Assessing the psychological impact of terrorism
Much discussion has centered on the physiological signs and symptoms of the various weapons of mass destruction, but what about the psychological state of the public after an attack?
Three scholars recently looked at that question at a special session on the topic at a bioterrorism symposium sponsored by the Johns Hopkins Univesity Center for Civilian Biodefense Strategies in Baltimore. The message was somewhat mixed, with the experts indicating that overall panic was unlikely, but noting that many people may present at medical centers with imagined ills.
"The one take-home point I really want to make is that our goal as leaders, as health care providers is — to prevent ideally — or to convert terror to a realistic fear in the wake of these sorts of events," said Ann Norwood, MD, Col, MC, associate chairman of the department of psychiatry at Uniformed Services University in Bethesda, MD.
Why are psychological responses important? "In the first place, they affect our physiological responses, and that can directly impact health care seeking behaviors," she said. "People take themselves to a health care provider or a hospital to get checked out because they are worried that they might have whatever [agent] it is."
Such "worried well" were reported after the 9/11 attacks, particularly by Pentagon employees who thought some biological or chemical weapon may have been used there. The problem is multifactorial, but begins with the body’s classic response to fear — the fight or flight syndrome.
"You can imagine if you start to feel these kinds of things that might just reinforce your concern and fear that you have been infected with something, so that there is a real true physiological response that can play into this health-seeking behavior and fear," Norwood said. "There’s a certain amount of hypersuggestibility right after something that kind of stuns us. Risk communication will be a critical factor in determining outcome to one of these events."
The smell (or lack thereof) of fear
Many bioterror and chemical agents are invisible and odorless. That taps into deep-rooted human fears of being invaded and destroyed by an invisible force, she said. Also, there is a delayed onset between exposure and illness, a lag that produces tremendous anxiety and uncertainty in those fearing they may have been infected. Moreover, because most biological weapons produce diseases that are rarely seen in American medical practice, there is limited knowledge about diagnosis, treatment, and outcome, said Norwood.
"As we saw with the anthrax, these agents may behave differently than we anticipated based on prior experience in terms of their infectivity, and ability to be aerosolized and so forth. Because of this uncertainty, physicians and patients really are in the same boat," she added.
All the more feared are agents such as smallpox that produce a grotesque appearance in the afflicted. The totality of these factors can result in "overwhelming emotions [that] can disrupt realistic problem solving," Norwood said. "Panic really is when people do what we don’t want them to do, and don’t do what we want them to do."
But the stereotypical "widespread panic" is actually a rare phenomenon in disaster and mass casualty situations, said Lee Clarke, PhD, professor of sociology at Rutgers University in New Brunswick, NJ. "We look at the World Trade Center, of course, and there we see very little panic. People were scared out of their minds, but that’s a perfectly rational thing to do. One of the reasons there wasn’t a higher death toll in New York is indeed that people generally responded well, but this is not surprising to those of us in disaster research. They did not rush, pushing people out of the way to get out of the building. They helped each other. They helped complete strangers."
If there’s a silver lining to 9/11 and the anthrax aftermath, it’s to some extent, our "imaginations have been stretched," and our worst fears nearly realized, Clarke said. "It used to be that we advised people not to imagine the worst cases. We would tell them that it was against their interest, and against good reason to concentrate on the risk, as opposed to the outcomes. We would tell them it was unreasonable, that perhaps we would even be prone to panic if we focused on worst-case possibilities, rather than the likelihood of an occurrence. But of course, we live in a worst-case world now, and I don’t think our imaginations are going back."
Much discussion has centered on the physiological signs and symptoms of the various weapons of mass destruction, but what about the psychological state of the public after an attack?
You have reached your article limit for the month. Subscribe now to access this article plus other member-only content.
- Award-winning Medical Content
- Latest Advances & Development in Medicine
- Unbiased Content