Historical perspective and future directions in research on psychiatric consequences of terrorism and other disasters

Introduction: This chapter will review the history of research on disasters and terrorism leading up to the state of the field at the time of the September 11th terrorist attacks and the methodological challenges faced in responding to this unprecedented event. This chapter will also discuss translations of empirical data to clinical intervention and policy, and the ramifications of disaster studies for future research and disaster planning. Historical perspective Catastrophic events have plagued mankind since the beginning of history. Emotional effects of disasters were recorded 4000 years ago in Egyptian cuneiform records (Kramer, 1969) and later in the Iliad of Homer (Shay, 1991). The Biblical floods of the Book of Genesis are even older, dating to approximately 5600 bc (Ryan and Pitman, 1998). Although history has provided ample opportunity to study psychiatric consequences of disasters, this area is a relatively new field of scientific inquiry. The first medical literature on psychiatric sequelae of disasters can be found in descriptions of Railroad Spine Syndrome by John Erichsen in 1867 in connection with locomotive accidents in England (Fischer-Homberger, 1970; Trimble, 1981). At the time, Railroad Spine Syndrome was thought to be caused by physical damage to the spinal cord (Erichsen, 1875). It was not long, however, before experts identified psychiatric origins to the syndrome, attributing its manifestations to extreme fear (Page, 1885) or hysterical neurosis (Putnam, 1883), possibly representing the first modern recognition of psychiatric origins in posttraumatic syndromes. War has provided opportunities to observe mass psychological casualties in soldiers.