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. Author manuscript; available in PMC: 2024 Apr 1.
Published in final edited form as: Psychiatry. 2022 Oct 3;86(1):42–52. doi: 10.1080/00332747.2022.2120309

Making Meaning of Surviving the Oklahoma City Bombing Seven Years Later

Alexander J Gajewski a,*, Helena Zhang a, Samir Abu-Hamad b, Whitney Pollio c, Katy McDonald d, David E Pollio e, Carol S North b,d
PMCID: PMC9992151  NIHMSID: NIHMS1857324  PMID: 36190776

Abstract

Objective.

No previous studies examined how survivors made meaning (i.e. interpreted the personal significance) of a disaster experience after seven years. This qualitative study follows up on a previously published analysis of 182 directly-exposed survivors of the Oklahoma City bombing, assessed after six months had elapsed for bombing-related psychopathology and meaning-making processes. The current study examines how 113 survivors (62% follow-up rate) made meaning of their bombing experience after seven years.

Method.

Survivors answered questions about the effects of the bombing on their beliefs and perspectives. Their responses were hand recorded by interviewers and transcribed. Content was coded into themes, allowing codes of multiple themes. Excellent interrater reliability was obtained (Cohen’s kappa≥.8).

Results.

The survivors were 50% (57/113) male, 93% (105/113) Caucasian, 34% (38/113) college educated, and 71% (80/113) married with a mean (SD) age of 42.5 (10.6) (range=19-69) years at the time of the bombing. Eight themes emerged and indicated that survivors matured in personal goals and character, interpersonal relationships, and philosophical thought (e.g. reconsideration of human nature and religion). More than one third of the comments included negative remarks about personal harm, especially psychological effects.

Conclusions.

Nearly two thirds of the material was positive in tone and consistent between six months and seven years. Negative content was entirely new relative to six-month baseline interview responses, suggesting many survivors incorporate greater reflection on negative outcomes in meaning-making processes over time. After several years, clinicians could encourage survivors to integrate positive and negative consequences as meaning. Longer-term studies are needed.

Keywords: terrorism, disaster, meaning making, qualitative, follow up

Introduction

In 1995 Timothy McVeigh detonated a truck bomb in front of Oklahoma City’s Alfred P. Murrah Federal Building, injuring more than 680 people and killing at least 167 (Shariat et al., 1998). Previous research on survivors of this disaster has demonstrated development of psychopathology in nearly half of survivors and PTSD in more than one third at six months (North et al., 1999). Qualitative research on survivors of this disaster detailed recounts of horrifying individual experiences, stories of escape and survival (Dang et al., 2022), changes in personal philosophy and newfound aspirations after six months (Lee et al., 2021), and reflection on the entire experience after 17 months (Turner et al., 2022). These studies contributed to understanding of survivors’ experiences and provided some insights into early psychological responses.

In general, existing literature on responses to disaster has largely focused on negative consequences, including posttraumatic stress disorder (PTSD), other psychopathology such as major depressive disorder and generalized anxiety disorder, and grief (Kanehara et al., 2016; Kristensen et al., 2012; Lowell et al., 2018; North et al., 2004; Oe et al., 2021; Steinert et al., 2015; Zhong et al., 2018). A smaller proportion of the literature has focused on more positive responses, including resilience, posttraumatic growth, spiritual coping, and finding meaning in loss (Bottomley et al., 2019; Drury et al., 2009; Hong et al., 2019; Lee et al., 2019; Lee et al., 2021). Common among the literature focusing on positive psychological responses is an assumption that these responses develop over time. Research that focuses on a limited, early period of time can only capture the beginning stages of the making of meaning, a cross section of a lifelong process (Frankl, 1959). Further, the making of meaning represents a process specific to individuals, therefore best studied over time using a qualitative methodology (Lee et al., 2021).

Unfortunately, prior studies assessing how survivors derived meaning from a disaster predominantly used a quantitative methodology and analyzed data collected within two years of the disaster (Aten et al., 2019; Drury et al., 2009; Gorven & du Plessis, 2021; Lee et al., 2019; Vollhardt & Staub, 2011; Wood et al., 2021). Only two previous qualitative studies conducted at an average of <4 years after the disaster examined meaning-making (Lee et al., 2019; Matheson et al., 2020). No studies investigated changes in responses over time, either prospectively or retrospectively. In summary, the literature has yet to demonstrate how the meaning survivors make from their disaster experiences evolves over time.

By analyzing interviews conducted seven years after the Oklahoma City bombing, the current study examined how highly exposed disaster survivors made meaning of their experience. The current manuscript parallels previous work by this team on the same sample of survivors of the Oklahoma City bombing interviewed six months after the bombing about the meaning they had made at that point (Lee et al., 2021). The current study addresses the limitations of the literature by analyzing reflections on making meaning at a much later point in the process. By studying the same sample at a second, later point in time, the current manuscript permits reflection on both later perspectives of the disaster experience and the evolution of meaning over time.

Methods

The original sample of 182 Oklahoma City bombing survivors was randomly selected from the Oklahoma State Department of Health registry of 1,092 directly-exposed adults, with a participation rate of 71% at approximately six months after the disaster. The original sample was fully described in an earlier publication (North et al., 1999). The 182 survivors that completed interviews were representative of registry population in terms of sex and age. The sample was biased towards inclusion of survivors located in heavily damaged buildings (79% vs 66%; χ21=11.25, P<.001) (North et al., 1999). The original study administered fully structured interviews of disaster-related psychopathology and presented nearly identical questions regarding survivors’ perspectives on their bombing experience as the follow-up interviews. The follow-up interviews that provide the main data for this study were conducted approximately seven years after the disaster. All study participants provided written informed consent at the time of recruitment for each interview. The seven-year study interviews were conducted at a mean (SD) of 84 (3) (range=79-91) months after the disaster. Nearly two-thirds (62%, 113/182) of the index sample completed seven-year follow-up interviews. Washington University granted Institutional Review Board approval for this study (#88-0832 approved 10/10/87 for the baseline study and #00-0922 approved 10/18/01 for the seven-year follow-up study).

In the follow-up interviews, survivors were asked four questions about the impact the bombing had on their personal beliefs and perspectives (see Table 1 for a list of these questions). Interviewers were mental health professionals who received a standard, week-long training program developed by the creators of the interview instruments and conducted by the principal investigator, who is a certified trainer on these instruments. For three yes/no categorical questions, numbers and percentages of responses are provided in the table. One question was open-ended. Survivors were asked to elaborate on open-ended responses to the four questions in addition to categorical responses to the three questions. The questions are listed in Table 1 and ask about effects of the bombing on survivors’ lives, changes in personal philosophy or perspective, changes in behavior, and positive consequences of the bombing. Interviewers recorded hand-written notes summarizing the open-ended responses to all four questions. Interviewer notes were compiled in a Microsoft Excel document.

Table 1.

Questions about survivors’ perspectives on their bombing experience with counts and percentages for “yes” categorical responses

Interview questions about survivors’ perspectives Yes
% (n)
1. How would you say the experience of this disaster has affected your life? (n=113) --
2. Have you developed any philosophy or perspective to help you resolve this experience? (n=103) 65 (67)
3. Did you do anything differently after the disaster as a result of your experience with it? 81 (91)
4. Can you think of anything positive that came about as a result of the disaster? (n=97) 89 (86)
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One researcher reviewed all of the material in the open-ended responses and identified themes characterizing the material. Three researchers developed inclusion and exclusion criteria for each theme. Next, pairs of two researchers independently coded responses into these themes, allowing one or more codes and themes as appropriate, until excellent interrater reliability was obtained, defined as Cohen’s kappa scores of ≥.8 (Cohen, 1960; Fleiss et al., 1981; McHugh, 2012). As part of developing interrater reliability, the pairs of reviewers developed precise definitions for each theme and resolved differences in coding through discussion, deferring to the principal investigator for instances of non-resolvability of differences. After excellent interrater reliability was achieved by pairs of raters (with Cohen’s kappa scores ranging from 0.8 to 1.0) raters individually coded responses using ATLAS.ti (ATLAS.ti Scientific Software Development, GmbH, Berlin, Germany).

Results

The seven-year follow-up sample included 113 survivors of whom 50% (57/113) were male, a mean (SD) of 42.5 (10.6) (range=19-69) years of age, 93% (105/113) Caucasian, 34% (38/113) college educated, 71% (80/113) currently married at the time of the bombing. Of the follow-up sample, 87% (98/113) were injured in the bombing and 43% (49/113) had a postdisaster psychiatric disorder, including 32% (36/113) with PTSD.

Nearly two thirds (62%) of the baseline sample of 182 survivors completed the seven-year follow-up interview. The participants who did not complete the follow-up interviews were more likely to be divorced/separated (35% versus 15%, χ2=9.56, df=1, p=.002) and had fewer complete years of education (mean=13.7, SD=2.0 versus mean=14.8, SD=2.0; t=3.43, df=180, p<.001) than those who did. The groups did not differ in sex, age, income, psychiatric disorders, injuries, treatment received, or other life events (North et al., 2011).

As seen in Table 1, approximately two thirds of respondents responded affirmatively that they had developed some philosophy or perspective to help resolve the bombing experience (question 2). More than 80% of survivors reported they have done something different because of their disaster experience (question 3). Almost 90% of the full sample could identify a positive outcome from their disaster experience (question 4).

Eight themes were identified in the qualitative content generated from the open-ended responses: reprioritizing life, altruism and self improvement, connection with others, religion and spirituality, appreciation for life/present awareness, acceptance, physical and financial loss, and emotional and psychological harm. The eight themes were grouped into four general categories: Personal aspirations, Connection with others, Personal perspectives, and Personal harm, including the connection with others theme that was advanced to a Connection with others category because it had no other associated themes. These categories and their associated themes are displayed in Table 2, which also lists numbers and proportions of coded material in each theme and category that summed to a total of 277 coded items. The largest category was Personal harm, followed by Personal perspectives, Personal aspirations, and Connection with others. The largest single theme was emotional and psychological harm. The following section describes the content of all eight themes within the four categories and provides illustrative quotes as appropriate for each theme.

Table 2.

Frequencies and proportions of a total of 277 items coded into established themes within categories

Theme n (%)
Personal aspirations 59 (21)
 Reprioritizing life 31 (11)
 Altruism and self improvement 28 (10)
Connection with others 50 (18)
Personal perspectives 68 (25)
 Religion and spirituality 14 (5)
 Appreciation for life/present awareness 38 (14)
 Acceptance 16 (6)
Personal harm 100 (36)
 Physical and financial loss 8 (3)
 Emotional and psychological harm 92 (34)
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Personal aspirations

This category constituted a little more than one fifth of all the qualitative content in terms of coded items. It included two similarly sized themes of reprioritizing life and altruism and self improvement. The material in both themes was generally positive.

Reprioritizing life

Many survivors reported that the bombing had precipitated major changes in their life goals. Some survivors stated appreciation that they had limited time on earth and had consciously re-evaluated how to spend that time. Numerous responses focused on a desire to not “sweat the small stuff,” to purge unproductive ventures, and to pursue activities they find meaningful. One survivor “got out of a bad marriage and a dead-end job.” Several survivors prioritized happiness ahead of work and money. For example, one survivor went on several family vacations that otherwise would not have happened.

In contrast, four survivors reported approaching their careers with newfound vigor. A manager became a “better boss [wanting] employees to be healthy.” A burned-out university chaplain decided to re-engage with the church. Several survivors sought further education, for example: “I sought a whole different vocation; I quit my job, went to law school, and now have a practice here in Oklahoma City.”

Altruism and self improvement

This theme addressed character growth and the enhancement of personal resilience, grouped together because they relate to the development of survivors’ inward-looking aspirations. Examples of reported character growth included becoming more goal oriented, developing more patience, and becoming a generally stronger person. From observing their own behaviors, others learned how they respond to crises or handle media attention and gained confidence in their ability to identify and handle problems. Survivors reported overcoming fears, including the fear of death.

This theme also included an enhanced sense of altruism and empathy for others. Survivors reported new longstanding feelings of being less selfish, more caring, and more considerate of others. One survivor “became very oriented to healing the office.” Another described increased willingness to stand up for both self and others. Several survivors committed to volunteering for worthy causes.

Connection with others

This category represented slightly less than one fifth of the total qualitative content in terms of coded items. It consists of just one theme, largely reflecting positive aspects of interpersonal relationships. The majority of responses coded in this category detailed survivors’ strengthened relationships with family. Several survivors described making a greater effort to express love. One gave more hugs and another made sure to say goodbye to his family every morning. Several survivors reported greater enjoyment of relationships with family and friends. The bombing caused one survivor to have to “grow up” and another to embrace parenthood. Many survivors indicated that they became more focused on their children, prioritizing their relationships with them, spending more time with them, or re-connecting with children with whom they had lost contact.

Several responses focused on newfound, closer relationships with co-workers. One survivor remarked that people in the community had resolved differences and were moved by the disaster to help one another. Additionally, “Oklahomans came together.” A handful of responses discussed broad unity, such as the “nation coming together.”

Personal perspectives

This category contained one fourth of all coded responses. Three themes comprising this category addressed integration of the bombing experience with personal perspectives: religion and spirituality, appreciation for life/present awareness, and acceptance of a traumatic experience. Almost all the material in the Personal perspectives category had a positive tone.

Religion and spirituality

Some survivors relied upon their religious faith and looked to it for comfort after the bombing. One survivor reported having “prayed more, [which] got rid of my anger.” Several survivors reported experiencing a closer relationship with their faith. Some pondered the existence of good and evil, and to which category humankind might belong. These reflections always concluded on a positive note, such as being “more committed to hearing all people,” feeling that the bombing was “strengthening,” or believing “God’s will is always for redemption.”

Appreciation for life/present awareness

This was the largest theme in the Personal perspectives category in terms of number of coded items. Several responses acknowledged that life is short, uncertain, fragile, and valuable. A number of survivors found comfort by cherishing each day, living one day at a time, living in the moment, focusing on what was in front of them, or appreciating the day ahead. One survivor vowed to “quit taking things for granted.” Another survivor articulated, “Things can always get worse, no matter how bad things seem; I look at what I do have, not what I don’t have.” Another survivor explained that there are “two choices: wallow in misery or get on with life.”

Acceptance

In this theme, survivors recognized their inability to undo the disaster, and they found peace in spite of their limited power. One survivor reported appreciation that “fate is something you cannot always control.” Another survivor acknowledged having been “in the wrong place, in the wrong time” and that “bad things happen.” One survivor reported having forgiven McVeigh. Some survivors reported they had shed their desire to understand the bombing: “We live in ambiguity, there are no black or white answers—why the bombing? It doesn’t matter, it is” and “I don’t have to have all the answers to cope. I don’t have to understand why I survived.”

Personal harm

This category contained more than one third of coded responses. The category is comprised of two themes, physical and financial loss and emotional and psychological harm. These themes had a predominantly negative tone.

Physical and financial loss

Financial losses included lost salary and business income, and physical losses involved injuries in the bombing. Specific physical losses included loss of an eye, other serious visual impairments, heart problems, and memory problems. These impairments caused one survivor to sacrifice a career as an airplane pilot, another to be unable to fish, hunt, or travel far from a hospital, and another to have to write down all important thoughts.

Emotional and psychological harm

This theme contained the vast majority of the material in this category. Posttraumatic responses included jumpiness in response to loud noises, refusal to sit in front of windows, avoidance of crowds and locations involved in the bombing, and disinterest in travelling. One survivor reported “running to get away” from any truck with a motor running and no driver. Survivors described hypervigilance in terms of feeling more cautious, guarded, and aware of their surroundings, including scoping out exits when entering restaurants and concerns about elevators at work. One survivor remarked, “I do not feel secure no matter where I am.” Another survivor noted that the bombing “made me hesitant of who I’m around.…Don’t back me in a corner.” Some survivors reported feeling more introverted or desiring to socially isolate. One survivor noted, “I shut down, stay to myself, and sometimes play solitaire for eight hours straight.” Several survivors described a new suspicion of other people.

Survivors expressed feelings of grief, sadness, depression, guilt, and anxiety. One survivor stated that after the bombing, “I don’t enjoy a lot of things that I used to.…[I] feel old and weary.” Several survivors said they felt anxious in crowds, fearful, or generally nervous. One survivor reported that the bombing “completely shattered my nerves.” One survivor stated that the bombing caused “a change in personality; sometimes I don’t know who I am.”

Discussion

This qualitative study conducted approximately seven years after the Oklahoma City bombing examined 113 survivors’ evaluations of the disaster’s impact on their lives. The study focused on survivors’ efforts to make meaning of their disaster experience. Eight themes emerged within the qualitative analysis and were grouped into four categories: Personal aspirations, Connection with others, Personal perspectives, and Personal harm.

Most of the qualitative content had a positive tone; however, the category pertaining to Personal harm was overwhelmingly negative. The material contained within the three positive categories suggested that survivors had matured in three major ways. One manner was development in life goals and personal character (Personal aspirations). Another was maturation in their approach to relationships with others (Connection with others). Yet another was philosophical development, such as reconsideration of the nature of mankind or the value of a religion (Personal perspectives). Previous studies were generally quantitative rather than qualitative and found that disaster survivors experienced meaning-making within two years of the disaster (Aten et al., 2019; Drury et al., 2009; Lee et al., 2021; Vollhardt & Staub, 2011; Wood et al., 2021). These studies focused on single, similar themes, largely describing religious engagement, altruism, and community unification.

The six positive themes described in this study were nearly identical to the themes found in the baseline study of the same disaster conducted by this team six months after the bombing (Lee et al., 2021). The previous study identified three categories: Personal aspirations (including reprioritizing life and altruism and self improvement), Connection with others, and Making meaning (including appreciation for life, religion and spirituality, and contemplating life, death, and humanity). The fact that survivors gave roughly the same answers to similar questions nearly seven years later suggests that the positive changes associated with exposure to a disaster are remarkably enduring and consistent over time.

The Personal harm category was newly identified at seven years after the bombing. The Personal harm category included both physical/medical (a small amount) and emotional/psychopathological content (the majority). About half of the material coded into the Personal harm category in the seven-year study was elicited by one question: “Did you do anything differently after the disaster as a result of your experience with it?” This subset of Personal harm material may have emerged at seven years because of a change in the question’s wording since earlier interviews. At six months, the question read: “Are you going to do anything differently in the future as a result of this experience?” (Lee et al., 2021). The six-month question solicited aspirations, whereas the seven-year question requested recounts of survivor experience. Naturally then, the six-month question may not have elicited the Personal harm material produced by the seven-year question.

The other half of the material coded as Personal harm came from responses to one question that was asked with identical phrasing at six months and seven years: “How would you say the experience of this disaster has affected your life?” The emergence of negative content in response to this question could be attributed to greater ease by survivors reflecting on the negative outcomes of the bombing with the passage of time and/or the permanency of a loss becoming evident to survivors only after many months or years had elapsed. Some reflections on negative consequences of the disaster with similar themes (especially anxiety over personal safety and distrust of others) were observed in a different sample studied at one year after the Oklahoma City bombing (Turner et al., 2022). By seven years, survivors appeared to have incorporated further negative cognitions into their meaning-making process. The addition of negative cognitions after the baseline interviews appeared to yield more balanced, comprehensive evaluations of personal meaning because the meanings described were no longer dominated by accounts of positive consequences (Lee et al., 2021). This integration implies the meaning derived from the disaster experience evolved over a period of years, a process that parallels the lifelong development of meaning described by Frankl and others (Frankl, 1959; Hong et al., 2019).

This study had notable strengths related to its sample and other methodology. A strength is that content was elicited from open-ended questions, allowing survivors to describe their experience in their own words. The study sample was relatively large, highly exposed to trauma in a terrorist attack, and randomly selected from a state registry of Oklahoma City bombing survivors. The baseline and follow-up samples had relatively high participation and low attrition rates, with little evidence of bias based on participant characteristics. The seven-year study is a follow-up study of survivors originally examined at six months using similar questions, allowing precise prospective comparison of postdisaster findings over time. A notable limitation is that the findings are not necessarily generalizable to survivors of other disasters, other types of disaster, or disasters in other locations. The qualitative part of this study was based on a limited number of directed questions. The interviews were not audio recorded and transcribed, rather relying on interviewers to hand write participant responses, which may have introduced errors and limited the depth of the content obtained. It is possible that subtle differences in methodology between the baseline and current study are responsible for the emergence of personal harm content at seven years. Additionally, one of the four questions asked specifically about any positive impact of the disaster, an explicit directionality that may have elicited predominantly positive material for that one question.

Not surprisingly, most of the literature on care for those exposed to disaster has focused on immediate and short-term evaluation and treatment (Kanehara et al., 2016; Steinert et al., 2015; Zhong et al., 2018). The current study’s results suggest how the care of those exposed to disasters might evolve over time, with a clinical focus beyond purely treating psychopathology. Previous findings on making meaning described how, over a relatively short period of time, most individuals create meaning primarily by focusing on positive effects, such as appreciation that they and other important individuals survived (Lee et al., 2021; Turner et al., 2022). Therefore, clinical facilitation of the development of positive meanings and pursuit of personal maturation in life goals, personal character, interpersonal relationships, spiritual connection, philosophical beliefs, or personal psychology would seem appropriate, especially for early postdisaster contemplation. Over the long term, there is negligible evidence to suggest that reflection on the negative consequences of a disaster represents pathological or disabling symptomatology. The current study suggests it may be a sign of normative disaster processing. At seven years, the clinical focus may need to shift to integrating the positive and negative effects into a more comprehensive understanding of the meaning of a disaster experience. To help survivors cope with a disaster experience, clinicians may need to demonstrate sensitivity to the evolution of psychological healing processes over time.

The findings from this study lead to an inescapable conclusion: the study of disaster responses among survivors cannot be fully captured solely using short-term or cross-sectional methodology. In the first seven years, personal understandings of the disaster changed in important ways from the first few months. As time passes, survivors’ perspectives on the disaster may continue to evolve. Additional investigation over subsequent decades is needed.

Acknowledgments

This research was supported by the National Institute of Mental Health Grants MH40025 and MH68853 to Dr. North.

Footnotes

Declarations

The authors report there are no competing interests to declare.

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