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Survivors of natural disasters and public tragedies typically display a range of emotional, physical and cognitive reactions in the aftermath of the event. These reactions vary greatly among survivors and are influenced by such factors as proximity to the event, the survivor's prior psychological functioning, available support systems, cultural norms and values, and the survivor's perceived ability to receive adequate help. As a general rule, the more one is affected by the event, the stronger the reaction.
In the case of a public tragedy or natural disaster, hospice professionals often are called upon-as an extension of our mission to help people cope with loss-to provide medical and bereavement support for our patients and families as well as for the community at large. This guide describes ways in which hospice professionals can provide vital assistance
Typical Reactions to Public Tragedies and Natural Disasters
Emotional Reactions:
- Shock and feeling overwhelmed-a disbelief that the event occurred; people may report feeling dazed or numb due to the enormity of the event.
- Panic, anxiety-may occur when the reality of the event begins to sink in. Thoughts are focused on loved ones' well-being, on one's own safety and on the protection of personal possessions. People may experience reoccurring thoughts of the event.
- Relief-for having avoided injury or death of self or others.
- Anger, irritability-at the forces of nature, at the perpetrators (in the case of a public tragedy), at self for not protecting others, at the government for a perceived delay in response, at God.
- Guilt-at being unable to help loved ones, about surviving.
- Grief-related to any losses incurred. Survivors may vacillate between anger and grief.
Survivors usually experience feelings more intensely than usual, and their feelings may seem unpredictable-crying one moment and being outraged the next, for example. Depression is common, particularly in the aftermath of the event.
Recurring emotional reactions are typical throughout the recovery process. Anniversaries of the event, such as at one month or one year, and visual and auditory reminders, such as rescue vehicle sirens, may trigger memories of the traumatic experience.
- Cognitive Reactions:
- Confusion
- Indecision
- Difficulty concentrating
- Forgetfulness
- Flashbacks of the event, usually accompanied by rapid heart beat or sweating
- Being startled easily
Physical Symptoms:
- Tension headaches
- Fatigue
- Changes in sleeping and eating patterns
- Bodily aches or pains
- Nausea
Interpersonal Reactions:
- Conflict
- Distrust
- Withdrawal
- Work or school problems
- Sensitivity, feeling rejected
Severe Emotional Reactions to a Disaster
The emotional, physical and cognitive symptoms described above generally begin to dissipate slowly at some point after the event. Each individual's reaction and emotional recovery timeframe is unique, influenced by the factors mentioned above.
There are certain severe reactions to a disaster, however, that may require immediate attention by a professional trained in post-traumatic stress response:
- Intense and continual re-experiencing of the event
- Extreme emotional numbing or denial of the event
- Terrifying nightmares or flashbacks
- Hypersensitivity
- Extreme irritability, anger, violence
- Disassociation: fragmented thoughts, preoccupation, unawareness of surroundings, amnesia
- Severe anxiety, panic attacks
- Severe depression; loss of hope, pleasure or interest; feeling hopeless and worthless; suicidal thoughts
- Substance abuse
If a loved one has died as a result of a public tragedy or natural disaster The period of shock is generally short-lived. This period may give way to intense separation distress and overwhelming grief. The bereaved person may search for the loved one, even if he or she knows the person has died. There may be anger at the deceased for dying, for leaving the survivor. Anger may be directed at others as well, especially if the disaster is man-made or could have been prevented.
Eventually the bereaved person begins to focus his or her grief response toward the psychological bonds with the dead person and the memories of their relationship.
Deaths resulting from natural disasters and public tragedies may lead to higher risk of bereavement complications for survivors, as these deaths are generally unexpected and traumatic. If the bereaved person is unable to see the body of the deceased, there may be additional complications.
Other risk factors for complicated grief include:
- Deceased is a child
- Other concurrent life stressors
- High levels of ambivalence in relation to the deceased
- A significantly dependent relationship
- Personal vulnerability and/or past history of coping with adversity
- Perceived lack of social support
- History of mental illness, substance abuse
Typical reactions of those not directly affected by a natural disaster or public tragedy
Those not directly affected by the event may experience overwhelming sympathy and yearn to help the victims. Those at a distance occasionally may experience some of the same emotional, physical and cognitive reactions described above. It is common to experience "survivor's guilt," and at the same time to feel relief at being spared. Those at a distance often report feeling more vulnerable after witnessing the results of a disaster and many begin to re-examine what is important in their own lives.
Interventions for Survivors of Public Tragedies and Natural Disasters
If an individual is suffering from any of the severe emotional symptoms described above, professional assistance should be sought from someone trained in handling traumatic stress response. (Contact the Red Cross or the National Organization for Victim's Assistance at the websites listed below.)
Individuals trained to respond immediately to a crisis focus on processing the incident and reflecting on its impact for the survivors, allowing for expression of emotions and thoughts associated with the event. They also provide education regarding the emotional reactions to anticipate, thus helping those affected to plan for the future. It is best if this debriefing occurs soon after the event, but it can take place at any time.
Many people are able to cope effectively with the emotional and physical demands brought about by a public tragedy or natural disaster by using their own support systems. It is not surprising, however, to find that serious problems continue to interfere with activities of daily living. Individuals experiencing ongoing issues should consult a trained and experienced mental health professional. These professionals educate people about common responses to extreme stress and help them find constructive ways of dealing with the emotional impact. Hospice professionals can be helpful in responding to long-term grief responses.
People who are directly affected by an event need to tell their story: what happened; what they felt and thought; how they reacted. It often is difficult for others who are suffering to listen and sympathize. At some point after the event, the emergency response crews go home, the media attention dwindles, and survivors are left to put their lives back together, dealing with complex personal and bureaucratic issues. Attentive listening by a hospice team member can help with feelings of isolation, frustration and weariness, as can the survivor's participation in a support group.
Survivors of natural tragedies need spiritual support as well. Often our spiritual convictions are shaken as a result of a public tragedy or natural disaster. We question how something so horrific could have happened. We search for the strength and will to persevere and move forward and we may struggle with new uncertainties in life. We often try to find meaning in the ways life has changed. The spiritual support of a hospice team member (particularly a chaplain) can bring out these signs of spiritual distress and confusion, allow them to be expressed and provide spiritual guidance and support.
Tips for coping with public tragedy or natural disaster
For those immediately affected by the event:
- Allow yourself to express the emotions you are feeling-don't wait, don't bottle them up.
- Don't hesitate to accept support and assistance from others; it helps those close to you to feel less helpless.
- Ask for support from those who can listen; expect that others in your support system also may be overwhelmed.
- Give yourself time to heal; be patient with changes in your emotional state.
- Write down your thoughts and feeling in a journal. Writing is a way to express emotions that are difficult to talk about.
- Join a support group for victims of the disaster/tragedy, one that is led by a trained professional. Groups can be especially helpful if you have a limited support system.
- Provide emotional support to others; helping others can alleviate the constant focus on our own pain.
- Take care of yourself physically to cope better with stress: Eat well-balanced meals, exercise, avoid drugs and alcohol, get plenty of rest.
- Re-establish regular routines, such as meal times and exercise, but don't force yourself to get back to the exact schedule that you maintained prior to the event. Take some time every day to relax, reflect and enjoy yourself in some way.
- Avoid major life decisions-such as relocating, changing jobs, ending a relationship-until the event has passed and you can make rational and well-thought-out decisions.
If you are not directly affected by the event:
- Acknowledge the reactions you have related to the event; talk with others about your thoughts and feelings.
- Remember that it is normal to feel both relief and guilt that you were not directly affected.
- Take a break from focusing on the event. Turn off the television and radio for a while; avoid the front page of the newspaper.
- Continue your typical routines.
- Keep things in perspective. Although the event was horrible, try to focus as well on the good things in your life, what you are grateful for.
- Volunteer with a disaster relief agency.
- Make a donation to a disaster relief agency or donate blood. Contributing can help combat feelings of helplessness. If you can't afford to make a contribution yourself, you still can volunteer to raise money for the organization.
- Help those who have incurred losses by acknowledging the loss in some way-send a card, a letter, observe a moment of silence.
- Help someone with a specific need-provide transportation, offer to care for a child or elder, do laundry, cook a meal.
Many people who have directly or indirectly experienced and survived a public tragedy or natural disaster report having improved relationships with others, a greater sense of personal strength even while feeling vulnerable, increased sense of self-worth, deeper spirituality and more appreciation for the little things in life.
Organizations Providing Assistance with Traumatic Stress Response:
Websites with information on Coping with Naturals Disasters and Public Tragedies:
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