This month marks the 100th anniversary of the paradigmatic American catastrophe, the San Francisco Earthquake and fire of April 18, 1906:
At almost precisely 5:12 a.m., local time, a foreshock occurred with sufficient force to be felt widely throughout the San Francisco Bay area. The great earthquake broke loose some 20 to 25 seconds later, with an epicenter near San Francisco. Violent shocks punctuated the strong shaking which lasted some 45 to 60 seconds. The earthquake was felt from southern Oregon to south of Los Angeles and inland as far as central Nevada.
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In the public's mind, this earthquake is perhaps remembered most for the fire it spawned in San Francisco, giving it the somewhat misleading appellation of the "San Francisco earthquake". Shaking damage, however, was equally severe in many other places along the fault rupture. The frequently quoted value of 700 deaths caused by the earthquake and fire is now believed to underestimate the total loss of life by a factor of 3 or 4. Most of the fatalities occurred in San Francisco, and 189 were reported elsewhere.
The scale of the devastation and loss of life was stunning and traumatized the Nation and the Bay area for years. After the fact, the lessons learned were incorporated into building codes (fireproofing in buildings, sturdier construction) and eventually our technology made it possible to experience later earthquakes as minor disasters marked by much less physical damage to structures and minimal loss of life. Earthquakes of magnitude 7 in America are no longer traumatic, overwhelming catastrophes; they are manageable natural disasters.
This week recordings of the 911 calls from 9/11 were released. All but one of the recordings has the caller's voice omitted and all we hear are the phone operators, who realize with growing anguish through the morning that they are not dealing with a typical emergency call. Here is an exchange between two people who are slowly becoming aware of the enormity of the disaster:
Operator 1490:
"This is operator 1490. I have a call from a lady at the Bank of New York. She states that the World Trade Center..."Operator 8736:
"Yeah we got that already."Operator 1490:
"She states that at the northwest side, that there's a woman hanging. There’s an unidentified person hanging from the top of the building. OK, that’s all the information. That's One World Trade Center."Operator 8736:
"Alright, we have quite a few calls."Operator 1490:
"I know."Operator 8736:
"Jesus Christ."Operator 1490:
"I know."
Put yourself in their shoes for a moment. They have been trained to know how to respond to fires, assaults, man with a gun calls, but nothing in their experience could prepare them for such an unprecedented event, two passenger jets slamming into two skyscrapers in New York City. 9/11 was a traumatic event in the life of New York and our nation, but what is often lost when discussing traumatic events is a precise understanding of what it means for a system to be traumatized.
According to the New York Times, within minutes the 200 Police Department operators were swamped with calls of the planes hitting the towers:
More than 3,000 calls flooded the 911 system in the first 18 minutes, and more than 57,000 in the 24 hours after the first plane hit the north tower. The calls from inside the towers totaled about 130, though many of those came from people in groups, sometimes of 100 or more.
Like everyone who collided in one way or another against this tragedy, the emergency operators had their own personal journeys to make on this day, states of mind marked by large and small epiphanies. The difference was that the operators had to continue doing their jobs while jousting with the raw reality inside the towers.
At times, the operators seemed overwhelmed. Then, perhaps trying to cut the tragedy down to something familiar, they often fixed on technicalities like which codes should be used to log the calls.
Here is the wikipedia definition of Psychological trauma [Emphasis mine-SW]:
Psychological trauma is a type of damage to the psyche that occurs as a result of a traumatic event. A traumatic event involves a singular experience or enduring event or events that completely overwhelm the individual's ability to cope or integrate the ideas and emotions involved with that experience. Trauma can be caused by a wide variety of events, but there are a few common aspects. It usually involves a complete feeling of helplessness in the face of a real or subjective threat to life, bodily integrity, or sanity. There is frequently a violation of the person's familiar ideas about the world, putting the person in a state of extreme confusion and insecurity. This is often seen when people or institutions depended on for survival violate or betray the person in some unforseen way.
The executive functions of the ego are those higher functions of our minds that allow us to negotiate stress and effectively make our way in the world:
Executive functions are elaborate functions of logic, strategy, planning, problem-solving, and hypothetico-deductive reasoning.
These capacities help you solve all complex problems encountered in daily life. Usually, you need to analyze the context and find the goal to be able to anticipate the probable consequences of the decision you are going to take.
Over the last few decades Psychologists have begun to explore and elucidate the various functions of the mind and brain that allow us to function at a high level. These functions tend to be the latest to develop and the most susceptible to disruption by trauma. When a person is traumatized, their ability to reason, tolerate anxiety and stress, problem solve, plan and understand are lost or severely impaired. We do not expect a traumatized person to act at the highest level of functioning and recognize they need significant support in order to recover their previous level of function. Traumatized patients are often found to be psychically numb and incapable of appropriate action; most of all they need time for their systems to re-equilibrate.
The analogue to executive functions in our society would include such systems as the 911 emergency notification system, the police, fire fighters, emergency medical technicians; all the institutions that keep our society functioning smoothly. When events overwhelm the ability of the executive functions to contain the damage, the entire system can crash.
Terrible disasters, by definition, overwhelm the ability of our system (and indeed of any extant system) to cope. By virtue of their unprecedented magnitude, 9/11 and Katrina overwhelmed our systems ability to cope. In our post-disaster recriminations and attempts for short term political profit, "cya" blame shifting, and our traumatized attempts to regain our equilibrium, we lose sight of the fact that certain disasters can never be adequately planned for.
The Bird flu is anticipated to make the jump to person to person transmission at some unpredictable future time; until it happens, we can never be fully prepared for all possible shapes the pandemic can take. We could spend several billions of dollars and possibly have enough Tamiflu stockpiled to protect most people. However, if the virus mutates into a non-lethal form just prior to person to person transmission, we will have wasted billions perhaps better spent preparing for the next, though unforeseen, pandemic. Alternatively, the virus could mutate and become resistant to Tamiflu rendering our billions completely wasted. Can anyone predict the effects on our systems of bird flu, quarantines, isolation, death rates somewhere between 2-3% and 50%? Of course not; we can construct scenarios, all plausible, can even "war game" it but once the flu hits the fan, all bets will be off. This is not a reflection on anyone's failure to prepare but rather on our failure to be able to prepare for traumatic events. If the flu hits and it is manageable, by definition it will not be traumatic; if it is unmanageable despite our bets efforts, it will be because our human systems have been overwhelmed. By all means we should ramp up our research on the basic mechanisms of disease, viral recombination, pathogen virulence, etc, but to blame "authority" for disasters is unhelpful, unwise, and unfair; it also perpetuates the dangerous belief that all we need is an almighty government and we will all be safe.
Take this to another level; the recriminations and carping post-9/11 have been sickening. The 9/11 Omission was an embarrassment that, predictably, was more interested in covering up culpability than exposing systemic errors. It should never have come to that. The fact is that even those who predicted airplane assaults on skyscrapers could never have planned for the specific scenario (and no one would have tolerated the intrusive TSA behavior pre-9/11; what guarantees there will not be another 9/11 is the behavior of the passengers on United 93, not anything the TSA has done.) Practice disasters, by their very nature as not-real scenarios, lack the authenticity of trauma; fantasies cannot traumatize in quite the way reality, with all its surprises, too often can. Can anyone plausibly argue that any amount of practice for disaster will prepare us for a nuclear 9/11? A nuclear weapon detonating in an American city (or any other city anywhere in the world) will be traumatizing on so many levels, not least because it will be (effectively) unprecedented. No amount of preparation can prevent it from overwhelming our ability to cope. (If you plan to bring up Hiroshima and Nagasaki, please explain how those experiences can help us prepare for a future nuclear strike in any meaningful way; Japan was traumatized for years by the events at those two cities and the people were thoroughly overwhelmed.) Unless we plan on stationing thousands of troops outside every potential target city, the idea that in the immediate aftermath of such a disaster we will be able to do more than try to survive for the next five minutes is risible. The survivors will be on their own for anywhere from hours to days; if there are multiple detonations in several cities, it could be weeks to months before society is functioning at any kind of adequate level again.
The lesson of 9/11 and Katrina that too few want to understand, because it is so disturbing, is that when the next catastrophe of traumatic proportions strikes, the only thing we can plan for is to be overwhelmed and traumatized until the healthier parts of the body politic can get help on the way.
Those whose disaster planning involves waiting to be told by the government what to do have no idea what a real disaster is and what kinds of disruption trauma causes. Let us all hope and pray that they never have to find out.
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