The valuable review by Hobfoll and his colleagues is an important distillation of recent science and previous work that can inform early response to those affected by mass violence. The five themes endorsed through this consensus process fit well with those identified through a range of other sources, including concepts such as psychological first aid and extending into the subsequent early intervention phase as the emergency settles. In many ways this review provides a challenge, or indeed to many challenges, for those who wish to take this field forward. Firstly, there must be recognition, not only of the cognitions, but of the affects that are the basic instinctive components of human response to catastrophe, to horror, to death, and to destruction. Fear, terror, anger, helplessness, rage, shock, grief, and many other feelings will dominate responses for both those directly affected and those who would help. This is central to one’s humanity. Intense attachment ideation also dominates response if there is separation from loved ones or if survival is threatened (Henderson & Bostock, 1977). Affects may impact on cognition. Experiencing the chaos of mass violence—the blood, dirt, gore, and devastation—means, as suggested, that safety is indeed a relative concept, often for a long time afterwards, one that is perhaps never experienced again, in the same way as it was before. As Slovic (1987), Slovic & Peters (2006), and others working in the area of risk perception have so clearly delineated, “risk as feelings” powerfully drives response with an automatic, rapid, “gut instinct,” “experiential” appraisal of threat. Perhaps immediate, intense affect is difficult for us, both scientifically and personally, so that how we stay with it and with those experiencing it, through uncertainty, danger, and the difficulties of the aftermath, requires knowledge and emotional skill repertoires we have to further define. I searched the article for the words compassion and empathy, but I could not find them, although I know all the contributors to be people with great compassion and great empathy. We will not have mass catastrophe without chaos, without affects, without compassion, and we should encompass these challenges in what we do and what we would advise others to do, through guidelines like these. The second challenge lies in the fluidity of human interactions through such experiences and the shifting interfaces of the victim/affected person-helper engagements. Psychiatry 70(4) Winter 2007 329
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