LINKS AND SHORT TOPICS
LINKS AND SHORT TOPICS
********************************************************* "If you want creative workers, give them enough time to play." - John Cleese
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The National Institute of Mental Health, National Institute on Drug Abuse offers grants for the study of interventions to reduce suicidal behavior in youth, and the development and testing of such interventions that build on both risk and protective factors. Both broad-based and targeted approaches need to be tested.
Contact: Web site: http://www.grants.nih.gov/grants/guide/pa-files/PA-00-077.html
* * * * * November 16-19: The 16th annual meeting, International Society for Traumatic Stress Studies, San Antonio, Texas. Contact: Web site: http://www.istss.org
* * * * * Depression Screening
http://www.depression-screening.org Visitors to this site will find a confidential screening for clinical depression from the National Mental Health Association. The test offers immediate results about people's risk for clinical depression to help them recognize depression and, if needed, seek treatment. The screening is not meant to substitute for a professional evaluation. The site also provides information on depression.
* * * * * China Cultural Tour Information
https://www.angelfire.com/biz3/odocspan/china1.html
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SOME EXAMPLES OF DISASTER RELATED EMOTIONAL PROBLEMS
Frequently among workers, questions are raised about the types of emotional distress to be expected with disaster victims. There is also interest expressed about learning ways in which these problems can best be handled by workers in the field.
Workers should realize that they are not expected to become instant experts in the diagnosis and treatment of mental disorders. The worker's role is first to identify those in need of help and then to offer verbal support, information, and advice when requested. Sometimes physical assistance, such as moving a victim's belongings or helping to repair damage to homes and property, is most helpful in overcoming emotional distress.
Following are some case illustrations of the more typical types of disaster-related emotional distress along with a brief discussion of ways the situation might be handled.
DEPRESSION
A worker finds a middle-aged man pacing up and down in front of his flood-ravaged home. Some of the water-soaked furniture has been dragged out into the yard to let the sun dry it out. However, the man has apparently abandoned further attempts to salvage his furnishings and is now walking about aimlessly in what remains of the front yard, wringing his hands.
This illustration of depression differs somewhat from the usual picture of the individual suffering from apathy and withdrawal, with no interest in what is going on around him. The example demonstrates that depression is frequently masked by, or expressed in, agitated activity which is aimless or nonproductive. Unless the depression in this phase is recognized and helped, it may readily progress to more serious mental and physical problems.
Help for the depressed person in this instance might take the form of verbal help, such as reassurance, encouragement, giving information about where and how to get help, and offers of physical assistance in salvaging belongings, making sure he has had something to eat recently, and providing hot coffee or tea while conversing.
GRIEF
A man appears in a one-stop relief center in a small western city severely damaged by an earthquake. He asks for help in acquiring a set of mechanic's tools. He needs the tools because his set was lost with his house and all the rest of his possessions in the earthquake. While giving the required information to the disaster worker, he mentions in passing that his son was killed in the earthquake.
This man appears to be in complete control of his emotions. He seems to be going about the business of re-establishing his life in a well-organized fashion. However, such behavior would be considered healthy and desirable only after a suitable period of mourning or "working through" the grief reactions to the death of his son. In this instance, there had been no time for mourning. The father was busying himself with constructive tasks that actually served to screen the emotional pain in order to avoid dealing directly with his loss. One doesn't have to be a specialist in human behavior to anticipate that the father would probably at some point experience the flooding of emotions he was now damming up and that he would be overwhelmed by them.
What could be done in such a case? It would seem presumptious and perhaps ill-advised to confront this man directly with his loss and to challenge his defense of suppressed emotions under these circumstances. Perhaps a brief, gentle comment on his loss is all that can be done at this time. Such a comment might permit the beginning of the experience of grief. The bereaved father has thus felt the touch of gentle understanding and in a sense has received permission to deal directly with his loss. The worker would want to alert relatives or close friends to the probability that the father might need help in the future in dealing with his grief.
Depending on the situation, there are many approaches which might be appropriate for assisting those suffering grief. It often might be desirable to convey empathy through those close to the victim rather than directly. Again, depending on the circumstances, it might be more suitable to offer direct assistance in the form of making arrangements, notifying relatives, or dealing with insurance matters.
ANGER
A rural valley with many small farms was devastated when a newly finished man-made dam gave way and flooded the area below it. Some citizen's who had suffered losses in the flood were seen throwing rocks at trucks belonging to the construction company that had built the dam. Anger was also expressed by local relief workers whose efforts were hampered by bureaucratic red tape. Victims exhibited anger toward relief workers both for interferring with their lives and for not doing enough to help those in need.
Anger is one of the natural and expected reactions to adversity. The degree of anger felt and ways in which it is expressed are related to many things, some of which are external, as in the case of negligence which caused or contributed to the catastrophe; and some of which are a reflection of the individual's experience of helplessness and frustration in the disaster itself.
In dealing with anger in disaster victims, it is important for the worker to be aware of the value of "ventilation" as a means of reducing the excess emotion which interferes with constructive handling of the causes. That is, it is important that the angry victim be permitted to express his/her anger verbally. It is generally not desirable to take direct action while in the grips of such strong feelings. On the other hand, an understanding listener should not try to exhibit anxiety while listening to the angry outbursts and recitals and not try to "talk him out of" being angry, nor express disapproval or other guilt-inducing reactions. Many people find it uncomfortable and difficult to listen to angry reactions of others. If one is aware of its therapeutic value and is sufficiently motivated, however, this important service becomes easier with practice.
GUILT
A woman whose home miraculously escaped damage in the flood, while the home of a close friend and neighbor was completely destroyed, appears at the local health center with various physical symptoms such as stomach cramps, loss of appetite, and severe headaches. Medical examination provides no apparent basis for the complaints. It was concluded that the patient was experiencing a severe anxiety attack. Consultation with a mental health professional revealed that the woman was suffering an overwhelming sense of guilt because she was spared the tragic loss suffered by her friend. Counseling helped her to accept the unpredictable nature of the disaster which ruined one person and spared the next. The woman was able to overcome her guilt and to offer welcome assistance to her neighbor in coping with her losses.
Guilt is a frequent occurrence among survivors of a disaster. We all experience to some degree the uneasiness which accompanies sudden and unexplainable good fortune. Our own sense of worthwhileness is called into question. Why have we been spared misfortune when others have suffered? We are glad to have been so favored, of course, but at the same time feelings of guilt arise because secretly we are relieved that the losses occurred to someone else instead of us. The opportunity to talk about and confront directly these natural human reactions with someone who is understanding and shares the same weaknesses is of great value. The knowledge that such feelings occur with most people provides a sense of acceptance and belonging which permits one to go on and to do what can be done to help others who have been less fortunate.
APATHY
An elderly man owned and operated a small private fishing lake and boat rental concession at his homesite. A flood destroyed his boats and equipment and completely filled the lake with mud. The old man, who lived alone, was discovered by neighbors several weeks later. He had taken to his bed, neglecting to eat or care for himself. At the time he was found, his weight and physical condition had deteriorated to the point where he was almost dead. At first he refused assistance. However, as a result of patient and persistent efforts by the neighbors, he was persuaded to allow himself to be taken to the hospital. Although he initially regained his health he did not survive long after being placed in a residence for the elderly.
In this case, the old man felt he could never regain what he had lost in the flood. There simply was not enough time or opportunity. He had little left to live for.
In disasters, apathy is frequently found in the elderly who have suffered significant losses of possessions, their homes, friends, and neighbors. There is a feeling, often all too real, that they will not again be able to recover or replace these losses. Assistance must take very concrete and immediate forms if it is to be of any value. Relatives or friends must be located if possible. Physicalrelocation should be as near as possible to what is familiar for the older person. Readjustment to new surroundings and strangers is often an overwhelming and sometimes impossible effort, as in the case illustrated above. As many people as possible should be involved, especially other elderly people who have gone through the same experience.
When apathy is encountered in the middle-aged person or in the adolescent, emphasis should be on immediate and active attempts to recover and replace the losses, to become involved in community rehabilitation, and to participate in social activities. The last mentioned is of particular importance for the adolescent.
FEARS
An otherwise normal 6-year-old girl who has experienced an earthquake becomes terrified and cries when a heavy truck passes by the house, causing a slight vibration. A 4-year-old boy, who was suddenly evacuated just before the flood destroyed his home, develops the habit of sleeping with all his clothes on and his remaining belongings packed in a suitcase kept at the foot of his bed in the mobile home he and his family now occupy. A 7-year-old boy, who survived a flood caused by torrential rain, is found crying and crouched under a stairwell when a light rain starts to fall.
These persisting fears are often found among young children and sometimes among adolescents and adults following a disaster. Thet are referred to technically as "traumatic neuroses". With most otherwise healthy persons such persistent fears tend to subside as time passes. If they continue to appear some months after the disaster it is apparent that the intervention of a mental health specialist is needed. Much can be done, however, in the immediate post-disaster period to relieve these symptoms and prevent their continued self-reinforcement.
With children it is essential that the child be given additional warm affection and understanding when experiencing the recurrence. Above all, the child should not be scolded or punished for exhibiting these fears. Talking with the child in a gentle and reassuring manner is helpful. Permitting or encouraging the child to talk about what is frightening him is also important. For adolescents and adults who display recurrent fear symptoms, permitting the victim to relive the experience verbally, to become actively involved in recovery efforts, and to learn more about the causes and means of possible protection from future disasters are particularly useful.
THE "BURN-OUT" SYNDROME
Two police officers are on duty at a checkpoint for autos entering the disaster area. It is their job to permit entry only to those who have homes or businesses in the area or who are involved in relief activities. There is a constant stream of vehicles lined up in both directions. The officers must inspect identification and passes, answer questions about disaster recovery activities, reassure anxious homeowners, and placate angry citizens frustrated at the delay. The officers have had 12-hour duty days for the past week, with only brief periods of relief. Their faces show fatigue. Their efficiency is at a low ebb. One officer describes his concern about his family to a relief worker. Another officer is anxious about all the work that needs to be done at his house. His wife is upset at his absence during this critical period. He feels the accumulating frustrations and anger of the people he is trying to assist. His work requires him to ignore his personal priorities. There are not enough replacements to permit him to attend to his family responsibilities.
The man is exhibiting excessive fatigue, irritability, anxiety, impatience, and all symptoms of the beginning of the "burn-out" syndrome. Front-line workers typically overextend themselves in disasters. This most often occurs when there are not enough relief workers, and the ones available want to help as much as possible. Sometimes, however, even when replacements are available, workers refuse relief and push themselves beyond their effective limits. Such action might seem altruistic and commendable. In reality, the tired and inefficient relief worker can be more of a liability than an asset in rescue and recovery activities. The workers during and immediately following the disaster need all the strength and energy they can gather. They must have clear heads to make critical and sometimes life-saving decisions. They must be able to cope not only with the physical consequences of the disaster itself but with the fears, anger, and physical and emotional suffering of the victims.
It is essential, therefore, that the worker is not overtired or weak from lack of food or rest. Often the worker fails to recognize these signs in him/herself although they are obvious to others. Those responsible for supervision of front-line relief workers must do everything possible to forestall the occurrence of the "burn-out" syndrome.
BIZARRE BEHAVIOR
A man whose entire herd of cattle was lost in a flood is apprehended while shooting his neighbor's surviving cattle. The man can offer no rational explanation for his behavior.
Sometimes the effects of the disaster can prove to be an overwhelming experience for victims. The excessive stress causes a breakdown of usually effective coping mechanisms. The individual exhibits irrational and bizarre behavior. He may temporarily "go crazy".
Contrary to popular misconception, this is an unusual rather than a usual occurrence during disasters. Most frequently, individuals who suffer emotional breakdowns are those who have had previous histories of breakdown and likely have had to be hospitalized for mental health treatment in the past. There are generally a few people in any community with histories of emotional breakdown. It is valuable for local mental health professionals to be aware of those who are more likely than most to suffer serious mental disturbance as a consequence of the disaster. Immediate assistance is required in the form of admittance to a hospital or emergency professional attention when the victim shows behavior which could be harmful to himself or others.
SUICIDE
A woman who lives alone is found dead of a self-inflicted gunshot wound following a flood which devastated the community where she lived.
As with mental breakdowns, suicide is not a common occurrence among disaster victims. The seriousness of this tragic aftermath is such that mental health and other relief workers need to be alert to those individuals who might be likely to react to excessive stress in this way. It has been found that those who do commit suicide usually have some previous history of attempts or communications to others about their intent to do away with themselves. Awareness of who in the community is susceptible to this sort of self-destruction is one of the vital roles the local mental health workers can play in alleviating the emotional suffering which accompanies all disasters.
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To search for further information in this area, go to the site below and begin by placing one or more of the following descriptors in the search box. Descriptors: Disaster and emotional problems, Emotions, disaster mental health, depression, grief, grieving, loss, anger, elderly, teen-agers and disasters, apathy, guilt, fears, burn-out, relief workers, disaster mental health professionals, fatigue, crisis intervention, bizarre behaviors, suicide, etc. 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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