With Haiti now much in disarray with its people suffering from a major earthquake, what can we expect in the coming weeks and months about the emotional reactions of the victims as they struggle to recover?
In the Oklahoma City National Memorial and Museum built after the 1995 Oklahoma City bombing, we have excellent follow-up and documentation of what the human response is to disaster.
Is the behavior documented at the memorial a model of what we can expect of individuals from other countries? Are the emotional responses the same for those whose lives are devastated by another type of trauma?
My international experience with disasters as a psychologist and team member with the University of Missouri’s International Center for Psychosocial Trauma would lead me to say definitely yes to both questions. As humans our responses to near-death experiences, to the loss of loved ones, and to the destruction of our way of way of life have much in common. The exhibits at the memorial, which I toured this month (January), are arranged to let us see what those emotional responses are over time.
The Memorial Museum covers three floors of one end of the former Journal Record Building also damaged in the explosion. I started the tour on the third floor where the scene is set by taking us to the hour before nine a.m. on April 19, 1995. It is a peaceful day; we see scenes of the city and what is happening outside and inside the building.
Next we enter a quiet room where the one recording made that morning is played. A case is being brought for permission to use ground water from under a home to bottle water for sale. Two minutes into the meeting there is an explosion, the room goes dark, and then on the wall are flashed the faces of the 168 people killed in the explosion. It takes my breath away.
Appearing on a screen in the next room are images of chaos and destruction taken from a helicopter when it still was not known exactly what had happened. We learn 700 people were injured, nine other buildings were destroyed and 25 were seriously damaged. In the background we hear police and emergency calls and reporters describing what they see. Hovering over all is a sense of confusion.
As we pass through the debris-filled rooms on the third floor, we are listening to comments by three groups of people: (1) those who survived the immediate explosion and destruction, (2) those who had lost loved ones in the explosion and (3) the first responders who dug out the bodies and attended to the injured and dying. The interviews on the large screen televisions are high definition, which gives scenes an almost three dimensional quality.
Survivors of the bombing
The interviews indicated that the immediate response of the survivors was confusion and shock. It was difficult for them to know what had happened. Some came out of the confusion quickly and began to look for an escape route out of the building and to help others make their escape. Much of the initial rescue work was done by victims. Most of the initial injuries of those who survived were caused by flying glass and stone and flames from the explosion. Eye injuries were common as were injuries from imbedded glass.
Stories from survivors focused on how they helped and were helped. One blind man led some others out because the air was so filled with smoke they couldn’t find their way out and he could. Many stories stressed how people acted bravely and cooperated well.
The most horrendous stories came from those trapped under the rubble. They had needed to talk themselves into remaining calm. “I’m still alive, I can’t quit, I can’t fall asleep.”
Once out of immediate danger victims felt relief, but then they thought about how close they had been to death. “The man next to me died. It was matter of inches.” “All six of my staff were crushed under the rubble.” It became clear that who died and who lived was often dependent upon some change in normal behavior that changed physically where they had been--a doctor’s appointment, a stalled car, or coming early to an appointment at the building.
Early after the bombing most of this group reported intrusive memories of the experience and hyper arousal. That is, any cues that reminded them of the experience caused anxiety and in some cases flashbacks. Many felt numb and tried to avoid thinking about the incident. Many of the survivors had to undergo long term rehabilitation because of their injuries before they could get on with their lives.
All felt that the bombing had changed their lives. A follow-up study found 34 percent still suffered from post-traumatic stress disorder years later. Some mentioned in their interviews that they felt surviving the incident had made them stronger.
Relatives of the deceased
The responses of the relatives of the deceased were initially of loss and grief. Some had been panicked about finding their wives, husbands or children in the rubble. For some it was a matter of waiting until the bodies were found; and until the bodies were identified, they still held out hope that their loved ones were alive.
As a result great care was taken with the recovery of bodies, even to the point of endangering the rescuers, so that bodies would be in the best possible condition. All methods possible were used to make correct identifications. In the end only one leg remained unidentified; it may have belonged to a 169th person.
This group saw their suffering as different from that of the first group, which led to some disagreements as to how the memorial should be designed. This second group had a strong belief that only someone who had lost a loved one would be able to understand what they were experiencing. At one point both groups saw themselves as different from each other, but as time passed they recognized they were all sufferers from the bombing.
To preserve the bodies the diggers worked slowly to remove the debris. The pain of survivors waiting for their loved ones to be recovered affected how carefully the workers took their task. Dogs had been brought in to sniff out live bodies
The emotional responses of first responders, police, firefighters, medical personnel, are often overlooked. After all, rescue work is what they were trained to do. Some did not want to admit they were responding emotionally to what had happened, but they talked about the nightmares and the flashbacks indicating the bombing had had a big impact on their lives. Some doctors had to amputate limbs without the use of anesthesia. One tells the story of amputating a leg where he had to lie in an awkward position on the victim while working with dull instruments.
We learned about critical incident stress and how it affects the first responders, and how they need to defuse by talking about their experiences. The Red Cross had been available for debriefings, but not everyone had wanted to talk about painful material, thinking it would only make them feel worse. Because of the resistance the debriefings were provided anonymously as much as possible because professionals don’t like others to know how much they are affected by death and destruction.
Of the rescuers one was killed by falling debris and 26 received severe enough injuries to need hospital attention.
On the second floor a film showed how Timothy McVeigh was caught almost by accident when he was stopped for driving without a car license and he indicated he was carrying a loaded gun. Only because he was held an extra day was the FBI able to find him so soon after the explosion.
Two rooms have special impact. One has pictures with mementos of all 168 who died. In the other room the focus is on how to spot a terrorist attack. One section has each of the major television news anchors telling what their reactions were to the bombing, what it meant, and what their thoughts were about terrorism.
The documentation at the memorial gave a picture that was consistent with my experiences working in trauma zones: earthquakes in India and Pakistan, Katrina and the tsunami in Indonesia and Sri Lanka.
From a mental health point of view the memorial gives the visitor important information that will fit any major catastrophe whether it be an earthquake, a hurricane or a terrorist attack. These interviews reveal how humans respond to life threatening events or events in which their loved ones are killed or injured.
I came out of this memorial emotionally exhausted, but knowing more about what it is like to undergo a major life threatening experience or to lose someone close due to a sudden and unexpected calamity.
In the summer of 1995 fifteen teachers from Oklahoma City attended a two month workshop the International Center for Psychosocial Trauma was running in at the University of Missouri. The participants included 30 teachers and doctors from Sarajevo, Bosnia. This was my first experience with the center and demonstrated to me how universal people's responses are to disaster. Later I went down to Oklahoma City with Kathy Dwein to run some additional training and I stayed over to visit the site with Dr. Paul Heath, a Veteran's Adminstration Psychologist who had been in the Murrah Building when it exploded. Glass was still working it way out of his neck at that time. When we were at the site he told the crowd gathered there that he was one of the surviors and they indicated a great deal of interest in hearing his story. That interest in what happened has continued to be high and the site has 300,000 visitors a year.