Learning From The Past and Planning For The Future
MENTAL HEALTH MOMENT October 17, 2003 "When you arise in the morning, think of what a precious privilege it is to be alive--to breathe, to think, to enjoy, to love." - Marcus Aurelius
Short Subjects
LINKS Rocky Mountain Region
Disaster Mental Health Institute
CONFERENCES AND WORKSHOPS:
THIRD 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 19-22, 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
MITIGATION PREVENTS PROPERTY DAMAGE FROM HURRICANE ISABEL
Taking mitigation measures to raise their home after Hurricane Floyd helped a Southampton County Virginia family during the latest bout with tropical weather. For the full story, go to: http://www.fema.gov/fima/vamitss.shtm
GOOD MANAGEMENT CAN REDUCE IMPACT OF NATURAL DISASTERS – Annan
Better planning and management could reduce the impact of natural hazards before they become disasters, United Nations Secretary-General Kofi Annan said today. “Natural hazards are a part of life. But hazards only become disasters when people’s lives and livelihoods are swept away,” the Secretary-General said in a message issued to mark International Day for Disaster Reduction. For the Full Story, go to: http://www.un.org/apps/news/story.asp?NewsID=8484&Cr=natural&Cr1=disaster
DEVELOPMENT IN SMALL ISLAND NATIONS FOCUS OF CARIBBEAN MEETING - UN
More than 150 representatives of Caribbean nations, regional and international agencies, and the private sector are in Trinidad and Tobago this week to discuss plans for the development of the Caribbean region, a United Nations spokesman said today. For the Full Story, go to: http://www.un.org/apps/news/story.asp?NewsID=8465&Cr=small&Cr1=island
FEMA AND NATIONAL CRIME PREVENTION COUNCIL PARTNER IN PREPAREDNESS THROUGH CITIZEN CORPS
Michael D. Brown, Under Secretary of Homeland Security for Emergency Preparedness and Response, announced an official affiliate partnership between the National Crime Prevention Council (NCPC) and President Bush's Citizen Corps initiative. Through this affiliation, Citizen Corps and the NCPC will work together to raise public awareness about crime prevention programs and actions that can reduce vulnerabilities to crime. Community safety is a top priority of both Citizen Corps and the NCPC. For the Full Story, go to: http://www.fema.gov/news/newsrelease.fema?id=5927
SECRETARY-GENERAL CONDEMNS FATAL ATT6ACK ON US DIPLOMATS IN GAZA
United Nations Secretary-General Kofi Annan strongly condemned the attack on a United States diplomatic convoy in Gaza today, killing three Americans, and he urged the Palestinian Authority to bring the guilty to justice speedily For the full story, go to: http://www.un.org/apps/news/story.asp?NewsID=8563&Cr=middle&Cr1=east
AL-QAIDA, TALIBAN MONEY LAUNDERING 'MORE SOPHISTICATED' - UN panel chair
Financial transactions of Al-Qaida and the Taliban have become more "sophisticated" to avoid detection, sometimes involving the use of a centuries-old system, according to the head of the United Nations Security Council's panel overseeing sanctions against the two groups. For the Full Story, go to: http://www.un.org/apps/news/story.asp?NewsID=8564&Cr=afghan&Cr1=
Press Briefing: http://www.un.org/News/dh/latest/afghan/munoz-prsbrief-14oct2003.htmCHILDREN'S MENTAL HEALTH DESERVES SPECIAL ATTENTION, Annan says
United Nations Secretary-General Kofi Annan today called upon all nations to “rededicate” themselves to protecting children with mental health problems. For the Full Story, go to: http://www.un.org/apps/news/story.asp?NewsID=8515&Cr=mental&Cr1=health
Press Statement: http://www.un.org/News/Press/docs/2003/sgsm8919.doc.htmTHE MEDICAL MINUTE: DEALING WITH DRY SKIN, A USUAL WINTER NUISANCE
As the weather turns cooler and we turn on the heat, many of us begin to notice rough, dry skin. As we grow older it becomes more of a problem. If the dryness is associated with cracked skin, redness or is limited to a few areas, it might be more than just a seasonal nuisance. It could be a skin disease, such as eczema. But, according to the latest edition of the Medical Minute, a service of the Penn State Milton S. Hershey Medical Center, if plain dryness is the problem there are various ways to combat skin dryness. Read the full story at: http://live.psu.edu/story/4310
ACCOMPLISHMENTS AND CHALLENGES IN MEDICAID MENTAL HEALTH
Medicaid has been a lifeline for people suffering from mental illness, providing access to a range of services to those who are disabled by mental illness or who have limited incomes. Notably, Medicaid pays for prescription medications, an essential component of the treatment package for people with mental health needs. However, this care is quite expensive. Both the price and volume of antipsychotic drugs and antidepressants have increased dramatically, seriously straining states' resources. In times of state fiscal crisis, it is Medicaid, often the second-largest state budget item after education, that is likely to take the hit. Optional service areas, including case management, community-based services, and unrestricted prescription coverage - areas that were expanded in flusher times - are now targets for retrenchment. Diane Rowland and her colleagues at the Kaiser Commission on Medicaid and the Uninsured detail the competing pressures states face to provide coverage and appropriate care within an environment of reduced resources. Cost containment strategies could well jeopardize the care of a vulnerable segment of the population, threatening to undermine the progress achieved in part through effective but costly drug therapies. For the full article, go to: http://www.medscape.com/viewarticle/462071?mpid=19667
SURVIVOR GUILT
Existential survivor guilt was first identified by Cobb and Linderman (1947)in their study of survivors of the Coconut Grove fire in New York in 1942. Such guilt is characterized by the survivor's confusion over his or her having lived and the meaning of this survival: "Why did I live when other people died?" With war veterans and holocaust victims, we sometimes see variations on this theme: the survivor wished to change places with the person who died, and the guilt is expressed as "I should have died, and they should have lived." Often, their own lives have been chaotic since the stressor. They feel that the person who died would have had a better life and more to live for. War veterans frequently say that the ones who were killed in war were the lucky ones. Their pain and suffering are over and their names are on a monument. After hearing about the trauma in an interview, the question can be asked "How come you lived through that?" Quite often the response is "I don't know. I ask myself that question all the time." or "Perhaps there is some purpose for my life after facing the probabilities of my own death."
Content guilt, as contrasted with existential survival guilt, is a result of a person's having done something to ensure his or her survival. This might have been to avoid responding to others in need, to have made a decision that resulted in other's deaths, or to have sought refuge for oneself when others remained threatened or suffering. This is a much easier form of survivor guilt to treat because the avoidant nature of this form implies a conscious effort to survive or operate effectively in the traumatic environment.
Because survivor guilt has both emotional and intellectual components, a major treatment goal is to separate out the affective and cognitive elements. The survivor must learn that it is okay to feel sad about someone's having died in a traumatic situation, but it is not rational or appropriate to feel total responsibility for that person's death. A war veteran or disaster survivor, failing to comprehend that, will blame him/ herself for the death of a friend, failing to realize that the enemy or the disaster was the killer. The war or the disaster should be blamed, not those who lived through it.
Abreaction
One course of treatment prescribed is individual therapy initially, followed by group or marital therapy, depending on the individual and the presenting problems. It is essential to get the story before putting a person in a group. While much of the real healing takes place in group, its precursors are in individual treatment. Putting a person into a survivor's group without knowing the story is like an attorney examining a witness on the stand without knowing in advance what the witness would say. Not all survivors are appropriate for all groups, and most groups are homogeneous and trauma-specific (i.e. combat veterans, special operations operatives, rape victims, medical personnel, disaster victims, mass casualty survivors, etc.).
Getting The Story Of The Traumatic Event
Trauma victims tend to remember the actual event in a slow-motion time warp, and often have tunnel vision. They forget many of the environmental factors in the trauma situation. The longer the trauma has been in the past, the less they remember of the environmental situation.
For a therapeutic intervention to be successful, one must get the story of the trauma in precise detail. For example, it is helpful to know the details about environmental conditions, particularly smells, articles of clothing, and other situational cues. It is important for them to tell you about the trauma scene as clearly and vividly as possible. It may be important for them to bring in memorabilia, such as newspaper clippings, photographs, letters written to relatives or friends, or perhaps audiotapes. Sometimes it is important to remind them that people do not die from crying, and that once they start crying they will stop. The more they tell the story, and the more successful you are with them in resolving the guilt issues, the less intense the emotions become.
Many stress victims are reluctant to discuss their guilt feelings or the trauma that they experienced. It is often necessary to spend several hours with them to uncover the traumatic situations involved.
Treatment Considerations
One goal of counseling is to separate the rational or cognitive component from the emotional "grief" component. Trauma victims seem to have a great need to hang on to the guilt. Therefore, to make them accessible to treatment you must let them maintain that affective component while you attack the issue of responsibility. It may often be helpful to make a comment like, "Gosh, that was a horrible thing. That must make you feel very sad." This gives words to their feelings of grief. People with survivor guilt really don't think that others can understand them. As you continue in treatment with them and continue to give them the affective part of the survivor guilt, the anguish will diminish over time. The intensity of their sadness begins to diminish as they begin to understand more about the trauma situation. The main goal in counseling with survivor guilt is to allow them to feel the sadness but to attack the issues of responsibility. There are a variety of ways of doing this and the therapist is limited only by his or her imagination. Some suggestions are explored below:
Shared Responsibility
The technique of getting survivors to share responsibility for what happened starts with pointing out other factors involved in the incident itself. One of the factors may simply be one of time and space. They may have been in the wrong place at the wrong time or they may simply have been victims of a random act. Many people who have been raised in organized religions tend to feel that what happened to them was paying them back for some past sin. With disaster victims, you focus on the fact that the disaster was responsible for the deaths. The disaster was responsible for the situation in which the trauma occurred. You do not necessarily try to absolve them of all responsibility, depending on their trauma situation.
Cognitive Restructuring
Survivors of trauma tend to remember the traumatic situation in an unchanged way. Their initial perception of the event is the way they continue to view it, as if the traumatic event were frozen in their memories. The healing process involves thawing those memories and looking at them realistically. Because the memories have a very negative focus, the goal of cognitive restructuring is simply to look at the original trauma in a different light.
The first step a client seems to go through in cognitive restructuring is one of confusion. That is a very positive sign that he or she is beginning to doubt the original perceptions of the situation and is realizing that perhaps the trauma has other aspects that have been ignored, forgotten, or devalued. It is good to make a point of letting clients know why this confusion is a good sign - a sign of change. When dealing with survivor guilt, it is important to find out what kinds of words people use to talk to themselves when they are thinking about the trauma situation, and to help change these words.
Clergy Referral
Trauma victims' religious beliefs are often either strengthened or weakened. They frequently say, "Where was God when I need him?" Trauma counselors should have some contact with clergy in their community. It is most important to have a clergyman who can listen to these rather dramatic and sometimes gruesome stories in a non-judgmental and practical way, but with a sensitivity to the theological implications for the victim.
The Message Is: The Victims Did The Best They Could
The bottom line of many of these concepts is to leave the survivor of trauma feeling that he or she did the best job in the situation that could have been done considering the circumstances and the resources available in the situation. As victims start to realize this, they often feel a need to do some form of restitution such as reaching out to other trauma survivors or making themselves available to the media for discussions about their experiences. One way to help them get to this point is to ask them how long they need to continue to make themselves suffer. Certainly the trauma survivor feels that no amount of retribution or restitution can make up for the loss of a friend or loved one, and perhaps the best they can do for that lost person is pull themselves together and make their own lives positive and productive.
Techniques/Special Points
A variety of techniques have been found useful with many individuals suffering survival guilt.
Many people suffering from survivor guilt can be helped substantially if the trauma happened when they were young and their youth becomes a subject for discussion. Many Vietnam veterans were quite young when the trauma occurred and they acted in a way that is now causing them the stress. With them, as with other young trauma victims, pain revolves around self-punitive survivor guilt that results from the way they behaved during the trauma. This is an opportunity to discuss with them the moral development of adolescence. Essentially, adolescent idealism means that people in their late teens and early twenties hold to very high moral standards. They tend to see the world as black and white, but when they find themselves in a trauma situation such as war, they soon learn that there are many gray areas. Nevertheless, they still judge themselves years later rather harshly because their moral development was frozen in time. Now they need to look at the moral aspects of their behavior in light of their further experiences in life. Point out that now they know life is not fair. Adolescent idealism holds that life is fair, that good things should happen to good people, and bad things should happen to bad people. Clinging to this adolescent belief system obviously leads to a very self-punitive position.
Included in the discussion of age in relation to the trauma, it must also be noted that there are often massive amounts of peer pressure from others in their group.
Empty Chair
Gestalt techniques tend to be particularly effective in dealing with survivor guilt when one can pose such questions to the client as, "If Joe were here and alive now, sitting in that chair, would he blame you for your actions, or if you had died instead of Joe, would you blame him for your death?" One is limited only by one's imagination in using such reversal techniques as writing a letter to a person who did not survive a trauma or to a dead relative with whom there is unfinished business.
Time
As discussed earlier, a person in a trauma experiences a warp in the perception of time. Events seem to unfold in slow motion, and retrospectively the person tends to think that they had more time to make decisions than they actually had. It is important to clarify how much time was actually available, how quickly the decision had to be made, and that given the information they had, they (not someone else) were in the best position to decide how they should act and likely did the best they could. It is also important to discuss the amount of experience they had had in similar trauma situations. If they had been in combat for six months, one would expect a different type of response than if they were on their first day of combat. Very similar parallels can be drawn with police officers and other emergency workers.
Technical Aspects
In working with victims who have on-the-job traumas, such as military, police, medical and other emergency workers, it may be very important to look at a trauma from a very technical sense. Did they in fact act correctly in that situation? Did they react according to procedures and standard policies? In working with police, military and medical persons in certain trauma situations they often find themselves having to make decisions that are normally made by persons much higher up in the line of authority.
Pride
It is helpful to maintain a positive focus and glean as many positive aspects of the person's behavior (during the trauma) as possible. The therapist continually looks for things in clients that can reinforce pride in their unit, their profession, or their behaviors.
Symbolic
There are many ways to ameliorate the guilt that someone else was killed in a trauma. Many trauma victims have used arts and poetry to express some of the feelings they've had toward the missing person or their feelings about the involvement in that situation. In working with suicidal people with survival guilt, some of the better interventions have included communicating that, "As long as you are alive, the memory of the victim remains." With some trauma victims, it may be necessary to visit the graves of buddies or loved ones who died, or review newspaper or other media reports of the trauma. Vietnam veterans may need to look at the Book of Friends (a registry of all those who died in Vietnam), the DAV Vietnam Memorial in Angel Fire, New Mexico, the Wall in Washington, D.C., or participate in some other forms of recognition that someone actually did die. In group therapy some sort of memorial symbol can be held during the last group session. It can be as simple as having a moment of silence and as complex as having a ceremony of lighting candles, talking about the death of a friend, and burning his or her name into a piece of plywood with a map or other symbol sketched on it.
Healing And Purification Rituals
Wilson (1986) describes the role of the Native American Sweat Lodge as a form of group therapy for combat veterans. This can be a potent and dramatic healing experience when utilized in conjunction with more traditional forms of therapy.
*************************************************************
SELECTED REFERENCES: Bard, M. and Sangrey, D. (1986). The crime victim's book. New York: Brunner/Mazel.
Cobb, S. and Linderman, E. (1947). Neuropsychiatric observations. Annals of Surgery.
Horowitz, M.J. (1976). Stress response syndromes. New York: Jason A. Ronson.
Wilson, J.P. (1986). Native American healing and purification rituals: Implications for the treatment of post-traumatic stress disorder of Vietnam veterans. Cleveland, Ohio: Cleveland State University, unpublished manuscript.
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
I Can't Get over It: A Handbook for Trauma Survivors
by Aphrodite Matsakis
Book Description
Best Overall Reference both for Professionals and Self-help, July 31, 2001 Reviewer: Rosemary Bannon Tyksinski - Seattle, WA United States
This is the best self-help book on the topic of trauma recovery. I have used this book with literally hundreds of patients who have experienced severe trauma -- and have yet to find a better single reference. The author guides you (and your therapist, if you have one) step by step through the entire process of recovery. She takes a psychoeducational approach through out. This approach helps to create necessary cognitive frameworks that trauma survivors desperately need in order to begin to make sense of the strange experiences they are often frightened to share with others. The careful building of these frameworks buffer the survivor against overwhelming emotions and feelings of helplessness. The author includes exercises for each phase of recovery, helps you with pacing and timing, and most of all, normalizes the subjective experience of the survivor. One of the most important things she articulates is the phenomenon of "secondary victimization." In brief, secondary victimization results from the well-meaning but damaging responses of your friends and loved ones to your trauma. Often, these ignorant reactions amplify the original trauma and complicate, or completely prohibit, healing. Her description of the biological reaction to traumatic incidents is priceless. Many fail to connect the many possible negative physical reactions to trauma with the traumatic experience itself. Because the physical symptoms sometimes occur weeks or even months after the event, people fail to see them as connected to the trauma. They often see them as isolated entities, adding to the feelings of craziness and being out of control. Just understanding how trauma can affect us biologically (sometimes permanently) lessens the pain and confusion of those reactions and can help the survivor reduce feelings of weakness and self-blame. This enables a person to begin to design effective strategies to address these symptoms. One of the other strengths of this book the inclusion of various kinds of trauma -- from childhood sexual abuse to military terror to auto accidents. This normalization of the survior's reaction across domains of trauma helps to de-emphasize the event and to refocus the indiviudal on moving through the sequale to complete healing. Healing is truly possible. This book is a wonderful tool.
Additional Readings at: Disasters and Culture in the search engine. Also try looking here for September 11, 2001: A Simple Account for Children.
Videos on Terrorism
Other videos about terrorism
**********************************************************************
**********************************************************************
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
||| Volume 1 ||| Volume 2 ||| Volume 3 ||| Volume 4 ||| Volume 5 ||| Volume 6 ||| Volume 7 |||
||| Volume 8 ||| Additional Links |||
Mental Health Moment Online
