Abstract
This article describes the concerns of survivors one year after the November, 1985, flood in Virginia, and the efforts to help them prepare for, and cope with, the flood's anniversary. In follow-up interviews with 103 households with significant flood losses, it was found that many survivors had, in addition to post-traumatic stress symptoms, certain common concerns regarding the anniversary of the flood. Program interventions included outreach crisis counseling, support group activities, and consultation and education. By helping survivors use the disaster's anniversary in a productive and positive manner, mental health workers can reinforce the healthy resolution to a traumatic experience.
Many researchers have studied the long-term psychological effects of disasters. (See, for example, Raphael, 1986; Sowder, 1985, for recent overviews of the disaster literature.) These studies consistently have found that disasters and traumas can have lasting negative consequences for the health and well-being of survivors. A common paradigm of long-term studies is to contact subjects for follow-up interviews one year after a disaster, such as a tornado (Bolin, 1982), fire (Green, Grace, Lindy, Tichener, & Lindy, 1983; Thompson, 1985), nuclear reactor accident ( Goldsteen & Schorr, 1982), or flood (Abrahams, Price, Whitlock, & Williams, 1976; Bennet, 1970; Erikson, 1976; Melick, 1978; Powell & Penick, 1983). Other long-term studies have followed up survivors for two years (Green, Grace, & Gleser, 1985), five years (Gleser, Green, & Winget, 1981), ten years (Ploeger, 1977), and even longer (Lifton, 1967).
The research consistently has found that a disaster's effect on most survivors gradually decreases over time. The minority of survivors who experience delayed or chronic post-traumatic stress are the exceptions. However, the underlying assumption in the long-term research methodology is that time is purely a physics variable, measured at the interval level, with each day added beyond the disaster equal to any other day. But just as individuals differ, so do days. Because of the psychological significance given to a certain day, many survivors are touched once again by the disaster. A brief but significant later point in time can powerfully evoke and activate the disaster experience. One such day is the anniversary of the event. A number of writers have noted that an "anniversary effect" may take place after a disaster (Sank, 1979) or the death of a loved one (Aiken, 1985; Bornstein & Clayton, 1972; Stephenson, 1985). However, little has been written regarding the dynamics of the "anniversary effect" and what strategies can be pursued to address this problem. This paper offers a psychological profile of survivors around the anniversary of the November, 1985, flood in Virginia, and describes efforts to help survivors prepare for, and cope with, the flood's anniversary.
The Flood of '85...and One Year Later
This article focuses on the impact of the flood on one county in the central Shenandoah Valley of western Virginia. About 76,000 people reside in this county which covers an area of 875 square miles. Bordered by the Blue Ridge and Appalachian Mountains, the county is not only predominately rural, it is also somewhat geographically isolated.
Beginning on October 31, Halloween night, 1985, it began to rain and continued to rain for five days. By November 4, rivers were out of their banks and flood control dam spillways were releasing water, menacing houses, businesses and farms throughout the county. About 6,000 people were evacuated, with 500 receiving shelter in the seven local evacuation centers. By the time the floods subsided, four people had died in the county and 4,000 homes were affected.
Immediately after the flood, the Harrisonburg-Rockingham Community Services Board organized an outreach disaster intervention program to help survivors handle the stresses they were facing. In the process of offering outreach crisis counseling services, the program staff completed a series of three needs assessments to design interventions to meet the changing needs of survivors. The final needs assessment, initiated nearly one year after the flood, provided follow-up data regarding the post-traumatic stress symptoms of members of the 103 households suffering the greatest flood losses. The survey revealed a long-term negative impact on many of the survivors. While fewer survivors reported stress symptoms in the year follow-up than in earlier needs assessments, it was also clear that many still had significant problems. For example, 58% of the survivors reported that they still worried about the weather. Nineteen percent reported that they continued to be bothered by anxiety, 32% by depression, 30% by fatigue, 25% by sickness, 15% by a change in appetite, and 14% avoided reminders of the flood. Moreover, other problems were at similar or even higher levels than at earlier points. A large majority (63%) continued to be bothered by memories or thoughts about the flood; 25% continued to feel angry; 21% still had trouble sleeping; 21% still had nightmares about the flood; 17% continued to have trouble concentrating; and 9% still had revivification experiences regarding the flood.
It was clear that although the flood had taken place nearly a year earlier, many of its survivors were still grappling with the challenge of recovering emotionally from the disaster. But beyond the general post-traumatic stress symptoms, the needs assessment interviews also showed that many survivors were concerned specifically about the upcoming anniversary of the flood.
The Anniversary Effect
In the follow-up interviews, survivors expressed certain common concerns regarding the flood's approaching anniversary. Although we were expecting an anniversary effect, our contacts with flood survivors during this time helped us to gain a better understanding of the dynamics of a trauma's anniversary. As with any major life event, whether positive or negative, the flood's anniversary was significant, and there were certain cognitive, affective and behavioral characteristics of the anniversary effect.
The anniversary evoked memories of the incident. Many survivors reported that they had many more recollections of the flood around its anniversary. The memories became not only more frequent, but also more vivid and clear. "Now I can remember it like it just happened yesterday," said one survivor on the anniversary. "I can close my eyes and see that water gushing through my window." The anniversary also spurred reflections on its meaning and place in one's life. "How can we ever forget the lives, homes, property, and businesses that were destroyed in the raging waters?" asked one minister on the anniversary. "One year later, we take time to pause, reflect, and remember." Many people spoke readily of inspiring examples of others' generosity and tireless assistance. The anniversary encouraged assessments of the flood's impact, and prompted a review of the changes that had taken place during the past year.
The original feelings and reactions to the event often re-emerged on the anniversary. With joyful events, such as births and weddings, the anniversaries are often times of celebrations. But with traumatic experiences, such as the flood, an anniversary can be a difficult and painful time. As one woman, whose husband died in the flood, said about the anniversary, "It reminds me that my husband is gone and I feel very sad." Although survivors often became anxious whenever it rained after the flood, many reported that they nearly panicked when it began to rain on the anniversary. One survivor described being awakened by the rain on the eve of the flood's anniversary. Although the sound of falling rain rarely bothered her, even after the flood, on this particular night, she was too frightened to return to sleep. Another family shared that they also had an apprehensive and sleepless anniversary night. A year earlier, the flood had surprised them in their sleep. Several others felt afraid that, in the words of one survivor, "It's going to happen all over again" on the anniversary. But along with these original emotions of fear, pain and grief, people also had positive feelings of relief and gratitude.
Many survivors used the period of a year as a convenient time frame for setting their goals, as a benchmark for making their plans. For months, one survivor had repeated, "I'm determined that I'll be back in my own house before a year's up--even if I have to throw a sleeping bag down and camp out in it!" Others used a year's time as a way to cope with their difficulties by temporizing them. It was common for the outreach workers to hear survivors say as the anniversary approached, "If we can only make it through this year, we can put the flood behind us." For some survivors, the anniversary was accompanied by some feelings of frustration, hopelessness and disappointment, because they had to acknowledge that some of their problems may be long-lasting, or even permanent.
There was a strong need to take some action on the anniversary. Some survivors took practical steps to be better prepared in case of a flood. A few went so far as to move their valued possessions to an upper floor or out of the basement--"just in case." But the vast majority commemorated their flood experience in some way. People usually wanted to reunite with those others who shared the past event. In fact, one survivor suggested, "Let's get together every year to keep our common bond strong." The commemoration took the form of a ritual, ceremony, or memorial plaque. A number of churches, for example, scheduled special anniversary services.
Anniversary Interventions
The guiding philosophy in addressing the anniversary was that the flood survivors were experiencing a normal reaction to an abnormal situation. We wanted to reassure survivors that there was nothing wrong with them for having these concerns at this time. Finally, we wanted to help them handle the anniversary reaction in healthy, positive ways. Our program used several different strategies, including offering outreach services, organizing support group activities, and providing consultation and education.
Outreach Services
Our first strategy was to continue offering outreach services to the flood survivors. Soon after the flood, outreach workers had contacted all affected households to find out their needs, to give them support and information, and to do any necessary crisis counseling. Over the year, we had identified individuals and families who were experiencing a great deal of distress. As the anniversary approached, the outreach workers gave priority to recontacting the more distressed survivors. We also sent letters to all affected households, offering suggestions on dealing with the anniversary and providing a brochure on flood preparedness.
Support Group Activities
The support group for flood survivors had been meeting regularly in a local church to give people a chance to share their experiences, exchange ideas, and offer encouragement to one another. As fall approached, the group participants, who generally numbered 8 to 12 at each meeting, began to focus on preparing for the anniversary of the flood.
As part of their flood anniversary activities, the group sponsored a covered dish supper, held on November 1. About 35 people attended the supper to share food, to share in thanksgiving, and to share their thoughts and reflections. In keeping with its philosophy, the support group did not arrange for an after dinner speaker. Instead, everyone, including the children, had a turn to speak on this occasion. The group also had special decorations, including a banner proclaiming, "We Survived the Flood of '85!"
Probably the most successful anniversary activity of the support group was a community-wide campaign to encourage residents to place a lighted candle in their front windows on the evening of the flood's anniversary. The program publicized the campaign on the radio, on television, and in the newspapers as one small way to make a positive statement on the occasion. "The purpose of the lighted candle," in the words of the group member who suggested the idea, "was to serve as a memorial to those who died in the flood, as a tribute to those who worked in flood relief, and as a symbol for the undying spirit of those who have survived the flood." The campaign proved to be very popular. At the support group meeting held on the night of the flood's anniversary, the members shared their reactions to seeing the many candle-lit windows in homes along the way to the meeting.
Consultation and Education
We consulted with the area's schools, churches, volunteer groups, and community services regarding the need to prepare survivors for the anniversary effect. Our education efforts involved all of the local media, including a series of articles in the local newspaper, television news items and an appearance on the area's radio telephone call-in program--as well as lectures and brochures. Throughout our campaign, we emphasized that survivors could use this anniversary time in a positive way, by reflecting on their inspiring memories of the generosity, courage and perseverance that they saw.
We consulted with the editors and staff of the Harrisonburg Daily-News Record, the most widely read newspaper in the area, in developing a special series of major articles highlighting the Flood of 1985. We began our community education efforts regarding the anniversary with an article which appeared in a mental health supplement to the newspaper in early October. The article ended with an invitation to contact the program if anyone would like to learn more about its services or to talk personally about flood concerns. The anniversary series articles began appearing on November 1 and continued for five days. While a number of articles reviewed the destruction and devastation of the flood, others emphasized the inspiring work of survivors and the challenges they faced in the months following the disaster. Photographs of the flood and its destruction were contrasted with photographs of present scenes. Several articles highlighted the contributions of volunteers, church groups, neighbors, and social service agencies in rebuilding the homes and lives of the flood survivors. Other pieces described the stress reactions of survivors and the challenges they faced in recovering from the flood. The series also focused on the aged, many of whom relied on their past experiences with floods in 1949 and 1936 to cope with the flood of 1985. One article detailed the actions households and communities can take to be better prepared for future floods.
We also consulted with the area's television station, which presented news reports on the area's recovery from the flood, the continued emotional impact of the disaster, and the need for flood preparedness.
On the day of the anniversary, the first author appeared on a local telephone call-in radio show. He described the progress that survivors have made since his two earlier program appearances, which took place immediately after the flood and six months after the flood. He offered information about the current concerns of survivors. In particular, he gave suggestions on ways to cope with the anniversary effect. For example, listeners were encouraged not to fight against the tendency to recall events from a year ago. Instead, they could channel this natural inclination in a positive direction by focusing on the inspiring memories they had, the positive experiences and changes that had occurred, and the realistic challenges they continued to face. He emphasized that survivors did not have to carry their burdens alone. They could talk with others about their thoughts and feelings--whether painful or positive. He also urged radio listeners who were friends and relatives of survivors to be especially supportive during this time. Finally, he advised listeners to take some constructive and positive action, such as having a lighted candle in their front window and learning about flood preparedness.
Discussion
We have limited information evaluating the success of the anniversary interventions, and although much of it is impressionistic and anecdotal, it is consistently positive. During each contact, the outreach worker followed a routine procedure of assessing briefly the survivor's reactions to the program's efforts. An overwhelming majority of the survivors--over 95%--judged the program to have been helpful. At the final meeting of the flood support group, the members were unanimous in their conclusion that the anniversary activities had played an important role in helping them cope during that difficult time. Some survivors even telephoned or wrote us simply to express their gratitude for our remembering and supporting them. We also know that the consultation and education programs reached thousands of people and were well-received.
Based on our experiences, we believe that there are a number of conditions necessary to implement a program addressing the anniversary concerns of disaster survivors. The first, and most essential condition, is that the anniversary program must be built on a foundation of an entire year of disaster intervention. It is highly unlikely that the survivors would have been as responsive to our efforts at the anniversary if we did not already have a relationship based on trust and acceptance. Following a disaster, many systems form a "trauma membrane" (Lindy & Grace, 1985), or boundary that is easily permeable at first to potential helpers but is later sealed against outsiders. Our early work immediately after the flood allowed us passage through the trauma membrane a year later.
An aggressive outreach approach is another necessary condition for an effective anniversary program. In disaster work, it is vital that mental health workers actively seek out the potential users of their services. Disaster survivors are not likely to contact mental health workers for treatment or consultation. If the local community mental health center had waited passively for the survivors to come to it, this program would never have been implemented.
Also, our emphasis on the anniversary effect as a normal, natural response to a disaster appears to have been reassuring to many survivors. They realized that they were not alone in having this common reaction. Unfortunately, disaster intervention programs often have been limited to providing intensive, short-term, and immediate help. Although such an approach is vital, it is only the first step. The anniversary of a disaster is another important time for information, support and counseling.
Finally, the program's approach of encouraging survivors to use the anniversary response in a positive manner was both appealing and helpful to the survivors. Thompson (1985), for example, found that survivors who found some positive meaning in the traumatic event were able to cope better.
Time is an intrinsic part of human existence and the dates of major life events can take on a certain significance and power. Disaster programs need to recognize the challenges that survivors face during the anniversary time. By helping survivors to use this time productively, we believe that disaster programs can reinforce the healthy resolution to a traumatic experience.
References
Abrahams, M. J., Price, J., Whitlock, F. A., & Williams, G. (1976). The Brisbane Floods, January 1974: Their impact on health. Medical Journal of Australia, 2, 936-939.
Aiken, L. R. (1985). Dying, death, and bereavement. Newton, Massachusetts: Allyn & Bacon.
Bennet, G. (1970). Bristol Floods 1968: Controlled survey of effects on health of local community disaster. British Medical Journal, 3, 454-458.
Bolin, R. C. (1982). Long-term family recovery from disaster. Monograph No. 36. Boulder: University of Colorado, Institute of Behavioral Science.
Bornstein, P. E., & Clayton, P. (1972). The anniversary reaction. Diseases of the Nervous System, 33, 470-472.
Erikson, K. T. (1976). Everything in its path: Destruction of community in the Buffalo Creek Flood. New York: Simon & Schuster.
Gleser, G. C., Green, B. L., & Winget, C. N. (1981). Prolonged psychosocial effects of disaster: A study of Buffalo Creek. New York: Academic Press.
Goldsteen, R., & Schorr, J. K. (1982). The long-term impact of a man-made disaster: An examination of a small town in the aftermath of the Three Mile Island nuclear reactor accident. Disasters, 6 (1), 50-59.
Green, B. L., Grace, M. C., Lindy, J. D., Tichener, 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., 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 (5), 672-678.
Lifton, Rl J. (1967). Death in life: Survivors of Hiroshima. New York: Random House.
Lindy, J. D., & Grace, M. (1985). The recovery environment: Continuing stressor versus a healing psychosocial space. In B. J. Sowder (Ed.) Disasters and mental health: Selected contemporary perspectives. (DHHS Publication No. ADM 85-1421). Washington, DC: U. S. Government Printing Office.
Melick, M. E. (1978). Self-reported effects of a natural disaster on the health and well-being of working class males. Crisis Intervention, 9 (1), 12-31.
Ploeger, A. (1977). A 10-year follow up of miners trapped for 2 weeks under threatening circumstances. In C. D. Spielberger & I. G. Sarason (Eds.) Stress and anxiety: IV. Washington, Hemisphere, 23-28.
Powell, B. J., & Penick, E. C. (1983). Psychological distress following a natural disaster: A one-year follow-up of 98 flood victims. Journal of Community Psychology, 11 (3), 269-276.
Raphael, B. (1986). When disaster strikes. New York: Basic Books.
Sank, L. I. (1979). Community disasters: Primary prevention and treatment in a health maintenance organization. American Psychologist, 34, 334-338.
Sowder, B. J. (Ed.) (1985). Disasters and mental health: Selected contemporary perspectives. (DHHS Publication No. ADM 85-1421). Washington, DC: U. S. Government Printing Office.
Stephenson, J. S. (1985). Death, grief, and mourning. New York: The Free Press.
Taylor, A. J. (1982). The stress of post-disaster body handling and victim identification work. Journal of Human Stress, 8 (4), 4-12.
Thompson, S. C. (1985). Finding positive meaning in a stressful event and coping. Basic and Applied Social Psychology, 6 (4), 279-295.
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