Learning From The Past and Planning For The Future
MENTAL HEALTH MOMENT September 29, 2000 ""A desk is a dangerous place from which to watch the world." - John le Carre LINKS AND SHORT TOPICS
LINKS AND SHORT TOPICS
The National Human Genome Research Institute Ethical, Legal, and Social Implications of Human Genetics Research (ELSI) is soliciting grant proposals for research and education activities that anticipate, analyze and address the implications of the discovery of new genetic technologies and the availability and use of genetic information. Contact: (301) 402-4997; email: elsi@nhgri.nhi.gov Web: http://www.nhgri.nih.gov/98plan/elsi
The National Institutes of Health has released a self-report on behavioral and social sciences research during 1998-99. Contact: Office of Behavioral and Social Sciences Research, (301) 402-1146
Web site: http://www1.od.nih.gov/obssr/obssr.htmDecember 6-8 The World Federation for Mental Health (WFMH) presents "The Promotion of Mental Health and Prevention of Mental and Behavioral Disorders", Atlanta, the first biennial international conference on prevention/promotion. Contact: WFMH, 1021 Prince St., Alexandria, VA 22314-2971, fax: (703) 519-7648 Web Site: http://www.wfmh.org/
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Disaster victims can suffer various losses. These can include loved ones, their health, material belongings, animals, employment, the environment to which they belong, and their dreams. It is normal to be shaken by a major loss and to suffer from it. During a disaster, the survivors experience great losses and suffer from them. The Warheit Model The Warheit Model (1979) takes into account the systematic relation among incidents in life, adaptation resources, and the consequences of stress. The model presumes that: * the biological constitution of the individual * the psychological characteristics of the individual * the culture * the social structure (particularly interpersonal relations) * the geophysical environment * the individual's life experiences are diverse sources that influence the filters which enable or prevent the individual to adapt to psychosocial stress during traumatic incidents. When assessing a situation, there are some pertinent and relevant questions which can help in understanding the current situation. * How did he/she perceive the incident? * What were the effects of the incident on this person? * What are the factors which minimized the effects of this traumatic incident? * What are the factors which amplified the effects of this traumatic incident? * What are the types of support which helped this person? * What are the adaptation mechanisms utilized by this person? Perception Of The Incident By The Person Description If the incident is perceived in a realistic manner: * There will be a realization of the relationship between the incident and the sensations of stress which, in itself, will reduce the tension. * It is probable that the situation of stress will be effectively resolved. If the perception of the incident is distorted: * The relationship between the incident and the sensation of stress will also be distorted. * There are different ways of distorting the incident. The person may amplify, generalize, or minimize the incident. * Any attempt to resolve the problem will be affected in the same way. Hypotheses To Be Verified For the person who experiences the traumatic incident: * What significance does the incident have for him/her? * How will it affect his/her future? * How will he/she interpret this incident? ~ Can he/she regard it in a realistic manner? or ~ Does he/she misinterpret its significance? Support By The Person's Natural Network Description * Support from the natural network includes the people who are accessible and who can be counted on for their assistance when it is needed. * In a situation of stress, a total lack of support or insufficient support can leave an individual in a vulnerable position liable to result in a state of disequilibrium or a crisis. Hypotheses To Be Verified For the person who experiences the traumatic incident: * Is he/she surrounded by a significant network? * Does the support received appear to him/her to be adequate and sufficient? * Is this support network easily accessible and for how long? Adaptation Mechanisms Utilized By The Person Description * These mechanisms reduce tension and facilitate adaptation to stressful situations. They can be put into practice consciously or unconsciously. * Throughout his/her life, an individual learns to use various methods to adapt to his/her feelings of anxiety and to reduce his/her tensions. The aim of these mechanisms is to maintain and protect his/her equilibrium. * When an incident which provokes stress occurs and the adaptation mechanisms already learned are not effective, the disturbance is then felt on a conscious level. Hypotheses To Be Verified For the person who experiences the traumatic incident: * Are adaptation mechanisms being utilized? * Are these mechanisms succeeding in maintaining and protecting his/her equilibrium? * How does he/she view his/her future? 5 STAGES OF THE MOURNING PROCESS IN DISASTERS These five stages are a very useful guide to understanding the different phases that a disaster victim or bereaved person may experience. Different individuals do not necessarily go through each stage, in the same order, or at the same rate. But this paradigm, applied in a flexible and intuitive manner, is a useful instrument for understanding the behavior of disaster victims. Negation When a misfortune or catastrophe is announced, our first reaction is not to accept it, but to refuse it. The contrary would be abnormal and it is an indication that, for our psychic organization, the most important thing is to avoid unpleasantness without actually denying reality. This refusal is, at the same time, the beginning of a process of becoming aware of a frightful reality and is aimed at protecting us from the violence of the shock. Anger Anger is an emotion caused by our impotence in regard to what has been arbitrarily imposed upon us. This anger is inevitable and enables the person to express his/her distress in regard to the situation. So we must not be surprised that survivors take out their anger on the people around them: families, friends, relief workers, government representatives, etc. Bargaining The person accepts the fact of the loss that he/she could have or has suffered due to the disaster or the tragedy, but he/she tries to gain either time, financial compensation or other, sometimes by bargaining with God, with the authorities, with insurance companies, etc. When a person bargains with God (even if he/she has never addressed God before), he/she promises to be "good" or to do such and such a thing in exchange for what he/she wants to obtain. Depression The path toward acceptance of the loss passes through a stage of depression. The lost being remains omnipresent. Certainly, in reality he/she is gone, we are aware of it, and we try to accept it. But on the inside, we reinforce our connections with him/her since he/she is no longer present in objective reality. This intense re-appropriation process helps lessen our pain and offers a degree of consolation by providing a sort of temporary survival of the loved one inside us. At the same time this movement enables us, little by little, to begin the work of becoming unattached. Little by little, these movements toward non-attachment become less frequent, the pain subsides, the sadness diminishes, the lost being seems to be less present, his/her importance has a tendency to decrease, the end of the mourning period is close. Acceptance This stage is neither happy nor unhappy. The loss has left a scar, just as any other wound, but the "I" is becoming free to live, love and create again. The person begins to look toward the future, plan projects; the mourning has ended. REACTIONS TO STRESS After having experienced an extraordinary incident, such as a serious threat to their life or the sudden destruction of their home, many people may experience distress. This distress is usually manifested in the person by normal reactions. For others, these reactions may affect their ability to function and to interact with the people around them. Acute Reactions These are reactions that many individuals (but not all) feel during a traumatic incident, immediately, in the hours and weeks following the incident. They are usually normal, but can affect certain individuals in a severe manner and may extend over a longer period. Cumulative Reactions These are reactions which occur after several traumatic incidents have been experienced. These incidents have either been suppressed or poorly metabolized. They make the individual vulnerable in his/her ability to deal with the actual situation. Delayed Reactions These are reactions which occur weeks, months, or even years after a traumatic incident. They usually involve mental health problems. DIAGNOSTIC CRITERIA OF PROBLEMS ASSOCIATED WITH A POST-TRAUMATIC STRESS DISORDER Source: Exerpt from DSM-IV (1994) A. The subject has experienced an extraordinary incident which causes evident symptoms of distress in most individuals. * A serious threat to life or physical integrity. * A danger or major source of unhappiness for the person's children, spouse, other close relatives or friends. * A sudden destruction of his home or neighborhood. * The discovery of someone who is seriously injured or has died in an accident or following an act of physical aggression. * Intense fear of the horror, lack of assistance or aid: in a child this may be manifested by disorganized or agitated behavior. B. The traumatic incident is constantly relived as is demonstrated by the presence of at least one of the following manifestations: * Repeated and overwhelming memories of the incident cause a feeling of distress: among young children, repeated games expressing themes or aspects of the trauma. * Repeated dreams concerning the incident, causing a feeling of distress: in a child this can be manifested by nightmares which may not necessarily be representative of the incident. * Sudden impression or reaction "as though" the traumatic incident was going to happen again: feeling of reliving the incident, illusions, hallucinations, and flash-backs, including those which occur when awake or when intoxicated. * Intense feeling of distress when the subject is exposed to incidents resembling an aspect of the trauma in question, or symbolizing it (anniversaries of the traumatic incident). * Physiological reactions when exposed to incidents resembling an aspect of the trauma in question, or symbolizing it: ~ A woman who has been raped in an elevator perspires abundantly when she enters an elevator. ~ The disturbance persists for at least a month. C. Persistent avoidance of stimuli associated with the trauma or dulling of the general ability to react (which did not exist before the trauma), as is demonstrated by the presence of at least three of the following manifestations: * Efforts to avoid thoughts or feelings associated with the trauma. * Efforts to avoid activities or situations which stimulate reminders of the trauma. * Inability to remember an important aspect of the trauma (psychogenic amnesia). * Marked decrease in interest in activities having a significant value: among young children, loss of recent developmental acquisitions such as toilet training or acquisition of language. * Feeling of detachment or becoming estranged from others. * Blunted affect: inability to experience feelings of tenderness. * Feeling that the future is "blocked": thoughts of not being able to have a career, marry, have children, or live for a long time. D. The presence of persistent symptoms manifested as neurovegetative hyperactivity (which did not exist before the trauma), as is demonstrated by the presence of at least two of the following manifestations: * Difficulty in going to sleep or interrupted sleep patterns. * Irritability or fits of anger. * Difficulty in concentrating. * Hyper-vigilance * Exaggerated involuntary reactions. E. If these symptoms (B,C,D) persist for at least one month. F. The disorder causes a clinically important stress or even a loss on the social, occupational, or functional level. Reactions Observed: Extraordinary Incident At least ONE of the following manifestations: * Repetitive memories * Repeated dreams * Impression that the traumatic incident is happening again * Acts as though the incident was happening again * Intense feeling of distress when exposed to incidents which resemble the incident or commemorate it. * Psychological reactions to situations resembling an aspect of the trauma. At least THREE of the following manifestations: * Effort to avoid any reminder of the trauma. * Avoidance of any activity which arouses memories. * Psychogenic amnesia * Marked decrease in interest for significant activities. * Feeling of detachment in relation to others * Inability to experience feelings of tenderness * Feeling that the future is "blocked" At least TWO of the following manifestations: * Difficulty sleeping * Irritability or fits of anger * Difficulty in concentrating * Hypervigilance * Exaggerated involuntary reactions If these symptoms persist for at least ONE MONTH FOLLOWING THEIR APPEARANCE. The disorder causes a clinically significant stress or even a loss on the social, occupational or functional level - THEN: POST TRAUMATIC STRESS DISORDER - REFER. ********************************************************* For further information on this topic, go to the URL below and search for books on the topic. Start by using the following descriptors in the search engine: PTSD, Post Traumatic Stress, stress, children and PTSD, occupational stress, disasters and stress, trauma, traumatology and disasters, disaster aftermath, etc https://www.angelfire.com/biz/odochartaigh/searchbooks.html ********************************************************* ********************************************************* 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. ********************************************************* George W. Doherty O'Dochartaigh Associates Box 786 Laramie, WY 82073-0786 MENTAL HEALTH MOMENT Online: https://www.angelfire.com/biz3/news
DISASTER RESPONSE: THE ADAPTATION PROCESS
