Trauma survivors more resilient than previously thought

People caught up in terrorist attacks or natural disasters are more resilient, both as individuals and in groups, than previously thought.

Far from being passive "victims" they can be highly organized survivors, so much so that they should be involved in drafting mental health guidelines to deal with major disasters.

Richard Williams, professor of mental health strategy at the University of Glamorgan, was speaking at a symposium on conflict and mental health at the Annual Meeting of the Royal College of Psychiatrists at Imperial College London.

Prof Williams drew a distinction between distress - a perfectly understandable reaction to a traumatic event - and a post-traumatic stress disorder (PTSD) and said that it was important not to medicalise, 'ordinary processes' such as bereavement.

He defined resilience as a person's ability to adapt psychologically, emotionally and physically to the situation "reasonably well" and without lasting detriment to themselves, or their relationships.

Resilience is not about avoiding short-term distress - indeed resilient people include those who show their distress, he told delegates. It is about adapting to their situation and being realistic about their recovery. "Resilient people may experience a period of distress and then recover with the support of their families and friends."

Strong relationships, an ability to receive help and social support, a belief in their own competence and strong self-esteem, lie at the heart of resilience. "What happens in your past comes alive in you during a disaster and you draw on that," said Prof Williams.

Survivors from disasters and terrorist events should be offered responses that draw on psychological first aid, Prof Williams told the conference. Being protected from further threat, being consoled and comforted and given immediate physical care, are all vital, as is being reunited with loved ones and linking up with other support services, if necessary.

The notion that crowds panic following disaster and terrorist attacks, is a myth. During the London bombings on 7 July 2005, the 'first responders' were the survivors in the bus and underground carriages in which the terrorists chose to detonate their bombs, as well as passengers on an adjacent train, said Prof Williams.

Referring to descriptions in a book by a London journalist who was present, and research, Professor Williams said: "Most of the survivors continued to experience thoughts of threat but the prevailing response was of calm, mutual help, concern and ordered behavior. They remained functional and did not panic. This group of people stuck in a very serious situation were behaving resiliently. This should influence what we do in the aftermath of a disaster."

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Williams R. Resilience in the face of terrorism and disaster Presentation, RCPsych Annual Meeting, London 2008 Jul 2.