SelfhelpMagazine

by Storm A. King

When disaster strikes, first aid teams rush to the site, ready to give aid to the injured. Modern science has recognized the need to address the psychological harm incurred by victims of a disaster. A quick response by trained psychologists and mental health workers has been shown to decrease psychological damage, and may mitigate or even prevent the later development of Post Traumatic Stress Disorder (PTSD) (Linton, 1995). The importance of this work is reflected in a recent action taken by the American Psychological Association (APA). In 1992, the APA formed the Disaster Response Network (DRN), which currently has 2,000 psychologists associated with it (Aguilera, 1995).

One method of administering this fast application of psychological first aid is Critical Incident Stress Management (CISM). Originally developed to treat public service workers exposed to extreme levels of trauma, it is currently finding widespread application in a variety of settings for treating anyone exposed to natural or manmade disasters, such as war, earthquakes or hurricanes (Jackobs, 1995). One purpose of the CISM team is to provide Critical Incident Stress Debriefing (CISD). This is most often a structured group session that offers educational information and psychological assistance designed to counter the effects of the trauma caused by the disaster experience. An important element of successful CISD is a sufficient level of social support for the victim following the disaster (Cook, 1989; Boscarino, 1995; Flannery, 1990).

The Internet is opening up new, unique opportunities for people to receive social and emotional support (Sproull & Keisler, 1995; Wellman & Gulia, 1995; King, 1994; Rheingold, 1994). Virtual communities are forming to discuss every imaginable topic(Cutler, 1994). These are loose knit social networks where members exchange ideas and information. There are particular factors about computer mediated communication that make it a possibly useful addition to the treatment of disaster trauma. This paper will examine the current theory and practice of Disaster Mental Health (DMH) efforts, and suggest possible ways of including the use of the Internet.

The Importance of Social Support in DMH

When normal, well adjusted people experience the extreme stress and trauma of a disaster, they may develop symptoms of psychopathology. These include anxiety, depression, sleep disturbances and a profound sense that the world is unsafe. "Many clinicians and researchers in the trauma field have intuitively understood the importance of social support in trauma and it's role in recovery" (Flannery, 1990), but there have been few empirical studies to support this belief. In a review of the findings of an associative relationship between social support and psychological trauma, Flannery describes two formats in which social support is received. He refers to networks as the "social structures in which a persons life is embedded." These are one's family, friends, co-workers and community links. Buffers are social exchanges that cushion or mitigate the negative effects of life stresses. They may or may not be found in one's social network. He recommends that in treating trauma victims "the development of networks and buffers should be a specific treatment goal, not a hoped for by-product" (Flannery, 1990). The Internet represents a means of expanding the social network one is embedded in. For disaster victims, this could represent a means of finding buffers that were not available. One of the factors that has been shown to be a large buffer for trauma victims is contact with others that experienced the same trauma (Boscarino, 1995). In the case of survivors of a plane crash or a train wreck, the victims most often return home to widely separated locations. The establishment of an Internet link for the exclusive use of those survivors would greatly improve their ability to debrief each other as to their personal outcomes from that disaster, and supply each other with a unique buffer against the effects of the trauma.

Using New Technology in DMH

E-mail is a form of communication that is increasingly becoming a part of people's normal lives. There is a lower sense of social presence using email. The lack of tactile sensory feedback and the privacy of being in one's own home contribute to a different sense of being connected socially than even the use of the phone. This "makes it easier to contact strangers because there is less concern about rude intrusion or interpersonal risk" (Wellman, 1996; Stoll, 1995). The ability to find ones peers, no matter how esoteric the topic of interest is, is causing an explosion in the number of and uses of virtual communities (King, 1994) Both these factors make email self-help discussion groups viable and useful, as well as therapeutic. DMH workers could be prepared to enter disaster work sites with the information about available Internet sites already set up, ready to go.

"Electronic technology may open a variety of strategies to deal with disasters. Communication could be enhanced (a) through portable cellular equipment including telephone, fax, and memo; and (b) through linkages to centralized data sources by modem." The availability of educational material, for example, has been largely through next-day delivery services and has yet to use computer bulletin boards. Electronic linkages will enhance the use of disaster consultants who may be geographically removed from the incident site. Research or other data relevant to specific disasters would become immediately available (Aguilera & Planchon, 1995).

In the immediate wake of a large disaster, information is at a premium. The uncertainty as to the extent of the disaster is a major stress for people who have loved ones in the crisis area. In the wake of the Northridge earthquake in 1994, thousands of people used the Internet and commercial interactive services such as America Online and Prodigy to keep each other informed and to seek information about loved ones. Every major natural disaster since that time has caused a huge increase in the use of interpersonal computer mediated communication, as members of virtual communities shared with each other the nationally felt sense of grief and shock. There are no studies I am aware of that document this phenomena.

After the bombing in Oklahoma City in April, 1995, the World Wide Web (at http://www.cpb.uokhsc.edu/okc_bomb/okc_bomb.html) was used to provide information about the current state of disaster relief work, victim identification, and the status of the investigation into the cause of, and the perpetrators of, the explosion. Usage of this web site peaked eight days after the bombing at 30,000 "hits" (number of times the web site was accessed) per day ( http://www.disaster.net/historical/ok/usage.html ).

An Internet Relay Chat (IRC) channel (a live, real time connection where information is seen as soon as it is posted) was set up the morning of the bombing. The records from that channel, which quickly became the Internet's source of official information, were kept and are still available on the Web (at http://www.disaster.net/historical/ok/procyon.html. This is a record of that channel for the two days following the bomb attack. From Wed. April 19, 12:15 am to Friday, April 21 12:15 (am or pm is uncertain) there were 78,137 words posted to just this one virtual forum. Many of those words were regularly repeated messages about where to go on the net for additional information, but most were comments and transcribed news reports. This appears to have been a grassroots effort that became the site for official information due to moderators that attempted to allow only people to post that were monitoring TV news, radio sources or other official information.

A following is a sample from that transcript (the logon names have been X'ed out):

<XXX> cnn just reported only 41 dead
<YYYYY> Headline News reports 53 dead
<ZZZZ> the FBI is studying videotapes of security cameras that were placed around the federal building.. the VTR's were located in the Phone Co's office across the street
<ZZZZ> KWTV reports 52 dead
<YYYYY> bloodied baby's image has come to symbolize the OKC tragedy...
<YYYYY> ... Southwestern Bell Telephone parking lot
<ZZZZ> They showed some video that was taken looking up from near the blast crater.. you can see the indentations in the concrete where rebar was ripped out
<YYYYY> Yeah, that was a BIG bomb
<ZZZZ> estimated at 1,000 lbs plus of explosive
<ZZZZ> The vehicle that delivered the bomb is believed to be a large van
<ZZZZ> update of dead is 52 officially, 12 are children
<YYYYY> REMINDER: this channel is intended for NEWS and UPDATES only.. please keep talk to #oklahoma1...

Since this time, Internet resources for disaster related information have grown considerably. There is now a centralized Web site with links to sties on the Web that are maintained by over a dozen different official emergency organizations (http://www.vita.org/disaster/others.html).

It can be seen from this example that there is a need to address the mental health aspects of a national disaster by means of the Internet. An email discussion group was formed around the topic of this bomb attack, but it was not done by any official disaster related organization.

About the Author:

Storm A. King is a Ph. D. candidate in a clinical psychology program. His current research projects are designed to determine the therapeutic value of virtual support groups, the self-help, mutual-aid groups that meet electronically. His has also proposed various ways that psychologists and mental health workers can use computer mediated communication to facilitate individual and group therapy efforts, and has written about the ethical considerations involved in the use of human subjects in the study of the psychology of virtual communities.