Learning From The Past and Planning For The Future
MENTAL HEALTH MOMENT March 22, 2002 "Even if you're on the right track, you'll get run over if you just sit there." - Will Rogers LINKS AND SHORT TOPICS
LINKS AND SHORT TOPICS
DISASTER INCREASES MARRIAGES, BIRTHS AND DIVORCES
Being hit with a disaster increases the number of marriages, births and divorces in a given population in the year following the event, according to a Penn State-led study that also suggests that assistance with family functioning, as well as individual mental health counseling, may be warranted as part of relief efforts. Catherine L. Cohan, assistant professor of human development and family studies, says, "We looked at marriage, birth and divorce records in South Carolina in the year following Hurricane Hugo in 1989 and found increases in all three major life transitions in the counties most affected. The pattern of the results suggests that the disaster was the impetus for people directly affected to take stock of their life and future, re-evaluate their priorities and take actions that had profound consequences for their lives." However, "some people may later regret such a big decision made in the midst of upheaval and emotional turmoil." The results are detailed in the March issue of the Journal of Family Psychology. For the full story by Barbara Hale, visit http://www.psu.edu/ur/2002/disastereffects.html
CLINICAL RESPONSIBILITY AND E-THERAPY
E-Therapy tries to bypass clinical responsibility and the accompanying legal and licensing dilemmas of online therapy. Drug Benefit Trends 14(1) 2002 http://www.medscape.com/viewarticle/424385?srcmp=psy-030802
DEPRESSION RESOURCE CENTER provides updated news, Conference Summaries, Journal Scans, MEDLINE Abstracts, clinical tools, and much more. http://www.medscape.com/resource/depression
NEW MEXICO BECOMES FIRST STATE TO LET PSYCHOLOGISTS PRESCRIBE DRUGS
Psychiatrists vowed to fight back after New Mexico Governor Gary Johnson (R) signed a bill Wednesday giving psychologists permission to prescribe medications, making his state the first to allow them to do so. Reuters Health Information 2002 http://www.medscape.com/viewarticle/429702?srcmp=psy-030802
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Children are one of the most vulnerable groups during and following a disaster. A disaster is a strange event and one that is not easily understood. It is emotionally confusing and frightening and it results in children needing significant emotional support from adults. Children, parents, and whole families who are in need of assistance are found in shelters, recovery centers, as well as other locations. A brief review of some of the basic principles and reminders from child development theory show how a child's current stage of development influences his/her behavior and understanding of traumatic events associated with the disaster. Below are some of the basic principles that may prove helpful in determining the best strategies for providing assistance to children during both the early stages of crisis response as well as the later stages of emotional recovery from the disaster:
DISASTERS AND CHILD DEVELOPMENTAL LEVELS It is important to be aware that children are operating in the world with a different set of cognitive structures than are adults and they are interpreting information from the environment in a different fashion. Cosario (1997) reasserted that when trying to understand children, it is important to remember that childhood is not simply an apprenticeship to the "real" world of adulthood. It is the current world in which children operate. It is the environment in which cognitive, social, and emotional development occur for each child. "Children create and participate in their own unique peer cultures by creatively taking or appropriating information from the adult world to address their own peer concerns" (p. 18). Hartup (1979) suggested that children really experience two worlds: the world of adult-child interactions (e.g. teachers and parents), and the world of peer interactions with children of similar age. It is important to be aware of the simultaneous presence of both of these environments in order to understand and relate to children as developing individuals. Children's emotional development parallels, complements, and interacts with their cognitive development. Kagan (1982), in studies of normal infant development, has shown that infants may smile if information is successfully integrated when confronted with new and different information. They show fear by crying or withdrawing if they cannot make sense of the information. Kagan's study of emotional development affirms that emotions are central to survival. Through emotional expression the infant expresses distress (e.g. a soiled diaper or hunger), pleasure (e.g. being comfortable and having a full stomach), and fear of strangers. Children in middle school and high school, learn to respect the social standard of non- aggression toward peers and acquire the skills necessary to problem solve conflicts and to modulate emotional expression accordingly. By adolescence, children are well skilled in expressing empathy, pride, shame, guilt and other emotions. Throughout normal development, they learn more sophisticated strategies of emotional expression. Tied closely to emotional development is the development of attachment. John Bowlby (1982) originally developed attachment theory by integrating psychoanalytic concepts of child development with parts of cognitive psychology, ethnology, and human information processing. He defines attachment theory as a way of conceptualizing "...the propensity of human beings to make strong affectional bonds to particular others, and of explaining the many forms of emotional distress and personality disturbance including anxiety, anger, depression, and emotional detachment to which unwilling separation and loss give rise" (Bowlby, 1982, p. 39). Attachment refers to the affectional bond that forms between a nurturing figure (usually the mother) and her child in the course of time and in response to consistent care. Bowlby states that there is an innate tendency within the human baby to seek and maintain proximity to the attachment figure. This behavior has the function of protecting children from the risk of harm. The field of attachment research was reviewed by Mary Main (1996) and found that, in the years since Bowlby's original formulation, the concept of attachment has been extended beyond infancy to account for behavior throughout the life span. Main has suggested that the development of the attachment relationship is based on social interaction.In the overwhelming majority of instances, children become securely attached to a nurturing caregiver. They also become attached to maltreating parents and the resulting attachment bond is expressed as an insecure attachment. The quality of the attachment bond is generally established at seven to eight months of age. It is characterized as either secure or insecure. Secure attachment is the result of an infant being able to rely on the caregiver as consistently available and nurturing. Infants who have incompetent, uncaring, or inconsistent caregivers express insecure attachment behaviors. Insecure attachment behaviors related to separation and reunion with the caregiver range from ignoring the caregiver to excessive and disquieting expressions of distress. Being securely attached to a nurturing caregiver is expressed further by using the caregive as a "secure base" from which one explores their immediate environment. For example, a small child who is playing in a park will run and play far away from his/her mother as log as he/she is within visual proximity. The child will wander farther and farther away only to spontaneously return to his.her mother and wil soon again wander off in spirited play. The child displays organized and confident behaviors while in the comforting presence of the caregiver. However, he/she can also appear disorganized and highly anxious or fearful upon being separated from or losing the caregiver. In disasters, brief separations from one's parents are common. Upon being separated from and losing proximity to his/her caregiver, the child will express fear and anxiety until again secure in knowing of the availability of the caregiver. Infants and very young children must be able to physically see objects in order to keep them psychologically available. With time, children can build psychological representations of objects. people, and relationships. Research has suggested that through the maintenance of mental models of their caregivers, children are influenced in their formation of relationships with their peers and in the development of successful interactions with their friends. Adolescents are influenced by models of adult caregivers in a similar manner as they begin to develop long-term relationships with significant others. A good deal of research has been conducted comparing the behaviors of securely attached and insecurely attached children. Carlson and Sroufe (Main, 1996) have reported "...in peer and school settings, children who felt secure as infants with their mother exhibit greater ego resilience as well as social and exploratory competence than insecure infants...Security with fathers also contributes favorably to outcome"(p. 240). Disasters are events in which separation and loss occur. Irrespective of the quality of a child's attachment to his/her caregiver as secure or insecure, the unexpected separation and disruption of one's secure environment results in fear, anxiety, and disorganization of one's own behavior. Children who have experienced secure attachment relationships with a nurturing caregiver are the most resilient in reconciling the disruption and in recovering from traumatic events. The disruption and loss experienced will most likely be more difficult to resolve for children who have experienced insecure attachment relationships. In a study of attachment relationships, Cassidy (1996) summarized some basic findings:* Be a supportive listener. * Be sensitive to the child's cultural, ethnic, and racial experiences. * Respond in a way that is consistent with the child's level of development. * Be aware of the child's emotional status. Is the child actively afraid or withdrawn? * Determine if the child is comfortable and secure with his/her current surroundings and those of the parents and other significant persons and/or pets. * Assist the child in normalizing his/her experiences. * Seek assistance from a child specialist or mental health professional, if necessary. Assistance is needed when the helper does not know what to do or think or if he/she is making things worse.The quality of parents' caregiving behavior initiates a process linked with the quality of peer relationships throughout childhood and early adolescence. PSYCHOSOCIAL DEVELOPMENT LEVELS Erik Erickson's theory of psychosocial development (Santrock and Yussen, 1987) provides a perspective about the social development of children. Erickson proposed that social development is the result of the interaction between internal biological forces and external cultural pressures. He proposed eight stages of development throughout the life span. Conflicts one experiences at each stage can be resolved in either a positive (adaptive) or negative (maladaptive) manner. The development of a psychologically healthy adult requires the successful resolution of conflict at each developmental stage. Erickson accounted for the variation of emotional expression and behavior among individuals on their resolution of conflict along a continuum of healthy to unhealthy outcomes. The eight stages of psychosocial development coincide loosely with eight life stages. Five of these stages occur from infancy through adolescence. Early infancy is the stage of "trust versus mistrust" in which the infant learns to view the world as a place where one can trust others to be supportive and caring, or a place where the infant cannot consistently rely on the support and nurturing of others. The stage of "autonomy versus shame and doubt" occurs during late infancy. Autonomy is the ability to control one's own actions such as toileting. Inability to learn such control may result in feelings of shame and doubt. Early childhood is the stage of "initiative versus guilt". The child is confronted with the conflict of relationships with parents and the unresolved feelings of love and hate. Taking the initiative and engaging in positive social activities resolves conflict. Failure to do so results in unresolved guilt. The stage of "industry versus inferiority" occurs during middle childhood. During this stage the child's cognitive knowledge, physical abilities, and social relationships are expanded. Upon comparing themselves with others, the child ultimately measures how he/she compares to peers. If the child feels incompetent and inferior instead of competent and adequate, his/her interactions with others will be different than if the child feels confident in how he/she compares with peers. During the turbulent and stressful years of adolescence, the child is confronted with the stage Erickson called "identity versus identity confusion". During this period the child resolves the conflict between "who I am and what I want to be" and struggles to decide the direction of his/her life. Resolution of the conflict associated with identity marks the end of childhood and the emergence of adult role- taking in society. Erickson's remaining three stages continue in a similar manner with issues of role performance and development throughout adulthood. SUMMARY Normative development throughout childhood is generally viewed as an active and complex process. It involves ongoing maturation of the child and how he/she engages people and events, attachment to significant adults, social relationships with peers, intellectual and emotional development, and the actual world in which he/she lives. Childhood is the culture in which individual development happens. The quality and characteristics of their environment directly influence the healthy development of children. Is it a setting in which basic needs are a struggle to meet and where danger and fear of personal safety are daily concerns? Or is it a world which is predictable in its organization and resources? Is it a nurturing place with companionship or a place of disregard and isolation? When a natural or human caused disaster invades the world of the child, the impact disrupts the normalcy of the environment and normal functioning. Most children enjoy successful and normal childhoods surrounded by adults and peers who can help them adjust to the impact of the disaster. Traumatic events can be successfully assimilated into their worlds within the context of their own individual development. For those children who are experiencing childhood as a negative environment and are actively developing maladaptive survival strategies, recovery from traumatic events will be a complex and time-consuming process. This can result in sustained and significant alterations in how successfully they are functioning in their world. For example, children may experience a drop in academic performance at school and disruptions in their social interactions with friends, siblings, or parents. Children who are experiencing such significant disruptions in their routine social and cognitive functioning may be at risk for developing Post-Traumatic Stress Disorder (PTSD) or another form of emotional disorder. ********************************************************************************* Linkages exist between family and peer systems * Children's daily experiences with parents affect their concept of self and relationships with others. * Children with more positive relationships with peers express more positive behaviors. * More positive behaviors result in being better liked by peers.REFERENCES Bowlby, J. (1982). Attachment and loss (Vol. 1). London: The Hogwarth Press. Cassidy, J. (1996). Attachment and representations of peer relationships. Developmental Psychology, 32(5), 892-904. Cosario, W.A. (1997). The sociology of childhood. Thousand Oaks, CA: Pine Forge Press. Hartup, W.W. (1979). The social worlds of childhood. American Psychologist, 34(10), 944-950. Kagan, J. (1982). Psychological research on the human infant: An evaluative summary. New York: W.T. Grant Foundation. Main, M. (1996). Introduction to the special section on attachment and psychopathology: Overview of the field of attachment. Journal of Consulting and Clinical Psychology, 64(2), 237-243. Santrock, J.W. & Yussen, S.R. (1987). Child development, an introduction (3rd ed.). Dubuque, IA: Wm C. Brown. To search for books on disasters and disaster mental health topics, children and disasters, schools and disasters, crisis intervention, schools and crises, suicide, PTSD and children, families and disaster and related topics and purchase them online, go to the following url: 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
