INTRODUCTION: FOCUSING ON THE COMMUNITY IN THE CASE OF EXTREME STRESS

Stevan E. Hobfoll, Kent State University, Kent, Ohio, USA Marten W. de Vries, University of Limburg, Maastricht, the Netherlands Rebecca P. Cameron, Kent State University, Kent, Ohio, USA

In the 1990s the enormity of both the individual and social problems related to trauma have become even more visible and apparent throughout the world. Global communication compels us to directly share the suffering and helplessness of millions of people subjected to social upheaval or disaster. Dramas ranging from incest and violence on city streets to systematic torture, war, and even genocide have become daily venue. Although not new historical developments, their sheer bulk in relation to our capacity to understand challenges the adequacy and scope of our knowledge and our ability to respond. National and international relief agencies, instead of cooperating with each other, often clash about even obsolete solutions. This volume aims to update and shape conceptual and practical knowledge of stress in communities by contributing insight into community responses under extremely stressful conditions.

Extreme stressors, such as disasters and war, are unlikely to occur at any given moment, and are the kind of event that people expect will only happen to some unidentified other in some far-away place. However, when disasters do strike, they often affect large numbers of people, and millions of people are involved at some time in their lives in such events. When discussing extreme community stress in this volume we mean circumstances that threaten the physical self, property, or security of large numbers of people who share a common living, work, or temporary setting (e.g., airplane passengers). These include such events as natural and technological disasters, war, social upheaval and resultant refugee flight, famine, and large scale epidemics. Although modem countries are somewhat buffered from the most devastating effects of disasters of human and natural origin, earthquakes, war, political upheaval, and technological catastrophes happen worldwide and affect all those involved deeply.

When extreme stressors strike, individuals', families', and communities' coping resources are put to the test. People do not know just how they, their family, their community, or their nation will respond in such extreme circumstances. We naturally base our beliefs on the data provided us by everyday life experiences. Because

S. E. Hobfoll and M. W. de Vries (eds.), Extreme Stress and Communities: Impact and Intervention, 1-10. © 1995 Kluwer Academic Publishers.

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extreme events typically do not occur in the same place with great frequency, we have little experience judging how we will react. Even in the case of some chronic community stressor, such as ongoing war, there, are few communities where enough cycles of the event have occurred to create a body of knowledge and understanding about how people will likely face these shattering events.

Some lessons learned as early as the ftrSt two world wars have largely been forgotten. but recalling them is instructive. The experience of World War II, especially, taught that most people can continue to function under highly stressful conditions. However, a very high percentage will also break down either physically or emotionally. For example, nearly one in four soldiers who landed in the Normandy invasion had to be relieved of duty owing to psychiatric difficulties (Marlowe, 1979).

Looking at different military units also reveals the importance of the community's influence. Following the failed defense of Pearl Harbor, those units involved in the defense continued to have very high levels of psychiatric breakdown throughout the war, even after significant turnover of the soldiers actually involved. This high rate of breakdown can be contrasted with the 442nd Regimental Combat Team of Nisei (second generation Japanese-American) fighters who shared a cultural background and had very high motivation to prove their loyalty to America. Despite being involved in some of the heaviest combat in the Italian campaign. they experienced little or no psychiatric breakdown in combat (Marlowe, 1979). A community can create a certain morale level that affects the stress experience. An Israeli psychiatrist was reviewing troops involved in staving off the Syrian invasion during the Yom Kippur war. In his expert and experienced evaluation these troops required immediate combat relief. having fought a sustained three days with little or no sleep and having experienced heavy casualties. Their response was to prepare their tanks for continued battle (Herzog. 1984).

Today, the best data source for extreme stress is a world-base of knowledge. In order to seek out the common elements and special circumstances that may occur following extreme stress, we need to look at as many events worldwide as possible. Inevitably this will be a daunting task, because by looking across communities, states, nations, and world regions, elements of differential history. widely varying economic situations, and variations in culture will enter the picture as important variables in the ultimate equation of understanding. Yet, this is our task, and we should come to appreciate the wealth of information that adding these larger contextual variables will bring to our emerging understanding. Even in the same country, for the same general kind of event. such as a hurricane, the response in Louisiana and Florida will be different. Indeed, different subcultures and economic classes who share the same region and disaster, may differ markedly in their responses (Norris & Thompson, in press). We must nevertheless begin to untangle this complicated web.

There is certainly an emerging base of knowledge in the study of extreme stress. Over the past 20 years, nearly 200 or more English-language articles concerning the psychological impact of natural and technological disasters have been published (Blake, Albano, & Keane. 1992). Simultaneously, there has been a marked

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increase in intervention into and study of war-related trauma (Milgram, 1986; Hobfoll, Lomranz, Eyal, Bridges, & Tzemach, 1989). The end of the Cold War has brought an unprecedented number of small wars, disputes, refugee flights, and situations of economic chaos. At the same time, mental health interventionists and researchers are showing increased interest in lending their expertise to aid people whose lives are disrupted by these events. Despite this level of attention, much remains to be learned concerning the linkages between extreme stress, coping, and psychological adjustment.

We know that disasters and war elicit both acute (e.g., Freedy, Kilpatrick, & Resnick, 1993) and prolonged psychological distress (e.g., see Green, Lindy, Grace, GIeser, Leonard, Korol, & Winget, 1990). However, beyond a very hazy, global view that there is a pathogenic effect of extreme stress, great ambiguity exists regarding the elements of disaster exposure responsible for adjustment difficulties. Most conceptual definitions emphasize acute factors such as injury or extreme threat. Other defmitions emphasize ongoing factors including a range of adversities within the post-disaster environment (e.g., residential displacement, job disruption) (Freedy, Resnick, & Kilpatrick, 1992). By empasizing a community context, however, much more is being learned, and the future of this area of work is showing increasing promise.

A Communal-Ecological Approach to Extreme Stress

Most of what is known about reactions to extreme stress is organized around individuals'responding. Although our empirical study of community-level stress is in its infancy, there is already a trend to individualize its study and our intervention responses. Albee (1980) wrote about the danger of thinking that we can provide an individualized mental health response to the problems of our society, given the numbers in need of mental health services and the limited resources available to provide services. If communities are unable to meet their mental health needs in the face of everyday stress, how could they possibly respond using individual-based models when whole segments of communities are impacted, often including the very professionals who normally serve in mental health service roles?

Hence, this volume attempts to address extreme stress on the level of the community. As Trickett (this volume) notes in his chapter on the ecological context of community stress, we need to become aware of the ecological diversity of communities and populations who are beset by extreme stress. Given the research and attempts at intervention that have been ongoing in many countries, with diverse populations, involving circumstances and situations ranging from floods to the Holocaust, we have a wealth of material to study and understand. To emerge from this with deeper insights, however, he emphasizes that we must learn to appreciate the variability in the way such events unfold among differing populations experiencing different circumstances. We can use these community-level insights to better understand the interventions that individuals fmd most effective in responding to events of such major proportions across widely varying ecological niches. This work

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can help us challenge and advance the underlying conceptualizations of theorists whose work has derived from clinical and normative populations.

The study of community stress also differs from the study and understanding of the experience of individual victims of extreme stressors, such as rape or violence. Of course, there will be different common patterns that emerge when individuals are exposed to traumatic stress alone, versus when this occurs as a shared event with a community. However, even these differences can only be understood if we give more directed thought to the nature and circumstances of community stress.

The Current Volume

Basic Stress Conce,pts and Where They Lead in the Study of Community Stress

Following an introduction to the ecological perspective in Section I (Trickett, this volume), Section n addresses some of the basic principles formulated by stress experts in the course of their research. Chapters examine principles of cognitive appraisal and treatment (Meichenbaum, this volume), biological aspects of the stress response (Strelau, this volume), myths about individual responding to extreme stress (Wortman, Camelley, Lehman, Davis, & Exline, this volume), and develop a schema for conceptualizing how the individual and community perspective compare and contrast (Jersusalem, Kaniasty, Lehman, Ritter, & Turnbull, this volume).

Extreme stress often engenders a need to create a new storyline for people's lives. The stories that were useful for guiding their understandings of the world are often shattered by traumatic events. What explained the world as it was, no longer explains the world as it has radically changed. This appraisal process is similar in many ways whether it involves individual responses to extreme personal events or community responses to extreme community events (Meichenbaum, this volume). Similarly, emerging research on the influence of temperament in the stress response calls attention to the biological involvement in the stress process when studying large scale stress.

Resources to Offset Stress: Am>lications to the Community Context

We have made the case that severity of exposure to extreme stress is of primary importance, but many community, social, and individual resources can affect psychological outcomes as well. Resources and conditions that facilitate or impede the employment of resources playa central role in determining how victims react to extreme stressors, and what physical and mental health consequences these reactions produce. Studies of the effects of resources and resource-facilitating circumstances help identify those victims likely to develop prolonged effects.

In Section m, authors examine general resource theories and specific resources that may be critical in adjustment to extreme stress. In particular, the role of mastery,

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optimistic beliefs (Schwarzer & Jerusalem, this volume), social support (Sarason, Sarason, & Pierce, this volume), and having a generally enriched reservoir of resources (Hobfoll, Briggs, & Wells, this volume) are explored. How these resources may be applied to conditions of extreme stress is delineated.

One important class of disaster resources is the community context. Community circumstances that may be important include the extent of community disruption, the centrality of the event (e.g., an airplane crash involving a group of strangers would be peripheral rather than central; see Green, 1982), the setting of the community (e.g., rural versus urban), and the nature of the community's official disaster response (e.g., adequate versus ineffective).

Community-level factors may be more important than the event itself. For example, a positive community response to the 1976 Teton Dam collapse was met by remarkably effective recovery (Golec, 1983). Despite major property loss and social disruption, recovery was facilitated by several community attributes: adequate warning (resulting in a low death/injury rate), a homogeneous (Monnon) population, maintenance of the community's social fabric, adequate financial compensation, a surplus of resources for immediate needs, and an organized regional disaster response. Section ill examines many of these issues in depth and provides a sound theoretical base for future research and intervention based on resource acquisition, maintenance, and sharing.

Bridges to Community Stress

In Section N the focus on the community elements of extreme stress is applied to specific issues relevant to extreme community stress. The cultural context is raised as a centerpoint for thinking about community stress events. Given that many disasters and wars occur in financially underdeveloped communities, but that disaster responses are often organized by Western interventionists, there is always the danger of culture clash (de Jong, this volume).

Specific issues of war and disaster are raised separately. However, bridges between the two are often made apparent. This section also develops methodological insights for evaluation of the impact of disasters and other extreme stressors. The chaos engendered by such events makes research difficult. However, a balanced approach involving no small measure of ingenuity has been successfully applied, and other researchers and interventionists may learn from these prior experiences. Solomon (this volume) explores critical fmdings regarding myths versus facts in the study of post-traumatic stress disorder in the aftermath of war. McFarlane (this volume) examines the influence of disasters from the viewpoint of both a clinician and a traumatic stress researcher. Bromet (this volume) and Norris, Freedy, DeLongis, Sibilia, and SchOnpfiug, (this volume) make recommendations for studying extreme stress on a community level.

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Long-Tenn Effects of Community Stress

Extreme stressors cast a long shadow, apparent for decades following the initial event. Section V examines the long-term effects of stress, invoking once again the importance of culture and context. Each chapter emphasizes that an event's importance is deeply shaped by the historical and social context in which it occurs and how these interact with the unfolding story of the lives of those affected.

Green (this volume) looks at how disasters in the United States may affect people's lives over time through reports of a series of carefully conducted follow-up studies. She looks at initial severity, loss of resources, and the ongoing intactness of the community as prominent among the variables that influence disaster's long-tenn effects. Lomranz (this volume) applies a life-span developmental approach to achieve a better understanding of the long-tenn effects of the Holocaust. Now examining mostly elderly victims, he delves into the interplay between their original experience, the impact of Israeli culture upon them, and how they helped shape Israeli culture. Jackson and Inglehart (this volume) make similar points in their study of the effects of chronic racism. They develop the thesis that racism not only victimizes its target group, but that its effects reflect back in changes in the racist group and the larger society. Finally, deVries (this volume) examines how culture itself should always be considered, both for its influence on how events affect people and for its self-perpetuating tendencies during extremely stressful periods.

Prevention and Intervention

Section VI discusses how intervention has been used to reverse or modify the negative sequelae that follow in the wake of extreme stress. Traumatology has chiefly been concerned with post-traumatic stress disorder (PTSD), and intervention has mainly focused on individual, clinical intervention. This section also provides a state of the art review of individual-based clinical intervention (van der Kolk, van der Hart, & Burbridge, this volume). However, a community approach sees the individual approach as only one small component of necessary intervention. Rather, the focus is on pre- and post-disaster preventive efforts. These are aimed at reducing the numbers of people who will need individualized therapy. Further, a community approach highlights the fact that most individuals will never be treated for their maladies, further emphasizing the importance of prevention and group intervention.

Pynoos, Goenjain, and Steinberg (this volume) discuss intervention with children amidst war and disaster. They provide insightful accounts based on their work worldwide. Milgram, Sarason, SchOnpflug, Jackson, and Schwarzer (this volume) discuss how community support can be catalyzed. They highlight that the community itself is taxed in the case of extreme stress and that a planful approach must both consider ways to shape people's understanding of the event and its meaning and act to limit widespread and chronic resource loss. Figley, Giel, Borgo, Briggs, and Haritos-Fatouros (this volume) offer a rich overview of intervention planning.

They present a strategic map for intervention efforts. Finally. 0mer looks at intervention with interventioiusts. He suggests that the overwhelmingly popular technique of critical events debriefing may not be effective and offers a more global understanding of aid to emergency service workers.

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In the conclusion. we return to each of these issues and offer suggestions for future research and intervention based on the comments and criticisms found throughout the volume. We highlight the community context of the volume and emphasize the ecological perspective for guiding the work of interventionists and researchers who. rather bravely and with great difficulty. approach this critical area of work.

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