Biomedical Engineering Reference
In-Depth Information
psychologically than those who rated resources as
either increased or decreased.
Culture provides a lens through which people
interpret losses and seek help during and in
the aftermath of disaster or terrorism. Culture
includes secular and religious belief systems,
support networks and resources, ritual practices
and traditions, language and dialects, and national
and group/tribal loyalties. Despite culture's perva-
siveness and potency, little is known about how
culture affects the impact of and recovery from
disasters [1,2]. Most studies of the post-traumatic
sequelae of disaster or terrorism have not system-
atically examined ethnic or cultural differences.
Of those that include ethnicity as variable, several
report that ethnicity is a predictor of post-traumatic
psychosocial impairment, with increased short-
term (but not long-term [17]) risk for Hispanics
living in New York City in the wake of September
11th and greater risk for African American children
and Hispanic and African American adolescents
and adults after hurricanes [1,2]. Communities
representing different cultures also may metab-
olize disasters differently. A study of disaster
survivors found that younger age was a risk factor
in Mexico, older age in Poland, and mid-adulthood
in the United States [1,2]. Another study found
that the gender difference in PTSD intrusion and
avoidance symptoms and bereavement reactions
were greater in a sample of hurricane survivors
in Mexico than in the United States, and in the
latter cohort African-American women and men
showed less difference on these symptoms than
Caucasian women and men [1,2]. These findings
indicate that it is not culture alone but a complex
combination of historical and current sociocul-
tural factors that influence post-disaster adjust-
ment. In ethnoculturally diverse communities, the
types and sources of help that affected individuals
and families seek and benefit from are likely to
vary depending upon the extent to which they
are embedded in pre-existing social networks and
connected to indigenous resources (e.g., secular
and faith-based organizations) that are familiar to
each ethnocultural group. Across cultures disaster
survivors are more likely to seek help from health
care professionals or lay healers than from mental
future (67%), and did not wish to receive profes-
sional treatment for stress (72%), despite gener-
ally feeling unsafe (60-68%) and sub-clinically
depressed (59%) [15]. Thus, remaining healthy and
functional in the face of repeated exposure to or
persistent threats of terrorism, and past experi-
ences of other forms of psychological trauma, may
require strong social support systems and active
positive coping [12].
11.1.3 Traumatic Grief: Shock, Loss
and Complicated Bereavement
Survivors and witnesses, as well as the family and
close friends or associates of persons killed or
severely harmed in terrorist incidents, often expe-
rience profound losses that compound the shock of
the psychological trauma caused by terrorism [11].
Traumatic grief (also referred to as complicated
bereavement) involves a combination of traumatic
stress reactions (which lead the person to attempt
to avoid reminders of terrifying or emotionally
devastating experiences, including losses) and grief
reactions (which lead the person to be preoccupied
with thoughts of lost loved ones or other losses).
Thus, traumatic grief involves a tension between
avoidance of unwanted memories a need to mourn
through painful remembrance, which can become
a debilitating vicious cycle.
Terrorism causes not only the loss of impor-
tant relationships due to death but also due to
losses that involve a failure to conserve or replace
crucial resources (e.g., housing, social services,
employment, and neighborhood contacts). A study
in rural China showed that a community distant
from the epicenter of an earthquake was less
adversely affected in terms of residents' quality
of life and stress reactions than a more prox-
imate community—but the more geographically
distant community received less support and thus
showed poorer outcomes and less positive change
in quality of life at a 9-month follow-up than the
more directly affected community [16]. While a
return to the
status quo ante
is impossible, earth-
quake survivors who believe that their personal and
social resources were still largely intact fared better
