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Learning From The Past and Planning For The Future
MENTAL HEALTH MOMENT September 20, 2002 "It' time to start living the life we've imagined." - Henry James
Short Subjects
LINKS Mental Health Moment Online CONFERENCES AND WORKSHOPS:
Basic and Advanced Critical Incident Stress Management Workshops
November 22-23, 2002
Holiday Inn
Casper, WY
Co-sponsored by:
Rocky Mountain Region Disaster Mental Health InstituteAnd Snowy Range A.S.I.S.T. CISM Team"Religious Aspects of Domestic Violence" November 24, 2002
Holiday Inn
Casper, WY
co-sponsored by:
Rocky Mountain Region Disaster Mental Health InstituteAnd The Governor's Domestic Violence Elimination (DoVE) CouncilFifth Annual Innovations in Disaster Psychology Conference
"Psychosocial Reactions to Terrorist Attacks"
Sept. 29-Oct 1
Location: Radisson Hotel
Rapid City, South Dakota
The Australasian Critical Incident
Stress Association Conference
The Right Response in the
21st Century
Location: Carlton Crest Hotel
Melbourne Australia
Friday October 3, 2003 thru
Sunday October 5, 2003
For further information
please contact the conference organisers
ammp@optushome.com.au4th World Congress on Stress
September 12-15, 2002
Edinburgh, Scotland
UNITED KINGDOM
Contact: Northern Networking Ltd
1 Tennant Avenue
College Milton South
East Kilbride, Glasgow G74 5NA
Scotland, UK
Tel: 44 (0) 1355 244966
Fax: 44 (0) 1355 249959
E-mail:
stress@
glasconf.demon.co.ukXV National Congress of
Clinical Psychology &
VII Iberoamerican Congress
of Health Psychology
October 3 - 5, 2002 Location: Santiago, CHILEX Mexican Congress of Psychology
October 23 - 25, 2002
Location: Acapulco, MEXICO
89th International Conference:
Stress and Depression
October 20, 2002
Milan, ITALY
Contact:
Istituto di Psicologia
Clinica Rocca-Stendoro
Corso Concordia 14
Milan 20129, Italy
Tel/Fax: 39-02-782627
E-mail: ist.roccastendoro@libero.itLatino Psychology 2002 conference
October 18-20, 2002
Location: Providence, Rhode Island, USA
Contact: Maria Garrido, Chair
"Latino Psychology 2002"
Adjunct Professor of Psychology
University of Rhode Island Email: mgarrido@etal.uri.edu3rd Ibero-American Congress on
Clinical and Health Psychology
November 20 - 23, 2002
Location: Caracas, VENEZUELA
Contact: Zuleyma Perez
Alcabala a Puente Anauco
Edificio Puente Anauco Piso # 2
Apartamento # 27
La Candelaria, Caracas (Venezuela)
Tel./Fax: (+58) 212-5713060
Email: apicsavenezuela@cantv.net
apicsa@attglobal.net
2002 BERLIN CONFERENCE ON
THE HUMAN DIMENSIONS
OF GLOBAL ENVIRONMENTAL CHANGE
December 6 - 7, 2002
Location: Berlin, GERMANY
Contact: Frank Biermann, Chair
DVPW Environmental Policy and
Global Change Section
biermann@pik-potsdam.de or
Sabine Campe, Manager
2002 Berlin Conference
sabine.campe@pik-potsdam.de
TRENDS IN WHITE AMERICAN IDENTITY TRACED TO 19TH CENTURY
During the 19th century, many white Americans used religion to create an identity as a new chosen people with a divine commission to convert non-white Americans into Christians and thus full Americans, according to a Penn State expert. As early as the American Revolutionary War, Americans started thinking of themselves as improved versions of English Anglo-Saxons, said Daniel B. Lee, assistant professor of sociology at Penn State DuBois, at a summer meeting of the American Sociological Association. This line of thinking was proclaimed from the pulpit, in lecture halls and in popular magazines. "White identity was defined largely in the 19th century and continues to be a major part of the social and political landscape due to the plasticity and emptiness of those concepts which support it," Lee notes. The full story is at: http://www.psu.edu/ur/2002/religion19thcentury.html
PHYSICAL, MENTAL ILLNESSES HINDER LOW-INCOME FAMILIES' ECONOMIC SECURITY
In a study of 254 low-income families in three U.S. cities, 52 percent report concurrent physical and mental health problems in both the primary caregiver and at least one of the children in the household. In addition, the separation of welfare assistance, Medicaid and health insurance programs has created major challenges for recipients to obtain and keep a lasting job--a key goal of welfare reform, researchers say. Linda Burton, professor of human development and family studies and sociology at Penn State, says that the health problems of parents and children appear to be integrally linked, and that solutions developed by policymakers should address both economic and health issues of families. Burton, an African American faculty member, and several colleagues presented their analysis -- part of a larger study of 2,400 families by experts at eight universities - this summer at an American Sociological Association meeting. The full story is at: http://www.psu.edu/ur/2002/welfarereform.html
Federal Disaster Funds Authorized For North Dakota
Federal disaster funds have been made available for North Dakota to help communities recover from the effects of a lengthy bout of extreme weather that began in early June, according to the head of the Federal Emergency Management Agency (FEMA).
Red Cross Disaster Preparedness Looks to the Future
At the Clara Barton Center for Domestic Preparedness, the American Red Cross is training first responders and for a new era of terrorism-related disaster response.
* * * * * * * * * * COURSE OFFERING AT:
University of Sydney, Health Sciences [This material has also been presented, in part, at International Trauma Conferences]
"Imagery and Art Therapy Processes for Survivors of Trauma."
Art Therapy - Imagery 2: PROCESSES FOR SURVIVORS OF TRAUMA Treatment & Prevention
Prerequisite: Art Therapy 1 OR CONTACT BETH STONE ABOUT ALTERNATIVES
Pre or Co-requisite: Counseling Theory and Practice. Professional experience is preferred.
6 credit points
The nonverbal processes of Art Therapy and Imagery are particularly important in working with survivors of trauma since much of the traumatic memories and emotions are encoded in nonverbal imagery. Additional evidence for the nonverbal encoding of traumatic memories is found in recent brain imaging studies. This course will offer students the opportunity to understand and experientially learn skills in some specific Art Therapy and Imagery processes to use with adults and young people suffering from symptoms of traumatic life experiences, including Post Traumatic Stress Disorder. The methods include processes of empowerment, protection, safety, reframing and re-imaging. With the emphasis on experiential skills training, we will also review diagnostic signs/ symptoms of trauma; look at some research in art therapy and become familiar with the work on trauma treatment by Herman, Horowitz, van der Kolk, and Keane. Although the subject is taught with an eclectic Gestalt Transpersonal framework, the Art Therapy methods may be integrated into Narrative, Psychodynamic, CBT, and other orientations.
INSTRUCTOR’S BACKGROUND:
BETH ANNE STONE is a registered Psychologist, MAPsS, Australia; Registered Art Therapist, ATR-BC, AATA; MFCC, AAMFT; Certificate in Gestalt Therapy, Gestalt Institute of San Francisco; and has a Post Graduate Certification in Interactive Guided Imagery [IGA]. She is on the Australian National Registry of Trauma Psychologists; Editorial Board of the Arts in Psychotherapy Journal. Beth has dual citizenship in the USA and Australia. beths@psych.usyd.edu.au
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NEWS ARTICLES ONLINE ORANGE YOU GLAD THAT WE'RE NOT PANICKING?
SEATTLE - Police seize state's biggest stash of fake IDs ever
West Nile Update - Total Dead This Year = 64 Total Infected = 1,438
International UKRAINE - 200 SOVIET NUKES LOST IN UKRAINE
http://english.pravda.ru/main/2002/09/13/36519.html
Bin Laden dead, says comrade
http://www.news.com.au/common/story_page/0,4057,5098478%5E401,00.html
TURKEY - Turkish police on alert over possible poison gas attack- heightened security around U.S., British and Israeli diplomatic missions
http://story.news.yahoo.com/news?tmpl=story&u=/ap/20020910/ap_wo_en_po/turkey_attacks_1
VENEZUELA - Bombs explode outside local television station; no injuries reported
http://story.news.yahoo.com/news?tmpl=story&u=/ap/20020913/ap_wo_en_po/venezuela_media_attack_1
UNDERSTANDING DISASTER BEHAVIOR
Mental health intervention in posttraumatic responses of victims following a disaster is designed to assist the victims in maximizing their coping skills to effectively deal with multiple problems arising in the postdisaster situation.
It is widely assumed that most victims were functioning adequately prior to the disaster, but that their abilities to cope may have been impaired by the stresses of the situation. Victims are unlikely to view themselves as exhibiting psychopathology even if they are experiencing stress-related symptoms. The treating professional should resist the temptation to view the victim as being psychopathological until such a diagnosis is clearly established.
Disaster victims may include all ages, socioeconomic classes, and racial or ethnic groups because disasters affect the entire population in an impacted area.
Research findings confirm that large-scale natural disasters can result in severe mental health problems, including substance abuse, for about 10 percent of victims. Some victims suffer more than others, depending on several interrelated factors. Those who may be particularly susceptible to physical and psychological reactions from a disaster include people who:
* are vulnerable from previous traumatic life events* are at risk because of recent ill health
* experience severe stress and loss
* lose their system of social and psychological supports
* lack coping skills
The frail elderly in general may find it difficult to cope with disaster and its consequences. It is not unusual to find older victims who are isolated from their support systems and live alone. As a result they are often afraid to seek help. Typical post-disaster problems with this group include depression and a sense of hopelessness. Unfortunately, a common response among some frail elderly people is a laxk of interest in re-building their lives.
Children are a special group because they usually do not have the capacity to understand and rationalize what has happened. Consequently, they may present emotional and behavioral problems at home or at school. Perhaps the most prominent disturbances reported in children after a disaster have been phobias, sleep disturbances, loss of interest in school, and difficult behavior.
Those with a history of mental illness may also require special attention. Under the stress of a disaster situation, relapses may occur in this population due to the additional stress or the difficulties in obtaining regular medication.
In summary, although the particular at-risk groups identified merit close attention from disaster workers, victims can be found among all social, economic, and ethnic levels, and among all segments of the population in the disaster area. Therefore, the task is to identify those who need special help in order to provide such help quickly and effectively, and to deal sensitively with all victims realizing that they are under emotional strain.
Special attention must also be given to the disaster workers themselves. These include medical personnel as well. They face unprecedented demands in meeting the needs of victims. They too may experience fatigue, fear, anger, and acute stress reactions. They need organizational and co-worker support to function with competence and sensitivity throughout the course of the emergency.
Basic Concepts In Understanding Disaster Behavior
Key constructs used to understand how individuals respond to disasters include stress resulting from the crisis, social supports at time of crisis, and coping skills of the individual victim.
* Some of the most significant work about individual response to disasters comes from theoretical formulations about stress. Dohrenwend and Dohrenwend (1981) linked stressful life events, mediated by social situations and personal dispositions, to health and mental health consequences for individuals. They offered several interpretations about these linkages. One interpretation is straightforward cause and effect: stressful life events result in adverse health changes. Other interpretations concern the intensification of stressful life events by social and personal dispositions; these combinations of factors result in adverse health change.Several theories relate stress to specific disaster situations, focusing on the event itself, and cultural responses to such emergencies. Frederick (1980) and others theorized that technological disasters create more mental stress than do natural disasters because they are defined, not as originating from God, but as originating from man. Baker (1964) differentiated between more frequent immediate psychological effects of the disaster experience and less frequent long-term consequences of disasters for the individual. Others looked at the magnitude of the disaster. Kastenbaum (1974), for example, hypothesized a significant difference between disasters that affect the individual's whole environment and those that affect only a part of it.
* Human service workers have little control over factors in the environment that cause stress among clients. Their efforts, therefore, are focused on increasing the social supports and coping skills of these persons so that they are better equipped to manage the stress and are less at risk for emotional problems. With regard to social supports, Taylor (1978) showed the importance of political, economic, and family interactions and supports in disasters. Political supports referred to functions served by public figures at disaster sites. Economic supports were defined as financial institutions that provide funds in aid of recovery of the community. Family supports referred to the functioning of family members in warning system evacuation and extended family assistance.
Barton (1969) pointed to the existence of a two-part emergency social system. The first part is identified by exploring individual patterns of adaptive and non-adaptive reactions to stress, particularly the motivational basis of various types of helping behavior (e.g., altruism and close relationship to the victim). Barton concluded that discrete patterns of individual behavior can be conceptually aggregated to reflect the community's informal mass assault on disaster-generated needs. The second part of the system is the community's formal organization. Barton broadened his initial discussion of the individual basis of helping behavior by examining a community model of the same.
* Formulations that relate individual coping responses to mass disasters focus on perception, personality characteristics, and social behaviors. Slovic et al. (1979) looked at the perception of risk in disaster situations. They stated that those persons who perceive the risk as great are more likely to heed warnings and to take some individual action to avoid or ameliorate consequences than those who do not. In the case of technological risks, those who perceive the risk as great are also more likely to blame the government for politics that allow the risk to occur.
Cohen and Ahearn (1980) pointed out that coping is partially dependent on emotional or psychological tools, those personal characteristics of individual strengths and weaknesses. These individual resources include ability to communicate, sense of self-esteem, and capacity for bearing discomfort without either disorganization or despair.
Lystad (1985b) stated that coping also depends on one's ability to seek support, understanding, and aid in problem resolution. Her work shows that disaster victims are better able to handle the losses of loved ones and property if they are well integrated into a social matrix of family, friends, and neighbors who are able to provide immediate assistance of comfort, food, clothing, housing, and physical care at times of crisis.
Phases Of Disaster-Related Behaviors
The experiences of mental health professionals have shown that the post-disaster period consists of several phases related to the emotional responses of victims as they experience and cope with crisis (Cohen and Ahearn, 1980; Farberow, 1986).
* The first phase occurs at the time of impact and immediately following. Emotions are strong and include fear, numbness, shock, and confusion. People find themselves being called on and responding to demands for heroic action to save their own and others' lives and/or property. Altruism is prominent, and people cooperate well in helping others to survive and recover. The most important resources during this phase are the family, neighbors, and emergency service workers of various sorts.* The second phase of disasters generally extends from one week to several months after the disaster. Symptoms include change in appetite, digestive problems, difficulties sleeping, and headaches. Anger, suspicion, and irritability may surface. Apathy and depression may occur, as well as withdrawal from family and friends and heightened anxiety about the future. On the other hand, even those who lost loved ones and possessions, develop a strong sense of having shared with others a dangerous experience. During this phase, supported by the influx of local, state, and federal agencies who offer all kinds of help, the victims clear the debris and clean out their homes of mud and wreckage. They anticipate that considerable help in solving their multiple problems will soon be available. Community groups that develop from the specific needs caused by the disaster are especially important.
* The third phase of the disaster, generally lasting up to a year, is characterized by strong feelings of disappointment, resentment, and bitterness if delays occur and hopes for, and promises of, governmental aid are not fulfilled. Outside agencies may pull out, and some of the indifenous community groups may weaken or disappear. During this phase, victims may gradually lose the feeling of shared community found earlier as they concentrate on solving their own individual problems.
* The last phase, reconstruction, may last several years if not the remainder of the lives of some victims. During this time the victims of large-scale disasters realize that they will need to solve the problems of re-building their homes, businesses, and lives largely by themselves, and they gradually assume responsibility for doing so. The appearance of new buildings replacing old ones, the development of new programs and plans, can serve to reaffirm the victims' belief in their community and their own capabilities. When such positive events are delayed, however, emotional problems which do appear may be serious and intense. Community groups - political, economic, religious, fraternal - with a long-term investment in the community and its people become crucial elements to successful reconstruction.
Disaster Worker Stress
Sources of Stress for Disaster Workers
Disaster workers are subject to three main sources of stress in their work. One arises out of the disaster itself. One arises drom occupational pressures. The third arises from organizational pressures.
At least three distinct types of disaster event stressors have been identified:
a. personal loss or injury: a worker is exposed to toxic substances on the job or a team member is injured or dies;b. traumatic stimuli: a high incidence of injury or death; gruesome sights, sounds, or activities;
c. mission failure or human error: a situation which could seemingly be prevented or no opportunity exists for effective action, such as an incident with no survivors.
Occupational pressures include:
a. time pressures and work overload;b. physical and emotional demands on workers, due to long hours, chaotic situations, and life-or-death decision making;
c. physical properties of the work environment: hazardous work conditions, limited human resources, bad weather;
Organizational pressures include:
a. problems in role clarity and role conflict: role ambiguity occurs among workers who are unsure of their responsibilities in the disaster; role conflict occurs when a worker must face competing demands from other personnel, the media, or the public;b. chain of command: when multiple response agencies are involved in the incident, it may be difficult to ascertain who is in charge;
c. organizational conflict, either within or between organizations, over allocation of resources, responsibility, or blame.
Effects of Stress on Disaster Workers
Disaster workers are normal persons who generally function quite well under the responsibilities, hazards, and stresses of their jobs. At times, when workers have been subjected to severe or prolonged stress in a disaster or traumatic situation, they may show signs of emotional and psychological strain. These reactions are normal reactions to extraordinary and abnormal situations and are to be expected under the circumstances. These reactions are usually transitory in nature and rarely imply serious mental disturbance or mental illness. Relief from stress and the passage of time usually lead to the re-establishment of equilibrium.
Physical symptoms are often the first to occur in acute stress reactions. They include increased heartbeat, respiration, blood pressure, nausea, upset stomach, diarrhea, sweating or chills, muffled hearing, headaches, soreness in muscles, lower back pain, pains in chest, faintness or dizziness.
All cognitive processes usually diminish under stress. These symptoms are often the next to appear after physical symptoms in an acute stress situation: memory problems, disorientation, slowness of thinking, mental confusion, difficulty using logic, poor concentration, loss of objectivity.
Psychological and emotional symptoms include anxiety and fear, anger and blaming, irritability, sadness, guilt, feelings of isolation and estrangement.
Behavioral symptoms include inability to express oneself verbally or in writing; hyperactivity; decreased efficiency; outbursts of anger; increased use of alcohol, tobacco, or drugs; social withdrawal and distancing.
Pre-disaster Interventions for Workers
Some of the most important stress management interventions for disaster workers take place pre-disaster. These activities are important in preparing workers for what they will likely encounter in the disaster situation. Preparation by both the individual worker and the organization can help minimize the effects of stress when it occurs and can help individuals and the organization cope with stress in a more efficient manner. Following are some useful pre-disaster interventions:
a. Collaborative relationship between emergency services teams and mental health professionals;b. Orientation and training to stresses likely to be encountered and to normal reactions to such stress;
c. Disaster planning, training, and drills, with an emphasis on the team approach and on support for team members.
Interventions During the Disaster
a. During the alarm phase, as much factual information as possible about what the team will find at the scene should be relayed to the workers.b. Look for stress reactions among co-workers in field operation; early identification are key in preventing worker burnout. Use mental health assistance in field operation if plans have been made to do so.
c. Supervisors should try to rotate workers between low-stress assignments, such as triage or morgue, to an hour or so if at all possible.
d. Supervisors should ask workers to take breaks if effectiveness is diminishing or order them to do so if necessary. On breaks, try to provide workers with bathroom facilities, a place to sit or lie down, food and beverages, shelter, an opportunity to talk about their feelings.
Interventions After the Disaster
a. A debriefing should be arranged for all team members involved in the disaster. A debriefing is a specific, focused intervention to assist workers in dealing with the intense emotions that are common at such a time.b. Plan for the letdown of team members after the experience. Discuss normal stress reactions in team meetings.
c. If workers' reactions are severe or last longer than 6 weeks, encourage them to use professional counseling assistance. This use does not imply weakness. It simply means that the event was so traumatic it had a profound effect on those individuals.
Disaster Workers as Survivors
Hartsough and Myers, National Institute of Mental Health (1985) emphasize that emergency and disaster workers are highly motivated and highly trained individuals. They perform strenuous, stressful, and often dangerous work. They seek to ease the suffering of victims. At the same time they put themselves at high emotional risk for stress reactions that may be harmful to themselves, their work life, and their family life.
It is important to remember and to give recognition to the inherent strengths and qualities of these workers, who embody the traits of the survivor personality:
A sense of commitment to and involvement in life.Traits of gentleness and strength, trust and caution, self-confidence and self-criticism, dependence and independence.
A feeling of control over their circumstances, and their willingness to admit what can't be controlled.
The ability to see change as challenge, not just a threat; the commitment to meet challenges in a way that will make them stronger persons.
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REFERENCES Baker, G. (1964). Comments on the present status and the future direction of disaster research. In: Grosser, G., Wechsler, H. and Greenblatt, M. eds. The threat of impending disaster. Cambridge: Massachusetts Institute of Technology Press.
Barton, A. (1969). Communities in disaster. Garden City: Doubleday and Company.
Cohen, R. and Ahearn, F. (1980). Handbook for mental health care of disaster victims. Baltimore: The Johns Hopkins University Press.
Dohrenwend, B. and Dohrenwend, B., (eds.) (1981). Stressful life events and their contexts. New York: Prodist.
Frederick, C. (1980). Effects of natural vs human-induced violence upon victims. Evaluation and Change. Special Issue: 71-75.
Kastenbaum, R. (1974). Disaster, death and human ecology. Omega 5 (1): 65-72
Lystad, M. (1985b). Human response to mass emergencies: A review of mental health research. Emotional First Aid 2 (1): 5-18.
National Institute of Mental Health. (1985). Disaster work and mental health: Prevention and control of stress among workers. by Harsough, D. and Myers, D. DHHS Pub No. (ADM) 85-1422. Washington, DC: Supt of Documents, U.S. Government Printing Office.
National Institute of Mental Health. (1986). Training manual for human service workers in major disasters, by Farberow, N. DHHS Pub. No. (ADM) 86-538. Washington, DC; Supt. of Documents, U.S. Government Printing Office.
Slovic, P., Lichtenstein, S., and fischoff, B. (1979). Images of disaster: Perception and acceptance of risks from nuclear power. In: Goodman, G. and Rowe, W. (eds.) Energy Risk Management. London: Academic Press, pp. 223-245.
Taylor, V. (1978). Future directions for study. In: Quarantelli, E. (Ed.) Disasters: Theory and Research. Beverly Hills, CA: Sage Publications, pp. 251-280.
To search for books on disasters and disaster mental
health topics, leaders, leadership, orgainizations,
crisis intervention, leaders and crises, and related
topics and purchase them online, go to the following url:
https://www.angelfire.com/biz/odochartaigh/searchbooks.html
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Contact your local Mental Health Center or
check the yellow pages for counselors, psychologists,
therapists, and other Mental health Professionals in
your area for further information.
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George W. Doherty
Rocky Mountain Region
Disaster Mental Health Institute
Box 786
Laramie, WY 82073-0786
MENTAL HEALTH MOMENT Online: https://www.angelfire.com/biz3/news
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