This document provides an overview of the short and long-term effects of disasters, including psychological impacts and responses. It discusses how over 80% of individuals exposed to trauma have some reaction in the first 24 hours, and how 20-50% still show significant distress after 12 weeks. Specific vulnerabilities for attorneys are discussed, like depression rates being twice the general population. Statistics on displaced attorneys after Hurricane Katrina are presented, followed by a case presentation of a 45-year-old attorney struggling after the storms. The document emphasizes the importance of resilience and finding strengths to counter adversity.

1. AFTERMATH OFAFTERMATH OF
DISASTERDISASTER
Short and Long-Term Effects ofShort and Long-Term Effects of
Disasters: An overview, impacts,Disasters: An overview, impacts,
related statistics, and a caserelated statistics, and a case
presentation for Attorneys in MS andpresentation for Attorneys in MS and
LA after Katrina and RitaLA after Katrina and Rita
Alexis Polles, MDAlexis Polles, MD

4. Outline for PresentationOutline for Presentation
• Disasters
-Causes of vulnerability
• Psychological responses to traumatic
stressors
• Impacts on Attorneys
• Statistics
• Case Presentation
• Closing Comments

5. BackgroundBackground
Disaster: An event or occurrence- usually sudden
and unexpected- that intensely alters the objects
and localities under its influence. It results in
loss of life and health in the local population,
causes severe environmental damage and the
destruction or loss of material goods resulting in
a dramatic disruption of normal patterns of life.
Such disruption…gives rise to the need for
immediate intervention and humanitarian aid.
Principles of Disaster Mitigation in Health Facilities

6. Involves response to (and
preparedness for) natural or man-
made events that affect an entire
community or communities.
(Usually) involve massive numbers of
casualties and extensive property
damage.
Randal Beaton, PhD, EMT
DISASTER RESPONSEDISASTER RESPONSE

7. Other Areas of VulnerabilityOther Areas of Vulnerability
• Administrative/Organizational
• Systemic
• Individual

8. Psychological Responses toPsychological Responses to
Traumatic StressorsTraumatic Stressors
Traumatic Stressor: Any event which is
outside of the realm of normal human experience
and very distressing is a traumatic stressor or
critical incident.
86% of individuals exposed (directly or indirectly)
to a traumatic event or critical incident tend to
have some kind of reaction within 24 hours of the
incident but such reactions may be delayed for
days to weeks.
Stress Management and Disasters

9. MaslowMaslow’’s Hierarchy ofs Hierarchy of
NeedsNeeds
Self-Actualization
Esteem
Love/Belonging
Safety
Physiological

10. Prevalence of Adverse PsychologicalPrevalence of Adverse Psychological
Effects Following DisasterEffects Following Disaster
• 0-24 hours
– 90%+ exhibit some untoward
psychological effects
• 12 weeks
– 20-50%+ still show significant signs of
distress
• 1-2 years
– 25%+ still show significant symptoms and
others previously free of symptoms
may first show a response
Coping with Disasters; Ehrenreich, John October, 2001

11. Factors Affecting Vulnerability toFactors Affecting Vulnerability to
Adverse Psychological EffectsAdverse Psychological Effects
• Greater severity and terror = greater likelihood
widespread and lasting negative effects.
• Intentional > unintentional > natural
• Mothers of children (5-10), people with prior
mental illness, those with poor social
adjustment, and those with prior personal
experience of trauma
Coping with Disasters; Ehrenreich, John October, 2001

12. Vulnerability factors cont.Vulnerability factors cont.
• Specific disasters (e.g. witnessing death of
loved one, losing a child, being entombed
or trapped, serious injury from disaster,
hospitalization as a result of the disaster)
• Stigmatization of the victims (e.g. rape, in
some cultures the victims are unable to tell
the family or friends for fear of
punishment or blame)
• Lack of availability of social support
networks.
Coping with Disasters; Ehrenreich, John October, 2001

13. The more severe the disaster, the less the
characteristics of individuals matter. In
very severe disasters, virtually everybody
shows adverse emotional responses.
Coping with Disasters; Ehrenreich, John October, 2001

14. Katrina and RitaKatrina and Rita
• Nationally
– Top headline from NY Times and LA Times all but five
days between 8/30/05 & 9/26/05
• Regionally
– SouthCentral region had a much lower rate on a
happiness index through the 2nd week of September
– Income does have a noticeable relationship to
happiness
– Many people care about others but few are “Saints”
• Locally “Unhappiness after Katrina”, Kimball, et al,
March 2006

15. Potential Victims Of A TraumaticPotential Victims Of A Traumatic
StressorStressor
1 Primary Victims
Those individuals most directly affected by the event,
e.g., the persons whose houses are blown down in a
hurricane.
2 Secondary
Victims
Those individuals who in some way observe the
consequences of the traumatic event on the primary
victims, e.g., bystanders, rescuers, and emergency
response personnel.
3 Tertiary Victims
Those individuals who are indirectly affected by the
traumatic event as a result of later exposure to the
scene of the trauma or to the primary or secondary
victims of the trauma, e.g., family members of primary or
secondary victims or passers by.
Stress Management and Disasters

16. Responses To A Traumatic SituationResponses To A Traumatic Situation
1 No Reaction
2 Normal Stress
Response
3 Psychological
and Behavioral Syndrome
4 Psychological
Disorders
Stress Management and Disasters

17. PRE-IMPACTPRE-IMPACT
PHASE:PHASE:
The majority of persons make some effort to prepareThe majority of persons make some effort to prepare
for the potential impact of a disaster. Others becomefor the potential impact of a disaster. Others become
indifferent and deny that there is any impendingindifferent and deny that there is any impending
danger and still others become anxious and somewhatdanger and still others become anxious and somewhat
disorganized. A few persons remain quite calm anddisorganized. A few persons remain quite calm and
focused.focused.
WARNINGWARNING
PHASE:PHASE:
During this phase a greater proportion of persons tendDuring this phase a greater proportion of persons tend
to become agitated and over-react but a few continueto become agitated and over-react but a few continue
to remain calm and purposeful.to remain calm and purposeful.
Persons tend to be fearful and they attempt to cope byPersons tend to be fearful and they attempt to cope by
either giving up, running away, or rescuing others.either giving up, running away, or rescuing others.
HEROISMHEROISM
PHASE:PHASE:
During this phase, efforts are made to survive andDuring this phase, efforts are made to survive and
recover property. This is a time of great altruism andrecover property. This is a time of great altruism and
overwork with possible irritability and exhaustionoverwork with possible irritability and exhaustion
HONEYMOONHONEYMOON
PHASE:PHASE:
Persons tend to share their experiences. GoodPersons tend to share their experiences. Good
outcomes are anticipated and hope and elationoutcomes are anticipated and hope and elation
prevails.prevails.
DISILLUSIONMENTDISILLUSIONMENT
PHASE:PHASE:
Disappointment occurs when aid is not as readilyDisappointment occurs when aid is not as readily
forthcoming as was anticipated and some people areforthcoming as was anticipated and some people are
seen as less fortunate than others. Depression oftenseen as less fortunate than others. Depression often
follows.follows.
REBUILDINGREBUILDING
PHASE:PHASE:
People need to accept that they must depend onPeople need to accept that they must depend on
themselves if they are going to move on and rebuildthemselves if they are going to move on and rebuild
their lives. Failure to do this leads to bitterness andtheir lives. Failure to do this leads to bitterness and
animosity.animosity.
PRE-INCIDENT
(ifappropriate)IMPACT
PHASE
POST-INCIDENT
Stress Management and Disasters

18. NURSESNURSES’’ RESPONSERESPONSE
• n=443 inpatient nurses in Kobe, Japan following
devastating earthquake
• 80% (335) completed general health
questionnaire at 1 & 8 months after the quake.
Compared to their usual state pre-earthquake,
nurses showed considerably increased total
scores on psychiatric symptoms; especially
somatic symptoms, sleep disturbance, anxiety
and social dysfunction.
BMJ 1996; 313:1144 (2 November)

19. Phases of DisasterPhases of Disaster
HONEYMOON
(COMMUNITY COHESION)
HEROIC
PREDISASTER
DISILLUSIONMENT
RECONSTRUCTION
A NEW BEGINNING
Warning
Threat
Impact
Inventory
(C
om
ing
to
Term
s)
W
O
R
KING
TH
R
O
U
G
H
G
R
IEF
Trigger Events and
Anniversary Reactions
--1 to 3 DAYS –Time------------------------------------1 to 3 YEARS --------------------------------

20. Reflection QuestionsReflection Questions
Where do you think you are on this
graph?
What is one issue of concern you have for
yourself, (one for) your family, your
work, your community?
What is one way (smaller is better) you
can take care of yourself this week?

21. Common Reactions of NormalCommon Reactions of Normal
People to an Abnormal SituationPeople to an Abnormal SituationNumberofpeopleaffected
Many
Few
Examples of moderate reactions:
•Persistent Insomnia
•Anxiety
Examples of severe reactions:
•PTSD
•Depression
Examples of
mild reactions:
•Insomnia
•Worry
•Feeling upset
Mild/Few
Severe/Many
Severity or number of symptoms

22. Common Immediate ReactionsCommon Immediate Reactions
• Denial/Indifference/Avoidance
• Refusal to evacuate
• Self-destructive “coping skills”, especially
excessive alcohol and substance use, excessive
work, etc.
• Despair
• Panic- Fight/Flight/Freeze
• Survival Guilt
• Destruction of personal
illusion of invincibility
DANGER
Adrenaline
Storm Ahead

23. •Decision making is influenced by personalDecision making is influenced by personal
psychological factors and cultural factors.psychological factors and cultural factors.
•Many professionals have an authoritarianMany professionals have an authoritarian
style with rigidity, inflexibility, and need forstyle with rigidity, inflexibility, and need for
highly predictable environment.highly predictable environment.
•There is a strong drive for achievement and aThere is a strong drive for achievement and a
fear of failure.fear of failure.
•They may respond with an attempt to regainThey may respond with an attempt to regain
control, though by outwardly behaving as thoughcontrol, though by outwardly behaving as though
everything is normal.everything is normal.

24. Personality TraitsPersonality Traits
• Type A behaviors
– driven
– competitive
– individualistic
– perfectionist
– compulsive

25. Common BehaviorsCommon Behaviors
• Inappropriate anger or resentment
• Inappropriate words or actions directed
towards another person
• Inappropriate response to patient needs or
staff requests

26. Inappropriate Words/ActionsInappropriate Words/Actions
Directed Toward AnotherDirected Toward Another
• Sexual comments/harassment
• Seductive, aggressive or assaultive
behaviors
• Racial, ethnic, or socioeconomic bias
• Lack of regard for others’ comfort/dignity

27. Inappropriate Responses toInappropriate Responses to
Clients/StaffClients/Staff
• Being uncooperative, defiant, rigid when
dealing with problems or responding to
requests for help
• Being avoidant or unreliable
• Unprofessional demeanor
• Recurrent conflict with others
• Difficulty with authority
• Belittling remarks near clients/families/staff

28. Review of Impacts ofReview of Impacts of
Katrina/RitaKatrina/Rita
• Acutely Traumatized Population
• Over-Burdened Professionals
• Disrupted Social and Economic Infrastructure
– Family dysfunction
– Migration and displacement
– Loss of tax base and social services
– “Getting on with life” leading to shift of priorities away
from problems of evacuees after the acute crisis has
settled
James Griffith, MD
Pine Grove Katrina Workshop
November, 2005

30. Bringing it HomeBringing it Home
• Cultural and Psychological Issues in
Attorneys

31. Failure = Lack of effortFailure = Lack of effort
Inability to ask for or receive helpInability to ask for or receive help

32. Depression in AttorneysDepression in Attorneys
• 10% prevalence of Major Depression >
twice that of the general population
• Applicants = general population
• End of first year, 32% depressed
• End of third year, 40% depressed
• Two years of practice, 17% -20% depressed,
12% problem drinkers, 6% both
• 33% in practice in Washington with depression,
problem drinking, or cocaine abuse

33. Prevalence of Alcohol ProblemsPrevalence of Alcohol Problems
• < 20 years practice = 18% prevalence
• > 20 years practice = 25% prevalence

34. Indicators of Problems inIndicators of Problems in
LawyersLawyers
• Being late for court
• Failing to file legal notifications
• Poor records
• Misappropriating funds
• Delays in taking care of mail
• Missing deadlines
• Failing to return calls
• Intentionally failing to pursue lawful
objectives

35. Less Specific IndicatorsLess Specific Indicators
• Irritability, moodiness, verbal
abuse
• Complaints from clients or staff
• Changes in schedule or absences
• Decline in quality of work
• Family problems
• Financial difficulties
• Isolation
• Physical deterioration
• Somatic Complaints

36. Indicators Specific toIndicators Specific to
AddictionsAddictions
• Long lunch hours
• Long sleeves
• Bathroom use
• Breath
• Coming in late and
leaving early
• Overt intoxication

37. STATISTICSSTATISTICS
There are 374 attorneys that
were living in Louisiana
prior to Hurricane Katrina
who are now living out of
state.

38. GULFPORT, MSGULFPORT, MS
• 1st
Weekend in June 2006
– Total of 8 “911” calls for suicide
attempts
• In the year since Katrina
– The number of completed suicides has
quadrupled
– The number of suicide attempts has
increased by 30%
WLOX News Broadcast 6/16/06

40. John BarristerJohn Barrister
• 45 year old general practice attorney from
a small town
• Married with no children
• Family History: Drug addiction in a
younger sibling. Workaholism and
perfectionism in his father. Chronic health
problems in his mother.

41. CopingCoping

42. ResilienceResilience
• The capacity to emerge from adversity
stronger and more capable:
– Best regarded as “something one does,”
rather than “something one is”
– Can refer to competencies of a person, a
family, or a culture in responding to
adversity
– Strengthened by identifying strengths,
skills, competencies, resources, personal
wisdom from lived experience, with which
adversity can be countered
James Griffith, MD
Pine Grove Katrina Workshop
November, 2005

43. • What is a competency you have noticed
in yourself, another person, your
family, and your culture?

44. Closing CommentsClosing Comments
• Traumatic events are frequently a source
of energy for new ideas, discoveries, and
growth.