Psychlgical Impact f the Tsunami in the Slmn Islands The tsunami that tragically struck the Slmn Islands caused extensive lss f life and injury as well as devastatin t prperty and cmmunity resurces. The cmbinatin f life-threatening persnal experiences, lss f lved nes and prperty, massive disruptin f rutines and expectatins f daily life, pervasive pstdisaster adversities, and enrmus ecnmic impact n families and the entire natin pse an extreme psychlgical challenge t the recvery f children and families in the affected area. This brief infrmatin sheet prvides an verview f expected psychlgical and physical respnses amng survivrs. The key cncepts include: Reactins t Danger Psttraumatic Stress Reactins Grief Reactins Traumatic Grief Depressin Physical Symptms Trauma and Lss Reminders Pst-disaster Adversity/Disruptin Appreciating the psychlgical implicatins f such an verwhelming event n the lives f the survivrs plays a crucial rle in cnsidering specific effrts that will be f greatest help t the affected cmmunities. The fllwing issues may be helpful t cnsider in effrts t respnd t disaster victims: Reactins t Danger It is imprtant t recgnize the difference between a sense f danger and reactins t traumatic events. Danger refers t the sense that events r activities have the ptential t cause harm. In the wake f the recent disaster, peple and cmmunities have greater appreciatin fr the enrmus danger f a tsunami and the need fr an effective early warning system. There are likely t be widespread fears f recurrence that are increased by misinfrmatin and rumrs. Danger always increases the need and desire t be clse t thers, making separatin frm family members and friends mre difficult. Psttraumatic Stress Reactins These reactins are cmmn, understandable, and expectable, but are nevertheless serius and can lead t many difficulties in daily life. There are three types f psttraumatic stress reactins. Intrusive Reactins are ways the traumatic experience cmes back t mind. These include: recurrent upsetting thughts r images that ccur while awake r dreaming strng emtinal r physical reactins t reminders f the tsunami feelings and behavir as if smething as terrible as the tsunami is happening again Avidance and Withdrawal Reactins include: aviding talking, thinking, r having feelings abut the tsunami aviding places and peple cnnected t the event feeling emtinally numb, detached r estranged frm thers lsing interest in usually pleasurable activities Psychlgical Impact f the Tsunami Acrss the Indian Rim Natinal Child Traumatic Stress Netwrk www.nctsnet.rg 1
Physical Arusal Reactins are physical changes that make the bdy react as if danger is still present. These include: cnstantly being n the lkut fr danger being startled easily r being jumpy r nervus feeling nging irritability r having utbursts f anger having difficulty falling r staying asleep r having restless, easily disturbed sleep having difficulty cncentrating r paying attentin Children may shw sme f these reactins thrugh their play r drawing. They may have bad dreams that are nt specific t the tsunami. In additin t increased irritability, children may als have physical cmplaints (headaches, stmachaches, vague aches and pains). Smetimes these are difficult t distinguish frm true medical cncerns. Grief Reactins Thse wh survived the tsunami have suffered many types f lsses including lss f lved nes, hme, pssessins, and cmmunity. Lss may lead t: feelings f sadness and anger guilt r regret ver the lss missing r lnging fr the deceased dreams f seeing the persn again These grief reactins are nrmal, vary frm persn t persn, and can last fr many years after the lss. There is n single crrect curse f grieving. Persnal, family, religius and cultural factrs affect the curse f grief. Althugh grief reactins may be painful t experience, especially at first, they are healthy reactins and reflect the nging significance f the lss. Over time, grief reactins tend t include mre pleasant thughts and activities, such as psitive reminiscing r finding psitive ways t memrialize r remember a lved ne. One f the many untward results f a tsunami is that sme family members bdies may nt be fund. This, unfrtunately, prevents the nrmal use f religius and cultural burial and murning rituals, and has put the experience f grief n hld. Whereas trauma is mre restricted t persnal experience f the tsunami, lss and grief extend well beynd the impacted area, indeed acrss the wrld. Traumatic Grief Peple wh have suffered the traumatic lss f a lved ne ften find grieving mre difficult. Their minds stay n the circumstances f the death, including preccupatins with hw the lss culd have been prevented, what the last mments were like, and issues f accuntability. These reactins include: intrusive, disturbing images f the manner f death that interfere with psitive remembering and reminiscing delay in the nset f healthy grief reactins retreat frm clse relatinships with family and friends, and avidance f usual activities because they are reminders f the traumatic lss Traumatic grief changes the curse f murning, putting individuals n a different time curse than is usually expected by ther family members, religius rituals, and cultural nrms that ffer supprt and cmfrt. Depressin Over time, the risk f depressin after the tsunami is an additinal majr cncern. Depressin is assciated with prlnged grief and is strngly related t the accumulatin f pst-tsunami adversities. Symptms include: persistent depressed r irritable md Psychlgical Impact f the Tsunami Acrss the Indian Rim Natinal Child Traumatic Stress Netwrk www.nctsnet.rg 2
lss f appetite sleep disturbance, ften early mrning awakening greatly diminished interest r pleasure in life activities fatigue r lss f energy feelings f wrthlessness r guilt feelings f hpelessness and, smetimes, thughts abut suicide Demralizatin is a cmmn respnse t acutely unfulfilled expectatins abut imprvement in pst-disaster adversities, and resignatin t adverse changes in life circumstances. Physical Symptms Survivrs f the tsunami may experience physical symptms, even in the absence f any underlying physical injury r illness. These symptms include: headaches, dizziness stmachaches, muscle aches rapid heart beating tightness in the chest lss f appetite bwel prblems In particular, near-drwning experiences can lead t panic reactins, especially in respnse t reminders. Panic ften is expressed by cardiac, respiratry, and ther physical symptms. Mre general anxiety reactins are als t be expected. Physical symptms ften accmpany psttraumatic grief and depressive reactins. Mre generally, they may signal elevated levels f life stress. Trauma and Lss Reminders Psttraumatic stress reactins are ften evked by trauma reminders. Many peple will cntinue t encunter places, peple, sights, sunds, smells, and inner feelings that remind them f the tsunami experience. The cean may becme a pwerful reminder. Additinally, the tide simply ging ut r even the wave in a bathtub while bathing a child can act as a disturbing reminder. Because the tsunami was accmpanied by a lud rar and the crashing f waves, lud nises can be strng reminders. Reminders can happen unexpectedly, and it can take quite a while t calm dwn afterward. Adults and children are ften nt aware that they are respnding t a reminder, and the reasn fr their change in md r behavir may g unrecgnized. The day f the week, the time f day, and the anniversary date are cmmn reminders. Televisin and radi news cverage can easily serve as unwelcme reminders. It is particularly difficult when family members have been tgether during a traumatic experience, because afterward they can serve as trauma reminders t each ther, leading t unrecgnized disturbances in family relatinships. Grief reactins are ften evked by lss reminders. Thse wh have lst lved nes cntinue t encunter situatins and circumstances that remind them f the absence f their lved ne. These reminders can bring n feelings f sadness, emptiness in the survivr's life, and missing r lnging fr the lved ne's presence. There are several types f lss reminders: Empty situatins ccur when ne wuld be used t being with a lved ne and they are n lnger there, fr example at the dinner table, during activities usually dne tgether, and n special ccasins, like birthdays and hlidays. Children, adlescents, and adults als are reminded by the everyday changes in their lives, especially hardships that result frm the lss. Examples include temprary r changed caretakers, decreases in family incme, depressin and grief reactins in ther family members, disruptins in family functining, increased family respnsibilities, lst pprtunities (fr example, sprts, educatin, and ther activities), and the lss f a sense f prtectin and security. Pst-disaster Adversities/Disruptin Successfully addressing the multitude f pst-disaster adversities nt nly saves lives, prtects health, and restres cmmunity functin, but cnstitutes an imprtant mental health interventin. Cntending with Psychlgical Impact f the Tsunami Acrss the Indian Rim Natinal Child Traumatic Stress Netwrk www.nctsnet.rg 3
adversities such as lack f shelter, fd, and ther resurces, and the disruptin f daily rutines can significantly deplete cping and emtinal resurces and, in turn, interfere with recvery frm psttraumatic stress, traumatic grief, and depressive reactins. Pst-disaster medical treatment and nging physical rehabilitatin can be anther surce f pst-disaster stress. New r additinal traumatic experiences and lsses after the initial experience are knwn t exacerbate distress and interfere with recvery. Likewise, distress assciated with prir traumatic experiences r lsses can be renewed by the experience f the tsunami. Children s recvery is put in jepardy withut prper caretaking, reunificatin with family members, and restratin f nrmal daily rutines fr example, schling. Sme adversities require large-scale respnses, while thers can be addressed, in part, by persnal and family prblem slving. What Are the Cnsequences f These Reactins? Pst-disaster reactins can be extremely distressing and may significantly interfere with daily activities. Fr adults, psttraumatic stress, grief, and depressive reactins can impair effective decisin-making, s vital in adapting t the recvery envirnment. They als cmprmise parenting. Fr children and adlescents, intrusive images and reactivity t reminders can seriusly interfere with learning and schl perfrmance. Wrries and fears may make it difficult fr yung children t return t schl r t venture any distance frm parents r caregivers. Avidance f reminders can lead adlescents t place restrictins n imprtant activities, relatinships, interests and plans fr the future. Irritability can interfere with getting alng with family members and friends. Trauma-related sleep disturbance is ften verlked, but can be especially persistent and affect daytime functining. Adlescents and adults may respnd t a sense f emtinal numbness r estrangement by using alchl r drugs. They may engage in reckless behavir. Adlescents may becme incnsistent in their behavir, as they respnd t reminders with withdrawal and avidance r verly aggressive behavir. Over time, there may be increases in marital discrd and dmestic vilence. Depressive reactins can becme quite serius, leading t a majr decline in schl r ccupatinal perfrmance and learning, scial islatin, lss f interest in nrmal activities, self-medicatin with alchl r drugs, acting-ut behavir t try t mask the depressin, and, mst seriusly, attempts at suicide. Traumatic grief can lead t the inability t murn, reminisce, and remember; t fear a similar fate r the sudden lss f ther lved nes; and t difficulties in establishing r maintaining new relatinships. Adlescents may respnd t traumatic lsses by trying t becme t self-sufficient and independent frm parents and ther adults, r by becming mre dependent and taking less initiative. Cping after Disaster In additin t meeting their basic needs fr fd, water, shelter, clthing, and medicine, there are several ways t enhance peple s cping. Physical: Stress can be reduced with prper nutritin, exercise, and sleep. Peple may need t be reminded that they shuld take care f themselves physically in rder t be f help t their families and cmmunities. Emtinal: Peple need t be reminded that their emtinal reactins are nrmal and expected, and will decrease ver time. Hwever, if their reactins are t extreme r d nt diminish, there are prfessinals wh can be f help. Scial: Cmmunicatin with, and supprt frm, family members, friends, religius institutins and the cmmunity are very helpful in cping after a disaster. Peple shuld be encuraged t cmmunicate with thers, and t seek and use this supprt where available. Daily Rutines: Fr children especially, it is imprtant t restre nrmal rutines, including mealtimes and bedtime, as much as pssible. Children feel mre safe and secure with structure and rutine. Meeting basic survival needs, restring a sense f safety and security, and prviding pprtunities fr nrmal develpment within the scial, family, and cmmunity cntext are imprtant steps t the recvery f children and adlescents. This prject was funded by the Substance Abuse and Mental Health Services Administratin (SAMHSA), US Department f Health and Human Services (HHS). The views, plicies, and pinins expressed are thse f the authrs and d nt Psychlgical Impact f the Tsunami Acrss the Indian Rim Natinal Child Traumatic Stress Netwrk www.nctsnet.rg 4
necessarily reflect thse f SAMHSA r HHS. Psychlgical Impact f the Tsunami Acrss the Indian Rim Natinal Child Traumatic Stress Netwrk www.nctsnet.rg 5