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Surviving a disaster

2003; Elsevier BV; Volume: 362; Linguagem: Inglês

10.1016/s0140-6736(03)15079-9

1474-547X

James Thompson,

Disaster Response and Management

James Thompson has an interest in psychological trauma and risk perceptions. He is a senior lecturer in Psychology at Royal Free and University College London Medical School, Middlesex Hospital, London W1N 8AA, UK. Imagine that you are falling headlong through space, and as you accelerate towards the deep dark ocean a passing seagull asks you: "What's your coping strategy?" Assuming you had the ability to reply, you might be tempted to give a variety of answers, many of them short. However, a possible response would be: "Currently I have no valid grounds which would allow me to distinguish between a coping strategy and pure abject terror. However, if I have the good fortune to land on a large inflatable liferaft, I am resigned to the fact that journalists will assume that some aspect of my character led to my having survived." You may find the above scenario somewhat unrealistic, in that people rarely formulate considered answers to inane questions, even when asked by seagulls, but it encapsulates a methodological dilemma about the psychological profile of survivors. Survival of extreme conditions involves many factors, some of them seemingly random. Patients of mine have had the misfortune to be seated next to an exploding hand grenade, while others in the hijacked aircraft went unscathed. No aspect of their character was involved. And yet, there is a fascination with the character of the survivor. We are reluctant to believe that their survival was random, and we seek a moral purpose, a redeeming virtue, or an easily applicable psychological trick that we can use in our own more humdrum lives. "I survived by playing imaginary chess/mentally revisiting old restaurants/reciting poetry/planning a new house/self mutilation and self pity…" All but the last option seem to have face validity, in that they provide a distraction from adversity, whereas the last seems dangerous and unproductive. We know little about the characters of dead strangers. However, we can comment on their behaviour. It is rarely a survival advantage to be well behaved. Compliant well-mannered people, awaiting instructions on what to do, often burn passively when a rush to the door could have got them out of the plane. "Negative panic", is the jargon phrase. What journalists describe as panic is usually a sensible flight from danger, a useful survival instinct only worth curbing in the special case of a confined space with a small exit. Even after dreadful nightclub stampedes, one should still consider what the death rate might have been if no one had shown any alarm. Some of those who died in the Summerland entertainment centre fire on the Isle of Man, UK, were patiently waiting to pay for their purchases. Gawping at an entertaining disaster is usually more common and more dangerous than panic, and the real challenge is to make bystanders recognise danger and run away. The Nazi death camps with their frequent "selections" gave prisoners some limited options: don't question the system, conserve energy, eat whatever you can find, look as fit as you can, think in the present and short term, but never of the past, and above all, have optimism and work for your own survival at all times. Some prisoners made themselves useful to influential guards, others feigned a matter-of-factness when reporting personal injuries, stressing the loss of labour that would result from their lack of health, and definitely not making any personal entreaties. In this terrible setting prisoners used the survival skills that all of us, in more benign but difficult situations, try to deploy. For example, in (old style) hijackings the strategy is: don't argue, don't become a target, form whatever relationship you can with the captors, stress your humanity, and your sympathy with the hijacker's cause. A colleague who was interviewing a psychopath asked "What sort of person would you find it difficult to kill?". After much thought at this novel possibility, the interviewee replied: "perhaps someone who has a dog". This colleague now carries a photo of a dog on all his travels. However, in (new style) hijackings: prepare to kill the hijacker with whatever is to hand. In one hotel fire most guests adopted a strategy of closing the door and putting a wet towel up against it. Logical, but mostly fatal for those who did that and nothing more. Those who realised they were suffocating and smashed the glass in the outside windows (usually a poor strategy that fans the flames) obtained oxygen and attracted the attention of firefighters on turntable ladders, and as such had a higher survival rate. A difficult thing, selecting a survival strategy. Is altruism a survival risk? Thinking of one's self alone, it must be, since it prolongs exposure to risk. Noble as it is, the wish to help others does not protect altruists against stress disorders. A sad task in trauma work is comforting famous heroes who have saved lives, and who are rightly celebrated by the public, but who still feel the aftermath of terror. Here are the familiar factors underlying psychological resilience, cast ironically as injunctions: get an education; have a good job in which you exercise control; have a good marriage (especially important for men); avoid having a previous psychiatric disorder; avoid negative life events; be optimistic; be stable rather than neurotic, with a tendency to extraversion; have accumulated personal or material resources; be male; consider the past briefly but not too deeply; don't avoid, escape or deny, but make little of; see the positive side and then move on to the next challenge before too long. At a pinch, just get an education—it seems to confer as much benefit on its own as being rich and educated. How does an education increase the chances of survival? An explanatory framework seems to help. If you are a soldier being shot at, establishing the calibre of the weapon and its probable location seems to be more useful than dwelling on the implicit evil of your attacker. Firefighters search for the seat of the fire, know how close they can stand with their hoses, follow set procedures, and are more upset by a failure to save someone than by the ferocity of the blaze. Doctors dispel the personal effects of the agony of illness to concentrate on the detail of disease. A tragedy for the patient is a process for the doctor. Psychologists have an explanation for everything, not always comprehensible, but a comfort while being assaulted. On the downside, the Just World hypothesis is good for teaching children to behave (do well and you will be rewarded because the world is fundamentally a just place), but it confuses gullible adults, who cannot understand why bad things happen to good people. In fact, everyone only gets their just desserts on average. The evil sometimes go scot-free, the good are sometimes unjustly punished. When events are virtually random, even the notion of punishment is inappropriate, although it may feel justified emotionally. More recently, researchers have looked at people's immediate interpretation of traumatic events and noted that those who elect (or are predisposed) to believe that the event is not really happening, or is happening, but not to them, are likely to have higher psychological distress later. Depersonalisation and derealisation seem to be poor strategies, although they might be safety valves for the more vulnerable, or for all of us under impossible stresses. In short, during the immediate event, move fast and in your own interest. In surviving the delayed effects, take an educated, realistic, resourceful view, and learn when to kiss the issue goodbye. Good luck.