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was ill. After the main party had moved on, the ill person's condition deteriorated cata-
strophically, and over a period of days the three rescuers worked virtually to the point of
exhaustion to save him.
During this ordeal, the rescuer became aware of several strong feelings. He found that
attending to a close friend aggravated normal feelings of inadequacy and guilt, particularly
guilt for not having more forcefully cautioned the person before he became so ill. He also
felt guilt for not having resisted more vigorously the decision to split the party, which left
the person who was ill with a support team barely able to provide for his care.
Inretrospect,therescuerrealizedthathehaddeferredtotheleader,despitehisowncon-
siderable judgment and experience, because the leader was a physician. During and after
the subsequent vigil, the rescuer began to question his confidence in the leader, in his as-
sociates, in himself, and even in the categories of people (doctors) who were members of
the rescue group. His confidence was further eroded following reuniting of the party when
people he considered significant acted like nothing had happened.
The rescuer kept these feelings hidden for some time, not realizing that others were ex-
periencing the same emotions. Only months later, when he made an offhand comment that
he was considering dropping out of the group, did he have an opportunity to share his pain
and begin to reconstruct relationships. Since then he has made a variety of recommenda-
tions, particularly that the emotional residue of stressful situations be discharged through
debriefings.
Healsoobservedthateventhoughsupportfromassociatesishelpful,inthelongrunthe
benefits fade unless rescuers recognize the value of their efforts and learn from their mis-
takes, rather than wallowing in destructive self-criticism. To grow, everyone must accept
responsibility for their actions, both good and bad.
Dissociation
Performing well in rescue situations requires a high level of objectivity. The rescuer's
emotional response to those involved in an accident and to their injuries must not interfere
with caring for them. To maintain objectivity, most rescuers dissociate, or split, their intel-
lectfromtheirfeelings,anddeny,orblockout,theemotionalshockoftheeventssurround-
ing them. Such defensive dissociation or splitting is effective but cannot be kept up indef-
initely. Eventually rescuers develop symptoms of decompensation—the inability to main-
tain defense mechanisms in response to stress—which results in personality disturbances
or psychological imbalance.
Symptoms of decompensation are highly variable. Some rescuers become withdrawn
and appear dazed, apathetic, forgetful, or tired. Others are open and expressive but become
irritable, irrational, destructive, or violent. Some shut off their feelings and become less
able to experience intimacy with their families and friends. Some become increasingly re-
liant on alcohol or other drugs.
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