HE.S.T.A.F.T.A. - Scientific Society of Mental Health Professionals
Article 4 / Issue 18, April 2021

INVESTIGATION OF TRAUMA, RESILIENCE AND POST TRAUMATIC GROWTH AFTER THE SAMOS EARTHQUAKE

  • Nikos KaldirimitzianPsychologist, Mental Health Center of Samos

Investigation of trauma, resilience and post traumatic growth after the Samos earthquake

Nikos Kaldirimitzian

Introduction

The subject of this article is trauma, resilience and post-traumatic growth in relation to a catastrophic event, such as an earthquake. Its purpose is to inform the public and specialists about the consequences of an earthquake at an individual, family and social level, but also to inform about (paradoxically) positive results which occur on the occasion of a natural disaster. Several devastating earthquakes have occurred in Greece in the recent decades, therefore we consider that the topic was important and relevant. It must also be noted that a great number of survivors need support to cope with the effects of earthquakes, while many professionals and volunteers are involved as health providers. Furthermore, economic status, political decisions, social support, before and after the earthquake, are factors connected, directly or indirectly, with the matter.

The method for drawing conclusions was not only presenting research or theoretical approaches from the international literature, but also to record the experiences of people who survived from the Samos earthquake. Maybe the reader will recognise feelings of fear, anxiety, despair, guilt and also in some cases elements of resilience. Initially, a survivor’s social media posts are presented, and other people’s narrations are included in the second and third part of the paper. The reason for presenting these stories is to better comprehend the concepts discussed in the article. The second part makes reference to scientific studies conducted after earthquakes, related to post traumatic stress disorder (PTSD), resilience and post traumatic growth (PTG). Finally, the framework of a systemic approach to trauma is described and concepts of resilience and PTG are developed at theoretical level.

Social media posts by an inhabitant of Samos

30/10/2020

Y: Guys our business has suffered damage but we are ok! Sorry for not replying to your messages, saving battery.

3/11/2020

Υ. How could it be otherwise? I am not surprised but I have to say it…

There are people close to us that support us. (We have either chosen them or they are Family. I love you guys!)

There are other people you never thought would give you a hand, and yet they reached out. Without making a fuss! (I thank you from the bottom of my heart! There are only a few of you but you are wonderful! You make the world a better place).

There are those who feel compassion but they can’t do anything to help (I understand! Take care guys and enjoy every moment as best you can).

There are those that give you a pat on the shoulder but… “hey, it’s your problem man”… They might say something nice (it doesn’t cost them anything) but that’s as far as they’ll go… (I don’t blame them…)

There are some people that couldn’t care less. As long as it’s not their *** on the line everything’s fine! Yet if they make a Facebook post they may get several likes… (It’s a pity though and useless… right? Think before you do it).

But there are some others who are soulless ******. They want to express their **** opinion but they completely disregard and disdain, and some even go so far as to blame, the people who suffer. (I feel sorry for you, maybe I loathe you as well. You are a burden to the planet. I think that you make this world a dirty place!! I’ embarrassed to even have to mention you, all the more since I hadn’t noticed you before. I had to be on the receiving end in order to find out about you).

P.S. I am not a fool. I know there are those of you who are enjoying it! We’ll deal with you down the line. Life isn’t over!

26/11/2020

Y: I am close to realizing that this whole thing is not a nightmare… It’s no joke. It is unbelievable how you like “freeze”, how you get “stuck”, how much you do not to accept the new reality…

It’s hard to realise that life goes on without you, even if you already knew it would! There is a great difference when you live it!!! It is not that you are angry with fate or that you are jealous of the “lucky ones”. It is that suddenly, you are not one of the “lucky ones”, you lose the ground from under your feet. Hours and days rush past and you feel lost and don’t know how to deal with it.

You have to philosophise it. You have to reflect about it.

Your friends are right when they tell you to do it. It is easier said than done… but it is hard to make reflections when you live in the eye of the tornado… yet they are right… there is no other way!!! You will either accept it… or you will go crazy… or you will jump off the first balcony you find! You have to fight it. That at least. To fight it. And you do it as best you can. Not just for you. You owe it. You know who you owe it to. You grit your teeth, you stop asking “why” and you try to stand on your own two feet. You feel for people who are like you, or worse off than you, like never before... You feel alone and you can feel their loneliness as well, even though you have your loved ones around you. Even though there are so many people supporting you with a kind word or an incredibly beautiful and generous heartfelt gesture… It’s strange, it’s hard… it’s reality… and you must find it again… You!!! Alone!!!! See… Believe it or not, a new day will dawn tomorrow! Some people, somewhere will cook bacon for breakfast and the smell will fill the entire house… Some people will look for a job, and some will go shopping… As I write this some people are crying tears of joy and some others have no more tears left to cry... That’s life right? That is how people are! And you wonder why you are writing these boring, silly and childish things that have already been told a thousand times before… Forget it… I only wanted to send you my love and say I’m sorry I’m not online more often to post wishes, to comment and that I don’t answer my phone...

6/12/2020.

  • Happy name day to all Nicholases. Forgive me but I am exhausted and I can’t wish a happy name day to everybody separately, even though some of you are VERY dear to me! The earthquake and the wounds it left behind is most definitely not the end of the world, even though some of us are still having a hard time coping with it.

On the other hand, at the same time, the vast majority, all of the people, they fight, we fight with another nightmare! Maybe, I think it’s a time for more essential “gifts” and “sharing” than stupid wishes. I don’t want to ruin anybody’s mood on a day like this.

I only wanted to share one wish. That we will all recognise what’s happening, so that we will come out of the darkness at some point. See what is really happening and fight it! Together! And then, albeit wounded, we’ll go back to the joys, the wishes, the dances, the hugs, the kisses, and the parties! So my gift, unfitting as it may be, is the following post that I stole from Dina and my wish is that St Nicholas will slap some sense into us, so that we won’t sink this ship we are sailing in...

20/2/2021

It wasn't easy at all!

It’s been over three months...

We're still alive though (as the song goes)

And we return strong and with a smile! We will celebrate next Monday!

Research following earthquakes

Earthquakes are a shaking of the earth's surface and sometimes are considered as a threatening and unpredictable natural disaster. Results and consequences of this disaster, such as mortality, morbidity, physical disability, mental trauma and psychosocial adjustment have been studied in recent decades. At the same time, earthquakes were found to be associated with an increased prevalence of various psychiatric illnesses among survivors, such as acute stress disorder, major depression, sleep disorder, post traumatic stress disorder (PTSD). Most studies document that the most common psychopathology that occurs is PTSD (Farooqui et al., 2017).

B and her husband X were together during the earthquake. B panicked, not only from the earthquake but also because their child was at a relative’s house. They felt better when they were all together again in a safe environment. For the next days B had trouble sleeping and the son kept telling his parents that he was afraid of earthquakes.

A study conducted in Taiwan investigated PTSD over the course of time. A sample of 1756 people was examined twice, six months and three years after the earthquake. Six months after the earthquake, 418 of them suffered from PTSD, and 1338 did not have PTSD symptoms. 9.1% of the PTSD group (38.418) and 3% of the non PTSD group (40/1338) suffered from PTSD when they were re-examined three years after the earthquake. The results showed that unresolved PTSD is related to young age, injury during the earthquake, significant financial damage, impairment of memory and attention. The prognostic factors for the onset of delayed PTSD were young age, loss of a family member, significant financial damage, and impairment of memory and attention. (Su et al., 2010).

A study evaluated the effect of peritraumatic dissociation of PTSD symptoms in 101 adults who sought treatment after exposure to a major earthquake (Duncan et al., 2013). Peri-traumatic dissociation is an experience of time distortion, de-objectifying, depersonalization, and cognitive or perceptual distancing during a traumatic event (Halvosen 2013). The researchers' hypothesis was that certain psychological difficulties could predict the existence of other symptoms of diseases and disorders. It was confirmed that peri-traumatic disconnection is a predictor for the onset of symptoms of PTSD and anxiety. Also, symptoms after PTSD predicted anxiety and depression (Duncan et al., 2013).

E-mail excerpt

- It was terrifying... Our family is fine, but we're afraid because there are aftershocks and we have frequent power outages... Samos mourns... Samos counts its wounds today, and some of them will be hard to heal... We are devastated... We are shocked because we knew these two kids who died ... Yesterday my son cried when he heard the bad news... His mother’s hug and my own was a comfort to him. While I was holding him I was happy he was okay, but I also felt guilty that I couldn't look the childrens’ parents in the eyes and help them face this unbearable pain.

Some studies after natural disasters have focussed on PTSD and complicated grief, (CG) (Eisma et al., 2019). A study was carried out on 803 survivors of the southwest Chinese city of Sichuan, who were mourning at least one person after the earthquake. Symptoms of complicated grief were examined in relation to PTSD symptoms. The results outlined five groups depending on the onset of symptoms of post-traumatic stress disorder (PTSD) and complicated grief (CG). The first group included 208 people with low PTSD and high CG, the second group included 205 people with high PTSD and high CG, the third group 145 people with low PTSD and partial CG, in the fourth group there were136 people with partial PTSD and partial CG, and in the fifth group 108 people with low PTSD and low CG. Prognostic factors for the occurrence of complicated bereavement were the female gender, the loss of a child or spouse, injury, and missing family members (Eismaetal. 2019).

When the earthquake occurred, R was alone in his apartment. He felt completely helpless. He calmed down when he moved out of the apartment and into the family’s summer house, where he felt safer for two weeks. He then returned home but the frequent aftershocks made him afraid and uneasy. The only time he felt safe was when his wife would come home from work.

Sippel et al. (2015) reported a study which was conducted on a large sample in Mexico after a natural disaster. The study investigated the relationship between PTSD symptoms and social support. Social Support refers to the psychological care and material assistance which are provided by social networks. The aim of social support is to develop the individual’s ability to cope with stress. The study found that greater social support was associated with fewer symptoms of PTSD, six to twelve months after the disaster. Also, severe PTSD symptoms predicted less social support, eighteen to twenty-four months after the disaster (Sippel et al., 2015).

_B lives with his mother who is in a vulnerable group due to a serious illness. During the earthquake, he took cover beneath a door frame. He realised that he had left his mother alone and helpless. At the first chance he got, he ran to help her. When the earthquake was over he felt guilty he only thought of himself and didn’t assist his helpless mother.  _

In a study focused on family function that involved 264 mourners, eighteen months after the earthquake in the Wenchuan region of Tibet in China, results showed that 37.1% of people reported moderate family dysfunction and 12.9% severe dysfunction. Less economic damage during the earthquake was an important predictor for positive family function. Also, good post-earthquake health is associated with positive family function, cohesion and adaptability. The effects of family cohesion and adaptability were significantly higher among mourners living with extended and nuclear families compared to those belonging to single-parent families. The ability of bereaved parents to give birth to another baby was a significant predictor for positive family function and cohesion. Low family function, cohesion and adaptability are significantly related to greater loneliness (Cao et al., 2013).

A research studied trauma and resilience in women who survived the 7 Richter earthquake in Haiti in 2010, and then settled in Boston, United States. The research revealed that unresolved legal issues, financial difficulties, and family dimension, threatened the success of adapting to the new reality. Also, support from friends, family and social organizations contributed to resilience (Lacet, 2012).

_During the earthquake, S. was at home with her husband. After the earthquake she was moved by the interest shown by family, friends, and acquaintances, from all over Samos and the rest of Greece, who contacted her. _

  • _ was in a village of Samos during the earthquake. That night she had a friend, whose house was damaged, sleep over at her home. She reported that helping her friend, also helped herself remain calm. It was as if being the carer gave her strength. _

A Chinese study looked at the relationship between resilience, demographics and social support in adult survivors, five years after the Sichuan earthquake, with a particular focus on gender differences in predicting resilience. Annual family income was the most important predictor of resilience for both men and women. One surprising result was that men who had a chronic illness had higher levels of resilience than those who did not suffer from a chronic illness. The researchers’ interpretation was that maybe male survivors who suffered from a chronic disease felt lucky to have survived the earthquake as well. Also, they may have gradually adapted to their illness before or after the earthquake, and with the appropriate social support they became stronger to face the challenges and adversities. (Ni et al., 2015)

Research conducted in Japan after an earthquake (resulting in a tsunami and radiation leakage from the destruction of a nuclear power plant) investigated the symptoms of PTSD, depression and physical health to check the predictive role of resilience in mental and physical health, but also to predict the sociodemographic factors of resilience. The results showed that people with high resilience experienced fewer PTSD and depression symptoms, better physical health, fewer restrictions on their roles due to physical or emotional problems, fewer physical pains, a better perceived sense of physical and mental health, greater vitality and better social functionality. The researchers also looked at differences between high and low resilience groups in relation to demographic characteristics, depression, PTSD and perceived overall health. Members of the high-resilience group tended to be married (or have a partner), were employed, with good nutrition and exercise habits. The same group showed fewer symptoms of depression and PTSD than the low-resilience group. Subsequently, occupational status, diet, physical activity, and alcohol use were investigated as sociodemographic factors predicting resilience. People who worked, had good eating habits, exercised physically and drank alcohol (more than twice a week) tended to show greater resilience. Alcohol consumption is an interesting predictor of resilience. In Japan alcohol use is treated with tolerance and alcohol consumption offers an important social function in maintaining relationships as opposed to what the case is in other European countries or the US. However more scientific research is needed in order to draw conclusions (Kukihara et al., 2014).

_When the earthquake occurred E and H were in their house. They rushed to their son’s school. When they found him and saw that he was alright they asked the young student how he experienced the earthquake. He said that he felt fine and it was as if something “exciting” had happened. He felt he was able to cope with a great challenge calmly, and that by following his teachers’ instructions, he and his classmates were able to get to safety. _

Research on Medical School students focused on predictive factors of psychological resilience, seven months after the earthquake in Canterbury region, New Zealand. Extroversion as a personality trait, low level of distress, high level of self-reported resilience before the earthquake, lack of exposure to more severe earthquake events, and low level of neurosis before the earthquake were predictors of a high level of resilience (Carter et al., 2016).

A Chinese study after the Wenchuan earthquake, studied post-traumatic development (PTG) after exposure to the media. The research showed that media exposure had different results, depending on the individual characteristics of survivors. Specifically, it was revealed that people with lower self-esteem or low results on a PTSD-related questionnaire had higher psychological development if they had more exposure to TV news. The same was not true for people with high self-esteem and high results in the PTSD questionnaire (Ma and et al., 2019).

PTSD and PTG often coexist in traumatic event survivors. A study focused on coexistence of PTSD and PTG in adolescent earthquake survivors in Wenchuan, China in 2008.

The largest percentage of adolescents (50.1%) belonged to the group in which PTSD and PTG coexisted. Members of this group were more likely to be in the last years of adolescence, to have experienced indirect exposure and reported post-traumatic fears (Zhou et al., 2018).

A study was conducted in Korea after the 7.0 Richter magnitude earthquake in Pohang City in 2017. It examined the mediating role of PTSD in the relationship between earthquake exposure level and post-traumatic development. PTSD occurred at a high rate in people who were married, had no religious beliefs, had a low income and had a higher exposure to the earthquake. PTG occurred in older, married, and religious individuals. PTSD and PTG had a positive correlation, with PTSD fully mediating the relationship between seismic exposure level and PTG (Seo et al., 2019).

An Italian study examined the relationship between depression and post-traumatic growth.

The sample consisted of young survivors who lived in the city of L' Aquila in 2009.

The results showed that post-traumatic growth was predicted by moderate levels of depression (Bianchini et al. ., 2017).

Discussion

Figley et al (2009) reported that “Trauma is by nature interpersonal and is, therefore, a systemic entity”. They defined Trauma “as an experience that is sudden and potentially deadly, often leaving lasting and troubling memories” and they wrote “either the experiencing or the re-experiencing affects and is affected by others”. More often the others are friends or family. Traumatic experiences create memories. Memories are often co-constructed, through interpersonal interaction, through the seeking for support, and/or through the making meaning process. (Figley et al., 2009)

Figley et al (2009) noticed that “equally important is addressing the secondary trauma in the traumatised person’s intimate support system that may result from initial notification about the primary traumatic event (and subsequent medical treatments and/or psychological/behaviour changes) and through the co-construction process. The linear modalities do not address secondary traumatic reactions. Therefore, the traumatised person who has a good result from linear treatment is surrounded by supporters who are still traumatised (secondarily) themselves”.

In addition, not only friends and family but neighbours colleagues and emergency personnel are indirectly exposed to traumatic events. It is noted that sometimes emergency personnel are exposed not only indirectly but also directly to the disaster.  Some of the professionals included in the emergency operations staff are doctors and nurses, other paramedics, mental health specialists, police officers, firefighters, rescue workers, emergency managers, media workers.  When the emergency personnel suffer from PTSD, depression etc, exposure to stressful tasks is the most important predictor. Also, the lack of previous professional experience and training is associated with the occurrence of PTSD, anxiety symptoms, etc. On the contrary, social support is a predictor of recovery and post-traumatic growth. Previous work experience with survivors can be a protective factor as well. Training was a predictor of post-traumatic growth for volunteers who offered assistance in devastating earthquakes (Karamanou, 2016).

According to the Linear Model, a traumatic event causes a catastrophic result. This approach focuses on the catastrophic dimension of the direct consequences, like for instance TV news stories about victims of extreme natural disasters do. The systemic approach does not view the individual as a victim, but rather as the mainly responsible party for shaping his reality and creating a desirable future (Jakovjevic et al., 2012). Skali (2009) referred to Michael White’s opinion that "no one is just a passive receiver of trauma". Trauma is testimony to the person’s history, and the scar of an old wound acquires the value of an element that defines and reveals his identity (Pomini, 2011).

In many cases a traumatic event can highlight a person's resilience and lead to post-traumatic growth. The framework can help or hinder this.

Resilience is the person’s ability to go on with his life after difficulties and adversities, or to continue having a life with goals despite the adversities (Tedeschi et al., 2004).

According to Patterson (2002), the term  resiliency  refers to the ability to overcome obstacles as a characteristic, whereas  resilience  refers to the process of managing challenging circumstances.

Many psychological and biological factors are related to resilience. Psychological factors include optimism, a healthy lifestyle, flexibility, adaptability, an active way of dealing with challenges, strong will, courage, morals, altruism, and dedication to a cause. Biological systems, like the sympathetic nervous system and the hypothalamus, pituitary, and adrenal system are directly related to stress resistance. The development of these systems depends on social systems, for example the relationships with important others. Therefore, resilient patterns and sufficiently good caregivers can predict individual resilience. Support that a person receives from family, friends, colleagues, community and other organizations has a great effect on mental and physical health and on the person’s ability to face challenges. Therefore, it is important to focus on social networks in order to understand and promote resilience to stress and trauma. Individual resilience depends on the operation of many interacting systems (Sippel et al., 2015).

Additionally, resilience can be recognised not only at an individual level but at a family or community level as well. Community resilience is considered as a key concept, as it underlines the interdependence of individual, family and community systems. Furthermore, community resilience highlights the consequences on different systems when one system is threatened (Sippel et al., 2015).

Community resilience indicators include housing accessibility, income stability, internet access, educational level, elected leadership, health indicators, healthcare accessibility etc. Moreover, there is a notion that healthy communities approach their history with pride, and their members participate in community festivities and events (Sippel et al., 2015).

Walsh (2013) noted that family resilience is the “ability of families to endure and come back with more strengths and resources after disruptive challenges”. Resilience is developed in environments with strong and supporting bonds. The implementation of resilience in families highlights that strong families are important protective factors for strong children. A crisis may function as a catalyst for appreciating values, assessing priorities, greater commitment to important relationships or post-traumatic growth. The family’s functioning model needs to change in order to adapt to the crisis. Family rules, habits, traditions, communication or standards may no longer be adequate and a family transformation may be necessary (Figley et al., 2017)

Family trauma-resilience refers to the systemic capacity and resources to (a) avoid or quickly mitigate the unwanted impact of trauma and (b) appreciate and develop the positive consequences. The resilience of the family also depends on its resources and mechanisms. Family adjustment to trauma can either help or hinder family function, but most of the time both occur. A balanced framework addresses trauma and discovers roads leading to development (Figley and co., 2017).

Sometimes resilience is considered synonymous with post-traumatic growth, but it is a different concept. When a person shows an improvement as a result of his struggle with trauma, it is an example of post-traumatic growth. It is a concept that explains the transformation that follows trauma. (Lorna Collier, 2016).

Post-traumatic growth is a positive change, which occurs as a result of trying to deal with serious crises. Growth, however, does not occur as a result of trauma. Post-traumatic growth comes with the individual's attempt to adapt to the new reality. The metaphor of an earthquake is used to describe this process. A psychologically seismic event can severely shake, threaten, or reduce to rubble many of the schematic structures that have guided understanding, decision making, and meaningfulness. Cognitive rebuilding that takes into account the changed reality of one's life after trauma produces schemas that incorporate the trauma and possible events in the future, and that are more resistant to being shattered. These results are experienced as growth (Tedeschi et al., 2004).

When someone is resilient at the time the trauma takes place, they may not experience post-traumatic growth, as they do not need to change their belief system. On the contrary, those who were less resilient exhibit post-traumatic growth, because they will have to give meaning to what has happened to them. (Collier, 2016).

Afterword

A catastrophic event, such as an earthquake, is likely to cause trauma. Trauma can often take the form of post-traumatic stress disorder. Individual responsibility, combined with the family context and the social environment, can contribute to rehabilitation.

The earthquake in Samos upset the local community. Seismic activity appears to have caused symptoms of traumatic stress in those who had direct exposure to catastrophic events and may have exacerbated the mental health of people suffering from mental illness before the earthquake. For most people who did not feel that their life was threatened, the earthquake is but a recollection. If two teenagers had not tragically lost their lives, we could have concluded that Samos endured the earthquake. This resilience could be studied in detail and the factors that contributed to it could be clarified.

It is important to clarify what exacerbates vulnerability and what helps a traumatised person (or family or even a community) to resist vulnerability and cross over to resilience. According to international literature, a large number of demographic, psychosocial and biological factors are related to the treatment of trauma and the emergence of resilience and post-traumatic growth. Adaptation (on an individual, family or community level) to a new functional reality after the earthquake is only possible through the collaboration and interaction of systems related to these factors. Research, after a natural disaster, can shed light on this interaction. Also future studies will clarify individual, familial and social needs in order to organize better interventions. The effectiveness of interventions can also be studied in relation to the time of their implementation.

References

Read the next article:

ARTICLE 5/ ISSUE 18, April 2021

The Approach of Synergic Therapeutic Complexity with Involuntarily Dislocated people

Renos Papadopoulos , University of Essex
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