|Coping with Natural Disasters: The Role of Local Health Personnel and the Community: Working guide (WHO - OMS, 1989, 108 p.)|
|PART II. The aftermath|
|Chapter 4. Action by the local health personnel|
The psychological reactions observed in most disasters can be divided into three phases.
In the first few minutes after a disaster strikes, panic rarely occurs but may arise when the event surprises a crowd indoors in an enclosed space (cinema, place of worship, etc.). In some cases fear is accompanied by a dazed reaction; people lose their bearings and cannot do anything. In general, this is a short-lived phenomenon.
In the hours that follow, a psychological reaction can be observed in most cases that is characterized by an urge to act, to seek contact with others and to participate spontaneously in rescue work. Bureaucratic and political barriers are swept away and suddenly psychological barriers and defences characteristic of private reserved behaviour also disappear. Their place is taken on the instant by types of behaviour marked by spontaneity, solidarity and outpourings of emotion. Whatever the reason for this positive psychological reaction, it should be known to the local health personnel (who experience it themselves in any case) and considered as the most valuable resource for coping with the situation.
In some instances, subsequent days witness the gradual onset of less active types of behaviour. The state of excitement dies down and its place may be taken first of all by a feeling of mental disquiet, which moves towards an attitude approaching slight depression, lack of confidence, fatigue, sadness and passivity. Gradually the reality of hard, competitive, sometimes pitiless relationships and the restoration of the barriers, stratification and conflicts of ordinary social life gain the upper hand. The reactions of disappointment and depression are aggravated by suspicion of favouritism and preferential treatment in the distribution of relief supplies. When confronted by this situation, the local health personnel must try to maintain and strengthen all the initiatives taken by the community.
Numerous experiments conducted after disasters either by local health workers or by volunteers have shown that community action influences the state of mind of the population and represents an effective means of preventing and controlling reactions of disquiet and depression. In fact, activities to maintain the communitys mental well-being largely coincide for the local health personnel with the capacity to stimulate and encourage the association of groups with projects aimed at achieving concrete objectives, i.e. a capacity to spur the community on to act for itself, which is moreover essential to the success of any programme of health education.
So far as psychological disorders are concerned, depression remains the main danger to be prevented and controlled. On the other hand, it does not seem as though pre-existing mental disorders get particularly worse. Spontaneous improvements may even be observed. In any event an attempt must be made to avoid shutting out or interning the mentally ill and the handicapped: the atmosphere of solidarity and the web of intense emotional relationships which develop after a disaster may make it easier to integrate them into the community and may have a real psychotherapeutic effect.
In many cases there are reports of insomnia, bed-wetting among children, anxiety states or psychosomatic disorders (palpitations, sweating, shortness of breath, feelings of giddiness, etc.), often accompanying slight depression. One very frequent phenomenon is worth mentioning: in the weeks and sometimes months following a particularly violent earthquake which has caused great damage, it is possible to detect instability and confusion, such as those that afflict people with head injuries. They generally disappear without treatment after a few months.