Coping With Public Tragedies and Natural Disasters

Survivors of public tragedies and natural disasters 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.

Typical Reactions To Public Tragedies & Natural Disasters

Emotional Reactions

• Shock, 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 recurring 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, or about surviving (when others did not).
• 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 heartbeat 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 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 and influenced by the factors mentioned above.

Certain severe reactions to a disaster, however, 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 his or her loved one, even if the person has died. Survivors may develop anger at their loved one for dying and leaving them alone, or anger at others if the disaster was man-made or could have been prevented.

Eventually the survivor should begin to focus grief response on 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, traumatic or may not enable the survivor to identify their loved one's body or verify the actual death.

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

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, knowing that others in your support system may be similarly overwhelmed.
• Give yourself time to heal; be patient with changes in your emotional state.
• Write your thoughts, emotions and feelings in a journal.
• 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 to redirect and ease 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.

Typical Reactions Of Those Not Directly Affected By A Natural Disaster Or Public Tragedy

People 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.

Tips for coping with public tragedy or natural disaster if you are not directly affected by the event:

• Acknowledge your reactions to the event; talk with others about your thoughts and feelings.
• Remember that it is normal to feel both relief and guilt if you were not directly affected.
• Take a break from focusing on the event. Turn off the television and radio for a while; avoid the news.
• 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 for 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, you can volunteer to raise money.
• 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, babysitting, elder care, 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.”

Interventions For Survivors Of Public Tragedies & Natural Disasters

If an individual is suffering from any of the severe emotional symptoms described above, seek professional assistance from someone trained in handling traumatic stress response.

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 about anticipatory emotional reactions to help those who were affected plan for the future. A professional debriefing is most helpful soon after the event, but it can take place at any time.

Many people are able to cope effectively via their own support systems. It is not surprising, however, to find that serious problems continue after the event and 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 the longer-term grief responses.

People who are directly affected by an event need to tell their story about what happened, what they felt and thought, and how they reacted. It often is difficult for others who are suffering to listen and sympathize.

Survivors of natural tragedies need spiritual support as well, even if their spiritual convictions are shaken as a result of a public tragedy or natural disaster. Victims might wonder how something so horrific could have happened, or they might struggle with new uncertainties as they search for the strength and will to persevere, move forward or start over.

The spiritual support of a hospice team member can identify and address signs of spiritual distress and confusion, allow them to be expressed, and provide spiritual guidance and support.

Organizations Providing Assistance With Traumatic Stress Response

• American Red Cross
• National Organization for Victim’s Assistance (NOVA)
• Crisis Hot Lines
• Salvation Army
• Association of Traumatic Stress Specialists, www.atss.info