ROCKY MOUNTAIN REGION DISASTER MENTAL HEALTH NEWSLETTER

Learning From The Past and Planning For The Future


MENTAL HEALTH MOMENT
November 9, 2001


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                 REMEMBER OUR VETERANS ON NOVEMBER 11
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"You must learn from the mistakes of others. You can't possibly live long enough to make them all yourself." 
- Sam Levenson


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TUESDAY - November 6, 2001 Wall Street Journal reported that the
drug Ecstasy has won an FDA green light to be studied as a treatment
for Post-traumatic Stress Disorder. The small study must still be
approved by a university board in South Carolina.
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READ THIS MONTH'S APA Monitor. There are some very good articles in
it about the APA DRN response to all three of the September 11 sites
on the east coast. If you cannot get access to a hard copy, go to
the APA web site and click on the link "Monitor on Psychology" for
the month of November. The web site is: http://www.apa.org
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'Virtual patients' for teaching and research
http://www.patsy.ac.uk
PATSy is an internat multimedia database that makes "virtual patients" available to students
of neuroscience, medicine and related fields through an archive of clinical and research cases.
The cases are suitable for consultation by researchers, students and clinical practitioners. The
system contains 56 cases (adults and children) showing symptoms of problems such as language
disorders, developmental reading and writing problems, visual impairments and a range of
acquired neurological disorders related to rehabilitation. Visit the site for a thorough
demonstration of the database capabilities.
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Disaster Mental Health Services - A Guidebook for Clinicians and Administrators
http://www.wramc.amedd.army.mil/departments/socialwork/provider/DMHS.htm
Produced by the Department of Social Work - Walter Reed Army Medical Center and the
National Center for Post Traumatic Stress Disorder.
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Australasian Journal of Disaster and Trauma Studies
http://www.massey.ac.nz/~trauma
Provides online articles, book reviews, links to other sites. Published by the Department of
Psychology, Massey University in Palmerston North, New Zealand. It is a peer-reviewed
electronic journal which collates and distributes original material on disaster and trauma
studies within Australia, New Zealand and the Pacific Rim. Provides a forum for publication
of original research, reviews and commentaries which will consolidate and expand the
theoretical and professional basis of the area.
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Puppeteering For Mental Health
http://modmh.state.mo.us/homeinfo/progs/disaster/publ.html
A Guidebook available to help state officials and mental health administrators establish a
disaster recovery program for individuals, families, and communities. Links to other sites and
further related information.
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Journal: "TRAUMATOLOGYe"
http://www.fsu.edu/~trauma
Volume 5, Issues Number 2 and 3 are Special Issues devoted to Disaster Mental Health articles
and studies, many of which were presented at the 1999 Rocky Mountain Region Disaster Mental
Health Conference held in Laramie, WY.
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SOME WILLING TO PAY FOR BENEFITS THEY WON'T USE

 Employees may be willing to help fund employment
 benefits that they will never use, in much the same way
 that citizens are willing to help fund national parks
 that they will never visit, according to a team of
 labor studies researchers. Robert Drago, Penn State
 professor of labor studies and women's studies, and his
 colleagues reasoned that work/family policies would be
 undervalued if only those who used them paid for them.
 They explored seven different policies by asking in
 each case if grade school teachers from four cities
 would be willing to fund the policy with a weekly
 payroll deduction. On the whole, the workers were found
 willing to pay, although not as much, for policies that
 they would likely never use. For example, even the
 teachers with low or no probability of using such
 policies exhibited a positive willingness to pay for
 after-school care and paid childbirth leave. The
 study's results appear in the October issue of
 Industrial and Labor Relations Review. For the full
 story by A'ndrea Elyse Messer, visit
 http://www.psu.edu/ur/2001/payforbenefits.html.

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STRESS MANAGEMENT


Stress Responses

Everyone has experienced stress at one time or another. Pushing oneself for weeks to meet a
deadline at work or school; going through a long divorce; caring for a sick relative or friend;
over-exertion in too much physical training - these push the body too much and often result in
getting sick.

Professionals in every field - executives, doctors, lawyers, people in positions where they must
make frequent rapid decisions - learn how to take advantage of their stress response. They use
it to bring their performance to a peak (consider athletes in competitive sports). However, these
people also learn how to lower their stress response. This can be accomplished subconsciously
or it can be trained. Anyone who has successfully learned how to juggle many tasks simultaneously 
has also learned to assess situations quickly, break them down into their most manageable parts,
prioritizing components, and dealing with them in order of urgency. Examples include airplane
pilots, stockbrokers, homemakers, secretaries, business executives, doctors in emergency rooms,
etc. Whether learned by trial and error or through training, such a pattern of behavior minimizes
stress responses, resulting in feeling more in control.

Stress can occur also over longer periods. There may be weeks, months or even years which are
more turbulent than usual.  This can be related to the stage of life or just with chance. For example,
as the parent of an adolescent, you may experience difficulties letting go as your child grows. Your
own aging parents may be ill at the same time. As a result, you find yourself constantly on call 
for unexpected responsibilities and difficult decisions. Another scenario related to phase of life 
might find you as the parent of a young child, your first, and simultaneously juggling a career with
the attendant pressures to succeed. If, at such times, you experience another unexpected stress
such as the loss of a loved one, you may not be able to cope.

If between stressful events your life settles down to a quiet baseline, your system will have a chance
to recover and be ready for the next event. However, without a safety net, a chronic load of stress
accumulates. This eventually takes a toll on your health because, unless the body has a chance
to recuperate, the effects of stress accumulate and build up.

Inescapable exposure to many different stressors simultaneously (e.g. a move, caring for children
and home, full-time work) over a period of time (usually months) can lead to a type of exhaustion
known as burnout. Some professions tend to be more prone to burnout than others. These include
teachers, emergency workers and others. They are faced with daily situations in their work lives 
that require important decisions and responses on their part. They often receive inadequate pay, 
inadequate assistance in their jobs, and too many patients, students or incidents on the job.

Stress can deplete the body's will to fight. Chronic illness is an example. Psychological stress is
another. Additionally, strenuous, unaccustomed and prolonged physical stress (e.g. running to 
your max on a treadmill) lasting for days; or chronic physiological stresses (e.g. lack of sleep and
food) all deplete the body's reserves. Initially, these chronic stresses keep the body's response switched
on, working at its maximum as long as the stress remains. If these extremes persist, however, the
response can fail, exhaustion is reached and burnout results.

Chronic unrelenting stress can change the stress response itself. However, with sufficient rest, persons
suffering from burnout can recover.

War is an experience in which all possible stresses combine in the extreme. They continue for 
prolonged periods and are unrelenting. These stressors include: physical stress; continuing strenuous
exercise in harsh environments of extreme heat or cold; threat of unpredictable life-threatening
attacks; lacl of sleep (3 or 4 hours or less a night for days at a time); lack of food (one meal or less 
for days); and the psychological stress of life-depending need for peak performance. Many recover
from these with minimal effect on their stress responses. However, some do not recover. They continue
to suffer hormonal, physical and psychological effects long after peace has returned and they have
gone home. Soldiers from all wars have experience some form of this syndrome. It has been given
different names at different times. In the Civil War it was called Da Costa's Syndrome; in World
War I, Shell Shock; in World War II, Battle Fatigue or "disordered action of the heart"; and in Viet
Nam and the Gulf War, Post Traumatic Stress Disorder (PTSD).

This syndrome does not just occur with soldiers. It is also seen in Holocaust survivors, those exposed
to traumas resulting from bombs, fires, rape, natural and man-made disasters and other traumatic
events and losses. For every individual who is exposed to a traumatic event, there is a different 
interpretation of its stressfulness.

There is another form of work stress - the demand for rapid-fire decision making - involving frequent, 
short but high intensity bursts of stress.

For example, consider a job in which you must be constantly vigilant. One second of inattention
might result in the death of hundreds of people whose lives depend on your moment to moment
judgments. Now, consider that you are working on this job at a small workstation surrounded by
dozens of other co-workers, all trying to concentrate on their mission. All around you there is constant
movement and distracting noise which you must ignore or lose your concentration. Your job requires 
lightening quick eye-hand coordination as well as an ability to react and give commands and 
directions in response to shifts in the tiny blips you see on the screen in front of you. Your job requires
perfect performance for hours at at time - sometimes late into the night or in the early dawn. The
job is that of an air traffic controller. It is a profession which places the worker under high stress and
high pressure on a constant basis. Members of this profession are at risk for high blood pressure,
stroke, heart disease, accidents and depression.

In 1983, air traffic controllers went on strike and thousands were laid off. A large percentage of 
controllers suddenly found themselves out of work. These were men in the prime of their lives, 
highly trained, heads of households, and skilled in a very specialized profession. They suddenly,
and without warning, lost their jobs without any recourse or possibility of returning to their profession.
As a result, many experienced clinical depressions during the first year following their lay-off. Others
turned to drinking to mask their problems. Most found new and productive jobs and put the strike
and depression behind them. Others did not.

Common stresses experienced by everyone can sometimes trigger emotional memories of stressful
events, including all of the accompanying physiological responses. Prolonged stress (e.g. divorce,
the end of a relationship, a hostile workplace, death of a loved one) can trigger elements of PTSD.

Consider the following scenario. You awaken refreshed and happy. You relax over coffee and 
breakfast while reading the morning paper. As a bright sun lights up your kitchen, you feel happy
and secure. You leave for work. Your workplace is a hostile environment. Day after day your boss
disparages you inappropriately. Your job is in jeopardy because of downsizing. There is an 
inadequate infrastructure to support your productivity. Physical surroundings  are noisy and 
cramped. You are not valued for your full worth. Your mood gradually deteriorates as you drive
closer to your office. You become increasingly more tense the closer you get. You experience a
rush of anxiety as you enter the parking lot. You feel mildly flushed and your heart rate increases. 
On top of all this, there are no parking spots because the company policy reserves spots only for
those of higher rank. However, you park there anyway, knowing that when you return at the end
of the day there will be a parking ticket on your windshield. As you leave your car and walk 
towards the office, you feel anxious, angry, demoralized and you dread the start of the work day.

Another example might be one in which you work on a job that you love. You work in a clean,
airy office with supportive co-workers and boss, enthusiastic management which values its workers.
However, home life is falling apart. You are in the middle of a nasty divorce from a controlling
spouse, someone who has emotionally or physically abused you during the marriage. For months,
day after day, your soon-to-be ex-spouse's attorney who is known as a pitbull divorce attorney, a
basher who takes pride in destroying lives rather than salvaging what may be left of the family's
spirit, uses grinding tactics to wear you down. He uses repeated questions designed to trap you 
and to set you up against yourself. He waits a few days, then escalates the legal demands, 
threatening subpoena and depositions. His threats come in waves. As soon as you regain some
balance, he hits you again. As a result, you feel like one of those inflatable, plastic punching toys
that is slapped down the moment it pops up again. The threat this attorney is using to try to break
your spirit is loss of custody of your children. As the target of these attacks, you might experience 
flushing, palpitations, an urgency to defecate every time the phone rings or when a letter is delivered
to your door. You might have repeated nightmares about losing your children, searching for them
and not finding them. You might wake up in a cold sweat and even continue to experience such
physical symptoms and anxiety long after the divorce is over and a settlement is reached.

These are some of the elements of PTSD which you might experience. The trigger for such symptoms
doesn't have to be very complex, especially if the initial event was severe enough. A single visual
element can sometimes expose a piece of memory which evokes a physiological response. Something
as innocent as a lawn marker for a house address (e.g. a gray stone with the address painted on it)
may, following the death of a loved one, remind one of a grave stone. For a few transient seconds
it brings on a rush of hormones and despondent feelings experienced when the loved one died.

Situations do not have to entail the risk of life to be real and potent stressors. Conversely, an incident
that involves risk of life may not necessarily be perceived by everyone as a major stress. Within hours
of the Northridge, California earthquake immune and hormone responses were measured in people
who had been at the earthquake epicenter. While some individuals seemed to respond with high 
stress and low immune responses, others did not.

Stress can cause sickness because hormones and nerve pathways which are activated by the stress
change the way the immune system responds. It becomes less able to fight off invaders. Genetics
and perceptions of the event also play important roles. Some people are high stress responders
and others are low. We do have control over how we perceive events. We can learn how to tone 
down physiological responses to stress. By doing so, we can minimize the effects of stress on disease.
Memories of what was or what should have been play an additional role along with learning.

In addition to the above stressful situations, there is another element that contributes to perceived
stress. Interpersonal relationshipd in some cases contribute to job stress and in others may buffer us
from it. These relationships can be the most powerful stressors most people encounter in their working
lives.

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REFERENCES

Davis, Martha, McKay, Matthew, and Eshelman, Elizabeth Robbins.  (2000). The relaxation
and stress reduction workbook. New Harbinger Publications, Inc.

Books on Stress Management

To search for books on disasters and disaster mental health topics, stress and stress management
and purchase them online, go to the following url:

https://www.angelfire.com/biz/odochartaigh/searchbooks.html
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               Contact your local Mental Health Center or   
               check the yellow pages for counselors, psychologists,   
               therapists, and other Mental health Professionals in   
               your area for further information.
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                        George W. Doherty
                        O'Dochartaigh Associates
                        Box 786
                        Laramie, WY 82073-0786

MENTAL HEALTH MOMENT Online: https://www.angelfire.com/biz3/news