CIVILIAN CATASTROPHE REACTIONS

Transient situational personality disorders resulting from severely traumatic experiences in civilian life, classified by the American Psychiatric Association (1952) under the subheading “Gross Stress Reactions.” The other type of disorder included in this category is combat reaction. Among the civilian experiences are auto accidents, plane crashes, earthquakes, tornadoes, fires, and sexual assault. In addition to these catastrophes, a large number of disturbing situations such as financial failure, divorce proceedings, social disgrace, and the sudden death of a loved person may produce traumatic reactions.The key feature of all these reactions is a temporary personality disorganization. The individual is for the time being overwhelmed and incapable of gathering his resources together to cope with the situation. The most acute and disrupting reactions are likely to occur when the victims have had a history of instability or immaturity, when prior traumas have made them sensitive to anxiety-provoking experiences, or when catastrophe occurs with little or no warning or preparation.Although the symptom picture may vary widely from case to case, Raker et al. (1956) have found significant common features among victims of tornadoes and other catastrophes. They have outlined the following three-stage “disaster syndrome”:(1) In the “shock stage” the victim is so dazed and stunned that he is unaware of the extent of his injuries and wanders aimlessly, making little effort to help himself or others—and in extreme cases he may become stuporous, disoriented and amnesic for the traumatic event. The reason for these intense reactions is that the victim is suddenly overpowered by anxiety. The threat to security is so great that he cannot meet it with his ordinary techniques of adjustment and therefore becomes totally disorganized.In the “suggestible stage” the victim passively accepts directions and is extremely concerned about other people involved in the disaster; but his efforts at assistance and even his performance of routine tasks are highly inefficient. This stage also results from temporary inability to deal with the situation, plus a tendency to regress to infantile, passive dependence on other people.In the “recovery stage” he gradually regains control. Nevertheless, he will probably remain somewhat tense and apprehensive, and constantly talk about the disaster or criticize the rescue workers. About one half of the victims re-enact the experience in recurrent nightmares. In this stage the tension and apprehensiveness are residual effects of the shock reaction, and the nightmares and repetitious talk are an unconscious attempt to reduce anxiety and “get it out of the system.”The three stages are clearly illustrated in this account of the Andrea Doria- Stockholm disaster off Nantucket Island:“During the phase of initial shock the survivors acted as if they had been sedated ... as though nature provided a sedation mechanism which went into operation automatically.” During the phase of suggestibility “the survivors presented themselves for the most part as an amorphous mass of people tending to act passively and compliantly. They displayed psychomotor retardation, flattening of affect, somnolence, and in some instances, amnesia for data of personal identification. They were nonchalant and easily suggestible.” During the stage of recovery, after the initial shock had worn off and the survivors had received aid, “they showed . . . an apparently compulsive need to tell the story again and again, with identical detail and emphasis.” The disaster reaction is frequently intensified by grief and depression caused by the loss of loved ones. It may be further complicated by feelings of guilt and self-reproach. A man or woman may be haunted for months or years by the thought, “There must be something I could have done.” Even totally unjustified feelings of guilt can cause extreme agitation, nightmares, tension symptoms, and a sense of impending doom. One of the survivors of the Cocoanut Grove fire, which took over 400 lives in Boston in 1943, developed such morbid guilt feelings for failing to save his wife that he finally committed suicide.The Cocoanut Grove disaster can be used to illustrate another type of traumatic reaction to panic. In acute panic the individual is thoroughly demoralized and overwhelmed by fear. He “loses his head,” acts in a completely irrational manner and tries to save himself without regard to others. This extreme reaction does not often occur in the usual disaster situation, such as a tornado, but tends to take place only where an unprepared group of people is suddenly threatened and opportunities for escape are extremely limited (Fritz,1957).This was exactly the situation at the Cocoanut Grove night club, where over six hundred people tried to get through only two revolving doors, even though many of them could have escaped through the kitchen.Another set of reactions may develop days or weeks after the catastrophe. This “post-traumatic syndrome” is characterized by mild to acute anxiety attacks; persistent tension with tremors, restlessness, and insomnia; recurrent nightmares directly or symbolically related to the traumatic event; irritability, often with startle reaction; avoidance of excitement of any kind, including sexual and social contacts or discussion of the incident. Post-traumatic reactions also develop after severe physical injuries, and the symptoms may be aggravated or prolonged by the possibility of compensation.The disaster syndrome and other shock reactions usually clear up quite rapidly if supportive psychotherapy is given immediately after the incident. Extra rest and sleep, with or without sedation, are practically always helpful. If prompt therapy is not given, there is not only a danger that the symptoms will become fixed, but that a post-traumatic syndrome will develop. In accident cases, such as being thrown from a horse or nearly drowning, it is often advisable to continue the activity in order to prevent anxiety from crystallizing. Although the prognosis in all these cases is generally favorable, some patients do not respond to therapy because of basic maladjustment or immaturity. See EMERGENCY PSYCHOTHERAPY, PANIC.