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Oklahoma City Workers Found to Be Resilient

Suffered few long-term mental health problems after bombing

TUESDAY, Dec. 17, 2002 (HealthDayNews) -- Their gruesome task -- piecing together and identifying the dead in the Oklahoma City bombing -- would give anyone nightmares.

However, a new study finds that people who handled bodies after the disaster suffered almost no mental health problems two years later.

Researchers surveyed 51 body handlers, who included career medical examiners, pathology residents, dentists and students in those fields. The survey found almost none of them showed symptoms of post-traumatic stress disorder or depression in 1997, two years after the disaster.

Only four body handlers described increased alcohol use or seeking ongoing treatment for mental or physical problems, which could be a sign of ongoing trauma, says study author Dr. Phebe Tucker, a professor of psychiatry at the University of Oklahoma Health Sciences Center in Oklahoma City.

Females, younger people and those who knew a victim or who had little professional experience handling disasters were more likely to have symptoms of post-traumatic stress disorder.

"The group as a whole did very well and they appear to be very resilient," Tucker says.

The study appears in the December issue of the American Journal of Orthopsychiatry.

Tucker says she was somewhat surprised at the ability of the body handlers to bounce back because their task was made more difficult by a sickening fact: Many of them knew someone who was killed.

Thirty-two of the body handlers, or about 63 percent, knew someone who perished in the blast. Past research has found higher rates of post-traumatic stress disorder and depression when people can identify with victims, Tucker says.

The study didn't determine what helped the body handlers cope.

Tucker suspects they were helped by the supportive environment in Oklahoma City, which included things as simple as providing refreshments to the body handlers to having on-site mental health professionals.

"The chief medical examiner was very attentive to the needs of his people," Tucker says. "There was a tremendous amount of community support. They felt they were doing something useful and necessary."

Robert Hayes, a professor emeritus of psychology at Ball State University, also believes the supportive environment helped. "The whole nation was giving everything it could," Hayes says. "No one felt alone."

As a volunteer Red Cross disaster mental health officer, he arrived on site a week after the blast and stayed for 10 days. While he dealt mainly with families of the victims, Hayes says the medical workers had "debriefing" sessions in which they could talk about their feelings.

"They could talk to a mental health professional, who could tell them the feelings they were experiencing were totally normal," Hayes says.

Mental health workers also reminded and encouraged body handlers to practice "self-care" -- getting back to their routine of eating, sleeping, recreation and spending time with family as soon as possible.

Charles Figley, a professor of social work at Florida State University and an expert in trauma, says he wasn't at all surprised by the findings. Medical examiners and others are trained to separate their emotions from the task at hand. People who figure out, either during training or through experience, that they can't handle the stress gravitate toward different fields, he explains.

"These are professionals at handling human remains, so consequently they have worked through and overcome the issues," Figley says.

Medical examiners are taught not to personalize or connect with victims. "It's drummed into their heads, 'Don't listen to the news. Don't get into the emotional psychosocial issues that go along with a disaster,'" Figley says.

Say, for example, a medical examiner finds a severed finger in the wreckage. It sounds cold, but they're taught "rather than seeing that the finger of a human being who has suffered, you learn to say to yourself, 'This is my job. This is my responsibility. If I get caught up in the emotions, I'm not going to be able to do my job. I'm letting my boss down and not fulfilling my responsibilities.'"

Still, Figley cautions the survey may underestimate the extent of the lingering stress. In her study, Tucker notes that not everyone responded to the survey.

"The ones who dropped out are the ones I would worry about," Figley says.

What To Do

The National Center for Post-Traumatic Stress has more information on recognizing it and coping with it. You can try the National Institute of Mental Health for information on dealing with depression.

SOURCES: Phebe Tucker, M.D., professor, psychiatry, University of Oklahoma Health Sciences Center, Oklahoma City; Robert Hayes, E.E.D., professor emeritus, psychology, Ball State University, Muncie, Ind.; Charles Figley, Ph.D., professor, social work, Florida State University, Tallahassee; December 2002 American Journal of Orthopsychiatry
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