Disaster Anniversary Reactions

James J. De Santis, Ph.D.
138 North Brand Boulevard, Suite 300
Glendale, California 91203-4618
TEL (818) 551-1714

Disaster Anniversary Reactions
by James J. De Santis, Ph.D.

Los Angeles has recently sustained a series of major disasters, both environmental and social: the Northridge earthquake and aftershocks (January 1994), the Altadena/Malibu firestorms (October 1993), and the South Central civil unrest (April 1992).

The impact of disasters on our patients and clients is something we are aware of as mental health professionals. We are also aware of the phenomenon of the "anniversary reaction." The intent of this article is to offer some observations that may stimulate clinical reflection in anticipation of disaster anniversaries.

An anniversary reaction may be defined as "behavior, symptoms, dreams, etc. that occur on an anniversary of a significant experience; their time-specific relationship to the original experience is rarely recognized by the subject and they appear to be a type of acting-out, i.e. an attempt to master through reliving rather than through remembering" (Campbell, 1981).

A psychological anniversary can be demarcated by a specific calendar date. "...Anniversary dates are very important. They may act like trip-wires, often resulting in emotional outbursts or setbacks even for those believed on the road to recovery" (Marrs, 1985). They can also be associated with a diffuse time of year, such as the season.

Hull, Lane, & Gibbons (1993) suggest an alternate form of the anniversary reaction whose timing is determined by the duration of psychotherapy. Calculated from the beginning of treatment, "a ‘resonance' is set up that links current events with the previous traumatic series....If other events 'line up,' particularly other losses from the patient's past and current life, destructive acting-out may ensue" (Hull, at el, 1993). They relate this to early childhood trauma; however, this may apply to disaster as well. For example, an individual who has survived two disasters six months apart might re-experience peak symptoms six months into treatment

While traumata can be multiple, so to can be sequelae. "Anniversary reactions...may present in various forms, including somatic symptoms and diseases, depression, psychosis, suicide, and homicide" (Gabriel, 1992). Certainly they can present in as varied a range as symptoms shortly following a disaster. It is probably important to recognize that trauma symptoms should be distinguished from mental illness and that the approach to treatment is to normalize the experience of symptoms (Kilpatrick, 1994).

Anniversary reactions may most tend to occur when a primary less has not been worked through and a secondary, symbolic, or future loss occurs. Treatment involves focusing on "the incomplete mourning" (Hull, at el, 1993) inevitable in the original loss. Disaster anniversary reactions in Los Angeles may be all the more complicated if multiple disasters have prevented the complete processing of any single event or loss. Individual traumata predating disaster can certainly add yet another wave of emotional reverberation.

An anniversary marks a time of heightened vulnerability. "Often, predicting anniversary reactions or discussing them with the patient in advance can be useful. Even if it does not prevent the anniversary reaction, a cognitive framework is created that helps to mitigate the damaging effects. Subsequently, these reactions should be connected to the original traumatic loss through interpretation. Losses in the present need to be connected to losses in the past" (Hull, at el, 1993).

While an anniversary reaction may not be purely conscious recollection and grief, an anniversary may certainly be an "occasion for taking stock" (Kilpatrick, 1994) and constructively processing losses through mourning. Such feelings may also be triggered by events not necessarily timed one year after a trauma but associated with some aspect of the trauma--like a family holiday following the death of a loved one--and are probably better conceptualized as grief and mourning rather than as an anniversary reaction (Wirth, 1994).

On the one hand, each subsequent anniversary may produce decreasing levels of distress if the trauma is being successfully worked through; on the other hand, each anniversary may be complicated if the individual is retraumatized in the meantime (Kilpatrick, 1994).

Just as post-traumatic reactions may be triggered at any time by a stimulus that resembles in form the original trauma, anniversaries are temporal "echoes of the original trauma" (Haley, 1978) that may harbor clues "to the aspects of the trauma that remain most conflictual to the person" (Scurfield, 1993). Factors unique to the individual must be evaluated in order to anticipate, recognize, and fully understand any anniversary reaction, including the context of personal history, background, and culture; including the severity and type of disaster and losses sustained; and including the person's aspirations and dreams.

Anniversary reactions are an important phenomenon. Their recognition in our roles as therapists to individuals and families and as consultants to organizations will better serve a beleaguered community.

References

Campbell, R. (1981). Psychiatric dictionary (5th ad.). New York: Oxford Univeristy Press.

Gabriel, M. (1992). Anniversary reactions: Trauma revisited. Clinical social work joumal, 20(2), 179-192.

Haley, S. (1978). Treatment implications of post-combat stress response syndromes for mntal health professionals. In C. Figlay (Ed.), Stress disorders among Vietnam veterans (pp. 254-267). New York: Brunner/Mazel.

Hull, J., Lane, R., & Gibbons, B. (1993). Early object loss and "secret anniversaries of the heart." Psychoanalytic psychology, 10(1), 77-91.

Kilpatrick, M. (1994). Personal communication.

Marrs, R. (1985). Why the pain won't stop and what the family can do to help. In W. Kelly (Ed.), Post traumatic stress disorder and the war veteran patient, (pp. 85-101). New York: Brunner/Mazel.

Scurfield, R. (1985) Post-trauma stress assessment and treatment: Overview and formulations. In C. Figley, (Ed.), Trauma and its wake: The study and treatment of post-traumatic stress disorder, (pp. 219-256). New York: Brunner/Mazel.

Wirth, B. (1994). Personal communication.

Thanks to the following individuals for their review and comments: Greg Ritzhaupt, M.A, Bonnita Wirth, Ph.D., & Margaret Ann Kilpatrick, M.S.W, B.C.D.