tsunami of 2004, a community will begin to come back to life—albeit after many years of continuous and painstaking reconstruction.

bandaAcehSome of the most frequently observed behaviors that occur following a disaster include intrusive reactions (efforts to process traumatic events), avoidance reactions (efforts to minimize distressing memories), and physical arousal reactions (efforts to keep the body prepared to survive additional threats). Intrusive reactions occur through recurring dreams about the event, persistent thoughts and images, and the experience of a continued sense of fear and danger. Avoidance reactions manifest as the survivor’s reluctance and resistance to discuss the event, to think about the event, or to revisit any reminders associated with the event. Physical arousal reactions include increased anxiety, hypervigilance, psychomotor agitation, difficulty sleeping, and concentration problems. All these post trauma reactions following a disaster of large magnitude should not be considered abnormal or necessarily indicative of mental health problems or of the need for continued treatment.

katrina_goes12In the best cases, first aid psychological support during major disasters takes place immediately after the event and may last up to one week. In the first critical days, rescuers engage survivors in conversations to determine whether they may be at greater risk for ongoing problems. An effort may also be made to identify survivors that are more likely to be at risk for further mental health problems, such as individuals with pre-existing personality and psychiatric disorders, those who exhibit the severest symptoms, those who lack social support, those who have a history of interpersonal difficulties, and those who have been previously exposed to trauma. Psychological first aid consists of a set of procedures that facilitate a survivor’s adaptive coping, and is based on the premise that safety, calm, self-efficacy, connectedness and hope must be promoted. In the initial, critical phase it is vital to provide survivors with human contact and engagement, physical and emotional safety and comfort, environmental stabilization, information, practical assistance, connections with social supports, information on available help, and linkage with collaborative services.

9-11In the second phase, after the first week and up to one month after the disaster, the primary goal of psychological aid is to promote anxiety management, further reduce stress, and begin the process of restoring normal functioning. This is accomplished through the development of targeted services such as psychoeducation, psychotherapy, skills enhancement, cognitive restructuring, and relaxation training. Care givers also remain alert to any signs of the development of mental health issues, such as derealization (a belief that the world has become strange or unreal), depersonalization (an unnatural feeling of detachment from one’s body), and flashbacks. In the final phase of recovery, taking place within 1 month and 3 months after the event, psychological care is provided to those in need—often for years afterwards.

The convergence of multiple disasters onto a finite geographic region at the expenses of the a limited number of individuals may appear as capable of affecting a specific locale only. In reality, as Chernobyl, Katrina, 9/11 and Banda Aceh have demonstrated, the repercussions quickly have a planetary impact. Stress is no longer a local phenomenon.

Japan-QuakeThanks to instantaneous communication and the transmission of color images via multiple media channels, the experience is quickly shared by the entire planet. This also means that stress is radiated from the epicenter of the disaster outward to all who view and hear it, thus creating intrusive, avoidance, and arousal reactions on a global scale. Moreover, the economic and political consequences of disaster are immediately felt by the financial markets, at the fuel pump, and even in the supermarket aisle.

The world of stress has never been so small.