Descriptions of disasters and their psychological impact as severe trauma on humans appear in ancient literature, such as Homer’s Iliad and Odyssey, and various religious texts. The historian Herodotus, in the sixth century BC, described a soldier who suffered from permanent blindness after he witnessed the death of a fellow soldier. More recently, soldiers who fought in the civil war suffered from a set of physical and emotional symptoms known as “Soldier’s Heart” or Da Costa’s syndrome, a possible predecessor of what we now refer to as post-traumatic stress disorder. While most disaster victims do not develop psychopathology, depending on the intensity and severity of the trauma, many survivors suffer from varying degrees of emotional problems. The common post-disaster psychiatric disorders are post-traumatic stress disorder (PTSD), major depression, and alcohol use disorder.¹ Although disaster-related emotional traumas have been known for years, the clinical evaluation and treatment of these traumas within the disaster situation are relatively recent developments. Modern disaster psychiatry dates back to the 1942 “Cocoanut Grove” nightclub fire in Boston which killed 492 people and left a community in grief. Erich Lindeman,² Stanley Cobb,³ and Alexander Adler⁴ published papers describing the psychiatric complications, symptomatology, and the management of acute grief related to this event.

There are several definitions of disaster. The definition offered by WHO is as follows: a “severe disruption, ecological and psychosocial, which greatly exceeds the coping capacity of the affected community.”⁵ There are different types of disasters based on etiology. Disaster may be caused by natural events, also known as “Acts of God” (e.g. flood, typhoon, tsunami, earthquake), by accidents or technological malfunctions (e.g. aircraft crash or power plant explosion), or by deliberate acts of human with ill-motives (e.g. gun-violence or terrorism). The frequency of disasters is increasing, which can be attributed to changes in climate, geopolitical situations, increasing use of technology, etc. According to EM-DAT, an emergency disaster database maintained by the Office of US Foreign Disaster Assistance (OFDA), natural disasters are steadily increasing in recent decades. This increase is both due to natural (e.g. climate change) and man-made factors (e.g. population movements, unplanned urbanization, deforestation, etc.). While better disaster preparedness and prevention programs have reduced the number of deaths from natural disasters, more people are left injured or displaced by the disasters.⁶ These facts underscore the need for increased involvement of health care professionals in the disaster relief.

Mental health professionals are becoming increasingly active within disaster response. More than 700 psychiatrists responded to the 9/11 attacks (Disaster Psychiatry Outreach, personal communication, 2010). Following the earthquake and tsunami in the Indian Ocean, hurricane Katrina in 2005, and the earthquake in Haiti in 2010, psychiatrists continued to volunteer in disaster relief. In the aftermath of the Newtown shooting disaster, under the leadership of Connecticut Psychiatric Society, more than 50 psychiatrists served, all together providing over 400 hours service. Mental health professionals can play important roles in various areas, as such, their participation in disaster relief should be encouraged. However, they should be aware that disaster psychiatry is not the same as trauma psychiatry, particularly in the immediate aftermath of disaster. The emphasis of disaster psychiatry is normality of responses not psychopathology. The primary focus is helping the population of high-risk groups, rather than individual treatment modalities. Disaster psychiatry aims to promote the overall medical health status of an affected community. It facilitates application and management of post-disaster aid (human services needs, financial, etc.) Disaster psychiatry is not an office-based practice, and disaster survivors with whom the provider interacts are not generally defined as “patients.” Though disasters can lead to decompensation in stable psychiatric patients, many individuals who might benefit from mental health support are in fact experiencing normal reactions to extraordinary circumstances. Often the psychiatric presentations (“symptoms”) in disaster survivors do not reach the threshold of psychiatric diagnostic criteria (“syndrome”). The skills required early on in disaster response, therefore, differ from those used in traditional trauma treatment. In addition, a mental health professional volunteering in a disaster situation may be asked to play other unusual roles, such as performing administrative, consultative, educational, and general medical duties.

Before committing to relief efforts, health professionals should be affiliated with a recognized organization, aware of major issues impacting those affected by disasters and knowledgeable about the appropriate intervention. There should be a clear understanding of the concerted purpose, and of one’s own motivation for responding. Responders themselves should be in good health to operate in a variety of circumstances, and should be careful not to become a burden to the relief effort.

Related posts:

Chapter 5 – Inhaled Anesthetics and Draw-Over Devices in Disaster Response Chapter 4 – Total Intravenous Anesthesia in Disaster Medicine Chapter 15 – Chemical and Radiologic Exposures in Trauma and Disasters Chapter 16 – Pain in Disasters Chapter 12 – High-Altitude Physiology and Anesthesia Chapter 21 – Operation Tomodachi: Anesthetic Implications

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