Disasters begin and end as local events. While there may be a large influx of outside expertise and resources in the days following the disaster, local mental health practitioners must be prepared to go it alone in the initial response. Inevitably, there comes a day when the media moves on to the next tragedy and state and federal resources stop flowing in, once again leaving the local community to care for its own.
In the days that have passed, I have thought much about the strength and complexity of my feelings as I stood before the building. Many of those thoughts have been about the nature of grief. It occurs to me that grief is neither a gift nor a curse although it may, at times, seem like both. Perhaps, instead, it is the dividend of our investment in or commitment to an individual or a group (parents. Federal workers, children). Without investment there is no loss. Without loss there is no grief. We earn our grief with our investment in others. It is therefore a precious dividend not to be avoided or shunned but embraced.'"'
One subset of intentional disasters that creates especially strong psychological, behavioral, and sociocultural responses is terrorism that employs chemical, biological, radiological, or nuclear agents, often referred to collectively as "weapons of mass destruction.''10*12 Although the use of anthrax in the US in 2001 and the 1995 sarin attack in Tokyo, Japan, did not cause mass death or destruction, they were very effective weapons of mass disruption. In these types of events, fear-driven behaviors may overwhelm medical care, influence evacuation behaviors, produce fear of exposure or contagion, create anxiety over what to expect or do, prompt hording of medication, and fuel intense worries about the status and well-being of loved ones.
NATURE OF PSYCHOLOGICAL RESPONSES
Norris and colleagues1314 reviewed the empirical research literature on 160 samples of disaster victims that were published between 1981 and 2001 and analyzed the findings, which incorporated more than 60,000 people. While in some areas the literature was conflicting, many predictors of distress (and in some studies, disorders) shared high commonality across a wide range of disasters. Some of the findings include:
* Women were more likely to be distressed than men (eg, women experienced twice the rate of posttraumatic stress disorder [PTSD | as men).
* Middle-aged adults reported more distress than did older and younger adults.
* Ethnic minorities generally experienced more distress than majority victims (often confounded by greater exposure).
* Children of distressed parents were more distressed than those of non-distressed parents.
* Mothers with young children were at high risk of distress.
* The greater the number of significant life events or chronic stress, the greater the probability of being distressed.
* Those with predisaster psychological symptoms or problems were more likely to be more highly distressed (especially true in low-magnitude disasters, not as helpful in extremely traumatic situations).
* Those who had higher neuroticism and worry and anxiety traits were more vulnerable to distress.
* Those with a greater loss of resources were more distressed than those with lower losses.
Most of these studies focused on psychopathology. However, some studies examined factors related to resilience (see also the article by Dr. Reissman et al., page 626). In one prospective study, three types of coping - active outreach, informed pragmatism, and reconciliation - were associated with a lower risk for psychiatric disorders.15 Feelings of self-efficacy, mastery, and higher self-esteem predicted less distress.16'21
Social and community factors were also important. Those who experienced higher "social embeddedness" and who received (or perceived) higher levels of social support…