Neuropsychological Insights Into Child Survival: Possible Protective Dissociation During Prolonged Entrapment After a Turkish Earthquake

Objective: Unknown etiology Background: Earthquakes and other catastrophic events can lead to conditions of being trapped under the rubble, which can cause minor-major health consequences. One of the most challenging issues in entrapment is the need to rescue people as fast as possible. A related issue for rescue forces is how long to continue searching for survivors. Indeed, sometimes victims survive longer than expected. The cases described below led us to postulate that certain adverse psychological effects of being trapped under the rubble may be beneficial for survival in such extreme situations. Case Reports: In this article, we report 2 cases of children who were rescued from under the rubble following an earthquake in Turkey in February 2023. The children were rescued approximately 1 week after the earthquake, exhibiting symptoms that could be understood as dissociation. We present converging neuropsychological and neurophysiological scientific evidence that enabled us to propose that dissociation-related imagination together with excessive sleep may have increased vagal nerve activity. Vagal activity in turn may have helped to reduce risk of infections and inflammation, and possibly increased the chance of survival. Conclusions: Although impossible to measure and prove in such extreme contexts, we propose a plausible psychobiological mechanism for those children’s symptoms and relatively long survival under entrapment. While only a speculation, dissociation might have been protective in such conditions. We discuss the limitations of these reports and the speculative mechanisms, and provide further implications for policy.