| 1The
author expresses gratitude to Christian Arrington
of the Oakland Unified School System for his assistance
with the statistical analyses of the data.
2The
author is in private practice and a Clinical Associate
Professor with the Department of Psychiatry and
Behavioral Sciences at Stanford University School
of Medicine
Abstract
The Pebble Beach
fire of 1987 destroyed 30 homes. Eighteen months
after the fire, ten adults, whose homes and belongings
were destroyed, were administered the Rorschach
Test and the SCL-90-R Test. Comparison with the
means of the normative groups for each test yielded
significant results above the p < .01
level. The long term traumatic impact on the personalities
was clearly reflected by interferences in thought
processes, perceptual distortions and depressive
reactions, inter alia.
The Traumatic
Impact of a Fire Disaster
as Reflected
in the Rorschach and SCL-90-R Tests
INTRODUCTION
There was a disastrous
forest fire in the Pebble Beach area of California
on May 31, 1987 that destroyed a community of
31 homes, severely damaged six other homes and
compelled the evacuation of over 200 people. The
people had little warning about the severity of
the fire and little time in which to leave their
homes. In some instances they had only time to
run to their cars, escaping while watching their
home and all their possessions explode with fire.
The fire had begun as an illegal campfire set
by local teenagers; it spread quickly and was
fanned by winds rising to 50 miles per hour and
the temperature reached 500 degrees Fahrenheit.
The conflagration swept up a hill, leaping from
roof to roof and from tree top to tree top, burning
homes as it raced. No one was killed in the fire
but the damage was immense in this upper class
community.
A law suit was
initiated, based on the allegation that the disaster
and its scope were predictable and that the community
organization had failed to provide adequate protection
from such a danger. The author was invited to
determine whether any mental health problems of
the thirteen fire victims that were related to
the traumata of the fire.
The present report
summarizes the psychological evaluation of ten
of these individuals. Each was given an intensive
three to four hour interview, the Rorschach Psychodiagnostic
Test, and the Symptom Checklist (SCL-90R). The
evaluation occurred 18 to 20 months following
the fire.
Knowledge about
the effects of traumata and disasters on individuals
and on social groups has slowly accumulated through
studies in the last fifteen years. Notable among
the earliest discussants of the effects of disasters
is Martha Wolfenstein (1957). Wolfenstein's analyses
of the impact of disasters upon the lives of victims
suggested that there were several phases of psychological
reactions which included the shock, followed by
an initial adjustment to the occurrence. Then
came reactions of disillusionment and depression;
next were efforts to internalize the facts of
the disaster and finally, a reorganization of
the personality in the recovery process. When
the internalization fails, psychopathological
symptoms emerge and fixate. The fixation results
in the post-traumatic stress disorder defined
in the Diagnostic and Statistical Manual III-R.
Summarizing the syndrome therein described, the
symptoms include a persistent re-experience of
the event as in recollections, dreams, or a sense
of reliving the event; persistent avoidance of
stimuli associated with the traumatic situation
as efforts to avoid thoughts or feelings associated
with the event, feeling of detachment, restricted
affect, etc.; and, persistent symptoms of increased
arousal as difficulty sleeping, irritability,
difficulty concentrating, etc.
Factors that contribute
to or interfere with re-adaptation include the
suddenness and duration of the event (Barton,
1969; Berren, Beigel and Ghertner, 1980), the
seriousness of the threat to life, bereavement,
the duration of suffering (Berren et al., 1980;
Gleser, Green and Winget, 1981), and the scope
of the disaster (Barton, 1969; Gleser et al, 1981).
In addition, the quality of family and community
support (Green, 1982), the source of the disaster--i.e.,
human error or natural disaster--prior experience
with the particular stress, or the victim's vulnerability,
and the wealth and availability of resources (Appley
and Trumbull, 1986), all assist or impede recovery.
Follow-up studies
of natural disasters have consistently shown an
increase of symptoms of psychological distress,
including symptoms of stress, anxiety, helplessness
and depression. The effects on bodily health were
evidenced by a significantly heightened frequency
of physical ailments, and by visits to physicians
and to hospitals. Furthermore, the mortality rate
increased for victims in the following year. Social
contacts were significantly lessened. People were
less satisfied with the quality of their lives
and reported less time spent in leisure. These
studies have been conducted from ten months to
ten years following a disaster. The percentages
of persons for whom psychic distress was reported
vary from a low incidence of 33% to a much higher
100% (Chamberlain, 1980; MacFarlane 1986; MacFarlane,
1988).
Man-induced disasters
are considered more harmful in their psychological
effects than "natural" disasters. The
following examples illustrate some incidents in
which human error was proven or suspected and
summarize briefly the results of the follow-up
studies on the victims. The knowledge that the
disaster could have been avoided seems to release
a rage and anger that are not observable in those
affected by natural disasters. Victims experience
heightened distrust and suspicion of others and
their motives. Their unresolved grief brings about
personality changes that involve guilt, rage,
demoralization, and a diminished elan vital.
The Coconut Grove Fire of 1943, assumed to
have been due to negligence, produced tremendous
horror and terror in those present at the time
as 400 persons were burned to death or otherwise
killed in their efforts to escape. One year later,
fifty per cent of the survivors still manifested
symptoms of sleep disturbances, increased nervousness
and anxiety, guilt over survival and fears related
to the events of the fire (Adler, 1943; Cobb and
Lindemann, 1943).
A four-year follow-up
study of a 1963 ship collision revealed that 75%
of the survivors had severe work-related problems
and persistent psychological distress symptoms
(anxiousness); mood disorders actually increased
over time and psychosomatic disorders became more
frequent (Leopold and Dillon, 1965). The effects
on the victims of another shipwreck were similar.
One and two years following the disaster, all
but one had manifest psychiatric disturbances
and none had returned to work on ships (Henderson
and Bostock, 1979).
A ten year follow-up
study of men who were buried alive for several
days in a mine disaster in Langede, Germany in
1963 documented that there were no continuing
friendships among the survivors (Ploeger and Andreas,
1974). Most survivors reported significant personality
changes characterized by heightened irritability,
phobias, and flashbacks to the event that were
hallucinatory at times. The shared experiences
of a disaster did not result in an intimacy or
enduring friendship as might have been anticipated.
The Buffalo Creek
dam break and flood of 1972 was a highly publicized
and intensively investigated disaster whose victims
were interviewed in two-year and five-year follow-up
studies (Gleser, Green and Winget, 1978; Gleser
et al., 1981; Green and Gleser, 1983; Lifton and
Olson, 1976; Rangell, 1976; Titchener and Kapp,
1976). When interviewed two years after the flood,
eighty per cent of the disaster victims had disabling
symptoms and problems in adjustment. Despair,
apathy, aimlessness, depression, hypertension,
sleeping problems and anxiousness were common.
The use of alcohol and nicotine increased. Psychosomatic
and health problems increased significantly and
measurably so, even five years after the disastrous
flood.
In view of the
above, psychological evaluation of the Pebble
Beach fire victims can be expected to show the
long-term effects of the fire on their personality.
This, too, was not a natural catastrophe, but
was considered preventable not only because of
its accidental inception but also because of the
careless management of the fire after it had begun.
In order to investigate the degree of internalization
of the trauma and the quality of adaptation to
the impact of the fire, the Rorschach psychodiagnostic
test was administered. This test was expected
to tap those effects of the trauma of which the
persons might not have been as consciously aware.
The SCL-90-R test was used as a self-report measure
of distress, which information was also discussed
in the interviews.
The difficulties
involved in assessing the effects of a trauma
on a person 18 months after the event are numerous.
The pre-fire personality of each is, by definition,
unknown and is not directly measurable; the immediate
impact of the fire on the person's behavior and
the effects of the loss of home and possessions
may only be inferred through self-reports, self-observations
or observations by others. In addition, there
was much instability, strain, insecurity and anxiety
due to the post factum turmoil still present at
the time of the evaluations. Some victims were
required to move three times in this period while
a new home or new possessions were acquired; additional
stress came with the process of completing claims
for insurance or governmental assistance and waiting
an unpredictable time for responses; and, the
rigors of the legal process itself, of filing
a suit, giving depositions, etc., heightened the
tension and re-enlivened the traumata. There is,
therefore, sufficient reason to expect that the
evaluations would show cumulative effects of the
disaster and its aftermath on the personality.
These effects are best evaluated through the utilization
of the Rorschach Test which includes scores that
estimate the degree of stress-related anxiousness.
It was assumed
that each fire victim would demonstrate significant
symptoms of post-traumatic stress because of the
suddenness of the event, the inability to make
any preparations for the situation, the total
loss of home and possessions, the paucity of resources
available to the people, the human error involved
in the onset of the disaster, and, the compounding
stress of litigation. Further, the post-traumatic
effects should be reflected in the results of
the SCL-90R and the Rorschach test and thereby,
provide evidence that many disaster victims fixate
in Phase Four (Wolfenstein, 1957).
METHOD
TIME
The psychological
evaluations occurred eighteen to twenty months
after the fire. Each person was interviewed and
administered the SCL-90-R and the Rorschach test
in this period. Therefore, it was assumed that
the time factor was a constant.
Three procedures
were used, as described below:
(1) A semi-structured
interview. The interview lasted three to five
hours for each person The contents of the interview
included (a) a pre-fire life history, (b) the
fire experience, (c) actions taken, and reactions
to the fire, in the following week, (d) long term
effects of the fire on the victims, and (e) the
individual differences in recovery from the fire
and its aftermath.
(2) The Symptom
Checklist-90-Revised (SCL-90-R). This is a frequently
used self-report test that requires the subject
to make self observations about anxiety-related
symptoms. The test is composed of ninety items
to which the subject responds by evaluating the
level of discomfort experienced on a five-point
scale varying from not at all to extremely. The
subjects were asked to evaluate the discomfort
of each symptom they experienced since the time
of the fire. The test is factored into scores
of somatization, obsessive-compulsive tendencies,
interpersonal sensitivity, depression, anxiety,
hostility, phobic anxiety, paranoid ideation and
psychoticism. There are two derived scores - the
Global Severity Index and the Positive Symptoms
Index.
The scores of
the fire victims were compared with two samples
originally reported in the SCL-90-R administration
manual (Derogatis, 1977). These are a psychiatric
outpatient group (N = 1002) and a non-patient
normative group (N = 974). Because of the small
sample size of the present study (N = 10), a t-test
for independent samples was used to determine
possible significant differences between the victims
and the two groups presented by Derogatis. The
level of confidence chosen was p<.01.
(3) The Rorschach
Psychodiagnostic Test. This test was administered,
scored and interpreted using the Exner method.
The scores were then grouped to provide a comparison
between the research fire group and the normal
non-patient adult group reported by Exner (Exner
1989).
A pooled estimate
t-test for two independent samples (Hayes, 1963,
p.320) was used to determine whether significant
differences existed between the means of the scores
of the Fire Victim Group and the selected normative
groups.
SAMPLE
The sample consisted
of ten persons whose homes had been destroyed
in the fire. There were four females and six males;
their ages ranged from 32 to 65 years. All were
of the upper middle socioeconomic class. All had
a college education. One person did not take the
SCL-90-R test due to time limitations.
RESULTS
The purpose of
the study was to determine whether victims of
a community disaster (i.e., a fire) manifested
symptoms of post-traumatic stress as measured
by the SCL-90-R and the Rorschach Psychodiagnostic
Test.
Hypothesis
1. There will be no significant differences in
the means of each SCL-90-R dimension between the
Fire Victim Group and the Normative Psychiatric
Outpatient Group or the normative non-patient
normals comparison group.
Insert
Table 1 about here
Table 1
presents the means, standard deviations, and the
t-test values for the Fire Victim Group
and the Normative Psychiatric Outpatient Group
as reported by Derogatis (1977) in the administration
manual. There were significant differences between
the fire group and the outpatient group on the
scales of Interpersonal Sensitivity (t
= 3.422 p < .0005), Depression (t
= 2.859, p < .005), Anxiety (t = 2.574,
p < .01), Phobic Anxiety (t= 7.205,
p < .0005), Paranoid Ideation (t
= 4.874, p <_.0005), and Psychoticism (t
= 6.851, p < .0005). In addition, the
Fire Victim Group obtained a significantly lower
GSI (M = .89 t = 2.703, p < .005).
There were three
symptom dimensions in which the Fire Victim Group
did not differ from the Normative Psychiatric
Outpatient Group. These were Somatization, Obsessive-Compulsive,
and Hostility symptoms. These results suggest
that the fire victims were as severely disturbed
as the psychiatric outpatient group on these dimensions
of personality. Therefore, there are some significant
differences between the Fire Victim Group and
the Normative Outpatient Psychiatric Group and
the null hypothesis is rejected for those specific
symptoms. However, on the GSI (General Stress
Index) the Fire Victim Group was significantly
lower, i.e., reported fewer symptoms, than the
Normative Psychiatric Outpatient Group and the
null hypothesis is rejected for the GSI.
Insert Table
2 about here
It was assumed
that the scores of the Fire Victim Group would
differ from those of the Normative Outpatient
Psychiatric Group because of the lack of previous,
acknowledged, psychiatric difficulties. It was
also assumed that their traumatization symptoms
would differ from those of the normed group for
the SCL-90-R. Table 2 presents the means, standard
deviations and t-values for the Fire Victim Group
and the Normative Non-Patient Adult Group. There
are significant differences in the t-value
between the groups on all symptom dimensions except
that of Phobic Anxiety symptoms. The Fire Victim
Group also scored significantly higher than the
normative group on the Global Severity Index of
symptoms (M = -.89, t = -4.181,
p < .005), indicating that the fire
victims suffered a greater level of general distress
than the normative group.
Hypothesis 2. There will be no significant
differences between the means of the Fire Victim'
Group and the means of the Normative Non-patient
Adult Group (Exner, 1986) an the scores of the
Rorschach Psychodiagnostic Test.
Insert Table 3
about here
Table 3 presents
the means and standard deviations for the two
groups on the primary variables in the scoring
of the Rorschach Test. The DO+ score was
significantly different at the p < .01
level indicating that the normative group gave
significantly more synthesized responses.
The variables
that were significantly different at the p
< .005 level of confidence were: (1) the D
score which indicates that the Fire Victim Group
gave significantly fewer large detail responses;
(2) the paired responses (2) were given
significantly less frequently by the Fire Victim
Group; (3) Pure F responses (M =
5.3, sd= 3.71) were given less frequently
by the Fire Victim Group; and (4) the Experience
Actual sum (EA) was significantly greater
for the Fire Victim Group.
Many scores attained
a level of significance at the p < .001
level. (1) The Fire Victim Group gave significantly
fewer popular responses (P) even though
there was no significant difference in the total
number of responses given; (2) the mean of the
Whole (W) responses was significantly greater
for the Fire Victim Group (M = 14.5) as compared
with the normative group (M = 8.58); the
Lambda (L) ratio was significantly lower for the
Fire Victim Group and suggests difficulty in utilizing
their inner strengths effectively; (3) the Form
Quality (~FQ) scores showed significant
differences between the groups. Surprisingly,
the Fire Victim Group gave significantly more
FO+ responses1 representing
superior, over-elaborated responses that are "unique
by the manner in which details are defined."
(Exner, 1986, p. 148). This group also gave significantly
more FQu and FQ- responses, demonstrating
that their perceptions were uncommon and showed
a "distorted, arbitrary and unrealistic use
of form in creating a response" (Exner, 1986,
p. 148). The Fire Victim Group provided significantly
fewer responses of ordinary form quality (FO)
The lack of appropriate form quality of the responses
given by the Fire Victim Group was also substantiated
by the percentages of total responses that reflect
perceptual accuracy. The X+% (conventional
form) ratios and the F+% (conventional
pure form) were significantly lower for the Fire
Victim Group whereas the X-% (distorted
form) ratios were significantly greater than expected;
(4) With regard to the individual determinants
of the Rorschach responses, the Fire Victim Group
produced significantly more blend responses, i.e.
used more determinants in their responses than
the Normative Non-patient Adult Group, which suggests
again that their responses were elaborated and
complex. While there was no significant difference
between the means of the groups on human and animal
movement (M, FM) responses, the Fire Victim
Group gave significantly more Ma (active
human movement) and a (total active movement)
responses. The significance of these ratios as
they relate to the ability to cope with stress
will be discussed. More importantly, the Fire
Victim Group gave significantly more inanimate
movement (m) responses, substantiating
an assumption of increased inner distress.
The color responses
(FC, CF, and C) relate to
the modulation of affect. The expectation would
be that traumatized individuals might show lessened
ability to control or to modulate their emotional
expressions. The responses of the Fire Victim
Group do show fewer FC responses but not
at a significant level, and a greater number of
CF responses, again not at the selected
level of significance. However, the Fire Victim
Group did give significantly more pure color (C)
responses (M = 1.0) than the Normative Non-patient
Adult Group (M = .12) at the p <.001
level.
Other determinants
that were given at the significance level of p
< .01 by the Fire Victim Group include the
achromatic color (C’) responses, the texture
(T) responses and the reflection (r) responses.
These scores suggest that the Fire Victim Group
were more tense and self-oriented than would be
anticipated. This seems substantiated by the es
(Experienced Stimulation) sum which would indicate
that the Fire Victim Group experienced many more
demands on their coping abilities than the normative
population.
Those scores and
ratios that were significantly different at the
p < .001 level of confidence were as
follows: (1) The mean of the whole (W)
responses was significantly greater at the p
< .001 level for the Fire Victim Group (M=
14.5) compared to the normative group (M
= 8.58); (2) the Suicide Constellation (S Con)
ratio showed that the Fire Victim Group had much
greater suicidal ideation (M = 5.2 for
the Fire Victim Group, M = 2.07 for the
normative group), as well as significantly greater
morbid (MOR) preoccupations; (3) the Depression
Index (DPI) showed that the Fire Victim
Group (M = 2.3) had significantly more
depression responses than those of the normative
adult group (M = .40); and, (4) the Schizophrenia
Index (SCZI) represents a cluster of variables
that are "related to problems in thinking
and perceptual adequacy" (Exner, 1986, p.
182); here, the Fire Victim Group manifested a
significantly greater SCZI (M =
2.3, s.d. = 1.73) than the normative adult
group (M = .95, s.d. = 1.08) at
the p < .001 level of confidence but
it is important to note that the SCZI scores
do not attain clinical significance.
Another level
of significance proposed by Exner (1986) posits
that any variables which deviate from the non-patient
group by more than one standard deviation are
considered to be clinically significant. It seems
important to observe that the S-Con, the
DEPI, and the SCZI scores did not
attain clinical significance, thus the Fire Victim
Group cannot be characterized as severely psychopathological.
The comparison
of the means of the Fire Victim Group with those
of a Normative Psychiatric Outpatient Group and
the comparison with the means of the Normative
Non-Patient Adult Group for the SCL-90-R and the
comparison of the Rorschach responses with the
normative adult sample give clear evidence that
the fire victims were distinctly different from
the comparison groups.
DISCUSSION
The purpose of
this study was to determine whether victims of
a fire that had destroyed their homes some eighteen
months earlier manifested measurable signs of
stress on the SCL-90-R and the Rorschach Psychodiagnostic
Test. Ten of the fire victims were administered
the Rorschach test; nine additionally took the
SCL-90-R.
THE SYMPTOM CHECK LIST
When the results
of the SCL-90-R test taken by the Fire Victim
Group were compared with the sample of psychiatric
outpatients, the scores on the scales of somatization,
obsessive-compulsive traits and hostility did
not differ. Moreover, the fire victims, as a group,
shared these traits to a similar degree with persons
in outpatient psychotherapy. Thus, they may be
assumed to have developed at least moderately
severe psychosomatic and physical symptoms, to
be wrestling with compulsive urges to undo the
trauma, and to experience unresolved anger and
irritability provoked by the disaster and its
consequences. Further, in comparison with the
normative standardization group on the SCL-90-R,
they were significantly more depressed, experienced
more anxiety, had heightened interpersonal sensitivity,
and suffered more paranoid ideation and psychoticism
(confused thinking) than the normative group.
Another important
feature is that the general severity of the fire
victims' symptoms (Global Severity Index) was
significantly less than that of psychiatric outpatients
but significantly greater than that of the Normative
Non-Patient Adult Group. This provides some basis
for the assumption that these individuals were
not psychiatrically ill prior to the fire and
that, even after the disaster, they were not that
emotionally disturbed. They did, however, report
significantly more distress than the normative
group, suggesting that the fire and its aftermath,
remained highly stressful even eighteen months
after the disaster.
THE RORSCHACH
TEST
The scores and
score ratios on the Rorschach obtained from the
Fire Victim Group were compared with the Non-patient
Adult Group reported by Exner (1986, pp. 257-258).
It became quite apparent that the Fire Victim
Group demonstrated many significant differences
from the Non-Patient Adult Group which suggested
that they experienced intrapsychic difficulties
to the extent that these emotional problems interfered
with their everyday functioning both in their
orientation to events, in their thought processes,
and in the expression of affect. The comparison
utilized Exner's (1986) criteria for clinical
significance as well as the confidence level of
.01 or greater. The following discussion focuses
on understanding the results of the Rorschach
test results of the Fire Victim Group.. Validity
of the test results
The protocols
of the Fire Victim Group were of sufficient length
to warrant careful consideration, that is, they
gave an average of 23.6 responses; Exner states
that 17-27 responses are normal. The Lambda (L)
score is significantly below the mean for the
Non-patient Group (p < .001); this suggests
that the fire victims' apprehensions interfere
with concentration or logical reasoning, that
they became over-involved with stimuli and have
difficulty perceiving economical solutions to
problems. The protocols may be assumed to be valid
and representative of the psychological state
of the group.
Stress tolerance
and control
Exner (1986, p.
315) avers that "a cluster of six variables
provides the first data set" from which to
interpret the test results in order to evaluate
the ability to tolerate stress and control responses.
These variables are: the EB (Erlebnistypus),
EA (Experience Actual), eb (Experience
Base), es (Experienced Stimulation), the
D score and the adjusted D Score.
Two of these variables, the EB and the
eb ratios, are meaningful only for the
interpretation of individual protocols and are
not considered in this report. The D score
of the fire victims falls within the normal limits,
although at the lower end of expectability. The
score indicates that under most circumstances
the fire victims had sufficient resources to be
able to direct their behavior in a deliberate
and meaningful way without loss of the ability
to control their actions. However, when the D
score and the adjusted D score are in the
minus range, the implication is that the persons
are more vulnerable to being overwhelmed by situational
demands. "People who fall into the D-2,
D-3 or lower categories are in an almost continuous
state of overload. They are upset with more experienced
demands for responses than they can handle easily."
The mean frequency of m responses is also
significantly greater than expected (M
= 3.0, p < .001); accordingly, this
suggests a fear of the disintegration of controls
over their behavior due to situational distress
and reflects an inner sense of possible disruption
in their lives. In fact, the fire victims experience
much more anxiety along with a sense of doubt
about their ability to cope with the demands of
life. (Exner 1986 pp. 317-318).
The EB
ratio and the eb ratio could not be computed
meaningfully for a group because they are meaningful
for individual protocols only. However the EA
(Experience Actual) sum and the es (Experienced
Stimulation) sum were computed,. both attained
clinical significance and both were significantly
greater than those of the normative group. The
suggestion from the EA sum is that the
fire victims did not have ready access to their
inner resources because of the stress under which
they were functioning. They could not easily summon
their coping strengths to resolve everyday situations.
That they do have sufficient inner strengths is
indicated by their production of the expected
level of M responses. The fire victims
differed significantly in the number of chromatic
color responses that they gave on the Rorschach
Test. They produced fewer FC responses
than the normative sample, indicating a lowered
ability to modulate or control affective expression.
This characteristic becomes more obvious when
considering the CF and C responses
which were given significantly more frequently
by the fire victims. These scores emphasize that
the fire victims experience some lack of control
over emotional expression, have become more susceptible
to stress, and are less able to modulate their
emotional life during stressful events.
The shading variables
(C’, T, V, and Y)
are all related to "impinging or irritating
affects" (Exner, 1986, p. 337), that is,
they signal the presence of distress in the individual.
The significantly greater T scores among
the fire victims (M = 2.2, p <
.001) strongly suggest that they have experienced
an emotional loss; that is, these scores reflect
the traumatic effect of the loss of house and
belongings on the fire victims as a group. According
to Exner( 1986, p.339), persons whose T scores
are elevated, experience stronger than usual needs
to be dependent on others. The Y scores
and the V scores did not differ significantly
from the normative group and provide evidence
that the fire victims did not suffer from feelings
of helplessness. Also the fire victims did not
differ significantly from the normative group
in their ability to view problem situations with
an appropriate perspective (V).
The achromatic
responses (C’) were also significantly
more frequent in the Fire Victim Group (M
= 2.2, p < .001). These responses indicate
that the fire victims experienced more depressive
affect; that is, they placed an internal constraint
over their emotions and such constraint causes
a sense of discomfort and uneasiness.
The results of
these scores on the Rorschach point to a lessening
of coping capacity among the fire victims; they
have increased anxiety, experience fears of losing
control over their behavior, feel somewhat constrained
and depressed, and have lessened ability to organize
their resources to react well to stressful situations.
Cognitive Qualities
The level of cognitive
operations appears quite high for the fire victims.
As a group they expended greater effort to organize
their responses (Zf = 16.7, p
< .001) than the adults of the normative sample,
i.e., they appeared to have chastened by their
experience and thus they showed a need to deal
with events in a particularly careful and thorough
manner. However, the efficiency of their organization
attempts is within that of the normative sample.
They also produced significantly more whole responses
(W) which suggests a need to deal with
a stimulus situation in its entirety; this is
supported by the fewer detail responses and fewer
unusual detail responses (D and Dd).
Their cognitive functioning has been affected
deleteriously. The Contamination (CONTAM)
score occurred significantly more frequently among
the fire victims' responses; yet the WSum6
score showed that the Fire Victim Group gave significantly
fewer signs of disturbed thought processes than
the normative group. The CONTAM score suggests
that the fire victims' responses may have been
compromised by the intrusion of symbols of their
traumatic experiences with the fire and its aftermath.
It appears that the fire victims suffered a loss
of practicality and efficiency in responding to
situations because, motivated by alarm, they are
compelled at once to take account of the whole
stimulus field.
Perceptual
Orientation
The orientation
to reality is an important process for the individual
as it directs the cognitive, affective and social
reactions to situations. It was assumed that the
fire victims would suffer a distortion of their
view of everyday contingencies because of their
experience with the fire, its unpredictability
and their unpreparedness for such a disaster;
this would sharpen their sensitivity to possible
dangers around them. The results of the Rorschach
clearly support the assumptions of a disruption
of normal perceptual processes during a status
emergens. The popular responses (P)
were clinically lower than those of the normative
group; the X+% (Conventional Form percentage)
was significantly lower (p < .001);
the F+% (Conventional Pure Form percentage)
was clinically lower; and the X-% (Distorted
Form percentage) was significantly greater than
expected (p < .001). All these percentages
were also clinically at variance with those of
the normative group. It thus appears that the
fire, which was a disaster of overpowering suddenness,
had a severely disruptive impact upon its victims'
ability to process reality experiences and this
corroborates the hypothesis that they now experience
difficulties in making appropriate responses,
especially under stress.
Special Scores:
S-Con, DEPI, SCZI
Scrutiny of the
indices of psychopathology in the Rorschach makes
it evident that the fire disaster and its aftermath
have caused these victims severe emotional injury.
The S-Con (Suicidal Constellation) score
is significantly greater than for the normative
group (p < .001), but it does not meet
Exner's (1986, p. 414) criteria for subjects at
high risk for self-destruction. Nevertheless,
since the catastrophe presented the fire victims
as a group with the peril of losing their lives,
it must have undermined their usual sense of invulnerability
or indestructibility. The results also confirm
some preoccupation with morbid, self-annihilative
thoughts, for the fire victims, as a group, had
significantly more Morbid (Mor) responses
(M = 2.0, p < .001) than the
normative group, which substantiates their preoccupation
with destructive ideas or dysphoric feelings.
Some individuals who gave these responses more
frequently could conceivably be at risk for suicidal
attempts.
The Depression
Index (DEPI) was also significantly greater
for the Fire Victim Group (p < .001).
While Exner's criteria (Exner, 1986, p.425) state
that three or more variables of the Depression
Index are required before a severe depressive
reaction may be presumed to be present, the indications
are that the fire victims as a group do experience
frequent episodes of depression and it seems quite
likely that one or more of them may have been
experiencing severe depressive reactions following
the fire.
It is assumed
that some individuals within the victim group
suffer from depressive experiences, in turn elevating
the Depression Index, and that the group, as a
whole, suffers more depressive moods than would
be anticipated when compared with a Normative
Non-patient Adult Group.
The Schizophrenic
Index (SCZI) for the fire victims does
not meet the essential criteria of five positive
variables necessary for the diagnosis of schizophrenia.
That is, the fire victims are not psychopathologically
compromised, nor do they show signs of severe
psychiatric disturbances.
SUMMARY
The fire victim
group showed signs of internal distress even eighteen
months following the experience with a fire that
destroyed their homes and endangered their lives.
The results of the SCL-90-R and the Rorschach
Test support the extrinsic evidence that such
a disaster leaves severe personal anxieties in
its wake. The victims were angry, hostile, and
resentful at the loss of their homes, had obsessive
preoccupations about the fire and the events that
followed, and suffered an increase in somatic
complaints on a level reported by persons in outpatient
psychotherapy. The orientation to other events
was disturbed, and paranoid-like projections increased
their anxiety and their fears of unexpected harmful
experiences. The characteristics of their thought
processes showed that they were an intelligent
group who struggled to take account of each and
every stimulus in a situation, even at the risk
of thereby incurring disadvantages and acting
without prudence. Their coping skills have been
damaged and, as a group, they seem less able to
organize their resources to meet stimulus demands
effectively.
The Rorschach
test results suggest that, on the whole, the reactions
to the destructive fire persist. The anxieties
have been internalized and the emotional harm
remains unrelieved. The fire victims carry the
scars of the damage to their ability to cope.
Only one victim chose to struggle with these anxieties
through psychotherapy and two had sought crisis
counseling that was, by their report, highly ineffective.
Wolfenstein's
(1957) analysis that individuals progress through
five identifiable phases as they attempt to adapt
to the impact of disasters suggests that, as a
group, the fire victims became fixated in the
fourth phase. They were still involved with struggles
to accept the effects of the disaster and to regain
mastery over their lives. To the extent that the
symptoms remain fixated, each fire victim is at
risk for maintaining a less than adaptive, depressive
personality style that represents a characterological
ossification of symptom formations. Guilt, irritability,
mourning, psychosomatic ailments, heightened sensitivities,
perceptual distortions and compulsions were in
evidence as the victims had reconstructed their
lives some eighteen months after the fire. As
a group, then, they well fit the diagnostic category
of the Post-Traumatic Stress Disorder described
in the DSM-III-R (1989).
REFERENCES
Adler, A. (1943).
Neuropsychiatric complications in victims of Boston's
Coconut Grove disaster. Journal of the American
Medical Association, 123, 1098-1101.
American Psychiatric
Association. (1987). Diagnostic and statistical
manual of mental disorders (3rd ed.). Washington,
D.C.: Author.
Barton, A. H.
(1969). Communities in disaster: a socio1ogica1
analysis of collective stress situations.
New York: Doubleday.
Berren, M., Beigel,
A., & Ghertner, S. (1980). A topology for
the classification of disasters. Community
Mental Health Journal, 17, 103-111.
Burgess, A. W.
& Holstrom, L. L. (1974). Rape trauma syndrome.
Archives of General Psychiatry, 13,
981-986
Chamberlin, B.
C. (1980). Mayo seminars in psychiatry: The psychological
aftermath of disaster. Journal of Clinical
Psychiatry, 41, 238-244.
Cobb, S., &
Lindemann, E. (1943). Neuropsychiatric observations
during the Coconut Grove fire. Annals of Surgery,
112, 814-824.
Derogatis, L.
R. (1977). SCL-90-R Baltimore, MD.: Johns
Hopkins University Press.
Derogatis, L.
R., Lipman, R. S., & Covi, L. (1973). SCL-90:An
outpatient psychiatric rating scale - preliminary
report. Psychopharmacology Bulletin, 9,
13-28.
Exner, J. E.,
Jr. (1986). The Rorschach: A comprehensive
system. Volume 1.(2nd ed.). New York:
John Wiley & Sons
Exner, J. E.,
Jr. (1974). The Rorschach: A comprehensive
system Volume 1. New York: John Wiley &
Sons.
Gleser, G. C.,
Green, B. L., & Winget, C. N. (1981) Prolonged
psychosocial effects of disaster: A study at Buffalo
Creek. New York: Academic Press.
Gleser, G. C.,
Green, B. L., & Winget, C. N. (1978). Quantifying
interview data on psychic impairment of disaster
survivors. Journal of Nervous and Mental Disease,
166, 209-216.
Goldberg, J.,
True, W., Eisen, S., & Henderson, W. (1990).
A twin study of the effects of the Vietnam war
on posttraumatic stress disorder. The Journal
of the American Medical Association, 263,
1227-1232.
Green, B. L. (1982).
Assessing levels of psychological impairment following
disaster: Consideration of actual and methodological
dimensions. Journal of Nervous and Mental Disease,
170 544-552.
Green, B. L.,
& Gleser, G. C. (1983). Stress and long-term
psychopathology in survivors of the Buffalo Creek
disaster. In D. Ricks & B. S. Dohrenwend (eds.),
Origins of Psychopathology (pp. 73-90).
New York: Cambridge University Press.
Green, B. L.,
Grace, M. C., & Gleser, G. C. (1985).Identifying
survivors at risk: Long-term impairment following
the Beverly Hills Supper Club Fire. Journal
of Consulting and Clinical Psychology, 53,
672-678.
Green, B. L.,
Grace, M. C., Lindy, J. D., Titchener, J. L.,
& Lindy, J. G. (1983). Levels of functional
impairment following a civilian disaster: The
Beverly Hills Supper Club Fire. Journal of
Consulting and Clinical Psychology, 51,
573-580.
Green, B. L.,
Lindy, J. D., & Grace, M. C. (1985). Posttraumatic
stress disorder: Towards DSM-IV. Journal of
Nervous and Mental Disease. 173, 406-411.
Hocking, F. (1970).
Psychiatric aspects of extreme environmental stress.
Diseases of the Nervous System, 31,
542-545.
Horowitz, M. J.
(1976). Stress response syndromes New York:
Aronson.
Ingham, J. (1981).
Neurosis: Disease or distress. In J.K. Wing et
al. (eds.), What is a case? The problem of
definition in psychiatric community surveys.
L. N. Grant McIntyre, London.
Leopold, R. D.,
& Dillon, H. (1963). Psycho-anatomy of a disaster.
A long term study of posttraumatic neuroses in
survivors of a marine explosion. American Journal
of Psychiatry, 119, 913-921.
Leivesley, S.
(1984). Psychological response to disaster, in
Epidemiology of Natural Disasters, Volume 5: Contributions
to Epidemiology and Biostatistics. Edited
by Seman J., Leivesley, S., & Hogg, C. Basel
Kargen Publications.
Lifton, R. J.
& Olson, E., (1976). The human meaning of
total disaster: The Buffalo Creek experience.
Psychiatry, 39, 1-18.
Lindy, J. D.,
Grace, M. C., & Green, B. L. (1981). Survivors:
Outreach to a reluctant population. American
Journal of orthopsychiatry, 51, 468-478.
Lindy, J. D.,
Green, B. L., Grace, M. C., & Titchener, J.
L. (1983). Psychotherapy with survivors of the
Beverly Hills Supper Club Fire. American Journal
of Psychotherapy, 37, 593-610.
Logue, J. M.,
Melick, H. E., & Hansen, H. (1981). Research
issues and directions in the epidemiology of health
factors of disasters. Epidemiology Review,
3, 140-162.
Madakasira, S.,
& O'Brien, K. (1987). Acute posttraumatic
stress disorder in victims of a natural disaster.
Journal of Nervous and Mental Disease,
175, 286-290.
McFarlane, A.
C. (1989). The aetiology of post-traumatic morbidity:
Predisposing, precipitating factors. British
Journal of Psychiatry, 154, 221-228.
McFarlane, A.
C. (1988a). The phenomenology of posttraumatic
stress disorders following a natural disaster.
Journal of Nervous and Mental Disease,
176, 22-29.
McFarlane, A.
C. (1988b). The longitudinal course of posttraumatic
morbidity: The range of outcomes and their predictors.
Journal of Nervous and Mental Disease,
176, 30-39.
McFarlane, A.
C. (1988c). The aetiology of post-traumatic stress
disorders following a natural disaster. British
Journal of Psychiatry, 152, 116-121.
McFarlane, A.
C. (1987). Life events and psychiatric disorder:
The role of a natural disaster. British Journal
of Psychiatry. 151, 362-367.
McFarlane, A.
C., (1986a). Long term psychiatric morbidity after
a natural disaster: Implications for disaster
planners and emergency services. Medical Journal
of Australia, 145, 561-563.
McFarlane, A.
C. (1986b). Posttraumatic morbidity of a disaster:
A study of cases presenting for psychiatric treatment.
Journal of Nervous and Mental Disease,
174, 4-14.
McFarlane, A.
C. (1985). The effects of stressful life events
and disaster: Research and theoretical issues.
Australian and New Zealand Journal of Psychiatry,
19, 409-421.
McFarlane, A.C.,
& Raphael, B. (1984). Ash Wednesday: The effects
of a fire. Australian and New Zealand Journal
of Psychiatry, 19, 913-921.
Rangell, L. (1976).
Discussion of the Buffalo Creek disaster: The
course of psychic trauma. American Journal
of Psychiatry, 133, 313-316.
Raphael, B. (1984).
Psychosocial aspects of disasters: Some Australian
studies and the Ash Wednesday bushfires. Medical
Journal of Australia, 141, 268-270.
Raphael, B., &
Middleton, W. (1987). Mental health responses
in a decade of disasters: Australia, 1974-1983.
Hospital and Community Psychiatry, 38,
1331-1337.
Tennant, C. (1983).
Life events and psychological morbidity: the evidence
from prospective studies. Psychological Medicine,
13, 483-486.
Titchener, J.
L, & Kapp, F. T. (1976). Family and character
change at Buffalo Creek. American Journal of
Psychiatry, 13, 295-299.
Wolfenstein, M.
(1977). Disaster: A Psychological Essay.
New York: Arno Press.
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