Emotional Effects of Oklahoma City Bombing Linger
By Elissa Crocker, RN, BSN
March 28, 2005
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.”
Researchers addressed the long-term effects of trauma in direct survivors of the bombing and their children in the fourth study. Ironically, this study was scheduled to begin in September 2001. The terrorist attacks in New York, Washington, D.C., and the plane that crashed in rural Pennsylvania, as well as the anthrax-based bioterrorism scares that followed, raised concern that acts of terror would continue to escalate.
Consequently, researchers resumed their work, using a noninvasive, low-stress interview process that involved recall and verbalization of bombing memories. Age- and gender-matched community-control groups were also included. The research team conducted physiologic assessments and looked at cortisol levels and symptoms of PTSD and depression. When they crunched the data, researchers were surprised.
“We found that adult survivors who were directly impacted had an increase in their heart rate and blood pressure during the interview,” Tucker says. “What we didn’t expect to find was that their children also had an increase in heart rate and blood pressure.”
Tucker says the findings support “an intergenerational transmission of the trauma experience from the empathic parent to the child.”
This phenomenon has also been seen in survivors of the Holocaust and their children. The “inheritance” of trauma is associated with the parents’ high levels of anxiety and subsequent inability to maintain a balanced perspective in the face of difficult circumstances. These negative coping mechanisms can significantly interfere with children’s developmental progress.
Another interesting outcome of the fourth study was that the adult community age -and gender-matched control group also expressed increased physiological responses — increased heart rate and blood pressures — during the interviews, although not to the extent of the direct victims.
“In a disaster community, everyone is exposed to some degree,” Tucker says.
The body remembers
Although cortisol levels in the direct survivors as a whole were the same as the comparison subjects, Tucker says in 10 survivors with documented cases of PTSD, cortisol levels tested high.
“Cortisol is a stress hormone,” she explains. “If you’re in a motor vehicle accident, you have high cortisol levels. In PTSD, you see low cortisol levels.”
Initially puzzled, researchers attribute this increase to the anxiety of study participation and retrospective reporting. “Even after six or seven years, direct survivors of terrorism carry bodily memories of the trauma, even if they report they are doing well overall,” Tucker says. “There is still something that increases their heart rate and blood pressure when they remember events.”
Although researchers don’t know if their findings will correspond with a risk for developing cardiovascular disease down the road, they do indicate a readiness for the fight or flight response.
“Something that’s learned at the point of trauma is kicked in that prepares people for action in case there’s another attack,” she says. “It shows that something lingers on.” According to Tucker, research is ongoing in an effort to understand resilience, including not getting ill, recovery, getting over illness, and post-traumatic growth.
Although the research continues, Tucker says insight has definitely been gleaned from the studies. In addition to identifying a novel predictor of PTSD, paranoid tendencies at the time of a terrorist act, researchers also documented the effective coping mechanisms of altruism, group support, and having a positive outlook. They also recognized that those with a history of going through terror or violence are more vulnerable, that trauma can be transmitted environmentally, and that somatic memories of trauma are real.
“Health care policy-makers can use this information to provide effective treatments immediately after a disaster and over the long haul,” Tucker says. “Our colleagues in New York City and other places have been very interested in what we’ve found.”
The impact of PTSD
Defined as a psychiatric condition that occurs after experiencing life-threatening events such as military combat, natural disasters, incidents of terror, serious accidents, or acts of violence, post-traumatic stress disorder frequently manifests a mixture of biological and psychological changes. Victims may feel detached and estranged, frequently reliving the experience through nightmares and flashbacks. PTSD, which is often complicated by depression and substance abuse, can impair an individual’s ability to function in family and social life, leading to occupational instability, marital and family discord, and divorce.
Although anxiety, anger, sadness, and other behavioral changes are normal for traumatized individuals to experience on a temporary basis, a lingering inability to achieve closure and a satisfactory resolution to psychological trauma over the passage of time can be indicative of PTSD.
Elissa Crocker, RN, BSN, is a freelance writer.