DISASTER WORK AND STRESS
George W. Doherty, M.S.
Stress is a natural phenomenon. It is not necessarily negative. The body needs certain levels of stimulation and stress in order to be able to function. Stress is the body's normal, adaptive response to the environment. A stressor is the actual event which produces a demand or stress on an individual. The resulting wear and tear on an individual is called strain (Mitchell & Resnik, 1981).
Stress and distress are two different things. When an individual is distressed it is due to a disorder in their adaptation to stressors. Stressors fall into a number of categories. Charlesworth and Nathan (1984) have identified the following, some of which are positive stressors:Cognitive
The following, generally considered to be positive events, are also considered stressors:Change
Increased energy and endurance
The stress reaction prepares the body for change. It puts the body on alert to respond and adapt. This reaction goes back to a much earlier time in the evolution of the human species. The need to adapt to the environment still exists, but the physical dangers no longer exist as they once did. However, the stress reaction provokes the same biochemical reactions.
The part of the brain known as the hypothalamus alerts the nervous system to release energy when faced with physical danger or threat. The nervous system alerts the endocrine system to send large amounts of hormones into the blood stream, mobilizing the body for action. Muscles tighten up, blood sugar rises, adrenalin and noradrenalin provide emergency energy. This all prepares the body for what Cannon (1929) termed the "fight or flight response".
Hans Selye (1956, 1978) labeled three phases of this normal defense reaction of the body "The General Adaptation Syndrome". General because the consequences of the stressors have effects on several areas of the body. Adaptation refers to its stimulation of defenses designed to help the body adjust or deal with the stressors. Syndrome indicates that the individual pieces of the reaction occur more or less together and are at least partially interdependent. These reactions are similar for all forms of animal life. The physiological responses are the same whether the stressor produces fear, anger, or anxiety (Mitchell & Resnik, 1981).
While the physiological effects occur whether the stress is positive or negative, the psychological effects depend on the type of stress. Excitement, joy and high self-esteem are associated with positive stress. This extra charge of energy, for a short time, produces a controlled form of intense concentration called "eustress". Some examples of eustress include athletes striving to win, surgeons operating for long hours, and marathons. Such examples of eustress contribute to individual excellence. The benefits of optimal stress, if handled properly, include: opportunity for increased growth and maturity, independence, and control.
ONGOING OR LONG-TERM STRESS EFFECTS
Following long continued exposure to the same stressor(s), to which the body has become adjusted, adaptation energy is finally exhausted. This results in what Selye called "diseases of adaptation". These include asthma, chest and back pains, migraines, neuroses, psychoses, skin rash, and others (Selye, 1956; Cox, 1978). Selye pointed out that if stressors did not diminish over a certain period of time, the organism would move from a state of alarm into a state of exhaustion. With continued exhaustion, severe illness may occur. Finally, if signs of the alarm reaction reappear, resistance is gone. The situation becomes irreversible, and the individual dies.
The following are some of the health effects that continued strain, wear and tear can have on individuals (Mitchell & Resnik, 1981; Davis et al, 1982; Charlesworth & Nathan, 1984):Decrease in the effectiveness of the body's immune system, with an increase in colds, flu, and other communicable diseases.
high blood pressure
Gastrointestinal upsets, diarrhea, ulcers, colitis
Muscle tension, strains, backaches, and back injuries
Increased problems with allergies, skin conditions, asthma
Possibly increased vulnerability to heart disease, diabetes, cancer
Weight loss or gain
Increase in use of alcohol, tobacco and other drugs
Psychological difficulties: depression, withdrawal, apathy; or anger, irritability, huperexcitability
Most of the time the stress reactions elicited are so mild that they go unnoticed. Everyone has experienced events which were intensely stressful for a brief period of time. However, once the threat has passed, systems return to normal. Such an isolated stress event, in spite of the internal havoc it raised, probably resulted in absolutely no long-lasting physical damage to the body. On the other hand, a constant state of agitation can result in serious health dysfunctions (Ivancevich & Matteson, 1980). While mild stress and short-term infrequent intense stress produce no lasting harm, constant stress, or acute stress, results in a step-by- step exhaustion of the body's fuel reserves, with the end result - burnout.
Burnout is an effect of long-term stress. It shows up most commonly in the level of an individual's work performance. Farberow & Gordon (NIMH, 1978) have defined burnout as a state of exhaustion, irritability, and fatigue which markedly decreases an individual's effectiveness and capability.
Burnout is an advanced stage of stress. It occurs when there is chronic stress over a long period of time. Burnout can be defined as "collapse of the human spirit". Emotional exhaustion is another way to define it. Some of the early signs of burnout are the same as those for advanced stages of stress: fatigue, sleep disturbances, negative attitude, disillusionment, lowered resistance to infection, hypertension, headache, and stomach disturbances.
IMPACT OF STRESS
The impact of stress depends on a number of factors. Three of these are one's general health, genetics, and prior exposure to stressors. These factors may strengthen and support a disaster worker, resulting in mitigation or softening of the emotional consequences of a disaster. On the other hand, they may place the worker at risk for stress reactions.
The relationship of stress to physical and psychological health has been documented extensively in literature and research. Selye's (1956) research has demonstrated that stressors can cause changes in the immune system, thus wearing down resistance. A super-abundance of hormones secreted can considerably reduce immunity to infection.
Evidence suggests that individuals with certain physical or psychological characteristics are more at risk as potential victims of stress disorders. For example, Type A individuals constantly strive to attain achievements. They are competitive and hard driving. They strive to accomplish more and more in less time. They are chronically impatient with people and situations which they perceive as thwarting their attempts.
Type B individuals, on the other hand, are characterized by the absence of these behaviors. They are relatively relaxed and easygoing, even though they too may be goal-oriented. They appear to have a protective shield which allows them to experience less stress.
EXPOSURE TO PREVIOUS STRESSORS
It is a recognized fact that illness is due to external viruses and pathogenic agents entering the body. However, there is increasing evidence that illness is also due to the eventual broken-down state of the body. After long and continuous exposure to stress (or intermittent periods of intensive stress) hypertension, coronary heart disease, diabetes and ulcers occur (Cox, 1978; Beehr & Newman, 1978).
Research has demonstrated that stressful experiences can make animals more or less vulnerable to a number of cancer tumors, and researchers can speed up the time at which the tumors appear by controlling the number of times the animals are exposed to stress. The stressors applied in these studies resemble many human experiences of stress, such as forced restraint, crowding, handling, shock and noise (as opposed to a non-demanding more protected environment). Over time, the body parts break down.
On the other hand, research has demonstrated that less severe physiological damage to the body occurs when the following circumstances are present: fewer major life changes, socially supportive relationships, experience in handling stress, immunity as a result of many experiences with stress, and high self-esteem (Klein, 1971; House, 1980).
ADDITIONAL FACTORS AFFECTING STRESS AMONG DISASTER WORKERS
Four groups of factors can affect the stress levels experienced by disaster workers. These include:A. Individual FactorsHealth
Previous traumatic experiences
Prior disaster experience
Identity and self-expectations
Perception and interpretation of the event
B. Interpersonal FactorsStrength of social support system
Pre-existing stresses in relationships
Expectations and needs of others
States of family members in disaster
C. Community FactorsSize of community
Previous degree of social solidarity
Prior disaster experiences
Amount of social disruption due to disaster
D. General Aspects of the Disaster or Type of EventWarning
Contrast of scene
Type of disaster
Nature of the destructive agent
Degree of uncertainty
Time of occurrence
Duration of disaster or continued threat
Scope of disaster
Location of disaster
There are three major sources of stress which disaster workers face in their work. These are: Personal loss or injury; Traumatic stimuli; and Mission failure or human error. Each of these can contribute significantly to the stress reactions workers experience during or after a disaster event.
Occupational stressors also affect workers in disasters. Disaster work involves some pretty heavy professional responsibilities. The stakes are high and often involve life or death. Public as well as self-expectations for workers are high. Emergency responses are immediate, continuous and often without letup. There are significant physical, mental and emotional demands placed upon workers under extremely adverse chaotic and traumatic conditions. The physical properties of the work environment can cause additional stress. These include: work area, amount of contact with victims (injured, dead and dying), weather, hazards, work conditions, living conditions, human resources, frustrations and bystanders.
There are also organizational stressors that can occur due to the nature of the emergency organization. Among these are stresses due to: differences among professional vs volunteer organizations; day-to-day vs disaster responsibilities (Warheit, 1970), role clarity and role conflict (Garaventa, 1984); the size of the organization (Garaventa, 1984); rank of the individual in the organization (Kahn et al., 1964; Schein, 1965); chain of command; organizational conflict; and rewards.