Guilt
A woman whose home miraculously escaped damage in the flood, while the home of a close friend and neighbor was completely destroyed, appears at the local health center with various physical symptoms such as stomach cramps, loss of appetite, and severe headaches. Medical examination provides no apparent basis for the complaints. It was concluded that the patient was experiencing a severe anxiety attack. Consultation with a mental health professional revealed that the woman was suffering an overwhelming sense of guilt because she was spared the tragic loss suffered by her friend. Counseling helped her to accept the unpredictable nature of the disaster which ruined one person and spared the next. The woman was able to overcome her guilt and to offer welcome assistance to her neighbor in coping with her losses.
Guilt is a frequent occurrence among survivors of a disaster. We all experience to some degree the uneasiness which accompanies sudden and unexplainable good fortune. Our own sense of worthwhileness is called into question. Why have we been spared misfortune when others have suffered? We are glad to have been so favored, of course, but at the same time feelings of guilt arise because secretly we are relieved that the losses occurred to someone else instead of us. The opportunity to talk about and confront directly these natural human reactions with someone who is understanding and shares the same weaknesses is of great value. The knowledge that such feelings occur with most people provides a sense of acceptance and belonging which permits one to go on and to do what can be done to help others who have been less fortunate.
Apathy
An elderly man owned and operated a small private fishing lake and boat rental concession at his
homesite. A flood destroyed his boats and equipment and completely filled the lake with mud. The old man,
who lived alone, was discovered by neighbors several weeks later. He had taken to his bed, neglecting to
eat or care for himself. At the time he was found, his weight and physical condition had deteriorated to the
point where he was almost dead. At first he refused assistance. However, as a result of patient and
persistent efforts by the neighbors, he was persuaded to allow himself to be taken to the hospital. Although
he initially regained his health he did not survive long after being placed in a residence for the elderly.
In this case, the old man felt he could never regain what he had lost in the flood. There simply was not
enough time or opportunity. He had little left to live for.
In disasters, apathy is frequently found in the elderly who have suffered significant losses of
possessions, their homes, friends, and neighbors. There is a feeling, often all too real, that they will
not again be able to recover or replace these losses. Assistance must take very concrete and immediate forms
if it is to be of any value. Relatives or friends must be located if possible. Physical relocation should be
as near as possible to what is familiar for the older person. Readjustment to new surroundings and strangers
is often an overwhelming and sometimes impossible effort, as in the case illustrated above. As many
people as possible should be involved, especially other elderly people who have gone through the same
experience.
When apathy is encountered in the middle-aged person
or in the adolescent, emphasis should be on immediate and active attempts to recover and replace the losses,
to become involved in community rehabilitation, and to participate in social activities. The last mentioned
is of particular importance for the adolescent.
Fears
An otherwise normal 6-year-old girl who has experienced an earthquake becomes terrified and cries
when a heavy truck passes by the house, causing a slight vibration. A 4-year-old boy, who was suddenly
evacuated just before the flood destroyed his home, develops the habit of sleeping with all his clothes on
and his remaining belongings packed in a suitcase kept at the foot of his bed in the mobile home he and his
family now occupy. A 7-year-old boy, who survived a flood caused by torrential rain, is found crying and
crouched under a stairwell when a light rain starts to fall.
These persisting fears are often found among young children and sometimes among adolescents and adults
following a disaster. They are referred to technically as "traumatic neuroses". With most otherwise healthy
persons such persistent fears tend to subside as time passes. If they continue to appear some months after
the disaster it is apparent that the intervention of a mental health specialist is needed. Much can be done,
however, in the immediate post-disaster period to relieve these symptoms and prevent their continued
self-reinforcement.
With children it is essential that the child be given additional warm affection and understanding when
experiencing the recurrence. Above all, the child should not be scolded or punished for exhibiting these
fears. Talking with the child in a gentle and reassuring manner is helpful. Permitting or
encouraging the child to talk about what is frightening him is also important. For adolescents and
adults who display recurrent fear symptoms, permitting the victim to relive the experience verbally, to
become actively involved in recovery efforts, and to learn more about the causes and means of possible
protection from future disasters are particularly useful.
The "Burn-out" Syndrome
Two police officers are on duty at a checkpoint for autos entering the disaster area. It is their job to
permit entry only to those who have homes or businesses in the area or who are involved in relief
activities. There is a constant stream of vehicles lined up in both directions. The officers must inspect
identification and passes, answer questions about disaster recovery activities, reassure anxious
homeowners, and placate angry citizens frustrated at the delay. The officers have had 12-hour duty days for the
past week, with only brief periods of relief. Their faces show fatigue. Their efficiency is at a low
ebb. One officer describes his concern about his family to a relief worker. Another officer is anxious
about all the work that needs to be done at his house. His wife is upset at his absence during this critical
period. He feels the accumulating frustrations and anger of the people he is trying to assist. His work
requires him to ignore his personal priorities. There are not enough replacements to permit him to attend to
his family responsibilities.
The man is exhibiting excessive fatigue, irritability, anxiety, impatience, and all symptoms of the beginning
of the "burn-out" syndrome. Front-line workers typically overextend themselves in disasters. This
most often occurs when there are not enough relief workers, and the ones available want to help as much
as possible. Sometimes, however, even when replacements are available, workers refuse relief and
push themselves beyond their effective limits. Such action might seem altruistic and commendable. In
reality, the tired and inefficient relief worker can be more of a liability than an asset in rescue and
recovery activities. The workers during and immediately following the disaster need all the
strength and energy they can gather. They must have clear heads to make critical and sometimes life-saving
decisions. They must be able to cope not only with the physical consequences of the disaster itself but with
the fears, anger, and physical and emotional suffering of the victims.
It is essential, therefore, that the worker is not overtired or weak from lack of food or rest. Often the
worker fails to recognize these signs in him/herself although they are obvious to others. Those responsible
for supervision of front-line relief workers must do everything possible to forestall the occurrence of
the "burn-out" syndrome.
INTERVENTION STRATEGIES
Basic Guidelines
People in crisis are extremely vulnerable. They are open to hurt as much as to help. The goal of crisis counseling should be to protect them from further harm, while providing them with immediate assistance in managing themselves and the situation. Crisis counselors provide brief, clear and gentle directions and support to distressed victims. As soon as possible, they help the victims take on responsibility for their own care. It is important to provide frequent reassurance and guidance when the situation is most threatening. The most important thing is to offer assistance to help the individual gain a sense of control of self and situation, and not to do everything for the victim.
Whenever possible, it is important to help the victim identify and focus on the problem, or the most important problem if there are several. This helps the individual gain a sense of perspective and to prioritize their recovery efforts. They need to be told what is happening and why to help reduce the sense of surprise or feeling that they are being lied to.
There are six T’s to providing support to those experiencing an emotional reaction to any crisis situation:
- Tears – Let the client know that it is normal, helpful and OK to cry.
- Touch – A gentle touch on the shoulder, hand, or a hug can be very supportive. It is generally a good idea to ask permission before touching.
- Talk – Encourage the individual to talk about the experience, not only with you, but with family and friends, or support groups. Talking helps one put the incident in perspective so they can put it behind them.
- Trust – You must build up a sense of trust between you and the individual. They need to know that what they share with you will be held confidential, and that you will be non-judgmental.
- Toil – Be willing to work with the client. Don’t rush them. Give them the opportunity to work through their emotions and problems.
- Time – It takes time to sit with a client. Let them talk, and let them know that the recovery process does take time.
Interventions
When working with the victims of a disaster, it is important that interventions focus on the resolution of the disaster-caused problems by adapting or reinforcing the victims’ coping techniques to meet the need. Keep in mind that our goal is to decrease emotionality and increase functioning. Crisis Counselors can help victims stabilize emotionally by:
- Utilizing their available support structure (e.g. family, friends, etc.).
- Establishing a realistic perception of disaster recovery.
- Predicting future problems.
- Providing opportunities to vent their anger, fear, frustration, and grief.
- Reinforcing use of present coping strategies or developing new ones to prevent the recurrence of the same problems in the future.
Handouts on disaster related stress and self-help techniques help normalize the responses for disaster victims and should be made available.
When working with victims of a disaster, it is important that
interventions must focus on resolution of the disaster-caused
problems by adapting or reinforcing victims' coping techniques
to meet the need. The goal is to decrease emotionality and
increase functioning.
PSYCHOLOGICAL IMPLICATIONS FOR DISASTER WORKERS
Factors Affecting Responders
Psychological effects are universally present to at least some degree in responders involved in disaster situations. Teams of responders on the spot of a disaster or following one have psychological reactions very similar to those of the victims. Their reactions vary with the magnitute of the event and the number of casualties. Consider, for example, the differences in effect between reactions of responders to a traffic accident vs an incident like the Oklahoma City bombing or Columbine High School.
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