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Letter to the Editor   |    
Dr. Ursano and Colleagues Reply
ROBERT J. URSANO, M.D.; RICHARD S. EPSTEIN, M.D.; CAROL S. FULLERTON, PH.D.
Am J Psychiatry 1999;156:1291-1291.

To the Editor: Edward J. Guerin, Dr.Med., draws our attention to the complexity of disasters—in particular, international disasters. Although we are not clear about what is meant by his construct "pre-traumatic self-perception" and we would disagree with his construct of "ghetto-like" living, we agree that community response and community cohesion can be very important to disaster recovery (1, 2). Our study did not directly address the community variables that Dr. Guerin refers to. However, in previous studies, it has been shown that emotional closeness to disaster victims and identification with the dead (3, 4) both affect the "metabolism" and "digestion" of posttraumatic stress symptoms and the risk of PTSD. Studies (5) suggest that the recovery environment can either facilitate or prevent recovery from PTSD following traumatic events. PTSD after exposure to trauma and disasters can be acute or chronic and potentially disabling.

Steinglass P, Gerrity E: Natural disasters and post-traumatic stress disorder: short-term versus long-term recovery in two disaster-affected communities. J Applied Social Psychol 1990; 20:1746–  1765
 
Bartone PT, Wright KM: Grief and group recovery following a military air disaster. J Trauma Stress  1990; 3:523–539
[CrossRef]
 
Jones DR: Secondary disaster victims: the emotional effects of recovering and identifying human remains. Am J Psychiatry  1985; 142:303–307
[PubMed]
 
Fullerton CS, McCarroll JE, Ursano RJ, Wright KM: Psychological responses of rescue workers: fire fighters and trauma. Am J Orthopsychiatry  1992; 62:371–378
[PubMed]
[CrossRef]
 
Ursano RJ, Fullerton CS, Norwood AE: Psychiatric dimensions of disaster: patient care, community consultation, and preventive medicine. Harv Rev Psychiatry  1995; 3:196–209
[PubMed]
[CrossRef]
 
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References

Steinglass P, Gerrity E: Natural disasters and post-traumatic stress disorder: short-term versus long-term recovery in two disaster-affected communities. J Applied Social Psychol 1990; 20:1746–  1765
 
Bartone PT, Wright KM: Grief and group recovery following a military air disaster. J Trauma Stress  1990; 3:523–539
[CrossRef]
 
Jones DR: Secondary disaster victims: the emotional effects of recovering and identifying human remains. Am J Psychiatry  1985; 142:303–307
[PubMed]
 
Fullerton CS, McCarroll JE, Ursano RJ, Wright KM: Psychological responses of rescue workers: fire fighters and trauma. Am J Orthopsychiatry  1992; 62:371–378
[PubMed]
[CrossRef]
 
Ursano RJ, Fullerton CS, Norwood AE: Psychiatric dimensions of disaster: patient care, community consultation, and preventive medicine. Harv Rev Psychiatry  1995; 3:196–209
[PubMed]
[CrossRef]
 
+
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