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ship between symptoms or personality characteristics
and hypoglycemia.
What may be in question here is not so much whethe^Jiypoglycemia is specifically related to certain psy­
chiatric syndromes but what type of patient is more
likely to be referred for study of hypoglycemia. Both
hysterical and obsessive patients are often concerned
wuh somatic complaints. In the search for the etiology
of their symptoms many laboratory procedures, includ­
ing a GTT. may be performed. In an effort to establish
a diagnosis, all of the patient’s complaints may be mis­
takenly attributed to hypoglycemia, although, in es­
sence. what brought the patient to the physician were
symptoms of depression or anxiety. The finding of a
reactive hypoglycemic glucose tolerance curve may be
more of an incidental finding than the basis for etiology
of the patient’s symptoms (17).
This formulation does not negate the concept of hy­
poglycemia as a real entity that can express itself in
multiple ways and cause genuine somatic discomfort.
Rather, we would emphasize that the numerous non­
specific somatic complaints of hysterical and obses­
sive patients may be overdiagnosed as hypoglycemia.
while more psychologically normal individuals may tol­
erate the symptoms of hypoglycemia with less anxiety
and therefore be less likely to seek medical attention.
This hypothesis is consistent with reports that it is
not uncommon for a nonsymptomatic volunteer sub­
ject to have a GTT with some markedly low val­
ues (IS. 19). In the report of Park and associates (19).
23% of an apparently normal population had blood sug­
ar levels below 50 mg/100 ml during a standard fivehour GTT. Another article (20) also stressed the epi­
demic nature of “nonhypoglycemia” and the number
of people who now regard themselves as hypoglyce­
mic without demonstrable GTT abnormality. Some of
the patients in our sample of 30 appeared to fall into
this category.
Another consideration is whether the anxiety and de­
pression experienced by a patient with a psychiatric
disorder affects glucose tolerance. However, our data
demonstrate no relationship between depression and
anxiety (as measured by the MMPI) and degree of hy­
poglycemia. Herzberg and associates (21) were also
unable to demonstrate a relationship between depres­
sion and glucose tolerance.
Fabrykant (22) noted that the hyperglycemic effect
of low-carbohydrate diets is limited to the first hours of
the GTT and that the magnitude of the hypoglycemic
response after carbohydrate restriction may exceed
the response in controlled tests after standard highcarbohydrate diets. Therefore, people who believe
themselves to be hypoglycemic may treat themselves
with low-carbohydrate diets and then have their self­
diagnosis “confirmed” by a five-hour GTT. Fabrykant
recommended that one not be too quick to ascribe
symptoms to hypoglycemia because of the danger of
overlooking a more serious illness. The findings of our
study suggest that one serious illness that can be easily
overlooked is depression.
294

This pilot study, which used volunteer subjects
believed themselves to have reactive hypOg].£$i
uncovered significant psychopathology but no ; v’
subject relationship between the severity of pSVc^
nc symptoms and the degree of hypog|yCen/aCh^cause of the popular interest in hypoglycemia and
potential of misdiagnosis of psychiatric illness,
research is indicated. Use of large numbers’ of
domlv selected subjects not already identified <
patients would be desirable but methodologically^1
cult because of such factors as the need for infOrnX
consent.

SECTION: Disaster at Buffalo Creek
fcSClAB—------------------------- ------------------------

^niilyand Character Change at Buffalo Creek
yjAMESL-TITCHENER. M.D., AND FREDERIC T. KAPP, M.D.

REFERENCES

1

Abrahamson EM. Pezct AW. Body, .Mind and Su«r >•
York. Holt. Rinehart & Winston. 1951
* 'iB
2. Fredericks C: Low Blood Sugar and You. New York
stellation International. 1969
* ',0?'
3. Steincrohn PJ Low Blood Sugar. Chicago. Henry RegneryQ

Rennie TAC. Howard JE- Hypoglycemia and tension-derr?
; vchiatric evaluation teams used observations of
sion. Psychosom Med 4:273-282. 1942
■ ■rilv interaction and psychoanalytically oriented
5. Portis SA, Alexander F: A psychosomatic study of hypoeh'.rfidual interviews to study the psychological
mic fatigue. Psychosom Med 6.191-206, 1944
/^effects ofthe 1972 Buffalo Creek disaster, a tidal
6 Portis SA: Life situations, emotions and hyperinsulinism, Va? ofsludge and black water released by the
Life Stress and Bodily Disease. Association for Research iNervous and Mental Diseases Research Publication, vol29.fi­
> fupse ofa slag waste dam. Traumatic neurotic
lled by Wolff HG. Hare CG Baltimore, Williams & Wilkins Cc
rfrtlions were found in 80% of the survivors.
1950. pp 390-405
l&trlying the clinical picture were unresolved grief,
7. Conn JW Seltzer HS: Spontaneous hypoglycemia. AmJJ.fr.1
rfiivor shame, andfeelings of impotent rage and
19.460-478. 1955
8. Skillein PG. Rynear son EH: Medical aspects of hypoglycemia) ■yptlessness. These clinical findings had persistedfor
»■
Clin Endocrinol Melab 13:587-603. 1953
two years since the flood, and a definite symptom
9. Edwards WLS. Lummus WF: Functional hypoglycemia and th
implex labeled the "Buffalo Creek syndrome" was
hyperventilation syndrome: a clinical study. Ann Intern
rdvasive. The methods used by (he survivors to cope
42:1031-1040, 1955
ylh the overwhelming impact of the disaster—first10. Conn JW; The diagnosis and management of spontaneous f-p
poglycemia. JAMA 134; 130-138. 1947
5 ■dtrdefenses, undoing, psychological conservatism,
Anthony D. Dippe S. Hofeldt FD, et al. Personality disorftf
i'ddehumanization—actually preserved their
and reactive hypoglycemia. Diabetes 22:664-675, 1973
fvptoms
and caused disabling character changes.
Marks V. Rose FC: Hypoglycaemia. Oxford, Blackwell Sexes
tific Publications. 1965. pp 136-165
13. Remein QR. Wilkerson HLC: The efficiency of screening lec­
tor diabetes. J Chronic Dis 13:6-21. 1961
14 Dahlstrom WG. Welsh GS: An MMPI Handbook. St Paul. Ue- | ;$c February 26, 1972, an enormous slag dam gave
versily of Minnesota Press. I960
u }• *4’'and unleashed thousands of tons of water and
15. Ensink JH, Williams RH: Disorders causing hypoglycemia.u
mud on the Buffalo Creek valley in southern
Textbook of Endocrinology. Edited by Williams RH.
<
, ‘Virginia. This Appalachian tidal wave destroyed
delphia. WB Saunders Co, 1974. pp 627-659
16. Landmann HR, Sutherland RL: Incidence and significance^ |
*n *ts Palh. killing 125 people and leaving
hypoglycemia in unselected admissions to a [psychoso '
homeless and carrying away human bodies.
service. Am J Dig Dis 17:105-108. 1950
jiinisu^ > r^Mrailers, cars, and other debris. It expended its
Fabrykant M: The problem of functional hyperinsulinism
.....^
5:1.1^* Z
no niore than 15 minutes at anv one point in
functional hypoglycemia attributed
to
nervous
caus
Uleu io
|955 | 18-mile-Iong valley
u. > . r.,
fa <uicy.
calory and clinical correlations.. Metabolism
.......______ 4.toy—*'7’
°e*°w the dam and the tipple of the Buffalo Min18. Jung Y. Khurana RC, Corredor DG. ct al: Reactive h>pv" K
cemia in women. Diabetes 20:428—134. 1971
,7'* . blinks’ ?•’*Mr1mpany sl0°d the town of Saunders; there was
19. Park BN, Kahn CB, Gleason RE: IInsuiin-glu<^®UcbioJ>tf3-_/;. f-.c
this town minutes after the black water
nondiabetic reactive hypoglycemia and asy . rhemical*^
. fl[fl L
hl
P.
u
gh
the dam. The sides of the valley are
cal hypoglycemia in normals, prediabetics and cheniic
.his point, and the wall of water and mud caics {abstract). Diabetes 21:373. 1972
. cC£ f
20. Yager J. Young RT: Nonhypoglyccmia is an epidetnlC
,rn side to side, miraculously sparing some
lion. N Engl J Med 291:907-908, 1974
. ,cpftr /
Herzberg B. Coppen A. Marks V: Glucose tolerance m
. &
!?8lh annual meetiny of the American F<svchiatric
sion. BrJ Psychiatry 114:627-630. 1968
.
4" • v^tion1
’ Anahe,m‘ Calif., May C9. 1975.
Fabrykant M: The problem of functional hypennSU
.v
functional hypoglycemia attributed to nervous causesof
^apP 3re Professors, Department of Psychiatry.
ary’ and neurogenic factors, diagnostic and lherapeU.
_ • Tj.
45229 C,nnaI* Medical Center. 234 Goodman St.. Cincinlions. Metabolism 4:480—190, 1955
. ‘

4.

homes but destroying many others as it slammed down
the valley.
The wall of water sped through 14 mining hamlets
with names like Crites. Becco. Lundale. and Pardee.
hitting their schools, churches, taverns, stores, and
homes, leaving no trace of some and damaging nearly
all. The sides of the valley become less steep and it
spreads out. so the black sludge and water became
more of a “flash flood” at Amherstdale and just an
overflow at Man. where it reached the Guyandotte Riv­
er.
None of the settlements in Buffalo Creek, which had
a total population of 4,000-5.000 inhabitants, were in­
corporated. There was no governmental organization
beyond the commercial structures provided by post of­
fices. schools, and churches. There are five deep
mines in operation and evidence of stripmining is ev­
erywhere. In spite of the stripping, the ugly tipples, the
dozen or so huge black heaps of waste, the railroad
and highway construction, it is still a beautiful valley.
and young adults there will tell you it was once much
more beautiful, with pleasant homes and gardens
where there are now primarily mobile homes. It was
and is a middle-class area. Nearly all families are sup­
ported by employment in the coal mines or in the sup­
porting industries and services. There is an accepted
(but not documented) belief that this valley had not
had the degree of emigration of young people that
typified others like it since the Depression.
There had been rumors for years that the dam would
give way. but hundreds of people reported they did not
believe it had really happened until a few moments af­
ter the fearsome sight and sound of the advancing water. All the survivors know' that the time of the dam
break (8:00 a.m. on a Saturday morning) was fortu­
nate. Few’ people were down in the road, and the chil­
dren were not in or waiting for the school buses. Nev­
ertheless, 125 were killed, and most lost their homes
and possessions.
Subsequently, a group of 654 survivors of this disas­
ter from 160 families began a legal action against the

Am J Psychiatry 133:3. March 1976
Am J Psychiatry 133:3. March 1976

295

family and character change

company that owned the dam. This group contacted
the law firm of Arnold & Porter in Washington, D.C.,
and a legal team headed by Mr. Gerald Stem traveled
to the area to interview survivors. His observations of
the psychological effects of the disaster and a summary
of the litigation are presented in “From Chaos to Re­
sponsibility" in (his section. The law firm first con­
tacted Robert J. Lifton. M.D., who assessed “The Hu­
man Meaning of Total Disaster" (1), and Kai Erikson,
Ph.D., whose observations of the situation in the com­
munity are presented in “Loss of Commonality at Buf­
falo Creek.” The suit was settled in July 1974 for SI3.5
million of which S6 million was for psychological
damages.
The legal team then retained one of us (J.L.T.) to or­
ganize a group of experts to interview the survivors
and assess for the court the psychological impairment
they had suffered as a result of the Rood. This paper
presents our findings on the severity and duration of
these psychological effects, a symptom complex we
have labeled the “Buffalo Creek syndrome." The size
and composition of the evaluation teams varied with
the nature of the families assigned to them. A full-sized
team consisted of a general psychiatrist, a child psychi­
atrist, and two psychologists or case workers. These
teams did their work in the valley itself, visiting the re­
spondents’ mobile homes and those houses that were
still standing.
We conducted a pilot study consisting of interviews
of 50 survivors in June of 1973. The court then directed
that all of the survivor-plaintiffs be interviewed, as all
were bringing suit separately. These evaluations were
carried out on several long weekends in the spring of
1974.
We began each evaluation with a family interview in
which we asked the survivors to talk about their expe­
riences on the “day of the black water" and during the
weeks and months that followed. As they talked, we
were able to see beyond the immediate clinical phe­
nomena to these people’s underlying feelings and their
ways of coping with them. The family sessions were
followed by psychoanalytically oriented individual in­
terviews with each family member, conducted in back­
yards, living rooms, or on porches.

evaluation findings

Disabling psychiatric symptoms such as anxiety, de­
pression. changes in character and lifestyle, and malad­
justments and developmental problems in children
were evident more than 2 years after the disaster in
over 90% of the individuals we interviewed. We asked
ourselves whether we were examining people who
were presenting major symptomatology and character
problems that resulted from basically weak ego struc­
tures and who were using the disaster in order to win a
large settlement from the mining company. Our an­
swer was and is “no." In our evaluations, we wit­
nessed difficult and prolonged struggles with powerful
296

Am J Psychiatry 133:3. March 1976

JAMES L. TITCHENER AND FREDERIC T. KAPP

feelings and ideas aroused by the traumatic exD •
me described transient hallucinations and deof the disaster and the very uneven attempts of
^iniost all reported anxiety, grief, and devivors to reorganize themselves and redevefo
•
-ith severe sleep disturbances and nightmares.
tered coping and adaptive mechanisms. The afb S^’’
..Jr.
anxiety was manifested in obsessions and
sociated with the catastrophe and its aftermath
about water, wind, rain, and any other remindas the psychological and social ways these’
• '-^the disaster could recur. Occasionally these obchose to deal with them, must be seen against theh?’’
disturbances coalesced and became a group
ground of the universal crises of human devel0D
',S5!VC enon. For instance, the wife of a community
The attendant threats of separation, abandon "
;• ;'r,°nnever slept when he was asleep so that one of
castration, and death—residuals of the developn?0*'
- ^^oll|d always be on the alert. On rainy nights,
crises of separation and individuation—provided f
received phone calls regarding rumors that ancontext for the meaning of the catastrophe to the •
.^dam was about to give way. He would then take
vors (2. 3).
;^n-fle and spend the night sitting on the supposedly
We found a definite clinical syndrome in the $un:
,i<ened dam, guarded by others to protect him from
vors of the Buffalo Creek disaster that arose from bo1'i§cfc
the immediate impact of the catastrophe on each in#
Grief over the loss of relatives, friends, possessions,
vidual and the subsequent disruption of the comnp
j mementos such as family Bibles, as well as the
mty and that affected everyone living there. We area.1!
•i,s of the feeling of communality discussed by Dr.
predisposed by previous experiences to be traunr'
rrikson, was widespread. For many, unresolved grief
tized by pathogenic forces as destructive and awesome
•.ifned into depressive symptoms, ideation, and behavas the Buffalo Creek catastrophe. Variations in theclii>
.u, and some developed a depressive lifestyle (5). In
ical picture resulted from individual differences b
ime individuals, depression was channeled into a
modes of processing and reorganizing the traumaticawide range of somatic complaints, with probable in­
perience (4).
creases in the incidence of duodenal ulcer and hyperA clear pattern emerged from our evaluations ard
Brision.
analyses. A traumatic neurotic syndrome was dlaj*
■ Many of these people have become listless, apathet­
nosed in more than 80% of the survivor-plaintiffs, ar4
ic; and less social since the disaster. They cling to lheir
changes in character structure were equally wide­
families, lack ambition, and are disinterested in former
spread. These changes, although they were attempts at
lobbies and sports. These changes have led to an overreadjustment, occasionally resulted in maladjustmcri
all limitation of essential expression, a lack of zest for
in the social sense and always went in the direction0?
work and recreation, and despair about ever again re­
psychologically disabling limitations.
suming the lifestyle they once had.
Character changes represent the stabilizing neuro­
sis. the psychologically hardening and fixating con­
sequences of the catastrophe. We found consciousar.d
THOUGHTS, FANTASIES, AND FEELINGS AROUSED
latent meanings and understandings and misundtf’
bythe disaster
standings of the disaster and its aftermath, all of which
were associated with the feelings and conflicts arouse*
The survivors referred to the disaster as “the end of
by the trauma. The result of this was changes in object
“
lime
” or “the end of everything," and noted that “No
relations and attitudes toward the self. We delineate
’One who was not there could ever really know what
various processes of reorganization—attempts at pL
■foppened.” They were haunted by visual memories
ting personality functions back together—that were • 1
Cmotions associated with the drownings of rela­
rected toward reintegration and resumption ofanoc
ys and friends and of blackened bodies and parts of
traumatized life.
'’ .
Bodies that were uncovered for weeks after the flood.
We shall indicate below how this personality reor*f
- All of the survivors had to confront the loss of a
mzation, which was so aimed at prevention
/ense of personal invulnerability. The former feeling of
ring experience of the traumatic state, actually/n
’Onifort and assurance about the continuity of life had
fered with flexible and effective recovery and taU.s^,
partly on magical beliefs that horrible things
served symptom patterns and forced changes in
,,^mis disaster do not happen to one; (hat they could
way of life.
■
;
’ ’ occur in nice sane communities in this country.
■
-e 'mP°ssible happened. The shock was over• •'■'Vin^f08 and a new oul,ook look form that reflected a
SYMPTOMS AND CHARACTER CHANGES
8 r°m the former sense of invulnerability to pessiconim
ernptmess* and hopelessness. We heard such
During the first days and on into the
"Nothing counts anymore"; “What’s
months after the disaster, the survivors reP?jaC'^X- . t-jgij ents
jo bpC now?”; an<J "Since we lost everything, what’s
organization and sluggishness in thinking an
■Wan'8aineci
trying?” The disaster took on the
making. They complained of having
. 'tofeer80^Chaos’ helplessness, and death, giving rise
trolling their emotions. These problems ran^,e|2#‘
•/. Thr*a£s
Personal insignificance.
emotional outbursts to the simple inability t0
e other reactions contributed to depressive

symptoms and lifestyles. The first was a feeling of im­
potent rage over the destruction to life, property, and a
way of life. This rage is an explosion of feeling against
the attack on the self. The victim has little outlet for
his anger or hope of satisfaction. This feeling had spe­
cial intensity because the destruction in Buffalo Creek
was man-made; it was caused by the inexplicable in­
humanity of a powerful corporation that gave terrible
evidence of not caring about its employees or their
community. The survivors’ guilt was expressed in a
wide variety of derivative feelings about the self, in
symptoms, in character change, and in behavior
through self-denial and lack of hope. These conflicts
were not resolved, and their persistence took form in
identification with the dead in dreams, actions, and at­
titude toward life (6).
No one behaves exactly as he thinks he should in a
hazardous situation, particularly in a situation he is
powerless to influence. Memory becomes clouded and
feelings of helplessness influence the way one looks
back on the traumatic event. Many people in Buffalo
Creek manifested “survivor shame.” One of the ac­
tual heroes of Buffalo Creek, who had been extraordi­
narily effective in mobilizing and leading rescue ef­
forts, was able to fend off depression and anxiety in the
first four weeks after the flood while he worked relent­
lessly to help others. When he attempted to return to
his former work, he was overwhelmed by anxiety and
depression connected with feelings of inadequacy. He
developed a phobia connected with his job, began
drinking heavily, and became clinically depressed.
We noted in many people a sense of isolation and
feelings of alienation combined with an increased need
for vigilance and a tightening of the ring around {he
family. Former feelings of self-assurance, sociability,
(rust in neighbors, and enjoyment of community activi­
ties disappeared. The isolation we observed clinically
can be explained by the depressive reactions, the
chronic anger, the loss of a way of life, and the dis­
solution of self-confidence and basic trust.
It has been hypothesized that the emotional distur­
bances aroused in the victims of disaster quickly dis­
appear after the stress has subsided. Our work at Buf­
falo Creek suggests that this is rarely the case; the man­
ifestations of a traumatic neurosis do not subside with
the receding flood waters. The effects may seem to dis­
appear quickly if one is not alert to the subtle coveringup behavior of the victims of a psychic trauma.
Lifton and Olson (1) explain the persistence of trau­
matic effects on the basis of an analysis of the nature of
the disaster itself and the special psychological effects
of such an experience. Our study complements their
work by showing how the effects of a traumatic event
are preserved by the modes of adaptation to over­
whelming fears and hopelessness. The very attempts
to protect self, family, and community from a recur­
rence of helplessness and loss are responsible for the
individual and societal neurosis and restrictive charac­
ter change. Our combined approach has been to show
what occurred, the nature of its impact on the psyche,
Azm J Psychiatry

March 1976

297

and why its effects became chronic.
One can analyze the sequential formation of the
“Buffalo Creek syndrome" as follows. The disaster ac­
tivated intense affects, including fear, rage, and help­
lessness. These waves of external and internal over­
stimulation overran the stimulus barrier and the ego's
capacity to integrate the traumatic experience and con­
trol and discharge the affects. There was temporary
ego collapse and the ego was damaged We estimate
that reorganization of the ego in whole or in part re­
quired 6 to 24 months. The course of the reorganiza­
tion and the way individuals processed these affects.
memories, and the associated conflicts made the ulti­
mate difference in outcome. The survivors’ course of
ego reorganization and their manner of processing the
disaster experience were reflected in their symptoms
and character change (2, 4, 7. 8). The variables in the
reconstitution of the personalities of the survivors we
studied can be divided into four categories.

. T and discouraging novel experience (11). Psyalso appeared in strange, symbolic reenactni
- -T^cal conservatism accepts survival as the only
trauma, sometimes leading to violence t0
g
existence.
,s a tra^e‘°^: the individual acothers. Freudian repetition compulsion wa
prevent helpplaced by the mechanism of undoing, Whi h°^ ‘- v r* hopelessness 10 lhe Presenl
as in the future’ as ifto say» “Better to live withfense against facing the anxiety associated *•' -* •
trauma.
t.
• ■;epe (han not to live at all.” Psychological conThe dreams of the survivors during the per
otisni functions as if the disaster will recur
tial shock and (in many cases) for months th ‘
• ’“'yroWtthus lola,ly distorting an individual’s view
were fantasied attempts to relive the disaster
-• future. If you live as though the dreaded uncera less painful outcome. At first, such dreams'
'
is certain to occur, you become a psychic consuccessful and people awoke from them in te re: :'
,.,-vative'
time passed, the drcams were modified. Althou^v '
/..uiiiinization
affects remained frightening, the subject matter sb'-!
n.hunianizaiion affects one’s view of life and hufrom the flood to previous, often long-past, ima/^'
relationships and has a direct toxic effect on perchaos and threats of annihilation. The drcams nof’'
I'jity function. Every disaster places man at the
er involved direct reliving of the disaster but nJ?
. -(%-y of forces beyond his control. The feeling of
depicted stressful episodes that represented re/ng a pawn of fate is dehumanizing—people feel
lions of normal developmental crises such as scr-'
tion. abandonment, castration, and guilt (|, 8)
-'iliout appeal, beyond empathy, and cannot be perJed or assuaged. When lhe catastrophe is man­
The regressive process in these traumatic neurov
tle, dehumanization is magnified. In Buffalo Creek,
differs from that in other psychoneuroses. Thego.-C
PERSONALITY RECONSTRUCTION
not gratification or mastery of infantile conflicts, b • -re was the terrible realization that other human
•?ings had planned, built, and maintained an unsound
raiher an attempt to work through recent trauimv
First-Order Defenses
.’jnand then acted irresponsibly and uncaringly after
anxiety. The anxieties of infantile and childhoy'
There was a continuous and steady deployment of a
resulting disaster. The defense of dehumanization
phases of personality development become the foe.
coordinated system of character-shaping firsi-order de­
an example of identification with the aggressor. It deof undoing because these problems had been success
fenses (9). i.e.. projection, externalization. and denial.
fully contained or overcome: dreams of long-pay!
•royed pride and joy in being human.
Projection defended against feelings of guilt and shame
Dehumanization may be mitigated by corrective exstresses that had been mastered provided reassuranc?
aroused by the disaster. The constructors of the dam.
to the survivors that they could overcome the reccf. ; ivriences with empathic people in lhe helping professtale and federal agency representatives, and intru­
trauma. Just as “examination dreams” attempt todc;. j • unsand private and public institutions. Collaboration
sions from the society outside of the valley became ob­
-ithother sufferers in a law suit against the dehumamzwith anticipatory anxiety by fantasying a past strep.
jects of increasing anger and fear. Externalization
that had been overcome, dreams that are charade/'
. g aggressor may also be useful in (hat it can ensure
blocked awareness of this anger and fear as well as
'.xitit will be more difficult for such organizations to
istic of traumatic neuroses attempt to neutralize the
feelings of helplessness. Individuals became sensitive
overwhelming anxiety of the traumatic event by reckl­
risk human life in lhe future.
to and acutely observant of the anxiety and unrest in
ing successful past adaptations
’ .
‘
-------to difficult _
situation}
their families, coworkers, and the social group. Denial
Each of these phases of dealing with normal stress.
defended against recognition that the self had been
reproduced in the survivors’ dreams, is common P 1 CONCLUSIONS
changed in any way: it disavowed the feeling of help­
all persons as part of human epigenesis. Each pa#
lessness and the awareness of psychological scar­
It is our belief that the reactions we have described
crisis included not only a deprivation of instinctual de­
ring (10). Denial enabled people to believe that while
mand but also a threat to the continuity of life. The lat­ - ire not those of individuals with weak egos who were
much had happened to them and to those around them.
ter aspect is what makes them particularly suitable k' . suggesting their complaints in order to win a law
they had not been affected in an essential way. and
-'Jit. These people, by and large, did not exaggerate
undoing the threat of annihilation experiencedins
that they were the same people they had been before
f’-ir complaints: the majority minimized or denied
trauma like the Buffalo Creek disaster.
the flood. This defensive complex protected against
Because undoing relies on omnipotence and magfc J Jaem. If their reactions were merely exacerbations o
emotions that would have otherwise reactivated mem­
it prevents recognition of the influence of gu"l)‘ £ cM neurotic symptoms and problems, we would have
ories and feelings of fright and helplessness. It was ori­
^countered a wider range of psychoneurotic reacshameful attitudes toward the self. The undoing
ented to the present and functioned continuously, pre­
vons. Although there were differences in modes of reess—aimed at fending off fearful anticipation of a recu
venting the gradual recollection and discharge of the
* '?onse, the uniformity of the psychological reactions
rence of the traumatic experience—is a continuing
feeling of helplessness and blocking recognition of the
?. ^uprising the Bufi’alo Creek syndrome was striking.
stacle to the relatively nonanxious acceptance o
irrationality of shame and guilt. Although one can nev­
man vulnerability that is necessary for readaptat’0 • I ••Par analyses of dreams and early memories, reported
er be the same after an experience with disaster, this
|
where (12, 13), support the consistency and severThe Psychological Emphasis on Survival
defensive system provides a desperate son of status
t Sethis syndrome.
quo that substitutes for personal regrowth.
>
We found a definable clinical entity characterized by
Psychological conservatism consisted of
of situations that might raise the level of excitaB ° & I . * well-delineated group of clinical symptoms and
Efforts to "Undo” the Disaster Experience
*•
in character and lifestyle (hat were related to
ther internally or externally. Il is the defensive an
Undoing consisted of efforts to change the past by
psychological counterpart of the psychic n.urnbI
reliving the disaster in dreams and other ways, giving
scribed by Lifton and Olson (1). We perceive
it a different outcome. Survivors’ memories of the
conservation as mental activity designed to con
early postdisasier period contained fantasies of magi­
havior by banking energies, surrendering anibi i
cal reliving of childhood stresses. Attempts at undoing
ducing enthusiasm, dampening socializing aI
298

Am J Psychiatry 133:3. March 1976

clear-cut psychopathogenic factors precipitated by the
disaster. All of us have in our unconscious memory
systems encounters with the various forms of dread
that a disaster reawakens. There need not be any pre­
existing neurosis for the Buffalo Creek syndrome to be­
come disabling and chronic. All of us are susceptible
to traumatic neurosis and the “death imprint."
To be successful in treating these traumatic neuro­
ses. we must substitute active recall and working
through of the painful memories of helplessness and
separation for counterphobic behavior, passive repro­
duction of lhe experience in dreams, and magical ways
of living out and reenacting the trauma. The change
from passive to active experience, from reproduction
to re-creation is the essential thing. By linking longpast and previously worked-through childhood anx­
ieties with the overwhelming anxieties aroused by the
recent disaster, we may be able to strengthen the ego
of the individual with a traumatic neurosis. Through
his relationship with helping and capable persons and
institutions, lhe disaster survivor is given an opportu­
nity for regrowth, much like the ego development that
came about as the individual met and dealt with the
normal crises of growing up.

REFERENCES

Lifton RJ, Olson E: The human meaning of (ulal disaster. Psy­
chiatry (in press)
2. Furst SS (ed): Psychic Trauma. New York. Basic Books. 1967
3. Freud S: Inhibitions, symptoms and anxiety (1926). in The Com­
plete Psychological Works, siandard ed. vol 20. Translated and
edited by Strachy J. London. Hogarth Press. 1959. pp 77-175
4. Titchcner JL. Ross WD: Acute or chronic stress as determi­
nants of behavior, character and neurosis, in American Hand­
book of Psychiatry. 2nd ed. vol 3. Edited by Arieti S. Brady EB:
Areti S. editor-in-chief. New York. Basic Books. 1974. pp 39-60
5. Engel GL: Anxiety and depressive-withdrawal. Ini J Psychoanal 43:89-97, 1962
6. Lifton RJ: Death in Life: Survivors of Hiroshima. New York.
Random House. 1967
7 Horowitz M: Stress response syndromes. Arch Gen Psychiatry
31:768-781. 1974
S. Ranged L: A further attempt to resolve the “problem of anx­
iety.” J Am Psychoanal Assoc 16:371—404. 1968
9. Kemberg O: The treatment of patients with borderline person­
ality organization. IntJ Psychoanal 49.600-610. 1968
10. Trunnell E. Holl W: The concept of denial or disavowal. J Am
Psychoanal Assoc 22:767-784. 1974
II. Luchterhand EG: Sociological approaches to massive stress in
natural and man-made disaster. Int Psychiatry Clin 8:29-53.
I.

12.

13.

1971
Titchener JL, Kapp FT. Winget C: The Buffalo Creek syn­
drome; symptoms and character change after a major disaster.
in Emergency Medical and Disaster Aid: A Source Book. Edit­
ed by Parad HJ. Resnik HLP, Parad LG. Bowie. Md. Charles
Press, 1975
Gottschalk LA. Gleser GC: The Measurement of Psychological
Stales Through the Content Analysis of Verbal Behavior. Berke­
ley. University of California Press. 1969

Am J Psychiatry 133:3. March 1976

299

"J

From Chaos to Responsibility
BY GERALD M. STERN, L.L.B.

7 he litigation initiated by the 625 survivors of the
Buffalo Creek flood who refused to settle with the coal
company claims office was a landmark case. For the
first time, individuals who were not present at the
scene of a disaster h ere allowed to recoverfor mental
injuries. Psychic impairment, the term coined for
these injuries, was found in virtually all of the
survivor-plaintiffs. In an out of court settlement, the
survivors were awarded$13.5 million. $6 million of
which was distributed on the basis of a point system as
compensation for (he psychological damages.

The destruction of the Buffalo Creek community
gave rise almost immediately to the creation oi a new
kind of group—a community of 625 survivors from 160
families who joined together to sue the coal company
that owned the dam. These individuals, unlike the ma­
jority of the survivors, refused to settle their cases at
the coal company claims office. Instead, they sought
legal help outside the state of West Virginia.
This group contacted Arnold & Porter, a law firm in
Washington. D.C.. and we agreed to represent them.1
We immediately went to Buffalo Creek and spent
many days interviewing survivors at Charlie Cowan’s
gas station, one of the few buildings remaining in the
Buffalo Creek valley. Mr. Cowan was the leader of the
citizens’ committee that called to ask for our legal
help. The survivors’ legal right to sue for traditional
damages was clear: they could sue for lost property,
for their homes and all their possessions, for physical
injuries, or for the death of family members. However.
it soon became apparent that they also had significant
mental injuries, and it was not so clear whether the law
would permit recovery for these damages.
The magnitude and significance of these mental and
emotional damages hit me personally when I inter­
viewed a coal miner who had lost his 22-month-old son
and his pregnant wife in the disaster. The flood waters
caught this family asleep in their home. As the wife dis­
appeared in the black water, she cried out to her hus­
band to save their son. He held the child tightly and
Presented at the 128th annual meeting of the American Psychiatric
Association. Anaheim. Calif.. May 5-9. 1975.

Mr. Stem is a partner in (he law firm of Arnold & Porter, 1229 19th
St.. N.W.. Washington. D.C. 20036.
:A much more detailed report of my observations and involvement
in this case will be presented in a forthcoming work (I).

300

Am J Psychiatry 133:3. March 1976

2

.1 ond>llons were mere,y l^e result of an aggravaf preexisting mental conditions. Our physicians
55?° d that
survivors’ psychiatric damages were
'■ ^isolely by the disaster. The coal company physi.a2recd This is a dispute juries must often ref incases involving psychiatric damages.
•
more interesting and more difficult legal quesresented by this case was whether the survivors
recover monetary damages at all, even if the jury
• -d that all of the survivors’ present psychiatric in^<were caused by the disaster. Traditionally the
" does not permit recovery for psychiatric injury on
a.*sole ground that the injury can be proven to have
•^caused by another person or persons. For ex­
ile, a mother who sees a truck run over and kill her
Jd may suffer severe psychiatric'trauma, but the law
■ jitionally has denied the mother recovery for her
■ -osuffering, terming her a mere bystander. Needless
isay, an individual who sees a friend killed has even
->s chance in the courts of recovering for mental suf­

tried to struggle to safety, but houses and debris b-,
tered him and the child as they were washed
down the valley. Somewhere in this maelstrom hel'
his grip on his son, who disappeared forever into r''
black waters. Eventually, this man was able r
struggle to safety, although his body was badly ]ac?.
ated by the jagged wood in the water. At the time I
terviewed him. my own son was exactly 22 monthold. I was terribly upset by his story and decided to tn
to expand the lawsuit to recover for his mental ago,-/
and for the mental suffering of others like him.
?
We contacted Robert J. Lifton. M.D., who had stud­ fering.
In this case, most of the survivors were not seriousied the survivors of Hiroshima. He agreed to interview
;vinjured physically. Many of them had run up the
a number of our clients and to help us explain toil­
of the valley just ahead of the flood waters, and
court in lay terms the common psychiatric injuriesd
•-v.-ncof them were not even in the valley at the time of
these survivors. He also suggested that we ask Dr. K;i ■
disaster. For example, one survivor was visiting in
Erikson, whose findings are reported in this section, 1$
J
Mexico, another was in Florida, some were in
study the sociological aspects of this disaster. With ■ ^il, and others were in hospitals in nearby towns outthese two men as our principal experts, we articulated
’.le the valley. Nevertheless, we insisted (hat all of
for the court and for the coal company defendant why
fie survivors were entitled to recover for their mental
we called the “psychic impairment’’ damages suffered
. -..Bering, even if they suffered no physical injury, saw
by every one of our survivor-clients.
'.heard no relative or friend in peril, or were absent
We coined the term “psychic impairment” to h'.--irn the valley on the day of the disaster. We argued
elude both the psychiatric damages identified by Dr.
; bleach resident of the valley, even those who were
Lifton and the loss of communality found by Dr. Erik­ . ’4 there during the flood, was a direct victim of the
son. We wanted to avoid alleging that the survivor? I vulcompany’s reckless conduct and not merely a bysuffered mental illness and felt that the phrase “psychic I 'bnder.
impairment’’had a less negative connotation.
| ihe court agreed with this contention and held that
Eventually we also employed a team of psychiatrist . I survivors—even those w ho were outside the valley
from the University of Cincinnati, some of whose find­
■ 4,ilcl’me of the disaster—could collect for mental in­
ings are also presented in this section, to interview
each of our clients. The coal company also retained3
r
psychiatrist—actually, a physician whose pnmaD
field was neurosurgery—and a young psychologist<5
training, who also examined each of the 625 men, wot*
en, and children involved in the lawsuit.
,
Our psychiatric studies indicated that almost al
the survivors were suffering from psychiatric (janlor>
of varying degrees as a result of this disaster. Inc - I '
trast, the physician retained by the coal
■T- •'
termined that the survivors generally suffered transient situational disturbances that he feD s
have abated soon after the disaster. The fact tna j T
•s
survivors still had disturbances when he exai
them some 18 months after the disaster led him
< •
sume almost invariably that these people were s
ing primarily from preexisting menial conditio11
Under traditional legal principles, if the s
had been physically.injured by the flood waters
a result, had suffered psychiatric damages,
recover full monetary damages unless then* c

jury if we could convince the jury that the coal compa­
ny’s conduct was reckless (i.e., more than merely neg­
ligent), and that this reckless conduct caused the survi­
vors’ menial suffering (2).
Once the coal company realized that the court would
not dismiss the psychic impairment claims of any of
the 625 survivor-plaintiffs in this lawsuit, we reached a
settlement for a total of SI3.5 million, to be divided
among the survivors by their own attorneys. We first
calculated the payments for real and personal property
losses, for wrongful deaths, lost wages, other miscella­
neous claims, expenses, and legal fees. This left ap­
proximately $6 million to be distributed for psychic im­
pairment. We distributed this money to the 625 plain­
tiffs using a point system based on their immediate
involvement with the disaster, their medical disability,
their loss of community ties, and the disruption of their
way of life. Each survivor received between S7.5C0
and $10,000 after all expenses and legal fees were de­
ducted. Approximately $2 million of the $6 million was
placed directly in a trust fund for the 224 children un­
der the age of 18 who were plaintiffs in the case.
The court’s approval of this substantial monetary
settlement for survivors' psychic impairment estab­
lished a significant legal precedent for recovery in cas­
es of mental suffering. The court was not bound by con­
cepts of space and lime. Instead, the court recognized
that it is the permanence of loss, rather than the wit­
nessing of the disaster, that causes mental suffering.
In other words, the court (and eventually the coal
company) was persuaded that the relief provided by
the law should be determined not by narrow traditional
legal principles but by fairly modern psychiatric and
sociological principles.
REFERENCES
I. Stern GM: The Buffalo Creek Disaster. New York. Random
House (in press)
2. Prince, et al v Pittston, 63 Federal Rules Decisions 28 [SD. W
Va (1974)]

Am J Psychiatry 133:3. March 1976

301

Loss of Communality at Buffalo Creek
BY KAI T. ERIKSON, PH.D.

The survivors of the Buffalo Creek disaster suffered
both individual and collective trauma, the latter being
reflected in their loss ofcommunality. Human
relationships in this community had been derivedfrom
traditional bonds ofkinship and neighborliness. When
forced to give up these long-standing ties with familiar
places and people, the survivors experienced
demoralization, disorientation, and loss of
connection. Stripped ofthe support they had received
from their community, they became apathetic and
seemed to have forgotten how to care for one another.
This was apparently a community that was stronger
than the sum of its parts, and these parts—the survix ors
of the Buffalo Creek flood—are now haxmg great
difficultyfinding the personal resources to replace the
energy and direction they had once found in their
community.

The trauma experienced by the survivors of the Buf­
falo Creek disaster can be conceptualized as having
two related but distinguishable facets—the individual
trauma and the collective trauma.
By individual trauma. I mean a blow to the psyche
that breaks through one's defenses so suddenly and
with such force that one cannot respond effectively.
As lhe other papers in this section make abundantly
clear, the Buffalo Creek survivors experienced just
such a blow. They suffered deep shock as a result of
their exposure to so much death and destruction, and
they withdrew into themselves, feeling numbed.
afraid, vulnerable, and very alone.
By collective trauma. 1 mean a blow to the tissues of
social life that damages the bonds linking people to­
gether and impairs the prevailing sense of commu­
nality. The collective trauma works its way slowly and
even insidiously into the awareness of those who suf­
fer from it: thus it does not have the quality of sudden­
ness usually associated with lhe word “trauma." It is.
however, a form of shock—a gradual realization that
the community no longer exists as a source of nunurance and that a pan of the self has disappeared. “I
continue to exist, although damaged and maybe even
permanently changed. “You” continue to exist, alPresented at the 128th annual meeting of the American Psychiatric
Association. Anaheim. Calif.. May 5-9. 1975.
Dr. Erikson is Professor of Sociology and Chair. American Studies
Program. Yale University. New Haven. Conn. 06520.

;o:

Am J Psychiatry 133:3. March /976

though distant and hard to relate to. But “we” noi
er exist as a connected pair or as linked cells in a la
communal body.
The two traumas are closely related, of course b
they are distinct in lhe sense that either of them
take place in the absence of the other. For instance *
person who suffers deep psychic wounds as the resub
of an automobile accident, but who never loses cor'
tact with his community, can be said to suffer from ir
dividual trauma. A person whose feelings of well-beir5
begin to wither because lhe surrounding communityistripped away and no longer offers a base of support
(as is known to have happened in certain slum clear­
ance projects) can be said to suffer from collective
trauma. In most large-scale human disasters,
course, the two traumas occur jointly and are experi­
enced as two halves of a continuous whole. For (he
purposes of this paper, however, it is worthwhile to in­
sist on the distinction at least briefly, partly because?.
alerts us to look for the degree to which the psych?:
impairment observed in settings like Buffalo Creek cabe attributed to loss of communality. and partly bc»
cause it underscores lhe point that it is difficult for
people to recover from the effects of individual trauma
when the community on which they have depended re­
mains fragmented.
I am proposing, then, that many of lhe traumalk
symptoms experienced by the people of Buffalo Creo.
are as much a reaction to lhe shock of being separate-}
from a meaningful community base as to the actual di­

, The flood itself forced the residents of the holinto a num^er
n.earby refugee camps from
they were’ f°r a vanety reasons» unable to esThe result was that the majority of the Buffalo
survivors remained in the general vicinity of
;^>0Id homes, working in familiar mines, traveling
familiar roads, trading in familiar stores, attend■ Yfanul*ar schools, and sometimes worshipping in faajar churches. However, the people were scattered
■ire or less at random throughout the vicinity—virtuX stranded in the spots to which they had been
Wished by lhe flood—and this meant that old bonds of
inshipand neighborhood, which had always dependJ on physical proximity, were effectively severed.
ftople no longer related to one another in old and acjstonied ways. The threads of the social fabric had
-.napped.
A year after the disaster (which is roughly when
fnostof the authors represented in this section first en­
countered these people) visitors to Buffalo Creek were
struck by a number of behavioral manifestations that
seemed to be exhibited by almost everyone in the val;-yand, for that matter, continue to this day. Several
vfthese manifestations are discussed elsewhere in this
section. I would like to mention three by way of illus­
trating a larger point.

demoralization

First, the survivors clearly suffer trom a stale of se­
vere demoralization. both in the sense that they have
lost much personal morale and in the sense that they
have lost (or so they fear) most of their moral anchors.
The lack of morale is reflected in a prolound apathy.
a feeling that lhe world has more or less come to an
end and that there are no longer any sound reasons tor
doing anything. People are drained of energy and con­
viction, not just because they are still stunned by the
savagery of the flood but because activity of any kind
ttems to have lost much of its direction and purpose in
^ absence of a confirming community surround.
They feel that the ground has been pulled out from un­
Mem, that the context in which they had worked,
$ayed, and cared for others has more or less dis­
appeared. One survivor said.

saster itself.
Il should be noted thal “community” means miw
more in Buffalo Creek than it does in most other parti
of the United States. Much has been said in
j
ture on Appalachia about the importance of kinship and neighborliness in mountain society. Although it J ■<
true that coal camps like the ones along Buffalo Crtt ?
difl'er in many ways from the typical Appalachian co>
munity. the people of Buffalo Creek were nonethd'
I don’t know. I just got to the point where I just more or
joined, together in the close and intimate bonds that I
I Jess don’t care. I don't have no ambition to do the things I
ciologists call gemeinschaft. The rhythms of ever} «.
used to do. I used to try to keep things up. But anymore I
life were largely set by the community in general^, ;
just don’t. It seems I just do enough to get by. to make it
governed by long-standing traditions, and the
■?
,astone more day. It seems like I just lost everything at
linkages by which people were connected were - :i- . ?nce, like the bottom just dropped out of everything.
strong. In Buffalo Creek, tightly knit communal
were considered the natural order of things, the e
I 4uMPP0se the c,inicai ierm f°r ihis state °f mind
lope in which people live.
“•
depression, but one can hardly escape the imLong stories must be made short in a Presen,
‘ Wr°n that il is’ al least in Part* a reaction to the amlike this, so I will simply summarize my theme
- :,ofs 'eS
P°sldisaster life in the valley. The surviing that lhe human communities along Buffalo
; ^Veare lijcrally out of place and uprooted. They had
were essentially destroyed by the disaster and is
r realized the extent to which they relied on the

rest of the community to reflect a sense of security and
well-being, or how much they depended on others to
supply them with a point of reference.
The people of Buffalo Creek are also haunted by a
suspicion that moral standards are beginning to col­
lapse all over the valley, and in some ways it would
appear that they are right. As is so often the case, the
forms of misbehavior people find cropping up in their
midst are exactly those about which they are most sen­
sitive. The use of alcohol, always a sensitive problem
in Appalachian society, has apparently increased, and
there are rumors everywhere that drugs have found
their way into lhe valley. The theft rate has also gone
up. and theft has always been viewed in the mountains
as a sure index of social disorganization. The crudest
cut of all. however, is that younger people seem to be
slipping away from parental control and are becoming
involved in nameless delinquencies. This is an ex­
tremely disturbing development in a culture so de­
voted to the family and so concerned about generation­
al continuity.
This apparent collapse of conventional morality has
a number of curious aspects. For one thing, observers
generally feel that there is much less deviation from
community norms than the local people seem to fear.
xMoreover. there is an interesting incongruity in these
reports of immorality—one gets the impression that
virtually everyone is coming into contact now with per­
sons of lower moral stature (han they did formerly.
This, of and by itself, does not make very much logis­
tical sense. One survivor said flatly.
The people of Buffalo Creek tended to group themsehes
together: therefore the breaking up of (he old communities
threw all kinds of different people together. Al the risk of
sounding superior. I feel we are living amidst people with
lower moral values than us.

Perhaps this is true—but where did all these sordid
people come from? Whatever else people_ may say
about their new neighbors in the refugee camps, they
are also from Buffalo Creek, and it is hard to avoid lhe
suspicion that their perceived immorality has as much
to do with their newness as with their actual behavior.
It may be that relative strangers are almost by defini­
tion less “moral” than familiar neighbors. To live with­
in a tightly knit community is to make allowances for
behavior that might otherwise look deviant. New
neighbors do not qualify for this clemency—not yet. at
least—and to thal extent, their very unfamiliarity may
seem to hint at vice all by itself.
The collapse of morality in Buffalo Creek thus seems
to have two edges. We have sufficient evidence to be­
lieve that certain forms of deviation are actually on lhe
increase, although this is a difficult thing to measure ac­
curately. However, we also have reason to believe
thal the breakdown of accustomed neighborhood pat­
terns and the scattering of people into unfamiliar new
groupings has increased the level of suspicion people
feel toward one another.

o:

Am J Psychiatry 133:3. March 1976

<-■ Z.

LOSS OF COMMONALITY

DISORIENTATION

The people of Buffalo Creek are also clearly suffer­
ing from a prolonged sense of disorientation. It has of­
ten been noted that the survivors of a disaster are like­
ly to be dazed and stunned, unable to locate them­
selves meaningfully in lime and space. Time seems to
stop for them; places and objects suddenly seem transi­
tory. They have trouble finding stable points of refer­
ence in the surrounding terrain, both physical and hu­
man. to help fix their position and orient their behav­
ior. All of this can be understood as a natural
consequence of shock, but the people of Buffalo Creek
seem to have continued to experience this sense of dis­
location for months and even years after the crisis.
“We find ourselves standing, not knowing exactly
which way to go or where to turn." said one individ­
ual. Another survivor noted. “We feel like we're living
in a strange and different place, even though it is just a
few miles up Buffalo Creek from where we were.”
Professional observers who have gone into the val­
ley on medical or research errands have noted repeat­
edly how frequently the survivors seem to forget
simple bits of everyday information—the names of
close friends, their own telephone numbers, etc.
People are often unable to locale themselves spatially.
even when they are staring at fixed landmarks they
have known all their lives. It is not at all uncommon
for them to answer factual questions about time—their
own age or their children’s grade in school—as if histo­
ry had indeed slopped on the date of the disaster. In
general, people all over the valley live with a lasting
sense of being out of place, disconnected, and tom
loose from their moorings, and this feeling has far out­
lasted the initial trauma of the catastrophe itself.
People normally learn who they are and where they
are by taking soundings from their fellows. As if em­
ploying a subtle form of radar, we probe other people
in our immediate environment with looks, gestures.
and words, hoping to learn something about ourselves
from the signals we get in return. But when there are
no reliable objects off of whom to bounce those explor­
atory probes, people have a hard time calculating
where they stand in relation to the rest of the world. In
a very real sense, they come to feel that they are not
whole persons, not entirely human, because they do
not know how to position themselves in a larger com­
munal setting.
Well. I just don’t feel like the same person. I feel like I
live in a different world. I don’t have no home no more. I
don’t feel normal anymore. I mean, sometimes 1 just won­
der if I’m a human being. I just feel like I don't have no
friends in the world, nobody cares for me. nobody knows
I even exist.
LOSS OF CONNECTION

A third manifestation of the disaster's psychosocial
effects is a condition that might be described as loss of

oW how to care for one another or to coordiconnection—a sense of separation from other
ononally. because the context that lent subFor better or worse, the people of the hollo
’ ^^and meaning to their relationships has disdeeply enmeshed in the tissues of their COrnW
j Two survivors pul it this way:
they drew their very being from them. When th1^*** ■<
'■
sues were stripped away by the disaster, peon|
Il person in the family is a loner now, a person
themselves exposed and alone, suddenly depend^
. » Each of us is fighting his own battles. We just don’t
their personal resources. The cruel fact is that m
'•’^’(0 care for each other anymore.
the survivors proved to have few resources^?0'
cause they lacked the heart or the competence h° k
•rhe family is not what they was. They’re not the same
cause they had spent so many years placing their kv
•0|e 1 don’t know how you’d put this, but before there
ties in the service of the larger community that th
]ove in the home. But now it seems like each one is a
did not really know how to mobilize them for their ?
■ Cerent person, an individual by himself or herself, and
purposes.
Ou*
'Hre’sjust nothing there.
Many people feel that they have lost meaningful c
nection with themselves. Much of their apparfinally, the difficulty people experience in sustaining
former strength was actually the reflected strength
- rni relationships extends beyond marriages and famthe community, and they are learning—to their ver
s out into the rest of the valley. In places like Bufgreat discomfort—that they cannot maintain anendur
Creek, relationships are part of the natural oring sense of self when separated from that larger ih*
being inherited by birth or acquired by physical
sue. They find that they are not very good at makir- ,
.dimity—and the very idea of “making" friends or
individual decisions, getting along with others, orc"
■forming” relationships is hard for these people to untablishing themselves as separate persons in the absence of a supportive surround. "Lonesome” is; f (fefSand and harder still for them to achieve.
One result of all the problems I have described is
word many of them use, and they do not use it to mean
the lack of human company. One woman who liai ’ f- .j the community (what remains of it) seems to have
moved to the center of a large neighboring town said of ' l?| its most significant quality—the power it gave
hcr new home: “It is like being all alone in the middle • f.ople to care for one anotheMn moments of need, to
of a desert." A man who continued to live in his dam­ -.. .-.sole one another in moments of distress, and to pro: Uvl one another in moments of danger. In retrospect,
aged home on Buffalo Creek said.
u
J
Well, there is a difference in my condition. Like some* * •<
body being in a strange world with nobody around. Yoa ?

it is apparent that the community was indeed stronger
than the sum of its parts in this regard. When the
people of Buffalo Creek were clustered together in the
embrace of a community, they were capable of remark­
able acts of generosity; when they tried to relate to
one another as separate individuals, they found that
they could no longer mobilize the energy to care. One
woman summed it up in a phrase: “It seems like the
caring part of our lives is gone."

CONCLUSIONS

To end with an oversimplified metaphor. I would
suggest that the people of Buffalo Creek were accus­
tomed to placing their individual energies and re­
sources at the disposal of the larger collectivity—the
communal store, as it were—and then drawing on
those reserves when the demands of everyday life
made this necessary. When the community more or
less disappeared, as it did after the disaster, people
found that they could not take advantage of the
energies they once invested in that communal store.
They found themselves almost empty of feeling, devoid
of affection, and lacking all confidence and assurance.
It is as if the cells had supplied raw energy to the whole
body but did not have the means to convert that ener­
gy into usable personal resources once the body was
no longer there to process it.

don’t know nobody. You walk the floor or look for sonic*
body you know to talk to, and you don’t have nobody.

In addition, the inability of people to come to term*
with their own individual isolation is counterpoinicd
by an inability to relate to others on a one-to-one basis.
Human relations along Buffalo Creek took their shape
from the expectations that pressed in on them from
all sides like a mold: they were regulated by the cus­
toms of the neighborhood, the ways of the community
and the traditions of the family. When that mold wsj
stripped away, long-standing relationships seenKto disintegrate. This is true of everyday acquaintancesbut it is doubly—and painfully—true of marriage
Wives and husbands discovered that they did not kn°*
how to nourish one another, make decisions, ore'^
to engage in satisfactory conversations when •
community was no longer there to provide a.con2$J
and set a rhythm. There has been a sharp
«
in the divorce rate, but that statistical *n4eX.vofj I
not begin to express the difficulties the surv1 . |
have relating to their spouses. It is almost as ii c°n . |
nal forces of one sort or another had knit tarrulyfi
J .,
together by holding them in a kind of SraV1
f
field, but when the forces of that field began.•
sipate. family members became scattered like 31
*
individual particles. Each individual nurses his
■
own hurts and tends to his or her own businessS- - /■

504

Am J Psychiatry 133:3, March 1976

Am J Psychiatry /33:3. March 1976

305

Children of Disaster: Clinical Observations at Buffalo Creek
BY C. JANET NEWMAN. M.D.

Most of the 224 children who were survivor-plaintiffs
of the Buffalo Creek disaster were emotionally
impaired by their experiences. The majorfactors
contributing to this impairment were the child's
developmental level at the time of the flood, his
perceptions of the reactions of his family. and his
direct exposures to the disaster. The author focuses on
children under 12. describing their responses to
fantasy-eliciting techniques and their observed
behavior after the flood compared with developmental
norms for their age and reports of their previous
behavior. These children share a modified sense of
reality, increased vulnerability to future stresses.
altered senses of the power of the self. and early
awareness offragmentation and death. These factors
could lead to "after-trauma" in later life if they
cannot make the necessary adaptations and or do
not receive special help to deal with the traumas.

As part of the psychiatric evaluation of the survivors
of the Buffalo Creek flood. 224 children were inter­
viewed and evaluated; most were found to be signifi­
cantly or severely emotionally impaired by their experi­
ences during and after the flood. In this paper I will fo­
cus on children under the age of 12. using as a sample
11 of the children 1 assessed personally.
As has been described elsewhere in this section, the
evaluation procedure began with an interview of the to­
tal family and proceeded to individual interviews. In
interviews of mothers, outlines of each child's devel­
opmental history and functioning before and after the
disaster were obtained. This information was passed
on to the child psychiatrists in order to help us place
each child in his parents’ developmental perspective.
Children were usually seen in their own rooms. They
were encouraged to recall their own experiences of the
flood; such expressions had often been submerged or
inhibited amidst the outpourings of more vocal family
members. The issues we discussed included past and
present family life, personal feelings, school experi­
ences. and the childrens' perceptions of future hopes.
Revised version of a paper presented al the !28ih annual meeting of
the Amencan Psychiatric Association. Anaheim. Calif.. May 5-9.
1975.
Dr. Newman is Director. Day Hospital Elementary Unit. Children's
Psychiatric Center. 3140 Harvey Ave.. Cincinnati. Ohio 45229. and
Associate Professor of Child Psychiatry. Department of Psychiatry.
University of Cincinnati College of Medicine.

306

Am J Psychiatry 133:3. March 1976

the nature of the disaster, and the meaning of the |

We used such fantasy-eliciting techniques as “n
wishes.” “draw a person.'’ and story telling
adolescent children were asked to draw a picture •
the flood as they remembered it. Special educate-,
from the Children’s Psychiatric Center obtains
school data to confirm or correct parental impress^-of major losses of academic achievement that
sisted long after the disaster.
The effects of the disaster on children can be attributed to three major factors: 1) their developmental lc\.
el at the time of the disaster. 2) their perceptions oflb
family's reactions to the disaster, and 3) their direct cv
posures to the disaster. This paper illustrates eachfactor and examines their numerous interactions.

DEVELOPMENTAL level

The developmental factor will be illustrated by con­
trasting the clinical evidence gathered from 3 latency
age children and 2 preschoolers. A depressed, hope*
less, and guilt-ridden 11-year-old boy who had discov­
ered human remains in his immediate environment lif­
ter the flood drew a starkly realistic picture of a com­
pletely submerged trailer that contained two people
screaming for help. A house above the trailer was half
filled with waler, and a panic-stricken figure tried to
keep afloat amidst the waves and debris of the Aockj
waters. Drawings by 2 younger children showed a pos­
sible symbolic meaning of mountains to Appalachian
children, i.e.. the provision of humanlike functions®*
cradling and life sustenance (this contrasts with Lift®1'
and Olson's remarks about the “overall environrne®«
including nature itself, as threatening and lethal 1An 8-year-old boy with a chronic anxiety reac*
drew the “house-mountain” depicted in figure
life-saving compensation for his temporarily l°st .
helpless parents. The drawing represents a t ratin'’
regression to a wishful merging of parental
to a house-mountain in a partially beneficent en*
ment. A 7-year-old child also indicated security nj^
ture in a picture of himself climbing a steep hill
his mother and aunt. He drew a tree below «•
saying. “This is a tree I can hang onto if I slide do
Nature offers support when human beings sU fl
seem helpless. In Appalachia, the mountains rep
not only slag heaps and flood threats but tangible?
suring security.

the trailer is destroyed, while the safe “mountain" acquires door
^’windows.

The experiences of 2 younger boys will be described
10isolate developmental factors at the preschool level.
Henry, who was 3 years old at the time of the disaster
*0(15 at the time of our interview, was the only son
.-.nd favorite child of his mother’s second marriage. He
»as the first to awaken on the morning of the flood.
Looking out his window, he viewed the uncanny and
perplexing sight of a house moving down the creek.
Unsure whether this was real or a dream, he awakened
Ms parents, conveying more cognitive bewilderment
lhan fright or anxiety. He remembered saying. “Come
4x1 look!” The parents rose instantly and managed to
evacuate the family to safety on hieh ground just in
time.
_ Two years after the flood, his mother told us that
Henry frequently slept in the same bed with her and
•oved to be rocked, although he had rarely needed this
;Vpe of attention before the disaster. She reported that
? often talked about the houses and cars that had
•■oated by in the flood and how they “went boom!” I
I that because Henry was the first to awaken and. in
'<sense, rescued his family, they regarded him with
/^gratitude and admiration. During the family inHcnry was hyperactive—he was friendly but
V'eh’ h.is ’nd,vidual interview, he recalled seeing
toCoOUse 2°ing by his window and asking his parents
■■Txln’?e|-an<J 1°°^- He denied being scared, but said. “1
^rea •
*1, ' Henry also remembered seeing a
baby on t0P °* an upside-down store that
tUtar°?l.,ng downstream. He said. “1 didn't like that
hated A-”
R°°d picture started with a creek as an alP^rfect circle. Then a curving line showed “how

the creek goes here.” A rounded object near the path
of the flood conveyed its force; as he explained. “The
flood threw this rock.” Then Henry spontaneously
drew a 3-sided rectangular but bottomless form nearby
with “windows” for eyes, explaining that this was a
person killed in the flood. Most children Henry’s age.
drawing their first human figures, use.crude circles for
heads or head-and-body combinations: in a precircle
phase they use primitive scribble-strokes to indicate
human figures. Henry had already manifested a capac­
ity for drawing circles but had applied this skill only to
his representation of the flood, using a bottomless rec­
tangle with windows for eyes as a human figure. Such
faces or human figures were interpreted as con­
densations of humans with buildings, stimulated by
this 3-year-old’s view of a peculiarly and perhaps
awesomely floating house and other buildings, includ­
ing the one the screaming baby was on. His flood expe­
rience started as he awakened from sleep, and sorting
dream from waking perception and reality is typically
difficult for young children. Developmentally. Henry
was at a stage of tenuous differentiation of dream from
reality and animate from inanimate objects, and motil­
ity is the first characteristic differentiating living from
inanimate objects.
To summarize. Henry’s drawing showed the human
figure as dehumanized and fused with a seemingly ani­
mated building. The bottomlessness of the human
face-figure suggests his lack of security, which was
shown clinically by hyperactivity and an excessive
need to be closer to his mother than he had been be­
fore. The circular flood moving huge rocks suggests
the projection of superhuman powers to nature. His
barely developed abilities to separate animate from in­
animate and actuality from fantasy or dreams help to
explain his current bewilderment, excessive anxiety.
and hyperactivity. His favored position in the family
and his role as “rescuer” have accentuated his sense
of narcissistic omnipotence, which allays his under­
lying feelings of helplessness and anxiety. It is likely
that his problems of immaturity, anxiety, and devel­
opmental deviations in cognition will become more evi­
dent when he starts school.
Peter was interviewed 2 years after the disaster.
which occurred when he was 26 months old. His par­
ents reported that he had been a happy baby, devel­
oping at normal rate. His father, a chronically disabled
miner, described how the family scrambled up the side
of the mountain behind their home and watched as
their house was swept away and a nearby bridge crum­
bled from the force of the flood. A frantic passerby
yelled to Peter’s father to aid in the rescue of two chil­
dren clinging to a floating mattress. As he ran to help.
his wife screamed for him to come back. Realizing the
danger, he ran back to his own children and led them
to higher ground, carrying Peter on his chronically
weak back.
Since the disaster. Peter cannot take a bath without
screaming, and he still wets the bed frequently and
screams in his sleep. He gets mad easily and always
Am J Psychiatry 133:3. March 1976

30

C. JANET NEWMAN

CHILDREN OF DISASTER

wants his own way. Peter's memories of the flood in­
volved concerns over the safety of his friends and an
older brother’s loss of his best friend. He referred to
the “two kids on a mattress" and worried aloud wheth­
er “their daddy, he might just not want them." This
must have represented his own fears at the hands of
his own father, who did not save all children, limiting
his efforts to the rescue of his own family. When
asked about troubles or worries he said, perhaps stoi­
cally, “I don't be sad, that’s all." When asked what
would make him happy he said. “1 don't know, maybe
if my daddy was handy."
Peter’s response to the three-wishes question was
touching and highly original and was probably related
to a 4-year-old's determination to hold on to reality,
with a resulting fear of pretending, even for a mo­
ment: “1 don’t wish.” he said proudly. His drawings.
made at age 4. about his flood experience when he was
2 years old. should remind the reader of Henry, who.
although he was perfectly capable of drawing good cir­
cles, drew a person as a house with a rectangular bot­
tomless face. Peter, although younger, is involved
with deeper, more sophisticated, more human views of

FIGURE 2
A 4-Year-Old’s Picture of Two Lost Children Condensed into tv
tive Human Figure

Mother makes another nest, with twigs, on a stronger
branch. The little bird grows up to have a family, dr.
maybe the mommy bird might gel sick or die. or a cat
might eat her. Or maybe the little bird might get sick or
poisoned. It might mistake weed-killer for seed. That
could happen. Oh well, the little bird probably got old and
then died.

the disaster.
Peter's first flood picture included irregularly round
or oval outlines of what he then chose io call win­
dows—an “ugly" window, a “shoe” window, and a
“big” window. (Windows with views of the creek be­
came highly important for many families.) As an after­
thought. Peter drew a longer shape and told me to
write “two kids on a mattress in the creek” within it. I
then said, “Let’s do that one again on a bigger page.”
Peter drew a mattress and started to draw the 2 chil­
dren in the form of lines. However, in the process, he
appeared to convert the children into 2 legs (one bare­
foot and one with a shoe)’ and then drew a body and a
head labeled “top.” creating a total human figure. He
was influenced by the fact that his siblings were draw­
ing people. Figure 2 is Peter's second drawing: the
writing is that of the interviewer during the process of
drawing and records Peter’s words. This is a powerful
condensation of a traumatic scene, combining his fa­
ther’s failure to save all of the endangered children.
particularly those on the mattress. These 2 children be­
came the 2 legs of the larger total human figure in the
picture. As with Henry, we see a variety of serious de­
velopmental interferences and emotional distortions in
the development of perception and cognition as mani­
fested in body image concepts.

REACTIONS BASED ON DIRECT FLOOD EXPERIENCES

Marie was the cute, articulate daughter of a strong
father and a dominating hypertensive mother; she was
8 years old at the time of the disaster. During the flood
’Many children were barefoot or half barefoot in the escape from the
flood and suffered frostbite:

• vas of smiling, childlike parents in flowered clothocr flood picture, drawn from hearsay, seems
'^’rnatic at first glance. However, the bubbly clouds
:;^drew were duplicates of the floral prints of the fa,*r's shirt and the mother's skirt in the draw-a-person
'■•ture. The houses stood hlSh above the languid
;
and the many bodies appeared mostly in cheer’upright positions. Only 2 small figures yelled,
- Help!” Marie exemplifies a child reacting to maternal
\ieties, reminding us of the children described by
^na Freud and Dorothy Burlingham in War and Chib
V/i (2)> w^° reacte(J Par more strongly to maternal
potions than to bombs.
The major clue to the anxieties underlying the fa­
de of pollyannaish denial was Marie’s response to
'iDespert Bird Fable, which elicits a child’s story of
; hata baby bird who can fly a little will do if a strong
•ind blows the family nest from the tree, scattering
<he mother and father and baby bird. Marie asked.
‘■Were they all close together or were they far apart?"
’then said, “What do you think?" Marie replied.

Marie's mother bundled her in blankets and c
her to shelter, never allowing the child to see tnt
stages of the flood.
During Marie’s interview, her “draw-a-perS

This story reveals a rapid descent from superficial
health into violent and even paranoid ideation, in­
volving the death of both mother and baby by violence
;.nd poison. This rapid weakening of defenses reveals
i. Marie’s vulnerability to and identification with a chron­
ically anxious mother, whose exacerbated anxieties
>he had been intimately exposed to in the apparent
service of being protected herself.
Richard, who was 716 years old at the time of the dimaster, was the middle child of 3, born to mature par­
I ents. On the day of the disaster, as soon as the water
< -velfell, Richard and his father searched for relatives.
? ^ey were concerned about the safety of Richard s
i:
sister, who had stayed overnight with a girl
I ‘Mend. The sight of the mutilated body of a boy Rich* J^sage was shocking to both the child and his father.
j *?!chard was described as a changed boy since the
|
having become tense, nervous, talking little to
: ^parents, and suffering from terrifying nightmares of
j’2jeone coming back from the black water to take
f ^lothe spirit world. When interviewed, he said that
•
S^epl
a blackjack under his pillow.
< '=21’1 r<^ S
picture conveyed a firm sense of
■«.
slrong sense of form combined with creative
*,ty'
dfew a truck carrying 5 bodies wrapped
'■
Set aSa’nst a background of a burning slag
?
a house with a large chunk missing. The sky
-re Vercasi and it was raining. His draw-a-person pic' ^v/n ^evei*• strutting, colorful comic book character
I *.
ln profile, shows color, movement, and detail

^nd indicates creativity and ego strength. Despite en­
during strengths in peer relationships, good school per­
formance, and basically warm family ties, Richard has
a chronic traumatic anxiety reaction manifested by
trembling hands, tension, inner tremulousness, diffi­
culty sleeping, and nightmares. In contrast to Marie,
who looks deceptively healthy and self-assured but
whose reawakened inner problems stem from close
ambivalent ties to a chronically anxious mother, Rich­
ard’s symptoms represent more purely a chronic overt
traumatic reaction to the disaster, in the context of
considerable ego strength.
David, 7 years old during the flood and 9 when inter­
viewed, was apparently well-adjusted before the disas­
ter. Afterward his grades fell, he tended to keep to him­
self, and got into fights. His most severe symptoms.
however, were crying in his sleep, sleep-talking
(saying he wants to "get home again"), and somnam­
bulism—he seems to be walking out of the house. Al­
though others direct him back to bed. he does not
wake up during these episodes but appears frightened.
Since the disaster he has been welting his bed several
times a night, something he did not do previously.
In his interview he appeared attractive and coopera­
tive but quiet and somber. He did not recall the con­
tent of his sleepwalking episodes, although he vividly
remembers people screaming while they were drown­
ing during the flood. David drew a bizarre person with
a strange colorless face looking backward and a bright­
ly multicolored body with feet pointing in the opposite
direction from the face (figure 3). Diagnostically, he
had symptoms of a traumatic neurosis with a dis­
sociative-type hysterical neurosis (exemplified by his
somnambulism) encapsulated within it. It seemed like­
ly that his trancelike sleepwalking was a repetition of
the original escape; this interpretation was supported
by his grotesque drawing of a person whose profile.
while colorless, had a fixed smile and slightly quizzical
or puzzled eyes. Facial distortions and poor fit to the
body are evident in the picture.
David’s pathology was focused and severe. Sleep­
walking usually occurs in stage 4 sleep when central
nervous system motoric inhibition of REM dreams
cannot occur (3). Certain types are called “somnambu­
listic trances" and may represent physical reenact­
ments or abreactions of traumatic situations (4). Da­
vid’s bizarre picture suggests an unconscious con­
nection between his sleepwalking state and his
conscious imagery.
Marie has become subtly but severely traumatized
through her direct relationship with a chronically anx­
ious and flood-traumatized mother, while Richard and
David’s more conspicuous and overt traumatic reac­
tions stem more directly from their flood experiences.
The contrasts in the symptom choices of Richard and
David are probably multiply related to their constitu­
tional backgrounds, developmental experiences pre­
ceding the trauma, and the exact circumstances of the
moment of greatest trauma each experienced in the di­
saster.
Am J Psychiatry 133:3. March 1976

Ain J Psychiatry 133:3. March 19 *

309

CHILDREN OF DISASTER

FIGURE 3
A 9-Year-Old's Drawing That Suggests a Link Between His Somnam­
bulism and Conscious Imagery

310

Am J Psychiatry /SS:S. March 1976

C. JANET NEWMAN

OBSERVATIONS ON OTHER AGE groups

I have not mentioned another group of ,.
those who were in utero during the flood. Oft *
preciousness lies in having survived the preena^ l'n*
frantic mother. Among their future stresses mavk'
never-ending tales or the silent allusions of th* f 1
about the disaster these children never experi
The parents may see them as magically and profo^
linked with the flood. These children, as well a$iN
born later (who will also feel left out. yet involved!
be unpredictably but importantly influenced bvih
lastrophe.
ec<
Although this paper has focused on preadoles
children, a few words must be said about adolesces
special vulnerabilities to the psychological effects r
the disaster. Because the almost total community dstruction. the loss of communality described cis'
where in this section by Dr. Kai Erikson, was so dis­
ruptive. especially to adolescents, they often In
to choose between rebellious predelinquent behavior
or compliant social withdrawal. They suffered deep!*
but privately when their parents broke down undo
stress. For example, in one family, the favored older
brother, who had been the ’good one” before the di­
saster. changed his behavior markedly—he missed fe
days of school, threatened the teaching staff, was sus­
pended five times, and is currently on probation be­
cause of his behavior. At home he sat up at night appre­
hensively listening to rain or roared away on his motor­
cycle. However, his next younger brother continued
to attend school regularly and made every' effort to con
centrate. The contrast between his very chaotic flood
picture and a carefully drawn pink dove of peace th.':*
his teacher had praised as “best in the class” shoya
the range and conflict of his inner experiences, which
he has internalized, but with unknown emotion?-1
strains.
.
Creative expressions emerged in many cases. Out cf
a highly disturbed large family living in two trailers in
a state of chaos came a touching picture drawn by aj
11-year-old boy (figure 4). Denying the turbulence C»
the flood, he drew an intellectually complex picWJ
with excellent perspective that showed a trestle, rod­
intersections. and a quiescent creek. He labeled
“the road to where we used to live.” In the
ground, brightly colored idyllic homes in red. y
and orange nestled among the woods on the
There were no people in the picture, but there
possibilities for human reconstruction. The three
matically split roads suggest important choices
made, and the colorful homes in the backgroun
gest hope.
. .s^
Finally, some older children did follow tne^^
and psychiatric interviews with great interest
phistication. They recounted hopes of being
£
and nurses, even though they were often ^iaV1pjjie^
lems in their basic school courses. They wrote
on safety regulations and dam construction aSfll()li(jf
projects and tried to master their experiences e

CHILDREN OE DISASTER

ally and intellectually. They will never forget this expe­
rience, and they will be watchful of all the adults who
have participated in it; they either idealize or are dis­
illusioned with parents and other adults. When they
grow up. they will watch the world closely. They will
have learned enormously both in and out of school.
CONCLUSIONS

Children in traumatized families within a shattered
community form their own theories of a disaster from
their own reactions and their perceptions of the reac­
tions of their parents and other adults. Their concep­
tions are also influenced by the social and legal proc­
esses associated with the disaster. All of these factors
permanently affect their sense of self in growing up.
The common heritage of most children of disaster is a
modified sense of reality, increased vulnerability to fu­
ture stresses, an altered sense of powers within the
self, and a precocious awareness of fragmentation and
death. In contrast to most of their parents, some of the

--rtission of the Buffalo Creek Disaster: The Course of Psychic
children manifested clear and enduring evidenc.
. . X**
hopefulness and creativity, despite obvious
limitations in their ability to achieve specific
Their sense of hope existed side-by-side with ser;‘- ’
signs of developmental limitations and serious pal[‘.V j ,'!,EORANGELL.M.D.
gy Indeed, the widening discrepancies between vsensitivities and academic achievement could leadu.
severe “after-trauma” in later life. They wouldrequ>7
unusual life adaptations or special help to respond CJ
structively or creatively to the traumas they had unde
gone.
address not only the inundation of psychic structures
• - f tecific contribution of the psychiatrist to the
in a horizontal sense but also the longitudinal effects of
study
of
the
human
disaster
at
Buffalo
Creek
REFERENCES
the flood—the disturbed continuity with the past, the
^'eson the course ofpsychic trauma. The initial
shattering of the present, and the inescapable portents
■
■ 71/ intrusion by the flood waters was followed by a
I. Lifton RJ. Olson E: The human meaning of total disaster.
for the future.
chiatry (in press)
',^■3 phase of the traumatic cycle, the physical
The work of the interdisciplinary evaluation team re­
2. Freud A. Burlingham D: War and Children. New York. Er
^cation of the survivors, with disruption of their
Willard. 1943, p 21
tained by the law firm representing the 625 survivor­
■toiind" and ‘ ‘surround. ’ ’ During this long
3. Kales A (ed): Sleep Physiology and Pathology. Philadelphia.)]
plaintiffs to assess the psychological impact of this ca­
' sequent period the level of trauma did not recede
Lippincott Co. pp 11I-H2
tastrophe
has profound implications, reflected in its ef­
4. West LJ: Dissociative reaction, in The Comprehensive Ttu
;kept rising, although at a slower pace. Distant
fects on the social decision-making process. The un­
book of Psychiatry. Edited by Freedman AM, Kaplan HI. R/. ; . clsof the trauma may succeed the more immediate
more, Williams & Wilkins Co. 1967, pp 885-899
precedented legal decision, reported elsewhere in this
u-5. The finite psychic space of the survivors is
section by Mr. Gerald Stern, permitted people who
^toadied upon by traumatic memories for an
were not on the scene of an accident to be awarded rep­
definite period of time, lea ving fe wer resources
arations for the psychic damages they suffered. The
^diable for normal effective living. The absorption
principle acknowledged in this case could well shake
I J merging of traumatic stimuli into a traumatophilia
all existing rules of the social order about the respon­
• .Acs still another potential problem. The
sibility of man to man.
f npecedented legal decision as to the linear effects of
\ ,})diic trauma on a succession of connected
; efivlduals will needfurther interdisciplinary
THE FIRST phase: PSYCHIC NUMBNESS
I deification.
b. offering opinions on the overwhelming hu;
experience of the Buffalo Creek disaster, the chali
is to separate our reactions of empathy and hori H (which, as Lifton and Olson [1] have pointed out.
• -trequickly and painfully shared by all mental health
V /ofessionals who came to the valley after the disaster)
r Tin the potential contributions of our specific protes’ 2^al expertise. Toward this end. I will focus on the
j
of psychic trauma (2), its nature and its effects,
•'Complement the findings of the interdisciplinary
r
°fsociologists, psychologists, attorneys, and oth' ’l'*bo took part in the evaluation of the effects of this
’•‘fenence on those who survived it.
' , loe articles in this section range from the individual
. ' collective, from the child to the adult, and from
i
epest *nner effects to the widest outer con•.^nces of this sudden, unassimilable disruption of
■ ■■., ;s.re^lionship to his physical world. These studies

•'toe 128th annual meeting of the American Psychiatric
j ''•Rih ’ Anaheim- Calif.. May 5-9. 1975.
FIinical Professor of Psychiatry. University ol CalitorIntend • Sch°ol of Medicine, and immediate Past President
i
tn nailnna' Psychoanalytic Association. Address reprint
■
^9 r' Rangell at 456 North Carmelina Ave.. Los Angeles.

To turn to the central focus about which psychia­
trists can reflect and from which other observations
will stem, (he Buffalo Creek flood was a violent intru­
sion into the peaceful psychic life of the community
massively beyond the “average expectable environ­
ment” (3). This eventuality was not. however, com­
pletely unexpected—the people in (he valley had long
lived with this possibility and knew it could be pre­
vented, but they said they had put it out of their minds.
Actually, it had been put not out but deeply in. had be­
come part of their living unconscious. It was in some
ways like the earthquake situation in California but
worse and more constant. The dam that finally broke
physically existed just above the valley and was visible
and ever present. Another difference, which added the
makings of a latent inner eruption to the potential ex­
ternal occurrences, was that there were in (he minds of
valley residents people (the owners of the dam) who
could and should have done something about the situ­
ation. Like the cave-in of a coal mine in a community
(hat has always lived in dread of such an occurrence.
the flood had been part of the mental as well as the
physical geography of Buffalo Creek, a feared event
buried in the minds of the people. The massive con­
vulsion of the physical world that took place on Febru­
ary 26, 1972, was a mental imprint come true. It was a
nightmare from which (his time they did not awake.
The black waters that roared through Buffalo Creek
Am J Psychiatry 133:3. March 1976

313

Am J Psychiatry 133:3. March 1976

------- ------------ .. .yur.,. ..

jj

COURSE OF PSYCHIC TRAUMA

valley when the fantasied, feared, and repressed event
became reality could be said to have flooded the egos
of those who lived through the disaster. All control
functions were overrun by the sudden influx: it was a
maximum dosage per unit time, a psychological over­
kill. The result was universal and with a common base
to all. the traumatic stale, the condition of psychic
helplessness that the anxiety signal presages and that
all of the ego’s defenses constantly work to prevent (4.
5). This was the phase of psychic numbness observed in
all of the studies of the survivors. The goal was merely
to live through it. to survive. Each individual held on
to whoever or whatever was left. “Psychological
conservatism.” which Drs. Titchener and Kapp de­
scribe in “Family and Character Change at Buffalo
Creek.” served to reduce excitation; no further stimuli
were wanted.
This stage of psychic numbness, of apathy, with­
drawal. and sluggishness, was still visible when the
evaluation teams arrived in Buffalo Creek 2 years lat­
er. Some of the observers were surprised that the trau­
matic neurosis was still visible, but what evidence is
there to assume that the residual or even basic effects
of so massive a trauma would not last a lifetime? Psy­
chological testing of survivors of the Nazi holocaust
has shown that after 30 years they still show such last­
ing effects as impairment in perceptual-cognitive func­
tioning. withdrawal from objects, inability to sustain
close relationships, and other subtle and overt se­
quelae.
While the legal experts perhaps needed to be con­
cerned about the claim of preexisting stales. I would
prefer to maintain clarity and not to have to use the
word “impairment,” to blur the fact that there hy/s
loss, injury, and illness. The effects of the disaster
were as ravaging as an epidemic of typhus or plague.
which is similarly visited upon a city from without, and
the preexisting vulnerabilities in the hosts to receive
the invading organisms are not an issue. The traumatic
neuroses overshadowed psychoneuroses. I do not
mean to say that there were no preexisting psycho­
neuroses. but rather that they no longer had a chance
to assert themselves. This is an issue that has plagued
every psychiatrist who has served in the military. Com­
bat neuroses in their acute phases are more uniform
(han different in their presenting syndromes: only later
can individual differences reappear and assert them­
selves again. During the years to come, as normalcy
returns to the Buffalo Creek survivors, they will have
the luxury of becoming individually neurotic again.

THE SECOND PHASE: “GROUND” AND
“SURROUND”

What happened to this community in terms of in­
coming traumatic stimuli did not stop w ith the cataclys­
mic events of that Saturday morning. As disorienting
and time-stopping as the flood was. it was only the first
phase. An individual who suffers a loss, however shal314

Am J Psychiatry 133:3. March 1976

lering. generally returns to his home to start
Hden to cumulative. The flood receded, but the level
and difficult process of repair. His “ground
§(r2ulT,a
nOt’ rat^er’ kept rising, although at a
ground into which the self can merge, is the h
i-j\verpace'
his security, the source of the nurturing sun r
-This was the phase studied intensively by Dr. Kai
sustain the processes of reparation. This wn?'Cs
rn’kson, described in this section from the sociological
sible in Buffalo Creek. The dazed survivors
7jndpo,nt as a l°ss
communality, the social tissue
tumed not to their familiar ground but to ^ere?tbinds people together. While this loss was universtrange surroundings. This may have been
j we should not overlook the fact that it was an indipossible course, but it was still depriving an(j r C: ■
.%’ual trauma as well. Just as the original traumatic
threatening. Rather than nurturance, the si
’rate, although universally shared, was individual in
continued to face challenges, for a long time a^i*'^
Bering, so was it with this second phase of the trauing a raw and vulnerable state.
fliatic cycle. The change from the familiar to a strange
In this double and almost death-dealing blow
surround during the period when rest and nurture were
survivors repealed the experiences of other holo’ .
needed superseded the initial trauma and prolonged
known to our generation Those who survived and^
jid compounded its effects in each survivor.
caped from Nazi Germany wandered into new I? T’*
The survivors of the atom bomb returned to crat *
where their homes had been. Many South Asiansh\
THE THIRD PHASE: FUTURE EFFECTS OF THE
had to leave their land after having left their dead 1trauma
all of these cases, the survivors' earth is also gone ■ •
ter their fellow humans have disappeared.
The articles presented in this section survey the ef­
Years ago. writing at another level and about more
fects of the disaster to date. Less measurable are the
comfortable aspects of human troubles, I described
future effects, especially those which are more subtle
“attachment to ground” as the psychic prerequisite
and internal. Are the children Dr. Newman inter­
for the maintenance of the social state of poise (6,7)
viewed who are now getting along well in school less
The opposite condition, a wavering hold on one’s sir* :• vulnerable to future stresses than those who are currounding psychic ground, results in a basic anxidt ; rently more turbulent and disturbed? Or is the reverse
with the threat ofcrumbling and even annihilation (i
the case? Only long-term longitudinal studies (which
the self. This is the source of the primitive anxiety tk-J
are not likely to be practical or feasible) would answer
people feel at the first threatening tremor of an earth­ < this and similar questions.
quake. In the more mundane case of seasickness, th:
There are subtle and far-reaching issues facing the
fear has been said to be not (hat one will die, but th},’ | survivors. In spile of the vastness of (he unconscious,
one might not. Underlying both of these disturbing
psychic space is limited. There is room and time in any
states is an elemental anxiety that stems from a div J individual psyche for only a limited amount of cogni­
orientation in the relationship of the organism to tk
tive ideation and a finite number of memories, fan­
earth under its feet.
tasies, and accompanying affects. The product of such
In the course of ontogenetic development, thisreh* I space and time comprises the psychic life of an individtionship extends from the ground beneath one to the I ual, the amount already spent and the amount still left.
space around him. to people, institutions, atmosphere, * Mourning is a model of such an occupation of psychic
and the culture. This is the common background in lh*
space, a paradigm of how obsessive thoughts and memphenomena described by Freud in the oral stage (8), | ones related to psychic work that needs to be done
the attachment studies of Bowlby (9). in Mahler’s con­
crowd and consume the psychic capacity. Traumatic
tributions on separation-individuation (10), the effect
memories of any kind encroach on this psychic time­
of motherlessness on the primates studied by
space and reduce its available quantity; this is why psy­
low (11), and in the natural experiments on human e
chic traumata age people.
fams studied and documented by Spitz in cases of
i have been treating a woman in her mid-seventies
rasmus resulting from early and massive deple­
^d have discovered that her apparent senility is due
tion (12).
..
•jot to an organic aging process but to the repression of
Not only did the ground of the Buffalo Creek v
ccades of a traumatic life. She had told herself—she
literally sink beneath the feel of its inhabitants, ini _
jought
this---------out with clarity7 UIIUU
through
her foggy memo2
rv
in e
fall nv<
ing the most primeval regression man can expene^
ntint usess,ons that nuu
had a Iiypuuiiv
hypnotic quality—uiai
that one
she uid
did
but when the survivors reached solid high
want to remember any part of her married life of
they were again deposited on an insecure teri?lP’, pr.
®se to 50 years. The volume and intensity of the traua social “envelope.”—an intriguing term used )
ro lc memories being repressed left her almost no
Kai Erikson—of unfamiliar space. The trauma l
f°r normal *’v*ng. She had by now* assumed the
not end, it merely changed. There are stra’11
' ' ticalUre’
menlaHy and physically, of a diffuse cormata (13). shock traumata (14). cumulative
• md’ flr?phy. without evidence, either neurological or
mala (15). and sudden overwhelming disruptive
yj .°8,cal. of any organic syndrome nor even conThe stimulus barrier can be bent as well as re!1^,
L ‘/ounngly ot cerebrovascular disease. She was like a
this point, the trauma of the survivors change
j?
£• acute, traumatic amnesia, except that this was

chronic, old, and massive. Her mental state undulated
dramatically with the emergence and rerepression of
forbidden thoughts. This poignant clinical experience
has made me wonder about the general psycho­
pathology of “old age.”
How much space will the Buffalo Creek experience
occupy in the minds of the survivors in their future
lives? We routinely treat patients who react to a de­
prived childhood by sacrificing a certain percentage of
their psychic lives. I have treated a patient who has oc­
cupied perhaps a quarter or a third of her free associa­
tions with obsessive preoccupation over her screaming
mother: her thoughts are similarly occupied outside of
the analysis. Another of my patients has been unable
to enjoy his current life because of the constant crowd­
ing of his psychic space by the coalesced memories of
the threats of castration that pervaded his tortured
childhood. I have pointed out elsewhere (17) the role
of such chronic traumata in producing the cacophony
of human relationships in ordinary' life.
These situations represent fairly common devel­
opmental traumata. How much more of a role do cata­
clysmic traumata like the Buffalo Creek disaster play?
What will be the long-term effects of the vivid, massive
“death imprint” described by Lifton and Olson (1)?
What will be the effects on children in whom death anx­
iety has been violently added to the normal anxieties
of separation and castration? It seems likely to me that
their memories will repeal the accumulated traumata
over lime like a long-acting timed-release capsule.
There was an element in this disaster that is not
present in truly natural catastrophic events, which
serves to explain further why the “Buffalo Creek syn­
drome” is not limited to reactions to external events,
but rather reflects added internal idiosyncratic forces.
I am referring to the human element, the thought and
the accusation that this horrible occurrence could have
been prevented. Unlike a natural disaster such as a tor­
nado. where inanimate forces of nature are solely re­
sponsible. the human object was involved in the Buffalo
Creek Flood, which arouses impulses of aggression
and retaliation. Channels for discharging these im­
pulses do not keep pace with the amount and quality of
the impulses aroused. The ego is bombarded from two
directions, and feelings of rage, impotence, anxiety.
guilt, and depression are added to the usual responses
to disaster.
The more external normalcy returns, the more will
traumatic neuroses and psychoneuroses be in a recip­
rocal relationship to each other. The residual trauma
will stimulate individual neuroses, and latent neuroses
will feed upon and perpetuate (he traumatic state.
Such restitutional movements are already evident in
the survivors and will increase with passing time.
Phobias, obsessions and depressions, and private anx­
ieties and conflicts have already been noted by various
observers, and survivors’ dreams are beginning to re­
veal their predisaster concerns.
There are other more subtle unknowns to cloud the
future. What happens when a traumatic effect merges
Am J Psychiatry 133:3. March 1976

315

over time into a traumatophilia? Such an outcome can
represent a repetition compulsion not in the service of
mastery but to satisfy a sense of guilt or a need for pun­
ishment, a trauma that is absorbed and utilized by the
psychic forces “beyond the pleasure principle” (18).
Or what will be the result when the pleasure formulae
or safety mechanisims themselves become altered and
individually fashioned as a result of the traumatic expe­
rience? 1 am reminded of a patient who was traumatically raped and now finds her husband and all other
men to whom she turns passive and weak. Or a patient
who, from a traumatic rejection in her first love, has
come to no longer believe in love. /Xnother patient,
similarly hurt, now feels “I’ll never again have a best
friend.” What will be the effects of the life-threatening
insult at Buffalo Creek, seen by the survivors as a re­
sult of neglect by people in authority, on trust, love,
and object relations? One can hardly begin to tell, but
one can be prepared so as not to be surprised.
In surveying this event and the reports that have
been presented in this section, we should not overlook
the effects of the studies themselves on the 625 survi­
vor-plaintiffs evaluated. Aside from the legal result,
the interest displayed by caring individuals from the so­
ciety outside the valley probably introduced a thera­
peutic influence, however circumscribed. This influ­
ence might be compared to the effects on a therapeutic
ward of the mere announcement of a program of treat­
ment. However, there may also be negative effects:
divisiveness has been introduced in the valley. Just as
the untreated “control ward” suffers by comparison
with the therapeutic community, those survivors who
were not among the litigants may feel left out and dis­
criminated against.
While an important and unprecedented legal deci­
sion has been achieved that greatly extends the defini­
tion of psychic trauma following an external event, the
full implications of the human phenomenon described
in this section cannot be estimated. Anyone who is
lost, hurt, or otherwise affected under traumatic cir­
cumstances affects others in an endless chain that is at­
tenuated only by emotional distance. It would be illu­
sory to believe that it is within our power or profes­
sional expertise to accurately describe ethical
guidelines for the rectification of the linear progress of
traumatic effects. I recently knew of an elderly couple
who were being displaced from their home for the
building of a federal project. During the process, the
husband, distraught over the dislocation, suffered a fa­

tal heart attack. What can we say or what
do about the effects on his wife? Or the child
chain of others? There are more questions th
answer. We must work side by side with the^^^sociology, philosophy, and all thinking and'f’^
people. No one or no group has a corner on
on wisdom.
eIWc$c.
REFERENCES
Lifton RJ. Olson E: The human meaning of total d'
chiatry (in press)
saslcr«
Rangell L: The metapsychology of psychic trauma ;n D
Trauma. Edited by Furst SS. New York, Basic BooU nv
51-S4
WKS’,%7.prl
Hartmann H: Ego Psychology and the Problem of \i.
lion (1939). New York, International Universities Press ]<£ '
4 Freud S. Inhibitions, symptoms and anxiety (1926), inTh p
plete Psychological Works, standard ed, vol 20. Translated
edited by Strachey J. London, Hogarth Press, 1959,pp75~|^'
5. Rangell L: A further attempt to resolve the “problem ol
iety." J Am Psychoanal Asso 16:371-404, 1968
6. Rangell L: The psychology of poise—with a special elaborai- on the psychic significance of the snout or perioral region Irf
Psychoanal 35:313-333. 1954
7. Rangell L: The quest for ground in human motivation. Un-\
lished manuscript. Presented at the meeting of the West Cv ■;
Psychoanalytic Societies, San Francisco, Calif, Oct 29,1955
8. Freud S: Three essays on the theory of sexuality (1905), in Tb-r
Complete Psychological Works, standard ed, vol 7. Translate
and edited by Strachey J London. Hogarth Press, 1953, pp jJL
245
9. Bowlby J; Attachment and Loss, vol 1: Attachment. NewYoA
Basic Books. 1969
10. Mahler MS: On Human Symbiosis and the Vicissitudes of Ir^rviduation. New York, International Universities Press, 1968
II. Harlow HF: Social deprivation in monkeys. Sci Am, 207 (5).
136.1962
12. Spitz RA: Hospitalism: an inquiry into the genesis of psychlaiftconditions in early childhood. Psychoanal Study Child l;53-7<
1945
13. Sandler J Trauma strain, and development, in PsytlW
Trauma. Edited by Furst SS. New York, Basic Books, 1967. r?
154-174
.1
14. Kris E: The recovery of childhood memories in psychoanalyse
Psychoanal Study Child 11:54—88, 1956
15. Khan MMR: The concept of cumulative trauma. PsyvhoJ—
Study Child 18:286-306, 1963
~
16. Kns M: Discussion presented at the Symposium on In anTrauma. Psychoanalytic Research and Development
New York. April 3-5, 1964
17. Rangell L: On the cacophony of human relations. Psyc 03
42:325-348. 1973
.
r t.L.
18. Freud S: Beyond the pleasure principle (1920), in The 0 •
Psychological Works, standard ed, vol 18. Translate
ed by Strachey J. London, Hogarth Press, 1955, PP

COMMUNICATIONS

>rbon Monoxide Encephalopathy: Need for Appropriate
treatment
• vK0Y GINSBURG, M.D., AND JOHN ROMANO, M.D.

ike authors describe severe psychiatric and
^urological sequelae in a patient who suffered carbon
onoxide poisoning as a result of a suicide attempt. A
tpvleivofthe literature revealed that 15 to 40% of
piiyffors of carbon monoxide poisoning develop
.■■uropsychiatric symptoms, often following a period
■fapparent recover}'. The authors advocate an
digressive treatment approach to carbon monoxide
rwoning, emphasize the diagnostic value of
extensive laboratory testing, and suggest that 2 to 4
xcks of bedrest may prevent delayed
Wiropsychiatric sequelae.

’ Recent observation of a patient with carbon monoxpoisoning drew our attention to the great variety of
^Urological and psychiatric symptoms in this disorder
to the lack of clarity concerning its clinical course
-^treatment. This paper describes the clinical course
u a patient with carbon monoxide encephalopathy, rej’cjvs some of the major findings from the literature,
*■'’ suggests some new approaches to treatment.

-Ase report
a 59-year-old housewife of Italian extraction.
•’ e depressed in June of 1973 and tried to commit sui^hiatrvV,Q^ Was ^one ,llc au(hors were with the Department of

■ A^wl of
Memorial Hospital. University of Rochester
'N’iurg
ed,cine ar»d Dentistry. Rochester. N.Y.. where Dr.
jr-'owin p\v k^S0CKlte Res*dent and U S. Public Health Service
■ ’^’Crsitv P^,a,ry’ a-ntl ^r- Romano is currently Distinguished
Nidation Fni|S?r 01 Psychiatry. Dr. Ginsburg is now a Grant
Behnv; i'U 13sychopharmacology. Department of Psychiarenrirw0™ Sc,ence« Stanford University. Palo Alto. Calif.
Univfrc-r,eC1Uf^ls 10
Romano at the Department of Psy•
ersny of Rochester. Rochester. N.Y. 14620.
*^ohnS?r^Ul? ,l^c 10 ’hank Drs. Robert Jovnt. Lowell Lapham.
. ,rauss for reviewing the manuscript.’

316

Am J Psychiatry 133:3. March 1976

cide by car exhaust inhalation. A neighbor who was a regis­
tered nurse investigated within an hour and found the patient
cyanotic and unresponsive. She was taken to the nearest hos­
pital emergency room, where she was stuporous but not com­
atose, and was not “cherry red.” Neurological examination
was unremarkable, and a carboxyhemoglobin level was not
obtained. An EEG and brain scan were within normal limits.
There was no history of neurological or psychiatric illness.
After admission the patient became more alert but ap­
peared depressed and could not concentrate. She was given
three electroconvulsive treatments within a week. At first
the patient seemed less depressed, but then she became in­
creasingly confused and withdrawn, refused to eat, and de­
veloped stereotyped picking movements. Three more ECT
treatments were given 3 weeks after admission, but the
patient’s confusion increased. Because of the unclear nature
of her illness, she was transferred to Strong Memorial Hospi­
tal for further evaluation.
A physical examination on admission revealed a mule, un­
cooperative patient with intermittent posturing. She respond­
ed with body movements to some commands but would not
open her eyes or talk. The only positive physical or neurolog­
ical finding was a bizarre gait: the patient would stand in
place and make small shuffling movements with her feet
while moving her body in a clockwise rotation.
Laboratory’ tests revealed that the patient’s hematocrit
was 35% and the hemoglobin revealed beta-thalassemia.
Electrolyte levels, calcium, phosphorous, blood urea nitro­
gen, serum glutamic oxalacetic transaminase, lactic dehy­
drogenase, alkaline phosphatase, creatinine, total protein, al­
bumin, glucose, uric acid, urinalysis, serology for syphilis.
T-4 by Murphy Pattee. brain scan, and skull X-rays were all
within normal limits. A lumbar puncture revealed normal
opening and closing pressures and no cells; cerebrospinal
fluid protein and glucose levels were within normal limits.
Electroencephalogram on admission and repeated five times
since to the present revealed persistent symmetrical mono­
rhythmic three-cycle per second activity which was only
present during drowsiness.
w
The patient spent most of her 4 months in the hospital on
the floor, silting, rocking, and staring blankly. She occasion­
ally responded by giving her name in a faint whisper but oth­
erwise would not talk to the nurses or her physicians. She
often defecated in bed. and was sometimes physically aggres-

Arn J Psychiatry 133:3, March 1976

317

;o£CIAL SECTION; Disaster at Buffalo Creek

family and Character Change at Buffalo Creek
l.

TiTCHENER. M.D.. AND FREDERIC T. KAPP, M.D.

^-(hiatric evaluation teams used observation* <».*’
family interaction and psychoanalytically oriented
individual interviews to study the psychological
aficrefficts of the 1972 Buffalo Creek disaster, a tidal
^oveofsiudge and black water released by the
u/llapse of a slag waste dam. 1'rau mafic neurotic
fractions were found in 80C’c of the survivors.
Underlying the clinical picture were unresolved grief.
wrvivor shame, and feelings of impotent rage and
hopelessness. These clinicalfindings had persistedfor
ihr two years since the flood, and a definite symptom
complex labeled the “Buffalo Creek syndrome" was
pervasive. The methods used by the survivors to cope
dth the overwhelming impact of the disaster—firstorder defenses, undoing, psychological conservatism,
and dehumanization—actually preserved their
tymptoms and caused disabling character changes.

On February 26, 1972, an enormous slag dam gave
and unleashed thousands of tons of water and
Mack mud on the Buffalo Creek valley in southern
^est Virginia. This Appalachian tidal wave destroyed
f'erjihing in its path, killing 125 people and leaving
"AW homeless and carrying away human bodies,
wes, trailers, cars, and other debris. It expended its
,oree in no more than 15 minutes at any one point in
ll* IH-mile-long valley.
below the dam and the tipple of the Buffalo MinCompany stood the town of Saunders; there was
\ trace of this town minutes after the black water
e ^ough the dam. The sides of the valley are
Point, and the wall of water and mud catrom side to side, miraculously sparing some

IK

l?c P?lh an"ual meeting of the American Psychiatric
Anaheim, Calif., May 5-9, 1975.

arc Professors, Department of Psychiatry,
'■’COba V229,c,nnau McdicaI Center, 234 Goodman St., Cincin-

homes but destroying many others as it slammed down
the valley.
The wall of water sped through 14 mining hamlets
with names like Crites. Becco. Lur.dale. and Pardee.
hitting their schools, churches, taverns, stores, and
homes, leaving no trace of some and damaging nearly
ah. The sides of the valley become less steep and it
spreads out. so the black sludge and water became
more of a “flash Hood" at Amherstdale and just an
overflow at Man, where it reached the Guyandotte Riv
er.
None of the settlements in Buffalo Creek which had
a total population of 4.OOQ-5.OOO inhabitants were in­
corporated. There was no governmental organization
beyond the commercial structures provided by post of­
fices, schools, and churches. There are five deep
mines in operation and evidence of siripmining is ev­
erywhere. In spite of the stripping, the ugly oppies, the
dozen or so huge black heaps of waste, the railroad
and highway construction, it is still a beautiful valley.
and young adults there will tell you it was once much
more beautiful, with pleasant homes and gardens
where there are now primarily mobile homes, h* w.s
and'lsa middle-class.area. Nearly all families are sup­
ported by employment in the coal mines m in the sup­
porting industries and services. There is an accepted
'(but not documented) belief that this valley had not
had the degree of emigration of young people that
typified others like It since the Depression.
There.had been rumors for years that the dam would
give way. but hundreds of people reported ihe> did not
believe it had really happened until a few moments af­
ter the fearsome’sight and sound of the advancing wa­
ter. Alt the survivors know that the time 6t me darn
break (8:00 a.m. on a Saturda> morning) was fmlu­
nate. Few people*were down in the road, and the chil­
dren were not in dr waiting for the school buses. Nev­
ertheless, 125 were killed, and most lost their homes
and possessions.
Subsequently, a group of 654 survivors pt thi •. disas­
ter from 160 families began a legal action against the

Am J Psychiatry 131:3. March IV/6

295

company that owned the dam. This group contacted
the law firm of Arnold & Porter in Washington. D.C.,
and a legal team headed by Mr Gerald Stern traveled
to the area to interview survivors. His observations.of
the psychological effects of the disaster and a summary
of the litigation are presented in “From Chaos to Re­
sponsibility” in this section. 'I he law firm first con­
tacted Robert J. Lifton. M.D.. who assessed “The Hu. man Meaning of Total Disaster” (I), and Kai Erikson,
♦ Ph.D.. whose observations of the situation in the com’ munity arc presented in “Loss of Commonality at Buf­
falo Creek.” The suit was settled in July 1974 for $13.5
million of which $6 million was for psychological
damages.
The legal team then retained one of us (J.L.T.) to or­
ganize a group of experts to,interview the survivors
and assess for the court the psychological impairment
they had suffered as a result of the flood. This paper
presents our findings on the severity and duration of
these psychological effects, a symptom complex we
have labeled the. “Buffalo Creek syndrome.” The size
and composition of the evaluation teams varied with •
the nature of the families assigned to them. A full-sized
team consisted of a general psychiatrist, a chi id psychi­
atrist. and two psychologists or case workers. These
teams did their work in the valley itself, visiting the re­
spondents' mobile homes and those houses that were
still standing.
We conducted a pilot study consisting of interviews
of 50 survivors in June of 1973. The court then directed
that all of the survivor-plaintiffs be interviewed, as all
W'ere bringing suit separately. These evaluations were
carried out on several long weekends in the soring of
1974.
We began each evaluation with a family interview in
which we asked the survivors to talk about their expe­
riences on the “day of the black water” and during the
weeks and months that followed. As they talked, we
w'ere able to see beyond the immediate clinical phe­
nomena to these people's underlying feelings and their
ways of coping w ith them. The family sessions were
followed by psychoanalytically oriented individual in­
terview's w'ith each family member, conducted in back­
yards, living rooms, or on porches.

EVALUATION FINDINGS'

Disabling psychiatric symptoms such as anxiety, de­
pression. changes in character and lifestyle, and malad­
justments and developmental problems in children
uere evident more than 2 years after the disaster in
over 90% of the individuals we interviewed. We asked
ourselves whether we w'ere examining people who
were presenting major symptomatology and character
problems that resulted from basically weak ego struc­
tures and who were using the disaster in order to win a
large settlement from the mining company. Our an­
swer was and is “no.” In our evaluations, we wit­
nessed difficult and prolonged struggles with powerful
296

Am J Psychiatry 133:3. March 1976

feelings and ideas aroused by the traumatic exp<r j
of
t hr’71
is nstcr and
and the
the very
verv uneven
Uneven attempts
attemnu
of the
disaster
, f'f r
vivors to reorganize themselves and redevelop
tercd coping and adaptive mechanisms. 1 he dffectj
sociated with the catastrophe and its aftermath, *
as the psychological and social ways these*
chose to deal with them, must be seeri against th
ground of the universal crises of human develop^ i
The attendant threats of separation, abandon^ <
castration, and death—residuals of the developm^
crises of separation and individuation—provided^
context for the- meaning of the catastrophe |q the
vors (2, 3);
'
We found a definite clinical syndrome in the m
vors of the Buffalo Creek disaster that arose fromMJ
the immediate impact of the catastrophe on e~ch
.
vidua! and the subsequent disruption of the conin* ?
nity and that affected everyone living there. Weiing |
predisposed by previous experiences to be
[
tized by pathogenic forces as destructive andawes^ '
as the Buffalo Creek catastrophe. Variations in theeb* J
ical picture resulted from individual differences i >'■
modes of processing and reorganizing the traumatic« »
perience (4).
A clear pattern emerged from our evaluations w
analyses. A traumatic neurotic syndrome was due
nosed in more than 80% of the survivor-plaintiffs,
changes in character structure were equally
spread. These changes, although they were attempt!»<
readjustment, occasionally resulted in maladjusim l
in the social sense and always went in the direction i ?
psychologically disabling limitations.
Character changes represent the stabilizing iw
sis, the psychologically hardening and fixating co» g
sequences of the catastrophe. We found conscious^ >
latent meanings and understandings and
;
standings of the disaster and its aftermath, all of wk* jj
were associated with the feelings and conflicts^* <
by the trauma. The result of this was changes inch* 5
relations and attitudes toward the self. We delink
various processes of reorganization—attempts
|
ting personality functions back together—-that
j
reeled toward reintegration and resumption of ***|
traumatized life.
...
We shall indicate below how this personalityJ
nization, which was so aimed at prevention ofs
ring experience of the traumatic state, actuJIy1
fered with flexible and effective recovery and tlw» * served symptom patterns and forced change
way of life.

i

5

SYMPTOMS AND CHARACTER CHANGES

During the first days and on into th*
months after the disaster, the survivors
organization and sluggishness in thinking
$
making. They complained of having
\ f
trolling their emotions. These problems r
emotional outbursts to the simple inability10

.
;

■ • imc <ic^cribC(1 lransicnJ hallucinations and de^Alniosl all reported anxiety, grief, and dc<;Cvcrc sleep disturbances and nightmares.
anxiety was manifested in obsessions and
water, wind. rain, and any other remindAn' ^c disaster could recur. Occasionally these obdisturbances coalesced and became a group
^ 'xJnenon. For instance, the wife of a community
^'never slept when he was asleep so that one of
^uoiild always be on the alert. On rainy nights,

received phone calls regarding rumors that anwas about to give way. He would then take
%c and spend the night sitting .on the supposedly
^/rned dam. guarded by others to protect him from
over the loss of relatives, friends, possessions,
j mementos such as family Bibles, as well as the
ha of the feeling of commonality discussed by Dr.
was widespread. For many, unreso’ved grief
,rej into depressive symptoms, ideation, and behavand some developed a depressive lifestyle (5). In
■-me individuals, depression was channeled into a
nJc range of somatic complaints, with probable inrtcases in the incidence of duodenal ulcer and hyper­
tension.

Many of these people have become listless, apathet­
ic nd less social since the disaster. They cling to their
families, lack ambition, and are disinterested in former
bobbies and sports. These changes have led to an over­
all limitation of essential expression, a lack of zest for
»od:and recreation, and despair about ever again re­
aming the lifestyle they once had.

NOUGHTS, FANTASIES, AND FEELINGS AROUSED
BY THE DISASTER

The survivors referred to the disaster as “the end of
irne” or “the end of everything." and noted that “No
one who was not there could ever really know what
happened.” They were haunted by visual memories
•mJ emotions associated with the drownings of rela­
tes and friends and of blackened bodies and parts of
Mies that were uncovered for weeks after the flood.
All of the survivors had to confront the loss of a
W of personal invulnerability. The former feeling of
wmfortand assurance about the continuity of life had
^nded partly on magical beliefs that horrible things
l;^jhis disaster do not happen to one; that they could
■’ .occur in nice sane communities in this country.
‘•^.n the impossible happened. The shock was over*“v--aingand a new outlook took form that reflected a
u<fjgfrom the former sense of invulnerability to pcs oemptiness, and hopelessness, We heard such
^nxmts as “Nothing counts anymore"; “What s
■ now?“; and “Since we lost everything, what s
;> bc gained by trying?” The’disaster took on the
chaos, helplessness, and death, giving rise
;:c
oi personal insignificance.
ucc other reactions contributed to depressive

symptoms and lifestyles. The first was a feclms r-f im­
potent rage over the destruction to life, property. and'a
way of life. Thi.s rage is an explosion of feeling acur.st
the attack on the self. The victim has little outlet for
his anger or hope of satisfaction. This feeling had spe­
cial intensity because the destruction in Buffalo Creek
was man-made; it was caused by the inexplicable in­
humanity of a powerful corporation that gave terrible
evidence of not caring about its employees or their
community. The survivors' guilt was expressed in a
wide variety of derivative feelings about the self, in
symptoms, in character change, and in behavior
through self-denial and lack of hope These conflicts
were not resolved, and their persistence took form in
identification w'ith the dead in dreams, actions, and at­
titude toward life (6).
No one behaves exactly as he thinks he should in a
hazardous situation, particularly in a situation he is
powerless to influence. Memory becomes clouded md
feelings of helplessness influence the why one looks
back on the traumatic event. Many people in Buffalo
Creek manifested “survivor shame." One of the ac­
tual heroes of Buffalo Creek, who had been extraordi-'
narily effective in mobilizing and leading rescue ef­
forts. was able to fend off depression and anxiety in the
first four weeks after the flood while he worked relent­
lessly to help others. When he attempted to return to
his former work, he was overwhelmed by anxiety and
depression connected with feelings of inadequacy. He
developed a phobia connected with his job. began
drinking heavily, and became clinically depressed.
We noted in many people a sense of isolation and
feelings of alienation combined with an increased need
for vigilance and a tightening of the ring around the
family. Former feelings of self-assurance, sociability,
trust in neighbors, and enjoyment of community activi­
ties disappeared. The isolation we observed’clinically
can be explained by the depressive reactions, the
chronic anger, the loss of a way. of life, and tne dis­
solution of self-confidence and basic (rust.
It has been hypothesized that the emotional distur­
bances aroused in the victims of disaster quickly dis­
appear after the stress has subsided. Our work at Buf­
falo Creek .suggests (hat this is rarely the case; the man­
ifestations of a traumatic neurosis do no* subside with
the receding flood waters. The effects may seem to dis­
appear quickly if one is not alert to the subtle coveringup behavior of the victims of a psychic trauma.
Lifton’and Olson (1) explain the persistence of trau­
matic effects on the basis cf an analysis ot the nature or
the disaster itself and the special psychological effects
of such an experience. Our study compler'jcnts their
work by showing how the effects oi a traumatic event
are preserved by the modes of adaptation
whelming fears apd hopelessness. I he very adempt*.
to protect self, family, and community from a recur­
rence of helplessness and loss are responsible tor tne
individual and societal neurosis and restrictive •'.?./r<;*.ter change. Our combined approach has been io now
what occurred, the nature of its impact on the p--.yx.Tx.
\n< JxPsych^iry 133:3. March i

f AV.iL'

(.HA RAC IER UlAM.E.

and xxhy its effects became chronic.
One can analyze the sequential formation of the
“Buffalo Creek syndrome” as follows. The disaster aqtjv'd’ed intense affects, including fear. rage, and help­
lessness. These waves of external and internal overstimulation overran the stimulus barrier and .the ego’s
capacity to integrate the traumatic experience and con­
trol and discharge the affects. There was temporary
ego collapse and the ego was damaged. We estimate
that reorganization of the ego in whole or in part re­
quired 6 to 24 months. The course of the reorganiza­
tion and the way individuals processed these affects,
memories, and the associated conflicts made the ulti­
mate difference in outcome. The survivors’ course of
ego reorganization and their manner of processing the
disaster experience were reflected in their symptoms
and character change (2,4, 7, 8). The variables in the
reconstitution of the personalities of the survivors we
studied can be divided into four categories.

PERSONALITY RECONSTRUCT ION

First-Order Defenses
There was a continuous and steady deployment of a
coordinated system of character-shaping first-order de­
fenses (9), i.e., projection, externalization, and denial
Projection defended against-feelings of guilt and shame
aroused by the disaster. The constructors of the dam,
state and federal agency representatives, and intru­
sions from the society outside of the valley became ob­
jects of increasing anger and fear. Externalization
blocked awareness of this anger and fear as well as
feelings of helplessness. Individuals became sensitive
to and acutely observant of the anxiety and unrest in
their families, coworkers, and the social group. Denial
defended against recognition that the self had been
changed in any way; it disavowed the feeling of help­
lessness and the awareness of psychological scar­
ring (10). Denial enabled people to believe that while
much had happened to them and to those around them,
they had not been affected in an essential way, and
that they were the same people they had been before
the flood. This defensive complex projected against
emotions that would have otherwise reactivated mem­
ories and feelings of fright and helplessness. It was ori­
ented to the present and functioned continuously, pre­
venting the gradual recollection and discharge of the
feeling of helplessness and blocking recognition of the
irrationality of shame and guilt. Although one can nev­
er be the same after an experience with disaster, this
defensive system provides a desperate sort of status
quo that substitutes for personal regrowth. .

Efforts to "Undo" the Disaster Experience

Undoing consisted of efforts to change the past by
reliving the disaster in dreams and other ways, giving
it a diilerent outcome. Survivors’ memories of the
early postdisaster period contained fantasies of magi­
cal reliving of childhood stresses. Attempts at undoing
298

Am J Psychiatry I.U.J, March 1976

also appeared in strange, symbolic reenactm^
f
trauma, sometimes leading to violence to t
others. Freudian repetition compulsion
* I
placed by the mechanism of undoing,
I
fense against facing the anxiety assoc:ated JLkt I
trauma.
’ .
™
3
The dreams of the survivors during the penod •/
tial shock and (in many cases) for months th^Ju •
were fantasied attempts to relive the disastci. but /I *
a less painful outcome. At first, such dreams\ere'
successful and people awoke from them in terror *
time passed, the dreams were modified. Although^
affects remained frightening, the subject matter
from the flood to previous, often iong-past. imaged
chaos and threats of annihilation. The dreams rm
'
er involved direct reliving of the disaster but inS
depicted stressful episodes that represented rep<h.
tions of normal developmental crises such as sepur*
tion, abandonment, castration, and guilt (I, 8).
The regressive process in these traumatic neuron
differs from that in other psychoneuroses. The goal*
not gratification or mastery of infantile conflicts, fa j
rather an attempt to work through recent trauma
anxiety. The anxieties of infantile and childhood
phases of personality development become the faw
of undoing because these problems had been succtv
fully contained or overcome; dreams of long-p&u
stresses that had been mastered provided reassure
to the survivors that they could overcome the rem F
trauma. Just as “examination dreams’’ attempt todr* |
with anticipatory anxiety by fantasying a past sift" |
that had been overcome, dreams that are charade r
istic of traumatic neuroses attempt to neutralize to
overwhelming anxiety of the traumatic event by rw^ |
ing successful past adaptations to difficult situation* j
Each of these phases of dealing with normal stmt •
reproduced in the survivors’ dreams, is common!®;
all persons as part of human epigenesis. Each
crisis included not only a deprivation of instinctual^
mand but also a threat to the continuity of life
|
ter aspect is what makes them particularly suitabK j
undoing the threat of annihilation experienced «* ;j
trauma like the Buffalo Creek disaster.
Because undoing relies on omnipotence anJm*# 4
it prevents recognition of the influence of gu”1’ •
shameful attitudes toward the self. The undoing
ess—aimed at fending off fearful anticipation of
!rence of the traumatic experience—is a continuing
stacle to the relatively nonanxious acceptance
man vulnerability that is necessary for readapt*11 i

The Psychological Emphasis on Survival

Psychological conservatism consistedlo
of situations that might raise the level of excit
ther internally or externally. Il is the d
•
psychological counterpart of the psychic num ‘
scribed by Lifton and Olson (1). We porcerieP .^
conservation as mental activity designed to co
havior by banking energies, surrendering amm
ducing enthusiasm, dampening socializing

j discouraging novel experience (-11). PsyI conservatism accepts survival as the only
j^ence. It is a trade-off: the individual acf*' Hnc'lessness in the present to prevent help-in the future, as if to say. “Better to live withi*4*0. than not to live at all." Psychological confunctions as if the disaster . will recur
^2l'X thus totally distorting an individual's view
If you live as though the dreaded uncer^•< certain to occur, you become a psychic con15
•^jitncnizolion
' ^humanization affects one’s view of life and hurtlationships and has a direct toxic effect on per‘^Itv function. Every disaster places man at the
v of forces beyond his control. The feeling of
h/i a rawn °f fate *s dchumnmzuog—people feel
-hodt appeal, beyond empathy, and cannot be peror assuaged. When the catastrophe is mandehumanization is magnified. In Buffalo <Teek,
was the terrible realization that other human
brings had planned, built, and maintained an unsound
kn and then acted irresponsibly and uncaringly after
5e resulting disaster. The defense of dehumanization
sinexample of identification with the aggressor. It der-'oyed pride and joy in being human.
Dehumanization may be mitigated by corrective ex­
periences with empathic people in the helping profes­
sions and private and public institutions. Collaboration
with other sufferers in a law suit against the dehumaniz­
ing aggressor may also be useful in that it can ensure
that it will be more difficult for such organizations to
risk human life in the future.

CONCLUSIONS

Il is our belief that the reactions we have described
re not those of individuals with weak egos who were
exaggerating their complaints in order to win a.law
siit. These people, by and large, did not exaggerate
ihtir complaints; the majority minimized or denied
6em. If their reactions were merely exacerbations of
^neurotic symptoms and problems, we would have
^countered a wider range of psychoneurotic reac,j»s. Although there were differences in modes of reWise, the uniformity of the psychological reactions
apprising the Buffalo Creek syndrome was striking.
wranalyses of dreams and early memories, reported

v^here (12, 13), support the consistency and severof this syndrome.

found a definable clinical entity characterized by
* ^-delineated group of clinical symptoms and
*^8 in character and lifestyle that were related to

clear-cut psychopathogenic factors precipitated by the
disaster. All of us have in our unconscious memory
systems encounters with the various forms of dread
that a disaster reawakens. There need not be any pre­
existing neurosis for the Buffalo Creek syndrome to be­
come disabling and chronic. All of us are susceptible
to traumatic neurosis and the “death imprint.”
To be successful in treating these traumatic neuro­
ses, we must substitute active recall and working
through of the painful memories of helplessness and
separation for counterphobic behavior, passive repro­
duction of the experience in dreams, and magical ways
of living out and reenacting the trauma. The change
from passive to active experience, from reproduction
to re-creation is the essential thing. By linking longpast and previously worked-through childhood anx­
ieties v'ith the overwhelming anxieties aroused by the
recent disaster, we may be able to strengthen the ego
of the individual with a traumatic neurosis. Through
his relationship with helping and capable persons and
institutions, the disaster survivor is given an opportu­
nity for regrowth, much like the ego development that
came about as the individual met and dealt with the
normal crises of growing up.

REFERENCES

1. Lifton RJ, Olson E: The human meaning of total disaster. Psy­
chiatry (in press)
2. Furst SS(ed): Psychic Trauma. New York. Basic Books. 1967
3. Freud S: Inhibitions, symptoms and anxiety (1926). in The Com­
plete Psychological Works, standard ed, vol 20. Translated and
edited by Strachy J. London, Hogarth Press, 1959, pp 77-175
4. Titchener JL. Ross WD: Acute or chronic stress as determ:nants of behavior, character and neurosis, in American Hand­
book of Psychiatry, 2nd ed, vol 3. Edited by Arieti S, B.ady EB;
Areti S, ediior-in-chief. New York, Basic Books, 1974. pp 39-60
5. Engel GL: Anxiety and depressive-withdrawal. Int J Psychoanal 43:89-97, 1962 ■
6. Lifton RJ: Death in Life: Survivors of Hiroshima. New York,
Random House. 1967 •
7. Horowitz M: Stress response syndromes. Arch Gen Psychiatry
31:768—7.81. 1974
8. Rangcll L: A further attempt to resolve the -problem of anx­
iety." J Am Psychoanal Assoc 16:371-404, 1968
9. Kemberg O: The treatment of patients with borderline person­
ality organization. In’ J Psychoanal 49:600-610. 1968
10. Trunnell Ei-Holt W: The concept of denial or disavowal. J Am
Psychoanal Assoc 22:767-784, 1974
11. Luchterhand EG: Sociological approaches to massive stress in
natural and man-made, disaster. Int Psychiatry Clin 8:24-53,
1971 .
12. Titchener JL, Kapp FT, Winget C: The .Buffalo Creek syn­
drome; symptoms and character change after a major disaster,
in Emergency Medical and Disaster Aid: A Source Book. Edit­
ed by Parad HJ, Resnik HLP. Parad LG. Bowie. Md, Charles
Press, 1975
‘ ’ •
• , . ,
13. Gottschalk LA, Gleser GC: The Measurement of Psychological
States Through the Content Analysis of Verbal Behavior. Berke­
ley, University of California Press, 1969

Am J Psychiatry 133:3, March 1976

299

DM

From Chaos to Responsibility
BY GERA’.D M. STERVL.L.B.

7/i\- litigation. initiated by the 625 survivors of the
Buffalo Creek flood who refused to settle with thi coal
company claims office was a landmark case. For the
first time, individuals who were not present at the
scene of a disaster were allowed to recover for mental
injuries. Psychic impairment, the term coinedfor
these injuries, was found in virtually all of the
survivor-plaintiffs. In an out of court settlement, the
sur\ ivors were awarded $13.5 million, $6 million of
which was distributed on the basis of a point system as
compensation for the psychological damages.

The destruction of the Buffalo Creek community
gave rise almost immediately to the creation of a new
kind of group—a community of 625 survivors from 160
families who joined together to sue the coal company
that owned the dam. Thes’e individuals, unlike the ma­
jority of the survivors, refused to settle their cases at
the coal company claims'oflice. 1,: .lead, they sought
legal help outside the state of West Virginia.
This group contacted Arnold & Porter, a law firm in
Washington, D.C., and we agreed to represent them.1
We immediately went to Buffalo Creek and spent
many days interviewing survivors at Charlie Cowan’s
gas station, one of the few buildings remaining in the
Buffalo Creek valley. Mr. Cowan v/as the leader of the
citizens' committee that called to ask for our legal
help. The survivors’ legal right to sue for traditional
damages was clear; they could sue for lost property,
for their homes and all their possessions, for physical
injuries, or for the death of family members. However,
it soon became apparent that they also had significant
mental injuries, and it was not so clear whether the law
would permit recovery for these damages.
The magnitude and significance of these mental and
emotional damages hit me personally when I inter­
viewed a coal miner who had lost his 22- mlh-old son
and his pregnant wife in the disaster. The ilood waters
caught this family asleep in their home. As the wife dis­
appeared in the black water, she cried out to her hus­
band to save their son. He held the child tightly and
Presented at the 128th annual meeting of the American Psychiatric
AsxKia’.iun, Anaheim. Calif.. May 5-9. 1975
Mr. Stern n a partner in the law firm of Arnold & Porter. 1229 19th
St , N.W., V,'a\hmgton, DC. 20036.

'A much more detailed report of my observations and involvement
in Ims case u dl be presented in a forthcoming work (1).

Vm)

Am J Psychiatry 133:3, March 1976

■
tried to struggle to safety, but houses and debris •
tered him arid the child as they were Washed
down the valley. Somewhere in this maelstrom.
i
his grip on his son, who disappeared forever into
black waters. Evertually, this man was able v
struggle to safety, although his body was badlv
ated by the jagged wood in the water. At the link la '
terviewed him, my own son was exactly 22 nxwh
oldv I was terribly upset by his story and decided to '
to expand the. lawsuit to recover for his mental ag*.
and for the mental suffering of others like him.
We contacted Robert J. Lifton, M.D , who had
ied the survivors of Hiroshima. He agreed to interview
a number of our clients and to help us explain to ft •
court in lay terms the common psychiatric injuriad
these survivors. He also suggested that we ask Dr.lU i
Erikson, whose findings are reported in this section.^
study the sociological aspects of this disaster. Wd
these two men as our principal experts, we articular
for the court and for the coal company defendant ww \
we called the “psychic impairment’’ damages sufftni
by every one of our survivor-clients.
We coined the term “psychic impairment” Io • g
elude both the psychiatric damages identified by Dr “
Lifton and the loss of communality found by Dr fri \
son. We wanted to avoid alleging that the survive*
suffered mental illness and felt that the phrase “psycta ;
impairment’’ had a less negative connotation.
a
Eventually we also employed a team of psychiatry I
. from the University of Cincinnati, some of whine W-jj
ings are also presented in this section, to mien*’ |
each of out clients. The coal company also retain^ j
psychiatrist—.actually, a physician whose
field was neurosurgery—and a young psycholojpM |
training, who also examined each of the 625 men.*0* y
en, and children involved in the lawsuit.
t
Our psychiatric studies indicated that alm<*1
I
the survivors were suffering from psychiatnc * J.
of varying degrees as a result of this disaster, in*
trast, the physician retained by the coal c0,n^?^
termined that the survivors generally suffer*
-•
transient situational disturbances that he fe”
»•
have abated soon after the disaster. The fact
•
survivors still had disturbances when he ex _ j
them some 18 months after the disaster led h‘,n
sume almost invariably ihal these-people wefe
ing primarily from preexisting menial c5)n^,nur,n'*
Under traditional legal principles, if the *
had been physically injured by the flood wan
a result, had suffered psychiatric damages. ”
recover full monetary damages unless
v

f
jitions were merely the result of an aggrava<^pn\istinp mental conditions. Our physicians
^hai th*-' snn ivors' psychiatric damages were
f^c l’’saslcr- The coal company physi"’reed. This is a dispute juries must often rctf^eS involving psychiatric damages.
interesting and more difficult legal ques■^^nted b>’ lfr,s casc was whctfrcr tbe survivors
‘ff-ovci monetary damages at all. even if the jury
t al| of the survivors' present psychiatric inwere* caused by the disaster. Traditionally the
snot permit recovery for psychiatric injury on
!
round that the injury can be proven to have
by another person or persons. For exmother who secs a truck run over and kill her
.Lv suffer severe psychialric’trauma. but the law
!
^a||y has denied the mother recovery for her
i suffering, terming her a mere bystander. Needless
■an individual who sees a friend killed has even
** fence in the courts of recovering for mental suf-

kuhiscase. most of the survivors were not seriousinjured physically. Many of them had run up the
vofthe valley just ahead of the flood waters, and
of them were not even in the valley at the time of
'disaster. For example, one survivor was visiting in
Mexico, another was in Florida, some were in
and others were in hospitals in nearby tow ns out[he valley. Nevertheless, we insisted that all of
•'‘(survivors were entitled to recover for their mental
'■ Jering, even if they suffered no physical injury, saw
i|fbeard no relative or friend in peril, or were absent
•.«the valley on the day of the disaster. We argued
each resident of the valley, even those who were
lit there during the flood, was a direct victim of the
j.Jcompany’s reckless conduct and not merely a by-

| uMer.
j The court agreed with this contention and held that
jiwA'ivors—even those who were outside the valley
k'thctime of the disaster—could collect for mental in­

GEP.A! D M. S . P EN-

jury if we could convince the jury that the coal compa­
ny’s conduct was reckless (i.c., more than merely neg­
ligent), and that this reckless conduct caused the survi­
vors’ mental suffering (2).
Once the coal company realized that the court would
not dismiss the psychic impairment claims of any of
the 625 survivor-plaintiffs in this lawsuit, we reached a
settlement for a total of $13.5 million, to be divided
among the survivors by their own attorneys We first
calculated the payments for real and personal property
losses, for wrongful deaths, lost wages, other miscella­
neous claims, expenses, and legal fees. This left ap­
proximately $6 million to be distributed for psychic im­
pairment. We distributed this money to the 625 plain­
tiffs using a point system based on their immediate
involvement with the disaster, their medical disability,
their loss of community.ties, and the disruption of their
way of life. Each survivor received between $7,500
and $10,000 after all expenses and legal fees were de­
ducted. Approximately $2 million of the $6 million was
placed directly in a.trust fund for the 224 children un­
der the age of 18 who were plaintiffs in the case.
The court’s approval of this substantial monetary
settlement for survivors’ psychic impairment estab­
lished a significant legal precedent for recovery in cas­
es of mental suffering. The court was not bound by con­
cepts of space and time. Instead, the court recognized
that it is the permanence of loss, rather than the wit­
nessing of the disaster, that causes mental suffering.
In other words, the court (and eventually the coal
company) was persuaded that the relief provided by
the law should be determined not by narrow traditional
legal principles but by fairly modern psychiatric and
sociological principles.
REFERENCES

1. Stern GM: The Buffalo Creek Disaster. New York, Random
House (in press)
2. Prince, et al v Pittston, 63 Federal Rules Decisions 28 (SD, W
Va (1974)]

Am J Psychiatry 133:3. March 1976

301

Loss of Communality at Buffalo Creek
HyKAIT. EHIKSON. PH.D.

7 he survivors of the Buffalo Creek disaster suffered
both individual and collective trauma, the latter being
reflected in their loss of communality. Human
relationships in this community had been derived from
traditional bonds of kinship and neighborliness. When
forced to give up these long-standing ties with familiar
places and people, the survivors experienced
demoralization, disorientation, and loss of
connection. Stripped of the support they had received
from their community, they became apathetic and
seemed to have forgotten how to care for one another.
This was apparently a'community that was stronger .
than the sum of its parts, and these parts—the survivors
of the Buffalo Creek flo.od—are now having great
difficulty finding the personal resources to replace the
energy and direction, they had once found in their
Community.

The trauma experienced by the survivors of the Buf­
falo Creek disaster can be conceptualized as having
two related but distinguishable facets—the individual
trauma and the collective trauma.
By individual trauma, I mean a blow to the psyche
that breaks through one’s defenses so suddenly and
with such force that one cannot respond effectively.
As the other papers in this section make abundantly
clear, the Buffalo Creek survivors experienced just
such a blow. They suffered deep shock as a result of
their exposure to so much death and destruction, and
they withdrew into themselves, feeling numbed,
afraid, vulnerable, and very alone.
By collective trauma, I mean a blow to the tissues of
social life that damages the bonds linking people to­
gether and impairs the prevailing sense of commu­
nality. The collective trauma works its way slowly and
even insidiously into the awareness of those who suf­
fer from it; thus it does not have the quality of sudden­
ness usually associated with the word “trauma.” It is,
however, a form of shock—a gradual realization that
the community no longer exists as a source of nurturance and that a pari of the self has disappeared. “I”
continue to exist, although damaged and maybe even
permanently changed. “You” continue to exist, alPrcKrnird at the IlHih annua) meeting of the American Psychiatric
Ashociai'on, Anaheim, Calif., May 5-9, 1975.
Dr Erikson is Professor of Sociology and Chair, American Studies
Program, Yale University, New Haven, Conn. 06520.

302

Am J Psychiatry 133:3. March 1976

though distant and hard to relate to. But “we” noirr>
er exist as a connected pair or as linked cells in a
communal body.
The two traumas are closely related, of count h!
they are distinct in the sense that cither ofihemQ>
take place in the absence of the other. For instanccif
person who suffers deep psychic wounds as thema \
of an automobile accident, but who never losnc^ ?•
tact with his community, can be said to suffer froon :
dividual trauma. A person whose feelings of weIRtq i
begin to wither because the surrounding community*
stripped away and no longer offers a base of supp^
(as is known to have happened in certain slum ch
ance projects) can be said to suffer from collects
trauma. In most large-scale human disasters.
course, the two traumas occur jointly and are expe'g
• enced as two halves of a continuous whole. For
purposes of this paper, however, it is worthwhile tot * 1
sist on the distinction at least briefly, partly becauv i
alerts us to look for the degree to which thepsydu
impairment observed in settings like Buffalo Creek o’? 1
be attributed to loss of communality, and partly N i
cause it underscores the point that it is difficult L'
people to recover from the effects of individual in- •
when the community on which they have depended*g
mains fragmented.
*
I am proposing, then, that many of the traiMi;
symptoms experienced by the people of Buffal ’ Cr# ;;
are as much a reaction to the shock of being sep*^'.
from a meaningful community base as to the acluJ, *,
saster itself.
It should be noted that “community” mean*®*
more in Buffalo Creek than it does in most other
of the United States. Much has been said in the1^
ture on Appalachia about the importance of
and neighborliness in mountain society. AlthW J
true that coal camps like the ones along Buffalo t I
differ in many ways from the typical Appalachofl_ j
munity, the people of Buffalo Creek were none’
joined together in the close and intimate bond’1
ciologists call gemeinschaft. The rhythms of*' ■
life were largely set by the community in IP**^;
governed by long-standing traditions, and t
,
linkages by which people were connected*
,
strong. In Buffalo Creek, tightly knit comnwwL
were considered the natural or^er of thing’lope in which people live.
Long stories must be made short in a PJ* v
like this, so I will simply summarize my
ing that the human communities along
were essentially destroyed by the disaster at*

qcod itself forced the residents of the holn»inihcr of nearby refugee camps from
,* , were, for a variety of reasons, unable to esresult was that the majority of the Buffalo
< ^^ivers remained in the general vicinity of
^Hbonies. working in familiar mines, traveling
'Miliar reads. trading in familiar stores, attend‘■f'jmrschools, and sometimes worshipping in fa■^‘’ -hiirches. However, the people were scattered
z' " ' less at random throughout the vicinity—virtu$lt\ndcd in the spots to which they had been
S^bv the flood—and this meant that old bonds of
‘^and neighborhood, which had always dependphysical proximity, were effectively severed.
i
no longer related to one another in old and ac* ^ed wavs. The threads of the social fabric had

'■ '-■•'ped.
! / year after the disaster (which is roughly when
.
of the authors represented in this section first en| tiered these people) visitors to Buffalo Creek were
| ^by a number of behavioral manifestations that
j ^med to be exhibited by almost everyone in the valI and. for that matter, continue to this day. Sc eral
i /these manifestations are discussed elsewhere in this
| tftion. I would like to mention three by way of il.lus-ziing a larger point.

fmoralization

I First, the survivors clearly suffer from a state of se­
vere demoralization, both in the sense that they have
wtmuch personal morale and in the sense that they
toe lost (or so they fear) most of their moral anchors.
The lack of morale is reflected in a profound apathy,
deeling that the world has more or less come to an
end and that there are no longer any sound reasons for
king anything. People are drained of energy and con­
flict!, not just because they are still stunned by the
uvagery of the flood but because activity of any kind
wmstohave lost much of its direction and purpose in
absence of a confirming community surround.
Mfeel that the ground has been pulled out from un^them, that the context in which they had worked,
W, and cared for others has more or less dis‘Pftared. One survivor said,
J don (know. I just got to the point where I just more or
don't care. I don't have no ambition to do the things I
^dtodo. I used to try to keep things up. But anymore I
Wdon’i. It seems I just do enough to get by, to make it
^one more day. It seems like I just lost everything at
• like the bottom just dropped, out of everything.

k^PP°se the Clinical term for this state of mind

. **depression, but one can hardly escape the im> .'on that it is, at least in part, a reaction to the am^:!cs^P°sl<l>saster life in the valley. The survipera^y oul of place and uprooted. They had
• rcalized the extent to which they relied on the

rest of the community to reflect a sense of security and
well-being, or how much they depended on others to
supply them with a point of reference.
The people of Buffalo Creek are also haunted by a
suspicion that moral standards are beginning to col­
lapse all over the valley, and in some ways it would
appeal that they are right. As is so often the case, the
forms of misbehavior people find cropping up in their
midst arc exactly those about which they arc most sen-.
sitivc. I he use of alcohol, always a sensitive problem
in Appalachian society, has apparently increased, and
there arc rumors everywhere that drugs have found
their way into the valley. The theft rate has also gone
up. and theft has always been viewed in the mountains
as a sure index of social disorganization. The crudest
cut of all, however, is that younger people seem to be
slipping away from parental control and arc becoming
involved in nameless delinquencies. This is an ex­
tremely disturbing development in a culture so de­
voted to the family and so concerned about generation­
al continuity.
This apparent collapse of conventional morality has
a number of curious aspects. For one thing, observers
generally feel that there is much less deviation from
community norms than the local people seem to fear.
Moreover, there is an interesting incongruity in these
reports of immorality—one gets the impression that
virtually everyone is coming into contact now with per­
sons of lower moral stature than they did formerly.
This, of and by itself, does not make very much logis­
tical sense. One survivor said flatly,
The people of Buffalo Creek tended to group themselves
together; therefore the breaking up of the old communities
threw all kinds of different people together. At the risk of
sounding superior, I feel we are living amidst people with
lower moral values than us.
Perhaps this is true—but where did all these sordid
people come from? .Whatever else people, may say
about their new neighbors in the refugee camps, they
are also from Buffalo Creek, and it is hard to avoid the
suspicion that their perceived immorality has as much
to do with their newness as with their actual behavior.
It may be that relative strangers are almost by defini­
tion less "moral” than familiar neighbors. To live with-’
in a tightly knit community is to make allowances for
behavior that might -otherwise look deviant. New
neighbors do not qualify for this clemency—not yet, at
least—and to that extent, their very unfamiliarity may
seem to hint at vice all by itself.
The collapse of morality in Buffalo Creek thus seems
to have two edges. We.have sufficient evidence to be­
lieve that certain fornis ofdeviarion are actually on the
increase, although this’is a difficult thing to measure ac­
curately. ’However, we also have reason to believe
that the breakdown of accustomed neighborhood pat­
terns and the scattering of people into uniamihar new
groupings has increa'sed the level ol suspicion people
feel toward one another.
Am J Psychiatry 133:3, March 1976

303

DISORILN FATION

connection—a sense of separation from other
t
For better or worse, the people of the hollaw * i
deeply enmeshed in the tissues of their commJ^ ; ?
they drew their very being from them. When
f
sues were stripped away by the disaster, people? i ‘
themselves exposed and alone, suddenly depend^/ I
their personal resources. The cruel fact is that
?
the survivors proved to have few resources—k
cause they lacked the heart or the competence,
cause they had spent so many years placing their
ties in the service of the larger community that iv
did not really know how to mobilize them for their
purposes.
Many people feel that they have lost meaningful^
nection with themselves. Much of their app^
former strength was actually the reflected strength 4
'
the community, and they are learning—to their vet
great discomfort—that they cannot maintain an ends?
ing sense of self when separated from that larger m
sue. They find that they are not very good at nuhj ;
individual decisions, getting along with others, ore
tablishing themselves as separate persons in the *
sence of a supportive surround. “Lonesome" hii
word many of them use, and they do not use it to ma j
. the lack of human company. One woman whobi
moved to the center of a large neighboring town sub
her new home: “It is like being all alone in the midi :
of a desert.’’ A man who continued to live in his dir!
aged home on Buffalo Creek said,

The people of Buffalo Ci cek arc also clearly suffer­
ing from a prolonged sense of disorientation. It has of­
ten been no’cd that the survivors of a disaster arc like­
ly to be dazed and < fanned, unable to .locate them­
selves meaningfully in time and space. Time seems to
stop for them; places and objects suddenly seem transi­
tory. They have trouble finding stable points of refercnee in the surrounding.tcrrain. both physical and hu­
man. to help fix their position and orient their behav­
ior. All of this can be understood as a natural
consequence of shock, but the people of Buffalo Creek
seem to have continued to experience this sense of dis­
location for months and even years after the crisis.
“We find ourselves standing, not knowing exactly
which way to go or where to turn,” said one individ­
ual. Another survivor noted,-“We feel like we’re living
in a strange and different place, even though it is just a
few miles up Buffalo Creek from where we were.”
Professional observers who have gone into the val­
ley on medical or research errands have noted repeat­
edly how frequently .the survivors seem to forget
simple bits of everyday information—the names of
close friends, their own telephone numbers, etc.
People are often unable to locate themselves spatially,
even when they are staring at* fixed landmarks they
have known all their lives. It is not at all uncommon
for them to answer factual questions about time—their
own age or their children’s grade in school—as if histo­
ry had indeed stopped on the date of the disaster. In
general, people all over the valley live with a lasting
sense of being out of place, disconnected, and torn
loose from their moorings, and this feeling has far out­
lasted the initial trauma of the catastrophe itself.
People normally learn who they are and where they
are by taking soundings from their fellows. As jf em­
ploying a subtle form of radar, we probe other people
in our immediate environment with looks, gestures,
and words, hoping to learn something about ourselves •
from the signals we get in return. But when there are
no reliable objects off of whom to bounce those explor­
atory probes, people have a -hard time calculating
where they stand in relation to the rest of the world. In
a very real sense, they come to feel that they are not
whole persons, not entirely human, because they do
not know how to position themselves in a larger com­
munal setting.
Well, I just don’t feel like the same person. I feel like I
live in a different world. I don’t have no home no more. I
don’t feel normal anymore. I mean, sometimes I just won­
der it 1 m a human being. 1 just feel like I don’t have no
triends in the world, nobody cares for me, nobody knows
I even exist.

LOSS OF CONNECTION

A third manifestation.of the disaster’s psychosocial
effects is a condition that might be described as loss of
304

Am J /'^ychiairy 133:3, March 1976

Well, there is a difference in my condition. Like
body being in a strange world with nobody around I*
don’t know nobody. You walk the floor or look for hw
body you know to talk to. and you don’t have nobody

In addition, the inability of people to come to ter®’
with their own individual isolation is counterpouM <
by an inability to relate to others on a one-to-one b** ■
Human relations along Buffalo Creek took their jh*
from the expectations that pressed in on them fro® •
all sides like a mold: they were regulated by ll*c*
toms of the neighborhood, the ways of the comnwM ,|
and the traditions of the family. When that
stripped away, long-standing relationships**®*/
to disintegrate. This is true of everyday acquaints
but it is doubly—and painfully—true of manuF .
Wives and husbands discovered that they did not
■
how to nourish one another, make decisions.
*
to engage in satisfactory conversations
ij
community was no longer there to provide a.cofl 2
and set a rhythm. There has been a sharp
|
in the divorce rate, but that statistical in<x'
|
not begin to express the difficulties the
j
have relating to their spouses. It is almost as if c * r.
nal forces of one sort or another had knit
together by holding them in a kind of
i
field, but when the forces of that field be^^,
sipate, family members became scattered lik* , v
individual particles. Each individual nurses w ‘ y t
own hurts and tends to his or her own busing
j;
&

£.

KAI 7. ERIKSON

. how io care for one another or lo-coordir^’^rinPy. because the context that lent sub
.-<*
meaning to their relationships has disf Two survivors put it this way:

on in the family is a loncr now, a person
F>'h -h of,,s’s Acting his own battles. We just don't
i w care for each other anymore.
f milY is not whal they was. They're not the same
f’c | don’t know how you'd put this, but before there
in the home. But now- it seems like each one is a
person, an individual by himself or herself, and
.^xjust nothing there.

r -«]y the difficulty people experience in sustaining
relationships extends beyond marriages and famM^oul into the rest of the valley. In places like BufVereek. relationships are part of the natural or­
bing inherited by birth or acquired by physical
dimity-and the very idea of “making" friends or
*f^nii.g” relationships is hard for these people to uni xMand and harder still for them to achieve.
itOne result of all the problems I have described is
I the community (what remains of it) seems to nave
Lm its most significant quality—the power it gave
j
to care for one another in moments of need, to
:j losole one another in moments of distress, and to pro­
pone another in moments of danger. In retrospect,

it is apparent that the community was indeed stronger
than the sum of its parts in this regard. When the
people of Buffalo Creek were clustered together in the
embrace of a community, they were capable of remark­
able acts of generosity; when they tried to relate io
one another as separate individuals, they found that
they could no longer mobilize the energy to care. One
woman summed it up in a phrase: “It seems like the
caring part of our lives is gone.’’

CONCLUSIONS

To end with an oversimplified metaphor, I would
suggest that the people of Buffalo Creek were accus­
tomed to placing their individual energies and re­
sources at the disposal of the larger collectivity—the
communal store, as it were—and then drawing on
those reserves when the demands of everyday life
made this necessary. When the community more or
less disappeared, as it did after the disaster, people
found that they could not take advantage of the
energies they once invested in that communal store.
They found themselves almost empty of feeling, devoid
of affection, and lacking all confidence and assurance.
It-is as if the cells had supplied raw energy to the whole
body but did not have the means to convert that ener­
gy into usable, personal resources once the body was
no longer there to process it.

Am j Psychiatry 133:3. March 1976

3o5

.,.D^

ij-

Children of Disaster: Clinical Observations at Buffalo* Greek
BY C. JANET NEWMAN. M.D.

f

Most of the 224 children who were survivor-plaintiffs
of the Buffalo Creek disaster were emotionally
impaired by their experiences. The majorfactors
contributing to this impairment were the child's
developmental level at the time of the flood, his
perceptions of the reactions of his family, and his
direct exposures to the disaster. The author focuses on
children under 12, describing their responses to
jantasy-eliciting techniques and their observed
behavior after the flood compared with developmental
norms for their age and reports of their previous
behavior. These children share a modified sense of .
reality, increased vulnerability to future stresses,
altered senses of the power of the self, and early
awareness offragmentation and death. These factors
could lead to * after-trauma" in later life if they
cannot make the necessary adaptations and/or do
not receive special help to deal with the traumas.

the nature of the disaster, and the meaning of the
suit.
We used such fantasy-eliciting techniques m
wishes,” “draw a person,” and story telling,
adolescent children were asked to draw a pictuit
the flood as they remembered it. Special educ^g
from the Children’s Psychiatric Center
school data to confirm or correct parental impress* I
of major losses of academic achievement dutp|
sisted long after the disaster.
The effects of the disaster on children can beattrU’
uted to three major factors: 1) their developmental In-J
el at the time of the disaster, 2) their perceptions oM 8
family’s reactions to the disaster, and 3) their directs I
posures to the disaster. This paper illustrates each k
tor and examines their numerous interactions.

DEVELOPMENTAL LEVEL

The developmental factor will be illustrated h utrasting the clinical evidence gathered from 3 Inc* |
As part of the psychiatric evaluation of the survivors
age children and 2 preschoolers. A depressed.
i
of the Buffalo Creek flood, 224 children were inter­
less, and guilt-ridden 11-year-old boy who haddiK* |
viewed and evaluated; most were found to be signifi­
ered human remains in his immediate environment^
cantly or severely emotionally impaired by theirexperiter the flood drew a starkly realistic picture of aw*'
ences during and after the flood. In this papei 1 will fo­
pletely submerged trailer that contained from
cus on children under the age of 12, using as a sample
screaming for help. A house above the trailer
j,
11 of the children I assessed personally.
filled with water, and a panic-stricken figure tried4 S
As has been described elsewhere in this section, the
keep afloat amidst the waves and debris of the ^2
evaluation procedure began with an interview of the to­
waters. Drawings by 2 younger children showed
tal family and proceeded to individual interviews. In
interviews of mothers, outlines of each child’s devel­ * sible symbolic meaning of mountain' to ApP:»U’^l
children, i.e., the provision of humanlike fund^’?
opmental history and functionihg before and after the
cradling and life sustenance (this contrasts with U* j
disaster were obtained. This information was passed
and Olson's remarks about the “overall en\in^^>,
on to the child psychiatrists in order to help us place
including nature itself, as threatening and lethal L |
each child in his parents’ developmental perspective.
An 8-year-old boy with a chronic anxiety rc* *
Children were usually seen in their own rooms. They
drew the “house-mountain” depicted in
were encouraged to recall-flu ir own experiences of the
life-saving compensation for his temporarily
flood; such expressions had often been submerged or
helpless parents. The drawing represents a tr^
inhibited amidst the outpourings of more vocal family
regression to a wishful merging of parental scvix*
members. 1 he issues we discussed included past and
to a house-mountain in a partially beneficent/11^
present family life, personal feelings, school experi­
ment. A 7-year-old child also indicated secu.n.?l<^
ences, and the childrens’ perceptions of future hopes,
ture in a picture of himself climbing a steep h"
his mother and aunt. He drew a tree **** t
J version of a paper presented at the 12Kth annual meeting of
the Araencon Psychiatric Association, Anaheim. Calif ’day 5-9,
saying, “This is a tree I can hang onto if I
1975.
1
Nature otters support when human being*
,
Dr Neuman is Director, Day Hospital Elementary Unit, i hildren's
seem helpless. In Appalachia, the mountain**^ ;
Psychiatnc ('enter. .114U Harvey Ave . Cincinnati. Ohio 45229. and
not only slag heaps and flood threats but ian»*
j
AsuKiatc Profcsso* of ( hild Psychiatry. Department of Psychiatry,
university of ( incinnati College of Medicine.
suring security.
|

j

306

Am j Psychiatry 133:3. March W

Drawing of 8 "House-Mount

■vsjtM

traiFef is destroyed, while the safe '‘mountain" acquires door

pfmdxn.

The experiences of 2 younger boys will be described
ip isolate developmental factors at the preschool level.

-ry, who was 3 years old at the time of (he disaster
afjat the time of our interview, was the only son
id favorite child of his mother's second marriage. He
.aihe first to awaken on (he morning of the flood.
ding out his window, he viewed the uncanny and
jciplexing sight of a house moving down the creek.
insure whether this was real or a dream, he awakened
b parents, conveying more cognitive bewilderment
Wright or anxiety. He remembered saying. “Come
id look!” The parents rose instantly and managed to
''oate the family to safety on high ground just in
’ae.
J*o years after the flood, his mother told us that
kwy frequently slept in the same bed with her and
‘stdlobe rocked, although he had rarely needed this
■T< of attention before the disaster. She reported that
jfofier talked about the houses and cars that had
^’edby in the flood and how they “went boom!” I
fol because Henry was the first to awaken and, in
‘*nsc’ rescued his family, they regarded him with
gratitude and admii tiion. During the family inHenry was hyperactive—he was friendly but
In his individual interview, he recalled seeing
going by his window ano asking his parents
^ntnd!ookdenied being scared, but said, “I
'*e
Henry also remembered seeing a
ln?
on top of an upside-down store that
”ng downstream. He said, “1 didn’t like that
*1 hated it.”
••'-JtrV
picture started with a creek as an alr ^t circle. Then a curving line showed “how

the creek goes here.” A lounded object near the path
of the flood conveyed its force: as he explained. “The
flood threw this lock.” Then Henry spontaneously
drew a 3-sidcd rectangular but bottomless form nearby
w ith windows' tor eyes, explaining that this was a
person killed in (he flood. Most children Henry's age.
drawing their first human figures, use crude circles for
heads oi hcad-and-body combinations, in a precircle
phase they use primitive scribble-strokes to indicate
human figures. Henry had already manifested a capac­
ity for drawing circles but had applied this ski!! only to
his icpiescalation of (he flood, using a bottomless rec­
tangle with window's for eyes as a human figure. Such
faces or human figures were interpreted as con­
densations of humans with buildings, stimulated by
this 3-ycar-old s view ot a peculiarly and perhaps
awesomely floating house and other buildings, includ­
ing the one the screaming baby was on. His flood expe­
rience started as he awakened from sleep, and sorting
dream from waking perception and reality is typically
difficult for young children. Developmentally. Henry
w as at a stage of tenuous differentiation of dream from
reality and animate from inanimate objects, and motil­
ity is the first characteristic differentiating living from
inanimate objects.
• To summarize, Henry’s drawing showed the human
figure as dehumanized and fused with a seemingly ani­
mated building. The bottomlessness of the human
face-figure suggests his lack of security, which was
shown clinically by hyperactivity and an excessive
need to be closer to his mother than he had been be­
fore. 'I'he circular flood moving huge rocks suggests
th. projection of superhuman powers to nature. His
barely developed abilities to separate animate from in­
animate and actuality, from fantasy or dreams help ,o
explain his current bewilderment, excessive anxiety,
and hyperactivity. His favored position in the family
and his role as “rescuer” have accentuated his sense
of narcissistic omnipotence, which allays his under­
lying feelings of helplessness ant’ anxiety. It is likely
that his problems of immaturity, anxiety, and devel­
opmental deviations in cognition will become more evi­
dent when he starts school.
Peter was interviewed 2 years after the disaster,
which occurred when he was 26 months old. His par­
ents reported that he had been a happy baby, devel­
oping at normal rate. His father, a chronically disabled
miner, described how the family scrambled tin the side
of the mountain behind their home and watched as
their house was swept away and a nearby bridge crum­
bled from, the force of the flood. .A frantic passerby
yelled to Peter’s father to aid in the rescue of two chil­
dren clinging to a floating mattress. As he ran to help,
his wife screamed for him to conn? back. Realizing (he
danger, he ran back to his own children and led.(Hem
to higher ground, can sing Peter on his chiomcally
weak back.
Since the disaster, .Peter cannot take a bath without
screaming, and he still wets the bee frequently and
screams in his sleep. He gets mad easily and always
Am ./ Psychiatry

Wc.rcA /*'76

*
want
* own u.n. Peter’* memories of (he flood inhi
vnj.cd concern
*
over *hc safety of his triends and an
vldcr brother'
*
** of his best friend. He referred to
Io
the "i'Ao k»d
*
on a mattress" and worried aloud wheth­
er “their daddy, he might jCst not want them. 1 his
must have represented hi
* own fears at the hands of
hrs own father, who did not save all children, limiting
* efforts to the rescue of his. own family. When
hi
asked about troubles or worries he said, perhaps stoic illy. “I den t be sad: that’s all." When asked what
would make him happy he said. “I don’t know , maybe
if my daddy was handy
Peter’s response to the three-wishes question was
touching and highly original and was probably related
to a 4-year-old * determination to ho|d on to reality,
with a resulting fear .of pretending, even for a mo­
ment: “I don't wish/' he said proudly. His drawings,
m ide at age 4. about his flood experience when he was
2 years old. should remind the reader of Henry, who,
although he was perfectly capable of draw ing good cir­
cles. drew a person aS a house with a rectangular botto nlcss face. Peter, although younger, is involved
w ith deeper, more sophisticated, more human views of
the disaster.
Peter’s first flood” picture included irregularly round
or os al outlines of w hat he then chose to call win­
dows—an "ugly" window, a ‘‘shoe" window, and a
“big" window. (Windows with view's of the creek be­
came highly important for many families.) As an after­
thought. Peter drew a longer shape and told me to
write “two kids on a mattress in the creek" within it. I
then said. “Let's do that one again on a bigger page.”
Peter drew a mattress and started to draw he 2 chil­
dren in the form of lines. However, in the process, he
appeared to convert (he children into 2 legs (one bare­
foot and one with a shoe)’ and then drew a body and a
head labeled “top." creating a total human figure. He
was influenced by the fact that his siblings were draw­
ing people. Figure 2 is Peter’s second drawing: the
writing is that of the interviewer during the process of
drawing and records Peter’s words. This is a powerful
condensation of a traumatic scene, combining his fa­
ther’s failure to save all of the endangered children,
particularly those on the mattress. These 2 children be­
came (he 2 legs of (he larger total human figure in the
picture. As with Henry, we see a variety of serious de­
velopmental interferences and emotional distortions in
Jhc development of perception and cognition as mani­
fested in tody image concepts.

FIGURE 2
A 4-Year-Old'i Pktur» of Two Lott Children Coodem«d tab
th® Human Figure

REACTIONS Base dos direct flood experiences

Marie uas the cute, articulate daughter of a strong
fuiher and a dominating hypertensive mother; she was
years old a». the time of the disaster. During the flood
wiuiaren

or lull barefoot in the ex; apt from the

a.uflcr-.J tfvUbUc.

**

Am J pi ry

h 1976

. •

I

1

Marie’s mother bundled her in blankets & j
her to shelter, never allowing the child to &
stages of the flood.
y&
During Marie’s interview, her “draw-u-J
*
0** |

I

C. JANET NEWMAN

smiling, childlike parents in flowered clothpicture, drawn from hearsay,’ seems
4 ^;-at firs1 glance. However, the bubbly clouds
were duplicates of the‘floral prints of the fa•^^bjrtand the mother's skirt in the draw-a-person
The houses stood high above the languid
^od the many bodies appeared mostly in cheer^Jicht positions. Only 2 small figures yelled,
exemplifies a child reacting to maternal
* tie$ reminding us of the children described by
Freud and Dorothy Burlingham in War and Chil^(2) who reacted far more strongly to maternal
f iio sthan to bombs.
major clue to the anxieties underlying the faLof pollyannarsh denial was Marie’s response to
fv<;pert Bird Fable, which elicits a child's story of
^12 baby bird who can fly a little will do if a strong
Mows the family nest from the tree, scattering
L toother and father and baby bird. Marie asked,
yere they all close together or were they far apart?”
jtbensaid. “What do you think?” Marie replied,

Mother makes another nest, with twigs, on a stronger
tanch. The little bird grows up to have a famih Or,
K)be the mommy bird might get sick or die, or a cat
eight eat her. Or maybe the little bird might get sick or
phoned. It might mistake weed-killer for seed. That
happen. Oh well, the little bird probably got old and
ben died.
lais story reveals a rapid descent from superficial
lei'ih into violent and even paranoid ideation, in­
king the death of both mother and baby by violence
dpoison. This rapid weakening of defenses reveals
ititi’svulnerability to and identification with a chronolly anxious mother, whose exacerbated anxieties
it had been intimately exposed to in the apparent
mice of being protected herself.
Rkhard, who was 7’/^ years old at the time of the di^r. was the middle child of 3, born to mature.partfi.On the day of the disaster, as soon as the water
nd fell, Richard and his father searched for relatives.
ty were concerned about the safety of Richard’s
sister, who had stayed overnight with a girl
’cd. The sight of the mutilated body of a boy Rich- ’
sage was shocking to both the child and his father.
l-Ud was described as a changed boy since the
”1 having become tense, nervous, talking little to
^Parents, and suffering from terrifying nightmares of
coming back from the black water to take
the spirit world. When interviewed, he said that
ktwal!y s.ept with a blackjack under his pillow.
guard’s flood picture conveyed a firm sense of
^•ta strong sense of form combined with creative
^hty. He drew a truck carrying 5 bodies wrapped
set against a background of a burning slag
a house with a large chunk missing. The sky
°^rcast and it was raining. His draw-a-person pic^dever-, strutting, colorful comic book character
^Pmfile, hows color, movement, and detail

$nd indicates creativity and ego strength. Despite en­
during strengths in peer relationships, good school per­
formance, and basically warm family tics. Richard has *.
a chronic traumatic anxiety reaction manifested bv
trembling hands, tension, inner tremulousness, diffi­
culty sleeping, and nightmares. In contrast to Marie.
who looks deceptively healthy and self-assured but
whose reawakened inner problems stem from close
ambivalent tics to a chronically anxious mother. Rich­
ard’s symptoms represent more purely a chronic overt
traumatic reaction to the disaster, in the context of
considerable ego strength.
David, 7 years old during the flood and 9 when inter­
viewed, was apparently well-adjusted before the disas­
ter. Afterward his grades fell, he tended to keep to him­
self, and got into fights. His most severe symptoms,
however, were crying in his sleep, sleep-talking
(saying he wants to “get home again”), and somnam­
bulism—he seems to be walking oat of the house. Al­
though others direct him back to bed,’he docs not
wake up during the'se episodes but appears frightened.
Since the disaster he has been wetting his bed several
times a night, something he did not do previously
In his interview he appeared attractive and coopera­
tive but quiet and somber. He did not recall the con­
tent of his sleepwalking episodes, although he vividly
remembers people screaming while they were drown­
ing during the .flood. David drew a bizarre person with
a strange colorless face looking backward and a bright­
ly multicolored body with feet pointing in the opposite
direction from the face (figure 3). Diagnostically, he
had symptoms of a traumatic neurosis with a dis­
sociative-type nysterical neurosis (exemplified by his
somnambulism) encapsulated within it. It seemed like­
ly that his trancclike sleepwalking was a repetition of
the original escape; this interpretation was supported
by his grotesque .drawing of a person whose profile,
while colorless, had a fixed smile and slightly quizzical
or puzzled eyes. Facial distortions and poor fit to the
body are evident in the picture.
David’s pathology Was focused and severe. Sleep­
walking usually occurs in stage 4 sleep when central
nervous system motoric inhibition of REM dreams
cannot occur (3). Certain types are called ‘‘somnambu­
listic trances” and may* represent physical reenact­
ments or abreactions pf traumatic situations (4). Da­
vid’s bizarre picture suggests an unconscious con­
nection between his sleepwalking state and his
conscious imagery.
Marie has become subtly but severely traumatized
through her direct relationship with a chronically anx-z
ious and flood-traumatized mother, while Richard and
David’s more conspicuous and overt traumatic reac­
tions stem more directly from their flood expeiicnees.
The contrasts in the symptom choices of Richard and
David are probably multiply related to their constitu­
tional backgrounds, developmental experiences pre­
ceding the trauma, and the exact circumstances of the
moment of gieatest trauma each experienced in the di­
saster.
Am J Psychiatry 133’3, March 1976

3<i9

(HH r»lf S nF DISASTf R

nCVRL 3
Drrwmg That SuggsUs a Link Between His Somnfim1 y
bfcwr*.
Owtsciovs Inxagvry

-<10

Ah: J p.^hiatry 13J.J. March 1976

OBSERVATIONS ON OTHER AGE GROUPS

I have not mentioned another group of
I
those who were in utcro during the flood. OfiCn . •
prcciousncss lies in having survivedthc pregnancy ?
frantic mother. Among their futiire stresses may unever-ending talcs or the silent allusions of thcf>A
about the disaster these children ne»er expend
7"
r, 1
The parents may sec them as mH""";lagicallyandprofou^
linked with the flood. These children, as wcl,aa^l
born later (who will also feel left out. yet involved!
be unpredictably but importantly influenced bytb^f
tastrophe.
Although this paper has focused on preadoltxw;
children, a few words, must be said about adoksceuf 1
special vulnerabilities to the psychological efTecihii
the disaster. Because the almost tota* community |
struction, the loss of commonality described
1
where in this section by Dr. Kai Erikson, was so A I
ruptive, especially to adolescents, they often fe
to choose between rebellious predelinquent I chin
or compliant social withdrawal. They suffered deer
but privately when their parents broke down undf
stress. For example, in one family, the favored oV
brother, who had been the “good one’’ before the#
saster, changed his behavior markedly—he missedl
days of school, threatened the teaching staff, was w
pended five times, and is currently on probation V fj
cause of his behavior. At home he sat up at nightapprhensively listening to rain or roared away on his nW
cycle. However, his next younger brother continue
to attend school regularly and made every effort toe ■<
centrate. The contrast between his very chaotic Ita
picture and a carefully drawn pink dove ofpciK’eita
his teacher had praised as “best in the class” ’h1*'
the range and confl’ct of his inner experiences.*^’
he has internalized, but with unknown emot**’
strains.
i
Creative expressions emerged in many cases.
a highly disturbed large family living in twotr."kn< ,
a state of chaos came a touching picture dra*i>ty*
li-year-old boy (figure 4). Denying the turbuk*'* < |
the flood, he drew an intellectually complex p*1* j
with excellent perspective that showed a trestk.
intersections, and a quiescent creek. He
“the road to where we used to live.” in the t' j
ground, brightly colored idyllic homes in
and orange nestled among the woods on the M
There were no people in the picture, but tb<r< ;
possibilities for human reconstruction. ^c l , \ h
matically split roads suggest important choke5Jmade, and the colorful homes in the backgti*^ |/
gest hope.
Finally, some older children did folio*’j
and psychiatric interviews with' great
i {
phistication. They recounted hopes of bcinf
and nurses, even though they were often
*
lems in their basic school courses. They
'7^
on safety regulations and dam construction|
projects and tried to master their experience'
i

Am J Psychiatry 133:3. March 1976

'A

ally- and mtcllcctually. 3 hey will never forget this expe--»cc and they will be watchful of all (he adults who
hr ' _■ :* ■’icipaied in it-: .♦hey either idealize or arc disij?j’>. ~-:c with parents and other adults. When they
grow ho. they uill wtfich th? world closely. They will
have learned enormously both in and out of school.
CONCLUSIONS

Children in traumatized families w'ithin a shattered
community form their own theories of a disaster from
their own reactions and their perceptions of the reac­
tions of their parents and other adults. Their concep­
tions are also influenced by the social, and legal proc­
essus associated with J he disaster. All of these factors
permanently affect their sense’of self in growing up.
The common heritage of most children of disaster is a
modified sense of reality, increased vulnerability to fu­
ture stresses, an altered sense of powers within the
self, and a precocious awareness of fragmentation and
death. In contrast to most of their parents, some of the

children manifested clear and enduring t-vxfo |
hopefulness and creativity, despite obvKiu$c- ’
limitations- in their ability to achieve spccifc3£
Their sense of hope existed sidc-by-side witS<Z |
signs of developmental limitations and seriouj^ ^*
gy. Indeed, the widening discrepancies between
sensitivities and academic achievement could le^ J
severe “after-trauma” in later life. They wouMr^l
unusual life adaptations or special help to rc^po^f
structively or creatively to the traumas they fad
gone.
REFERENCES

1.

Lifton RJ, Olson E: The human meaning of total dhwafc
chiatry (in press)
2. Freud A, Burlingham D: War and Children. New YortbJ
Willard, 1943, p 21
3. Kales A (ed): Sleep Physiology and Pathology. Phihdtlpfcj|
Lippincott Co, pp 111-112
4. West U: Dissociative reaction, in The Comprehensntft»J’
book of Psychiatry. Edited by Freedman AM, Kaplan HI I*1.'
more, Williams & Wilkins Co, 1967, pp 885-899

9- s

,.fUSsion

l^e Buffalo Creek Disaster: The Course of Psychic

.^kaNge'-um.d.

'"^contribution of the psychiatrist to the
d\'ofthe human disaster at Buffalo Creek
* wthe course ofpsychic trauma. The initial
^intrusion by the flood waters was followed by a
,J nhose of the traumatic cycle, the physical
^xCtion of the survivors, with disruption of their
’ riJ"and "surround." During this long
fluent period the level of trauma did not recede
Atpl rising, although at a slower pace. Distant
^tsofthc trauma may succeed the more immediate
r« The finite psychic space of the survivors is
touched upon by traumatic memories for an
'tfriie period of time, leaving fewer resources
Joblefo'normal effective living. The absorption
diverging oftraumatic stimuli into a traumatophilia
■vi still another potential p oblem. The
wcedented legal decision as to the linear effects of
'Tchic trauma on a succession of connected
yiduals will needfurther interdisciplinary'
silication.

address not only the inundation of psychic structures
in a horizontal sense but also the longitudinal effects of
the flood—the disturbed continuity with the past, the
shattering of the present, and the inescapable portents
for the future.
The work of the interdisciplinary evaluation team re­
tained by the law firm representing the 625 survivor­
plaintiffs to assess the psychological impact of this ca­
tastrophe has profound, implications, reflected in its ef­
fects on the social .decision-making process. The un­
precedented legal decision, reported elsewhere in this
section by Mr. Gerald Stern, permitted people who
w-ere not on the scene of an accident to be awarded rep­
arations for the psychic damages they suffered. The
principle acknowledged in this case could well shake
all'existing rules of the social order about the respon­
sibility of man to man.

THE FIRST phase: psychic numbness

To turn to the central focus about which psychia­
trists can reflect and from which other observations
will stem, the Buffalo Creek flood was a violent intru­
'Offering opinions on the overwhelming husion into the peaceful psychic life of the community
’jexperience of the Buffalo Creek disaster, the chal­
massively beyond the “average expectable environ­
et is lo separate our reactions of empathy and horment’’ (3). This eventuality was not, however, com­
‘Hwhich, as Lifton and Olson 11] have pointed out,
pletely unexpected—the people in the valley had long
•stquickly and painfully shared by all mental health
lived with this possibility and knew it could be pre­
^essionals who came to the valley after the disaster)
vented, but they said they had put it out of their minds.
td the potential contributions of our specific profesActually, it had been put not out but deeply in, had be­
expertise. Toward this end. I will focus on the
come part of their living unconscious. It was in some
•Anof psychic trauma (2), its nature and its effects,
ways like the earthquake situation in California but
•complement the findings of the interdisciplinary
of sociologists, psychologists, attorneys, and oth- ** worse and more constant The dam that finally broke
physically existed just above the valley and was visible
*ho took part in the evaluation of the effects of this
and ever present. Another difference, which added the
on ^ose who survived it.
makings of a latent’inner eruption to the potential ex­
7* articles in this section range from the individual
ternal occurrences, was-t'hat there were in the minds of
^collective, from the child to the adult, and from
valley residents people (the owners of the dam) who
^deepest inner effects to the widest outer con­
could and should have done something about the situ­
duces of this sudden, unassimilable disruption of
ation. Like-the cave-in of a coal mine in a community
'relationship to his physical world. These studies
that has always lived in dread of such an occurrence,
the flood had been part of the mental as well as the
physical geography of, Buffalo Creek, a feared event
•SJ11 ’J* J28th annual meeting of the American Psychiatric
buried in the minds of the people. The massive -con­
jAnaheim, Calif.. May 5-9, 1975.
vulsion of the physical world that took place on Febru­
Professor of Psychiatry, University of Califor­
ary 26, 1972, was a mental imprint come true. It was a
fe
. * School of Medicine, and immediate Past President
Psychoanalytic Association.. Address reprint
nightmare from which’.this time they did not awake.
at 456 North Carmelina Ave., Los Angeles,
The black .waters that roared through Buffalo Creek
Am J Psychiatry 133:3, March I97o

313

f

Cs/i

OF rs)< Hl^JRAt MA

•'t

tering, generally returns to his home to slant i
valley when the fantasied, feared, and repressed event
became reality could be *a.:d to have flooded the egos . and difficult precess of repair. His “ground,”4^1
ground into which the self can merge, is tfx s
of thoMi who lived through the disaster. All control
his security, the source of the nurturing
1
functions were overrun by the sudden influx; it was a
sustain the processes of reparation. This
maximum dosage per .unit rime, a psychological oversible in Buffalo Creek. The dazed survivors
ki’l. The result was universal and with a common base
turned not to their familiar ground but to
to all. the traumatic stale, the condition of psychic
strange surroundings. This may have been th
helplessness that the anxiety signal presages and that
possible course, but it was still depriving and fo*I
all ofthe ego’s defenses constantly work to prevent (4,
threatening. Rather than nurturance, the
‘ j *| his « as the phase of psychic numbness observed in
continued to face challenges-, for a long time and/y'
all of the studies of rhe survivors. The goal was merely
ing a raw and vulnerable state.
?j
to live through it. to survive. Each individual held on
In this double and almost death-dealing
to whoever or whatever was left. “Psychological
survivors repeated the experiences of other holoo*,!
conservatism.” which Drs. Titchcner and Kapp de­
known to our generation. Those who survived^*
scribe in “Family and Character Change at Buffalo
caped from Nazi Germany wandered into ncwb^-J
Creek.” served to reduce excitation; no farther stimuli
The survivors of the atom bomb returned toc^l
were wanted.
where their homes had been. Many South Asiamfol
This stage of psychic numbness, of apathy, with­
had to leave their land after having left their deal A
drawal. and sluggishness, was still visible when the
all of these cases, the survivors’ earth is also gw4
evaluation teams arrived in Buffalo Creek 2 years lat­
ter their fellow humans have disappeared.
er. Some of the observers were surprised that the trau­
Years ago, writing at another level and about
matic neufo.sis was still visible, but what evidence is
comfortable aspects of human troubles, I dcxnbf
there to assume that the residual or even basic effects
“attachment to ground” as the psychic prerequty; [
of so massive a trauma’would not last a lifetime? Psy­
chological testing of survivors of the Nazi holocaust
for the maintenance of the social state of poise vC .
has shown that after 30 years they still show such last­
The opposite condition, a wavering hold on one's o
ing effects as impairment in perceptual-cognitive func­
rounding psychic ground, results in a basic nwr ;
tioning. withdrawal from objects, inability to sustain
with the threat of crumbling and even annihilate«
close relationships, and other subtle and overt se­
the self. This is the source of the primitive anxiety lb ’
quelae.
people feel at the first threatening tremor of an w a
While the legal experts perhaps needed to be con­
quake. In the more mundane case of seaJcknoU|
fear has been said to be not that one will die, buttbl
cerned about the claim of preexisting slates, I would
one might not. Underlying both of these disiuitw*
prefer to maintain clarity and not to have to use the
states is an elemental anxiety that stems from 4* i
woid “impairment,” to blur the fact that there was
orientation in the relationship oi the organism to*^
loss, injury, and illness. The effects of the disaster
were as ravaging as an epidemic of typhus or plague,
earth under its feet.
5
In the course of ontogenetic development, if JI
which is similarly visited upon a city from without, and
the preexisting vulnerabilities in the hosts to receive
lionship extends from the ground beneath one to
space around him, to people, institutions, atnw'P^ J
the invading organisms are not an issue. The traumatic
and the culture. This is the common background^*?
neuroses overshadowed psychoneuroses. I do not
phenomena described by Freud in the ord sugc j
mean to say that there were no preexisting psycho­
the attacnmenl studies of Bowlby (9). in Mahler y*>
neuroses, but rather that they no longer had a chance
to assort themselves. This is an issue that has plagued
tributions on separation-individuaiion (10).
of motherlessiiess on the primates studied h.!
every psychiatrist w ho has served in the military. Com­
bat neuroses in their aCute phases are more uniform
low' (11), and in the natural experiments on huff f
than diflerent in their presenting syndromes; only later
fants studied and documented by Spitz in case^ ^
Can individual ditlerences reappear and assert them­
rasmus resulting from early and massive
a
selves again. During the years lu come, as normalcy
tion(I2).
j
returns to the Buflalo Creek survivors, they will have
Not only did the giound of the BiflaloGee
the luxury of becoming individually neurotic again.
literally sink beneath the feel of its inhabit^’
ing the most primeval regression n'an cane'l*
but when the survivors reached solid hig«
! HE SECOND PHASE: “GROUND** AND
they were again deposited on an insecure
’surround”
a social “envelope,”—an intriguing terui u*
•
Kai 1 j ikson—of unfamiliar space. The t»au,,u ( r.
Whit happened to this community in terms of in­
not end, it merely changed.* There are
coming traumatic stimuli did not slop with the cataclys­
mala (13), shock traumata (14), cumu
mic events o! that Satutday morning. As disorienting
mala (15), and sudden overwhelming d’sru^‘*
and tune-stopping as the flood was, n was only the first
I he stimulus barrier can be bent as web
phase. An individual who sutlers a loss, however shat­
this point, the trauma of the survivors
J
314

An, J piy(rk:Jlfy IJJJ

0

I 1.0 RAS'GEIJ,

,0 cumulative. The flood receded, b’itjhe level
^n‘q(<id not; rather, it kept rising, although at a

*' i na ce •
’ *C was the phase studied intensively by Dr. Kai
described in this section from the sociological
as a loss of commonality, the social tissue
■
sndspe°plc tofcthcr. While this loss was univer| ^‘ should not overlook the fact that it was an indi■

trauma as well. Just as the original traumatic
though universally shared, was individual in
ng.so was ’l w’^ l^’s sccor,d phase of the trauj^ycle. The change from the familiar to a strange
during the period when rest and nurture were
superseded the initial trauma and prolonged
impounded its effects in each survivor.

■ ptETHIRD phase: future effects of the

• niWMA

•- pie articles presented in this section survey the ef■i fccts of the disaster to date. Less measurable are the
■1 future effects, especially those whic.i are more subtle
•
internal. Are the children Dr. Newman inter­
li ftwed who are now getting along well in school less
: mlnerable lo future stresses than those who are cur' rtnilymore turbulent and disturbed? Or is the reverse
jit case? Only long-term longitudinal studies (which
irenot likely to be practical or feasible) would answer
*isand similar questions.
There are subtle and. far-reaching issues facing the
wrvivors. In spite of the vastness of the unconscious,
psychic space is limited. There is room and time in any
individual psyche for only a limited amount of cogni­
se ideation and a finite number of memories, fan­
cies, and accompanying affects. The product of such
space and time comprises the psychic life of an individ­
ual, the amount already spent and the amount still left.
Mourning is a model of such an occupation of psychic
space, a paradigm of how obsessive thoughts and.memories related to psychic work that needs to be done
crowd and consume the psychic capacity. Traumatic
Emories of any kind encroach on this psychic timeS^eand reduce its available quantity; this is why psydiictraumata age people.
I have been treating a woman in her mid-seventies
L^have discovered that her apparent senility is due
to an organic aging process but to the repression of
^adesofa traumatic life. She had told herself—she
JMght this out with clarity through her foggy memo­
missions that had a hypnotic quality—that she did
®f**ant to remember any part of her married life of
^ito50 years. The volume and intensity of the trau...c Memories being repressed left her almost no'
for normal living. She had by now assumed the
, .'lre«b(Jlh mentally and physically, of a difl use corSjlr°Phy,’ without evidence, either neurological or
°gical, of any organic syndrome nor even conof cerebrovascular disease. She was like a
acute, traumatic amnesia, except that this was

chronic, old. and massive. Iler mental state undulated
dramatically with the emergence and rerepression of
forbidden thoughts. This poignant clinical experience /
has made me wonder about the general psycho­
pathology of “old age.”
How much space will the Buffalo Creek experience
occupy in (he minds of the survivors in their future
lives? We routinely treat patients who react to i de­
prived childhood by sacrificing a certain percentage of
their psychic lives. I have treated a patient who has oc­
cupied perhaps a quarter or a third of her free associa­
tions with obsessive preoccupation over her screaming
mother; her thoughts arc similarly occupied outside of
the analysis. Another of my patients has been unable
to enjoy his current life because of the constant crowd­
ing of his psychic space by the coalesced memories of
the threats of castration that pervaded his tortured
childhood. I have pointed out elsewhere (17) the role
of such chronic traumata in producing the cacophony
of human relationships in ordinary life. •
These situations represent fairly common devel­
opmental traumata. How much more of a role do cata­
clysmic traumata like the Buffalo Creek disaster play?
What will be the long-term effects of the vivid, massive
“death imprint” described by Lifton and Olson (1)?
What will be the effects on children in whom death anx­
iety has been violently added to the normal anxieties
of separation and castration? It seems likely to me that
their memories will repeat the accumulated traumata
over time like a long-acting timed-release capsule.
There was an element in this disaster that is not
p. esent in truly natural catastrophic events, which
serves to explain further why the “Buffalo Creek syn­
drome” is not limited to reactions to external events,
but rather reflects added internal idiosyncratic forces.
I am referring to the human element, the thought and
the accusation that this horrible occurrence could have
been prevented. Unlike a natural disaster such as a tor­
nado, where inanimate forces of nature are soiely re­
sponsible, the human object was involved in the Buffalo
Creek Flood, which- arouses impulses of aggression
and retaliation. Channels for discharging these im­
pulses do not keep pace with the amount and quality of
the impulses aroused. .The ego is bombarded from twodirections, and feelings of rage, impotence, anxiety,
guilt, and depression are added to the usual responses
to disaster.
The more ■external normalcy returns, the more will
traumatic neuroses and psychoneuroses be in a recip­
rocal relationship to each other. The residual trauma
will stimulate individual neuroses, and latent neuroses
will feed upon and perpetuate the traumatic state.
Such restifutional movements are already evident in
the survivors and will increase with passing time.
Phobias, obsessions and depressions, and private anx­
ieties and conflicts have already been noted by yarious
observers, and survivors’ drcams are beginning to re­
veal their predisaster concerns.
There arc other niore subtle unknowns to cloud the
future. What happens when a traumatic cflect merges
Ahi J Psychiatry 133:3. SLwh; 1^76

315

COVRML OF PSYCHIC TRAl MA

over time into a tfaumatophilia? Such an outcome can
repicsent a repetition compulsion not in the service of
ru-Mvry Hn to satisfy a sense of guilt ora need for pun­
ishment.* trauma :hat is absorbed and utilized by the
psychic forces “beyond the pleasure principle” (18).
Or what will he the result when the pleasure formulae
. or safety mcchanisims themselves become altered and
* individually fashioned ay a result of the traumatic expe■ ricr c? I am reminded of* a patient who was traumatically raped and now finds her husband and all other
men to whom she turns passive and.weak. Or a patient
who. from a traumatic rejection in her first love, has
come to no longer believe in love. Another patient,
similarly hurt, now feels “I’ll never again have a best
frrnd.” What will be the effects of (he life-threatening
insult at Buffalo Creek,’seen .by the survivors as a re­
sult of neglect by people.in authority, on trust, love,
and object relations? One can hardly begin to tell, but
one can b? prepared so as not to be surprised.
In surveying this event and the reports that have
been presented in this section, we should not overlook
the effects of the studies themselves on the 625 survi­
vor-plaintiffs evaluated. Aside from the legal result,
the interest displayed by caring individuals from the so­
ciety outside the valley probably introduced a thera­
peutic influence, however, circumscribed. This influ­
ence might be compared to the effects on a therapeutic
ward of the mere announcement of a program of treat­
ment. However, there may also be negative effects:
divisiveness has been introduced in the valley. Just as
the untreated “control ward” suffers by comparison
with the therapeutic community, those survivors who
were not among the litigants may feel left out and dis-'
Ciimi ..tied against.
While an important and unprecedented legal deci­
sion has been achieved that greatly extends the defini­
tion u! psychic trauma following an external event, the
full implications of the human phenomenon described
in this section cannot be estimated. Anyone who is
lost, hurt, or otherwise affected under traumatic cir­
cumstances affects others in an endless chain that is at­
tenuated only by emotional distance. Il would be illu­
sory to belies e that it is within our powzer or profes­
sion J. expertise to accurately describe ethical
guidelines tor the rectification of the linear progress of
traumatic effects. 1 recently knew of an elderly couple
who were being displaced fiorn their home for the
budding o! a federal project. During the process, the
husband, distraught over the dislocation, suffered a fa­

?.‘6

A.-.-. J ^syikiatry 133:3, March IW

tal heart attack. What can we say or what
. i
do about the effects on his wife ? Or the children^*
chain of others? There are more• questions th.-)!),,*
answer. We must work side by side with the la., •
sociology, philosophy, and all thinki ig and
people. No one or no group has.a comer on eth*,
on wisdom.
*
REFERENCES
1. Lifton RJ, Olson E: The human meaning of total
chiatry (in press)
2. Rangell L: The metapsychology of psychic irauir-i, m
?
Trauma. Edited by Furst SS. New York, Basic Booh |%’ > I
51-84
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3. Hartmann H: Ego Psychology and the Problem ol Ady* ’
tion (1939). New York, International Universities Press, in T
4. Freud S: Inhibitions, symptoms and anxiety (1926). in The Cow
plete Psychological Works, standard ed, vol 20. Translated &
edited by Strachey J. London, Hogarth Press, 1959, pp7V|T|
5. Rangell L: A further attempt to resolve the “problem d a*.
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6. Rangell L: The psychology of poise—with a special clatanM
on the psychic significance of the snout or perioral rejpon, Im)
Psychoanal 35:313-333. 1954
7. Rangell L: The quest for ground in human motivation. Uap*
fished manuscript. Presented al the meeting of the West Co*
Psychoanalytic Societies, San Francisco, Calif, Oct 29,
8. Freud S: Three essays on the theory of sexuality (1905). Th
Complete Psychological Works, standard cd, vol 7. Truiujii
and edited by Strachey J. London, Hogarth Press, 195), pp 1$
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245Bowlby J: Attachment and Loss, vol 1: Attachment. New Yurt.I |

Basic Books, 1969
Mahler MS: On Human Symbiosis and the Vicissitude* of to t
viduation. New York, International Universities PreM. Wm »
11. Harlow HF: Social deprivation in monkeys. Set Am, 20 (ft «
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12. Spitz RA: Hospitalism: an inquiry into the genesis of psycto**
conditions in early childhood. Psychoanal Study Child
1945
. 13. Sandler J: Trauma, strain, and development, in
Trauma. Edited by Furst SS. New York, basic Books. I*T ft
154-174
14. Kris E: The recovery of childhood memories in psycl»**h*
Psychoanr’ Study Child 11:54-88. 1956
15. Khan MMR: The concept of cumulative trauma.
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Trauma, Psychoanalytic Research and Development b
New York. April 3-5, 1964
. I
17. Rangell L: On the cacophony of human relations.
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8
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\ PP *
/

10.

Journal of Psychosomatic Research, Vol. 18, pp. 437 to 456. Pcrgamon Press, 1974. Printed in Great Britain

COMMUNITY
^^6, V
j
K°rarnbnga|a

DISASTER: EFFECTS ON MENTAL AND PHYSlC/£a°re'66uv34 ■

STATE*
Warren Kinston and Rachel Rosser
(Received 13 May 1974)

Abstract—Although there is an extensive literature on various aspects of disaster, there has been no
comprehensive review of its psychiatric consequences. This article brings together the phenomeno­
logical and dynamic descriptions of the immediate and longer term mental effects of disaster as
observed in the individual and in groups. Present knowledge on management of these effects is
summarized and some conclusions arc reached on the implications for future planning of disaster
relief services.

"Things can he so had that to he sane is insane”
Nietzsche

The general field of enquiry loosely encompassed by the term “disaster” has not yet
found an established position in the psychiatric canon. There seem to be theoretical.
practical And emotional reasons for this. A disaster besets the researcher with major
practical difficulties. In his review article, Hocking [1] identifies the following theoreti­
cal difficulties: the subject overlaps with other disciplines (notably sociology), it
challenges the existence of a boundary between illness and health, and it is relative!}
remote from traditional psychiatric approaches such as organic psychiatry, experi­
mental psychology and psychoanalysis. However these factors alone do not appear to
be an adequate explanation for a delay of 17 yr before any systematic or detailed
study of the psychological and social effects of the atom-bombing of Hiroshima. Until
Lifton's classic study published in 1967 [2] all that was available were a few fragment­
ary, or exaggeratedly technical, reports, and Lifton noted that often researchers were
so struck by the human suffering encountered that they ceased research and dedicated
themselves to much needed social welfare programmes.
Equally conspicuous is the omission of psychiatry from the disaster canon. The
field has been studied by sociologists, medical workers, administrators and military
strategists. It is covered routinely by the media and provides a stimulus for the
creative arts. But the extensive literature on disaster planning does not consider
psychological understanding and the psychiatric needs of the victims.
The absence of disaster in the psychiatric canon is of theoretical interest. However
the absence of psychiatry from the disaster canon reflects a lack of insight which is of
practical consequence. This was shown in the Hartford Disaster Exercise [3]. In this
project, a simulated major explosion was arranged in cooperation with the Health,
Police, Fire and Civil Defence Departments, five hospitals, the Red Cross and
Ambulance Association, the University Department of Medicine, the State Depart­
ment of Health, and the local medical association. The episode was videotaped and
th'e “victims” subsequently interviewed. It was found that the rescue personnel
became confused and were disturbed by the sight of massive injuries, and that the
victims were unnecessarily handled and placed in uncomfortable, inconvenient and
dangerous positions. At no time did anyone stay with a specific victim to give comfort
The Maudslcy Hospital, London, S.E.5, England.

437

i 'f'

438

Warrf.n Kinston and Rachel Rosser

and reassurance. In the 10 yr prior to this there had been only four other well docu­
mented and comparable studies and the finding-; in these were identical. The explana­
tions offered in the article and subsequent New England Journal of Medicine editorial
[4] were in terms of “poor rescue” and the existence of a “community problem”.
There was no mention of psychological understanding.

This article is an attempt to use the information in the literature to develop a
psychiatric approach to disaster and to suggest its implications for the planning of
services. The nomenclature of Tyhurst [5] and Glass [6] is used. A limited number of
outstanding psychiatric papers arc described in detail and other documented psycho
logical phenomena arc mentioned. The long term effects are examined in the context
of the phenomena of World War II.
DEFINITION: CLASSIFICATION: DIFFICULTIES

Disaster is defined, for the purposes of this review, as a situation of massive.
collective stress. The psychological phenomena of disaster are the consequences of
the combined individual stress reactions and of reactions to changes in the social
milicul Hence the psychic distress and behavioural disturbance of an individual
cannot be fully understood or managed unless they arc analyzed as elements in the
disruption of the equilibrium of a social system. “When an entire population is
reduceq to inferior status” for example “the individual’s self-respect is damaged in
ways not reparable by himself” (Krystal [7]).

As a consequence, hypothetical models may become unmanageably complex
(Barton [8]). But in addition there are more practical obstacles to coherent research
and understanding. The physical situation of a disaster is rarely one which lends itself
to the usual research techniques, the psychological sequelae powerfully affect the
observers, there is a great variation in the types of disaster, and they exist in completely
different socio-cultural settings. Often the victims resist investigation, and the relief
organisations resist investigators.
There is no generally agreed or obviously fundamental taxonomy. Constructs of classification have.
included: man-made (e.g. bombs), natural (e.g. fire); internal (e.g. tyranny, infiation), external
(c.g. war, flood); acute (e.g. earthquake), chronic (e.g. poverty, racialism). Tyhurst [5, 9] provided a
classification of the phases of disaster which was extended by Glass [6] and has been accepted by
many psychiatric workers (Table 1). These authors define five phases: pre-impact (threat), warning,
impact, recoil and post-impact. During the impact phase the stress is physical, maximum, direct,
unavoidable; prior to this it develops from the stress of worry and preparation to one of imminent
danger, and subsequently secondary stresses due to the nature of the disaster and its effects on persons
and property begin to operate. The detailed descriptions of each of these phases is still incomplete,
because most studies arc varying mixtures of anecdote, description and analysis. As early as 1957
Dcmcrath and Wallace [10] pointed out the absence of a defined disastcrology. However despite the
subsequent amassing of data, Barton [8] commented in 1969 that most of it was valueless and that
researchers still had not developed a set of propositions to test. The diffuseness of the literature has
also resulted in important discrepancies remaining undebated.

METHODOLOGY

-

T

The methods vary in the number of victims studied, the detail in which they are
investigated and the extent to which the information is systematic and quantifiable.
They include single case reports, numerous anecdotal studies, some more systematic;
studies and experimental work. The peculiar methodological problems have been v-.;.
analyzed by Killian [11],

Table 1.- -1 m phases of disaster (based on the classification or Tyhurst and Glass)

Stress
Of education, worry,
preparation etc.

Duralion/timc perspective
Months -yea rs/fu t u re
-

Psychological phenomena
Denial or over-reaction vs optimal
amount of anxiety

Social phenomena
‘’Optimal social stress"
Social preparedness

Warning

Imminence of primary stress

Min hr/present or immediate
future

Denial vs protective action

Precautionary activity

Impact

Maximum, direct, unavoidable

Min-hr, months-yr/present
(automatic)

12-25 per cent effective, tense,
excited, too busy to worry
75 per cent dazed, stunned.
bewildered i.c. disaster syndrome
(absence of emotion, inhibition of
activity, docility, indecision, lack of
responsiveness, automatic
behaviour -j- physiological
manifestations of fear)
12-25 per cent grossly inappropriate
behaviour, anxiety and affective
states, hysterical reactions.
psychosis

Scope of impact: community to
nation
Emergency social system: the
unorganized immediate response
(role definition, role competence)
with ad hoc leadership.
Family as the basic unit

Recoil

Suspension of primary stress.
Secondary stresses due to nature
of disaster or self

Depends on individual and
disastcr/immcdiate past

Normals (90 per cent) show return of Convergence behaxiour
Inventory and rescue
awareness and recall. Dependency,
Organized reconstructive effort,
talkativeness, child-like behaviour.
emotional release. Search for safety. relief and restoration of services
Unstable group formation.
Psychopathic liberation. Special
phenomena e.g. staring reaction,
counter-disaster syndrome

Rest of life/past-present-future

Grief, depression, post-traumatic
neuroses
Psychosomatic illness
Increased physical illness,'deaths
Altered attitudes
Recovery (?)

Post-impact Derivatives of primary and
secondary effects: personal and
social

Further details in text and bibliography.

Permanent reconstruction and
long-term recovery'. New
equilibrium with modifications:
alterations in morale, economy,
cultural values. Feed-back to
threat phase

Disaster: Effects on mental and physical state

Phase
Pre-impact
(threat)

Warren Kinston and Rachel Rossi r

440

(1) Single cases
Except for the psychoanalytical literature, there are surprisingly few case studies. One of the earliest
scientific reports was ’.hat of the surgeon, Jean Baptiste Henry Savigny following the ship-wreck of
the Mcduse, well known from Gcricault’s painting [12]. Similarly James [13] recorded his relicci ions
on his mental reactions following the San Francisco earthquake of 1906. In his account of his own
ship-wreck experience, Lilly [14] reviews other similar personal experiences which led to hallucina­
tions. confusion, ’Xiranoia, suicide, murder and cannibalism. Janis [15] used a transcription of the
delirious ramblings following rescue to analyse the fantasies and the elements of the unusual mental
resilience of a young man who narrowly escaped drowning. Although this experience would not
strictly fall within our definition of disaster, information from such a study is important because
studies of individuals during the acute phase of massive collective stress are not available.
(2) Anecdotal accounts
Anecdotal accounts vary in sophistication. Often they arc produced by “experts” who happened to
be on the scene at the time [16-25], but sometimes planned studies arc reported in anecdotal form
[26-31].-The primary result has been an extensive duplication of certain fundamental observations
which will ic described in the section on Psychological Phenomena. The data is not sufficiently
uniform to permit comparisons to be made, but a number of the papers contain interesting and
potentially significant details which do not appear in the more systematic studies.

(3)

Systematic studies

Methods used for systematically collecting information include clinical studies, structured inter­
views, questionnaires and hard observations of a limited number of parameters.
Clinical studies contribute most of the information on the opportunities for and the effectiveness of
psychiatric intervention [32-40].
Liftoil’s study of the victims of Hiroshima [2] is one of the best examples of structured nerviewing.
He picked 33 survivors at random from lists kept by the Hiroshima University Research Institute for
Nuclear Medicine and Biology plus ‘2 survivors who were particularly articulate or personally
prominent in the A-bomb problem. *ine interviews were recorded, transcribed, and translated, and
they specifically explored the individual's recollection of the original experience and its meaning in
the present, residual concerns and fears of all kinds, and the meaning of his identity as a survivor.
Qualitative case studies using interviewing techniques have been extensively used by sociologists.
However, Barton [8] reviewing 21,600 interviews of 103 disasters dealt with by organizations such as
the National Academy of Science Disaster Research Council, University disaster investigating
committees and the National Opinion Research Centre, found that after excluding false alerts, morale
surveys, epidemics, small samples etc. he was left with 5,500 interviews of 22 disasters of which 4,000
were quite unsystematic, leaving 1,500 interviews of the Holland Flood and the Arkansas Tornado.
The latter study by Fritz and Marks [41] is very frequently quoted. It demonstrates the importance of
the question of retrospective falsification since it reports a nuch lower incidence of transient shock
than is usually described and the validity of the figure is not investigated. Other studies using interview
techniques provide useful data [42-45].
Questionnaires, m contrast with more or less unstructured intci views have the advantage that
systematic quantifiable information is obtained from a large population. Their disadvantages arc
that they depend on recall of a traumatic experience weeks after the event. Also they often cover
areas in which the questioners arc not expert, and this has produced one soiree of controversy
(Quarantelli and Dynes [46]). This technique has been applied to a limited extent by psychologists
and sociologists.
Observations using epidemiological methods give a limited amount of reliable information. A few
such studies are available such as Bennet’s study of the effects of flooding in Bristol on subsequent
mortality rates in the affected population [47].
(4)

Experimental studies

There are three principal experimental methods. Disasters can be simulated, as described by
Menczer [3]; however, this method has not been used to study psychological phenomena. The
reactions of people in particular stressful situations can be recorded c.g. the observations by Pope
and Rogers of the mental state of a group of scientists during an arctic survival experiment, or
Ahearn’s [49] study of the reactions of large groups experimentally confined in an austere environment.
In addition conclusions relevant to disaster may be drawn from many of the results of laboratory
experiments on psychological reactions to special stresses such as sensory deprivation or starvation.

Disaster: Effects on mental and physical state

441

(5) Journalistic accounts
Editors find that disasters arc an inexhaustible source of excitement for their readers. Newspaper
accounts often provide particularly detailed information on emotions and attitudes of the victims and
rescuers which is unobtainable elsewhere. One of the best recent accounts of cannibalism is probably
the Sunday Times report on the Chilean air crash of October 12th. 1972 [50].
CASE STUDIES

We have selected three papers which together define many of the immediate,
short term, and longer term psychiatric complications to be expected in a disaster.
The first of these is the major contribution by Cobb and Lindemann (1944) studying the survivors
of the fire at the Cocoanut Grove Nightclub [35]. This study was done at the Massachusetts General
Hospital where 114 of the casualties were taken. 39 were alive on arrival. The city fire services and the
hospital emergency programme were geared up in expectation of air-raids and handled the disaster
with exemplary efficiency. The dead were identified immediately and the survivors listed, thus avoiding
feelings of confusion, hostility and despair which have been documented when this is not done. The
relatives were interviewed by social workers who involved the psychiatrists in the care of those
overwhelmed by acute grief. From the relatives the psychiatrists turned to the injured, all of whom
they visited on the Sth day. Fourteen of the 32 survivors had neuropsychiatric problems; the
commonest problems (50 per cent) were reactions to bereavement, but there were also cases of
psychosis, phobic anxiety and complications of carbon monoxide poisoning. It was this work which
enabled Lindemann to provide the first detailed description of the phenomenology of acute grief [34],
Cobb and Lindemann drew the following conclusions: (1) Psychiatric problems will be overlooked
unless a psychiatrist secs all the victims of a disaster. (2) Severe emotional problems are due to
crises in human relationships involving conflict and guilt rather than to the impersonal horror of the
disaster itself, hence the nature of the disaster may not be a useful predictor of consequent psychiatric
morbidity. (3) A psychiatrist can be useful in three phases, (i) initially during emergency medical care,
when confused ..excited patients have to be removed to quiet surroundings and sedated: in this phase
patients are disturbed by the frequent changes of medical and nursing staff and tne psychiatrist can
provide continuity by developing, a relationship with them: (ii) then during convalescence in hospital:
psychiatrists can advise on the timing of badjriews and can.support the patient in adjusting to bereave­
ment, material loss and disability; (iii) finally when the patient returns to the community: psychiatrists
can help to reduce prolonged maladjustment and traumatic neurosis. It is striking that despite
excellent planning and numerous precautions designed to minimize psychological stress, there was a
high incidence of psychiatric illness. Numerous subsequent studies have confirmed that much serious
psychiatric morbidity goes undetected by non-psychiatrically trained medical personnel [51, 52].

The second study by Leopold and Dillon [32] described psychiatric disturbances in
36 survivors of a marine explosion in 1957 on the Delaware River.
Initially almost all had features of a post-traumatic neurosis. In the ensuing 4 yr the symptoms be­
came worse, most of the victims requiring psychiatric treatment. Of particular importance to these
conclusions was the elimination of compensation as an actiological factor in prolonged morbidity.

. The third study by Popovic and Petro vic [36] described the Skopije earth quake and
consisted of observations made by psvehiatrists within 24 hr of a major disaster.
Of the population of 200,000, 3,300 were injured and oxer 1.000 killed. The Institute of Mental
Health in Belgrade sent two psychiatrists, a psychiatric social worker and two nurses; they arrived
22 hr after the earthquake and stayed for 5 days. A team of local psychiatrists was organized to tour
evacuation camps and a reception centre was established for acutely disturbed patients. They noted
that much of the population was in a mild stupor which the team found infectious, that the victims
congregated in small unstable groups and that rumours of doom spread. After the initial confusion,
severe psychiatric disturbance was rare, and this they attributed to the rapid evacuation of the more
disturbed patients, to prompt outside help, and to responsible reporting by the press which minimized
the formation of rumours. Depression was prevalent on the 2nd and 3rd days while after-shocks
continued. Children who were evacuated to institutions were transiently disturbed.

Although these studies are detailed and relatively comprehensive, and many
subsequent papers have confirmed their principal conclusions, they do not explore
some areas of practical and theoretical importance. They do not stratify the population
at risk: in practice it would be valuable to be able to predict the more vulnerable
sections of the community, their different patterns of response and the appropriate
management of these. They document the commoner psychiatric phenomena but

442

Warren Kinston and Rachel Rosser

omit the less frequent reactions e.g. pscudopsyclioses [53] and hysterical reactions [541
They arc written in behavioural and phenomenological terms but it has been necessary
to search elsewhere for dynamic understanding of human expc icnce during the
various phases of disaster.
PSYCHOLOGICAL PHENOMENA

The literature on the psychological phenomena of the threat, impact, and early
aftermath phases was comprehensively reviewed by Wolfenstcin [55]. The principal
findings in this monograph are summarized here. There is no comparable review of
long-term effects. However the effects of some of the exceptional stresses ■ f the
Second World War have recently been studied and the war neuroses, concentration
camp sequelae, and the Hiroshima A-bomb effects arc used in this paper as paradigms
for the understanding of long-term consequences of disaster.
Threat
In the threat phase, denial of the potential disaster may be superficial or deep, it may be continuous
or intermittent, it may be total, partial or minimal, but it seems to be universal and in that sense is
“normal” (Wolfenstcin). Persons who get fearful and go to psychiatrists tend to be diagnosed as
"neurotic”. Lifton [2] would refer to this denial as a “consistent human adaptation”. Like any other
adaptation it has its advantages and its disadvantages. All responsibility jends to be displaced onto
leaders or authorities. The individual feels that he has neither the knowledge nor the means to affect
his own destiny. The authorities attempt to use a rational approach as part of the constructive worry­
ing they are paid to do. However, predictions arc often so inaccurate ’hat they seem to be based
more on fantasy than reality. For example in World War 11, expert advisers to the British Government
predicted 20,000 -50.000 deaths pcr day from air-raids, whilst in 2 yr the total number was about
45,(XX); they predicted mass panic which was totally absent; and by contrast they estimated destruc­
tion of properly al one thirty-fifth of what it was (Schmidcberg [56]). Denial continues through the
warning phase and sometimes into impact. Acknowledgement of the danger would result in physical
inconvenience and psychic distress. During the Hawaiian tsunami (tidal wave) of May 1960, for
example, evacuation was minimal [43]. People may openly refuse to fantasy the danger, e.g. on the
banks of the Rio Grande festive crowds watched and cheered the rising flood waters [55].
When the danger is admitted emotional altitudes such as faith and distrust become important,
because of the difficulties of knowing the efficacy and reality of the precautionary measures taken by
the relevant authorities. The authorities are seen as “parents”, and the disaster is attributed to the
“powers-that-be”. Rules of safety thus become equated with rules of obedience e.g. in the blitz
people left uncovered windows which the wardens could not sec. Superstition and ideas of magical
control flourish, e.g. the fear that disaster may be precipitated by thoughts, speech or actions. Fantastic
rumours which indicate a change in the way in which life is construed are common: the classic one
is that a drug has been put in the wine or water io reduce libido and potency [55].

Impact '
Jn sudden sex
disasters, there is an illusion of centrality. For example in a tornado people believe
that only their own house has been hit. The myth of personal invulnerability, so powerful in the threat
phase, suffers a sudden reversal: the individual is actually encountering death. There then follows a
second major shock when the total destruction is appreciated and the expected sources of refuge and
aid are absent. Recollections of this period vary greatly but the evidence suggests that individuals
swing between feelings of terror and elation, invulnerability and helplessness, catastrophic abandon­
ment and miraculous escape. The subsequent reconstruction of the illusion of immunity depends on i.
whether the disaster is experienced as a “near miss” or “remote miss”, and on the actual amount of
loss.
•
Soon after impact victims appear to be “dazed”, “stunned” or “bewildered”. They show absence -j.
of emotion, inhibition of activity, docility, indecisiveness, lack of responsiveness and automatic
behaviour, together with the physiological manifestations of autonomic arousal. This is the “disaster •
syndrome” (Wallace [42]). It has been explained in various ways: as apsychic closing off from further^
stimuli, as energy being drained to intense internal work, as a response to fantasies like “if I don’t
react then nothing has happened” or to feelings of helplessness and the impossibility of undoing afi >
the damage. This reaction is the antithesis of the commonly anticipated one of panic. Panic is

Disaster: Effects on mental and physical state

443

conceived as a reaction to the conflict between egotistic and altrui . . j impulses. In the face of massive
death, people have unacceptable feelings such as sadomasochistic excitement, and ideas and wishes
such as "rather him than me" (as if there were a competition for survival) and “he can die instead of
me" (as if the death of one person assured the life of another). The thought of sacrificing others to
survive oneself is common in fantasy (though the action is rare in reality) and produces guilt feelings.
Panic only occurs under very specific circumstances which are not the rule in disaster, and a large
body of research indicates that human beings under threat of death arc not motivated by a simple
drive for physical safety [57]. A complicated social situation with a wide variety of attitudes and
motivations develops [58].

Recoil
In the recoil phase, the normal response is a slow return of awareness and recall. The victims become
dependent, talkative, childlike, form unstable groups and seek safely. Emotional release occurs.
Specific patterns of behaviour have been noted. There may be psychopathic liberation including
looting, rape and heavy drinking [18]. Wallace [42] has described a “counter-disaster syndrome” of
over-conscientiousness, hyperactivity, loss of efficiency and irrational behaviour, c.g. a surgeon v
abandons sterile-technique. The "staring reaction” also occurs in outside observers as well as those
involved, and along with “convergence behaviour” may interfere with rescue and relief. It is accomp­
anied by obsessional preoccupations with the personal implication of the event. Following the murder
of J. F. Kennedy, the average U.S. adult spent 8 hr per day for the next 4 days at his T.V. or radio,
and Janis [15] interprets this as an attempt to work through the cultural damage.

Early aftermat\

As the unorganized immediate individual response gives way to the organized social response, it
becomes clear that psychological events have to be understood in the context of a social situation
within a particular culture at a given historical moment.
Psychological reactions to loss of loved objects and grief reactions always feature significantly and
their characteristics have been well described in the literature (Parkes [59]). The expression of these
emotional states may be affected by cultural attitudes. Wolfcnstein comments, for example, that in
the U.S. there is a prohibition against experiencing despair, helplessness and discouragement which
conflicts with the victim's need for acknowledgement of his suffering. Feelings of fear and apprehen­
sion commonly persist for some time. U ially they arc linked to the idea that the disaster will recur;
aftershocks of earthquakes arc associated with much more conscious fear than the initial major
shock. Also new disasters are fantasied and as rumours these fantasies rapidly spread. For a while
the world is an unsafe place and people feel anxious about being left alone or separated from their
. loved ones.

There arc extreme emotional difficulties in dealing with death, especially on a
massive scale, and altitudes towards the corpses are coloured by fear and guilt. On
the one hand authorities deny them importance (“nothing needs to be done” U.N.
Disaster Relief Coordinating Committee) and insist on rapid disposal by incineration
and mass burial [60]. On the other hand, survivors have difficulty in mourning their
relatives unless they “know” of the death by identification of the body: after the
earthquake in Naples in 1968 people spent days searching the rubble for corpses [60].
Following any disaster, relief operations are impeded by enquiries about missing
people.
The disaster persists as a “tormenting memory”. People are apt to find themselves
forced to relive it over and over again and, although this is painful, it seems often to
be curative in that the feelings of extreme distress associated with the event are
gradually extinguished. Repeated discussion often focusses on regrets and recrimina­
tions regarding actions taken before or during the event. For a few the distress and
fear do not diminish and they “do not get over it”; others avoid any reminder of the
experience and may deny actual consequences. The memory is subject to intra­
psychic distortion. William James wrote on the 1906 San Francisco earthquake:
“I realize now how inevitable were men’s earlier mythological versions (of disaster)
and how artificial and against the grain of c ur spontaneous perceiving are the later

j
1

444

Warrin Kinston and Rachel Rosser

habits which science educates us” [13]. lie refers to the re-evocation of primitive
animistic views of causality in which the disaster is seen as intentional and purposive.
People are unable not to ask the reason why, and they invoke God, destiny, fate, or
similar substitutes which are endowed with human qualities and a relationship with
humanity. Associated with this intense intrapsychic relationship with the powersthat-bc are thoughts and feelings about leading a better life or relaxing moral standards,
attitudes of defiance, ideas of being punished, and postures of hope or despair.
Survival may be seen as a confirmation of immortality, as being protected again, or as
evidence of continued victimization.
A disaster also incorporates many situational therapeutic factors [28] and Wolfenstcin describes the well-documented phenomenon of the “rise and fall of the post­
disaster utopia”. To the survivors it is a relief that the threats and dangers have come
from the outside and that he can feci blameless; the remedial needs are specific.
immediate, obvious and preponderantly physical, and results arc quickly seen from
attempts to deal with them; danger, loss and suffering are public not private and are
immediately present so that there is a liberation from the past and future; and the
most damaged families arc a support for the remainder (“relative deprivation”).
The initial tendency following a disaster is to give without stint and accept without
restraint, but this soon becomes replaced by feelings of hostility, giccd, independence,
suspicion, envy and competition. For example the relief organizations, which give
compensation on needs not losses arc resented because the individual’s experience is
proportional to his loss. The problem of anger, blame and hostility is extremely
complex as these affects arc always evoked and variously displaced, often with
damaging consequences. Lacey [27] comments on the hostility of Abcrfan directed
towards the National Coal Board, Local Authority and Government which hampered
recovery efforts, and towards the Tavistock research workers. Wolfenstein gives many
examples of the inappropriate handling of these feelings. Reports repeatedly highlight
the irrationality with which such irrational matters are handled.
Following massive destruction of a place, people prefer to move back and rebuild.
Relatively few move away and those who do so tend to for “neurotic” reasons. This
has been seen many limes in tornado cities, bombed cities, Hiroshima, and now in
Managua which is being rebuilt on the identical site for the third time after total
destruction by earthquake. Material reasons do not seem enough to explain this, nor
sentimental attachment. The myths which justify remaining on the site include the
inevitability of fate, the belief in the random distribution of disasters, and the idea
that running away will provoke further disaster. There are also feelings of loyalty and
guilt, wishes to undo the damage or to master the event, and defiant refusal to be
scared away.
Special groups: children

The first major group of papers emerged from the experiences of the bombardment
and the evacuations and parent-child separations during World War II [61-63].
Acute disturbance was found to be common, but transient, if separations did not
occur; separations however had lasting effects sometimes. More recently the effects
of disaster on children have been described in detail and some predisposing factors
have been defined, e.g. Fraser [64]. Children’s reactions must be understood within

Disaster: Effects on mental and physical state

445

the context of the family. In the early phases of disaster their reactions arc a function
of the way in which reality filters down to them and so they mirror their parents’
reactions rather than relating directly to the event [65-67]. The most predominant
fear at all ages is separation from the parents. If this docs not occur, and if the parents
c< pc with the situation, children may show little awareness of danger and minimal
anxiety. The “disaster syndrome’’ in children takes the form of purposeless excitement.
Studies of the Vicksburg tornado [37, 45, 68] in which many children died in a matinee
cinema performance confirmed the high incidence of manifest regressive and
behavioural symptoms and suggested that the slowest rate of emotional recovery
occurred when parents created a tense atmosphere in which the episode had to be
“forgotten’’. Most families could only permit one member to grieve at a time. Parents
who were pathologically distant from or demanding of their children became more so
at impact and recoil (also 64). In the early aftermath children show compulsive
patterns of working over the disaster and associated painful scenes, such as burials,
verbally, or in play and dreams, often to the distress of their parents. Post-traumatic
fears of recurrence and reactions to reminders of the event are indicative of pathology
related to mishandling of the earlier phases. The general conclusion is that children
rarely peed specialist psychiatric treatment but that they do benefit from an oppor­
tunity to ventilate their anxieties to a sympathetic adult. Those most at risk arc
between 8 and 12 yr. have a previous history of physical or emotional illness, and
come from unstable homes.
Special groups: the aged

There, are few detailed studies of the behaviour or of the subjective experience of
the aged in disaster. The literature has recently been comprehensively reviewed by
Friedsam [69], and general aspects arc discussed by Townsend [70] and Titmuss [71].
The aged usually receive warnings later than the rest of the population, are less
willing to leave their homes, restrict their attention more to immediate family and
less to other members of the community and are particularly at risk of physical but
not of psychiatric damage, although a brief reaction of agitated depression with
confusion is common. In general the old experience a much deeper sense of deprivation
than the younger members of the community, this reflecting the real impn hability of
their being restored to their former state. The aged of low social status experience
strong feelings of resignation to yet further unavoidable suffering.
LONG-TERM PSYCHOLOGICAL SEQUELAE

War neuroses

In the 1940’s controversy focussed upon whether the acute post-traumatic neurosis
of war was determined by a constitutional predisposition, by the trauma itself, or by
some combination of these. Brill and Beebe [72] studied 1000 men with acute traumatic
neurosis and found that the only factors which correlated with it were low educational
level and stress of combat. If units in battle were defeated and cut off, break-down
was universal. This was called “battle fatigue” or “combat exhaustion” and it
occurred in willing, stable soldiers who had made an efficient adjustment to battle in
units of high morale. Swank [73] in his study of combat exhaustion in over 4000
survivors of the Normandy campaign, found that all soldiers became incapacitated
after approximately 75 per cent of their companions were killed. Reid [74] found

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Warren Kinston and Rachel Rosser

similar results in studies of bomber crews in the U.K. Acute traumatic neurosis and
combat exhaustion are similar stereotyped reactions which involve symptoms of
emotional tension (anxiety*, insecurity, nightmares, excessive startle responses,
phobias), cognitive impairment (apathy, poor memory, preoccupation, retardation,
confusion), somatic complaints (chiefly headache, gastrointestinal distress, backache),
and rarely, conversion phenomena (ataxia, stuttering, weakness, anesthesia). Swank’s
account is unusual in noting the polarization of the attitudes of the doctors who
tended to assume either that all the soldiers were neurotic, otherwise they would not
have broken down, or that they were all stable, otherwise they would have been
previously excluded. The treatment regime included rest, sedation, ventilation of
anxieties, abreactions, narcosis and rapid return to the front.
The general belief seems to have been that the incidence of acute traumatic neurosis
was relatively high compared to that of chronic traumatic neurosis. However, this has
not been confirmed by long-term follow-up studies. Lidz [75] studied those involved
in the Guadalcanal evacuation and found that every survivor subsequently developed
neurotic symptoms in civilian life. Futterman [76], in a study of ex-servicemen 5 yr
after the war, found many unsuspected cases of post-traumatic neurosis. Archibald
and Tuddenham [77], in a controlled study of a group of victims of acute traumatic
neurosis 15 yr after the acute episode found, that 70 per cent suffered from chronic
traumatic neurosis, the majority having acquired additional symptoms. One-third
were unemployed and one-third were in unstable employment The relationship
between stress and physical illness is well documented and has been sh< wn to be
quantifiable. The incidence of organic disease in the affected population would
therefore be predicted to alter following disaster, as a long-term effee;. In 1954 the
U.S.Y.A. National Research Council studied mortality rate and illness incidence in
8000 soldiers in the 6 post-war years. They found gross differences; the prisoners of
war having a higher morbidity and mortality than combat veterans and those in
Japanese camps being more severely affected than those in European camps. This
was thought to reflect the relative degrees of stress.
As yet there is no literature available on long-term consequences of brief stress
reactions. For example, large numbers of persons suffered acute reactions during the
London air-raids for which their only, and apparently cflectivc, treatment was tea
and sympathy from the wardens, and these have never been traced and studied. An
investigation of psychiatric and physical symptoms in such a group would not exclude
more subtle sequelae such as changes in attitudes in patterns of emotional response
and in beliefs. All these are related to a person’s capacity to lead a constructive life,
to have some inner contentment, to be a loving parent and so on. Ernest Jones
estimated that only 8 per cent of soldiers who lost a leg developed a “normal” response
of resignation and acceptance [78]. Kardiner [79] described chronic traumatic neurosis
as an alteration of the concept of self and world and a constriction of the life space.
In the literature on survivors of the concentration camps and of the Hiroshima
A-bomb mental adaptations are examined in detail.
Nazi concentration camps

The concentration camps caused “trauma beyond the comparable and conceivable” (Eisslcr [80]).
The features of the stress included continuous threats of death and torture, separations and humiliation.
All drives except hunger had to be suppressed. Extreme cruelty had to be witnessed and endured,
and no expression or altruistic response was permitted. Rules were capricious and contradictory and

Disaster: Effects on mental and physical state

447

coping behaviour was often less important than chance. The reactions of the victims were cither
apathy (the Mussulmann state) leading to death, or the "camp mentality” characterized by irritability,
egotistic behaviour, envy, absorption with food, lack of compassion, absence of sex drive and
familiarity with death. There has been only one detailed study of the concentration camps: Kogon’s
Dor SS Staat in 1947 [SI]. There was very little literature on the victims for over 15 yr after the war
and then in the early 1960’s studies appeared from Israel, Norway, Germany and the U.S.A. [82-87].
The literature is now extensive.
The typical response has been variously called the conccntration-camp syndrome, the post-KZ
syndrome, and the survivor syndrome. It consists of emotional tension (anxiety, phobic fears,
hypochondriasis, nightmares, insomnia, excessive startle response), cognitive impairment (poor
memory, preoccupations, loss of concentration), psychosomatic complaints, heightened vulnerability
to stress, chronic depression with guilt and isolation and disturbed sense of self- and body-image.
Thus it closely resembles post-traumatic neurosis. The syndrome is chronic, severe and resistant to
treatment. Chodoff [88] describes the two sets of attitudes typical of concentration camp survivors
following the failure of their post-disaster utopian dreams: cither s<elusiveness, apathy, helplessness,
passivity, fatalism and dependency, < suspicion, hostility, mistrust csaicism and a quiet bitterness
or quarrelsome belligerence.
The aetiology has been c icnsixely investigated, particularly in Norway. One of the more recent
reports by Strom [>•'?] desci.bed a detailed study m 227 non-Jewish Norwegian survivors of the
concentration camps. In only 10 was there evidence of psychiatric illness prior to imprisonment,
whereas 223 had symptoms at the time of examination. This could not be attributed to previously
operative social or psychological factors. The neuropsychialric picture was due to both psychological
stresses and-,organic brain damage and the symptoms caused by each of these two factors were found
to be separable.
1: is widely recognized that these patients avoid treatment: of the 1,000 cases studied by Grauer
[90] only 10 were prepared to return for free psychiatric help. Many victims make a paradoxically
good overt socio-economic adjustment [91].
Hiroshima
The most detailed •:«dy of the internal world* of long-term post-disaskr survivors is that of Lifton
in Hiroshima [2], He described the painful immediacy and intense emotion which accompanied the
re-creation of the event by the survivors. This is similar to the responses of survivors of the concentra­
tions camps. It was "an indelible imprint of death immersion which has formed the basis of a perma­
nent encounter with death, a fear of annihilation of self and individual identity along with the sense
of having virtually experienced the annihilation; the destruction of the non-human environment, of
the field or context of one’s existence and so of one’s bcing-in-the-world, and replacement of the
natural order of living and dying with an unnatural order of death-dominated life.” The hibakusha
(survivors) suffer a profound emotional disturbance which affects almost all aspects of their life, so
profoundly that they seem to have become a different category of being. Lifton emphasized the
importance of the concept of the "survivor”, one who has come into contact with death in some
bodily or psychic fashion and has himself remained alixe. The survivor seems to be unable to conclude
that it was logical and right for him and not others io survive, and is bound by a conviction that his
survival was made possible by others deaths. Guilt and shame over survival priority developed very
rapidly after 1 liioshanu. and as in concentration camp \ ictims it has been intense and persistent.
The hibakusha seem to be living a life of grief, mourning for family, anonymous dead, and things
(houses, streets, personal objects) which are lost symbols of their former self. The dead seem to be
always with them. The living identify with the dead and remain preoccupied with the inevitable
incompleteness of this process. They fear the dead, need to placate them, and submit to their moral
arbitration. Lifton construed the train of thought as: "I was almost dead. . . I should have died. . .
I did die or at least am not alive... or if I am alive it is impure of me to be so. . . anything which I
do which affirms life is also impure and an insult to the dead who alone are pure. .. and by living as
if dead, I take the place of the dead and give them life”.
The victims are victimized. Although they are eligible for extra benefits, they are discriminated
against socially and in business. This is reminiscent of the conflicts that emerge as the post-disaster
utopia collapses. The hibkusha crave special care and nurturance, which they then perceive as
insincere, humiliating and unacceptable. Consequently they become intensely resentful. They also
show survivor paranoia and survivor exclusiveness (“we who have been through it are different”)
which disturb social integration. The non-hibakusha have attitudes towards the hibakusha similar to
those that the hibakusha have towards the dead, i.e. fear and guilt. They are "survivors once
removed”. This leads to the tendency to cast out the tainted (the hibakusha), and the response of
honoring martyrs while resenting survivors.
Formal psychiatric illness is not common. Psychosomatic illnesses are prevalent and hypo­

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Warren Kinston and Rachel Rosser

chondriasis and “neurasthenia” arc usual. The hypochondriasis is associated with ideas about cancer
and fears of death and dying, and the neurasthenia is manifested by vague complaints such as fatigue,
irritability, sensitivity to weather, difficult) in coping, dizziness, malaise and depression.
Lifton suggested a mechanism of mental adaptation to the psychological impact of disaster. Death
annihilates at the physical level (bodies, houses) and mastery is required of this death immersion.
It also annihilates at the psychological level (friendships, life cohesion). The hibakusha must work
firstly to emanicipatc himself from his bondage to the dead, and secondly to re-establish himself
among the living. A process of the formulation of the relationship of the self to the world is necessary
for this. Positive formulations involved “non-resistance” which enabled the survivor to absorb the
losses and “sacrifice with a sense of special mission” which enabled the survivor to justify the con­
tinuation of his life. Negative formulations involved imagery of break-down, revenge, bitterness and
continuous strife, which tended to generate more guilt and anxiety. When guilt and anxiety were
excessive, they hindered the development of any formulation and this resulted in further difficulties
in adjustment.
Tor many years the experience was relatively intractable as a subject for symbolic transformation
in art. The principal factors interfering with the creative response were the guilt and anxiety associated
with conflicts between literal and artistic truth, and the resistance of the subject to integration within
the wider human framework of death and survival. However with the passage of time, works of art
which do seem to encompass the experience have appeared.
MANAGEMENT

There is evidence that specialized psychiatric skills could be useful in all phases of a
disaster. However, psychiatrists are rarely called upon and their intervention is
actively resisted in the early phases by other helpers and in the late phases by the
victims themselves. Although a significant proportion of persons may be disturbed in
the acute phase, it is not clear what priority should be assigned to psychiatric help
relative to other relief. In the Ancash earthquake psychiatrists were summoned
urgently as it became apparent that psychiatric complications were hindering other
.care [IS]. In more developed countries this should be feasible as a routine and in
Jugoslavia, for example, the psychological impact of disaster has been considered in
planning relief services.
In the acute phase, 10 per cent of the population may be so disturbed as to require
specific intervention such as rest, removal from the site, physical restraint, sedation
and personal attention. The commoner later complications are grief or depressive
reactions, post-traumatic neuroses, and transient emotional disturbances in children.
Those most at risk are the bereaved, injured and children separated from their parents.
General supportive therapy along simple psychotherapeutic lines is the usual approach
and provides al least temporary relief. Apart from the orthodox methods of individual
treatment, there is little information on the special problems of treating communities
where death, disablement, material loss and bereavement are prevalent. The com­
munity response may be therapeutic, aggravating or both.
Barton [8] has produced a model of the factors, individual and collective, that may significantly
affect the community response and he suggests that the community as a whole, as well as individuals,
must be a target for management. For example it is important to be aware of the significance of the
media in both aggravating and ameliorating the individual’s psychic distress. An obvious role for
psychiatrists would be to set up groups to work through the community’s shared experience in a
constructive way. Victor Frankl [92,93] attempted constructive psychological work of this kind within
the setting of continual massive psychic assaults in the concentration camps.

Hocking concludes his review by stating: “If extreme stress is prolonged, break­
down is universal, once this occurs removal of the stress may result in only a temporary
improvement, the individuals arc left with an impaired capacity to adapt to everyday
life including the physical and psychological stresses of ageing” [1]. It is not clear
whether treatment can reduce the amount of disability. A major problem in psychiatric

Disaster: Effects on mental and physical state

449

treatment is firstly, the reluctance of the victim to recognize his need for help, and
secondly, the reluctance of the psychiatrist to acknowledge the need.
Krystal [94] showed that the allocation of restitution payments from Germany was a function not of
diagnosis or psychosocial state but of the centre in Germany where the case was handled. He found
that even when sickness was identified it was rarely treated: 31 of the 697 potential patients received
treatment. In Japan, Lifton estimated that 10-20 per cent of the hibakusha are still unregistered, and
although political pressure has resulted in gross, and largely gratuitous, extensions of medical benefits
to hibakusha, the existence of mental illness as a consequence of the A-bomb is not accepted.

The main source of information on the outcome of the treatment of the chronic
complications of severe stress is the literature on the survivors of the concentration
camps. The treatment has generally been psychoanalytic and there is controversy
about its efficacy.
De Wind [95] claims that massive stress is neither an indication nor a contraindication to therapy.
However, he lists many specific difficulties including the formation of a delusional transference,
affect lameness and dread of affects, somatization, special counlerlransferencc problems, survivor
guilt precluding recovery, loss of basic trust, inability to realize that aggressive wishes arc not omni­
potent. excessive guilt over enjoyment of sado-masochistic gratification, and the use of the experience
as a resistance to the resolution of the infantile neurosis. On the basis of 22 cases treated with psycho­
analysis and others treated with psychotherapy, he concludes that the pathogenic influences of the
experiences may be relieved and once again it can become possible for a victim to take his existence
for granted apd to feel that the world is a safe place.

A possible beneficial effects of a community response in the long-term has been
demonstrated in Israel.
The kibbutz provides a secure psychosocial milieu which probably facilitates integration and
self-acceptance with a possibility of new identity formation, and the country has special museums,
periodicals, occasions of public mourning and so on. Community efforts of this kind might also
minimize the second generation effects which are well documented [96J. The children are psychologic­
ally comparable to those whose parents have had massive deprivation in their childhood. This
cultural “working through” seems to be both a spontaneous and purposive development in many
countries winch have been ravaged by civil war. It takes the form of continual reminders of the
struggle and reiteration of its value and of the heroism of those who suffered, expressed in the media,
arts and public works.
PREVENTION

Primary
The psychological effect of warnings in terms of social action is discussed by Janis
[97]. The problem is one of the human capacity for vigilance, and the tendency to
become hypervigilant, or, more usually, to adapt. Because of this extensive use of
denial, psychiatrists might have a role in alerting the public. Some kinds of disaster
are almost completely preventable.
Psychological work must be done to minimize the psychological impact of disaster.
There is agreement that a qualified rather than total belief in immunity and the
absence of disaster constitutes a favourable condition for withstanding an extreme
event. There must be an admission of the possibility of occurrence yet a belief in
survival. In admitting the event to consciousness, Janis refers to the work of worrying.
Anticipation is a small-scale preliminary exposure on the level of imagination and
can have an inoculating effect. By rehearsing and familiarizing oneself with the
coming event one may reduce the risk of being overwhelmed by the experience.
In the Bengal famines of 1943 and 1971, the notable feature was the refusal of the governments
(British and Pakistani, respectively) to do this [21]. However Janis gives examples of the ill-considered
and highly charged emotional reactions which develop with the forcible breaking down of denial [98].
Jacobson [25], describing the various individual and interpersonal crises which developed in a large
group of passengers confined aboard a sky-jacked plane, commented on the “normal” response of
refusal to accept emergency, threat and crisis. She suggested the exploitation of normal life crises

450

Warren Kinston and Rachel Rosser

and the use of non-insight oriented encounter groups to provide people with an acquaintance with
their own feelings and responses to threat.

Secondary

The most important aspect of psychological care is the social provision of physical
care: i.c. physical care is psychological care, and this is the prime and essential function
of relief organizations. General psychological first-aid should be understood by all
responsible personnel involved in disaster relief. It involves fundamentally the
establishment of effective human contact with those who are disturbed or upset. The
principal requirements are for personnel to accept every victim’s right to have his own
feelings, to accept the victim's limitations as real, and to accept their own limitations
199].
A variety of social factors which influence psychological recovery have been identified [')]. It is
essential that local governmental bodies and relief organization* are aware of these. Separations of
loved ones (pm ticulai i> children from parents) arc traumatic and every effort should be made to
pievent them. The confusion, anxiety and guilt can be minimized by accelerating the natural processes
of reorientation and reidentification; leaders are needed, lists of dead and injured arc necessary, the
establishment of effective communications and centres of information is important, and the spread
of rumours must be halted. Competition between relief organizations must be rapidly dealt with.

In addition to the fundamental physical, psychological and social approaches to
relief, specialist psychiatric care is required for acutely disturbed victims. Their
prompt treatment may be essential for efficient operation of other services, and may
have a favourable effect on the long-term prognosis of those affected.

Tertiary
Working through at the individual and group level is an important aspect of the
ultimate acceptance of the event and its consequences; and it may also aid in the
development of constructive altitudes and efforts. Psychiatric treatment, rehabilitation
and general community work may also be needed [7, 79].
PLANNING SERVICES

To outline a plan for an ideal psychiatric disaster relief service, it would be necessary
to predict the approximate number of psychiatric casualties of different types and to
calculate the amount of psychiatric manpower required at various times after the
event to handie this. This involves the following methodological problems. (1) The
Jack of tools to measure the prevalence of treatable and untreatable psychiatric
morbidity in a community. (2) The lack of control groups and “before and after” data
for disaster: a disaster is unpredictable and most routinely collected data reflects
nosocomial factors which are changed by the crisis rather than true morbidity.
(3) Lack of information on the effectiveness of various psychiatric techniques.
Quantitative data is currently available from the various studies described earlier in this paper.
The literature on life crises and their relation to mental and physical illness provides models from
which further deductions can be made about morbidity following a disaster. A variety of studies
[100—105] have compared the number of stressful life events preceding mental illness with that in
control groups. Brown et al. [100, 101] in an important group of papers have examined the relation­
ship between life events and subsequent mental illness. They conclude that severely threatening events
may be formative in depressive illness and may trigger schizophrenic illness, and that depressive
illness may also be triggered by milder stresses. Cooper and Sylph [105] suggest that severe life events
may cause neurotic illness and milder events may precipitate them. Using the experimental data of
these workers, the incidence of depressive illness in a disaster-struck community could increase by

Disaster : Effects on mental and physical state

451

350 per cent and that of unspecified neurotic illness by 1100 per cent. Of (he unspecified neurotic
illness, 30 per cent would be assumed to be substantially caused by, rather than precipitated by, the
disaster. This group at risk might be relatively more difficult to identify. Brown ct al. wrote ‘‘our
l.-rmulation of the problem is based on the explicit assumption that vulnerability to events varies
with the spontaneous onset rate which may be interpreted as the degree of latent psychiatric disturb­
ance” and ‘‘nor is it reasonable to reach any sort of final conclusion about the proportion of patients
involved in a total environmental effect” (which could be a disaster, for example) ‘‘without a complex
analysis which takes account of a whole range of other possible social influences”. We suggest that
their model might be extended to examine data on the psychiatric morbidity following disaster and
elaborated to define factors which affect the degree of latent disturbance in an individual which might
be useful in identifying those at risk (our reading suggests that age, previous psychiatric history, and
ethnic isolation would be important), and the immediate and delayed effects of the total community
experience and the type of disaster on the relation between events and illness.

Thus the incidence of illness reaches a maximum shortly after the disaster and is
compounded < caused illness, precipitated illness and illness which would have
occurred al that lime anyway. The incidence then falls slowly io below normal fot
the population, reflecting the premature occurrence of precipitated illness, and
eventually returns lo normal. The prevalence will of course persist above normal
reflecting the existence of long-term complications. To predict the amount of man­
power which can be productively introduced into the area, data is required on the
effectiveness of intervention. This urgcnllx needs investigation. Until it is clarified no
definite conclusions can be drawn regarding the relative priorities of psychiatric,
medical and other relief services in situations of limited resources. We would make
the following suggestions for present-day practice:
(1) A psychiatrist should visit all major disaster areas in the first few days after the
event and should advise on first aid and on the psychiatric services which are likely to
be needed in the immediate and longer term future. This judgement will clearly be
related to the normal standards of care available in the area.
(2) A world-wide register of psychiatrists particularly interested and experienced
in the various aspects of disaster should be set up. These might advise as expert
consultants to regional psychiatric centres.
(3) Teams of psychiatrists and auxiliary personnel should be available for integra­
tion with the general relief response in areas where there arc no developed psychiatric
services.
GENERAL DISCUSSION

Disaster and the concept of disease

Much of the controversy in documenting and in managing the psychiatric sequelae
of disaster is a reflection of the confusion between a variety of different models of
illness, such as the pathological, the statistical, the sociological and the psycho­
dynamic. This discussion considers some of the consequences of this confusion. A
major problem in describing human behaviour in psychiatric terms is its definition
as normal or abnormal in the context of a particular model. The study of a disease as
a specific entity has been heuristically convenient, but it must also be understood by
the clinician as a state of being, a dimension of the person’s way of life [106]. Engel
and others have used grief as a model for this approach [107, 108].

Responses to stress: psychodynamics
The concept of the continuity of disease process is related to the fact of the con­
tinuity of stress. It is not clear exactly what mental processes are involved in sustaining

452

Warren Kinston and Rachel Rosser

and dealini with stress, in “coping'", “surviving", or “gelling over it", nor what arc
the mental sequelae.
Physical stress and psychic trauma cannot be equated because psychic trauma is not so much
determined by the physical intensity of a situation as by the meaning and affects evoked in a particular
individual. Any experience which provokes distressing effects (fright, anxiety, shame, physical pain
etc.) is potentially traumatic. The essence of the traumatic situation is an experience of helplessness
on the part of the ego in the face of the accumulation ofyich internal excitation (109). This is universal
in infancy, but rare in adulthood; however a disaster can be just such a situation. What is threatening
to a particular person depends on the amount of psychic pain and painful affects he can tolerate;
with maturity and emotional development this tolerance increases [109, 110].

In children, “developmental studies have demonstrated that trauma may result,
not only in lhe fixation of defences and inhibitions, but also in the disruption of ego
capacities and the narrowing of the range of techniques and patterns of behaviour
available for dealing with objects and with the environment’’ [111]. This is closely
comparable with Kardincr's description of the psychopathology of the adult with
chronic traumatic neurosis [79].
A distinction may be made between the single massive experience (shock trauma)
comparable to the acute disaster, and the accumulation of difficult experiences (strain
trauma) comparable to the chn nic disaster. In the latter case a variety of accumulating
tensions and affective states results in an increasing slate of ego strain, and eventually.
as the adaptive responses fall, a strain trauma, with the subsequent development of
new ego organization to preserve a feeling of safety [112],
Many writers [7, 90. 94] emphasize ■’•'it the psychopathology during and following prolonged
states of disaster is to be understood as a reality oriented adaptation (albeit to the abnormal reality
of the disaster situation) rather than as attempts to benefit from secondary gain, or as defensive
regressions to ward off reactivated inner conflicts. Other work [2. 94, 113] suggests that one of the
fundamental and more obvious alterations in an adult subjected to severe stress is in his formulation
of existence. With increasing age, formulations may take on a negative pessimist’.: diminishing
quality [32, 72. 114).

Classification of responses to stress

Although evidence shows that disaster alters the affects, ideas, altitudes and
physical health of those exposed, there is not much literature contributed by organic­
ally-oriented psychiatrists. The reactions are often not functionally disabling,
somatization and real physical ill health leads the patient to general physicians, and
few victims present
psychiatric patients will, formal abnormalities in their mental
stale. By contrast the ps\choanal}lically-oriented psychiatrists find a plethora of
symptoms and often severe pathology. They claim that this discrepancy arises because
when the psychiatrist is experienced as unreceptivc, emotional catharsis is inhibited,
and the patient retires into a defensive isolation and takes up a posture of health.
Where psychiatric disturbance is overt and less disputed, it is often difficult to accom­
modate in existing taxonomies. Roth takes some of the more severe reactions to
disaster as examples of syndromes falling outside the traditional division between
neurosis and psychosis [53]. The typical stress response known as post-traumatic
neurosis, post-KZ syndrome, and combat exhaustion has been relatively clearly
delineated but is not recognized in the International Classification of Diseases as a
separate diagnostic category. Attempts to assess the psychiatric morbidity in the
survivors of concentration camps in traditional nosological terms resulted in the
improbable conclusion that the incidence of mental illness in this group is lower than
that of a control group [1J 5].

Disaster ; Effects on mental and physical state

453

The a-.’e of the survivor [2]

Langer [116], in a review of historical studies of the great plagues, postulate the
aggregate effects of psychological trauma as the mechanism whereby disaster brings
changes in a society or culture (also cf. ref. [117]). Following the Black Death there
was an age marked by misery, depression, anxiety and a general sense of impending
doom. The plague was a chronic frightening threat about which nothing could be
done. However, today we both expect and demand survival; society admits the
narcissistic entitlement, the right to survive.
Whether we face the traditional disasters such as natural disaster, economic
disaster and disasters involving deprived minorities, or the more modern disasters of
overpopulation and environmental pollution, our close contact with them in a world
shrunk and made emotionally immediate by telex Kion-satcllite communication turns
us all into both participants and
- ivor*.. As such the sequelae of disaster discussed
in this paper are relevant to u> all.
REFERENCES
U,.'Hocking F. Human Reactions to extreme environmental stress. Med. J. Aust. 2, 477 (1965).
\2 Lifion R, J. Dcalh in Life. Su. vixors of Hiroshima. Random House, New York (1967).
3. Mlnczer L. F. The Hartford disaster exercise. A'civ £7#/. J- Med. 278, 822 (1968).
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r
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64.
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456

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103.

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NTTG CIPHER

CURRYCdLUM SESSION - V
Situation Analysisr
I.
We are not aware of
any national
policy
for health personnel on disaster* management.

or

guide1ines

2.
Lack of effective linkages with organisations like DNDRO
and between civil and defence sectors
especially during
interdisastex phase with regard to transfer of knowhow.

3.
Lack of adequate formal training of various personnel so
thatpolicies
made
by
the
centre
are
translated into
prac ties 1 •;?<< ■ I on .
horizontally
commi i ni c at i on
both
adequate
4.
Lack
of
(intersectoral) and vertically (down to community level)

5.
The various training programmes that take place in India
at present, are
only
short, term
activity
and
adhoc
a r range mentf
6.

Lack of adequate resource; mobilisation

7.
Lack of hard scientific and epidemiological data on
all
India basis
to enable
better
preparation
for
future
es pecially rega rd ? n g man - made d i. s aste rs .

GOALS OF THE TRAINING
1.
The basic goal is to train manpower on various
of disaster cycle and. principles of management.

aspects

2.
Specific skills on disaster management will
be decided
according to the level of participants
and
the nature
of
their work.
KEY PERSONNEL:
LEVEL™! State level personnel:
Chief secretary and secretaries of civil supplies, water
supply, animal husbandry, industry and chemicals, infor­
mation and broadcasting, €:cology, and any other relevant
department.

Director of Medical Services

Police and Fire Chiefs

G.C.O of state units of array
-

Metereology - state chief
State level NGOs
Relief Commissioner

Levc.l II (District level functionaries.)
Level III (Block level workers)
Level IV
(Community and village level)

•J I PM ER should i \rst lake up
level
I
key personnel
for
training.
Later, if deemed desirable, the levels II may
be
taken up for training.
Types of Disasters to be covered;

1.

General principles of disaster cycle and its management

2.

Focus of disasters of south India
(all except earthquake and Land-slide)

3,

Focus or. man-i? de disasters applicable to India.

Duration of Training for Level-I:
3 days workshop and 2 workshops per year

(For level II, content and duration to be decided
in consultation with ievei-I functionaries)

Instructional Methods;

1.

Introductory lectures

2.
Case studies and simulated problems using
or computer.

sand

models

3.
Group discussion
with trigger-filro/vldeo
clips
motivate
personnel
and
sensitise
them
emotional/religious/social issues in a disaster.

CONTENT FOR LEVEL-I:
I.

Disaster management information system (DMIS)

2.

Disaster epidemiology

3.

Rapid assessment and response

4.

Re 1ief measures
1ntersectora1 coordinateon

to
on

EVALUATION:

Short-term:

Feedback and performance in simulation
exercises

Long term:

Feedback from the key personnel on how they
perform in training other levels and their
activity during disasters.

FOLLOW-UP ACTIVITIES:
-

Observer from JIFMER can visit workshops for leva’’
and III.

II

Mock-drills (Dry-runs) at various levels

Case studies of actual disasters and learn from them
Revise curriculum from these experiences.

Moderator:

Dr. A. J. Ve Hath

Rapporteur: Dr.K.R.Sethuraman

A GLIMPSE OF JIPMER

Jawaharlal Institute of Postgraduate Medical Education and
Research, (JIPMER) is a living tribute to the memory of late
Pandit Jawaharlal Nehru.
It is situated in the Union Territory
of Pondicherry considered a 'micrcosm’ of India.
The institute
is under the administrative control of the Union Ministry of
Health and Family Welfare and provides comprehensive health care
to the community besides maintaining high standards of medical
education and research.
Historical background:
The origin of JIPMER can be traced back to the establishment
of the "Ecole de Medicine de Pondicherry” in 1823 by the French
Government.
This was considered as one of the oldest schools of
tropical medicine.
With the def.acto transfer of Pondicherry in
1955, the Government of India upgraded the medical school to the
Dhanvantari Medical College.
By the end of 1958, a separate
campus was acquired at Gorimedu, now renamed as Dhanvantari
Nagar, 5 Kms away from the Pondicherry town and the construction
of the college and hospital buildings started.
On the 13th of
July 1964, the new college building was declared open by the then
President of India Dr. S. Radhakrishnan.
The Institute was
upgraded to a regional centre for postgraduate medical education
and research and was officially named as JIPMER.
Since then the
activities of the institute have multiplied and diversified.

The goals of the Institute are:
1.
To
develop patterns of teaching in undergraduate and post­
graduate medical education so as to establish and demonstrate
high standard of medical education to all medical colleges and
other allied institutions in India.

2.
To bring together in one place, educational facilities of the
highest order for the training of personnel in all important
branches of health activity;

3.

To attain self-sufficiency in postgraduate medical education;

4.

To render medical care of the highest order;

5.

To produce teachers of caliber; and

6.

To provide a forum for useful research.

Budget:

Planning

and

policy

matters

1

are

monitored

by

the

Advisory-cum-finance committee, with the Secretary, Ministry of
Health and Family Welfare as the Chairman and the Director Gener­
al of Health Services as Vice Chairman.
The budgetary allocation
for 1989-90 was Rs. 107.5 millions.
Campus:
The institute has a residential campus of 190 acres.
There
are six hostels for students and about 400 residential quarters
for staff. There is well furnished guest house.

Academic:

ry.

JIPMER is affiliated to the Central University of Pondicher­
The institute runs following courses:

1)

Undergraduate:

MBBS

75 students are admitted to the MBBS course annually for
which purpose a national level entrance examination is held every
year.

2)

Postgraduate degree course:

General Medicine, Obstetrics and Gynaecology, Pathology,
Pharmacology, Pediatric Medicine, Radio-diagnosis, Anaesthesiolo­
gy, Dermatology, Biochemistry, Community Medicine, General Sur­
gery, Orthopaedic Surgery, Ophthalmology, 0to-rhino-Laryngology,
Anatomy, Microbiology and Psychiatry.
3)

Diploma Course:

Diploma in Child Health (DCH), Diploma in Orthopaedics
(D.Ortho), Diploma in Ophthalmology (D.O.), Diploma in Medical
Radio Diagnosis (DMRD), Diploma in Leprosy (D.Lep).

4)

M.Ch.

(Genito Urinary Surgery)

5)

M.Sc.,

(Medical Biochemistry)

6)
Para-medical courses, Bachelor of Medical Records Science
(D.M.R.Sc), B.Sc. Medical Lab Technology, (B.Sc., M.L.T), Medical
Records Technician (M.R.T).

The teaching faculty consists of 118 teachers, 333 residents.
The undergraduate and postgraduate results in various examina­
tions have been consistently good.
In the recent All India PG
Entrance Examinations, the first four ranks were secured by
JIPMER students.
In a statewise survey of pass rate in the
primary and final National Board Examinations (NBE),
JIPMER was
placed in the highest group.

2

The institute building has four air-conditioned lecture
theaters with audio-visual facilities, a set of 8 laboratories,
four museum halls and seminar rooms in each floor.

Library:

The library building which has an attached air conditioned
seminar hall, houses over 25,600 books and 340 journals.
/Back
volumes of medical journals are available from 1930 onwards and
number of bound volumes has exceeded 19,000.
The Library also provides the following facilities/services :
Interlibrary loan
Bibliographic reference service
MEDLINE search facility (through the courtesy of WHO/NIC)
Translation service
PG research cubicles (10)
Book bank for Scheduled Gaste/Tribe students

Seating capacity of the Library
Undergraduate section
Postgraduate section

..
..

175
75

The Hospital:
JIPMER hospital caters to the health care needs of the people
of Pondicherry and the neighbouring areas of Tamilnadu.

The daily average outpatient attendance exceeds 3000.
Major­
ity of the patients come from rural areas traveling long dis­
tance.
For their convenience three rest houses are available in
the campus.
The present bed strength of the hospital is 850 inclusive of
64 paying ward beds.

There is a separate post partum block with a ward of 10 beds
for implementing post partum programme and 20 beds for treatment
of leprosy.
The hospital facilities are available to patients
free of cost.
Over 30000 patients are admitted annually for
various ailments.
Nearly 4,55,000 investigations are carried
out, besides 40,000 operations.

All patients are provided with laundered cloth during their
stay in the hospital to avoid infection and there is a cloak room
for keeping their belongings.
of

Other notable features of JIPMER hospital include a network
ancillary services, viz, central sterile supply department

3

(CSSD), hospital kitchen, a mechanised laundry, a central work­
shop, printing press, animal house and a horticulture section.

Medical Records Department:

Medical Records Department maintains
case records and
furnishes information of patients for patient care, research and
planning.
The records are maintained at a centralised place with
a, unique numbering system for each patient.
The diseases and
procedures are classified as per the World Health Organisation's
International Classification, ninth revision for easy retrieval
of information.
Information about diseases, operations and case
records from 1966 are provided by this department for the purpose
of research, publications, thesis and dissertation.
Medical Illustrations Division:
The medical illustrations division has a studio for centra­
lised production of colour slides.
This division consists of
Artist Section, Photographic Section and caters to the needs of
all departments, in the preparation of audio-visual materials for
teaching, publication and presentation.
Annually about 5000
slides in 35 mm size and 2500 clinical photographs are prepared
for various departments of this Institute.

Field practice areas for community training:
Rural and urban health centres were established as extension
units of JIPMER in 1959 and 1961 respectively.
The staff working
at these health centres are under the administrative control of
the Director, JIPMER and are supervised by the Department of
Preventive and Social Medicine. They provide:
1. Training in community health to undergraduate medical
students, medical interns (rotatory house surgeons), Postgraduate
medical students and other health workers.

2.

Service; Primary health care to the community.

3. Research: On community health problems
aspects of delivery of health care.

and

on

various

Jawaharlal Institute Rural Health Centre (RHC):

The Rural Health Centre at Ramanathapuram provides family centered, comprehensive health services to 12 villages in Union
territory of Pondicherry with a population of 14680
or 2730
families (1983).
It has one sub-centre at Sedarapet and a sub­
sidiary health centre at Coodapakkam.

4

Participation of other Departments:

Teaching staff from other departments such as Obstetrics and
Gynaecology, Ophthalmology and Dermatology visit the centre
periodically for providing consultation to referred cases.

Jawaharlal Institute Urban Health Centre (UHC):

v

The Urban Health Centre was established in May 1959 to serve
a population of 2300 of Kurichikuppam area.
Subsequently, the
service area was expanded in 1964 and 1983.
At present, the
centre provides comprehensive family centered health care to the
population of 8090 (1964) living in 1545 families in Kurichikup­
pam, Vazhakulam and a part of Vaithikuppam areas of urban Pondi­
cherry .
Some selected health indices to highlight the achievements
of the two health centres are given below:-

INDIA

UHC

RHC
1990

Birth rate *
20
Death rate *
9
Infant mortality rate +
44
Maternal mortality rate+
0
Antenatal care (%)
100
Antenatal TT (%)
100
Eligible couple pro51
tection (%)

Curren t

2000

18
7
33
0
100
100
53

34
12
105
4
40-50
20
32

21
9
60
2
100
100
60

100
100
100
99.4

65
25
05
20

Immunisation coverage (%)
BCG
DPT
Polio
Measles

100
100
100
87

85
85
85
80

* = per 1000 population, + = per 1000 live births
Under the Reorientation of Medical Education (ROME) Scheme,
JIPMER has established a rural referral complex consisting of six
primary health centres, with the dual objective of providing
comprehensive health care to the rural population and also to
give community orientation to the students and teachers.
Under
this scheme, mobile clinic camps are held monthly in villages
with the participation from eight clinical departments.

5

On an average over 900 patients are seen in the general OPD
at each camp and a further 400-500 receive services from special­
ists.
Laboratory investigations and health education are the
other important activities of the Mobile Clinic.
The clinics are
utilised for training of undergraduates, interns and postgraduate
students.

Before each camp a preliminary house to house survey is
carried out by interns and residents to identify the prevailing
health problems and for selecting the cases which require spe­
cialists’ care.
This is followed by a 5 day visit when the
mobile clinic is stationed continuously in the village for pro­
viding comprehensive health care services.
Teachers from the
departments of Ophthalmology, General Medicine, General Surgery,
Pediatrics, ENT, Obstetrics & Gynaecology, Dermatology and Den­
tistry visit the clinic on different days for providing consult­
ancy services.
The mobile clinic periodically revisits the
villages covered for providing follow-up services. One hundred
and five camps have been held so far since 1980 covering 228
villages benefitting over 1,25,000 rural population.
JIPMER participates in National health programmes like

1.
2.
3.
4.
5.
6.

Family Planning
Leprosy Eradication
Malaria Eradication
Programme on prevention of Blindness
Universal Immunisation Programme
Integrated Child Development Services (ICDS)

National Teacher Training Centre

The National Teacher Training Centre (NTTC) established in
1975 with WHO support is the first such centre for the training
of health professionals in educational technology.
Obj ectives:

1.

To promote the training of teachers of health professionals
in educational science and technology.

2.

To promote the development
educational process and

3.

To promote and conduct educational research

and

6

application

of

systematic

Educational activities conducted by the NTTC

Target group

No. of
courses

No. of parti­
cipants

National Course in
Educational Science

Medical teachers

25

511 (from 79 medi­
cal Colleges)

Workshop on Educa­
tional Planning etc.

Deans, Principals

6

76

workshop on Educa­
tional Science

Postgraduate
S tuden ts

12

210

Activi ty

WHO Fellows from
other countries

14

The centre is actively engaged in promoting Reorientation of
Medical Education through staff development activity and consult­
ancy services.

The concerted action by various departments and the commit­
ment of staff and students have contributed to the academic
atmosphere that pervades in this institute and enables it to
march ahead with sustained motivation.

Compiled
(1991).

by:

Dr.D.K.Srinivas

and

Mr.B.V.Adkoli,

NTTC,

JIPMER,

7--I0

GROUP DISCUSSION ON CURRICULAR DETERMINATS
FORTRAINING AND FUTURE PLANS OF THE
JIPMER CENTRE

JIPMER is expected to train key personnel
from the States of Andhra Pradesh, Tamil Nadu,
Pondicherry, Karnataka and Kerala in Disaster
Preparedness and Response. It is necessary as a
first step to develop curricula for organising such
training programmes and also to prepare a plan
regarding the future rolc of JIPMER Centre. The
participants were therefore divided into two groups
for holding group discussions and to make re­
commendations.

into practical action properly. There is also a lack
of adequate communication both intersect orally
and vertically down to the community level. The
various training programmes in India are only
short term adhoc arrangements. Eventhough some
data are available, there is a clear lack of hard
scientific and epidemiological data on an All India
basis to enable a belter preparation for the future
especially with regard to man-made disasters.
Recommendations:—

Deliberations and Recommendations of Group-A

The Group-A focussed on curriculum develop­
ment. Dr. A.J. Veliath was the moderator and
Dr. K.R. Sethuraman was the rapporteur. The
following points were taken up for discussion:

— What should be the goals of training pro­
gramme?
— What levels* of key personnel are to be trained?
— What types of disasters should JIPMER
Centre focus on for training?
— What should be the duration and frequency of
training for different levels* of personnel?
— What type of teaching/learning methods would
be effective to achieve the goals?
— What methods of evaluation should be
adopted?
(* Level refers to level in hierarchy and also
to the type of trainee, for example: administrator,
physician etc.)
Situation Analysis:—

It was felt that there is at present a lack of
awareness of the national policy or guidelines for
health professional on disaster management. There
is also a lack of effective linkage with various
government and non-government organisations
and between civil and defence sections—especially
during the interdisaster phase. There is a lack of
adequate formal training of various personnel, so
that the policies by the Centre are not translated

In view of the above, it is necessary to have
formal and well stipulated goals of training. These
should endeavour:

i)

to train manpower on various aspects of
the disaster cycle and the principles of dis­
aster management.
ii) to develop specific scientific skills on dis­
aster management which should be decided
according to the level of the participants
and the nature of their work.

The key personnel to be trained are classified
as follows:
Level /• State level personnel:—

Relief Commissioner of the respective states,
Secretaries, Health, Civil Supplies etc.
Directors of Medical and Health Services.
other Stale level officers of different depart­
ments.
- Stale level NGOs.
Level 2: District level functionaries:—
— District Magistrate,
District Chief Medical Officer of Health and
other district health officials.
- District level NGOs.
Level 3: Block level officials:—

Block development officer.
Medical Officers and other staff members of
Primary health centres.

I.eiel 4

Coninmniiy ami village level workers.—

ll was fell that JIPMF.H should hist take up
level-1 key personnel for training. Later, if deemed
desirable and feasible. Level-2 may be taken lor
training
The training programmes should:
I) cover general principles of the disaster
cycle and its management;
2) focus on disasters common in South India
such as Hoods, cyclone etc
3) focus on man-made disasters as applicable
to India. The duration of the training for level-1
should be of 3 days. I here can be 2 worships
per year. Il was decided that for level-2, the
content and duration should be decided in
consultation with level-1 functionaries.

The instructional methods to be adopted lor
training should include:

introductory’ lectures:
case studies and simulated problems using
sand models or computer models,
3) group discussions, trigger-films, video clips
etc. to motivate the personnel and sensitize
them on emotional religious social issues
involved in disaster

I)
2)

The core content for level-1 training must consist
of:
I) disaster management information systems
(DMIS):
2) disaster epidemiology:
3) rapid assessment and response:
4) relief measures;
5) intersectoral coordination.

There is a need for continuous evaluation of
the training programme. This must include a short­
term evaluation based on feedback and perfor­
mance in simulation exercises and a long-term
evaluation based on feedback from the key per­
sonnel on how they perform in training other
levels of workers, and their own activity during
actual disasters.

National Teacher Training Centre

JAWAHARLAL INSTITUTE OF POSTGRADUATE MEDICAL EDUCATION & RESEARCH
PONDICHERRY 605006

CORE FACULTY TRAINING WORKSHOP IN DISASTER PREPAREDNESS
(W.H.O Sponsored)

29th to 31st August,

1991

LIST OF PARTICIPANTS

Dr.Olavi Elo
W.H.O Representative to India
Nirman Bhavan
New Delhi 110 011

Dr.Brij
Bhushan
Deputy Addl. Director General (EMR)
Dte. General of Health Services
Nirman Bhavan
New Delhi 110 011
Dr.S.P.Mukhopadhyay,
Professor and Head, Dept of P&SM,
All India Institute of Hygiene
& Public Health,
110, Chittaranjan Avenue,
Calcutta 700 073.

Lt. Col. S.S. Verma
Commanding Officer
Station Health Organization
Delhi Cantt
Delhi 110 010

Dr.V.M.Meher-Homji
French Institute
P.B.33
Pondicherry 605001

Sri.G.S.Ganesan
Director
Cyclone Warning and Research Centre
Regional Matereological Centre
50 College Road, Madras 600 006
Dr.Jacob D Raj
Director, PREPARE,
364 North Main Road
Anna Nagar West
Madras 600 101

Dr.P.N. Pandit
575
16th Block Main
III Block, Koramangala
Bangalore 560 034
Dr.Shirdi Prasad Tekur
Community Health Cell
26, V Main, I Block,
Koramangala, Bangalore 560

034

Participants from JIPMER

Dr.S.Chandrasekar
Director,

Dr.A.J. Veliath
Medical Superintendent,
Dr.K.R.Se thuraman
Assoc Professor of Medicine,
Dr.N.Ananthakrishnan
Asssoc Professor of Surgery,

Dr.K.M. Rajendran
Professor of Anaesthesiology,
Dr.R.Sambasiva Rao
Professor of Microbiology

Dr. D.K. Patro
Assoc Professor of Orthopaedic Surgery,
Dr.S.Jayan thi
Assoc Professor of Pathology,

Dr.D.K.Srinivasa
Project Officer, NTTC,

National Teacher Training Centre
Jawaharlal Institute of Postgraduate Medical Education & Research
Pondicherry 605006

W.II.O

sponsored workshop for Training Core Faculty
Preparedness

in

Disaster

29th to 31st August, 1991

Venue: Library Seminar Hall
INAUGURAL SESSION

Agenda
Thursday:

Arrival of Dr.Har Swarup Singh
His Excellency the Lt. Governor of Pondicherry
'Welcome and objectives of the workshop
- Dr.S.Chandrasekar, Director, JIPMER
Brief report of NTTC activities
- Dr.D.K.Srinivasa, Project Officer, NTTC

Inauguration - Dr.Har Swarup Singh
His Excellency the Lt. Governor,
Pondicherry
Introduction of Resource Persons and the Faculty
Vote of thanks

..STRIKEBE PREPARED! :

JAWAHARLAL INSTITUTE OF POSTGRADUATE MEDICAL EDUCATION AND
RESEARCH, PONDICHERRY 605006
NATIONAL TEACHER TRAINING CENTRE
PLANNING MEETING FOR DISASTER PREPAREDNESS TRAINING

PROGRAMME

WEDNESDAY 16.9.92

01.00 pm
02.30 pm
04.30 pm

Registration
Welcome and Opening rema^rks - DR. D.S. DUBEY,Director
Objectives of Meeting and How do we work.
Presentation by visiting Resource Persona.
Discuss ion.
Distribution of topics / reaponiaibi1it1ea.
Formation of groups.
Lunch
Group Work.
Preview meeting

THURSDAY

17.9.92

09.00 am

Group Work (continued)
- Formulate Objectives and
Contents of module

09.30
09.45
10.00
10.30

am
am
am
am

12.30 pm

01.00 pm
02.00 pm

Lunch
Group Work(continued)

FRIDAY

18.9.92.

_
on|_
| __

Floods & Cyclone
CPR
First aid

PLENARY SESSION

09.00 am
- Group Presentations
to
12.0 ONoon
Strategy for monitoring, co-ordination, development
o f mat e i r i ala.
01.00 pm
Lunch
02.00 pm
Preparation of review of reports and proposals for
future activities of JIPMER centre, (core group
meet inmg)

NATIONAL TEACHER TRAINING CENTRE

LIST OF PARTICIPANTS
1.

DR. JACOB *D. RAJ,
Executive Secretary (PREPARE),
4, Sathalvar Street,
Mugappalr [Jest (PADI),
MADRAS 600 050.

2.

DR. SHIRIDI PRASAD TEKUR,
Community Health Cell,
326,
V Main
1st Street,
Koramangala,
BANGALORE -560 034.

3.

SHRI SUAMI SUATMANANDA,
Ramakirishna Mission,
Rajahmundry Centre,
ANHDRA PRADESH.

4.

LT. COL. SHAMMSHER SINGH,
Officers Training School,
Lucknow.

5.

DR. BRI J BHUSHAN,
Dy. Asst. General of Health Services,
D.G.H.S.,
Nirman Bhavan,
Nev/ Delhi .

6.

DR. DARA S. AMAR,
Prof. & Head of the
Deptt. of Community Medicine,
St. Johns Medical College,
BANGALORE

7.

DR. G. PRABHAKARAN,
Rotary SAVE CHILDREN FUND
Vishakapat inam,
A. P .

8.

LT. COL. N.K. PARMAR, Vr.C.,
DADG (3-C)
Office of Director General
Armed Forces Medical Services,
Ministry of Defence,
New Delhi.

9.

TUO OFFICIALS FROM ANDHRA PRADESH.

JIPMER PARTICIPANTS
1.

DR. D.S. DUBEY,
Director.

2

DR. A.J. VELIATH,
Medical Superintendent.

3

DR. D.K. SRINIVASA,
Director P.rof.of P & S.M.
Project Officer, NTTC.

and

4

DR. K.M. RAJENDRAN,
Prof, of Anaesthesiology.

5

DR. N. ANANTHAKRISHNAN,
Prof, of Surgery.

6

DR. K.R. SETHURAMAN,
Prof, of Medicine - Through Proper Channel.

7

DR. D.K. PATRO,
Assoc. Prof, of Ortho.

8

DR. S.
Assoc.

9

DR. T.K. DUTTA,
Assoc. Prof, of Medicine.

JAYANTHI.,
Prof, of Pathology - Through Proper Channel.

- Through Proper Channel7.

10

DR. S.
Assoc.

JAGDISH,
Prof, of Surgery.

11

DR. R.
Assoc.

CHANDRASEKAR,
Prof, of Psychiatry

12

DR. VISHNU BHATT,
Assoc. Prof, of Paediatrics - Through Proper Channel.

*13

DR.
Sr.

SANTHOSH KUMAR,
Resident, P & S.M.

Deptt'.

- Through Proper Channel.

14

DR. RAVISHANKAR,
Q,
Assoc, Prof, of Anaesthesiology -Through Proper Chennel1

15

MR. K. VIJAYAN PILLAI,
Technical Supervisor, NTTC - Through Proper Channel.

JAWAHARLAL

INSTITUTE OF
RESEARCH,

POSTGRADUATE MEDICAL
PONDICHERRY 605006

NATIONAL TEACHER

PLANNING

TRAINING

EDUCATION AND

CENTRE

MEETING ON DISASTER PREPAREDNESS PROGRAMME
(From 16th to 18th September, 1992)
LIST

OF

RESOURCE

(WHO)

PERSONS

Telephone Numbers
Office

Residence

1.

DR. JACOB D. RAJ,
Executive Secretary (PREPARE),
4, Sathalvar Street,
Mugappair West (PADI),
MADRAS 600 050.

654211
655015

655291

2.

DR. SHIRIDI PRASAD TEKUR,
Community Health Cell,
326,
V Main
1st Street,
Koramangala,
BANGALORE -560 034.

531518

620740

3 .

SHRI SUAMI SUATMANANDA,
Ramakirishna Mission,
Rajahmundry Centre,
ANHDRA PRADESH.

73112
78127

4 .

LT. COL.
Officers
Lucknow.

240181
240182 Extn.2761

5 .

DR. DARA S. AMAR,
Prof. & Head of the
Deptt. of Community Medicine,
St. Johns Medical College,
BANGALORE

530724 Extn.413

531737

6 .

LT. COL. N.K. PARMAR, Vr.C.,
DADG (3-C)
Office of Director General
Armed Forces Medical Services,
Ministry of Defence,
New Delhi.

3019580

3294660

7 .

DR. A. MUNAUARKHAN,
Joint Director (Epidemiology),
Directorate of Public Health
and P.M.,
MADRAS.

454175
454311
Extn.to J t.
(Epidemic)

8 .

DR. A. CHOCKALINGAM,
Deputy Director of Health Services,
CUDDALORE,
Tamil Nadu.

20134

9.

MR. N.K. RANGANATHAN,
Addl. Asst. Commissioner,
(Revenue Admn.)
MADRAS.

830550
269 .

SHAMSHER SINGH,
Training School,

848012
extn
Room No.210.
Director

Extn.

National Teacher Training Centre
JAWAHARLAL INSTITUTE OF POSTGRADUATE MEDICAL EDUCATION & RESEARCH
PONDICHERRY 605006
W.H.O Sponsored Core Faculty Training Workshop on

Disaster preparedness

Dates: 29th to 31st August 1991.
Venue: LIBRARY SEMINAR HALL , JIPMER.

Project Officer:
Dr . D . I< . Srinivasa

Project Director:
Dr. S.Chandrasekar

Genl. Rapporteur:
Dr.N.Ananthakrishnan

PROGRAMME

29.08.1991 Thursday
9.00 am

Regis tra tion

9.30 am

Inaugura tion

Dr.Liar Swarup Singh
His Excellency the Lt. Governor of Pondicherry
10.30 am

Tea

SESSION I
11.00 am

Chairperson
Rapporteur

: Dr.S.Chandrasekar
: Dr. A.J. Veliath

Key note address:
’Present Status of Disaster Preparedness at the
Global Level’
- By Dr.Olavi Elo

12.00 noon

’Consideration of Environmental Issues: Towards
Long-term Disaster Preparedness'
- By Dr.Meher-Homji

01.00 pm

Lunch

1

SESSION II

Chair Person
Rapporteur

Dr.Olavi Elo
Dr.A.J.Ve1ia th

2.00 pm

'Disaster Profile in India'
- Dr.Brij Bhushan

2.45 pin

Reaction time and Discussion

3.15 pm

Tea

3.30 pm

'Health Aspects of Disasters and their Management'
- Dr.S.P.Mukhopadhyay

4.15 pm

Reaction time and Discussion

30.08.1991 Friday

SESSION III
Chairperson
Rappor teur

Dr.Brij Bhushan
Dr.Raj endiran

9.00 am

'Relief and Management of Mass Casualties'
Lt. Col. S.S.Verma, AMC

9.45 am

Reaction time and Discussion

10.00 am

'Role of Statistical Techniques in Quantitative
Risk Assessment'
- Dr.A.W.Deshpande

10.45 am

Reaction time and Discussion

11.00 am

Tea

11.15 arn

’Role of Voluntary Agencies in Disaster Relief’
- Dr.Shirdi Prasad Tekur

12.15 pm

Reaction time and Discussion

12.30 pm

Visit to JIPMER Hospital

1 .00 pm

Lunch

2

SESSION IV
Chairperson
Rapporteur

Dr.S.P.Mukhopadhyay
Dr.Rajendiran

:
:

2.00 pm

’Disaster Relief’
- Dr.P.N.Pandit

2.45 pm

Reaction time and Discussion

3.00 pm

'Disaster Relief - The PREPARE
Experience'
- Dr.Jacob D Raj

4.00 pm

Visit to Auroville

31.08.1991 Saturday

SESSION - V
Chairperson
Rapporteur

Dr.Olavi Elo
Dr.K.R.Sethuraman

:
:

9.00 am

'Curriculum Determinants in Relation to Disaster
Preparedness'
- Dr.D.K.Srinivasa

9.30 am

Group Work on ’Curriculum Development for Training
and Future Plans for the Centre'

11.30 am

Plenary Session

1.00 pm

Lunch

SESSION - VI

Chairperson
Rapporteur

:
:

Dr.A.J.Veliath
Dr.K.R.Sethurman

2.00 pm

Status Paper on 'Organisation of Relief and
Rehabilitation - Tamil Nadu'
- Sri G.S.Ganesan

2.45 pm

Status Paper on 'Disaster Preparedness and Relief
Pondicherry'
Collector, Government of Pondicherry.

3.30 pm

Valedictory Session

3

SESSION-V

CURRICULUM DEVELOPMENT AND TRAINING AT JIPMER CENTRE
The JIPMER Centre is expected to train key personnel from
the states of Andhra Pradesh, Tamil Nadu, Pondicherry, Karnataka
and Kerala in Disaster Preparedness and Response. It is neces­
sary to develop curricula for organising the training programmes
The group is requested to consider the following issues and offer
suggestions :

Group-A:

On curriculum development and a schedule for implemen­
tation .

Group-B:

Future plans of JIPMER Centre.

DISCUSSION POINTS FOR GROUP-A
n

What should be the goals of training programme?

g

What level* of key personnel are to be trained?

h

What types of disasters should JIPMER Centre focus on?

d

What should be the duration and
different levels* of personnel?

■

What type of teaching/learning methods would be effective to
achieve the goals?

a

What methods of evaluation should be adopted?

■

What mechanism should be established to aid in follow up?

frequency

of

training

for

(* Level refers to level in hierarchy and also to the type
e.g. administrator, physician etc.)

' A'wi?

- J / PAI g

National Teacher Training Centre
JAWAHARLAL INSTITUTE OF POSTGRADUATE MEDICAL EDUCATION & RESEARCH
PONDICHERRY 605006

CORE FACULTY TRAINING WORKSHOP IN DISASTER PREPAREDNESS
(W. H. 0 Sponsored)

29th to 31st August,

1991

LIST OF PARTICIPANTS

Dr.Olavi Elo
W.H.O Representative to India
Nirman Bhavan
New Delhi 110 011

vOr.Brij
Bhushan
Deputy Addl. Director General (EMR)
Dte. General of Health Services
Nirman Bhavan
New Delhi 110 011
Dr.S.P.Mukhopadhyay,
Professor and Head, Dept of P&SM,
All India Institute of Hygiene
& Public Health,
110, Chittaranjan Avenue,
Calcutta 700 073.

/Lt. Col. S.S. Verma
Commanding Officer
Station Health Organization
Delhi Cantt
Delhi 110 010

Dr.V.M.Meher-Homji
French Institute
P.B.33
Pondicherry 605001

Dr.A.W.Deshpande
,““al

Engineering Research Institute

Sri.G.S .Ganesan
Director
Cyclone Warning and Research Centre
Regional Matereological Centre
50 College Road, Madras 600 006

Dr.Jacob D Raj
Director, PREPARE,
364 North Main Road
Anna Nagar West
Madras 600 101
Dr.P.N. Pandit
575
16th Block Main
III Block, Koramangala
Bangalore 560 034
Dr.Shirdi Prasad Tekur
Community Health Cell
26, V Main, I Block,
Koramangala, Bangalore 560

034

Participants from JIPMER
Dr.S.Chandrasekar
Director,
Dr.A.J. Veliath
Medical Superintendent,
Dr.K.R.Sethuraman
Assoc Professor of Medicine,
Dr.N.Ananthakrishnan
Asssoc Professor of Surgery,

Dr.K.M. Rajendran
Professor of Anaesthesiology,
Dr.R.Sambasiva Rao
Professor of Microbiology

Dr. D.K. Patro
Assoc Professor of Orthopaedic Surgery,
Dr.S.Jayanthi
Assoc Professor of Pathology,
Dr.D.K.Srinivasa
Project Officer, NTTC,

The Director & the Project Officer

National Teacher Training Centre,
JIPMER

cordially invite to the inauguration of the
CORE FACULTY TRAINING WORKSHOP
on
DISASTER PREPAREDNESS
(W.H.O sponsored)
by Dr.Har Swarup Singh

His Excellency the Lt. Governor of Pondicherry

in the Library Seminar Hall, JIPMER
at 9.30am on 29th August,

1991

National Teacher Training Centre
Jawaharlal Institute of Postgraduate Medical Education & Research
Pondicherry 605006
W.H.O

sponsored workshop

for Training Core
Preparedness

Faculty

in

Disaster

29th to 31st August, 1991
Venue: Library Seminar Hall

INAUGURAL SESSION
Agenda

29.08.91

Thursday:

9.30 am

Arrival of Dr.Har Swarup Singh
His Excellency the Lt. Governor of Pondicherry

9.35 am

Welcome and objectives of the workshop
- Dr.S.Chandrasekar, Director, JIPMER

9.50 am

Brief report of NTTC activities
- Dr.D.K.Srinivasa, Project Officer, NTTC

10.00 am

Inauguration - Dr.Har Swarup Singh
His Excellency
the Lt. Governor,
Pondicherry

10.15 am

Introduction of Resource Persons and the Faculty

10.25 am

Vote of thanks

1

SQ

INDIAN SOCIETY OF HEALTH ADMINISTRATORS (ISHA)
*N

104 (15/37), CAMBRIDGE ROAD CROSS, GLSOOR, BANGALORE-560 008
CABLE: HEALTHADMN
® : 574297/531979

Fax

INLAND : 0312-261468 ICFAX-569
FOREIGN: 0091 -812-261468 ICFAX-569

Telex : 0845/2696 or 8055/ICTP/1071

3 February,1992

G-65/92/HO "7 G

Dr Shirdi Prasad Tekur
Community Health Cell
No.326, V Main, I Block
Koramangala
Bangalore - 560 034
Dear Dr Tekur,

Sub: Workshop on "Disaster Planning and Management of
Health Services", for District Health Officers:
February 17 - 21,
1992 at Indian Social
Institute, Bangalore
1.
Kindly refer to our correspondence on the above subject
regarding your participation in the above Workshop and sharing
with the participants about your experiences in Disaster Planning
in the health and allied areas.
2.
We are happy to inform you that the Government of India has
now confirmed the dates.
We shall request your availability on
any day, February 18-21, 1992, since on the first day of the
Workshop, there would be general discussions on Health Policy and
Management.
Please let us know the date convenient to you.
Also, kindly let us know the exact title of your presentation.

3.
We expect approximately 35-40 participants.
They would be
District Health Officers/District Medical Officers from
Karnataka, Madhya Pradesh, Gujarat and Andhra Pradesh.
4.
As indicated earlier,
we shall provide the local
hospitalities and accommodation arrangements at Indian Social
Institute, No.24 Benson Road, Bangalore-560046, Phone:575189,
which is also the venue of the Workshop.
A map showing the
directions to reach ISI is enclosed.

We look
regards,

forward to hearing

from you

soon,

and with kind

Cordially yours,

Dr Ashok Sahni
Professor and
Hony Executive Director

encl:aa

INDIAN SOCIAL INSTITUTE
24 BENSON ROAD,
BANGALORE - 560 046.

INDIAN SOCIETY OF HEALTH ADMINISTRATORS (ISHA)
104 (15/37), CAMBRIDGE ROAD CROSS, ULSOOR, BANGALORE-560 008
CABLE: HEALTHADMN
® 574297/531979
FaxriNLAND :
haX[_FOREIGN :

081 2 - 261468 ICFAX - 569
"1 T( . 0845/2696 or 8055/ICTP/1071
0091 -812-261468 ICFAX-569 J e,ex ‘
‘

G-65/92//|(q_$-

10 February 1 992

Dr Shirdi Prasad Tekur
Community Health Cell
No# 326, V Main, I Block
Koramangala
Bangalore - 560 034
KARNATAKA
Dear Dr Tekur,

Sub: Workshop on ’’Disaster Planning and Management of
Health Services”, for District Health Officers:
February 17-21, 1992 at Indian Social Institute,
B angalore.
1.
Kindly refer to our telephonic discussion todayo
Thank you
very much for agreeing to take a session for the participants
on 20th February, 1992, at 9.00 AM on ” Collaboration between
Voluntary Agencies and Government Agencies in Disaster Responses”.
As discussed, we shall be happy to have your participation and
professional inputs during the entire workshop from 17-21
Please feel free to attend any of the sessions as per your
convenience,
Particularly, we would suggest that you could
participate on the first day at the inaugural session when the
participants would introduce themselves.

We look forward to meeting you at the workshop.
With kind regards,

Cordially yours

Dy Ashok Sahni
Professor and
Hony Executive Director
nb

INDIAN SOCIAL INSTITUTE
24 BENSON ROAD.
BANGALORE - 560 046.

I THE STATES

Tension in the air
Bihar, already riven by deep social and economic divisions, watches with concern
a government move to introduce land reforms.
KALYAN CHAUDHURI

nent trouble. But who knows, even now
someone may claim my land.”
Puranjit Sinha echoed the sentiments
ofa large number ofpeople in rural Bihar,
including a big section that belongs to the
backward classes. Pappu Yadav, an inde­
pendent Member of Parliament, who has
a following among Yadavs, who belong
to the Other Backward Classes (OBC),
has warned of dire consequences if there
is “any attempt to redistribute rural land”.
Pappu Yadav, who is now undergoing
trial in connection with the murder of
Communist Party of India (Marxist)
leader Ajit Sarkar, hails from rhe SaharsaMadhepura area where Yadavs have tra­
ditionally been landlords.
The situation is not different in
Nalanda, Patna and Jehanabad districts
of the violence-prone central Bihar.
Landowners belonging to the Kurmi and
Yadav communities are in no mood to
share their land with sharecroppers. Said
a rickshawpuller, a Muslim, from
Motihari: “I was a sharecropper for the
last 20-25 years but the landowner forced

me to hand over the land as he did not
want to take chances. The result is that
now at my age I have to pull a rickshaw.”
There is also the fear of lumpen ele­
HE kick of land reforms has been
ments taking advantage of the situation
blamed for many of rhe ills of Bihar.
and farmers themselves using them to set­
However, by a curious irony, it is now
tle scores with their rivals. Statements by
feared that rhe likely introduction ofland
people like Pappu Yadav make it clear
reforms by the Rabri Devi government
that in the matter ofland the interests of
will trigger the bloodiest round of vio­
the upper castes and the advanced sec­
lence in rhe Stare’s history.
tions among the backward classes such as
Driven by political considerations,
Kurmis and Yadavs converge. This, peo­
particularly the outcome of the panchayple fear, may lead to a spate of violence.
at elections, which were held in June after
There are indications that naxalite
a gap of24 years, the RashtriyaJanata Dalgroups such as rhe Maoist Communist
Congress(I) coalition government has
Centre (MCC) and the People’s War
reportedly prepared a set of land reform
(P.W.) fear that the proposed land reforms
measures to distribute land to sharecrop­
will check the growth of their support base
pers and tillers of rhe land. The package,
among the landless poor. Predictably, they
according to informed sources in the gov­
have described the package an eyewash.
ernment, includes “very radical” reforms
They may not be averse to inciting vio­
that were drafted by the Congress(I) gov­
lence in order ro sabotage the proposals, it
ernment led by Bindeswari Dubey (1985is feared. The MCC has entrenched itself
89) and passed by the legislature. But, the
in some central Bihar districts where,
sources say, the measures have been sub­
according to intelligence officials, land rev­
stantially modified by rhe present gov­
enue collection has fallen substantially.
ernment to “suit its own
Making matters worse is
political and caste equations”.
the hostilities between the
According to a senior offi­
MCC and the P.W. on rhe
cial, the package contains a
one side and the Communist
provision that seeks to make a
Party of India (Marxistsharecropper the legal owner
Leninist) Liber- ation, anoth­
of the land he works on if he
er naxalite group, on the
other. With its base having
•pays 15 years’ land tax ro the
shrunk to pans of Patna and
government. At current rates,
the tax amount would be a pit­
Jehanabad
districts,
the
tance. There is also a provision
Liberation group is on rhe
that would enable sharecrop­
defensive. Informed sources
pers to have their names reg­
say that the group is likely to
istered
in
government
assert its presence through
records.
violence.
Measures like these are
A formal announcement
certain to stir a hornet’s nest.
of the land reforms package is
The more cautious among the
delayed because Laloo Prasad
■indowners have started takYadav. RJD supremo and for­
mer Chief Minister, is wary
■g pre-emptive steps. Says
iiranjit Sinha, a retired engiabout
its
ramifications.
gjr who owns about 20 acres
However, political compul­
.f land in his village in
sions may ensure that it is not
(jginparan district: “I have Rashtriya Janata Dal leader Laloo Prasad Yadav with wife and
delayed any further. Non-per­
^dy taken possession of Bihar Chief Minister Rabri Devi and other party leaders outside formance has been a charge
^hnd because of the immi- the Prime Minister's residence in New Delhi on September 2.
levelled against (he RJD
in Patna

T

p)‘

FRv |

OCTOBER 12/2001

KALYAN CHAUDHURI

LOODS and drought have stalked
Bihar simultaneously in the past
two months. With very' little to fall
back upon, people suffer in silence or
migrate to other Stares in search of a
livelihood.
The northern planes of the State are
flooded by rivers flowing from the hilly
regions of neighbouring Nepal, which
received heavy rain. According to
Agriculture Department officials, rain­
fall in 34 districts has been below the
average this year. In Samastipur,
Muzaffarpur, Begusarai, Bhagalpur,
Darbhanga and Madhubani districts,
the shortfall has been 20 to 35 per cent.
But all these districts are
reeling under floods,
which have claimed 101
lives and damaged stand- !
ing crops on one lakli 1
hectares. The loss is esti­
mated at over Rs.500
crores. Informed sources
said over 60 lakh people in
16 districts had been
affected.
After an aerial survey
of the flood-affected areas.
a Central government
team said that the floods
had caused “immense
damage”. The State gov-

F

ernment has sought over Rs.300 crores
from the Centre for flood relief.
The situation worsened in the third
week of September when the turbulent
Burhi Gandak river breached its
embankments in Samastipur district.
Vast areas in the Bibhutipur block in the
district are under water. Nearly 50 panchayats were affected in this area. Other
northern Bihar districts, including
Saran,
East
Champaran,
West
Champaran and Goplagunj, also faced
the fury of the Gandak, the Burhi
Gandak. the Adhwara Bagmati and the
Kosi. In Gopalganj, Saran and West
Champaran, rhe Army was pressed into
service to provide relief. Three people
were killed at Aurai in north Bihar on

August 6, when the police opened fire
on a group of people protesting against
“irregularities” in the distribution of
relief materials.

N contrast, the spectre of drought
looms large over the districts of
Bhojpur, Rohtas, Gaya, Munger, Patna
and Aurangabad in central Bihar where
the rainfall has been 25 to 45 per cent
below the average. The rains were
delayed and scanty. The rainfall during
June was 95-3 mm as compared to the
normal of 178.3 mm; in July it was
156.5 mm, much below the normal of
316.6 mm. As a result, large tracts of
land remain barren. Although the time
for sowing rhe kharif crop is coming to
an end, paddy saplings have not been
planted in about half the cropped area
in the State. ■

I

Taking refuge on rooftops, at a
flood-affected village in Bihar.
(Below) People being evacuated
from a village in Gopalganj district.

REUTERS

Floods and drought

Oxfam International - India Contingency Plan for Disaster Preparedness
CONSULTATION ON DISASTER PREPAREDNESS IN SOUTH INDIA

Dear Dr. i helma Narayan,

You are cordially invited for a "CONSULTATION ON DISASTER PREPAREDNESS IN SOUTH
INDIA" on 27th March 2004, Saturday (10.00 a.m. to 5.00 p.m.) at Bangalore. The Venue is:

Student Christian Movement of India Hall
29, 2nd Cross, CSI Compound,
Mission Road, Bangalore - 560 027
Ph: 080-22223761

Disaster Contingency Planning
A Disaster Contingency Plan is a framework for intervention, in case of a disaster. The process of
planning involves analysing various disaster scenarios and mapping existing resources (human,
physical and financial). This mapping is aimed at indicating what is in place for disaster response
and which physical and financial resources have to be enhanced, to be fully prepared for an
effective response as a proactive humanitarian agency in the region.

India Contingency Plan
Oxfam International is currently developing an India Contingency Plan to be prepared for Disaster
Response for the whole of India. Much of this information will be drawn from Oxfam GB’s four
country offices, Government sources (National and State level), surveys of INGOs, as well as
other primary and secondary research. In addition, consultations will be held in different regions,
to gain an understanding of what various groups are doing to prepare for a disaster in terms of
scenario analysis and resource mobilisation. It will be an opportunity for different groups to link up
with each other and explore how they could participate in disaster response and preparedness.
These workshops are in the states in which Oxfam GB is not currently working, or in which the
local office has not undertaken Contingency Planning.

South Indian Consultation
The Consultation on Disaster Preparedness in South India is to be held on 27th March 2004,
Saturday from 10.00 a.m. to 5.00 p.m. in Bangalore. The aims of the Consultation are:
1) To bring together groups and networks working in the region, to discuss issues related to
disaster preparedness.
2) To compile information from networks and groups for analysing disaster scenarios and
mapping the resources available (human, physical and financial).
3) To get regional networks and groups to link up for contingency planning.

Please confirm your participation by phone or e-mail (Ph: 080-36858056; E-mail:
navthom@yahoo.co.uk).
Sincerely,
Naveen Thomas
Oxfam Associate

(Facilitated and Supported by OXFAM GB in India)
Oxfam International is a confederation of 12 organizations working together in more than 100
countries to find lasting solutions to poverty, suffering and injustice. To achieve the maximum
impact on poverty, Oxfams link up their work on development programs, humanitarian response
and lobbying for policy changes at the national and global level. Oxfam GB has four Programme
offices located in four different regions (Lucknow, Kolkata, Hyderabad and Ahmedabad) that
directly support programme activities in their respective regions.

Oxfam International - India Contingency Plan for Disaster Preparedness
Workshop Timetable (DRAFT)

Saturday 27th March 2004

Time

Session
Length

Session

Session Details

10.00 a.m.

30 Minutes

Introductions

Icebreaker: Personal experiencesofa natural disaster. Each Person to
introduce themselves and say one thing they felt worked well in terms of
existing response mechanisms.

o
©
o
©

10.30 a.m.

45 Minutes

Opening
Context
& Overview

State(s) Disaster Profile - Tamil Nadu / Kerala and Karnataka
45-minute presentation by Oxfam staff.
•
©
©

11.15 a.m.

15 Minutes

Break

11.30 a.m.

60 minutes

Reflective
&
Critical
thinking

Define Objectives of the workshop
Go through timetable
Brief intro to Oxfam and our Humanitarian Work in India
Oxfam International and Contingency Plan

Demographic Information
Disaster Profile/ Vulnerability Mapping
What the National / State Government will do in the event of
disaster

Brainstorm
Is the profile Oxfam presented accurate, or a fair assessment? We
want your input.
Can we collectively think of areas where there are gaps in the
Government intervention? In what ways could we work to strengthen /
support intervention?

12.30 p.m.

60 Minutes

Vulnerability
Mapping

01.30 p.m.

60 Minutes

Lunch

02.30 p.m.

60 minutes

Scenario
Analysis

In State-by-State Groups, list all the vulnerabilities faced in your State.
Prioritize these and each group reports back.

Vulnerability of States: Disaster Scenario. In groups we will analyze
what we identified as the disaster we are most vulnerable to.

We will look at two scenarios and collectively profile the resources
1. Moderate Disaster
2. Severe Disaster

3.30 p.m.

30 Minutes

Break

Tea

4.00 p.m.

60 Minutes

Resource
Assessment

Civil Society Capacity / Resource Mapping
(Human, Physical & Financial Mapping of each State)
A Self-Assessment for your Organization.

5.00 p.m.

30 Minutes

Concluding
Session

What can we conclude from the day?
What do we agree on in terms of areas we could work on?
What happens next?
Questions and Reflections on the day?

Oxfam - India Contingency Plan for Disaster Preparedness
Saturday 27th March 2004

Workshop Timetable

Bangalore

Time

Session
Length

Session

Session Details

10.00 a.m.

30 Minutes

Introductions

Icebreaker: Personal experiences of a natural disaster. Each Person to
introduce themselves, and say one thing they felt worked well in terms
of existing response mechanisms.
®
o
o
©

10.30 a.m.

45 Minutes

Opening
Context
& Overview

State(s) Disaster Profile - Tamil Nadu / Kerala and Karnataka
45-minute presentation by Oxfam staff.

0
o
®

11.15 a.m.

15 Minutes

Break

11.30 a.m.

60 minutes

Reflective
&
Critical
thinking

Define Objectives of the workshop
Go through timetable
Brief intro to Oxfam and our Humanitarian Work in India
Oxfam International and Contingency Plan

Demographic Information
Disaster Profile/ Vulnerability Mapping
What the National / State Government will do in the event of
disaster

Brainstorm
Is the profile Oxfam presented accurate, or a fair assessment? We
want your input.
Can we collectively think of areas where there are gaps in the
Government intervention? In what ways could we work to strengthen /
support intervention?

12.30 p.m.

60 Minutes

Vulnerability
Mapping

01.30 p.m.

60 Minutes

Lunch

02.30 p.m.

60 minutes

Scenario
Analysis

In State-by-State Groups, list all the vulnerabilities faced in your State.
Prioritize these and each group reports back.

Vulnerability of States: Disaster Scenario. In groups we will analyze
what we identified as the disaster we are most vulnerable to.

We will look at two scenarios and collectively profile the resources
1. Moderate Disaster
2. Severe Disaster

3.30 p.m.

30 Minutes

Break

Tea

4.00 p.m.

60 Minutes

Resource
Assessment

Civil Society Capacity / Resource Mapping
(Human, Physical & Financial Mapping of each State)
A Self-Assessment for your Organization.

5.00 p.m.

30 Minutes

Concluding
Session

What can we conclude from the day?
What do we agree on in terms of areas we could work on?
What happens next?
Questions and Reflections on the day?

____

Tamil Nadu

Tamil Nadu is situated in the southern most extremity of India.
More than 62,110,839 people live in just 1,30,053 sq km, making
it one of the most densely populated States in the country, it also
ranks in the 10 most populous States. The percentage of people
living below the poverty line is much less than that of the Indian
average. Natural hazards that impact Tamil Nadu include
cyclones and the associated storm surges, roods and flash
floods - including in the urban areas. The area also has a small
vulnerability to earthquakes and it is prone to droughts.

TAMIL NADU

State Profile
Area:

1,30,058 sq km

Capital:

Chennai

Number of Districts:

28

Population Statistics
Population:

62,110,839

Population Density:

478 people per sq km

Urban Population:

43.9%

Rural Population

56.1%

Scheduled Tribes

19.8%

Number of Villages:

16,317

Percentage Living Below Poverty:

21%

Demographic information based on 2001 Censu

Tamil Naclu - Disaster Vulnerability Profile
Other Information
Disaster

Scenario

i

. Cyclone
&
Wind Storm

Likelihood of
Occurrence (5
Highest-1Lov/est)

|

Tamil Nadu has a coastal length of over 800km and as a result is vulnerable to Cyclones and Wind
Storms. The maximum probable estimated wind speed is 203 km/ph.
Most Vulnerable Districts
Tanjavur, Pudukkatoi. Ramanathapurum, Cr.dambaranar, Tirunelveli and Kanyakumari, are
particularly vulnerable. Also at risk are Tanjavur. Cuddalore, Chengai Anna, and Madras.

|

Potential Number of People at Risk: 36.360.'.06 people

!

Impact
Tamil Nadu has a densely populated coastal line, this coupled with construction of housing in
vulneraole areas, as well as poorly built ewe i’ngs have all combined to increase the losses over
time. The height of storm tides can reach extreme heights above normal sea level. Particularly
vulnerable are: Tuticcrin (6.47m), Pamian Pass (11.4m), Nagappattmam (4.91m), Chennai
(3.62m). The storm surges that follow do also come further inland.

Floods in the State usually follow cyclones ano r.eavy rains.
■ Flood

1

Impact:
5,600 houses damacec annuallv
There is a moderate risk of earthquakes in the State.

' Earthquake
Most Vulnerable Districts:
Coimbatore, Niligiri and Tirunelveli Kat.

i

Impact:
Each of these areas has a high percentage cf houses' built from either clay & stonewalls or from
burned brick walls - neither material is able to withstand even a moderate earthquake.

Potential Number of People at Risk: 7,790,127 people
i Drought

Most Vulnerable Districts (Central Water Commission)
Coinbature, Dharmapuri, Madurai, Salem. Tirucnirapalli, Tiruneveli, Kayakuman
Potential Number of People at Risk: 19.472.ISO people

j

Kerala - Disaster Vulnerability Mappin
Disaster

Scenario

Cyclone
S
Wind Storm

Almost 96.9% of the State lies in high wind-speed areas.

Other Information

Likelihood of
Occurrence (5
Highest-1Lowest)

Most Vulnerable Districts
Calicut, Cannore, Emakulam, Mallapuram are particularly at risk.

Impact
In the event of a storm, weakly built houses would be at risk. Two pons have been identified as being
particularly vulnerable to high tides in the event of a cyclone:

Beynor: Tice height could reach 4.12m above sea level
Cochin: Tide height could reach 3.45m aoove sea level
Potential Number of People at Risk: 9,140,383 people

Flood

Drought

The floods Kerala often faces follow on from the cyclones, rather than from an overflow of rivers.
Although the heavy monsoons cause problems. 60% of the annual rair.fa I occurs in the monsoon,
concentrated in just a couple of days. Coastal erosion and drainage congestion are problems in some
areas too. Flood prone areas are particularly densely populated - Alleppy is cne such district.

Potential Number of People at Risk:
The last few years have seen water levels fall considerably, impacting crops, drinking water and electric
power. The water levei this year is down by 27%. The number of rainfall cays has gone down from 120
to 100 days annually. The average annual rainfall is 3018 mm but this year it has gone down to 2270
mm.
Most Vulnerable Districts:
Alappuzha. Kollam. Kozhikode, Palakkad, Thrissur, Wayanad and Thiruvananthapuram. Kannur,
Kasargod, Kottayam and Malappuram have also suffered.

Earthquake

Impact:
Severe Scarcity of Drinking water, Crops Destroyed, Electric Power supply down
Potential Number of People at Risk: 26.380,059 people
Moderate hazard. Though experts have predicted an earthquake could reach 6.5 on the Richter scale.
Though the whole State is in a hazard zone.

Most Vulnerable Districts: All
Impact:
In the State (according to the 1991 Census) more than 8 million homes are made from either clay and
stonewalls or burned brick walls. These dwellings would be vulnerable in the event of an earthquake
with serious damage and potential loss of life.
Potential Number of People at Risk: 31,838,619 people

Historically:
In 1992 983 vLages were
affected when -.eavy rams fe.i.
121% above re usuai rainfail
level. Deaths: 60 ceocle

I

Karnataka
Karnataka lies North of Tamil Nadu and is India’s eighth largest
State. It is knov/n as the Silicon Valley of the east with a
growing urban population. However, agricultural still makes up
a significant sector with 66% of its labour force engaged in this
sec:cr. 20% of its population lives below poverty-well below
the national average. Karnataka is vulnerable to all four major
natural disasters: earthquake, flood, cyclone and drought.

State Profile
Area:

191. 791 sq km

Capital:

Bangalore

Number of Districts:

27

Population Statistics

Tumk ur

Population:

52,733,958 people

Population Density:

275 people per sq km

Urban Population:

33.98 %

Rural Population:

66.02%

Number of Villages:

29,433

Percentage Living Below Poverty:

20%

Demographic Information based on 2001 Census

Karnataka - Disaster Vulnerability Mapping
Disaster

; Scenario

Ea-thquakes

Moderate risk of earthquakes

Other Information

Districts:
Dakshina^ Kannada, Uttara, and Bellary are most vulnerable.
In the incident of a moderate hazard the mainly clay and stonewall and burner rack
housing will not withstand even a moderate quake.

Potential Number of People at Risk: 7,083,807 people
Drought

Occurs on average once in every four years in North Karnataka.

Most Drought Prone Districts (Central Water Commission):
Sangalore. Belgaum, Bellary, Bijapur, Chikmangalur, Chitradurga. Dharwar. S.oarga.
Hasan. Kolar, Mandya. Mysore. Raichur, Tumkur
Potential Number of People at Risk: 34,801,544 people

D_. ozones and
‘.‘.'nd Storms

There is only a moderate risk of severe cyclone and windstorms occurring. A'rc speeo
can reach 33 m/s - 39 m/s. However the weak roofs on houses in the vulneroz-e areas
will not survive such wind speeds. Localized risk rather than a state disaster.
The Maximum probable surge height above the concurrent mean sea level is 3.7 m. In the
event of a cyclone the coastal belt may expenence a disaster.
Potential Number of People at Risk:

“ocas

There is no major flood problem in Karnataka. However in the coastal district of Uttar
Kannada and Dakshina Kannada floods of damaging proportions do take place cue to
Riverbanks spilling.
Potential Number of People at Risk:

Impact:
Suicides: in 2003 in the space cf 6
months 200 farmers committed suicide,
as a result of the drought. Often this was
related to loans that could not be paid
back due to the destruction of crops
resulting from the drought.

Likelihood of
Occurrence
(5 Highest-1Lowest)

OXFAM GB IN INPIA

Oxfam's Mission

Oxfam works with others to find lasting
solutions to overcome poverty and suffering.
Oxfam's Focus
♦
<&
♦

o
o

Secure a right to livelihoods
Promote education and health
Reduce vulnerability to natural disasters
and conflict
Ensure the right to be heard
Ensure gender equality and freedom from
discrimination

Oxfam's Culture

♦
♦

a

Make a difference
Be collaborative
Be accountable
Be cost-effective
Be innovative

xfam GB believes in the dignity of people and their
capacity to overcome their problems. Oxfam and its
partners work with the poorest and the most vulnerable in
their struggle against poverty, suffering and injustice. In India
for more than 50 years, Oxfam GB has supported and
nurtured several innovations and new initiatives by small
and upcoming social organisations and social activists. Many
of these organisations and individuals have since become
role models in the field of development practice. Today,
Oxfam's dual mandate of humanitarian response and
development work has broadened. As a campaign
organisation, Oxfam speaks out globally on behalf of the
poor people on issues such as trade and violence, advocating
changes in policies and practices that keep poor people poor.
The campaigns are inspired by Oxfam GB's grassroots
experience in over 80 countries.

O

Livelihoods
A majority of poor people, especially women and marginalised groups
like adivasis and dalits, have insecure livelihoods. The situation is worse
for people who live in disaster prone areas.

Oxfam’s work on livelihoods in India is its oldest and largest programme,
focussing on three main areas:
Improving economic security of small producers and farmers,
especially women and those vulnerable to natural disasters.
Expanding access to better and fairer markets.
Safeguarding rights of the urban poor.
This programme

Builds community organisations, assets and infrastructure.
Establishes rights, particularly of women, over natural
productive resources, namely, land, water and forests.
Improves the quality of natural and productive resources by
promoting appropriate sustainable management practices.
♦
Ensures greater access to markets for poor producer groups,
particularly women's groups, on fair terms.
♦
Improves working conditions and secures labour rights, particularly
for women, in the unorganised sector.
Integrates community-based disaster mitigation and disaster
preparedness initiatives.
♦
Promotes access to basic services like health and education.
.. Influences policy and practice so that these are pro-poor and
gender-just.

♦

Gender Equality
Different forms of discrimination, oppression and violence against
women cut across class, caste, religion and ethnic groups.

Oxfam's work on gender aims to secure gender equality at all levels

and strives to create a fundamental shift in the perceptions, attitudes
and behaviours of women and men to end violence against women.
This programme

Views through a gender perspective all work undertaken by the
organisation and its partners.
Generates public awareness and debate on violence against women
at home and at the workplace.
Provides shelter, legal aid, medical aid and counselling to victims
of violence.
Supports training and gender sensitisation of authorities dealing directly with violence against women.
Advocates for legislation to safeguard women from domestic violence.

Disaster Preparedness & Response
India is prone to recurring natural disasters
like droughts, cyclones, floods and
earthquakes. Poor people, especially
women and children, are more vulnerable
to these disasters.

Oxfam's humanitarian programme responds

to disaster and builds a culture of disaster
preparedness through a two-pronged
approach:
♦

♦

Integrating community-based disaster
preparedness and mitigation with
security of livelihoods for vulnerable
communities.
Strengthening skills and capacities for
disaster preparedness and response at
various levels by working with
communities, local NGOs, local
administration, state and national
government as well as with international
NGOs and donors.

This programme
Maps disasters on an ongoing basis.
Provides immediate relief to people affected by natural and man-made disasters.
Networks with organisations with similar mandates to respond to emergencies in a coordinated manner.
Supports community-based disaster preparedness work.
Ensures gender is mainstreamed in all aspects of disaster preparedness and response.
Builds capacities of civil society organisations and the government for disaster preparedness and response.
Influences policies and practices on disaster preparedness and disaster response.
Advocates international standards of quality for humanitarian aid.

Girls' Education
Though more girls are going to school today their
literacy levels continue to lag behind those of
boys. Girls from dalit, adivasi and other
r^^ginalised sections of society as well as those
Wng in difficult circumstances face more
barriers.

Oxfam's programme on education promotes

rights of vulnerable girls to quality education.
This programme
♦

♦

Supports grassroots initiatives that can
serve as best practice models.
Encourages adult education with a focus

on women.
Advocates for a conducive policy
environment for universal primary

education.

Response to Conflict & Peace Building
In India's pluralistic society people from different
religious, ethnic backgrounds, classes and castes live
and work together. Yet, there are conflicts and women

are often the worst victims.

Oxfam's work on peace building focuses on reduction

of societal conflict, building of communal
harmony and strengthening of peace processes.
This programme
♦

♦
♦

♦

Responds to the immediate needs of affected
communities.
Supports initiatives to understand and analyse
conflict situations.
Promotes alternate, peaceful ways of resolving
conflicts.
Aids peace processes, especially involving the
youth.
Documents women’s experiences of suffering
and coping with societal conflicts.

HIV/AIDS
HIV/AIDS, despite interventions by the government and NCOs, remains a major challenge. Lack of awareness
and access to public health services make the situation critical.

Oxfam's work on HIV/AIDS focuses on prevention strategies and access to care, support services and

treatment.
This programme
♦

Generates awareness about
HIV/AIDS.
Encourages innovative care
structures for those affected
by HIV/AIDS.
Supports behavioural change
processes to prevent and
contain HIV/AIDS.
Builds capacities of diverse
groups, like traditional birth
attendants, drug users,
women’s groups, networks of
dalit people, commercial sex
workers and panchayat
members, to deal with HIV/
AIDS.
^a.rnPa’Sns,t0 ’nte8rate HIV/AIDS into health care provisions.
vocates for increased access to medicine and care programmes to prevent the spread of HIV/AIDS.
Fosters networks for policy advocacy.
romotes integration of HIV/AIDS into all development initiatives.

Priority
Campaigns
Make Trade Fair Campaign
The Make Trade Fair (MTF) campaign is the
cornerstone of our livelihoods programme. We
believe that trade can be a powerful engine for
economic growth in developing countries if the rules
are not rigged in favour of rich nations.

Oxfam’s global research report, 'Rigged Rules and
Double Standards’ argues for new forms of
international cooperation and a new architecture of
the WTO to enable poor producers in developing
countries to avail opportunities that trade creates.
Oxfam’s 'Cut the Cost’ campaign, within the larger
MTF campaign, lobbies for greater access to
medicines for the poor in developing countries.

'Ofe MTF campaign is against
♦
♦

MAKE TRADE FAIR
www.maketradefair.com

Agriculture export subsidies given by rich nations. This depresses international prices and deprives poor
farmers in developing countries from getting fair returns through exports.
Practices of Transnational Corporations (TNCs) that prevent poor producers from getting a fair price for their
products and exploit labour down the value chain.
Patents on drugs which hinder access to affordable medicines. This has pernicious effects on public health in
the poorest nations of the world.

The campaign creates space for civil society to engage with global trade issues through awareness generation and
public debate. Popular events help carry voices of the poor farmers and producers to national and international
trade negotiation fora. The campaign lobbies governments to change the rigged rules.

In India, the campaign focuses on food security and livelihoods concerns in agricultural commodities, TRIPS and
public health; and nature of employment in the unorganised sector.
—

Campaign to End Violence Against Women
The Campaign to End Violence Against
frmen (CEVAW) is pivotal to our

Gender Equality programme.
CEVAW, to be launched soon, will
strengthen ongoing efforts of Oxfam and
its partners to end violence against women
in India. It will focus on changing attitudes,
behaviours and practices of men and
women that justify and perpetuate
violence. Oxfam will work with civil society
groups and build on its grassroots work and
experiences across the country. CEVAW is
poised to unfold in the five countries of
South Asia to highlight different
manifestations of violence. In India,
CEVAW will focus on domestic violence.

Oxfam GB’s first overseas
programme was in India. Registered
as Oxfam (India) Trust to work in
India, we operate through a
network of six offices located in
New Delhi, (National Office)
Lucknow (for Uttar Pradesh,
Uttaranchal, Madhya Pradesh)
Ahmedabad (Gujarat, Rajasthan),
Hyderabad (Andhra Pradesh,
Maharashtra), Bhubaneswar (Orissa,
Jharkhand), and Kolkata (West
Bengal, Bihar, Assam).
New Delhi
C-5 Qulab Institutional Area
New Delhi - 110 016
Tel 011 265164 81/87
Tel 011 2652 1971/5135
Tel 011 268566 38/89
Fax 011 26856728
newdelhi@oxfam.org.uk

Lucknow
1-Dilbagh, Butler Road
Lucknow - 226 001
Uttar Pradesh
Telefax 0522 22047 83-85
oxfamlko@oxfam.org.uk

Ahmedabad
1st Floor, Manikyam Building
Opp. Samudra Annexe, Off CG Road
Navrangpura
Ahmedabad - 380 006
Gujarat
Tel 079 264036 45/48
Fax 079 26406511
ahmedabad@oxfam.org.uk

Hyderabad
Plot No. 18
Amaravalhi Cooperative
Housing Society
Near Kausalya Estates
Khar Khana
Secunderabad - 500 009
Andhra Pradesh
Telefax 040 2774 1891/1229
Telefax 040 5522615
hydcrabad@oxfam.org.uk

Bhubaneswar
Plot No. 1116, Jaydurga Nagar
Jhapada P.O. Box 170
Bhubaneswar - 751 006

/
1

Orissa
Telefax 0674 2571531/2570485/2570278
Fax 0674 2570915
oxfambsr@oxfam.org.uk
Koikata

Oxfam GB was set up in 1942 at Oxford, UK, as the Oxford Committee
for Famine Relief in response to hunger and famine in Greece. Today,
Oxfam GB is a member of Oxfam International, a growing worldwide
movement of 12 non-governmental organisations that share the same
goal and together work in more than 100 countries. Other Oxfam
International members are Oxfam America, Oxfam Solidarite (Belgium),
Oxfam Canada, Oxford Community Aid Abroad (Australia), Oxfam Hong
Kong, Intermon Oxfam (Spain), Oxfam Ireland, Novib-Oxfam

Netherlands, Oxfam New Zealand and Oxfam Quebec.

Photos: Shaitan Parker/Oxfam

R.K. Yadav/Oxfam

Asha Handicrafts/Oxlam

Oxfam

30/SB New Alipore
Camellia Block B
Kolkata - 700 053
West Bengal
oxfamcal@oxfam.org.uk

.ebsite:

KN-21

w
73

KARNATAKA
tl

79

74

Karnataka
Earthquake Hazard Map
’' 18

0

20

40

50

SO

100 km

18

Sca,gl H H H H R

Gulburga

17

Biiapur

Raichur
elgaum

□harwad
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Uttar^
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Chtlradurga

\ Shimoga

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Bangalore

5.0J916;

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c

..Bangalore

° Mangalore
Mandya

Bangalore
'■.Rural

adikon

Kodagu

Mysore

District Town

Magnitude (Richter Seal
5.0 to 5.0
6 0 io 6.5

Moderate Damage Risk Zone (MSK Vli;

Low Damage Risk Zone (MSK Vl>
.ov. Damage Risk Zone (MSK V)
Major Fault

Tu= Tumkur

S

t-isw or

TN-23

TAMIL NADU E

-- 13

10 X

9 ..

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Consj’Unt: D Anr.rtf I. 473

Map ia based on: 12.5 M Map ,(M. SOI, G 01

8<tJC Wnd Speed Mop. I S’875'3) 1087 CjOGno Dal3. 1691-19-M ImD. GOJ

TN-22

w

TAMIL NADU

82

Tamil Nadu
Earthquake Hazard Map
0

20

40

60

60

13'.

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12

11

10 --

O

District Town

©

Magnitude (Richter Scale)
> 5.0 to 6.0
Moderate Damage Risk Zone (MSK VII)

9:

Low Damage Risk Zone (MSK VI)

Very Low Damage Risk Zone (MSK Vor less)
—-——

Major Fault
Minor Fault

Ti =

Tlruchchirappalli

Py =

Pondicherry

8
82°
83
------------------- j-----------------------------------

____ S

E

KR-16

KERALA

E

BMTPC: Vulnerability Atas

Consultant: Dr. Anand S Arya

Map is based on: 1:2.5 M Map. 1990, S.O.I., G.O.I.

Basic Wind Speed Map, I.S.:875(3)-1987

Cyclone Data, 1891-1994. IMD. G.O.I.

KR-1?

KERALA
E

W

N

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KN-22

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Karnataka
Wind and Cyclone Hazard Map
0

20

60

40

30

100

Scalel H l-l HTTH

IS

Bldar

Gulburga

-- 17°

Bliapur

Rolchur

Belgaum

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Karwar
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J
o

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Probable Max. Surge Height (m)

(S.C.S.)

Severe Cyclonic Storm only

c.s.

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R.F. = H

Risk Factor High

R.F. = L

Risk Factor Low

Moderate Damage Risk Zone - B (Vo= 39m/s)

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+
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H------------------------------- 1——————i--------- -——-In
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Basic Wind SpMdtAap.t.SU75(3;-*987 CyconeData. 1891-1994, IMD.GOI

<

Page 1 of4

Main Identity

From:
To:
Sent:
Subject:

"Times Foundation" <timesfoundation@timesgroup.com>
<phmsec@touchtelindia.net>
Thursday, September 08, 2005 5:02 PM
Work Shop on - Minimum Standards in Humanitarian Respose

Kindly Visit http://www.timesfoundation.org if you can not view html mails
You may \ iew and register the Capacity Enhancement Program upcoming workshops by clicking here

TIMES FOUNDATION & SCHUMACHER CENTRE DELHI, Invite you to the:

Workshop on , “The Sphere Project, Understanding Sphere Project The Humanitarian Charter and Minimum Standards in Humanitarian
Response” (Disaster Management Standards)
16th & 17th September 2005
Objective

To introduce the participants to the Humanitarian Charter & Minimum Standards in
Humanitarian Response and understand the key concepts and guidelines in promoting
quality and accountability in humanitarian sector
Content

• Introduction to Sphere Project - The Humanitarian Charter & Minimum Standards in
Humanitarian Response
• Key suggestions of the Sphere Projects and understanding the Sphere Handbook
• Application of Sphere guidelines in humanitarian response measures in the sectors of
Food, Shelter, WATSAN and Health Services
• Introduction to SPHERE, HPN, ALNAP, some of the international initiatives to improve
quality and accountability in humanitarian sector

Methodology

The course will be facilitated through a combination of lecture and participant led interactive
discussions, giving practical insight into application of Sphere Project. Some of the real life
cases will be presented leading to meaningful discussions.
Registered participants will have to undertake a home assignment prior to attending the
course and will receive the pre-course study material in advance
The discussions and orientation will be based on the Sphere Handbook 2004 edition.

Outcome

At the end of the two day course, the participants would have gained insight into Sphere
Project and how to^apply Sphere to enhance quality and efficiency in humanitarian response

Page 2 of4

measures at the grassroots and organizational level. The participants will have an insight
into the design of Sphere Handbook and how to use the handbook in planning and
implementation of humanitarian projects.
Target Audience
The participants to the two day course will be field practitioners, managers, humanitarian
workers, academicians and students who are engaged in humanitarian sector or are
interested in pursuing meaningful career in humanitarian sector.
Training Organization

Schumacher Centre Delhi (SCD)
New Delhi
Schumacher Centre Delhi (SCD) is one of the newest among a number of organisations in the
UK, US and elsewhere that make up the Schumacher Family. SCD was established with the
initial aim of propagating Schumacher’s name, ideas and thinking at the national level to
government, diplomatic, corporate and development circles. For the past three years SCD has
worked as a forum for interchange of relevant ideas and thinking in rural development and
disseminate knowledge through trainings and other means.
Trainer
The course will be facilitated by Mr. P. V. Krishnan, former coordinator of Sphere India multi­
agency coalition initiatives in India and one of the leading resource persons in sphere
institutionalization.

He has more than 15 years of experience in development field and worked as independent
consultant to Oxfam GB, SIMAVI (Netherlands), MPDL (Spain), Lutheran World Service India,
UNICEF, American Red Cross, Christian Aid Bangladesh, Lutheran world Federation
Cambodia, Lutheran World Service India and Dan Church Aid, India
He has facilitated a number of training workshops in development sector on a wide range of
disciplines, particularly in management and organizational development. Some of the key
workshops facilitated are:
■ Facilitated AZEECON Regional workshop in Puri, India (Dec 2004)
■ Facilitator of the national consultations on Future of Sphere Project (April/May 2004)
■ Facilitated three day management workshop for Oxfam Partners in J&K (Jan 2003)
■ Three-day workshop on Modem Management Techniques for NGO leaders for diocesan
leaders of West Bengal, April 2002
■ Five-day workshop on Disaster Preparedness Planning, DIPECHO MPDL project,
Andhra Pradesh, June 2002
■ Three-day workshop on Disaster Management for field officers of LWS, Eastern Region,
conducted at Gopalpur, April 2000
■ Six-days workshop on Project Planning and Formulation Methods for SAP partners,
Hamdard University, New Delhi - May 1997
■ Visiting Faculty in Vishwa Bharati University, Dept, of Social work, Sriniketan in 199697

Venue

9/9/05

Page 3 of 4

The programme will be conducted at ’The Oneness Centre' 4 Tilak Marg, Opposite to Tilak
Marg Police Station, New Delhi - 110002

Duration
The programme will be conducted on 16th & 17th September, 05.

Timing
1000 hrs to 1700 hrs

Registration Fee
Rs. 2,000/-

Rcgistration fee includes workshop participation, course material, refreshments and is nonrefundable. However, in case you are unable to attend, you could replace your name by
nominating another participant. Payment to be made in cash or by demand draft favouring
"Times Foundation" at the below given address:
'The Oneness Centre' 4 Tilak Marg, New Delhi-110002
How to Participate

The participants are requested to fill up the 'Registration Form" and send it to Times
Foundation, 4, Tilak Marg, New Delhi - 110002. For registration, please contact Mr. Anil
Chopra/Thomas at: 011-23782396/19

For queries regarding the workshop, the participants may contact Ms. Angela Devi/Ms.
Sandhya Sriram at: 011-23302864,23302856,23302103.
Email: timesfoundation@timesgroup.com/angela.devi@timesgroup.com/sandhya.sriram@time

Registration closes 14th September, 2005
Note: To facilitate greater interaction and participation, the workshop is limited to a
maximum of 20 participants on first come first served basis.

This is part of an initiative of Times Foundation who has evolved a comprehensive capacity
enhancement programme to offer opportunities to non-governmental organisations and other
people organizations for collective learning. The programme aims to support organisations to
strengthen their role in society and improve the outreach of their activity by building up their
capacity.
Information for Non Delhi participants
We would not organize the lodging and boarding logistics. The Program is Non - residential
and Outstation Participants are requested to directly make their own arrangements.
An option is to contact Asian Guesthouse, Delhi for accommodation at the below given
Address which has provided support for past trainings:

Mr. Abhijeet Gopal

9/9/05

Page 4 of 4

Asian Guest House
14 Scindia House, Kasturba Gandhi Marg
Cannaught Palace, New Delhi
Telephone: - 23314658,23313663,23310229,23313393,9313975013
E-mail: abhijeetgopal@yahoo.co.in
For queries regarding payments contact K.Angela Devi or Sandhya Sriram at 011
23302864/2103, angela.devi@timesgroup.com / sandhya.sriram@timesgroup.com

Times Foundation, 7, Bahadurshah Zafar Marg, New Delhi - 110 002, Tel: 23782031,
23302864 E-mail: timesfoundation@timesgroup.com, Website:
http: / / www.timesfoundation.org
Looking forward for your participation.

Thanks & Regards
K.Angela Devi
Programme Coordinator
Times Foundation
REGISTRATION FORM
Programme Title:

Name:

Organization/Institution:

Qualification:
Brief on current responsibilities:

Other significant Training’s attended (if any):
Particular area of interest in training (mention your major expectations):

Contact Address :

Telephone:
Fax:
Email:
Date:
Signature:

For

queries

regarding

payments

contact

Angela

Devi

or

Sandhya

Sriram

at

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9/9/05

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