friends and familiar routines and settings, or simply the physical force of the disaster itself
friends and familiar routines and settings, or simply the physical force of the disaster itself. The last mentioned can in some cases bring about overwhelming feelings of inadequacy in some who are suddenly confronted with their own feelings of helplessness and mortality.

Feelings and Behavior Symptoms

• Emotional shock

• Apathy

• Numbness

• Agitated depression

• Disorientation and confusion

• Perseverative behavior

• Hyperactivity

• Minimal emotional control, e.g. explosive anger, uncontrollable crying

• Physical symptoms, e.g., dizziness, nausea, fainting spells, headaches, hyperventilation, rapid heartbeat

Treatment Options

• Give verbal and physical reassurance

• Assist in coping with some specific and tangible problem

• Help in relocating loved ones

• Help in getting care for loved ones who are injured

• Help in locating and making arrangements for loved ones who did not survive

• Give assistance and encouragement in assessing extent of damage to personal property and beginning to repair or rebuild damaged home or business

• Assist in getting medical attention if needed

People Requiring Emergency Medical Care

Those who are in need of immediate and surgical treatment, in addition to suffering from physical shock, may also experience anxiety caused by separation from loved ones or a lack of information about the extent of damage to home, place of business, or the community itself. The degree of anxiety experienced by the injured person may aggravate his/her physical state and affect response to medical treatment. Having mental health services available at medical treatment facilities during and following the disaster has been found useful. The worker may provide invaluable relief and reassurance to the injured person by obtaining information about loved ones or about the status of property and possessions.

Human Service and Disaster Relief Workers

Workers in all phases of disaster relief - whether protective services, nongovernmental shelters, clothing and food services, governmental rehabilitation and reclamation services, or human service workers - expose themselves to unprecedented personal demands in their desire to help meet the needs of the victims. For many the disaster takes precedence over all other responsibilities and activities, and the workers devote all their time to the disaster-created tasks, at least in the immediate post-impact period. As some order returns, many of the workers, especially volunteers, return to their regular jobs, but at the same time attempt to continue with their disaster work. The result of the overwork is the "burn-out" syndrome, a state of exhaustion, irritability, and fatigue which creeps up unrecognized and undetected upon the individual and markedly decreases his/her effectiveness and capability. The best way to forestall the "burn-out" syndrome is to expect it, to be alert to its early signs, and to act authoritatively in relieving the stress. Four primary areas of symptomatology have been identified:

Symptoms

Thinking: Mental confusion, slowness of thought, inability to make judgments and decisions, loss of ability to conceptualize alternatives or to prioritize tasks, loss of objectivity in evaluating own functioning, etc.

Psychological: Depression, irritability, anxiety, hyperexcitability, excessive rage reactions, etc.

Somatic: Physical exhaustion, loss of energy, gastrointestinal distress, appetite disturbances, hypochondria, sleep disorders, tremors, etc.

Behavioral: Hyperactivity, excessive fatigue, inability to express self verbally or in writing, etc.

Management

The first step is to be aware of, to be alert for, and to recognize the symptoms of "burn-out" syndrome when they first appear. The earlier they are recognized the better. All personnel need to be instructed about the early symptoms so that they may recognize it not only in themselves but also in their fellow workers. Any such observations, either about themselves or about others, should be reported to their supervisors. The latter also need to be alert to any early symptoms in their staff so that they can intervene. The supervisor should talk to the individual and try to get him/her to recognize the symptoms in him/herself. The supervisor can then make sure the person is relieved from his/her duties for a short period of time. Guilt over leaving the activity is relieved by giving official permission to stop and by pointing out how the worker is no longer helping because of the loss of his/her effectiveness. The worker can be reassured that he/she can return and that he/she will have improved greatly as a result of the short recuperation. The supervisor should at first attempt to persuade the helper to take the time off, but, if necessary, should order it. The syndrome may appear early or well into the post-disaster period, from 2 weeks to a year. On the average, it seems to take about 4 to 6 weeks for most of the symptoms to appear.

 

Cultural and Ethnic Minorities

Regardless of how many announcements may be made on radio or TV, this group will not understand what assistance is available if they do not understand the language. Cultural differences, especially of race and language, may be important. For these groups, it is essential that outreach efforts be channeled through representatives or facilities in the area. Differences in language and/or customs, if ignored, will lead to frustration by those attempting to provide services. It is important to provide education about differences in the grieving process, provide handouts on disaster related stress in appropriate languages, assist with referrals to culturally appropriate counseling services, etc.

 

ETHNIC GROUP FACTORS

  • Previous history of trauma or stress in country of origin
  • Immigration status
  • Level of trust or mistrust of government agencies
  • Level of acculturation
  • Language fluency or literacy
  • Social status
  • Economic situation and ability to recover financially
  • Disaster losses may re-awaken prior losses and trauma
  • Mistrust of "outsiders"
  • Definition of family and individual's role in family
  • Support systems
  • Role of those perceived as "helpers"
  • Belief system regarding disaster (e.g. fate, responsibility, punishment, guilt)
  • Religious belief systems
  • Values regarding asking for help
  • Rituals and traditions, particularly relating to grieving

SOME EXAMPLES OF DISASTER RELATED EMOTIONAL PROBLEMS

 Frequently among workers, questions are raised about the types of emotional distress to be expected with disaster victims. There is also interest expressed about learning ways in which these problems can best be handled by workers in the field.

Workers should realize that they are not expected to become instant experts in the diagnosis and treatment of mental disorders. The worker's role is first to identify those in need of help and then to offer verbal support, information, and advice when requested. Sometimes physical assistance, such as moving a victim's belongings or helping to repair damage to homes and property, is most helpful in overcoming emotional distress.

Following are some case illustrations of the more typical types of disaster-related emotional distress along with a brief discussion of ways the situation might be handled.



Depression

A worker finds a middle-aged man pacing up and down in front of his flood-ravaged home. Some of the water -soaked furniture has been dragged out into the yard to let the sun dry it out. However, the man has apparently abandoned further attempts to salvage his furnishings and is now walking about aimlessly in what remains of the front yard, wringing his hands.

This illustration of depression differs somewhat from the usual picture of the individual suffering from apathy and withdrawal, with no interest in what is going on around him. The example demonstrates that depression is frequently masked by, or expressed in, agitated activity which is aimless or nonproductive. Unless the depression in this phase is recognized and helped, it may readily progress to more serious mental and physical problems.

Help for the depressed person in this instance might take the form of verbal help, such as reassurance, encouragement, giving information about where and how to get help, and offers of physical assistance in salvaging belongings, making sure he has had something to eat recently, and providing hot coffee or tea while conversing.

Grief

A man appears in a one-stop relief center in a small western city severely damaged by an earthquake. He asks for help in acquiring a set of mechanic's tools. He needs the tools because his set was lost with his house and all the rest of his possessions in the earthquake. While giving the required information to the disaster worker, he mentions in passing that his son was killed in the earthquake.

This man appears to be in complete control of his emotions. He seems to be going about the business of re-establishing his life in a well-organized fashion. However, such behavior would be considered healthy and desirable only after a suitable period of mourning or "working through" the grief reactions to the death of his son. In this instance, there had been no time for mourning. The father was busying himself with constructive tasks that actually served to screen the emotional pain in order to avoid dealing directly with his loss. One doesn't have to be a specialist in human behavior to anticipate that the father would probably at some point experience the flooding of emotions he was now damming up and that he would be overwhelmed by them.

What could be done in such a case? It would seem presumptuous and perhaps ill-advised to confront this man directly with his loss and to challenge his defense of suppressing his emotions under these circumstances. Perhaps a brief, gentle comment on his loss is all that can be done at this time. Such a comment might permit the beginning of the experience of grief. The bereaved father has thus felt the touch of gentle understanding and in a sense has received permission to deal directly with his loss. The worker would want to alert relatives or close friends to the probability that the father might need help in the future in dealing with his grief.

Depending on the situation, there are many approaches which might be appropriate for assisting those suffering grief. It often might be desirable to convey empathy through those close to the victim rather than directly. Again, depending on the circumstances, it might be more suitable to offer direct assistance in the form of making arrangements, notifying relatives, or dealing with insurance matters.

Anger

A rural valley with many small farms was devastated when a newly finished man-made dam gave way and flooded the area below it. Some citizens who had suffered losses in the flood were seen throwing rocks at trucks belonging to the construction company that had built the dam. Anger was also expressed by local relief workers whose efforts were hampered by bureaucratic red tape. Victims exhibited anger toward relief workers both for interfering with their lives and for not doing enough to help those in need.

Anger is one of the natural and expected reactions to adversity. The degree of anger felt and ways in which it is expressed are related to many things, some of which are external, as in the case of negligence which caused or contributed to the catastrophe; and some of which are a reflection of the individual's experience of helplessness and frustration in the disaster itself.

In dealing with anger in disaster victims, it is important for the worker to be aware of the value of "ventilation" as a means of reducing the excess emotion which interferes with constructive handling of the causes. That is, it is important that the angry victim be permitted to express his/her anger verbally. It is generally not desirable to take direct action while in the grips of such strong feelings. On the other hand, an understanding listener should not try to exhibit anxiety while listening to the angry outbursts and recitals and not try to "talk him out of" being angry, nor express disapproval or other guilt-inducing reactions. Many people find it uncomfortable and difficult to listen to angry reactions of others. If one is aware of its therapeutic value and is sufficiently motivated, however, this important service becomes easier with practice.