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Learning From The Past and Planning For The Future
MENTAL HEALTH MOMENT October 11, 2002 "The more I learn, the more I realize I don't know. The more I realize I don't know, the more I want to learn." - Albert Einstein
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 Team14 CEUs each
"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) Council4 CEUs
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.auX 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
VIII European Conference
on
Traumatic Stress (ECOTS)
May 22 - 25 2003
Location: Berlin
GERMANY
Contact:
Scientific Secretariat
VIII ECOTS Berlin 2003
c/o Catholic University of
Applied Social Sciences
Koepenicker Allee 39-57
D-10318 Berlin
Tel: +49-30-50 10 10 54
Fax: +49-30-50 10 10 88
E-mail:
trauma-conference@kfb-berlin.de
Deadlines:
Registration
31 October 2002
WHERE WERE YOU IN '62?
Forty years ago this month, a day not unlike September 11, 2001, Americans realized that the oceans no longer protected us from enemy attack. Those who are old enough to remember John F. Kennedy and October 22, 1962 will never forget the fear that swept through homes and cities when the president went on TV, grave and gray, to proclaim a crisis. He read a stern ultimatum to the Russians. It called them nuclear cheats and liars for placing offensive missiles in Cuba. He also left the impression that his counteractions might at any moment provoke a rain of Soviet missiles. For six days and nights the news terrified the American public. Nikita Krushchev had wagered that a bold plan to ship nuclear weapons to Cuba would solve a host of problems at home and abroad. However, he did not think such an action would lead to nuclear confrontation. President Kennedy decided to avoid violent measures for as long as possible. However, he did not want to reveal the tactical reasons for preferring a blockade. He insisted that his aides use "the Pearl Harbor explanation" for rejecting an air strike - that Americans do not engage in pre-emptive surprise attacks. Americans certainly did not underrate the gravity of the events: families drew close, planned emergency escapes, hoarded food, and hung on every news bulletin. The Cuban missile crisis had profound historical implications. Nations reached for the diplomatic prowess that nuclear weapons seemed to confer. In moments of our greatest vulnerability (40 years ago and again on September 11,2001) it has been our inability to imagine the future that has condemned us to suffer the shock of it. Read a very good comprhensive article on the 1962 Cuban Missile Crisis in the October, 2002 issue of Smithsonian.
DATA REANALYSIS SHOWS CRANIAL MEASUREMENTS ARE HEREDITABLE
A reanalysis of the data of an early 20th century study by the father of modern American anthropology has shown that Franz Boas was wrong and that there is a substantial genetic component to cranial form that can be used in modern forensics, according to Penn State and University of Tennessee anthropologists. "After Boas published his study in 1912, everyone said you cannot use cranial measurements to tell differences in populations," says Corey Sparks, graduate student in anthropology at Penn State. "Uncritical acceptance of his findings has resulted in 90 years of misunderstanding about the magnitude of (cranial) plasticity." Sparks, working with Richard Jantz, professor of anthropology, University of Tennessee, looked at the data from Boas' "Report presented to the 61st Congress on Changes in Bodily Form of Descendants of Immigrants," which was published by Columbia University Press in 1928 as "Materials for the Study of Inheritance in Man." The data contain information on head measurements, on approximately 13,000 European-born immigrants and American-born children from the New York City area. No one had analyzed the data since Boas' days. For the full story by A'ndrea Messer, visit http://www.psu.edu/ur/2002/race.html
WHAT'S IN THE NEWS: DUSTING UP CLIMATE HISTORY
The latest edition of "What's in the News," a current events program for school children that is produced by Penn State Public Broadcasting, shows how sometimes a change in the weather brings a change in the course of history. That's what happened in the 1930s when poor farming practices combined with a prolonged absence of rain to turn much of the Great Plains region to dust. The "Dust Bowl," as the region became known, covered some 50 million acres of land. By the mid 1930s, many farmers had given up their battle with the wind and migrated to California in search of better opportunities. Because of its impact on American history, meteorologists for Weatherwise magazine voted the Dust Bowl the biggest weather and climate event of the 20th century. However, the number one climate event of all time just might be the 1,000-year-long drought and cool spell that struck the Middle East about 12,000 years ago. Besides climate history, "What's in the News" will look at current drought conditions and other recent events. For more information, visit http://www.witn.psu.edu
United States Fire Administration (USFA) Requests A National Salute To Fallen Firefighters
On Sunday, October 6, the nation came together and remembered its fallen firefighters during the National Fallen Firefighters Memorial Weekend. The Firefighters Memorial Weekend honors these brave men and women, recognizes their dedication to the fire service and memorializes their ultimate sacrifice. For further information go to: http://www.usfa.fema.gov/dhtml/media/02-173.cfm
Federal, State And Local Coordination On Hurricane Lili Speeds Response And Recovery Efforts
Federal, state and local coordination efforts to prepare for Hurricane Lili got recovery assets in place and ready for use as soon as President Bush declared Louisiana was eligible for federal assistance. Within two hours of the request for assistance from Louisiana Governor Mike Foster, President Bush authorized the aid during a telephone call with Federal Emergency Management Agency Director, Joe M. Allbaugh. For further information, go to: http://www.fema.gov/nwz02/nwz02_174.shtm
NEWS ARTICLES ONLINE Al-Qaeda planned 'dirty bomb' attack, claims Islamist http://www.smh.com.au/articles/2002/10/07/1033538883132.html
World looks for ways to thwart terrorist 'dirty bombs' http://www.csmonitor.com/2002/1007/p07s01-wogi.html
VIRGINIA - Search for sniper widens to Virginia http://www.upi.com/view.cfm?StoryID=20021006-051923-7648r
TAUNTON -- If a disaster occurred at the Pilgrim Nuclear Power Plant, or in the city, Taunton is prepared. http://www.tauntongazette.com/site/news.cfm?newsid=5612944&BRD=1711&PAG=461&dept_id=24232&rfi=6
International YEMEN - Yemen's al-Qaeda supporters http://7am.com/cgi-bin/wireclicker.cgi?http://news.bbc.co.uk/1/hi/world/from_our_own_correspondent/2168543.stm
AFGHANISTAN - Bin Laden Fate Unclear, but Karzai Says Omar Alive http://7am.com/cgi-bin/wireclicker.cgi?http://www.reuters.com/news_article.jhtml; jsessionid=CPTJFNZBEFSU4CRBAEKSFEY?type=worldnews&StoryID=1539969
QATAR - Qatar-based TV says Bin Laden threatens new anti-US strike http://news.xinhuanet.com/english/2002-10/07/content_586848.htm
MALAYSIA - Malaysia unsure on U.S. terror suspect hunt http://famulus.msnbc.com/FamulusIntl/reuters10-06-203307.asp?reg=PACRIM
ISRAEL - At least 9 Palestinians dead in Gaza raid-witnesses http://famulus.msnbc.com/FamulusIntl/reuters10-06-203903.asp?reg=MIDEAST
GERMANY - German police smash Islamic terrorist cell http://www.thescotsman.co.uk/international.cfm?id=1110042002
North Korea - U.S. plans for preemptive nuclear strikes on north korea revealed http://www.disinfo.com/pages/news/id2794/pg1/
MALAYSIA - Malaysia's PM Mahathir says war on terrorism being handled badly http://www.channelnewsasia.com/stories/southeastasia/view/21066/1/.html
HALLOWEEN IS COMING: CONTEMPORARY LEGENDS CONFRONT LIFE'S MYSTERIES
Contemporary legends, especially those involving the occult and macabre, are a socially accepted way for people, particularly teenagers, to make sense of life and confront the mystery of death, says a Penn State folklore researcher in his book. Contemporary legends about satanic cults, aliens and ghosts are not collective delusions or sinister fantasies that threaten society, notes Bill Ellis, associate professor of English and American studies at the Penn State Hazleton campus. Rather than being finished products, legends are always works in progress circulating among young and old, according to Ellis, author of "Aliens, Ghosts and Cults," published by the University of Mississippi. In their own fashion, the stories serve a rational purpose by allowing people to find reason and order in what often appears to be a chaotic universe filled with unexplainable happenings. For the full story by Paul Blaum, visit: http://www.psu.edu/ur/2001/urbanlegends.html
TRAUMA AND STRESS FOLLOWING SEPTEMBER 11
The September 11, 2001, terrorist attacks were the largest human-made disaster in the United States since the Civil War.
Studies after earlier disasters have reported rates of psychological disorders in the acute postdisaster period. A review of research on the mental health consequences of natural and man-made disasters found that events that involve intentional violence are more likely to be associated with symptoms of severe psychological distress, including PTSD, than are disasters not characterized by human malfeasance (Norris, Byrne, Diaz, Kaniasty, 2001). The scope of the terrorist attacks was unprecedented in the United States and represent an equally unprecedented exposure to trauma in the United States. They have provided a unique opportunity to longitudinally examine the process of adjustment to a national traumatic event.
After the September 11 terrorist attacks, many adults and children received counseling. This article attempts to present results of a number of studies undertaken with residents of New York, Washington, DC, and other parts of the country following the events of September 11, 2001. While somewhat preliminary and necessarily limited in scope, they provide some valuable insights into responses of individuals following an event of such enormous impact.
Assessing Initial Responses
Because there have been few such incidents in the United States, there have been few studies of their impact. Studies of the bombing of the Murrah Federal Building in Oklahoma City, Okla, are the most relevant. For example, North et al (1999) found that one third of a sample of 182 persons directly exposed to the blast reported patterns of symptoms that met criteria for PTSD 6 months later. Smith et (1999) conducted random telephone interviews in Oklahoma City and Indianapolis, Ind (a comparison site), 3 to 4 months after the bombing and found that 43% of those living in Oklahoma City reported 4 or more stress symptoms compared with 11% of those living in Indianapolis.
Silver et al (2002) examined the degree to which demographic factors, mental and physical history, lifetime exposure to stressful events, September 11 experiences, and coping strategies used shortly after the attacks predict psychological outcomes over time. They looked at a national probability sample of 3496 adults who received a web-based survey. 2729 (78%) individuals completed the survey between 9 and 23 days following the terrorist attacks. A random sample of 1069 panelists who live outside New York City were drawn from the original sample (2729). They received a second survey. 933 (87%) completed it within 2 months after the attacks. A third survey (n=787) was completed 6 months following the attacks. Outcome measures were September 11-related symptoms of acute stress, posttraumatic stress, and global distress.
Silver et al report that 17% of the U.S. population outside New York City reported symptoms of September 11-related posttraumatic stress 2 months following the attack and 5.8% did at 6 months. They found that high levels of posttraumatic stress symptoms were associated with female sex (Odds Ratio [OR] 1.64, 95% Confidence Interval[CI], 1.17-2.31), marital separation (OR 2.55, 95% CI, 1.06-6.14), pre-September 11 physician-diagnosed depression or anxiety disorder (OR 1.84, 95% CI, 1.33-2.56) or physical illness (OR 0.93, 95% CI, 0.88-0.99), severity of exposure to the attacks (OR 1.31, 95% CI, 1.11-1.55), and early disengagement from coping efforts (e.g., giving up: OR 1.68, 95% CI, 1.27-2.20; denial: OR 1.33, 95% CI, 1.07-1.64; and self-distraction: OR 1.31, 95% CI, 1.07-1.59).
Silver et al concluded that the psychological effects of a major national trauma are not limited to those who directly experience it. They found that the degree of response is not predicted simply by objective measures to or loss from the trauma. They found instead that the use of specific coping strategies shortly following an event are associated with symptoms over time. They found in particular that disengaging from coping efforts can signal the likelihood of psychological difficulties up to 6 months following a trauma.
Schlenger, Caddell, Ebert, et al (2002) assessed psychological symptom levels in the United States following the events of September. They examined the association between postattack symptoms and a variety of indices of exposure to the events. They used a web-based epidemiological survey of a nationally representative cross-sectional sample using the Posttraumatic Stress Disorder (PTSD) Checklist and the Brief Symptom Inventory. These were administered 1 to 2 months following the attacks.
They sampled 2273 adults, including oversamples of the New York City and Washington, DC, metropolitan areas. Outcome measures were: Self-reports of the symptoms of PTSD and of clinically significant nonspecific psychological distress and adult reports of symptoms of distress among children living in their households. They found that the prevalence of probable PTSD was significantly higher in the New York City metropolitan area (11.2%) than in Washington, DC (2.7%), other major metropolitan areas (3.6%), and the rest of the country (4.0%). However, a broader measure of clinically significant psychological distress suggested that overall distress levels across the country were within expected ranges for a general community sample. In multivariate models, sex, age, direct exposure to the attacks, and the amount of time spent viewing TV coverage of the attacks on September 11 and the few days afterward were associated with PTSD symptom levels. Sex, the number of hours of television coverage viewed, and an index of the content of that coverage were associated with the broader distress measure. More than 60% of adults in New York City households with children reported that 1 or more children were upset by the attacks.
Schlenger, Caddell, Ebert, et al concluded that one to 2 months following the events of September 11, probable PTSD was associated with direct exposure to the terrorist attacks among adults. The prevalence in the New York City metropolitan area was substantially higher than elsewhere in the country. However, overall distress levels in the country were within normal ranges. They call for further research to document the course of symptoms and recovery among adults following exposure to the events of September 11 and to further specify the types and severity of distress in children.
Brandes et al (2002) found that trauma survivors with high levels of PTSD symptoms showed impaired attention and immediate recall for figural information and lower IQ, but no impairment of verbal recall and learning. Sheeran and Zimmerman (2002) found that the Posttraumatic Diagnostic Scale (PDS) performed as well in a general psychiatric setting as it did in original trauma-focused validation studies, independent of PTSD status as a primary, versus secondary, reason for presenting.
Galea, Ahern and Resnick et al (2002) assessed the prevalence and correlates of acute post-traumatic stress disorder (PTSD) and depression among residents of Manhattan five to eight weeks after the attacks. They used random-digit dialing to contact a representative sample of adults living south of 110th Street in Manhattan. Participants were asked about demographic characteristics, exposure to the events of September 11, and psychological symptoms after the attacks. After interviewing 1008 adults, they found that 7.5 percent reported symptoms consistent with a diagnosis of current PTSD related to the attacks. 9.7 percent reported symptoms consistent with current depression ("current" was defined as occurring within the previous 30 days). Among respondents living south of Canal Street (i.e., near the World Trade Center), the prevalence of PTSD was 20.0 percent. Predictors of PTSD in a multivariate model were Hispanic ethnicity, two or more prior stressors, a panic attack during or shortly after the events, residence south of Canal Street, and loss of possessions due to the events. Predictors of depression were Hispanic ethnicity, two or more prior stressors, a panic attack, a low level of social support, the death of a friend or relative during the attacks, and loss of a job due to the attacks.
Galea, Ahern and Resnick et al concluded that there was a substantial burden of acute PTSD and depression in Manhattan after the September 11 attacks. Experiences involving exposure to the attacks were predictors of current PTSD. Losses as a result of the events were predictors of current depression. They suggest that, in the aftermath of terrorist attacks, there may be substantial psychological morbidity in the population.
Working With Children
Following the terrorist attacks, school and health care personnel provided early intervention counseling in Manhattan. Stuber et al (2002) assessed the prevalence and correlates of counseling for experiences related to the disaster by children aged four to 18 years who live in Manhattan. They looked at a representative sample of 1,008 adult residents of Manhattan who were living below 110th Street five to eight weeks after the attacks. They interviewed 112 parents or primary caretakers about their child's level of exposure to the disaster, the extent of loss, receipt of counseling services, and behavioral reaction. 22 percent of the children had received some form of counseling related to their experiences after the disaster. More than half of the counseling received (58 percent) was delivered in schools. Predictors of counseling in a multivariate model were male sex (Odds Ratio [OR]=5.3), having a parent with current posttraumatic stress disorder related to the attacks (OR=4.3), and having at least one sibling living in the household (OR=3.6).
Stuber at al concluded that parents' own level of posttraumatic stress was associated with whether their children received counseling related to the September 11 attacks. They suggest that this finding has important implications, because parents act as decision makers for their children in seeking health care.
People who are not present at a traumatic event may also experience stress reactions. Schuster et al (2001) assessed the immediate mental health effects of the terrorist attacks on September 11, 2001. They used a random-digit dialing three to five days after September 11 to interview a nationally representative sample of 569 U.S. adults about their reactions to the terrorist attacks and their perceptions of their children's reactions. They found that forty-four percent of the adults reported one or more substantial stress symptoms. 91 percent had one or more symptoms to at least some degree. Respondents throughout the country reported stress syndromes. 98 percent coped by talking with others, 90 percent turned to religion, 60 percent participated in group activities, and 36 percent by making donations. Eighty-five percent of parents reported that they or other adults in the household had talked to their children about the attacks for an hour or more. 34 percent restricted their children's television viewing. Thirty-five percent of children had one or more stress symptoms. 47 percent were worried about their own safety or the safety of loved ones.
Schuster et al concluded that after the September 11 terrorist attacks, Americans across the country, including children, had substantial symptoms of stress. They suggest that even clinicians who practice in regions that are far from the attacks should be prepared to assist people with trauma-related symptoms of stress.
Some Suggested Approaches
Acosta and Levenson (2002) offer a variety of clinical techniques for emergency mental health practitioners and first responders for use with victims of critical incidents. Their suggested interventions are based on the theory and clinical practice of Emergency Medical Hypnosis, Neuro-Linguistic Programming, and Ericksonian Psychotherapy. Specific examples of how they were applied with police personnel following the World Trade Center attack are provided along with specific clinical guidelines. These suggested interventions are designed to augment and enhance standard CISM, mental health, and medical practice in the field.
Data on postdisaster increases in substance use are sparse. Vlahov, Galea, and Resnick H, et al (2002) conducted a random digit dial telephone survey to estimate the prevalence of increased cigarette smoking, alcohol consumption, and marijuana use among residents of Manhattan, New York, 5-8 weeks after the attacks. 988 persons responded. 28.8% reported an increase in use of any of these three substances. 9.7% reported an increase in smoking. 24.6% reported an increase in alcohol consumption. 3.2% reported an increase in marijuana use. Persons who increased smoking of cigarettes and marijuana were more likely to experience posttraumatic stress disorder than were those who did not (24.2% vs. 5.6% posttraumatic stress disorder for cigarettes; 36.0% vs. 6.6% for marijuana). Depression was more common among those who increased than for those who did not increase cigarette smoking (22.1 vs. 8.2%), alcohol consumption (15.5 vs. 8.3%), and marijuana smoking (22.3 vs. 9.4%). The results of this study suggest a substantial increase in substance use in the acute postdisaster period after the September 11th attacks. Increase in use of different substances may be associated with the presence of different comorbid psychiatric conditions.
No acutely administered pharmacologic treatment has been shown effective in accelerating the process of recovery or in preventing the development of chronic PTSD. However Marshall and Garakani (2002) suggest that pharmacologic interventions would prevent sensitization of circuits related to context-dependent threat perception, dysregulation of affect, and/or dysregulation of normal circadian rhythms. They suggest that these areas are of theoretical interest and deserve further study.
Chronic post-traumatic stress disorder (PTSD) has been associated with cognitive impairments involving memory and attention (Brandes et al 2002). The association between cognitive impairment and early PTSD symptoms is unknown, yet such association may lead to poorer processing of traumatic memories and thereby contribute to subsequent PTSD. Brandes et al (2002) evaluated the relationship between PTSD symptoms and cognitive functioning within 10 days of traumatic events. Forty-eight survivors were assessed for symptoms of PTSD, anxiety, depression and dissociation and for immediate and delayed verbal and figural memory, attention, learning and IQ. Survivors with high levels of PTSD symptoms showed impaired attention and immediate recall for figural information and lower IQ. They did not, however, show an impairment of verbal recall and learning. The observed difference was not explained by anxiety or dissociation. It disappeared, however, when the effect of depressive symptoms was controlled for. Lower IQ and impaired attention are associated with early PTSD and depressive symptoms. Poorer attention may have a role in shaping traumatic memories.
Bessel A. van der Kolk, MD, has been active as a clinician, researcher and teacher in the area of posttraumatic stress and related phenomena since the 1970s. His work integrates developmental, biological, psychodynamic, and interpersonal aspects of the impact of trauma and its treatment. His book Psychological Trauma was the first integrative text on the subject, painting the far-ranging impact of trauma on the entire person and the range of therapeutic issues that need to be addressed for recovery.
Van der Kolk and his various collaborators have published extensively on the impact of trauma on development, such as dissociative problems, borderline personality and self-mutilation; cognitive development in traumatized children and adults; and the psychobiology of trauma. He was co-principal investigator of the DSM-IV Field Trials for Post Traumatic Stress Disorder. His current research is on how trauma affects memory processes and brain imaging studies of PTSD.
Conclusions and Summary
One to 2 months following the events of September 11, probable PTSD was associated with direct exposure to the terrorist attacks among adults, and the prevalence in the New York City metropolitan area was substantially higher than elsewhere in the country (Schlenger et al, 2002). However, overall distress levels in the country were within normal ranges. Further research should document the course of symptoms and recovery among adults following exposure to the events of September 11 and further specify the types and severity of distress in children.
The coordinated attacks on the World Trade Center (WTC), the Pentagon, and commercial civilian aircraft on the morning of September 11, 2001, were the most deadly terrorist acts ever to occur in the United States. For those directly exposed, the attacks undoubtedly meet the "traumatic event" criterion for posttraumatic stress disorder (PTSD), as set forth in the current edition of the Diagnostic and Statistical Manual of Mental Disorders (1994). Considerable research indicates that individuals directly exposed to a traumatic event are at increased risk for PTSD, for other psychiatric disorders, and for somatic symptoms and physical illnesses.
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Vlahov D, Galea S, Resnick H, et al (2002). Increased Use of Cigarettes, Alcohol, and Marijuana Among Manhattan, New York, Residents After the September 11th Terrorist Attacks Am J Epidemiol. 155:988-996.
Weathers FW, Litz BT, Herman DS, Huska JA, Keane TM. (October 25, 1993). The PTSD Checklist (PCL): reliability, validity, and diagnostic utility. Paper presented at: Annual Conference of the International Society for Traumatic Stress Studies; San Antonio, Tex.
Yehuda R. (2002). Posttraumatic stress disorder. N Engl J Med. 346:108-114.
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
RECOMMENDED READING
Individual and Community Responses to Trauma and Disaster:
by Robert J. Ursano (Editor), et al
The Structure of Human Chaos
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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.
**********************************************************************
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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