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We’ve all heard the common cliche that time heals all wounds, but does it apply to traumatic events and acts of violence that seem to defy rational explanation? Since a bomb destroyed Oklahoma City’s Alfred P. Murrah Federal Building on April 19, 1995, mental health professionals and researchers in the area have been seeking scientific answers to this question.

“As the occurrence of terrorism increases nationally and internationally, it’s important to understand the effects of these acts on the emotional well-being of survivors,” says Phebe Tucker, MD, professor and director of the Psychiatry and Anxiety Research Clinic in the Department of Psychiatry and Behavioral Services at the University of Oklahoma Health Sciences Center. “This can help mental health providers to identify people at risk and start early treatment. It can also help us identify coping mechanisms so we can help others to cope.”

Tucker spoke with Nursing Spectrum about four research projects conducted at the OU Health Sciences Center in the wake of the worst case of domestic terrorism in U.S. history. The projects were implemented in stages up to seven years after the bombing.

Erosion of trust

The first study involved 86 people who sought treatment six months after the bombing with Project Heartland. This program was developed with funds from the Federal Emergency Management Agency to provide crisis counseling, support, outreach, and education for individuals affected by the bombing.

The purpose of the study was to identify predictors of post-traumatic stress disorder (PTSD) by using retrospective reports (remembered reactions) of feelings participants had at the time of the bombing. These reports were then compared to patients’ statuses six months later. Tucker says the Project Heartland study revealed that PTSD symptoms correlated with retrospective reports compatible with disassociation at the time of the bombing.

“In other words, they tuned out,” Tucker explains. “Or they felt very anxious or fearful just after the bombing.”

Tucker says these are logical findings, but the study also produced a twist.

“We didn’t expect to find that those who were more likely to have PTSD symptoms were also more concerned about other people’s reactions at the time of the bombing,” she says.

Tucker was admittedly perplexed by this apparent tendency toward mild paranoia. “The only thing we could come up with is that this is a link to terrorism [in general]. Because when you have a terrorist act, you look around and are concerned with what others are doing.”

Researchers have concluded this behavior represents an erosion of society’s sense of trust.

Support key for body handlers

The second study examined 51 people who handled bodies of victims after the bombing. This group typically consisted of first responders; medical examiners; and other professionals involved in rescue, recovery, and identification of deceased victims. However, this study focused upon body handlers in the medical examiner’s office.

The magnitude of the disaster exceeded the staffing capability of the medical examiner’s office. Medical professionals from the community — whom Tucker describes as “altruistic volunteers” — had the grisly task of identifying decomposing and dismembered bodies over a 17-day period. Added to this already complicated situation, 70% of these volunteers had no personal forensic or disaster experience, and 63% knew a bombing victim personally.

Although body handlers are traditionally at a high risk for PTSD, individuals in this case demonstrated remarkable post-trauma resiliency. In fact, a year after the bombing they displayed few symptoms of PTSD, and symptoms declined further after another year.

“We looked at coping mechanisms folks used, and they said they spent more time with others and focused on the positive,” Tucker explains. “That’s one good thing that came out of the bombing. There was a tremendous amount of community support and a spirit of altruism.”

She also attributes the healthy recovery of the body handlers to the leadership and support the medical examiner provided. “Dr. Fred Jordan is a very charismatic and caring individual,” Tucker says. “And I think he took very good care of his examiners.”

Different perspectives

The Murrah bombing struck all of America at its core, including people who don’t look like they just came out of a Norman Rockwell painting. A third study took into account Asian and Middle Eastern immigrants who lived in certain areas of Oklahoma City. Tucker describes this group as quiet and not directly exposed to the bombing’s effects, so their experiences were frequently overlooked.

Despite having minimal direct exposure, this population displayed notable symptoms of PTSD. When researchers dug deeper, they found out why.

“Many of them reported being exposed to terrorist events or political violence in their countries of origin,” Tucker says. “In fact, that’s why they came to this country.”