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In 2006, Sara Clemence wrote a highly prescient article for Forbes, which reported the results of a survey of experts revealing that pandemic influenza and terrorism were at the top of the list of factors that would devastate the US economy. They were right! But why? If we can determine why they possess such potential for devastation, we can better mitigate their adverse impact on individuals, organizations, and communities.
My assertion is that infectious diseases (especially pandemics), terrorism (especially bioterrorism), radiation-related disasters, and even pollution-related disasters are the most psychologically toxic disasters of all for those who will survive. They have the ability to reshape the future and leave a legacy lasting decades or more e.g., Chernobyl, the World Trade Center attacks, the pandemic of 2020.
The basis for my conclusion is fundamentally simple: I believe there resides in all of these disasters a common denominator, which I view as an underlying latent taxon serving to not only unite these disasters into one taxonomic category but to serve as their primary toxic mechanism: ambiguity and uncertainty.
Disasters Can Be a Perfect Storm of Psychological Toxicity
I use the term “disasters of uncertainty” to refer to disasters wherein ambiguity with regard to their respective nature and uncertainty with regard to their trajectory, before, during, and even after their impact, serve to increase their psychological toxicity. Disasters of psychological uncertainty result due to a “perfect storm” of psychological toxicity. As such, they will create the largest number of “psychological casualties.” Ultimately, they will have the most severe adverse impact and toxic legacy of all disasters.
The United States was ranked the best-prepared country in the world to handle a pandemic in late 2019 by the Nuclear Threat Initiative (NTI) and the Johns Hopkins Center for Health Security (JHCHS). Yet the pandemic of 2020 presented challenges (and unprecedented responses), some of which were unique, but others were reminiscent of other disasters wherein phenomenological ambiguity/uncertainty was a major psychological theme serving to feed the resultant angst and overall psychological toxicity. Such uncertainty will inevitably heighten psychological morbidity, that is, the number of “psychological casualties,” to the point of potentially overburdening existing mental health systems and crippling the economy, creating many more indirect casualties.
The Psychological Casualty
The term “psychological casualty” may be used to describe any survivor of a disaster who is rendered unable to perform the essential activities of daily living as required. This represents a form of functional impairment in activities such as childcare, elder care, maintaining constructive relationships at home or at work, earning a living, though able to show up for work perhaps the tendency to make errors or simply not perform adequately on the job, and finally even the ability to maintain personal hygiene may be impaired.
The consequences of such impairments can be profound, especially with individuals in healthcare, education, the military, emergency response, the transportation industry, and other high-risk or far-reaching professions.
Three Dimensions of Psychological Toxicity
Psychological casualties increase as psychological toxicity increases. Here I propose a simple three-factor formula for estimating the relative number of psychological casualties in relation to other disasters: Morbidity/Lethality x Duration x Ambiguity.
Simply said, the number of physically ill and dying interacts with the duration of the exposure to the threat (the longer, the more toxic) which interacts with the ambiguity surrounding media messaging, understanding of the threat itself, and governmental guidance.
Responding to Disasters of Uncertainty
So why are epidemics, pandemics, pollution, radiation, and terrorism so stressful compared to other disasters? Why are they likely to be associated with higher burnout, psychological trauma, domestic conflict, and even economic devastation?
In my opinion, it’s because these disasters are the highest of all disasters on the three interacting dimensions of psychological toxicity I described above. For this reason, we would expect them to generate the greatest number of psychological casualties and wreak the greatest havoc on the economy and on society in general.
Given the magnitude and breadth of their impact, I believe the most effective way for local, state, and federal agencies to respond to disasters of uncertainty is to adapt the standard of care in physical healthcare to psychological healthcare, i.e., develop and mobilize a disaster mental health continuum focusing on resilience rather than pathology.
Just such a continuum is currently being used at the Johns Hopkins medical institutions. It uniquely embraces the power of wellness, peer support-based psychological first aid, employee assistance programs, chaplaincy/spiritual support, resilient leadership training, and a full array of psychiatric services.
I believe this comprehensive model can be adapted for all levels of critical incident/disaster management in response to any and all disasters of uncertainty.
© George S. Everly, Jr., Ph.D.
