Learning From The Past and Planning For The Future
MENTAL HEALTH MOMENT November 7, 2003 "We cannot direct the wind, but we can adjust the sails." - Bertha Calloway
Short Subjects
LINKS Rocky Mountain Region
Disaster Mental Health Institute
CONFERENCES AND WORKSHOPS:
CALL FOR PAPERS:
CONFERENCE ON RURAL CRISIS INTERVENTION
AND CURRENT STATE OF CISM/CISDTHIRD ANNUAL
CRITICAL INCIDENT STRESS MANAGEMENT
WORKSHOP SERIES
Rocky Mountain Region
Disaster Mental Health Institute
Dates & Locations:
Laramie, WY: November 12-15, 2003
Casper, WY: November 21-22, 2003
Contact: George W. Doherty
Box 786
Laramie, WY 82073
Email: rockymountain@mail2emergency.com
Download FlierIV Mexican Congress of Social Psychology
November 5 - 7, 2003
Location: Tlaxcala, MEXICO
Contact: Manuel Gonzalez, President of SOMEPSO
(Mexican Society of Social Psychology)
Phonr: +52 55 5804 4790, Fax: 5804 4789
Email: gona56@hotmail.com,
gona@xanum.uam.mx, somepso@yahoo.com
International Conference on Creativity and
Imagination in Education and Methods of Mastery
November 17-20 2003
Location: Moscow, RUSSIA
Contact: Vladimir Spiridonov
Vygotsky Institute of Psychology
The Russian State University for the Humanities
Miousskaya Square 6, 125267
Moscow , Russia
Phone: +7-095-250-61-47, 7-095-250-66-32
Fax: +7-095-250-44-33
Email: mdyadyunova@mail.ru
Middle East/North Africa Regional
Conference of Psychology
December 13 - 16, 2003
Location: Dubai, United Arab Emirates
Contact: Dr. Raymond H. Hamden
MENA RCP, PO Box 11806
Dubai, United Arab Emirates
Phone: +971-4- 331-4777
Fax: +971-4-331-4001
E-mail: menarcp@hotmail.comSociety for Judgment and
Decision Making Annual Meeting
November 10 - 11 2003
Location: Vancouver, CANADA
Society of Australasian
Social Psychologists 33rd Annual Meeting
April 15 - 18, 2004
Location: Auckland, NEW ZEALAND
27th National AACBT Conference
(Australian Association for
Cognitive and Behavior Therapy)
May 15 - 19, 2004
Location: Perth, Western Australia
AUSTRALIA
5th Conference of the
European Academy of Occupational Health Psychology
November 20-21, 2003
Location: Berlin, Germany
37th Annual Conference
Association for Advancement of
Behavior Therapy (AABT)
November 20 - 23, 2004
Location: Boston, Massachusetts, USA
STUDY SAYS MEDIA INFLUENCE PERCEPTIONS OF TERRORISM, NOT ACTION
A national survey of 1,000 Americans indicates that nearly two-thirds of respondents feel the media has influenced their views on the importance of terrorism as a national problem, according to the Jimirro Center for the Study of Media Influence at Penn State. However, respondents did not necessarily take related action. "This study clearly shows that Americans' views about the threat of terrorism are shaped at least in part by the media," said Ann Major, associate professor of communications and director of the center. More than 65 percent of respondents indicated that media reports have shaped their views about the terrorism problem. Only 7.9 percent said that the problem was unimportant and that their beliefs had not been shaped by the news. Read the full story at http://live.psu.edu/story/4440
NATURAL DISASTERS ILLUMINATED BY B-MOVIE CLIPS
Movie clips, town meetings, debates and backgrounders for public affairs departments do not seem like assignments for a course on natural hazards, but in Penn State's "Earth 101 - Natural Disasters: Hollywood vs. Reality" class, these exercises out-distance and out-pace lectures. As described by its co-creator this week at a meeting of the Geological Society of America in Seattle, the class each semester covers five of the possible topics, which include volcanos, earthquakes, floods, impacts from outer space, tornados, hurricanes and tsunamis. Each topic gets a different learning approach and set of movie clips. The class for non-science majors teaches critical thinking, how science works and how to make decisions on science-based topics. Read the full story at http://live.psu.edu/story/4571
Fire Damage Studies To Begin
As California's disastrous 2003 wildfires diminish, state and federal officials today began to assess the infrastructure damage throughout the southland. Teams from the Federal Emergency Management Agency (FEMA) and OES started meetings today with state agencies and local officials in Riverside, Los Angeles and Ventura counties to conduct preliminary damage assessments, which will be the basis for determining how much assistance is needed to repair roads, buildings and other infrastructure damaged and destroyed by the fires. For more information, go to: http://www.fema.gov/news/newsrelease.fema?id=7572
Wildfire Destroys 12 Colorado Houses
Quinter Fike stirred the ashes of his still-smoldering cottage with an iron pipe, looking for a 16-gauge shotgun his father gave him for his 13th birthday. "It should be about right here," he said, but he had to give up after a minute or two. Despite a cold drizzle, the wreckage of the stone-walled building was still too hot 24 hours after a wind-driven wildfire roared through. Firefighters contained the 3,500-acre wildfire in the foothills northwest of Denver last Thursday, along with a second fire of more than 1,000 acres near Castle Rock south of Denver. But Fike and a handful of others found heartbreak when they returned to their property in the hills above this historic mining town. Authorities said at least 12 homes were destroyed around Jamestown. Eyewitnesses counted up to 18. Fike's home in Jamestown survived, but the stone-walled cottage he, his wife and son built 20 years ago, along with several nearby cabins they used as rentals, were destroyed. "This was our retirement, this was our livelihood," said Fike, a short, trim man of 65 with a salt-and-pepper goatee. "When I look at the landscape, the desire to rebuild, I'm beyond thinking of it," he said. "It obviously won't look the same for years." Neighbor Leon Hill, 66, teared up as he recalled the elk and deer antlers, record albums, books and other heirlooms he and his wife, June, lost in the fire. They had to leave their home of 19 years so quickly Wednesday there was no time to save many treasures. "We'll probably be remembering things we lost 100 years from now," he said, shaking his head.
No homes were lost in the fire south of Denver. Both fires erupted last Wednesday and spread quickly ahead of winds gusting to 50 mph. Both were believed to have been caused by downed power lines. Boulder County sheriff's Lt. Joe West estimated the cost of fighting the Jamestown fire at $400,000, excluding property losses. No cost estimates were available on the Castle Rock fire. Walking in the early morning chill near Castle Rock, resident Tom Burns looked at patches of blackened earth, charred pinon and scrub oak, some of it still smoldering. Here, homes that sell for an average of $400,000 had been spared. "It's not burned to the ground and I'm happy about that,'' Burns said. "I don't know how scrub oak recovers, but I think it could be a lot worse."
While cold, damp weather shut down the fires, authorities warned against writing off the threat in Colorado's drought-parched forests and plains. Small fires were reported in the central and southern sections of the state Thursday -areas that saw none of the wet weather. "We need to be very careful until we break the back of the drought," Gov. Bill Owens said.
National Interagency Fire Center: http://www.nifc.gov
Annan discusses poverty and regional issues with Chilean President
United Nations Secretary-General Kofi Annan discussed poverty, social policies and regional developments during talks today with Chile's President Ricardo Lagos on the first leg of his South American tour. Mr. Annan and Mr. Lagos also conferred over the recent trade talks in Cancún, Mexico, and the Asia-Pacific Economic Cooperation summit in Bangkok, Thailand, according to a UN spokesman in New York. For more information, go to: http://www.un.org/apps/news/story.asp?NewsID=8803&Cr=&Cr1=
Human rights situation in occupied Palestinian areas has deteriorated - UN expert
A United Nations human rights expert today condemned an "escalation of violations against the Palestinian people" and called on the international community "to act decisively to protect Palestinians by taking urgent steps to remove the impunity that Israel enjoys." For more information, go to: http://www.un.org/apps/news/story.asp?NewsID=8804&Cr=palestin&Cr1=
Overhauling the Nation's Mental Health System
In its final report, the President's New Freedom Commission on Mental Health recommends "a fundamental transformation" that, if achieved, will require stronger intervention on the part of primary care practitioners as well as a national commitment to making "recovery" from mental illness the expected outcome in these patients. Clinician News 7(7) 2003 For the article, go to: http://www.medscape.com/viewarticle/462261?mpid=20543
THE MEDICAL MINUTE: CHOCOLATE FOR YOUR HEART?
Chances are you have plenty of chocolate treats left over from Halloween. The good news is that you can go ahead and indulge a little, since medical studies have shown that eating chocolate might actually lower your risk of heart disease and cancer. Hard to believe, right? According to the latest edition of the Medical Minute, a service of Penn State Milton S. Hershey Medical Center, chocolate's benefits come from flavonoids, a group of diverse chemicals that can inhibit blood clots, dilate arteries and work as antioxidants. Flavonoids are especially high in cocoa powder and dark chocolate. A little more than an ounce of dark chocolate has about the flavonoid content of a cup of tea or a glass of wine. Cocoa powder has about twice as much. Read the full story at http://live.psu.edu/story/4582
CRISIS INTERVENTION AND CISM FOR RESPONDERS
Since the 1980s, posttraumatic stress intervention has focused heavily on psychological debriefings to help prevent posttraumatic stress disorder. While debriefing is considered to be important, mental health professionals are unsure about outcomes. There are some who suggest that debriefing may be somewhat hindered by its pathogenic nature rather than being a positive method for preventing trauma stress. Others, however, suggest opportunities for intervention to mitigate traumatic stress reactions, develop resilience, and establish necessary individual and organizational resources.What do we mean by the term crisis intervention?
Everly & Mitchell (1999) define crisis intervention as "the provision of emergency psychological care to victims as to assist those victims in returning to an adaptive level of functioning and to prevent or mitigate the potential negative impact of psychological trauma."
Procedures for crisis intervention have evolved from the work of people such as Lindemann (1944). He conducted studies on grieving in the aftermath of a major conflagration at a nightclub. Kardiner and Spiegel (1947) devised three basic principles in crisis work:
1) immediacy of interventions;2) proximity to the occurrence of the event; and
3) the expectancy that the victim will return to adequate functioning.
Caplan (1964) concentrated on community mental health programs that emphasized both primary and secondary prevention.
An effective response to a crisis depends in part on the characteristics of the crisis and in part on the therapist's comprehensive understanding of the client. This includes both manifest clinical circumstances and problem formulation. One description of the elements that make up a workable formulation is offered by Perry, Cooper and Michels (1987):
1) A summary...that describes the patient's current problems and places them in the context of the patient's current life situation and developmental history;2) a description of nondynamic factors that may have contributed to the psychiatric disorder;
3) a psychodynamic explanation of the central conflicts, describing their role in the current situation and their genetic origins in the developmental history; and
4) a prediction of how these conflicts are likely to affect treatment and the therapeutic relationship.
Among the factors to include are such issues as genetic predisposition, mental retardation, overwhelming trauma, and drugs or any physical illness affecting the brain. In assessing current life problems, the therapist should be on the lookout for changes in biological (including physical illness), psychological and social circumstances of the client's life.
Chrzanowski (1977) defined several common categories of crisis:
The emergence of an acute psychosis, which may or may not require hospitalization.
Self-destructive acting out often associated with alcohol or drug abuse, promiscuity, or delinquency.
Major illness or serious accidents involving the client or people close to him/her.
Family disturbances, including separation and divorce.
Economic crisis.
Severe transference distortions (i.e., psychotic transference).
Serious countertransference distortions.
The paradoxical upsurge of disturbed and disturbing emotion and behavior when the client is threatened by success in the therapy, including the prospect of termination, as cause of crisis.
The response of a significant other who perceives the client's improvement as a threat. There are many models of crisis intervention. However, there is general agreement about the principles of crisis intervention employed by emergency mental health professionals. These principles are:
to alleviate the acute distress of victims;
to restore independent functioning; and
to prevent or mitigate the aftermath of psychological trauma and post-traumatic stress disorder (PTSD) (Butcher, 1980; Everly & Mitchell, 1999; Flannery, 1998; Sandoval, 1985). Variables identified by those who have studied crisis intervention as important agents of change in crisis procedures are:
ventilation and abreaction,
social support and
adaptive coping (Flannery, 1998; Raphael, 1986; Tehrani &Westlake, 1994; Wollmann, 1993). Negative emotional impact is a common reaction among those who go through a traumatic event. Sharing this impact (ventilation) with others is generally viewed as an important step in recovery. Sharing releases repressed emotions (abreaction) related to the traumatic event. Social support networks provide victims with information and let them know that they are not alone in their reactions to trauma, giving victims some of the assistance needed to begin again. Adaptive coping involves cognitive and behavioral skills which emphasize information gathering, cognitive appraisal and skill acquisition (Flannery & Everly, 2000).
Many U.S. soldiers returned from World War II, Korea and Viet Nam “shell-shocked” and suffering from the effects of critical incident stress, often referred to as “battle fatigue.” In 1980, the American Psychiatric Association formally recognized the civilian version of battle fatigue, which became known as post-traumatic stress disorder (PTSD). Post-traumatic stress is defined as “...the development of characteristic symptoms following a psychologically distressing event that is outside the range of human experience.” (DSM-IV, 1994). Symptoms are characterized by intrusive recollections, excessive stress arousal, withdrawal, numbing, and depression. The signs and symptoms must last more than 30 days for an individual to be diagnosed with PTSD. An estimated 4 to 10 percent of individuals who experience a critical incident will develop a full-fledged posttraumatic stress disorder (Blak, 1991). Research also has shown that critical incident stress affects up to 87 percent of all emergency service workers at least once in their careers (Pierson, 1989). In many cases, the stress from one incident can be compounded by two or more factors. For example, an officer involved in an armed confrontation exchanges gunfire with a suspect. The officer is wounded, the suspect dies, and the incident becomes a media event. The injury to the officer, the use of deadly force, and the media scrutiny—conceivably three separate critical incidents—multiply the stressors on the officer.
Critical incident stress manifests itself physically, cognitively, and emotionally. The officer might experience some or all of these reactions immediately, or perhaps not until after a delay. While in most instances the symptoms will subside in a matter of weeks, a few of those affected by such stress will suffer permanent emotional trauma that will adversely affect their continued value to the department and cause serious problems in their personal lives.
A critical incident is any event that has a stressful impact sufficient to overwhelm the usually effective coping skills of an individual. Critical incidents typically are sudden, powerful events that fall outside the range of ordinary human experiences. Because they happen so abruptly, they can have a strong emotional impact.
Critical Incident Stress Management (CISM) interventions allow for the ventilation and sharing of negative emotions. They provide necessary social support to victims, offer the educational components that open the door for victims to gather information, engage in cognitive reappraisal and begin the journey of learning new skills.
The incident debriefing session is psycho-educational and takes different forms, depending on the age group involved. It can be performed through activities including drawing, writing, or discussion. For example, it could be a puppet theater for very young children or an interactive story book for the 6-12 year olds. Adolescents could participate in a forum type meeting in which each person is given the opportunity to give their point of view. For adults, a regular debriefing session could be held; and, for the elderly, a round table type discussion. Even though the incident debriefing session may take different forms, the same rules should apply in order for the session to attain specific objectives.
An incident debriefing session generally helps alleviate acute reactions to stress manifested during the incident or those which persist following it, thereby reducing or eliminating the delayed reactions to stress. This intervention is a rational way of dealing with stress reactions. The intervention model is based on three specific objectives:
to help the individuals express the feelings they experienced
to help them understand their emotional reactions and their behavior
to encourage the return to dynamic equilibrium Mental health professionals (counselors, social workers, psychologists, psychiatrists, therapists, psychiatric nurses, etc.) risk the possibility of becoming traumatized themselves as they treat the traumas of their clients. Vicarious experiencing of what is heard from clients can affect counselors as if the events were happening to them personally.
Psychiatrists have been found to have the highest suicide rate of the medical specialties. Mental health workers are well-advised to recognize and treat their own stress just as they do that of their clients.
Harmful effects of emotional stress have also been recognized in war veterans. From “shell shock” in World War I to “battle fatigue” in World War II to “post traumatic stress disorder” in the Vietnam War, mental health professionals have been presented with the challenge of helping veterans deal with the horrors they met in battle. If the memories of such experiences are not recalled and processed, those individuals may suffer from the related stress for years. When veterans of World War II appeared on television in news coverage of the 50th anniversary of the end of that war, many of them cried. Many had not talked about their experiences with anyone else in all that time.
More recently, attention has been given to the stress present in the jobs of emergency workers in the civilian areas. A number of organizations (e.g. The International Critical Stress Foundation and others) have been founded to assist in the reduction of job stress of police, firefighters, emergency medical personnel, and employees in emergency dispatch centers. Job stressors in these occupations have been associated with substance abuse, divorce, suicide, and family violence.
One of the primary interventions of critical incident stress management is the provision of opportunities for the workers to talk out their memories and emotions from traumatic situations which occur on the job. Usually within two or three days following a particularly traumatic event (e.g., death of a child, multiple casualties, injury or death of a colleague), they have an opportunity to meet individually or in a group setting for a debriefing. The debriefing is led by a mental health professional accompanied by one or more emergency services peers who were not involved in the critical incident. The debriefing process is structured and usually takes about two hours.
Experience has shown that the debriefers then will need debriefing themselves. Intervention is a powerful tool in assisting mental health workers to handle their reactions to trauma and stress. The concept of “talking out” the stress of emergencies, crises, disasters, catastrophes, etc. has been adopted in other venues as well. For example, mental health workers have been added to the American Red Cross disaster response services to tend to the emotional health of the Red Cross workers. They also provide emergency assistance to those directly affected by the disaster. In today's difficult times, where incidents, locally as well as those experienced vicariously by TV and news reports, it is important for mental health professionals to be aware of and trained to respond to the effects of such incidents. This is especially true for rural environments where many mental health professionals are generalists. Rural areas, especially in the western U.S., are underserved and professionals trained in such techniques and responses are usually not as readily available as in urban areas.
REFERENCES Author (1994).Diagnostic and Statistical Manual of Mental Disorders, 4th ed., rev. (Washington, DC: American Psychiatric Association).
Blak, R. (1991). “Critical Incident Debriefing for Law Enforcement Personnel: A Model,” in Critical Incidents in Policing, eds., J. Reese, J. Horn, and C. Dunning, rev. ed. (Washington, DC: US Government Printing Office), 23-30.
Butcher, J.N. (1980). The role of crisis intervention in an airport disaster plan. Aviation, Space, and Environmental Medicine, 51, 1260-1262.
Caplan, G. (1964). Principles of preventive psychiatry. New York: Basic Books.
Chrzanowski, G. (1977). The occurrence of emergencies and crisis in psychoanalytic therapy. Contemporary Psychoanalysis, 13, 85-93.
Erikson, E. (1959). Identity and the life cycle. Psychol Issues Monographs 1.
Everly, Jr., G.S. & Mitchell, J.T. (1999). Critical Incident Stress Management (CISM):A new era and standard of care in crisis intervention (2nd Ed.). Ellicott City, MD: Chevron Publishing.
Flannery, Jr., R.B. (1998). The Assaulted StaffAction Program: Coping with the psychological aftermath of violence. Ellicott City, MD: Chevron Publishing.
Flannery, Jr., R.B. & Everly, Jr., G.S. (2000). Crisis intervention: A review. International Journal of Emergency Mental Health, 2 (2), 119-125.
Kardiner, A. & Spiegel, H. (1947). War, stress, and neurotic illness. New York:Hoeber.
Lindemann, E. (1944). Symptomology and management of acute grief. American Journal of Psychiatry, 101, 141-148.
Perry, S., Cooper, A. & Michels, R. (1987). The psychodynamic formulation: Its purpose, structure, and clinical application. American Journal of Psychiatry, 144, 543-550.
Pierson, T. (February 1989). “Critical Incident Stress: A Serious Law Enforcement Problem,” The Police Chief, 32-33.
Raphael, B. (1986). When disasterstrikes. NewYork: Basic Books.
Sandoval, J. (1985). Crisis counseling: Conceptualizations and general principles. School Psychology Review, 14, 257-265.
Tehrani, N. &Westlake, R. (1994). Debriefing individuals affected by violence. CounselingPsychology Quarterly, 7, 251-259.
Thackrey, M. (1987). Therapeutics for aggression: Psychological/physical crisis intervention. New York: Human Sciences Press.
Wollman, D. (1993). Critical Incident Stress Debriefing and crisis groups: A review of the literature. Group, 17, 70-83.
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
The Vulnerability of Cities: Natural Disaster and Social Resilience
by Mark Pelling
Book Info
Text looks at the literature on disasters and urbanization in light of recent catastrophes. Presents three detailed studies of cities in the global South, drawn from countries with contrasting political and developmental contexts: Bridgetown, Santo Domingo, and Georgetown. Softcover, hardcover available from the publisher. DLC: Urban ecology--Developing countries.
Additional Readings at:
Also try looking here for September 11, 2001: A Simple Account for Children.
Videos on Terrorism
Other videos about terrorism
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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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