| 1The
author expresses gratitude to Christian Arrington
of the Oakland Unified School System for his assistance
with the statistical analyses of the data.
2The author is in private
practice and a Clinical Associate Professor with
the Department of Psychiatry and Behavioral Sciences
at Stanford University School of Medicine
Abstract
The Pebble Beach fire of 1987 destroyed
30 homes. Eighteen months after the fire, ten adults,
whose homes and belongings were destroyed, were
administered the Rorschach Test and the SCL-90-R
Test. Comparison with the means of the normative
groups for each test yielded significant results
above the p < .01 level. The long term
traumatic impact on the personalities was clearly
reflected by interferences in thought processes,
perceptual distortions and depressive reactions,
inter alia.
The Traumatic Impact of a Fire
Disaster
as Reflected in the Rorschach
and SCL-90-R Tests
INTRODUCTION
There was a disastrous forest fire
in the Pebble Beach area of California on May 31,
1987 that destroyed a community of 31 homes, severely
damaged six other homes and compelled the evacuation
of over 200 people. The people had little warning
about the severity of the fire and little time in
which to leave their homes. In some instances they
had only time to run to their cars, escaping while
watching their home and all their possessions explode
with fire. The fire had begun as an illegal campfire
set by local teenagers; it spread quickly and was
fanned by winds rising to 50 miles per hour and
the temperature reached 500 degrees Fahrenheit.
The conflagration swept up a hill, leaping from
roof to roof and from tree top to tree top, burning
homes as it raced. No one was killed in the fire
but the damage was immense in this upper class community.
A law suit was initiated, based
on the allegation that the disaster and its scope
were predictable and that the community organization
had failed to provide adequate protection from such
a danger. The author was invited to determine whether
any mental health problems of the thirteen fire
victims that were related to the traumata of the
fire.
The present report summarizes the
psychological evaluation of ten of these individuals.
Each was given an intensive three to four hour interview,
the Rorschach Psychodiagnostic Test, and the Symptom
Checklist (SCL-90R). The evaluation occurred 18
to 20 months following the fire.
Knowledge about the effects of
traumata and disasters on individuals and on social
groups has slowly accumulated through studies in
the last fifteen years. Notable among the earliest
discussants of the effects of disasters is Martha
Wolfenstein (1957). Wolfenstein's analyses of the
impact of disasters upon the lives of victims suggested
that there were several phases of psychological
reactions which included the shock, followed by
an initial adjustment to the occurrence. Then came
reactions of disillusionment and depression; next
were efforts to internalize the facts of the disaster
and finally, a reorganization of the personality
in the recovery process. When the internalization
fails, psychopathological symptoms emerge and fixate.
The fixation results in the post-traumatic stress
disorder defined in the Diagnostic and Statistical
Manual III-R. Summarizing the syndrome therein described,
the symptoms include a persistent re-experience
of the event as in recollections, dreams, or a sense
of reliving the event; persistent avoidance of stimuli
associated with the traumatic situation as efforts
to avoid thoughts or feelings associated with the
event, feeling of detachment, restricted affect,
etc.; and, persistent symptoms of increased arousal
as difficulty sleeping, irritability, difficulty
concentrating, etc.
Factors that contribute to or interfere
with re-adaptation include the suddenness and duration
of the event (Barton, 1969; Berren, Beigel and Ghertner,
1980), the seriousness of the threat to life, bereavement,
the duration of suffering (Berren et al., 1980;
Gleser, Green and Winget, 1981), and the scope of
the disaster (Barton, 1969; Gleser et al, 1981).
In addition, the quality of family and community
support (Green, 1982), the source of the disaster--i.e.,
human error or natural disaster--prior experience
with the particular stress, or the victim's vulnerability,
and the wealth and availability of resources (Appley
and Trumbull, 1986), all assist or impede recovery.
Follow-up studies of natural disasters
have consistently shown an increase of symptoms
of psychological distress, including symptoms of
stress, anxiety, helplessness and depression. The
effects on bodily health were evidenced by a significantly
heightened frequency of physical ailments, and by
visits to physicians and to hospitals. Furthermore,
the mortality rate increased for victims in the
following year. Social contacts were significantly
lessened. People were less satisfied with the quality
of their lives and reported less time spent in leisure.
These studies have been conducted from ten months
to ten years following a disaster. The percentages
of persons for whom psychic distress was reported
vary from a low incidence of 33% to a much higher
100% (Chamberlain, 1980; MacFarlane 1986; MacFarlane,
1988).
Man-induced disasters are considered
more harmful in their psychological effects than
"natural" disasters. The following examples
illustrate some incidents in which human error was
proven or suspected and summarize briefly the results
of the follow-up studies on the victims. The knowledge
that the disaster could have been avoided seems
to release a rage and anger that are not observable
in those affected by natural disasters. Victims
experience heightened distrust and suspicion of
others and their motives. Their unresolved grief
brings about personality changes that involve guilt,
rage, demoralization, and a diminished elan vital.
The Coconut Grove Fire of 1943, assumed to have
been due to negligence, produced tremendous horror
and terror in those present at the time as 400 persons
were burned to death or otherwise killed in their
efforts to escape. One year later, fifty per cent
of the survivors still manifested symptoms of sleep
disturbances, increased nervousness and anxiety,
guilt over survival and fears related to the events
of the fire (Adler, 1943; Cobb and Lindemann, 1943).
A four-year follow-up study of
a 1963 ship collision revealed that 75% of the survivors
had severe work-related problems and persistent
psychological distress symptoms (anxiousness); mood
disorders actually increased over time and psychosomatic
disorders became more frequent (Leopold and Dillon,
1965). The effects on the victims of another shipwreck
were similar. One and two years following the disaster,
all but one had manifest psychiatric disturbances
and none had returned to work on ships (Henderson
and Bostock, 1979).
A ten year follow-up study of men
who were buried alive for several days in a mine
disaster in Langede, Germany in 1963 documented
that there were no continuing friendships among
the survivors (Ploeger and Andreas, 1974). Most
survivors reported significant personality changes
characterized by heightened irritability, phobias,
and flashbacks to the event that were hallucinatory
at times. The shared experiences of a disaster did
not result in an intimacy or enduring friendship
as might have been anticipated.
The Buffalo Creek dam break and
flood of 1972 was a highly publicized and intensively
investigated disaster whose victims were interviewed
in two-year and five-year follow-up studies (Gleser,
Green and Winget, 1978; Gleser et al., 1981; Green
and Gleser, 1983; Lifton and Olson, 1976; Rangell,
1976; Titchener and Kapp, 1976). When interviewed
two years after the flood, eighty per cent of the
disaster victims had disabling symptoms and problems
in adjustment. Despair, apathy, aimlessness, depression,
hypertension, sleeping problems and anxiousness
were common. The use of alcohol and nicotine increased.
Psychosomatic and health problems increased significantly
and measurably so, even five years after the disastrous
flood.
In view of the above, psychological
evaluation of the Pebble Beach fire victims can
be expected to show the long-term effects of the
fire on their personality. This, too, was not a
natural catastrophe, but was considered preventable
not only because of its accidental inception but
also because of the careless management of the fire
after it had begun. In order to investigate the
degree of internalization of the trauma and the
quality of adaptation to the impact of the fire,
the Rorschach psychodiagnostic test was administered.
This test was expected to tap those effects of the
trauma of which the persons might not have been
as consciously aware. The SCL-90-R test was used
as a self-report measure of distress, which information
was also discussed in the interviews.
The difficulties involved in assessing
the effects of a trauma on a person 18 months after
the event are numerous. The pre-fire personality
of each is, by definition, unknown and is not directly
measurable; the immediate impact of the fire on
the person's behavior and the effects of the loss
of home and possessions may only be inferred through
self-reports, self-observations or observations
by others. In addition, there was much instability,
strain, insecurity and anxiety due to the post factum
turmoil still present at the time of the evaluations.
Some victims were required to move three times in
this period while a new home or new possessions
were acquired; additional stress came with the process
of completing claims for insurance or governmental
assistance and waiting an unpredictable time for
responses; and, the rigors of the legal process
itself, of filing a suit, giving depositions, etc.,
heightened the tension and re-enlivened the traumata.
There is, therefore, sufficient reason to expect
that the evaluations would show cumulative effects
of the disaster and its aftermath on the personality.
These effects are best evaluated through the utilization
of the Rorschach Test which includes scores that
estimate the degree of stress-related anxiousness.
It was assumed that each fire victim
would demonstrate significant symptoms of post-traumatic
stress because of the suddenness of the event, the
inability to make any preparations for the situation,
the total loss of home and possessions, the paucity
of resources available to the people, the human
error involved in the onset of the disaster, and,
the compounding stress of litigation. Further, the
post-traumatic effects should be reflected in the
results of the SCL-90R and the Rorschach test and
thereby, provide evidence that many disaster victims
fixate in Phase Four (Wolfenstein, 1957).
METHOD
TIME
The psychological evaluations occurred
eighteen to twenty months after the fire. Each person
was interviewed and administered the SCL-90-R and
the Rorschach test in this period. Therefore, it
was assumed that the time factor was a constant.
Three procedures were used, as
described below:
(1) A semi-structured interview.
The interview lasted three to five hours for each
person The contents of the interview included (a)
a pre-fire life history, (b) the fire experience,
(c) actions taken, and reactions to the fire, in
the following week, (d) long term effects of the
fire on the victims, and (e) the individual differences
in recovery from the fire and its aftermath.
(2) The Symptom Checklist-90-Revised
(SCL-90-R). This is a frequently used self-report
test that requires the subject to make self observations
about anxiety-related symptoms. The test is composed
of ninety items to which the subject responds by
evaluating the level of discomfort experienced on
a five-point scale varying from not at all to extremely.
The subjects were asked to evaluate the discomfort
of each symptom they experienced since the time
of the fire. The test is factored into scores of
somatization, obsessive-compulsive tendencies, interpersonal
sensitivity, depression, anxiety, hostility, phobic
anxiety, paranoid ideation and psychoticism. There
are two derived scores - the Global Severity Index
and the Positive Symptoms Index.
The scores of the fire victims
were compared with two samples originally reported
in the SCL-90-R administration manual (Derogatis,
1977). These are a psychiatric outpatient group
(N = 1002) and a non-patient normative group (N
= 974). Because of the small sample size of the
present study (N = 10), a t-test for independent
samples was used to determine possible significant
differences between the victims and the two groups
presented by Derogatis. The level of confidence
chosen was p<.01.
(3) The Rorschach Psychodiagnostic
Test. This test was administered, scored and interpreted
using the Exner method. The scores were then grouped
to provide a comparison between the research fire
group and the normal non-patient adult group reported
by Exner (Exner 1989).
A pooled estimate t-test for two
independent samples (Hayes, 1963, p.320) was used
to determine whether significant differences existed
between the means of the scores of the Fire Victim
Group and the selected normative groups.
SAMPLE
The sample consisted of ten persons
whose homes had been destroyed in the fire. There
were four females and six males; their ages ranged
from 32 to 65 years. All were of the upper middle
socioeconomic class. All had a college education.
One person did not take the SCL-90-R test due to
time limitations.
RESULTS
The purpose of the study was to
determine whether victims of a community disaster
(i.e., a fire) manifested symptoms of post-traumatic
stress as measured by the SCL-90-R and the Rorschach
Psychodiagnostic Test.
Hypothesis 1. There will be
no significant differences in the means of each
SCL-90-R dimension between the Fire Victim Group
and the Normative Psychiatric Outpatient Group or
the normative non-patient normals comparison group.
Insert Table 1 about
here
Table 1 presents the means,
standard deviations, and the t-test values
for the Fire Victim Group and the Normative Psychiatric
Outpatient Group as reported by Derogatis (1977)
in the administration manual. There were significant
differences between the fire group and the outpatient
group on the scales of Interpersonal Sensitivity
(t = 3.422 p < .0005), Depression
(t = 2.859, p < .005), Anxiety (t
= 2.574, p < .01), Phobic Anxiety (t= 7.205,
p < .0005), Paranoid Ideation (t
= 4.874, p <_.0005), and Psychoticism (t
= 6.851, p < .0005). In addition, the
Fire Victim Group obtained a significantly lower
GSI (M = .89 t = 2.703, p < .005).
There were three symptom dimensions
in which the Fire Victim Group did not differ from
the Normative Psychiatric Outpatient Group. These
were Somatization, Obsessive-Compulsive, and Hostility
symptoms. These results suggest that the fire victims
were as severely disturbed as the psychiatric outpatient
group on these dimensions of personality. Therefore,
there are some significant differences between the
Fire Victim Group and the Normative Outpatient Psychiatric
Group and the null hypothesis is rejected for those
specific symptoms. However, on the GSI (General
Stress Index) the Fire Victim Group was significantly
lower, i.e., reported fewer symptoms, than the Normative
Psychiatric Outpatient Group and the null hypothesis
is rejected for the GSI.
Insert Table 2 about here
It was assumed that the scores
of the Fire Victim Group would differ from those
of the Normative Outpatient Psychiatric Group because
of the lack of previous, acknowledged, psychiatric
difficulties. It was also assumed that their traumatization
symptoms would differ from those of the normed group
for the SCL-90-R. Table 2 presents the means, standard
deviations and t-values for the Fire Victim Group
and the Normative Non-Patient Adult Group. There
are significant differences in the t-value
between the groups on all symptom dimensions except
that of Phobic Anxiety symptoms. The Fire Victim
Group also scored significantly higher than the
normative group on the Global Severity Index of
symptoms (M = -.89, t = -4.181, p
< .005), indicating that the fire victims suffered
a greater level of general distress than the normative
group.
Hypothesis 2. There will be no significant differences
between the means of the Fire Victim' Group and
the means of the Normative Non-patient Adult Group
(Exner, 1986) an the scores of the Rorschach Psychodiagnostic
Test.
Insert Table 3 about here
Table 3 presents the means and
standard deviations for the two groups on the primary
variables in the scoring of the Rorschach Test.
The DO+ score was significantly different
at the p < .01 level indicating that the
normative group gave significantly more synthesized
responses.
The variables that were significantly
different at the p < .005 level of confidence
were: (1) the D score which indicates that
the Fire Victim Group gave significantly fewer large
detail responses; (2) the paired responses (2)
were given significantly less frequently by
the Fire Victim Group; (3) Pure F responses
(M = 5.3, sd= 3.71) were given less
frequently by the Fire Victim Group; and (4) the
Experience Actual sum (EA) was significantly
greater for the Fire Victim Group.
Many scores attained a level of
significance at the p < .001 level. (1)
The Fire Victim Group gave significantly fewer popular
responses (P) even though there was no significant
difference in the total number of responses given;
(2) the mean of the Whole (W) responses was significantly
greater for the Fire Victim Group (M = 14.5) as
compared with the normative group (M = 8.58);
the Lambda (L) ratio was significantly lower for
the Fire Victim Group and suggests difficulty in
utilizing their inner strengths effectively; (3)
the Form Quality (~FQ) scores showed significant
differences between the groups. Surprisingly, the
Fire Victim Group gave significantly more FO+
responses1 representing superior, over-elaborated
responses that are "unique by the manner in
which details are defined." (Exner, 1986, p.
148). This group also gave significantly more FQu
and FQ- responses, demonstrating that their
perceptions were uncommon and showed a "distorted,
arbitrary and unrealistic use of form in creating
a response" (Exner, 1986, p. 148). The Fire
Victim Group provided significantly fewer responses
of ordinary form quality (FO) The lack of
appropriate form quality of the responses given
by the Fire Victim Group was also substantiated
by the percentages of total responses that reflect
perceptual accuracy. The X+% (conventional
form) ratios and the F+% (conventional pure
form) were significantly lower for the Fire Victim
Group whereas the X-% (distorted form) ratios
were significantly greater than expected; (4) With
regard to the individual determinants of the Rorschach
responses, the Fire Victim Group produced significantly
more blend responses, i.e. used more determinants
in their responses than the Normative Non-patient
Adult Group, which suggests again that their responses
were elaborated and complex. While there was no
significant difference between the means of the
groups on human and animal movement (M, FM) responses,
the Fire Victim Group gave significantly more Ma
(active human movement) and a (total active movement)
responses. The significance of these ratios as they
relate to the ability to cope with stress will be
discussed. More importantly, the Fire Victim Group
gave significantly more inanimate movement (m)
responses, substantiating an assumption of increased
inner distress.
The color responses (FC,
CF, and C) relate to the modulation
of affect. The expectation would be that traumatized
individuals might show lessened ability to control
or to modulate their emotional expressions. The
responses of the Fire Victim Group do show fewer
FC responses but not at a significant level,
and a greater number of CF responses, again
not at the selected level of significance. However,
the Fire Victim Group did give significantly more
pure color (C) responses (M = 1.0) than the
Normative Non-patient Adult Group (M = .12)
at the p <.001 level.
Other determinants that were given
at the significance level of p < .01 by
the Fire Victim Group include the achromatic color
(C’) responses, the texture (T) responses
and the reflection (r) responses. These scores
suggest that the Fire Victim Group were more tense
and self-oriented than would be anticipated. This
seems substantiated by the es (Experienced
Stimulation) sum which would indicate that the Fire
Victim Group experienced many more demands on their
coping abilities than the normative population.
Those scores and ratios that were
significantly different at the p < .001
level of confidence were as follows: (1) The mean
of the whole (W) responses was significantly
greater at the p < .001 level for the
Fire Victim Group (M= 14.5) compared to the
normative group (M = 8.58); (2) the Suicide
Constellation (S Con) ratio showed that the
Fire Victim Group had much greater suicidal ideation
(M = 5.2 for the Fire Victim Group, M
= 2.07 for the normative group), as well as significantly
greater morbid (MOR) preoccupations; (3)
the Depression Index (DPI) showed that the
Fire Victim Group (M = 2.3) had significantly
more depression responses than those of the normative
adult group (M = .40); and, (4) the Schizophrenia
Index (SCZI) represents a cluster of variables
that are "related to problems in thinking and
perceptual adequacy" (Exner, 1986, p. 182);
here, the Fire Victim Group manifested a significantly
greater SCZI (M = 2.3, s.d.
= 1.73) than the normative adult group (M =
.95, s.d. = 1.08) at the p < .001
level of confidence but it is important to note
that the SCZI scores do not attain clinical
significance.
Another level of significance proposed
by Exner (1986) posits that any variables which
deviate from the non-patient group by more than
one standard deviation are considered to be clinically
significant. It seems important to observe that
the S-Con, the DEPI, and the SCZI
scores did not attain clinical significance, thus
the Fire Victim Group cannot be characterized as
severely psychopathological.
The comparison of the means of
the Fire Victim Group with those of a Normative
Psychiatric Outpatient Group and the comparison
with the means of the Normative Non-Patient Adult
Group for the SCL-90-R and the comparison of the
Rorschach responses with the normative adult sample
give clear evidence that the fire victims were distinctly
different from the comparison groups.
DISCUSSION
The purpose of this study was to
determine whether victims of a fire that had destroyed
their homes some eighteen months earlier manifested
measurable signs of stress on the SCL-90-R and the
Rorschach Psychodiagnostic Test. Ten of the fire
victims were administered the Rorschach test; nine
additionally took the SCL-90-R.
THE SYMPTOM CHECK LIST
When the results of the SCL-90-R
test taken by the Fire Victim Group were compared
with the sample of psychiatric outpatients, the
scores on the scales of somatization, obsessive-compulsive
traits and hostility did not differ. Moreover, the
fire victims, as a group, shared these traits to
a similar degree with persons in outpatient psychotherapy.
Thus, they may be assumed to have developed at least
moderately severe psychosomatic and physical symptoms,
to be wrestling with compulsive urges to undo the
trauma, and to experience unresolved anger and irritability
provoked by the disaster and its consequences. Further,
in comparison with the normative standardization
group on the SCL-90-R, they were significantly more
depressed, experienced more anxiety, had heightened
interpersonal sensitivity, and suffered more paranoid
ideation and psychoticism (confused thinking) than
the normative group.
Another important feature is that
the general severity of the fire victims' symptoms
(Global Severity Index) was significantly less than
that of psychiatric outpatients but significantly
greater than that of the Normative Non-Patient Adult
Group. This provides some basis for the assumption
that these individuals were not psychiatrically
ill prior to the fire and that, even after the disaster,
they were not that emotionally disturbed. They did,
however, report significantly more distress than
the normative group, suggesting that the fire and
its aftermath, remained highly stressful even eighteen
months after the disaster.
THE RORSCHACH TEST
The scores and score ratios on
the Rorschach obtained from the Fire Victim Group
were compared with the Non-patient Adult Group reported
by Exner (1986, pp. 257-258). It became quite apparent
that the Fire Victim Group demonstrated many significant
differences from the Non-Patient Adult Group which
suggested that they experienced intrapsychic difficulties
to the extent that these emotional problems interfered
with their everyday functioning both in their orientation
to events, in their thought processes, and in the
expression of affect. The comparison utilized Exner's
(1986) criteria for clinical significance as well
as the confidence level of .01 or greater. The following
discussion focuses on understanding the results
of the Rorschach test results of the Fire Victim
Group.. Validity of the test results
The protocols of the Fire Victim
Group were of sufficient length to warrant careful
consideration, that is, they gave an average of
23.6 responses; Exner states that 17-27 responses
are normal. The Lambda (L) score is significantly
below the mean for the Non-patient Group (p
< .001); this suggests that the fire victims'
apprehensions interfere with concentration or logical
reasoning, that they became over-involved with stimuli
and have difficulty perceiving economical solutions
to problems. The protocols may be assumed to be
valid and representative of the psychological state
of the group.
Stress tolerance and control
Exner (1986, p. 315) avers that
"a cluster of six variables provides the first
data set" from which to interpret the test
results in order to evaluate the ability to tolerate
stress and control responses. These variables are:
the EB (Erlebnistypus), EA (Experience
Actual), eb (Experience Base), es
(Experienced Stimulation), the D score and
the adjusted D Score. Two of these variables,
the EB and the eb ratios, are meaningful
only for the interpretation of individual protocols
and are not considered in this report. The D
score of the fire victims falls within the normal
limits, although at the lower end of expectability.
The score indicates that under most circumstances
the fire victims had sufficient resources to be
able to direct their behavior in a deliberate and
meaningful way without loss of the ability to control
their actions. However, when the D score
and the adjusted D score are in the minus
range, the implication is that the persons are more
vulnerable to being overwhelmed by situational demands.
"People who fall into the D-2, D-3 or
lower categories are in an almost continuous state
of overload. They are upset with more experienced
demands for responses than they can handle easily."
The mean frequency of m responses is also
significantly greater than expected (M =
3.0, p < .001); accordingly, this suggests
a fear of the disintegration of controls over their
behavior due to situational distress and reflects
an inner sense of possible disruption in their lives.
In fact, the fire victims experience much more anxiety
along with a sense of doubt about their ability
to cope with the demands of life. (Exner 1986 pp.
317-318).
The EB ratio and the eb
ratio could not be computed meaningfully for a group
because they are meaningful for individual protocols
only. However the EA (Experience Actual)
sum and the es (Experienced Stimulation)
sum were computed,. both attained clinical significance
and both were significantly greater than those of
the normative group. The suggestion from the EA
sum is that the fire victims did not have ready
access to their inner resources because of the stress
under which they were functioning. They could not
easily summon their coping strengths to resolve
everyday situations. That they do have sufficient
inner strengths is indicated by their production
of the expected level of M responses. The
fire victims differed significantly in the number
of chromatic color responses that they gave on the
Rorschach Test. They produced fewer FC responses
than the normative sample, indicating a lowered
ability to modulate or control affective expression.
This characteristic becomes more obvious when considering
the CF and C responses which were
given significantly more frequently by the fire
victims. These scores emphasize that the fire victims
experience some lack of control over emotional expression,
have become more susceptible to stress, and are
less able to modulate their emotional life during
stressful events.
The shading variables (C’,
T, V, and Y) are all related
to "impinging or irritating affects" (Exner,
1986, p. 337), that is, they signal the presence
of distress in the individual. The significantly
greater T scores among the fire victims (M
= 2.2, p < .001) strongly suggest that
they have experienced an emotional loss; that is,
these scores reflect the traumatic effect of the
loss of house and belongings on the fire victims
as a group. According to Exner( 1986, p.339), persons
whose T scores are elevated, experience stronger
than usual needs to be dependent on others. The
Y scores and the V scores did not
differ significantly from the normative group and
provide evidence that the fire victims did not suffer
from feelings of helplessness. Also the fire victims
did not differ significantly from the normative
group in their ability to view problem situations
with an appropriate perspective (V).
The achromatic responses (C’)
were also significantly more frequent in the Fire
Victim Group (M = 2.2, p < .001).
These responses indicate that the fire victims experienced
more depressive affect; that is, they placed an
internal constraint over their emotions and such
constraint causes a sense of discomfort and uneasiness.
The results of these scores on
the Rorschach point to a lessening of coping capacity
among the fire victims; they have increased anxiety,
experience fears of losing control over their behavior,
feel somewhat constrained and depressed, and have
lessened ability to organize their resources to
react well to stressful situations.
Cognitive Qualities
The level of cognitive operations
appears quite high for the fire victims. As a group
they expended greater effort to organize their responses
(Zf = 16.7, p < .001) than
the adults of the normative sample, i.e., they appeared
to have chastened by their experience and thus they
showed a need to deal with events in a particularly
careful and thorough manner. However, the efficiency
of their organization attempts is within that of
the normative sample. They also produced significantly
more whole responses (W) which suggests a
need to deal with a stimulus situation in its entirety;
this is supported by the fewer detail responses
and fewer unusual detail responses (D and
Dd). Their cognitive functioning has been
affected deleteriously. The Contamination (CONTAM)
score occurred significantly more frequently among
the fire victims' responses; yet the WSum6
score showed that the Fire Victim Group gave significantly
fewer signs of disturbed thought processes than
the normative group. The CONTAM score suggests
that the fire victims' responses may have been compromised
by the intrusion of symbols of their traumatic experiences
with the fire and its aftermath. It appears that
the fire victims suffered a loss of practicality
and efficiency in responding to situations because,
motivated by alarm, they are compelled at once to
take account of the whole stimulus field.
Perceptual Orientation
The orientation to reality is an
important process for the individual as it directs
the cognitive, affective and social reactions to
situations. It was assumed that the fire victims
would suffer a distortion of their view of everyday
contingencies because of their experience with the
fire, its unpredictability and their unpreparedness
for such a disaster; this would sharpen their sensitivity
to possible dangers around them. The results of
the Rorschach clearly support the assumptions of
a disruption of normal perceptual processes during
a status emergens. The popular responses
(P) were clinically lower than those of the
normative group; the X+% (Conventional Form
percentage) was significantly lower (p <
.001); the F+% (Conventional Pure Form percentage)
was clinically lower; and the X-% (Distorted
Form percentage) was significantly greater than
expected (p < .001). All these percentages
were also clinically at variance with those of the
normative group. It thus appears that the fire,
which was a disaster of overpowering suddenness,
had a severely disruptive impact upon its victims'
ability to process reality experiences and this
corroborates the hypothesis that they now experience
difficulties in making appropriate responses, especially
under stress.
Special Scores: S-Con, DEPI,
SCZI
Scrutiny of the indices of psychopathology
in the Rorschach makes it evident that the fire
disaster and its aftermath have caused these victims
severe emotional injury. The S-Con (Suicidal
Constellation) score is significantly greater than
for the normative group (p < .001), but
it does not meet Exner's (1986, p. 414) criteria
for subjects at high risk for self-destruction.
Nevertheless, since the catastrophe presented the
fire victims as a group with the peril of losing
their lives, it must have undermined their usual
sense of invulnerability or indestructibility. The
results also confirm some preoccupation with morbid,
self-annihilative thoughts, for the fire victims,
as a group, had significantly more Morbid (Mor)
responses (M = 2.0, p < .001) than
the normative group, which substantiates their preoccupation
with destructive ideas or dysphoric feelings. Some
individuals who gave these responses more frequently
could conceivably be at risk for suicidal attempts.
The Depression Index (DEPI)
was also significantly greater for the Fire Victim
Group (p < .001). While Exner's criteria
(Exner, 1986, p.425) state that three or more variables
of the Depression Index are required before a severe
depressive reaction may be presumed to be present,
the indications are that the fire victims as a group
do experience frequent episodes of depression and
it seems quite likely that one or more of them may
have been experiencing severe depressive reactions
following the fire.
It is assumed that some individuals
within the victim group suffer from depressive experiences,
in turn elevating the Depression Index, and that
the group, as a whole, suffers more depressive moods
than would be anticipated when compared with a Normative
Non-patient Adult Group.
The Schizophrenic Index (SCZI)
for the fire victims does not meet the essential
criteria of five positive variables necessary for
the diagnosis of schizophrenia. That is, the fire
victims are not psychopathologically compromised,
nor do they show signs of severe psychiatric disturbances.
SUMMARY
The fire victim group showed signs
of internal distress even eighteen months following
the experience with a fire that destroyed their
homes and endangered their lives. The results of
the SCL-90-R and the Rorschach Test support the
extrinsic evidence that such a disaster leaves severe
personal anxieties in its wake. The victims were
angry, hostile, and resentful at the loss of their
homes, had obsessive preoccupations about the fire
and the events that followed, and suffered an increase
in somatic complaints on a level reported by persons
in outpatient psychotherapy. The orientation to
other events was disturbed, and paranoid-like projections
increased their anxiety and their fears of unexpected
harmful experiences. The characteristics of their
thought processes showed that they were an intelligent
group who struggled to take account of each and
every stimulus in a situation, even at the risk
of thereby incurring disadvantages and acting without
prudence. Their coping skills have been damaged
and, as a group, they seem less able to organize
their resources to meet stimulus demands effectively.
The Rorschach test results suggest
that, on the whole, the reactions to the destructive
fire persist. The anxieties have been internalized
and the emotional harm remains unrelieved. The fire
victims carry the scars of the damage to their ability
to cope. Only one victim chose to struggle with
these anxieties through psychotherapy and two had
sought crisis counseling that was, by their report,
highly ineffective.
Wolfenstein's (1957) analysis that
individuals progress through five identifiable phases
as they attempt to adapt to the impact of disasters
suggests that, as a group, the fire victims became
fixated in the fourth phase. They were still involved
with struggles to accept the effects of the disaster
and to regain mastery over their lives. To the extent
that the symptoms remain fixated, each fire victim
is at risk for maintaining a less than adaptive,
depressive personality style that represents a characterological
ossification of symptom formations. Guilt, irritability,
mourning, psychosomatic ailments, heightened sensitivities,
perceptual distortions and compulsions were in evidence
as the victims had reconstructed their lives some
eighteen months after the fire. As a group, then,
they well fit the diagnostic category of the Post-Traumatic
Stress Disorder described in the DSM-III-R (1989).
REFERENCES
Adler, A. (1943). Neuropsychiatric
complications in victims of Boston's Coconut Grove
disaster. Journal of the American Medical Association,
123, 1098-1101.
American Psychiatric Association.
(1987). Diagnostic and statistical manual of
mental disorders (3rd ed.). Washington, D.C.:
Author.
Barton, A. H. (1969). Communities
in disaster: a socio1ogica1 analysis of collective
stress situations. New York: Doubleday.
Berren, M., Beigel, A., & Ghertner,
S. (1980). A topology for the classification of
disasters. Community Mental Health Journal,
17, 103-111.
Burgess, A. W. & Holstrom,
L. L. (1974). Rape trauma syndrome. Archives
of General Psychiatry, 13, 981-986
Chamberlin, B. C. (1980). Mayo
seminars in psychiatry: The psychological aftermath
of disaster. Journal of Clinical Psychiatry,
41, 238-244.
Cobb, S., & Lindemann, E. (1943).
Neuropsychiatric observations during the Coconut
Grove fire. Annals of Surgery, 112, 814-824.
Derogatis, L. R. (1977). SCL-90-R
Baltimore, MD.: Johns Hopkins University Press.
Derogatis, L. R., Lipman, R. S.,
& Covi, L. (1973). SCL-90:An outpatient psychiatric
rating scale - preliminary report. Psychopharmacology
Bulletin, 9, 13-28.
Exner, J. E., Jr. (1986). The
Rorschach: A comprehensive system. Volume
1.(2nd ed.). New York: John Wiley & Sons
Exner, J. E., Jr. (1974). The
Rorschach: A comprehensive system Volume 1.
New York: John Wiley & Sons.
Gleser, G. C., Green, B. L., &
Winget, C. N. (1981) Prolonged psychosocial effects
of disaster: A study at Buffalo Creek. New York:
Academic Press.
Gleser, G. C., Green, B. L., &
Winget, C. N. (1978). Quantifying interview data
on psychic impairment of disaster survivors. Journal
of Nervous and Mental Disease, 166, 209-216.
Goldberg, J., True, W., Eisen,
S., & Henderson, W. (1990). A twin study of
the effects of the Vietnam war on posttraumatic
stress disorder. The Journal of the American
Medical Association, 263, 1227-1232.
Green, B. L. (1982). Assessing
levels of psychological impairment following disaster:
Consideration of actual and methodological dimensions.
Journal of Nervous and Mental Disease, 170
544-552.
Green, B. L., & Gleser, G.
C. (1983). Stress and long-term psychopathology
in survivors of the Buffalo Creek disaster. In D.
Ricks & B. S. Dohrenwend (eds.), Origins
of Psychopathology (pp. 73-90). New York: Cambridge
University Press.
Green, B. L., Grace, M. C., &
Gleser, G. C. (1985).Identifying survivors at risk:
Long-term impairment following the Beverly Hills
Supper Club Fire. Journal of Consulting and Clinical
Psychology, 53, 672-678.
Green, B. L., Grace, M. C., Lindy,
J. D., Titchener, J. L., & Lindy, J. G. (1983).
Levels of functional impairment following a civilian
disaster: The Beverly Hills Supper Club Fire. Journal
of Consulting and Clinical Psychology, 51,
573-580.
Green, B. L., Lindy, J. D., &
Grace, M. C. (1985). Posttraumatic stress disorder:
Towards DSM-IV. Journal of Nervous and Mental
Disease. 173, 406-411.
Hocking, F. (1970). Psychiatric
aspects of extreme environmental stress. Diseases
of the Nervous System, 31, 542-545.
Horowitz, M. J. (1976). Stress
response syndromes New York: Aronson.
Ingham, J. (1981). Neurosis: Disease
or distress. In J.K. Wing et al. (eds.), What
is a case? The problem of definition in psychiatric
community surveys. L. N. Grant McIntyre, London.
Leopold, R. D., & Dillon, H.
(1963). Psycho-anatomy of a disaster. A long term
study of posttraumatic neuroses in survivors of
a marine explosion. American Journal of Psychiatry,
119, 913-921.
Leivesley, S. (1984). Psychological
response to disaster, in Epidemiology of Natural
Disasters, Volume 5: Contributions to Epidemiology
and Biostatistics. Edited by Seman J., Leivesley,
S., & Hogg, C. Basel Kargen Publications.
Lifton, R. J. & Olson, E.,
(1976). The human meaning of total disaster: The
Buffalo Creek experience. Psychiatry, 39,
1-18.
Lindy, J. D., Grace, M. C., &
Green, B. L. (1981). Survivors: Outreach to a reluctant
population. American Journal of orthopsychiatry,
51, 468-478.
Lindy, J. D., Green, B. L., Grace,
M. C., & Titchener, J. L. (1983). Psychotherapy
with survivors of the Beverly Hills Supper Club
Fire. American Journal of Psychotherapy,
37, 593-610.
Logue, J. M., Melick, H. E., &
Hansen, H. (1981). Research issues and directions
in the epidemiology of health factors of disasters.
Epidemiology Review, 3, 140-162.
Madakasira, S., & O'Brien,
K. (1987). Acute posttraumatic stress disorder in
victims of a natural disaster. Journal of Nervous
and Mental Disease, 175, 286-290.
McFarlane, A. C. (1989). The aetiology
of post-traumatic morbidity: Predisposing, precipitating
factors. British Journal of Psychiatry, 154,
221-228.
McFarlane, A. C. (1988a). The phenomenology
of posttraumatic stress disorders following a natural
disaster. Journal of Nervous and Mental Disease,
176, 22-29.
McFarlane, A. C. (1988b). The longitudinal
course of posttraumatic morbidity: The range of
outcomes and their predictors. Journal of Nervous
and Mental Disease, 176, 30-39.
McFarlane, A. C. (1988c). The aetiology
of post-traumatic stress disorders following a natural
disaster. British Journal of Psychiatry,
152, 116-121.
McFarlane, A. C. (1987). Life events
and psychiatric disorder: The role of a natural
disaster. British Journal of Psychiatry.
151, 362-367.
McFarlane, A. C., (1986a). Long
term psychiatric morbidity after a natural disaster:
Implications for disaster planners and emergency
services. Medical Journal of Australia, 145,
561-563.
McFarlane, A. C. (1986b). Posttraumatic
morbidity of a disaster: A study of cases presenting
for psychiatric treatment. Journal of Nervous
and Mental Disease, 174, 4-14.
McFarlane, A. C. (1985). The effects
of stressful life events and disaster: Research
and theoretical issues. Australian and New Zealand
Journal of Psychiatry, 19, 409-421.
McFarlane, A.C., & Raphael,
B. (1984). Ash Wednesday: The effects of a fire.
Australian and New Zealand Journal of Psychiatry,
19, 913-921.
Rangell, L. (1976). Discussion
of the Buffalo Creek disaster: The course of psychic
trauma. American Journal of Psychiatry, 133,
313-316.
Raphael, B. (1984). Psychosocial
aspects of disasters: Some Australian studies and
the Ash Wednesday bushfires. Medical Journal
of Australia, 141, 268-270.
Raphael, B., & Middleton, W.
(1987). Mental health responses in a decade of disasters:
Australia, 1974-1983. Hospital and Community
Psychiatry, 38, 1331-1337.
Tennant, C. (1983). Life events
and psychological morbidity: the evidence from prospective
studies. Psychological Medicine, 13,
483-486.
Titchener, J. L, & Kapp, F.
T. (1976). Family and character change at Buffalo
Creek. American Journal of Psychiatry, 13,
295-299.
Wolfenstein, M. (1977). Disaster:
A Psychological Essay. New York: Arno Press.
©1997 by The
American Academy of Experts in Traumatic Stress,
Inc. |
