What is disaster psychology?

Introduction

Disaster psychology deals with the reactions and responses of victims and witnesses of natural and artificial catastrophes, such as earthquakes, tornadoes, hurricanes, airplane crashes, train wrecks, toxic spills, industrial accidents, fires, explosions, terrorism, and school shootings, which often involve mass casualties. In 2011, the American Red Cross (ARC) estimated that it responded to over 70,000 disasters requiring external emergency aid every year, ranging from single-home fires or floods to national catastrophes. In addition, international events such as the 2004 tsunami in Southeast Asia and the 2008 terrorist attacks in Mumbai, India, require the assistance of emergency workers from around the world.

Mental health professionals use their skills to help trauma survivors and relief workers cope with the drastic changes and shock associated with tragedies. Many mental health professionals consider disaster service a social responsibility. Even though people may not have obvious physical wounds, they usually suffer emotional pain. Disaster mental health personnel often serve as media contacts to educate the public about ways to resume normalcy.

Short-term crisis mental health services assess the psychological status of affected populations, provide grief counseling, and initiate individual and community recovery. They provide emotional support when relatives identify bodies at morgues. Volunteers help victims who temporarily suffer survivor guilt, anxiety, mood swings, sleep disturbances, social withdrawal, and depression by reassuring them that they are reacting normally to abnormal, unexpected, and overwhelming situations that have disrupted their lives and that their heightened emotions will eventually lessen.

Long-term disaster psychology recognizes how catastrophes can result in some participants having post-traumatic stress disorder
and other delayed or chronic reactions such as nightmares and flashbacks, which are sometimes triggered by disaster anniversaries or sirens. Therapists also deal with disaster-related conditions such as substance abuse, irrational fears, and self-mutilation.

In addition to providing practical services, some disaster psychologists conduct research to develop more effective methods to help people during disasters. Procedures are developed to be compatible with varying coping styles for adults and children. Disaster psychologists often conduct workshops and conferences to teach techniques based on prior experiences to mental health relief workers, health professionals, and community leaders. Preparation and planning for future disasters is an important component of disaster psychology. Disaster mental health providers educate representatives of schools, municipalities, humanitarian organizations, and corporations about disaster readiness.

Disaster mental health professionals create educational materials to inform people about how to cope with disasters. Most disaster psychology literature addresses how disasters make people feel vulnerable and helpless and suggest practicing psychological skills to acquire some control during volatile situations. For example, after the September 11, 2001, terrorist attacks on the United States, many disaster psychological pamphlets emphasized how to keep in perspective the actual personal risks of unknown threats such as anthrax contamination and biological warfare.

Historical Development

Mental health professionals developed disaster psychology methods based on medical triage techniques and practical experiences with disasters. Several notable disasters were crucial to establishing disaster mental health services. When 491 people died in Boston’s Cocoanut Grove nightclub fire in 1942, Erich Lindemann investigated how survivors reacted emotionally. Disaster mental health authorities often cite Lindemann’s trauma and stress study as the fundamental work addressing disaster crisis theory. Pioneers in this emerging field used studies of military and civilian reactions to war-related stress and anxiety.

In 1972, a dam collapse resulted in the flooding of Buffalo Creek in West Virginia, causing 125 deaths. Approximately five thousand people became homeless. When survivors sued the dam’s owner, attorneys hired mental health consultants, who collected information about the psychological impact of the disaster on the community. This information was evaluated twenty years later, when investigators conducted a follow-up psychological study of survivors. The 1974 Disaster Relief Act stated that Federal Emergency Management Agency (FEMA) emergency funds could be used for mental health services. The Three Mile Island nuclear meltdown in 1979 revealed the need for mental health disaster services to be better coordinated and focused.

A decade later, the ARC emphasized that coordinated professional mental health response procedures comparable to medical health response plans were crucial. Often, ARC nurses who were not qualified to provide psychological services encountered disaster victims and relief workers in need of such help. The situation was exacerbated by the succession of major disasters in 1989: the Sioux City, Iowa, airplane crash in July; Hurricane Hugo in the Caribbean and southeastern United States in September; and the Loma Prieta earthquake in the San Francisco Bay area in October. Psychologists who assisted airplane crash survivors and victims’ families suggested that the American Psychological Association (APA) work with the ARC to establish a national plan for the training of disaster mental health personnel.

Mental health teams were assigned to accompany ARC relief workers when Hurricane Hugo occurred. These volunteers were already exhausted when the San Francisco earthquake took place, but instead of returning home, relief personnel were asked to transfer to San Francisco. Unfamiliarity with inner-city and ethnic cultures, language barriers, and long-duration service assignments intensified relief workers’ stress, and the need for mental health services for relief workers became apparent.

Professional Organization

Although mental health professionals provided disaster services throughout the twentieth century, disaster psychology emerged as a professional field during the 1990s. In 1990, the APA financed a California Psychological Association disaster-response course, and the ARC assisted with the class. Tornadoes in Illinois in the spring of 1991 prompted the Illinois Psychological Association to respond to the ARC’s request for mental health services. The first community request for disaster mental health services occurred after a tornado devastated Sherwood, North Dakota, in September 1991. Citizens sought help for their children in coping with the damage and casualties.

The ARC established the Disaster Mental Health (DMH) services by November 1991 and issued guidelines for training, certification, and service. Psychologists attending ARC disaster training began offering courses in their regions. The APA agreed to collaborate with the ARC the next month. Representatives of the APA and ARC decided that the APA’s Disaster Response Network (DRN) would prepare psychologist volunteers to offer free mental health services to survivors and relief workers at disaster scenes. After Hurricane Andrew hit Florida in 1992, approximately two hundred DRN psychologists helped survivors with the ARC. The APA has established task forces to evaluate mental health responses to various catastrophes.

The APA sponsors a Committee on Psychiatric Dimensions of Disaster (CPDD), formed in 1993 after three years of development as a task force. Members of this committee supply educational information to help psychiatrists provide disaster-related services. The committee seeks to advance the field of disaster psychiatry through training and research to determine the optimum psychiatric treatment for disaster victims. Members distribute materials to district branches to aid local response to potential disaster situations. The American Psychiatric Association also posts information about disaster topics on its website (http://www.psych.org).

The APA’s emergency-services and disaster-relief branch cooperates with other mental health groups and emergency services to prepare professionals to respond appropriately and effectively to psychological aspects of disasters. Multiorganization conferences in 1995 and 1996 clarified mental health professionals’ roles during disasters and approved APA goals. Facing such challenges as 2005’s Hurricane Katrina demonstrated the need for such coordinated efforts to aid victims.

Psychiatrists often feel limited by the ARC's prohibition of psychiatrists from prescribing medications while acting as ARC volunteers, and some mental health professionals formed local groups to intervene during disaster relief. Disaster Psychiatry Outreach (DPO) was established after the 1998 Swissair Flight 111 crash as an effort to provide better disaster mental health services in the New York City vicinity. Most DPO volunteers are qualified to prescribe medications for survivors and their families. Ethical and legal concerns specific to disaster mental health services provided by any source include abandonment of victims and solicitation of patients.

Disaster Procedures

At a disaster scene, mental health professionals aid medical emergency workers in identifying people who are behaving irrationally. Disaster psychologists help people deal with injuries or losses of family members and homes. Specific emotional issues might include disfigurement, loss of body parts, or exposure to grotesque scenes. Psychologists soothe disaster victims undergoing sudden surgical procedures.

Most disaster survivors and relief workers are resilient to permanent emotional damage. Volunteers advise people who seem likely to suffer psychiatric disorders due to the disaster to seek professional treatment. People in denial who ignore disaster-induced psychological damage can develop disorders such as post-traumatic stress disorder (PTSD), which can have a detrimental effect on social and professional interactions. The fourth edition of the APA’s
Diagnostic and Statistical Manual of Mental Disorders
(1994, DSM-IV) was the first to classify acute stress disorder (ASD), which has symptoms resembling PTSD but lasts only a few days to several weeks within one month of trauma. ASD is distinguished from PTSD by the presence of dissociative symptoms beginning either during the disaster or soon after.

Disaster mental health professionals introduce new methods, such as critical incident stress management (CISM) and critical incident stress debriefing (CISD), based on experiences and research. CISM was created to help emergency personnel who undergo stages of demobilization, defusing, debriefing, and education. Debriefing helps people voice their experiences and often provides group support from colleagues. Relief workers immersed in such stressful situations as recovering bodies often seek counseling. Twenty percent of the 1995 Oklahoma City bombing emergency workers received psychological attention. After the September 11, 2001, terrorist attacks, counselors reported that approximately two thousand emergency workers sought their services.

Research topics include evaluation of how PTSD is related to disasters or how heroes react to public attention, disaster-stimulated life changes such as marriage or divorce, stress reactions of secondary victims who are not directly affected by disasters, and variables such as gender, religious affiliation, and ethnicity. Children, adolescents, and elderly victims have unique needs during and after disasters. Other possible research groups include the homeless, the disabled, and people who are medically or mentally ill at the time of the disaster. Researchers use computer and technological advances to enhance studies of data and model disaster scenarios.

Internationally, academic programs, symposiums, and conferences explore disaster-related mental health topics. The University of South Dakota’s Disaster Mental Health Institute (http://www.usd.edu/arts-and-sciences/psychology/disaster-mental-health-institute/) offers a comprehensive curriculum of undergraduate and graduate disaster psychology courses to train ARC-approved disaster mental health personnel.

Bibliography

Austin, Linda S., ed. Responding to Disaster: A Guide for Mental Health Professionals. Washington: Amer. Psychiatric, 1992. Print.

Everly, George S., Jr., and Jeffrey T. Mitchell. Critical Incident Stress Management (CISM): A New Era and Standard of Care in Crisis Intervention. 2nd ed. Ellicot City: Chevron, 1999. Print.

Fullerton, Carol S., and Robert J. Ursano, eds. Posttraumatic Stress Disorder: Acute and Long-Term Responses to Trauma and Disaster. Washington: Amer. Psychiatric, 1997. Print.

Gist, Richard, and Bernard Lubin, eds. Response to Disaster: Psychosocial, Community, and Ecological Approaches. Philadelphia: Brunner, 1999. Print.

Greenstone, James L. The Elements of Disaster Psychology: Managing Psychosocial Trauma; An Integrated Approach to Force Protection and Acute Care. Springfield: Thomas, 2008. Print.

Jacobs, Gerard A. “The Development of a National Plan for Disaster Mental Health.” Professional Psychology: Research and Practice 26.6 (1995): 543–49. Print.

Norwood, Ann E., Robert J. Ursano, and Carol S. Fullerton. “Disaster Psychiatry: Principles and Practice.” Psychiatric Quarterly 71.3 (2000): 207–26. Print.

Luber, Marilyn, ed. Implementing EMDR Early Mental Health Interventions for Man-Made and Natural Disasters: Models, Scripted Protocols and Summary Sheets. New York: Springer, 2014. Print.

Raphael, Beverley, and John P. Wilson, eds. Psychological Debriefing: Theory, Practice and Evidence. New York: Cambridge UP, 2000. Print.

Roeder, Larry W., ed. Issues of Gender and Sexual Orientation in Humanitarian Emergencies: Risks and Risk Reduction. New York: Springer, 2014. Print.

Somasundaram, Daya. Scarred Communities: Psychosocial Impact of Man-Made and Natural Disasters on Sri Lankan Society. New Delhi: SAGE, 2014. Print.

Ursano, Robert J., Brian G. McCaughey, and Carol S. Fullerton, eds. Individual and Community Responses to Trauma and Disaster: The Structure of Human Chaos. New York: Cambridge UP, 1994. Print.

Wilson, John P., and Catherine So-kum Tang, eds. Cross-Cultural Assessment of Psychological Trauma and PTSD. New York: Springer, 2007. Print.

Zaumseil, Manfred, et al., eds. Cultural Psychology of Coping with Disasters: The Case of an Earthquake in Java, Indonesia. New York: Springer, 2014. Print.