Learning From The Past and Planning For The Future
MENTAL HEALTH MOMENT September 13, 2002 "It's not that I'm afraid to die. I just don't want to be there when it happens." - Woody Allen
LINKS Mental Health Moment Online
CONFERENCES AND WORKSHOPS:
Basic and Advanced Critical Incident Stress Management Workshops
November 22-23, 2002
Rocky Mountain Region Disaster Mental Health Institute
AndSnowy Range A.S.I.S.T. CISM Team
"Religious Aspects of Domestic Violence" November 24, 2002
Rocky Mountain Region Disaster Mental Health Institute
AndThe Governor's Domestic Violence Elimination (DoVE) Council
Fifth Annual Innovations in Disaster Psychology Conference
"Psychosocial Reactions to Terrorist Attacks"
Sept. 29-Oct 1
Location: Radisson Hotel
Rapid City, South Dakota
SANTA FE SYMPOSIA
nine different weekend symposia
on a variety of mental
October 11-27, 2002
Institute for Meditation &
Psychotherapy: Bill O'Hanlon,
Peter Tanguay and others.
For more information
anda brochure, contact:
92 Elm Street APA502
Pittsfield, MA 01202
Tel: (413) 499-1489
Fax (413) 499-6584
27th Congress of the World Federation
for Mental Health
February 21-26, 2003
ICMS Pty Ltd (Congress Secretariat)
84 Queensbridge Street
Southbank VIC 3006, Australia
Tel: 61 3 9682 0244
Fax: 61 3 9682 0288
89th International Conference:
Stress and Depression
October 20, 2002
Istituto di Psicologia
Corso Concordia 14
Milan 20129, Italy
Seventh World Congress
onon Stress, Trauma & Coping,
"Crisis Intervention in
a Changing World"
February 12-16, 2003
Latino Psychology 2002 Conference
October 18 - 20, 2002
Location: Providence, Rhode Island, USA Contact: Maria Garrido, Chair
"Latino Psychology 2002"
Adjunct Professor of Psychology
University of Rhode Island
MEDICAL MINUTE: EARLY TREATMENT OFFERS HOPE FOR DEPRESSION
No one will forget the tragic events of last Sept. 11. The impact of the horrific images that played and replayed on network news during the days and weeks that followed caused thousands of people to seek treatment for a variety of health problems brought on by psychological trauma. As the nation recalls 9/11, feelings of dread or sadness return for many. Depression is a common problem touching 19 million Americans every year and affecting nearly 10 percent of the population at any time. For most, it is a state of life with ongoing feelings of inadequacy or unhappiness. For some, it is a progressive problem that can end tragically. However, current anti-depression medications are easier for most people to tolerate and are effective for long-term treatment. Depression can be treated quickly and just as effectively as high blood pressure or diabetes. For more information, visit the Sept. 11 Medical Minute at http://www.psu.edu/ur/2002/medicalminute003.html. Medical Minute is a weekly service by experts from the University's College of Medicine at the Penn State Milton S. Hershey Medical Center. For more information, visit: http://www.hmc.psu.edu/.
CONFRONTATION WITH IRAQ INVOLVES PITFALLS
An offensive against Saddam Hussein would entail two dangerous pitfalls for U.S. and allied forces -- one technological, the other psychological -- according to a Penn State political scientist. First, the enormous edge Americans enjoy in conventional military arsenals may make Hussein all the more inclined to fall back on weapons of mass destruction, even nuclear missiles, says Stephen J. Cimbala, distinguished professor of political science at Penn State's Delaware County campus, near Philadelphia, in his new book, "The Dead Volcano: The Background and Effects of Nuclear War Complacency" (Praeger). Second, Hussein, as already demonstrated by his war with Iran in the 1980s, represents a culture where brutal losses in war are an accepted fact of life. "To the surprise and chagrin of Western audiences, they may be quite willing both to inflict and endure horrific casualties, as well as dispense with legal niceties governing the conduct of war," Cimbala says. For the full story by Paul Blaum, visit:
RESEARCHERS TO EXAMINE EFFECT OF RURAL LIFE ON CHILDREN
Researchers from Penn State and the University of North Carolina will conduct a five-year, $16.5 million study of the biological, individual, family and community processes that lead to good or poor outcomes for rural children. According to the National Institute of Child Health and Human Development, which is funding the study, the project will follow 1,400 children from selected rural counties in North Carolina and Pennsylvania from infancy through the first three years of the children's lives in order to gauge their development. Experts from Penn State's College of Health and Human Development and College of the Liberal Arts will focus on approximately 600 children from three Pennsylvania counties. For more information, visit: http://www.hhdev.psu.edu/news/news_res/9_6_02_rural.html
A Nation Remembers; A Nation Recovers - FEMA Publishes One-Year Anniversary Report
In observance of the first anniversary of 9/11, the Federal Emergency Management Agency (FEMA) has published A Nation Remembers; A Nation Recovers, a collection of personal stories from the frontlines of the disaster in New York, Pennsylvania, and at the Pentagon.
The Federal Emergency Management Agency (FEMA) today took a significant step to strengthen its preparedness and hazard reduction programs by signing a Memorandum of Understanding (MOU) with the Association of American State Geologists (AASG).
After Peace Corps volunteer Stacy Ragan was evacuated from Turkmenistan, she joined the American Red Cross International Disaster Response Unit (IDRU) in New York City to help the international recovery from September 11.
NEWS ARTICLES ONLINE
INS to begin fingerprinting 'suspicious' tourists.
ALABAMA - State opens emergency center, urges vigilance after warning.
CALIFORNIA - County organizes to counter biological or chemical attack.
USA - Nuclear sites bolster security.
IOWA- Governor Opens State Emergency Center.
ASIA - Nine U.S. Embassies Close Worldwide
Nelson Mandela: The United States of America is a Threat to World Peace
HAMBURG - German police question 4 more suspected in Sept. 11 plot
DISASTER ANNIVERSARIES: MENTAL HEALTH ISSUES
(from Myers, D. (1994). Disaster Response and Recovery: A Handbook for Mental Health Professionals. Rockville, MD: Center for Mental Health Services.)
An anniversary, by definition, is the recurrence of an event or the re-awakening of feelings surrounding an event that took place in the past. An anniversary may also be a commemorative celebration of an important date.
Anniversary remembrances occur consciously and unconsciously, and are a part of our biology, psychology, history, and culture.
Derivation Of Anniversary Reactions
Biologically, all animals have a finely tuned awareness for signals of danger. Sights, sounds, smells, or other reminders of a threatening event usually evoke a memory of the threat and alertness for present danger. These sensitivities help to explain the "trigger reactions" of disaster survivors. Situation, sights or sounds that remind people of the disaster experience can evoke a stress response. For example, earthquake survivors frequently become anxious when a truck rumbles by, rattling windows.
Besides having acute alertness for danger, animals including humans have an exquisite sensitivity to the changing of the seasons. Mating, nesting, foraging, and hibernating all take place in response to cues from the environment: changes in light/dark cycles, temperature, smells, etc. Many ancient human traditions and rituals have evolved around time of the year or change of the season: rites of Spring, celebrations of the harvest, festivals of light in the darkness of the winter solstice. It is not surprising, then, that the normal stimuli associated with the "time of year" can evoke memories of an event, a heightened sense of anxiety, and re-awakening of feelings associated with the event.
Many disaster survivors report restlessness and fear with the return of the season in which a disaster occurred. For example, the return of the annual storm season will likely bring anxiety to people who have survived a hurricane the previous year. A woman whose neighbor was killed in a massive mudslide reported 10 years later that she still gets jitters when it rains (Johnson, 1992).
Psychological literature discusses "anniversary reactions" as the individual's response to unresolved grief resulting from significant losses (Cavenar, Spaulding, and Hammet, 1976; Pollock, 1970). From a psychodynamic perspective, Szekely (1978) describes the death of a close relative or friend or other "historic" event as leading to a modification of an individual's self-image. The change converts the event into a type of "monument" in the individual's personal history. These unconscious, timeless, and permanent self- and object-representations have a temporal character that is associated with feelings of longing or hopeful expectancy. Szekely (1978) describes two pre-disposing conditions for the generation of anniversary reactions: strain/trauma and unfinished mourning. Disasters in which individuals have experienced intense trauma and significant losses contain both pre-disposing conditions. For individuals who have experienced core losses, such as the loss of a loved one or the loss of a home and all the artifacts of one's history, mourning is still in progress at the one-year anniversary. It takes much longer than a few months to truly begin to make peace with the past and turn to the future. In their study of loss and mourning, Zunin and Zunin (1991) found that the lives of the bereaved may still be strongly affected a year and a half to three years later.
Some individuals may experience complicated or "pathological" bereavement with an intensification, a prolongation or an inhibition of normal grief. In these cases, anniversary reactions can be used in clinical treatment as an opportunity to work through incomplete mourning (Cavenar, Spaulding, and Hammet, 1976; Pollock, 1970).
For normal people dealing with the abnormal situation of disaster, the anniversary can also provide an opportunity for emotional healing. By recognizing, allowing, and attending to the feelings and issues inherent in the anniversary reaction, an individual can make significant steps forward through the natural process of grief.
Formal recognition of anniversaries is part of human history and culture. Some anniversaries are of a happy nature: celebrations such as birthdays, weddings, historic events, and religious holidays. Anniversaries of such occasions prompt joyous memories and feelings. Some anniversaries are of a commemorative nature, in remembrance of tragic events or losses. Examples include the anniversary of a loved one's death or a day of honor for many who have died, such as Memorial Day.
Many cultures and religions have established traditions and rituals for grief and mourning, during which the first year is a formalized period of mourning. For example, Judaic law has established specific stages of mourning. There are guidelines for appropriate activities regarding marriage during the mourning period, the amount of grief to be shown, and the type of garments to be worn. In many cultures, the one-year anniversary of the death ends the formal period of mourning.
Pollock (1972) hypothesizes that cultural mechanisms and traditions have been derived from the awareness of the intrapsychic needs of the individual. They arise from the need to achieve psychosocial equilibrium through institutional regulations. In other words, religious and cultural belief systems regarding mourning and anniversary processes have evolved from the normal and natural psychological processes.
Similar to culturally prescribed response to major loss, most communities stricken by disaster develop formal mechanisms to commemorate the anniversary of the event for one or more years. Depending on the meaning of the event to the community, anniversary remembrances may continue to take place for many years. Survivors of the 1906 San Francisco earthquake still meet at 5:12 AM each April 18 to remember the anniversary.
Disaster Anniversary Reactions
Not all disaster survivors experience anniversary reactions. However, many people do, and are troubled because they did not expect the reactions and do not understand them. it is important for disaster mental health personnel to be familiar with commonly experienced anniversary reactions in order to provide anticipatory guidance and public education about the normalcy of the reactions.
frequently reported anniversary reactions among disaster survivors include the following.
Memories, Dreams, Thoughts, and Feelings
At the anniversary of the 1985 Appalachian floods, an older woman reported that she simply couldn't keep her mind off the flood during the weeks approaching the anniversary. She reported remembering things she hadn't thought about for months. Parents may find their children suddenly talking about the disaster again. Adults and children alike may experience dreams about the disaster or other disturbing dreams.
For many people, the memory and feelings that occur on the anniversary are vivid. On the 10th anniversary of the 1982 flood and mudslide disaster in Marin County, California, fire Battalion Chief Waterbury remembered the search operation he had led. For 25 hours firefighters near hypothermia searched in driving rain for a woman who was missing in the rubble of her mudslide- ravaged home. Looking back, the chief recalled the numbness that gripped his stomach when her body was unearthed. "The same mental pictures keep coming back, even though it's been 10 years ago. It seems like it was almost yesterday to me.... I still have the vision, recall that feeling, the frustration of searching so hard, that feeling of hope, only to have it dashed at the end. There's still a certain amount of pain" (Johnson, 1992).
Grief, Sadness, and Regret
Individuals who lost loved ones frequently find that the anniversary of the death stimulates feelings of grief and pangs of longing. "She loved to ride her bicycle to the store and back with me. It would tickle her to death that she could outrun me," said a Hurricane Hugo survivor at the storm's anniversary. "But her bicycle's put up now. Nobody's been on it since she's gone." His youngest granddaughter had died in a fire sparked when Hugo's winds blew down power lines (Greene, 1990).
In their book on condolence, Zunin and Zunin (1991) include a letter from Princess Alice written to her mother, Queen Victoria, on the anniversary of the death of her father, King Albert.
The grief associated with the loss of a home can also intensify at the time of the anniversary. People living in temporary dwellings may experience a rekindling of sadness over the loss of their home and the lack of a permanent replacement.
Even people who have rebuilt their homes or found new dwellings to rent frequently feel a sense of loss at the anniversary. one fire survivor explained that their new home resembled the one they lost. However, they would still go to certain parts of he house, expecting to find what was there before. At the anniversary of the fire, they particularly thought back on what was gone.
People who have been forced to relocate to another locale may experience intense homesickness. "I miss the island terribly," said a survivor of Hurricane Hugo one year after the storm. He was forced to move off Pawley's Island after the hurricane. "I don't know the tides like I used to, -and I miss seeing the moon every night. And I miss the smell, and the changing seasons that were so evident on the island" (Greene, 1990).
Besides memories and mourning of lost loved ones, homes and communities, people may also grieve for belongings they lost, especially precious keepsakes they wished they could have saved. At the anniversary of the 1990 Santa Barbara, California wildfire one woman lamented that all she took with her as she escaped the wind-whipped blaze were her bills. She deeply regrettedv not picking up some cherished mementoes nearby. Family photographs, bibles, baby books, a deceased son's military awards, a grandfather's birth certificate, the family piano, 27 years of Christmas decorations - these are the things people think about with longing at the time of the anniversary. "A house is just concrete and glass," observed a survivor at the one-year anniversary. "It's the other stuff that has memories...those are the things that you really miss" (Schultz, 1991).
For some survivors, life during the first year after the disaster is simply too busy for them to grieve. One year after the 1989 Loma Prieta earthquake in California, many people expressed relief at the waves of grief that were occasioned by the anniversary. Many people reported having been so busy with the paperwork and practicalities of rebuilding, they had not yet given themselves time to "let down" and mourn their losses. After one year, things were far enough along on a concrete level for them to take time to deal with their feelings. "This is the first time since the earthquake that I've been able to cry," said one San Francisco resident as she wept at the one-year anniversary commemoration. "I've been numb for so long" (Seligman, October 18, 1990).
Fear, Anxiety and Stress
For many individuals, symptoms of fear and anxiety begin to recede a few months after the disaster, only to re-surface around the time of the anniversary. Some report a resurgence of jumpiness, startle responses, and vigilance about safety.
For individuals who were severely traumatized, the fear may not be significantly diminished by the end of the first year, and the anniversary rekindles it even more. One six-year-old boy who narrowly escaped the flames of the 1990 Painted Cave fire in Santa Barbara, California still panicked one year later every time he heard a siren (Schultz, 1991). During Hurricane Hugo, a mother had to tie her family to a high railing to keep them from being swept away by rising floodwater. "I'm still scared," said her eight-year-old, looking back a year later. "I almost drowned in that storm. I just can't help it" (Greene, 1990).
Crisis counseling services in northern California experienced an upsurge of calls in the week preceding and following the one-year anniversary of the Loma Prieta earthquake. Many survivors reported anxiety when traveling on bridges or under freeway overpasses. "People still feel shaky; their nightmares are coming back," reported an Afterquake Project counselor. "They're not sure what they can do. They feel more vulnerable" (Seligman, October 17, 1990).
Frustration and Anger
The anniversary can also re-awaken resentment and anger about the disaster. One flood survivor remarked at the time of the anniversary, "I keep remembering things that weren't fair." Survivors may remember the things that irritated them, the things they lost, the time taken away from their lives, frustrations with the bureaucratic aspects of the recovery process, or impatience at the slowness of rebuilding and healing. Many homes are still not rebuilt at the first anniversary. Owners of nearly one-half the structures destroyed in the 1990 Santa Barbara, California wildfire had not submitted applications for permits to rebuild at the first anniversary (Schultz, 1991). In the aftermath of the East Bay (CA) firestorm of 1991, only 12% of homes destroyed in the city of Berkeley were under reconstruction at the one-year anniversary and none had been completed (Wee, 1992). A Red Cross worker commented on the stress level in Santa Cruz, California a year after the Loma Prieta earthquake: "The whole year has been very strange. People realize a year has gone by and they are not fully recovered, financially and spiritually" (Samuelson, 1990). For some people, this anniversary-time reflection is an impetus for people to seek mental health counseling and support. Disaster mental health programs often report an increase in calls for service at the time of the anniversary.
Survivors may experience anger and resentment at the losses dealt them, and at their real or perceived inability to rebuild their lives or recoup their losses. A 91-year-old woman's apartment was demolished in the 1989 Loma Prieta earthquake. Her husband of 50 years died shortly after that. She reflected at the one-year anniversary: "My husband couldn't stand all this. It was too much for him. The terrible shock, the loss of things, the terrible problem of where to go next, and then to fill these empty rooms, the furniture he had to seek out and try to buy and get here. Of trying to replace everything, the lamps, the toaster, everything...all nerve wracking. He had latent leukemia for three or four years but he was doing very well and then the leukemia became virulent.... We were minding our own business. The earthquake was not on our agenda...we lost everything" (Drewes, 1990). One Santa Barbara fire survivor stated that he had many things on his life agenda that he would have preferred doing that year other than selecting toilets and bathroom fixtures for the house he was rebuilding.
For one Santa Barbara couple, the one-year anniversary of the fire brought up a sense of failure. They had disagreed about whether to rebuild their home after the fire. She wanted to move away from the area, while he insisted on rebuilding. One year later, reconstruction was far behind that of their neighbors, primarily due to ongoing differences between the man and his wife at every stage of the reconstruction. Their relationship had deteriorated, each blaming the other for creating problems. The woman felt isolated, sad, and depressed. The man, who was retired, did little besides work on the new home.
Many survivors welcome the cleansing tears, the commemoration, the reflection, and the fellowship that the anniversary of the disaster can offer. However, some survivors attempt to "ward off" anniversary reactions by avoiding reminders and making efforts to treat the anniversary as just an ordinary day. A young man who lost his father in the collapse of the Oakland, California Cypress Structure freeway after the 1989 earthquake was asked how he planned to spend the day of the anniversary. "I see no sense in celebrating an earthquake," he said (Chiang, 1990). Even if people prefer to treat the anniversary as "just another day," it can be useful to educate them about the common reactions that they or their loved ones might encounter. Then, they will not be taken by surprise or feel they are having a "setback" if reactions occur.
Recovery from disaster takes place on many levels. It involves rebuilding physically, emotionally, and spiritually. For most people, the anniversary is a landmark point in the recovery process. It takes time for humans to integrate an event of such magnitude into their life experience. By the one-year anniversary, enough time has passed for people to have developed some perspective on the event and its place in their hearts, minds, and lives.
Based on recollections of the disaster, survivors often confront the haunting question "What would I do differently if I had to go through it again?" They often do so in hopes their answers might help others who confront such a situation. Unanimously, survivors recommend preparedness planning. They discuss eliminating hazards from the home and neighborhood envirnoment. They emphasize adequate insurance and recommend videotaping every room in the house, including contents of drawers and closets, for insurance purposes. Survivors warn of the importance of having safety equipment and disaster supplies. They underscore the importance of duplicating essential documents and photographs and storing copies off-site. They agree on the importance of keeping photographs and mementoes in one place in the home so they can be easily evacuated. And they unanimously advise having a family plan for evacuation and a designated site to meet each other if separated.
Many people also reflect on ways in which, despite the losses and trauma, their lives have changed for the positive. A disaster causes a reassessment of values and beliefs. Many people can recognize the challenges they have overcome, and acknowledge the courage, stamina, endurance, and resourcefulness within themselves. They often reflect with appreciation on the loved ones and friends who have helped them through. Survivors may feel grateful for deeper and more meaningful relationships. In reaching the anniversary of the disaster, people achieve an important transition: that of seeing themselves no longer as "victims", but truly as "survivors".
"It took away a certain part of my history and a certain part of my life, and you just don't rebuild that in a year," said a survivor of the 1990 Santa Barbara, California fire. But he also gained a new perspective on himself and what is important in life in the wake of the fire, he said. "It really got me to take a look at how I was living my life before. It amplified some things that needed correcting. It really turned my life around.... Without the fire, I wouldn't have half of what I have right now." A film maker and artist by trade, he was inspired to create a video documentary of the fire and its survivors. The video was shown at a local theater on the anniversary of the fire as a benefit for the Red Cross. It has since won two major awards.
Another survivor reflected on his neighborhood before and after the disaster. "We weren't nearly as close before the fire," he said at an anniversary block party on his street that had been destroyed. While many homes were yet to be rebuilt, neighbors gathered and reminisced as they ate cake decorated with rubble and a chimney sending out colorful plumes of smoke. "This has been the best part of the fire. The fences came down and we became friends," he said (Malcolm, 1991).
The reflection occasioned by the anniversary often becomes a landmark point in the recovery process. It allows people to sharpen their perspective on the event and its place in their hearts, minds, and lives. It allows people to look back over the past year, recognizing how far they have come and the challenges that have been surmounted. it is a time for survivors to look inward, to recognize and appreciate the courage, stamina, and resourcefulness of themselves and each other throughout this process of recovery. it is a time for people to look around and appreciate the loved ones and friends who have helped them through the healing. It is also a time when most people can look forward. In reaching the anniversary of the disaster, most people recognize that they have achieved an important transition: that of seeing themselves no longer as "victims", but truly as "survivors".
Cavenar, J.O., Spaulding, J.G. and Hammett, E.B. (1976). Anniversary reactions. Psychosomatics 17(4): 210-212.
Chiang, H. (October 18, 1992). Buck Helm's children settle with state. San Francisco Chronicle, p. A-3.
Drewes, C. (October 17, 1990). Surviving, one year after quake. San Francisco Examiner, p. B-1.
Greene, L. (October 7, 1990). Message from Hugo. The Press of Atlantic City, p.F-1.
Johnson, N. (January 4, 1992). Disaster: The great storm of '82. Marin Independent Journal p.1.
Malcolm, C. (June 27, 1991). Fire-united friends mark anniversary. Santa Barbara News-Press.
Pollock, G.H. (1970). Anniversary reactions, trauma and mourning. Psychoanalytic Quarterly 39(3): 347-371.
Pollock, G.H. (1972). On mourning anniversaries: The relationship of culturally constituted defense systems to intra-psychic adaptive processes. Israel Annals of Psychiatry and Related Disciplines, 10(1): 9-40.
Samuelson, S. (October 18, 1990). santa Cruz. San Francisco Examiner, p. A-10.
Schultz, C. (June 27, 1991). Flames die but pain lives on. Santa Barbara News-Press.
Seligman, K. (October 18, 1990). Survivors celebrate 1st anniversary of Loma Prieta. San francisco Examiner, p. A-10.
Seligman, K. (October 17, 1990). Temblor left many nerves on shaky ground. San Francisco examiner, p. A-8.
Szekely, L. (1978). Anniversaries, unfinished mourning, time and the invention of the calendar: A psychoanalytic 'Apercu'. Scandinavian Psychoanalytic Review, Vol 1: 115-146.
Wee, D. (1992). Personal communication.
Zunin, L.M. and Zunin, H.S. (1991). The art of condolence: What to write, what to say, what to do at a time of loss. New York: Harper-Collins Publishers.
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