Dr. Ursano and Colleagues Reply

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.