Mass traumatic terror in Oklahoma City and the phases of adaptational coping,part I: Possible effects of intentional injury/harm on victims' post-traumatic responses

The bombing in Oklahoma City shook the entire nation from “sea to shining sea.” This tremendous collective sensation was made even worse when available evidence revealed that this act of terrorism had not been committed by some terrorist from the Middle East but one from Middle America. The blast stunned the nation's sense of collective safety, while it raised serious questions about our ability as a nation to manage violence, and the profound feelings of discontent and narcissistic injuries among distressed Americans. Was it this failure to address chronic discontents that led to this tragedy of mass violence? These larger sociocultural and political issues are being debated in public and private forums throughout the nation, an activity that is likely to continue for some time to come. As these issues are debated in the public arena, victims' levels of psychological distress are expected to rise, as they attempt to process the traumatic shock in their minds and bodies. Specifically, this article has two parts and focuses on acute and post-acute psychophysiological traumatic stress responses in victims, as well as issues pertaining to assessment, prevention, and treatment. Part I addresses the nature of disasters, with a special emphasis on the victim's subjective evaluation (meaning) of the reality of a catastrophe caused by intentional human strategy. The article, additionally, discusses issues of epidemiology of stress reactions, post-traumatic stress disorder, co-morbidity, risk factors, and assessment and diagnostic considerations. Part II, to be published in the next of issue of the Journal, will focus on issues of prevention as well as post-disaster intervention. Prevention of chronic post-traumatic stress disorder after the Oklahoma City bombing is a critical objective by debriefers and mental health professionals. A proposed four-phase model called “self-efficacy adaptational coping” will be presented in Phase II as well. The present article is probably the first major discussion on the traumatic effects of the blast on individuals, families, and the communities of Oklahoma City, and the first to offer some broad guidelines to intervention. Since it predates future empirical studies, the author relies on his almost 20 years of experience in the field of traumatic stress, and on a review and integration of pertinent disaster outcome studies in the national and international literature.