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More than PTSD: |
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More than PTSD: |
Abstract
Much of the research on disasters focuses on symptoms and recovery in the weeks and months following the incident with relatively few studies examining the longer term effects. The emphasis is often on pathological responses, such as Post-Traumatic Stress Disorder, rather than proactive forms of adaptation and recovery. This paper describes a small scale study of Disaster Action in Britain using qualitative interviews. The research highlights the importance of examining the broader social, political and legal consequences of disaster in understanding continuing proactive responses by disaster survivors.
Both the academic literature and public perception, then, did not seem to do justice to this phenomenon of long
term, proactive response after disaster. I therefore set out to explore the experiences, feelings and opinions of
disaster survivors, many of whom approach the tenth anniversary of their disaster. What is it that drives some
survivors, albeit a minority, to engage in active response? What can those in disaster management learn from
their experiences in the immediate and longer term?
Significant features of these deaths which increased their effects on the national community were their
suddenness, timing and, as befits definitions of disaster, their scale. Furthermore, developments in technology
and news styles meant that much of the media coverage included live footage of a scene at the point of or
shortly after death has occurred (see, for example, Deppa, 1993). One of the first of these was a fire at a soccer
stadium in Bradford in May 1985. Many switched on their televisions on a Saturday afternoon for the weekly
match results only to be confronted with scenes of a blazing wooden stadium and individuals, one at least on
fire, running from the scene. Other disasters included an aeroplane fire at Manchester Airport during the middle
of the holiday season, the sinking of a British ferry off Zeebrugge with substantial loss of life, a fire at Kings
Cross (one of the busiest underground stations in London), the blowing up of Pan Am 103 over Lockerbie four
days before Christmas, live coverage of fatal crushing at Hillsborough soccer stadium at the FA Cup semi-final
(a key feature of the national sporting calendar) and the sinking of the Marchioness pleasure boat on the River
Thames during the August bank holiday weekend, 1989.
The effects of these disasters on those directly bereaved was further exacerbated by the nature, scale and public
context of the deaths. Writers in grief and bereavement such as Worden (1991:98) have highlighted how sudden
deaths are more difficult to grieve than where there is some prior warning. Learning about or suspecting the
sudden death of a loved one in these contexts and through the media was particularly distressing for relatives,
especially given the uncertainty surrounding initial unsubstantiated reports and the media intrusion which was a
persistent characteristic (Walsh, 1989:121). In the immediate aftermath this included photographers taking close-up pictures of survivors being broken news of personal loss, of distressed relatives arriving at the scene, and of
journalists seeking information and interviews with the physically or psychologically injured (Note 1).
Public interest in these disasters has continued in the months and years since, in relation to the processes of
public inquiry, inquests and the collection/distribution of disaster funds. A public discourse of shock, sympathy,
blame, and accountability tends to be orchestrated through the media and a well-rehearsed narrative is imported
which polarises the 'heroes' and the 'villains', regardless of the appropriateness of these constructions. This not
only has implications for the emotional healing processes of survivors but means that the issues surrounding
these disasters and their consequences persist for the bereaved.
It was against this backdrop that Disaster Action came to be formed in 1991 (Note 2). The chairperson of one
of the family groups invited people affected by disasters to come together and form an umbrella group,
independent but supportive of the individual support groups, that might take a broader perspective of the issues
surrounding disasters. Functioning both as a mutual support and pressure group, members are bound together by
the fact that although each of their personal experiences is different they share some common experiences and
misgivings about the causes of disasters, the way in which they as individuals were treated by the authorities in
the aftermath and the inadequacy of the wider systems of inquiry and accountability within the British political
and legal system. Their aim to use their experiences to the advantage of others is highlighted in their literature:
Our committee is made up of individuals and representatives from all the family groups set up after recent tragedies. As an umbrella group for all these 'grass roots' organisations, we're well aware of the dreadful thread running through these disasters. They weren't Acts of God. They needn't have happened. Preventing future disasters is the main aim of Disaster Action. We don't want anyone else to go through what we've been through.
(Information Booklet. Disaster Action, 1990)
To this end the organisation has been campaigning since its inception for changes in the law to ensure stronger
safety cultures within organisations, greater accountability and new legislation on corporate responsibility which
would mean that failing to ensure reasonable safety measures becomes a serious criminal offence. They have
responded to the Law Commission's Consultative Paper on Involuntary Manslaughter with a view to promoting a
bill on corporate manslaughter soon to come before parliament. Members of Disaster Action also give regular
presentations to the media and contribute to the training programmes of practitioners such as emergency planners
and the emergency services based on their experiences and views. One member reflected thus on the opportunity to learn from experience:
Disaster Action exists because people come together with like experience with the understanding that they know their lives have changed, with the knowledge that emergency planning is not all that it could be and that the human dimension of emergency planning, certainly in the past, has been missing... we try to supply it. And because of the nature of our experience we have credibility.
For this research it was felt that qualitative methods, namely in-depth interviews, were the most appropriate for
exploring the experiences, feelings and opinions of the members of Disaster Action. This is in contrast to much
of the previous research into the psycho-social effects of disaster which has tended to use quantitative methods
and focused on the shorter term impact of disasters, that is to say from the immediate impact phase in the first
few months up to the first year or so (e.g. Konkov, 1991; Maida, 1993; Winje & Ulvik, 1995; Hagstrom, 1995). In Britain psychologists such as James Thompson at University College London have carried out a number of studies on psychological reactions to British disasters such as the Kings Cross Fire, the Lockerbie air disaster, the sinking of the Jupiter cruise ship, the Hillsborough soccer stadium disaster and the sinking of the
Marchioness (Thompson, 1991; 1995). The main tool for such research is questionnaires designed to measure
indicators of psychological distress such as depression, anxiety and Post-Traumatic Stress Disorder. These are
distributed and analysed with an emphasis on the immediate impact and the benefits of initial debriefing and
short term outreach mental health intervention programmes (Note 3). While such methods are useful for
diagnostic purposes and are often used for medico-legal purposes such as compensation claims, they rarely go
beyond the first few months or years. By way of contrast, there are very few qualitative studies using
ethnographic methods such as in-depth interviewing and participant observation and taking a longer term
perspective in examining the effects of disasters. The few exceptions tend to be personal survivor accounts
(Campion, 1998), Homewood, 1989), Taylor et al, 1995) and there have also been televised documentaries
using interviews with survivors from the disasters at Aberfan (thirty years on) and Hungerford (ten years after
the shootings).
The research methods for this study include participant observation (in particular attendance at AGMs and at
presentations given by Disaster Action) and a review of literature and other documentary material (including
publicity material, information leaflets and reports produced by Disaster Action, as well as official reports into
disasters). The main research tool is in-depth interviews with members of Disaster Action, particularly those on
the Executive Committee. Interviewees were invited to talk about life just before the disaster, their experiences
and feelings relating to the disaster itself, and key events and issues for them following the disaster. Although
the number of interviews is small (six so far with a further ten being planned), the fact that the interviews are
long (ranging from one and a half to three hours), and relatively unstructured, has elicited rich data from which
key themes are being selected.
Depth of understanding is given a higher premium in this study than attempts to generalise the experiences and
effects of disaster, especially given the fact that, even with the same disaster, each individual's experience and
interpretation is subject to difference and variation. A further reason for not generalising in this case is that the
people being interviewed for this study are exceptional in the fact that they are the minority who remain
organised. Of all those affected by disaster they have become most publicly active, not only as members of the
family groups set up after respective disasters, but also as members of Disaster Action, the umbrella group.
Thus although the sample is clearly not representative of all people affected by disasters, some interesting
similarities have emerged among their experiences and outlook after the disaster.
An emerging theme is the significance of the social, legal and political context of death through disaster for the processes of constructing an account of death, grieving and longer term psycho-social rehabilitation. This arises from the fact that disasters involve 'complicated' forms of death.
The fact that the British disasters in the 1980s were attributed to human/socio-technical causes has resulted in a
series of inquests, inquiries and investigations, many of which are ongoing and complicate the psychological and
social processes of grief. A feature of the British judicial system is long, drawn out and bureaucratic procedures.
Although these are needed in order to conduct a thorough and comprehensive review of the evidence, the time-frame and bureaucratic manner in which they are conducted can also contribute to and prolong the emotional
trauma of relatives and survivors. Worden states that such legal interruptions can delay the grieving process, but
suggests that when cases are closed, this can help put some closure on grief (1991:99). Worden is focusing on
situations involving a trial. However few public inquiries into disasters in Britain have lead to prosecution
and with many of the disasters in the 1980s there are outstanding calls for full and open inquiries until which
there cannot be a sense of closure. Added to this, the ups and downs of ongoing legal battles have left survivors
feeling victimised by, and as angry at the systems of inquest and inquiry, as they are at the fact of the deaths
themselves.
This last point is particularly significant. For campaigners within Disaster Action an outstanding issue is not simply the fact of loss and the mode of death but also the way in which the bodies were dealt with after death and the way in which relatives have been treated in the immediate aftermath and since. They are often presented with conflicting accounts of death which themselves become the subject of inquiry and speculation. Some relatives feel that the events after the deaths were at least as devastating as the fact of the death itself; in other words for them death is only the beginning of the disaster. These events in the aftermath are important because they are part of the process by which relatives and other survivors make sense of the death. The process of constructing an account of death is often far from straightforward after disaster; in fact it is often quite a lengthy and disordered process in contrast to what would be the normal and expected order of events.
On Friday March 1987 the Townsend Thoresen ferry The Herald of Free Enterprise capsized just outside
Zeebrugge harbour after sailing with its bow doors open. In the first few days conflicting estimates were given
of the number on board and the number of fatalities. The bodies of some on board were only recovered after the
ferry was righted five weeks after the disaster. One family of a member of the crew on board was twice told
that he had survived. On the first occasion the man's brother was told that he was fine and was walking and
that he could go and meet him off a returning ferry. Twelve hours later the family were told a different story,
that the man had been pulled out on to the hull of the ship and taken to hospital in Belgium, ill but alive. Thirty
six hours later the family were told to expect the worst. They then had to wait for five weeks before the body of
their loved one was brought home.
Although the inquiry into the disaster clearly identified the company as being 'infected from top to bottom with
the disease of sloppiness' and the 192 victims were found by the inquest jury to have been unlawfully killed,
attempts at private prosecution of P&O European ferries for manslaughter by some of the families failed. Now, over ten years later, the family's frustration is compounded by the fact that although the design of Ro-Ro ferries has long been acknowledged as being fundamentally flawed, the International Maritime Organisation and ferry companies have resisted and postponed implementing changes which would greatly reduce the vulnerability of ferries. It was the chairman of the Herald Families Association who spearheaded the foundation of Disaster
Action which, on the basis of this and other cases of unsuccessful prosecution attempts following disasters,
continues to campaign on the issue of corporate responsibility and accountability.
The second example relates to the Marchioness Disaster. On the evening of Saturday 20 August 1989 the
Marchioness riverboat sank on the River Thames after being struck by a dredger. Fifty one people were killed.
Over the following week bodies were recovered and the missing were eventually confirmed as dead. However
relatives were denied access to view the deceased and formally identify their loved ones. Bodies were returned
to them in sealed coffins with instructions from the coroner that they should not be allowed to view. The
funerals went ahead. One mother was finally granted permission to see photographs of her dead son three
months later. This was only after she applied and gained access to the photos. In the process she turned the
page and came across a post-mortem report, an experience she described as like being 'punched in the stomach'.
No one had informed her that this had even taken place.
The inquest was opened within the first few days and adjourned. It was resumed in April 1990 and adjourned
again. Nearly two years later the coroner admitted that the hands of some of the deceased had been removed but
no explanation was given as to why. The coroner refused to resume the inquest at this stage. Eventually, after
continued campaigning by the relatives and survivors, a new inquest was granted in April 1995 - six years after
the sinking. A verdict of unlawful killing was brought by the jury, but fifteen months later the Crown
Prosecution Service ruled that there was insufficient evidence to take further action.
The Marchioness Action Group only heard a full account of the events on the River Thames at the second
inquest in 1995 when a police statement was read out in full. Given that this was six years after the disaster,
relatives and survivors were angry that they were denied an opportunity to hear such information sooner and in
fact had to fight to learn about the events that night and what went wrong. The evidence at the second inquest
was not new, simply evidence that had not been called for the previous inquest. On the basis of this and
dissatisfaction with inquest procedures following other disasters, members of Disaster Action have raised
questions about the politics of inquests and the role, training and authority of coroners.
In order to understand the psychological and social consequences of disaster for relatives and survivors, it would
therefore seem to be more useful to adopt a concept of disaster as an extended ongoing process rather than as a
single event. This is in line with contemporary analyses within crisis literature as highlighted by Forgues and
Roux-Dufort (1998) who refer to an increasing consensus on the appropriateness of considering crises as
cumulative processes over an extended span of time and space. Furthermore, the concepts of rehabilitation and
recovery in the latter stages of the disaster cycle need to be operationalised in a way that looks further beyond
the first few months and years than has tended to be the case in previous studies. In these latter phases of
disaster it is also important to address the social, legal and political systems and structures in place to respond to
disasters since they will determine the nature and effectiveness of lessons learned as well as processes of
accountability and responsibility.
We have to get people to understand that unless the inquiries are conducted properly, unless there are conclusions drawn, the families will not rest... (others) sometimes find it hard to understand why people continue to want answers to questions many years down the line... you continue to want justice but that message can sometimes be a little hard to get across.
At the same time, their experiences motivate and inspire continued campaigning initiatives in the area of
corporate responsibility and public inquiries and provide a legitimate and valuable platform for educating those
within disaster management who may learn from them and respond better in future incidents (see, for example,
Dix, 1997).
Recent examples illustrate this continuing role at a national level. Disaster Action have contributed to guidelines
produced by the Emergency Planning Society (May, 1998) focusing on good practice in addressing the human
aspects of disaster. They have also been invited to comment on a Home Office working party report
investigating and seeking to improve the role of inquiries and inquests following disasters (HMSO, 1997).
Finally Disaster Action have commissioned a report which will highlight the defects of the criminal justice
system in investigating and prosecuting companies responsible for accidents and disasters. This document, which
in principle has the support of various action groups, trades unions and others. will be a vehicle for lobbying
parliament to introduce new legislation on corporate responsibility.
These examples and this study highlight a familiar theme, namely that there is an opportunity to learn from the
past with respect to responding to the human dimensions of disaster. In addition to this, the qualitative approach
used here also highlights the importance of adopting a perspective which looks to the longer term and which
includes the views and experiences of those directly involved in the aftermath of disaster. Indeed, some disaster
survivors may be uniquely placed and motivated by their experiences to complement the views of practitioners by
contributing to the development of disaster plans, participating in emergency exercises and commenting on
policy-making at local and national level, as well as providing networks of mutual support for those affected by
future tragedies.
Campion, M. (Ed) (1998 forthcoming) Jupiter's Children. Liverpool: Liverpool University Press.
Deppa, J. (1993) The Media and Disasters: Pan Am 103. London: David Fulton Publishers.
Dix, P. (1997) Corporate Responsibility - The Victim's Perspective. The Safety and Health Practitioner, June 1997.
Emergency Planning Society (1998) Responding to Disaster: The human aspects. Emergency Planning Society.
Forgues, B. and Roux-Dufort, C. (1998) Crises: Events or Processes? Paper presented at a conference on
Hazards and Sustainability: Contemporary Issues in Risk Management, Durham University Business School,
Durham May 1998
Hagstrom, R. (1995) The Acute Psychological Impact on Survivors following a Train Accident. Journal of Traumatic Stress, 8 (3), 391 - 402.
HMSO (1997) The Report of the Disasters Inquests Working Group the Home Office. London: Her Majesty Stationery Office.
Hodgkinson, P. and Stewart, M. (1991) Coping with Catastrophe: A Handbook of Disaster Management. London: Routledge.
Homewood, S. (1989) Zeebrugge: A Hero's Story. London: Bloomsbury.
Konkov, F. (1991) Primary Psychological Intervention with Families of Earthquake Survivors in Armenia. The American Journal of Family Therapy, 19 (l), 54 - 59.
Maida, C. (1993) Child and Parent Reactions to the Los Angeles Area Whittier Narrows Earthquake. In Allen R D (Ed) (1993) Handbook of Post-Disaster Interventions' (Special Issue) Journal of Social Behaviour and Personality, 8 (5), 421-436.
Parkes, C. M. (1995) Guidelines for Conducting Ethical Bereavement Research in Death Studies, 19, 171-181.
Taylor, R., Ward, A. and Newburn, T. (eds) (1995) The Day of the Hillsborough Disaster: A narrative account. Liverpool: Liverpool University Press.
Thompson. J. (1991) Theoretical Issues in Responses to Disasters. Journal of the Royal Society of Medicine, 84, (January), 19-22.
Thompson, J. (1995) Psychological Effects of the Marchioness Disaster on Survivors and Relatives. European Journal of Psychiatry, 9, (4), l97-208.
Turner, B. and Pidgeon, N. (1997) Man Made Disasters. Oxford: Butterworth-Heinemann
Walsh, M. (1989) Disasters: Current Planning and Recent Experience. London: Edward Arnold
Weir, D. (1998) Man Made Disasters Revisited. Paper presented at a conference on Hazards and Sustainability: Contemporary Issues in Risk Management. Durham University Business School, Durham May 1998
Winje, D. and Ulvik, A. (1995) Confrontations with Reality: Crisis Intervention Services for Traumatised Families after a School Bus Accident in Norway. Journal of Traumatic Stress, 8, (3), 429-444.
Worden, W. (1991) Grief Counselling and Grief Theory. London: Routledge.
Note 2.
Disaster Action includes members of family groups and survivors associated with the following disasters:
| Date | Location | Incident | No. of Fatalities |
|---|---|---|---|
| 11/5/85 | Bradford | Football stadium fire | 56 |
| 22/8/85 | Manchester | Aeroplane fire | 54 |
| 6/3/87 | Zeebrugge | Ferry sinks | 192 |
| 8/11/87 | Enniskillen | Terrorist bomb | 11 |
| 18/11/87 | Kings Cross | Underground fire | 31 |
| 6/7/88 | Piper Alpha | Oil rig explosion | 167 |
| 21/10/88 | Greece | Cruise ship sinks | 4 |
| 12/12/88 | Clapham | Train collision | 36 |
| 21/12/88 | Lockerbie | Air crash | 270 |
| 8/1/89 | Kegworth | Air crash | 47 |
| 15/4/89 | Hillsborough | Overcrowded stadium | 96 |
| 20/8/89 | Marchioness | Riverboat sinks | 51 |
Note 3.
One might question the ethical appropriateness of exploiting the opportunity to distribute questionnaires
to vulnerable individuals in the first few hours or days given that they are likely to be in shock and may not be
emotionally prepared to fully exercise their right to informed consent. One such study was carried out by a
psychologist studying trauma who distributed questionnaires to 83 people on the very day their homes and
neighbourhood had been destroyed by fire (Kurt Kieiner - New Scientist 28 June 1997:6). This research has paid close attention to Colin Murray Parkes' guidelines (Parkes, 1995) for conducting ethical bereavement research which highlight the great care that should be taken in approaching, conducting and using research carried out with potentially vulnerable people.
