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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).
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