Disaster Syndrome

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P Valent
Melbourne, Australia

Features of Disaster Syndrome
Wallace described the responses of Petun warriors who in 1649 returned to their village to find their kin had all been slain or captured. They sat down in the snow, mute, and no one stirred or spoke for half a day. Wallace noted that such responses are ubiquitously found in disasters and are variably described as shock, stupor, and being dazed, stunned, and numbed. He added that, as well as sitting, victims may stand motionless or wander aimlessly. Emotion such as pain, grief, fear, and anger are missing, and people are docile. The state may last up to hours or even days, injured people remaining dazed longer. The features of disaster syndrome are opposite to the anger and fear (fight and flight) sympathetic nervous system-associated arousal in posttraumatic stress disorder (PTSD) and some other anxiety disorders. This suggests that there may be a variety of emotional and biochemical survival responses in trauma that can develop into a variety of later symptoms.

The Place of Disaster Syndrome in Disasters and among Similar Syndromes
The behavioral features of disaster syndrome described by Wallace are still valid in descriptions today and are called by the original name. However, various psychological, behavioral, and physiological lines of research emphasize different aspects of what is behaviorally disaster syndrome and call them by different names. The psychological equivalent has been called psychic shock and the physiological equivalent general adaptation syndrome; conservation-withdrawal syndrome spans the all biopsychosocial aspects.

Psychic Shock
Psychic shock is the subjective view of being stunned. It has been most studied in bereavement and dying and is seen there as the first stage of the grieving process.
Subjective feelings of psychic shock as a response to being told the news of someone's death use physical metaphors such as an assault, a blow on the face, head or the guts, being knocked out, or winded. Psychological terms include being overwhelmed, not being able to take it, the world shattering around one, and sinking into a black hole.
Defenses against such sensations include denial voiced as disbelief and dissociation, described variably as feeling numb or as experiencing a sense of unreality of the world or of oneself. A common description is looking at oneself and the events as if they were a film.

General Adaptation Syndrome
Selye described general adaptation syndrome as a ubiquitous triad of physiological stress responses that were associated with psychic shock. The stress responses are the enlargement of the adrenal cortex and increased levels of cortisol; shrinking of the thymus gland, spleen, and lymphatic structures (along with compromising immunocompetence); and deep ulcers in the stomach. Selye noted that these responses help organisms to adapt to overwhelming situations.

Conservation-Withdrawal Syndrome
Conservation-withdrawal syndrome, described by Engel and Schmale, enlarges on the features of disaster syndrome by emphasizing immobility, quiescence, and unresponsiveness, accompanied by sagging muscles, feelings of extreme fatigue, constricted attention, and detachment.
Adding to general adaptation syndrome, conservation-withdrawal is associated with parasympathetic, trophotrophic activity, which may manifest in diminished heart rate to the point of arrhythmia and possibly asystole and even death. Gastric secretions have been noted to diminish, possibly because food intake does not occur in this state. The syndrome has been observed at all ages, ranging from neonates to adults, and in various situations in which no definite course of action was possible.

Sense and Purpose of Disaster and Associated Syndromes
Initially it may be difficult to see these responses of being overwhelmed as adaptive. However, just as physical shock helps survival, so may psychosocial shock. For instance, Darwin noted that immobility made animals less likely to be seen and be attacked and that the deathlike state could stimulate predators to release their grip. Immobility could also help others to scoop the unresisting person to safety and help members of the group to find its previously abandoned members. Further, the associated psychosocial limpness or docility may facilitate cooperation with helpers and their directions. Last, a type of psychological encystment and conservation of energy could provide a buffer space for the replenishment of reserves.
Selye and Engel and Schmale also saw their respective syndromes as primary regulatory organismic templates that enhanced the survival of the species. They were at the opposite end of the spectrum to fight and flight, and they occurred in situations in which fight and resistance could be fatal but in which rolling with the punches and surrendering old goals and finding new ones was advisable.
Valent integrated the biopsychosocial features and purposes of these syndromes into a survival strategy that he called adaptation. The strategy adapts the organism to situations requiring initial surrender, but through processes such as grieving it facilitates the organism's turning to new hopeful situations and bonds. If this does not occur, physiological symptoms, depression, and other illnesses can occur.

Unfolding of Disaster Phases and of Disaster Syndromes
The features of later disaster phases and the unfolding of the disaster syndromes (or the adaptation survival strategy) follow.

Ensuing Disaster Phases
In the postimpact phase (Wallace's stages 2 and 3) of disasters, survivors emerge from their cocoons. They are grateful to be alive, help others, and reconnect with family and friends. Survivors drop their usual reserves to become a cohesive altruistic community. The accompanying optimism has been called the postdisaster euphoria. At the same time, anger is often directed at outsiders whose help is seen as unempathic. In addition to Wallace's original stages are the recovery and reconstruction phases, hard prolonged times of rebuilding the physical environment and internal lives. The names, timing, and contents of the phases are flexible, indicating fluctuating progression. Similar phases occur in other traumatic situations, although different contents are emphasized in the literature. For instance, in bereavement psychological features are emphasized. After shock come the phases of searching, then anger, guilt, and working through, followed by acceptance and turning to new bonds.

Unfolding of Disaster Syndrome
Physiological stress response derivatives of disaster syndrome (or adaptation survival strategy) may manifest clinically as hypotension, dizziness, tiredness, fatigue, and the sense of being ill. Prolonged compromised immune competence may help to account for the increased rates of infections, autoimmune diseases, and cancers following disasters, bereavements, and other traumas. Thus, this specific response may be significantly involved in the frequent stress-induced maladies. Maladaptive psychological unfolding includes hopelessness, despair, giving in, unresolved and chronic grief, and clinical depression.

Treatment
The treatment of psychic shock, like physical shock, includes physical and psychological warmth, comfort, and support. Physical contact with another human, a reassuring voice, explanations of what is happening, hope, and connection with loved ones are helpful. Later treatment depends on the nature of the evolving symptoms and illnesses. The best treatment is prevention or mitigation of circumstances in which people are overwhelmed.

Further Reading
American Psychiatric Association (1994). Diagnostic and statistical manual of mental disorders (4th edn.). Washington DC: American Psychiatric Association.
Engel, G. L. and Schmale, A. H. (1972). conservation-withdrawal: a primary regulatory process for organismic homeostasis. In: Ciba Foundation symposium: physiology of emotion and psychosomatic illness, pp. 57-85. New York: Elsevier.
Raphael, B. (1984). The anatomy of bereavement. London: Hutchinson.
Raphael, B. (1986). When disaster strikes. London: Hutchinson.
Selye, H. (1946). The general adaptation syndrome and the diseases of adaptation. Journal of Clinical Endocrinology 6, 117-196.
Valent, P. (1998). From survival to fulfillment: a framework for the life-trauma dialectic. Philadelphia: Taylor and Francis.
Wallace, A. F. C. (1957). Mazeway disintegration: the individual's perception of socio-cultural disorganization. Human Organization 16, 23-27.

Glossary
Disaster Natural calamities such as floods, earthquakes, and fires; also human-made calamities and other traumatic situations.
Disaster phases Time periods around disasters. These are (1) preimpact, the period before the disaster; (2) impact, when the disaster occurs; (3) recoil, the period immediately after impact; (4) postimpact, the period days to weeks after impact; and (5) recovery and reconstruction, the period months or years after impact.
Survival strategies Biopsychosocial templates that evolved to enhance survival in specific circumstances. Examples are fight, flight, adaptation, and attachment.
Trauma An experience in which a person's life is grossly threatened and from which a variety biological, psychological, and social wounds and scars result.
Traumatic situations External situations in which trauma occurs.

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