The Human Face of Disaster

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The Human Face of Disaster

• Professor Beverley Raphael
• Director, Centre for Mental Health

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Overview (1)

• Pre-disaster
• Prevention planning Readiness mitigation
• Impact Acute and Continuing
• Response recovery The human faces
  individuals populations

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Overview (2)

• Exposures and Impacts
• Trauma Death encounter
• Loss - Loved ones, Resources
• Dislocation Separation
• Strengths / Resilience
• Meaning
• Natural - fate/God
• Man-made / Malevolence neglect

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Psychological TraumaDeath Encounter -
Reactive Processes (1)

• Shock dissociation
• Fear, traumatic anxiety
• Re-experiencing avoidance death images
• Arousal scanning for threat
• reactivity/sleep/startles/cognitive
• Cognitive focus/deaths

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Psychological TraumaDeath Encounter -
Reactive Processes (2)

• Outcomes
• Normal reactions over time
• Inclusive, mastery, learning, memory
• Acute stress disorder lt 1 month
• Post-traumatic stress disorder gt 1month
• anxiety disorders, depression / behavioural
  changes

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Neuro Imaging BOLD signal intensity variations
in subjects with PTSD (Lanius, 2003)
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BOLD FMRI assessing interregional brain activity
in subjects with and without PTSD. Grid indicates
regions of greater covariation in PTSD subjects
(Lanius et al 2004)
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Psychological Impact September 11 Galea et al
2002, De Lisi et al 2003
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Those living near WTC
7.5
Those living south of 110th St, Manhattan
1.7
1
3
6
0 with PTSD
Months
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Mitigation Death Encounter Prevention
Treatment of PTSD related disorders

• High risk eg high reactivity (HR, ASD)
• ? CBT exposure therapies (Individ/ Grp/
  CR/ Pop)
• ? Related models pharmacotherapy
• ? CISD Not indicated / May harm
• Capacity Building of Health Services
• ? To provide appropriate responses for other
  frequent
• traumatic exposures
• ? Personal disasters
• BUILDING RESILIENCE
• ? Social Mitigation

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Exposure Loss,Grief Bereavement (1)

• Reactive processes / Phenomenology
• Shock, numbness
• Anger protest
• Searching yearning
• Arousal scanning for the lost person
• Sadness, mourning
• Cognitive focus, lost person

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Source Darwin., C. (1889). The Expression of
the Emotions in Man and Animals.
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Exposure LossGrief and Bereavement (2)

• Outcomes
• Normal grief over time
• Complicated grief / bereavement
• Depression and other disorders
• Behavioural changes

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BOLD functional MRI with separated partners
neutral thoughts vs. grief state ruminations
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Mitigation of Bereavement Prevention of
depression related Disorders

• High risk bereavements
• ? Positive expectancies for normal grief
• ? Specialised bereavement counselling for high
  risk
• (death, relationship)
• ? Individual, Group Community
• Capacity Building of Health Systems
• Particularly to deal with other losses
• Building Resilience
• Social mitigations

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Mitigation Psychological Trauma Bereavement

• Exposures are different may overlap
• Life Threat Loss of loved ones
• Mental Health Impacts
• Reactive Processes Different phenomena
  physiology
• Disorders
• PTSD Depression Spectrum Social/Behavioural
• Interventions Mix of both may be required
• Trauma Circumstances death
• Loss Review/History of lost relationship
• Social mitigations

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Dislocation and Separation

• Separation of families reunion /
  grief
• Destruction of common ties, homes, networks,
• Social Systems
• Places , Shelter
• Place Country
• Refugees Home , Belonging
• Renewal
• ? Actions for adaptation, and Re-building

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Tsunami Disaster Death Dislocation

• Mass deaths - survival
• Mass grief bodies / DVI / Burials
• Injury
• Uncertainty
• Social structures impacted
• Immediate, event reminders triggers
• Long term impacts

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Social Systems the Human Face of Disaster (1)

• Prevention / Planning (The Lucky Country)
• Social phenomena of reaction
• Honeymoon / convergence
• Altruism and social networks
• Phase of disillusionment
• Disaster responders ? Hidden victims
• Spontaneous social organizations
• Making meaning / blame / human factor
• Shared meanings

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Social Systems the Human Face of Disaster (2)

• Social rituals
• eg. Memorialisation, testimony
• Social cultural issues
• eg. Cultures of meaning, of reaction, of recovery
• Place, name, identity
• Co-ordination through chaotic times
• Aid actions, motivation and outcomes
• Best of human nature
• Altruism and hope and renewal