Emotional Impact of Disaster:
Children of school age, on the other hand, have a much broader repertory of responses. Some children at this age will spend an inordinate time retelling the traumatic incident in detail, but with a lack of emotion. Others will become fixated in a state of constant guardedness, as though braced for danger at any moment.
Aware of the irreversiblity of death, they are less prone than the younger child to dwell incessantly on the fantasy that a dead loved one will return. But children of this age will often re-enact the tragedy in fantasy, imagining themselves as having rescued the victim, according to Dr. Pynoos and Dr. Eth.
Teen-agers, they write, tend to resemble adults in reacting to disaster. One common reaction is a premature entrance to adulthood, a false sense of readiness to take on adult responsibilities. Teen-agers are also prone to respond with rebelliousness, such as truancy and sexual adventures, all out of keeping with their personality before the trauma. Dr. Pynoos and Dr. Eth note that teen-agers are much more realistic in their understanding of the event itself than are the younger children, who sometimes blame themselves for the disaster. Teen-agers, on the other hand, while they can accurately assess how little their own acts may have figured into the chain of events, may still inflate their guilt feelings at having survived, as many adults do.
Symptoms Arise in 'Shell Shock'
Such variations in the impact of disaster must be seen against the broader background of the normal progression of psychological responses, which have been recognized for centuries. When the diarist Samuel Pepys described his reactions to the Great Fire of London, which destroyed much of the city in 1666, his account followed what psychologists have come to see as a classic pattern: disbelief followed by a forgetfulness of the disaster, insomnia, disturbing dreams and extreme anxiety.
Similar symptoms are commonly observed among the ''shell shock'' victims of the wars. The pattern, now called the ''post-traumatic stress syndrome,'' includes recurrent dreams of the traumatic event, the numbing of emotions, and guilt about having survived when others have not.
While there is no prescribed sequence for psychological recovery from disaster, experts recognize specific stages that oscillate in ways that can differ from person to person. Some of the most detailed research on the emotional aftermath of disaster is described by Dr. Horowitz in his book ''Stress Response Syndromes,'' published by Jason Aronson.
Normal Recovery Process
The normal immediate response to a severe trauma, Dr. Horowitz says, is an outcry of fear, rage or sadness at the terrible impact on one's life, which is often followed closely by a state of dazed shock. That shock is the beginning of a psychological denial of the tragedy, a denial that seems to serve a positive purpose in allowing the person to come to grips with his shattered world at a rate he can manage. For weeks or even years after the event, denial - blocking the facts from awareness - oscillates with intrusive thoughts of the tragedy, as the person slowly comes to face its full emotional truth.
When that process of adjustment goes awry, though, a variety of more severe problems can arise, according to Dr. Horowitz. For example, the immediate impact of the disaster may be overwhelming, leaving the person emotionally swamped. If the initial reaction of, say, distress and fear is not relieved, the person may sink into a state of total exhaustion or the feelings may escalate into outright panic.
During the longer course of recovery, Dr. Horowitz has found, people may either fall prey to extremes of denial or to being emotionally flooded by thoughts of the event. Extreme denial can take many forms, including a general numbing of emotions, serious loss of the ability to concentrate or to follow a train of thought, or an avoidance of topics even vaguely associated with the event. On the other hand, when memories of the event intrude too much, it can take such forms as an excessive alertness of dangers that do not exist, sudden waves of uncontrollable emotion, bad dreams or constant rumination on the event that cannot be put out of mind.
When the psychological process of coming to grips with the event goes uncompleted, Dr. Horowitz notes, the dangers can be more subtle, sometimes taking the form of psychosomatic complaints like stomach problems, headaches or inability to work or to love. When the recovery process goes awry in these ways, Dr. Horowitz notes, psychotherapy that deals with the original trauma is called for, even years later.
''The sudden emergence of fears or nightmares long after the tragedy has passed usually surprises everyone else, who thought the person had already recovered,'' Dr. Horowitz said. A recent report in The American Journal of Psychiatry tells of a World War II veteran who had no post-war problems until, 40 years later, he became haunted by a repeated nightmare of an incident from the last days of the war. In that encounter, he had shot German soldiers who turned out to be teen-age boys in uniforms with imitation rifles; in the dream they appeared as his own grandson.
Witnesses Affected as Well
Witnesses to a disaster can be as profoundly affected as the victims. One risk to bystanders or unseasoned rescue workers at the scene of a disaster is from encountering a dead and mangled body, according to Dr. Horowitz, who said, ''The sight can leave a person with a profound death fright, feeling that life has no meaning, or severly depressed if they are prone to it.''
To be sure, disasters can bring out the best in people, who put aside fear and self-concern to rally to the needs of the moment. ''Even though people may be dazed,'' Dr. Horowitz said, ''most function enormously well during the emergency itself, especially in direct response to seeing someone in pain or need.''