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The Medical Implications of Nuclear War, Institute of
Medicine. ~ 1986 by the National Academy of Sciences.
National Academy Press, Washington, D.C.
Psychological Consequences of Disaster:
Analogies for the Nuclear Case
JAMES THOMPSON, PH.D.
M'ddlesex Hospital, London, England
INTRODUCTION
No disaster experienced in recorded history resembles the potential
destruction of major nuclear war. Nonetheless, past disasters can give us
pointers to the likely responses of those who survive the immediate effects,
though it will always be necessary to interpret the findings carefully with
due allowance for the differences that restrict the applicability of the
comparison.
Localized disasters such as explosions and fires give a partial view of
likely reactions, which, in the case of nuclear war, would be repeated
across whole continents. Earthquakes and floods give a better understand-
ing of large-scale and generalized destruction, though it is correspondingly
more difficult to comprehensively evaluate how everyone reacted. All
these disasters differ from the nuclear case in that there is always an
undamaged outside world able to offer some help and assistance. Fur-
thermore, the imponderable effects of radiation will impose a delay on
rescue attempts, since most people will be unable to establish when it is
safe to come out from what remains of their shelters. The electromagnetic
pulse is likely to have severely damaged the communication networks on
which all effective relief operations depend. Most of all, the probable
extent of the physical destruction to civilization would be so extensive as
to make unlikely any concerted rescue operation, even if it could be
mounted. Most people would be concerned with their own survival, and
290
OCR for page 291
PSYCHOLOGICAL CONSEQUENCES OF DISASTER
291
the illusion of centrality that is held by disaster victims would, for many,
be more of a reality than an illusion.
Classification of Disasters as Analogies for the Nuclear Case
It is a matter of considerable relief that, as yet, there are no references
to how people have reacted to a major nuclear war. Therefore, in order
to provide some illustrative guidance, data about other catastrophes have
had to be used as analogies for the nuclear case.
Disaster Agents
A descriptive system first put forward by Hewitt and Burton (1971),
and later adapted by Leivesley (1979), can be used to divide disaster
agents into five categories:
Atmospheric: cyclone and hurricane, tornado, drought, snow, fire
Hydrologic: flood, storm surge, Tsunami
Geologic: earthquake, landslide, volcano
Biologic: epidemics, crop diseases, and biological warfare
Technologic: Accident (engineered structures, transport, chemicals, nu-
clear reactors, nuclear weapons, nuclear weapons testing, radioactive ma-
terials, fired, war (conventional bombing, nuclear weapons)
Disasters can also be categorized by the extent of energy release, fre-
quency of occurrence, and period of duration. An earthquake can last for
a few seconds, an avalanche for a few minutes, a blizzard for several
hours, a flood for days or even weeks, and a drought for months or even
years.
In general, the disasters that cause most casualties, earthquakes, floods,
and cyclones, occur with the lowest frequencies. This means that such
terrible events tend to be rare in most people's experience, and thus it is
hard to learn how to predict them and protect people against their worst
effects. The power of these natural events may also make it seem futile
to take many protective steps.
In a more general sense, there are a wide variety of hazards which may
lead to disaster. The perception of these hazards has an important impact
on whether precautionary steps are taken. Hazards can be classified into
the following categories:
Natural tornado, earthquake, flood
Quasinatural air and water pollution
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292
Social-epidemic and riot
Man-made building collapse, fire, car accident, boat accident
HEALTH CONSEQUENCES OF NUCLEI We
People's perceptions of hazard have been studied by factor analytic
methods (Kales, et al., 1976), and it has been found that they can be
organized into two factors. The first factor, which accounts for most of
the variation in perceptions, is orderly, relaxed, and peaceful versus cha-
otic, tense, and ferocious. The second factor is natural, uncontrollable,
and fair versus artificial, controllable, and unfair. From this it will be
evident that wars are seen as chaotic, tense, and ferocious and also arti-
ficial, controllable, and unfair.
Turning now from the disasters themselves to the impact that they have
on humans, differences exist between the levels at which the response of
victims to the disaster can be studied. Individuals can be studied, or the
level of analysis could be raised to that of the family, the community,
and society as a whole.
Appropriateness of Analogies
The problem with the approach by analogy is that no single disaster
approximates all the features of a nuclear war. Although Hiroshima and
Nagasaki represent the only examples of nuclear bombing, the weapons
used there were very much smaller in their explosive power than those
that are available today. The bombings occurred without any warning, the
construction of housing was very different from that of modern European
cities, and the population had no knowledge of nuclear explosions or
radioactivity. In terms of psychological reactions, Japanese culture was
very different from that of present-day Europe, with there being a high
degree of group identification and respect for authority.
Most of all, the surrounding areas were not under nuclear attack and
were able and willing to give some assistance. Communications were
maintained at a national level, so that radio and telegraph, roads, and
railways in the surrounding countryside were all functioning. Despite this,
the basic effect of the blast was the same.
A modern nuclear war could involve the detonation of large numbers
of far more powerful weapons, with or without any warning, over large
sections of the Northern Hemisphere. Such a nuclear war might last hours,
weeks, or months and the electromagnetic pulse could serve to disable
most electronic communications.
In terms of sheer physical destruction, earthquakes give an indication
of the effects of massive blast damage, but not even these physical effects
are really comparable. Depending on the intensity and waveform of the
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PSYCHOLOGICAL CONSEQUENCES OF DISASTER
293
quake, different types and degrees of damage occur, but they are different
in form from blast damage. In some cases the tremors preceding the major
event serve as a warning, particularly in areas where earthquakes have
already been experienced by the population. Although earthquake damage
can be widespread, radio communications are generally still possible and
there is no fear of immediate contamination, as would be the case with
radioactivity.
Massive fires resemble the effects of postnuclear firestorms, but, once
again, present data are based on the fact that there is an undamaged outside
world to come to the assistance of those in the fire zone. Hurricanes and
tornadoes replicate many features of blast damage, but they generally
come with some warning and do not leave immediately contaminated
ground. Floods cause widespread damage, generally come with some
warning, and often lead to fears of health risks. Major epidemics leave
the physical world undamaged, but they replicate the immense depletion
of population that would follow a major nuclear war and come closest to
revealing attitudes to radioactive contamination.
Table 1 summarizes the major features of disasters as analogies for a
major nuclear war and gives very rough, and highly debatable, estimates
of impact for illustrative purposes only. It serves not so much to tie down
each disaster into a rigid system of measurement, but simply to summarize
some of their major features to make comparisons possible.
ANALYSIS OF HUMAN REACTIONS TO DISASTERS
Although past disasters are imperfect guides to the future, they must
be studied if likely future reactions are to be understood. Leivesley (1979),
in a study on disasters and welfare planning, gives over 400 references
and Kinston and Rosser (1974) give 117. Quarantelli (1980) has worked
extensively in this area, and Churcher et al. (1981) have reviewed the
literature with reference to nuclear war. Kinston and Rosser (1974) re-
viewed the psychological effects of disasters, which they define as situ-
ations of massive, collective stress, in an attempt to draw some conclusions
from the extensive but unsystematized literature on human reactions to
catastrophes. They note that there has often been a reluctance to fully
investigate these reactions, as if researchers were averting their eyes from
what they found. It was 17 years before any attempt was made to study
the psychological consequences of the bombings of Hiroshima and Na-
gasaki. Even civil defense exercises set up to deal with simulated disasters
fail to meet the pressing psychological needs of the supposed victims, and
reveal an apparent unwillingness to confront the misery of personal trag-
edy.
OCR for page 294
294
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OCR for page 295
PSYCHOLOGICAL CONSEQUENCES OF DISASTER
295
Even when prompt and effective treatment is available, as in the burns
victims described by Cobb and Lindemann (1944), and despite excellent
planning and precautions to minimize psychological stress, 43 percent of
the survivors showed evidence of psychiatric illness. This indicates the
pressing need to investigate as fully as possible how people react to
disasters and to be aware of the psychological impairment which usually
results.
Despite a measure of reluctance to investigate the consequences of
catastrophes, some features have been identified. Kinston and Rosser
(1974) use a classification system based on the work of Tyhurst (1951)
and Glass (1959), who categorize the phases of disaster as threat, warning,
impact, recoil, and postimpact. Although these categories merely represent
points along a continuum and describe average reactions which may not
occur in all people, they help us understand the course of events.
Threat
All life is subject to potential hazards, but some hazards are more evident
and dangerous than others. Earthquake belts, volcanic slopes, war zones,
and floodplains all carry particular risks. In terms of the risk of nuclear
war, countries that themselves deploy nuclear weapons are especially at
risk, and within those countries missile bases and possibly urban centers
are likely targets. The evaluation of risk is a problematic subject, involving
subjective estimates and attempts at calculated probabilities.
Slovic and Fischoff (1980) have looked at public perceptions of a variety
of hazards and have shown that perceived risks are often at variance with
actual risks. These differences may be partly accounted for by the prom-
inence that the media gives to dramatic events, thus increasing their sa-
lience over less newsworthy occurrences. But Slovic et al. (1982) have
shown that when both experts and members of the public are asked to
rate hazards by other perceived characteristics such as whether the risk is
voluntary and what the extent of catastrophic potential might be, much
of the difference between the two groups disappears.
Threat is the condition under which we live at present. It is evident that
a pressing danger exists, but the perceived salience of the threat varies
from person to person and from time to time. Chivian (1983) has reviewed
children's sense of nuclear threat, and argues that this is more widespread
and substantial than generally realized. Escalona (1963, 1965, 1982) has
extensively studied children's and adolescents' fears about nuclear war,
which she feels threatens their belief in the future and the trustworthiness
of their parents. Schwebel (1982) suggests that the nuclear threat is a
contributing factor in anxiety and other disorders noted among teenagers.
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296
HEALTH CONSEQUENCES OF NUCLEAR WAR
Beardslee and Mack (1982) conclude that children are deeply disturbed
by the threat of nuclear war and have doubts about their own survival. In
the United Kingdom, 52 percent of teenagers feel that nuclear war will
occur in their lifetime, and 70 percent feel that it is inevitable one day
(Business Decisions, 19831. Tizard (1984) reviewed the literature on chil-
dren's fears about nuclear war. She found that many of the studies were
unsystematic, but that methodologically sound studies, which had asked
large representative samples of graduating high school students in the
United States neutral questions about the future, found increasing levels
of alarm about the nuclear threat. Bachman (1984), in a study of the sort
described above, found that the proportion of adolescents who often wor-
ried about the nuclear threat rose from 7 percent in 1976 to 31 percent in
1982, and the feeling that nuclear or biological annihilation would occur
in their lifetimes rose from 23 percent in 1976 to 35 percent in 1982.
Solantous et al. (1984), in a survey of 5,000 Finnish 12- to 18-year-
olds, found that even in this nonnuclear, neutral country, 79 percent of
the 12-year-olds and 48 percent of the 18-year-olds named a probable
future war as their major fear.
Adults share this concern and show a general perception that they are
at risk because of nuclear weapons, though this is rarely stated as the
most pressing worry people face. A 1982 Gallup Poll found that 72 percent
of an adult sample was worried about nuclear war, and 38 percent thought
that nuclear war would occur.
In general, there is no consistent relationship between such anxieties
and attitudes to nuclear weapons policies. Despite evidence of anxiety in
many people, the most consistent reaction appears to be some form of
denial, which Lifton (1967) describes as "consistent human adaptation."
Some people avoid the subject totally. Other reactions are resignation,
helplessness (Seligman, 1975), fatalism, and unquestioning trust. The
myth of personal invulnerability, that necessary fiction of everyday life,
holds strong and allows people to continue the necessary tasks of living.
All authority tends to be displaced onto leaders and authorities, and people
tend to feel helpless and unable to influence events through their actions.
Warnings
To understand the way that people respond to warnings of impending
catastrophes, it is necessary to review the accounts that have been given
of those disasters in which warnings were possible. A few points must be
considered about the relationships among warnings, stress, and behavior.
For a warning to be effective it must have a reliable association with the
threat, and there must be a credible action to take in response to it.
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PSYCHOLOGICAL CONSEQUENCES OF DISASTER
297
However, humans have considerable shortcomings as estimators of the
probabilities of future hazards (Slovic et al., 1974; Kahneman et al., 1982~.
Even when a hazard is acknowledged, people may perceive it in many
different ways, seeing it as improbable or, on the other hand, so inevitable
as to vitiate any human actions.
Research on responses to stressors indicates that appraisal of threat is
a psychological process, and knowledge about a stressor tends to improve
coping responses in any situation in which coping responses are possible.
In general, having something to do that reduces the threat, or even simply
appears to do so, reduces the impact of stressors. In studies of experimental
stress on animals, the least affected groups are those that receive warnings
of impending shocks and can reduce the probability of receiving them by
carrying out avoidance behaviors, however onerous. The groups that suffer
most stress, as measured by the rate of stomach ulceration, are those that
suffer an equal number of shocks without benefit of warning and cannot
reduce their frequency by any instrumental means (Weiss, 1973~. Without
a warning these animals can never relax, since they have no safety signal
and could experience a shock at any time. A reliable warning, on the
other hand, does cause temporary high levels of anxiety, but once the
danger is over, safety can be assumed by the absence of danger warnings.
Such helpless animals suffer considerably, and their helpless behavior has
many similarities to human depression (Seligman, 1975), which is char-
acterized by a failure to initiate responses, even when these might lead
to the avoidance of further stresses. The safety signal hypothesis should
explain why the conventional bombing attacks on London appeared to
cause less psychological stress than those of the V-bombs later in the war.
In the first case the air raid sirens and the eventual all clear provided
reasonably reliable signals of safety, but with the rockets no such indication
was possible.
Studies of Disaster Warnings
Simply because a warning has been given does not mean that it will be
heeded. Denial can continue in some individuals up to the moment of
impact itself. During the Hawaiian tidal wave of May 1960, evacuation
was minimal (Lachman et al., 19611; and on the banks of the Rio Grande,
festive crowds watched and cheered the rising floodwaters (Wolfenstein,
1957~. These active denials of danger have their place in everyday life,
but when they are carried over in the face of a real threat, they constitute
a danger in themselves, since they obstruct preventative action. The myth
of personal invulnerability still holds. A measure of this delusion can be
gauged by the finding that the majority of people believe that they are
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HEALTH CONSEQUENCES OF NUCLEAR WAR
more likely than average to live past 80 years of age (Britten, 19831. Once
the danger is admitted, people who are very trusting may overrely on
official pronouncements. Those who lack faith in parental establishment
figures may be susceptible to rumor. Precautionary activity depends on
the adequacy of information as to what needs to be done and whether a
group effect begins to take place once people take the warning seriously.
Conflicting advice is usual (Churcher et al., 1981), and many people may
be unable to decide on a consistent response.
Some studies have looked at the warning process in detail, and these
will be considered as analogies for likely reactions to warnings of an attack
with nuclear weapons.
Short Warning Times
Drabek and Stephenson (1971) have given a detailed account of the
behavior of 278 families randomly selected from approximately 3,700
families who had been evacuated from their homes prior to a flood in
Denver, Colorado. At 5:30 p.m. one cloudy afternoon, in which there
had been occasional showers throughout much of the day, police cars
cruised past suburban houses with the following announcement: "A 20-
foot wall of water is approaching this area. You have 5 to 15 minutes to
evacuate. Leave for high ground immediately."
The events leading to this announcement need a brief summary. After
a tornado earlier in the day, a wall of water was seen sweeping down one
of the tributaries of the South Platte River, which flows through Denver.
The local sheriff raised the alarm at 3 p.m., and this was received with
some incredulity, since a major flood had not occurred on the river for
100 years. By 4 p.m. police began evacuating those closest to the river,
and by 5 p.m. they broadened the area of evacuation. Throughout the
warning period radio and television responded in a sporadic fashion. Some
stations carried on with normal programs, while others gradually shifted
to increased flood coverage. This led many people to switch from one
station to another in an attempt to confirm conflicting stories which seemed
impossible to believe. The wide area of television coverage meant that
people in safe areas converged on the danger zone to contact friends and
relatives or, in the largest number of cases, simply because of curiosity.
From the viewpoint of the families in the danger area, their many attempts
to confirm the warnings frequently yielded contradictory information, and
of those who evacuated immediately, as many as one-third returned home,
often infiltrating through police lines which had been set up to prevent
looting. At 8:15 p.m. the floodwaters arrived, causing considerable dam-
age but no loss of life because of the evacuation.
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PSYCHOLOGY CONSEQUENCES OF DISASTER
299
Drabek and Stephenson argue that five analytical characteristics are
especially important. In contrast to more typical slowly developing floods
this one was (1) sudden, (2) unexpected, (3) unfamiliar to the populace,
and (4) highly localized in its danger area; and (5) warnings were received
in quite varied social contexts.
Response to warnings suggests that individual responses are affected
greatly by group memberships, with the most important being the family
unit. Most people responded to the flood as family members, not as isolated
individuals; and of those families that were together at the time of warning,
92 percent evacuated together. When family members were separated at
the time of the initial warnings, which happened for 41 percent of the
total sample, their immediate concerns were making contact with each
other.
Although 52 percent received their warnings from mass media (as op-
posed to 28 percent from peers and relatives and 19 percent directly from
the authorities) these people were far more likely to ignore the message
or spend time attempting to confirm it than those who got more direct
warnings. For example, see the results in Table 2.
Although mass media sources often urged evacuation of very specific
areas, these warnings tended to be viewed as background information,
while a direct request from the authorities was far more likely to get people
moving. Mass media seemed to generate the behavior of further infor-
mation seeking-people stayed "glued" to their sets rather than leave as
advised.
Mass media and peer recommendations to evacuate were received with
skepticism by 60 percent of respondents, but when the authorities were
the source, such skepticism occulted in only 22 percent of cases. Even
in this case one police officer recounted an experience in which a woman
casually approached the car from which he was broadcasting the evacuation
TABLE 2 Response of Denver Residents to Flood Warnings
Attempted
Continued Routine Confirmation Evacuated
Message Content Activity (percent) (percent) (percent)
"Some areas flooding
or evacuating" 36 38 26
"River rising" 38 33 29
"Flood water coming
down River Platte" 29 25 46
"Evacuate" 22 18 60
SOURCE: Drabek and Stephenson (1971:Table 2).
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HEALTH CONSEQUENCES OF NUCLEAR WAR
warning over a loudspeaker and calmly asked "What theater is it at?"
Several exchanges were required before the woman was willing to accept
that it was not a publicity stunt.
The overwhelming bias was to interpret the warnings as nonthreatening
and then search for other clues with which to discount or confirm them.
Rather than being sterile receptacles of news, people actively worked on
what they had been told, and even when they came to accept that a flood
was imminent, they still maintained a feeling of personal invulnerability
and thought that their own house would not be hit.
Another study of short warning times, in this case of about 1.5 hours,
was conducted by Hodler (1982), who surveyed residents in the path of
a tornado which had passed through Kalamazoo, Michigan, killing 5
people, injuring 79, and leaving 1,200 homeless. The storm had first been
spotted and tracked at 2:30 p.m. and was routinely handled by the mass
media, which at 3:45 issued a severe thunderstorm warning. A tornado
was seen 15 miles to the west of the city, and the civil defense sirens
sounded at 3:56, with the mass media by that time making near continuous
emergency broadcasts. By 4:10 the tornado struck. A random sample led
to 263 personal half-hour interviews. Two-thirds of the subjects had heard
the warning sirens, but 17 percent of those did not know what they meant.
Safety was sought by 48 percent, the warnings were disregarded by 18
percent, and 22 percent tried to confirm the warning by looking outside
or turning on their radios and televisions. This means that in total 40
percent did not try to evacuate. Michigan had experienced 306 tornados
between 1953 and 1975, so this lethargic response was not based on
Ignorance.
Longer Warning Times
Perry et al. ~ 1982) investigated the level of perceived risk, the warnings
received, and the extent to which these were believed by residents near
the Mount St. Helens volcano about 16 days after moderate earthquakes
indicated that it had come to the end of a 123-year dormant period. At
the time when the telephone survey started on a sample of 173 respondents,
a state of emergency had been declared for the surrounding area, and
when data collection was completed two days later, the news media re-
ported that the immediate crisis was over. The study thus affords a quick
look at a crucial phase in the disaster warning process. Residents monitored
news media avidly, with a majority of 55 percent even hearing four or
more volcano reports per day, while only 10 percent heard only one per
day. Television was the most common source of news at 98 percent, with
newspapers at 91 percent and radios at 87 percent following close behind.
Interpersonal contact was a somewhat less frequent source, though 70
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HEaLTH CONSEQUENCES OF NUCLEAR WAR
need to work through the events in order to give them some meaning.
The need for explanation is part of dependency and leads to rumor and
absurd gullibility. People will be anxious to obtain reliable news, and will
expect their own experiences to be news. The monitoring of the news
serves as an attempt to reconstruct a comprehensible set of explanations
and to reduce the uncertainty brought about by uncontrollability. For
example, following the assassination of President Kennedy the average
U.S. adult spent ~ hours per day for the next 4 days listening to the radio
or watching television, behavior which Janis (1971) interpreted as an
attempt to work through the cultural damage. In this dependent and vul-
nerable state, chance factors can have a disproportionate effect on the
interpretation of the event and the view as to what must be done in the
future. Scapegoats may need to be found, and chance may provide them.
Scientists, militarists, and politicians may escape initial attention, while
those involved in bringing relief may be the target of frustration and
feelings of betrayal (Lacey, 1972~.
Once the immediate danger is past, some survivors will begin to take
steps to cope with the consequences. Even as the warning of danger is
announced people will find themselves in conflicting roles. They will have
to decide whether they should continue with their jobs, take up civic and
emergency duties, or return to look after their families. Killian (1952)
found that conflicting group loyalties and contradictory roles were sig-
nificant factors affecting individual behavior in critical situations. Typi-
cally, it is the person without family ties who leads rescue work, while
the others generally run to their homes to discover if their families are in
danger. Even so, Killian reported that some who were searching for their
families, after a tornado had struck, were capable of helping others they
found on the way. Those whose occupational roles bore little relationship
to the needs created by the disaster, such as shopkeepers, disregarded
their jobs more easily and came to the assistance of the community.
Faced with an overwhelming catastrophe, family bonds are likely to
predominate over civic duties, because everyday tasks and responsibilities
will be seen as irrelevant and futile by most people. It should be noted
that natural disasters generally come without warning, and rarely require
emergency workers to leave their families unprotected while moving them-
seIves to places of relative safety, as would apparently be required of
them in the event of nuclear war.
Postimpact
Gradually, individual reactions become coordinated into an organized
social response. The form this will take depends very much on cultural
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PSYCHOLOGICAL CONSEQUENCES OF DISASTER
307
norms. Many of the victims will be coping with the consequences of loss
and bereavement. This will diminish their capacity to interact socially in
a productive manner. Victims need some form of acknowledgment of their
suffering, but social norms may deny them the right to express their grief
and hopelessness. Fear and apprehension persist, and many may feel that
the catastrophe will recur. Aftershocks of an earthquake commonly cause
more fear than the initial shock itself. People develop a conditioned fear
response, and their capacity to maintain control of their emotions is di-
minished. Disaster persists as a tormenting memory, and is relived again
and again.
CONVENTIONAL BOMBING
Although conventional bombing campaigns involve far less explosive
power and far longer time courses than would be likely to be the case in
a nuclear war, they should be given some attention for two main reasons.
First, the mass raids on cities in some instances approach the extent of
destruction caused by small nuclear weapons. Second, facts and fictions
about the Blitz influence both popular and official perceptions of the way
Londoners would react to a future bombing campaign.
Many accounts have been given of World War II bombing raids (Titmus,
1950; Ilke, 1958; Janis, 1951; Harrison, 1978), and in this instance, it
would be most informative to collate data from many different sources to
highlight the common features that have emerged.
Preparations
The Blitz raids were preceded by a long period of international tension,
which gave the public and the authorities time to make practical and
psychological preparations. The previous data on urban bombing were
sparse, and the predictions were that there would be massive casualties
and considerable panic, and that if deep shelters were provided this would
lead to a shelter mentality in which people would refuse to come out to
work. As a projection of the reports from Guernica, Spain, this was an
understandable view, as was the overriding fear of a gas attack.
The very long conditioning period of the phony war served to give the
population time to develop coping responses. Duties were allocated which
served to give key community members an important role in air raid
preparations, thus providing them with something to do and setting a
coping example for others to follow.
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308
HEALTH CONSEQUENCES OF NUCr;FAR WAR
Effects
When the bombing began, however, social cohesion and morale broke
down very quickly in the worst-affected areas, though censorship ensured
that this was not widely known at the time. Badly damaged zones had to
be cordoned off by the police, and emergency services were unable to
cope. All this occurred despite the fact that there was warning of attack
and pauses between attacks and that 1.5 million women and children had
been evacuated. The fact that the bombing could not be maintained without
pause gave the population time to make some adjustments, and the for-
tuitous fact that a bomb fell near Buckingham Palace while the East End
was receiving the brunt of the attack defused an explosive social divide
and made Londoners fee} that they were all in it together. The shelter
policy resulted in fewer casualties than had been calculated, but the extent
of damage to housing and infrastructure had been severely underestimated,
as had been the problems of dealing with large numbers of displaced
homeless people. Nearly a quarter of a million homes were damaged
beyond repair, while 3.5 million suffered repairable damage, though these
losses could not be made good during the war period. Emergency services
adapted to the new demands, but in many areas of London fires raged
uncontrollably. The authorities had prepared for massive casualties and
panic. Instead they got a dazed but functioning population that required
food, clean water, shelter, and new forms of social organization. Titmus
(1950) observed: "The authorities knew little about the homeless who in
turn knew less about the authorities."
The speed with which the large number of people in a dazed and
bewildered condition could be organized and rehabilitated determined the
rate at which the damage could be repaired, production returned to full
capacity, and further demoralization in surrounding areas avoided. What
was needed, the observers of that time agreed, was a "much more powerful
and imaginative organization" to deal with "the purely psychological and
social effects of violent air attack" (mass observation of 1940, cited in
Harrison, 1978~. This organization should have brought a wave of social
help, hot tea, and sympathy to snatch people out of their introversion and
to link them up again with the outside world.
The impact of World War II bombing on the United Kingdom population
was twofold. First, there were the direct casualties (about 60,000 deaths
plus injuries); but second, and more numerous, were those who suffered
disruption and loss because of damage to the structure of society itself.
Children and old people suffered disproportionately through neglect, such
that their wartime mortality figures were elevated and accounted for an-
other 6,000 deaths through indirect effects.
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309
The raid on Coventry on the night of November 14-15, 1940, caused
such damage to the infrastructure of that city that in the aftermath there
was close to being a breakdown of social organization. Food had to be
brought in from Birmingham and Stoke on Trent, and entry into the
damaged areas was prevented by armed troops.
In the Southampton raids, large sectors of the population ignored official
instructions and began "recking, moving out into the country and sleeping
in hedges during the night, and then some of them trecked back in to
work the next day. The stresses of long periods of deprivation and un-
certainty caused deep rifts in society that were also noted in Japan and
Germany during the air war.
Toward the end of the war the V-bomb campaign imposed new stresses
on London's population, and this was particularly the case for the V2
rocket, which fell without warning. Stress levels were very high, and a
new evacuation began again. No all clear was ever possible until the
launch bases themselves were destroyed.
The raids on Hamburg in 1943 caused heavy casualties and mass evac-
uation. Only because of the evacuation were there sufficient undamaged
houses (only about 50 percent of the housing stock remained) for the very
much smaller population that returned to the city to live in cramped
quarters.
Summary
The findings from conventional bombing offer only a very partial view
of reactions to nuclear war. The power of nuclear weapons is so great
that massive destruction can be caused virtually without warning on a
society which is now even more interdependent and tightly coupled as an
industrial system. It is thus more fragile and will have to absorb more
damage without time to recover. However, conventional bombing does
provide an analogy. The aftermath of a major nuclear war would be like
Coventry trying to get help from Hamburg, while Dresden seeks help
from both.
NUCLEAR BOMBING: HIROSHIMA AND NAGASAKI
The bombings of Hiroshima and Nagasaki offer a partial view of the
effects of a potential future nuclear war. The weapons were very small
by present-day standards, the culture and the era were different, and there
was neither warning nor any knowledge of radiation. The Hiroshima bomb,
at about He equivalent of 12,500 tons of TNT, would now be regarded
as a small battlefield weapon or merely as the detonator of a 1-megaton
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HEALTH CONSEQUENCES OF NUCLEAR WAR
strategic bomb. However, these bombings are still the closest examples
of what would occur in a contemporary nuclear war, with larger explosions
occurring on a potential 18,500 strategic targets (SIPRI, 19841.
Considering the importance of these events for our era, the bombings
of Hiroshima and Nagasaki have been underreported. Some accounts have
been repeated often, but much of the film material collected at the time
has only recently been released, and the work done with the survivors
was incomplete and often exaggeratedly technical, avoiding personal ac-
counts and bypassing a mass readership. The account here is taken from
Thompson (1985~.
Lifton (1967) picked 33 survivors at random from lists kept by local
Hiroshima research institutes, plus 42 survivors who were particularly
articulate or prominent with regard to the atom bomb. A structured in-
terview explored the individual's recollection of the original experience
and its meaning in the present, as well as residual concerns and fears,
and the meaning of his or her identity as a survivor.
No account can hope to capture what the survivors experienced. They
were submitted without warning to an explosion so vast that it seemed
that the world itself was coming to an end. At 8:15 a.m. on August 6,
1945, most people in Hiroshima were in a relaxed state, since the all clear
had just sounded. Few people could recall their initial perceptions. Some
saw the pika a flash of light or felt a wave of heat, and some heard
the don-the thunder of the explosion depending on where they were
at the moment of impact. Everyone assumed that a bomb had fallen out
of a clear sky directly on them, and they were suddenly and absolutely
shifted from normal existence to an overwhelming encounter with death,
a theme which stayed with each survivor indefinitely (Lifton, 1963~. Those
far from the city were shocked to see that Hiroshima had ceased to exist.
A young university professor, 2,500 meters from the hypocenter at the
time, summed up those feelings of weird, awesome unreality in a fre-
quently expressed image of hell:
Everything I saw made a deep impression-a park nearby covered with dead
bodies waiting to be cremated . . . very badly injured people evacuated in my
direction . . . Perhaps the most impressive thing I saw were girls, very young
girls, not only with their clothes torn off but their skin peeled off as well . . .
My immediate thought was that this was like the hell I had always read about.
. . . I had never seen anything which resembled it before, but I thought that
should there be a hell, this was it.
In Nagasaki a young doctor Akizuki (1981) was preparing to treat a
patient when the atom bomb exploded. After pulling himself from the
debris of his Urakami hospital consulting room, he was eventually able
to look out of where the window had been to the world outside.
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PSYCHOLOGICAL CONSEQUENCES OF DISASTER
311
The sky was dark as pitch, covered with dense clouds of smoke; under that
blackness, over the earth, hung a yellow-brown fog. Gradually the veiled ground
became visible, and the view beyond rooted me to the spot with horror. All the
buildings I could see were on fire.... Electricity poles were wrapped in flame
like so many pieces of kindling. Trees on the near-by hills were smoking, as were
the leaves of sweet potatoes in the fields. To say that everything burned is not
enough. The sky was dark, the ground was scarlet, and in between hung clouds
of yellowish smoke. Three kinds of color black, yellow and scarlet- loomed
ominously over the people, who ran about like so many ants seeking to escape.
What had happened? Urakami hospital had not been bombed I understood that
much. But that ocean of fire, that sky of smoke! It seemed like the end of the
world (Akizuki, 1981~.
After encountering so much horror, survivors found that they were
incapable of emotion. They behaved mechanically, felt emotionally numb,
and at the same time knew they were partly trying to pretend to be
unaffected in a vain attempt to protect themselves from the trauma of what
they were witnessing.
I went to look for my family. Somehow I became a pitiless person, because if I
had pity I would not have been able to walk through the city, to walk over those
dead bodies. The most impressive thing was the expression in people's eyes
bodies badly injured which had turned black their eyes looking for someone to
come and help them. They looked at me and knew I was stronger than they....
I was looking for my family and looking carefully at everyone I met to see if he
or she was a family member but the eyes the emptiness the helpless expres-
sion-were something I will never forget (Lifton, 19631.
A businessman who had hastily semirepaired his son's shoe before he
went to work in the city center was overcome with guilt that this same
shoe had- prevented his child from fleeing the fire. The man fruitlessly
searched for his child's body and was left in a state of perpetual self-
accusation.
Most survivors focused on one ultimate horror which had left them with
a profound sense of pity, guilt, or shame. A baby still half-alive on his
dead mother's breast, loved ones abandoned in the fire, pathetic requests
for help which had to be ignored- each survivor earned a burning mem-
ory.
In Nagasaki, Akizuki was swamped by burnt survivors clamoring for
water and medical attention.
Half naked or stark naked, they walked with strange, slow steps, groaning from
deep inside themselves as if they had travailed from the depths of hell. They
looked whitish; their faces were like masks. I felt as if I were dreaming, watching
pallid ghosts processing slowly in one direction as in a dream I had once dreamt
in my childhood.
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HEALTH CONSEQUENCES OF NUCLEAR WAR
Severely injured people cried out for help. Parents refused to leave dead
children, still requesting that they be attended by the doctor. Passing planes
caused panic, and victims tried to hide till they passed. Most survivors
had witnessed terrible scenes, piles of dead bodies heaped up in streams,
mothers and children locked in each other's arms, a mother and her fetus
still connected by its umbilical cord, all dead (Akizuki, 1981~.
These survivors were so profoundly affected by what they had expe-
rienced that all aspects of their subsequent lives were marked by it, and
they felt that they had come into contact with death but remained alive.
Survivors attempt to make sense of the fact that they have survived while
others have perished. Unable to accept that this was a chance occurrence,
survivors are convinced that their survival was made possible by the deaths
of others, and this conviction caused them terrible guilt. Guilt and shame
developed very quickly in Hiroshima survivors, as it did in those who
escaped concentration camps, and in both cases it has been intense and
persistent. Lifton set out the train of thought of Hiroshima survivors thus:
I was almost dead . . . I should have died . . . I did die or at least am not alive
. . . or if I am alive it is impure of me to be so . . . anything which I do which
affirms life is also impure and an insult to the dead who alone are pure . . . and
by living as if dead, I take the place of the dead and give them life.
This is the painful accommodation that the Holocaust survivor makes
to the joyless fact of having survived. It is grief made the more keen by
there being no bodies to be buried and mourned, nor any familiar land-
marks to show that life continues, and thus aid the adjustment to loss.
Person, body, house, street, city, and even nature itself have been con-
sumed.
Summary
Although proper follow-up studies of psychological effects do not ap-
pear to have been done, psychotic disorder is uncommon; but depression
and anxiety about cancer; fears of death and dying; and generalized com-
plaints of fatigue, dizziness, irritability, and difficulty in coping are usual.
This pattern is similar to that found after major civil disturbances and can
be conceptualized as an understandable concentration of the attention on
possible danger signals to the exclusion of long-term plans. The absence
of proper follow-up studies is itself a psychological phenomenon worthy
of note, since it suggests that the scientific community itself averted its
eyes from the long-term consequences of the disaster.
In Lifton's view the experience of the atomic bombings differed from
other disasters in that it plunged the survivors into an interminable and
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PSYCHOLOGICAL CONSEQUENCES OF DISASTER
313
unresolvable encounter win death. The immediate horrifying carnage was
followed by long-term delayed effects, thus breaking He myth of personal
invulnerability in a permanent way. In experiential terms, every victim
saw his secure sunlit world destroyed in an instant. It felt like the end of
the world, not just the end of one city. It is not hard to understand why
they should disgust the apparent "all clear."
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Representative terms from entire chapter:
psychological consequences
