Psychological effects on people in natural disasters

Psychologic Effect on People in a Natural Disaster

The world has never been a benign or sterile environment, but history has shown time and again that humans are resilient creatures that are capable of enduring a great deal. In some cases, though, the overwhelming nature of an event can be so devastating that people experience a wide range of adverse psychological effects that can have life-threatening implications if left unattended. Although the terrorist attacks of September 11, 2001 clearly illustrated the enormous impact that manmade disasters can have on people, natural disasters such as tsunamis, hurricanes, tornadoes and so forth also can have these same adverse effects as well. In order to identify what these adverse psychologic effects are and what can be done about them, this paper provides a review of the relevant peer-reviewed and scholarly literature concerning the psychologic effect on people in a natural disaster, followed by a summary of the research and important findings in the conclusion.

Review and Discussion

There is certainly no lack of natural disasters in the world today. According to Richman and Fraser (2001), "Any attention paid to the variety of news media confirms that disasters are common occurrences throughout the world. The stories of the destructive power of natural disasters, such as floods and fire, fascinate us. We want to understand what happened, to learn how victims are responding, and to be assured that something is being done to help" (133). Indeed, it is difficult to watch the news coverage of such a natural disaster affect others without experiencing some level of "there but for the Grace of God" reaction, and this empathetic reaction on the part of many people suggests that people not only want to be reassured that something is being done to help those affected, but that the resources that can help them exist in the first place.

According to Richman and Fraser, it is important to understand why some people react in adverse ways to natural disasters while others come through the experience with little or not adverse outcomes. These authors report that, "Historically, labeling an event as a 'disaster' means that it has several characteristics in addition to the destruction of property, loss of life, and widespread injury. The event also has an identifiable beginning and end; adversely affects a relatively large group of people; is 'public' and shared by members of more than one family; is out of the realm of ordinary experience; and, psychologically, is traumatic enough to induce stress in almost anyone" (Richman and Fraser 134). Beyond these characteristics, the authors suggest that three additional characteristics to this list to define disasters as: (a) events that are relatively sudden, (b) highly disruptive, [and] - time-limited (even though the effects may be longer lasting)" (Richman and Fraser 134).

It is also important to take into account the origin of the disaster; in this regard, Raphael (1986) identified two broad classifications that are appropriate for the purposes of this study: (a) "natural" (i.e., earthquakes, tornadoes, fires, floods, and hurricanes) and (b) "man-made" (i.e., sniper shootings, terrorist attacks, airplane crashes, toxic releases, etc.), but Breton, Valla and Lambert (1993) emphasize that both natural and man-made disasters can be psychologically or physically detrimental to human lives. Likewise, as Saleh (1996) reports, "Increasingly, worldwide mental health counselors are being called upon to provide services in the aftermath of disasters and traumatic crises, whether natural or man-made. Naturally occurring disasters include earthquakes, hurricanes, typhoons, floods, fires and tsunamis" (519) as Stout (2002) points out, though, some studies have indicated that the long-term psychologic morbidity that is typically associated with man-made disasters appears to be greater than because of the intentional nature of the human violence involved compared with that associated with random nature of natural disasters, but emphasizes that in some cases, the conditions of people who experienced natural disasters also become chronic and severe. This point is also made by Myers and Wee (2005) who report that in contrast to man-made disasters, "An obvious characteristic of natural disasters is the unambiguous physical impact, resulting in property damage, injury, and death of victims. They often have a clearly identifiable 'low point' at which, from the victim's point-of-view, the 'worst is over' and restoration and recovery can proceed" (8).

Besides the sources of the disaster, even the age of those who experience natural disasters can have an significant influence on their reaction. In this regard, Stout advises, "Each year millions of children are exposed to critical events, such as natural disasters, but not all of these children will become traumatized" (49). In fact, some children appear to possess some resilient qualities that their adult counterparts may lack in their reaction to natural disasters. For instance, citing the American Psychiatric Association's definition for trauma, Stout notes that, "For adults, an event will be considered traumatic if it 'overwhelms' the individual's 'perceived' ability to cope with it. The two key words here are overwhelm and perceived. A traumatic event is thought to overwhelm an individual's normally effective coping skills. This condition does not always apply to children" (50).

This different reaction on the part of young people compared to adults is based in large part on how the event is perceived by children using their adult reactions as a gauge. For example, Stout also notes that, "Children, especially young children, interpret events in part by using their caregivers' reactions to such events as a model for determining whether the world is safe or unsafe. If the child's family offers a message of hope and personal action that can be taken by the child or the family, the event is more likely to be managed and the child does not become overwhelmed" (51).

Nevertheless, as Brown (1990) points out, traumatic events may require a significant length of time to be processed fully, and some children who experience natural disasters may manifest psychological problems later in life as a result. According to Brown, "Unresolved grief, various physical assaults, operations and injuries, experiences of war and natural disasters, and so forth -- can give rise to problems and neuroses in adult life" (25). In their study of children's reactions to natural disasters Richman and Fraser report that children appear to be more resilient to psychological problems following a natural disaster to the extent:

They have family support systems able to respond to their needs;

Their daily routine is quickly restored (including a return to school); and,

They are given the opportunity to discuss and work through their fears and disaster experiences in a structured environment (Richman and Fraser 142).

While the need for additional research in this area is emphasized by Richman and Fraser, other authorities likewise stress the need for additional research concerning how natural disasters affect both young and old in psychical ways that can contribute to psychological problems. For example, there is growing evidence that the adverse reactions to natural disasters experienced by some people can have some profound effects on the immune system throughout the life course in ways that can contribute to other physical maladies that can then contribute to higher levels of stress in a vicious circle of escalation (Baum, Revenson and Singer, 2001). For instance, according to Baum and his colleagues, "There is now substantial evidence for the role of psychological stress in susceptibility to upper respiratory infectious disease. [However], it remains unclear whether associations between psychological factors and infectious disease are attributable to stress-induced changes in immunity" (691).

Furthermore, the studies of individual and community responses to natural disasters to date indicate that a prior history of traumatic life events (i.e., physical/sexual assault, expose to homicide, witnessing a death, injury, threat to life, destruction of home or community) are associated with higher incidences of post-traumatic stress disorder (PTSD), as well as other anxiety-related disorders (Saleh 520). As Saleh points out, though, "PTSD can exist without previous events, but it does appear one can be predisposed to the disorder. It is also possible that an entire community can experience PTSD after disaster or crisis" (520). Therefore, it is also important to recognize that a natural disaster can have adverse psychological effects on victims, of course, but on other affected individuals in the community as well as on the relief workers themselves. In this regard, Saleh emphasizes that, "The counseling response to disasters needs to be inclusive of crisis intervention and mid- and long-term effects. Mental health services need to be rendered to victims, those closest to the victims, those involved in rescue and relief efforts, and members of the community who may suffer post-traumatic stress as results of the disasters or crises" (519).

Likewise, Baum and his colleagues (2001) report that the lingering emotional distress that can result from exposure to a natural disaster is viewed as a precipitating factor for developing PTSD. According to Vasterling and Brewin (2005), "PTSD is unique among psychiatric disorders in that the symptoms of the disorder are tied directly to an etiological event, the trauma stressor" (5). Although the primary symptoms of PTSD have remained fundamentally consistent in the various editions of the Diagnostic and Statistical Manual of Mental Disorders (DSM) since 1952, Vasterling and Brewin note that the latest fourth edition (DSM-IV) contained a revised definition of trauma. This revision, they note, was "partly in recognition of research demonstrating that traumatic events were in fact not uncommon. DSM-IV defines the traumatic stressor as when a person 'experienced, witnessed, or was confronted with an event or events that involved actual or threatened death or serious injury, or a threat to the physical integrity of self or others" (Vasterling and Brewin 6).

The diagnostic criteria established by the Fourth Edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) for PTSD state that an individual must have:

Witnessed, experienced, or otherwise been confronted with an event that involved actual or possible death, grave injury, or threat to physical integrity; and,

The individual's response to such a traumatic event must include severe helplessness, fear or horror (cited in Clancy 2004).

According to Clancy (2004), a number of professions such as law enforcement, firefighters and combat veterans tend to experience a higher incidence of PTSD than the population at large. In this regard, Clancy advises:

particular psychological term, Post-Traumatic Stress Disorder (PTSD), is used when specific clinical criteria concerning symptoms are met. PTSD may exist if symptoms persist for longer than one month and cause significant distress or impairment in social, occupational, or other important areas of functioning. The severity of symptoms for PTSD varies. It tends to wax and wane, but usually diminishes over time. More than half of PTSD cases resolve within three months. (30)

In fact, PTSD appears to be a more common reaction to natural disasters than previously believed, due in large part to the changing definitions and diagnostic criteria that have been applied to the disorder in recent decades. For example, researchers studied the impact of a natural disaster that occurred in 1972 in Buffalo Creek, West Virginia, when a dam collapsed and flooded the entire community with significant loss of life and property. Not surprisingly, almost everyone in the community suffered psychological consequences, with fully 90% of the survivors being symptomatic 2 years following the disaster and more than 33% continuing to suffer from disabling psychiatric symptoms even 5 years later (Myers and Wee). According to these authors, "Most of the symptoms fell into the categories of generalized anxiety disorder (GAD) and major depression disorder (MDD). Many years later, these data were reanalyzed for probable posttraumatic stress disorder (PTSD) which had not been a diagnosis at the time of the original study" (Myers and Wee 9). Subsequent analysis of the survivors identified a rate of PTSD at 2 years that was almost half (44%) among adults and almost a third (32%) among children, and the incidence of PTSD remained high 14 years after this natural disaster (Myers and Wee 9).

The findings are congruent with the results of a study by Vogel and Vernberg (1993) that found, "Conclusions concerning children's responses to disasters have shifted over time. Early studies, beginning in the 1950s, concluded that children's responses are relatively mild and transient. By the 1970s and 1980s, however, evidence emerged that for some children after some disasters, effects can be more severe and longer lasting" (465). The changing definitions of PTSD provided by the DSM have focused additional attention on children's reactions to natural disasters in recent years. As Vogel and Vernberg point out, "The latter findings became increasingly salient with the introduction of the diagnosis of posttraumatic stress disorder (PTSD) and a shift from reliance primarily on parental report to more direct examination of children" (465). The research to date suggests that children's reactions to natural disaster generally include: moderate levels of fear and anxiety, mild sleep disruption for a few months, some hypersensitivity, and temporarily heightened dependency on parents; however, these reactions are typically transient and milder than many observers might expect (Vogel and Vernberg). According to these authors, "The emphasis on short-term reactions was consistent with a U.S. government manual concerning the mental health needs of children who experience major disasters" (Vogel and Vernberg 465).

A survey of 1,000 adults conducted by Norris and Uhl (1993) following Hurricane Hugo determined that disaster-related acute stressors (including personal loss, financial loss, and especially injury and life threat) were predictive of elevations in seven domains of chronic stress (i.e., marital stress, parental stress, filial stress, financial stress, occupational stress, ecological stress, and physical stress); in addition, increased reports of symptoms of depression, anxiety, and somatization were identified and a number of adverse mental health effects from Hurricane Hugo were related to deterioration in perceived social support (Norris and Uhl).

More recently, Norris, Friedman, Watson, Byrne, Diaz and Kaniasty (2002) determined that when natural disasters resulted in severe destruction and disruption, such as in the case with the 1992 natural disaster that accompanied Hurricane Andrew, the resulting psychological effects were severe. According to Myers and Wee (2005), "As of 2001, Hurricane Andrew was the most thoroughly researched disaster in U.S. history. Thirty-three percent of Andrew's victims met the criteria for PTSD, and [presented with] several physiological measures indicative of lower immune functioning" (15). Likewise, Perilla, Norris, and Lavizzo (2002) studied residents of the region and determined that one quarter of the residents satisfied the criteria for PTSD, with symptom levels differing according to the severity of exposure. The majority of the studies of Hurricane Andrew to date have identified a high incidence of psychological disturbance, particularly in those neighborhoods that experienced the most losses and where the danger had been the most severe (Norris et al., 2002).

While the treatment of PTSD has become the sharp focus of an increasing number of studies in recent years due in large part to the alarming number of combat veterans returning from the Middle East who are suffering from this condition, the vast majority of these studies have been devoted to psychological responses to man-made disasters. For example, according to Person and Fuller (2007), this is especially true in cases of people who are already suffering from some type of mental disorder. In this regard, Person and Fuller emphasize that, "There is growing concern that the management of persons with psychiatric disabilities after disaster has been inadequate. Unfortunately, the literature is extremely limited, and empirical evidence on the best practices for addressing the needs of persons with psychiatric disabilities after disasters is sparse" (238).

Indeed, "sparse" is an understatement with a recent search of three popular databases conducted by Person and Fuller identified just 12 journal articles on this subject. These authors report that, "The 12 reviewed articles included persons with psychiatric disabilities after both natural disasters and acts of terrorism, both in close proximity to the disaster site and far away and in three different treatment modalities. All of the studies used clinically-based samples" (Person and Fuller 239). The findings of these studies suggest that the resiliency to natural disasters among this population mirrors that of the general population, but here again, more research is needed. In this regard, Person and Fuller add that, "The available literature indicated that many persons with psychiatric disabilities demonstrate an ability to handle the stress of a disaster without decompensation from their primary illness. However, the literature also revealed that persons with severe mental illness (SMI) can experience posttraumatic stress disorder (PTSD), depression, anxiety, and illness exacerbation after disaster" (239).