Initial Impact of the Trauma
We know that hundreds of thousand of men, women and children saw their homes, streets and cities destroyed before their eyes. They witnessed death and destruction above and beyond the usual human experience. The scenes of dead bodies in the streets with injured people with no immediate access to medical care or good or water which we saw on our television screens, were just a small sampling of what the people in Haiti have been going through. Not only were they witnessing all these things but they were living them.
The initial reaction in the aftermath of a disaster for many people will be a blunting of their feelings. They will be stunned or numb. Initially people may not accept what has happened. In New York City immediately after the 9/11 attack many family members did not believe that loved ones working in the World Trade Center who did not come home and were not registered in a hospital, actually had died. There were "missing persons posters" all around Manhattan which eventually were turned into memorial posters as the truth sank in.
Grieving is More Complicated Than Usual
Just about every survivor in Haiti can be expected to be going through a very personal grieving process. Over 150,000 people are known to have perished. Grief is a something that we all must go through at various times in our lives. There are various stages of grieving and ultimately most people while never forgetting a lost loved one, are able to resolve their grief in an expectable manner. However when the death is totally unexpected, traumatic, violent or involves children, the grieving takes on a much more complicated form. It is prolonged and much more difficult to resolve. There are often other psychological complications such as post traumatic stress as described below, alcohol and drug problems, anger, depression and suicidal behavior.
Most Will Have Symptoms Post Traumatic Stress
After this type of a mass trauma, at least half of the people will likely experience some symptoms of post traumatic stress. They will have recurrent and intrusive distressing recollections of the events that they have seen and been through. This can include nightmares and daytime flashbacks. At times people will act or feel as if the traumatic event were recurring. There may even be hallucinations or misperceptions where real things are misperceived as something related to the recent traumatic events. For example, the noise or vibrations of a passing plane or truck might immediately bring back a flood of the feelings that occurred during the earthquake. This can include rapid heart beat, fast breathing and other physical symptoms. When there are even mild after-shocks following a major earthquake some people are overwhelmed with emotion.
In the aftermath of such an event, people suffering post traumatic stress symptoms can make efforts to avoid conversations or thoughts associated with the trauma. They may avoid certain locations or even people who will remind them of the recent trauma. Some will feel detached and estranged from other people and may not be able to have any loving feelings for a long time. There can be difficulty in falling or staying asleep, increased outbursts of anger, and difficulty concentrating. Quite characteristically people who are having symptoms of post traumatic stress will have an exaggerated startle response in which they can typically appear to "jump out of their skin" after a loud or unexpected noise.
After other disasters that have been studied, it has been shown that most people don't develop the full criteria for a full blown Post Traumatic Stress Disorder. We know that with time with support of people who care about them and if they can return to their previous life, with a normal grieving period, most people have the resiliency to recover from the symptoms of post traumatic stress. But this is a big "IF". When the destruction and loss of life is so wide spread and the poverty and lack or resources is greatly limited despite the great efforts of the world community, we can not predict an easy psychological recovery from this trauma.
Psychological First Aid
The Psychological First Aid that will be administered will be to first to assure physical safety, medical care, food , water, shelter and most important will be assistance in getting information about loved ones. Ideally the people who are making death notifications will be sensitive and skilled in doing this delicate task but that is something that can't be counted on. A continuous flow of truthful, helpful information is generally more important than any pressure to do a cathartic type of therapy at this stage. Included in the information that is given out should be advice about importance of getting proper sleep and avoiding any tendency to use drugs and alcohol to deal with painful feelings. As the weeks and months go on, people who are having psychological difficulties, are unable to function because of these feelings or may even be suicidal are identified and offered proper treatment. Obviously the people who provide the treatment need to be skilled in administering it and also have understanding of the setting, culture and religious beliefs of the population.
Secondary Victims are the Rescue and Medical Personnel
This discussion would not be complete without mentioning the potential secondary victims of psychological trauma who are mostly the emergency rescue workers, doctors and nurses as well as the members of the media. Despite previous experiences with this type of work, they can be traumatized by the continuous exposure to sights of death, injury, tragedy, and heartbreak especially involving children. They can develop symptoms of post traumatic stress described above. Many of the teams will be aware of this possibility as part of their training and will be sure that they support each other and get proper rest.
Don't Forget the Impact on the Reporters
One evening I saw Anderson Cooper, CNN anchor, reporting from Haiti. He was telling about the dead bodies of children being pulled out of the rubble and other very difficult scenes. He was clearly emotionally affected. It is the job of the working press to view the worst of all the destruction, talk to victims, as well as the families of those who have perished. They often work around the clock without much rest. I have had experience working with media people who have been through disasters and I have seen the emotional toll that can be taken on them.