ROCKY MOUNTAIN REGION DISASTER MENTAL HEALTH NEWSLETTER
ROCKY MOUNTAIN REGION DISASTER MENTAL HEALTH NEWSLETTER
Learning From The Past and Planning For The Future
MENTAL HEALTH MOMENT
December 14, 2001
"Ask not what your country can do for you. Ask what you can do for your country."
- John F. Kennedy
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MIDDLE-AGED WOMEN ARE ON BEST BEHAVIOR WITH THEIR AGING MOMS
Results of a Penn State study show that middle-aged daughters tend to
dominate in interactions with their aging mothers but they do it while being
just as nice as they can be. Dr. Eva S. Lefkowitz, assistant professor of human
development and family studies, led the study. She says, "Our results show
that middle-aged women take charge in conversations with their mothers, just
as they do with their teenage children. However, the women structure, rather
than control, the conversations with their mothers and offer supportive,
encouraging, engaged, enthusiastic and humorous exchanges." Lefkowitz and
her co-author Dr. Karen Fingerman, associate professor of human development
and family studies at Penn State, detailed their results in a poster, "Negative
Expression and Positive Involvement During Conversations Between Women
and Their Mothers," presented Nov. 15, at the Gerontological Society of America
meeting in Chicago, Ill. Fingerman notes, "Mothers and daughters in late life
have strong relationships, in part, because they are so good at expressing
positive feelings and not expressing their negative ones. We know that the
daughters in our study all had some problems with their mothers based on their
responses in individual interviews but, in their mothers's presence, they acted
with good humor, grace and acceptance."
In their study, 46 mothers, ages 69 to 93, were audio-taped while completing
a problem-solving task with their daughters. Each of the women had been
shown a picture of a mother and daughter and asked to write a story about it.
When their stories were complete, the mothers and daughters were brought
together and asked to prepare a joint story.
In some mother/daughter pairs, the daughters resolved the problem of preparing
a new story by suggesting that they simply submit the story that the mother had
written independently. Other mother/ daughter pairs negotiated solutions by
developing a new story together. The conversations that took place during the
negotiations were recorded and coded for overall talking time and rated on
negative expression and positive involvement. Lefkowitz says,"Some negative
expression goes on everyday with whomever you're around. Negative expression
doesn't necessarily mean fighting. However, there was an especially low level of
negativity between the mothers and daughters in this study. On the scale of one
to five that we used, the mean was just 1.2 for mothers and 1.3 for daughters."
While both the mothers and daughters were very careful of the other's feelings,
the daughters also displayed more positive involvement with their mothers.
Fingerman says, "As people enter late life, in general, we see decreases in
negative emotions. The older mothers are not negative, in part, simply because
they are old. Middle-age is generally a generative period when people have a
lot of responsibilities and care for a lot of people. In this case, the middle-aged
daughters were being generative towards their mothers."
Lefkowitz notes that the mothers also said that they experienced less negativity
in the conversations than did the daughters. Even though the level of negativity
was very low, the daughters perceived the interactions as slightly more negative
than the mothers. "Even though the daughters were feeling more negativity,
they didn't express it. Not expressing the negativity that they feel may be
another part of the daughter's structure giving role in the conversations," she adds.
The study was supported in part by grants to Fingerman, including a University of
Michigan Rackham Graduate School Dissertation Award, an American
Psychological Association Dissertation Grant, Society for the Study of Social
Issues Grants-In-Aid, and a grant from Sigma Xi.
Contact: Barbara Hale bah@psu.edu
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RED CRESCENT DELIVERS WATER TO AFGHAN REFUGEES
An internationally-funded Iranian Red Crescent project is providing fresh
water supplies to 20,000 settled Afghan refugees in eastern Iran. Years of
drought and the current Afghan crisis have a made a difficult water
situation there much worse. Now the International Federation is planning to
hugely increase the number of people being helped.
"Not a single drop of rain for the past five years!" the Afghan refugees say
unanimously, pointing at the cloudless sky. The surrounding area is as dry
as it could be and rocky and hilly as well - making up the unique scenery
of this bleak area of the country close to Afghanistan and Pakistan. With
Iran experiencing its third successive year of drought, the Iranian Red
Crescent and the Federation are working hard to bring clean water to
20,000 Afghan refugee families, among the most vulnerable people in the
country.
More at: http://www.ifrc.org/docs/news/01/112902/
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IRAN'S DUSTY PLAINS
As the eddies of dust carry away the last remnants of the soil that used to
cover Iran's "breadbasket" regions, 25 million people are despairing of ever
seeing a greener, lusher future. The drought that has swept across much
of the Caucasus, Central and South Asia, is now in its fourth year in Iran
and has reached 10 of the country's 28 provinces with the most most
affected areas being Fars, Keran, Khorasan and Sistan-va-Baluchistan in
the Iranian south-east.
As the situation has worsened, the Iranian government has allocated 500
million US dollars this year to combat the effects of the drought, mainly to
construct water pipelines. With water reserves down by 45 per cent
according to the Iranian Ministry of the Interior and average rainfall below
25 per cent the usual amount, help is needed.
http://www.ifrc.org/Docs/News/01/071901/
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RESPONSES OF DISASTER VICTIMS IN OTHER CULTURES
Whereas physical health risks and injuries sustained as the result of a disaster are generally similar
across cultures, the psychological responses to disasters, loss and surrounding stressors tend to
be different among cultures (Lechat, 1990). PTSD, depression and anxiety appear to be the most
common reactions to severe crises and disasters. There are a number of clinical and epidemiological
studies of natural and man-made disasters in various countries. Studies of victims and survivors
of disasters provide data about these responses. For example, de la Fuente's (1990) article on the
psychological impact of the 1985 Mexican earthquakes reported that 32% of the victims displayed PTSD,
19% had generalized anxiety and 13% had depression.
Zhang & Zhang (1991) examined the long-term psychological effects of the 1976 Tangshan earthquake in
China. They administered the 16PF, 2 attitude tests, and individual interviews to 110 paraplegic (aged
25-70) and 100 non-paraplegic subjects (aged 20-70). Results suggested the presence of long-term
psychological effects. The authors suggest that the after-effects of earthquakes should be considered
not only as physical disasters, but also with reference to the psychological shock caused by the earthquake.
In a study exploring the role of primary care workers in providing mental health services to adult victims
following a volcanic eruption in Armero (Colombia) and earthquakes in Imbabura (Ecuador), Lima et al
(1990) used a self-reporting questionnaire 7-20 months after the disaster. 200 adults in 4 camps in
Armero were interviewed. Twelve months following the disaster the questionnaire was given to 100 clinic
patients in the same area. They replicated the study in Ecuador with 150 adult clinic patients. Results
showed the frequency of emotional disorders among disaster victims was proportional to the
magnitude of the catastrophe. Victims from different disasters showed similar profiles. Lima and Pai
(1992-1993) summarized the findings of the Colombian and Ecuadorian projects. A high prevalence of
emotional distress was reported at the baseline surveys (55%-40%). This was 3-4 times greater than the
rates seen in ordinary clinical situations. This distress corresponded to well-defined psychiatric
disorders, mostly PTSD and major depression. Lima and Pai emphasized the importance of relying on
general health care workers to provide adequate mental health care to disaster victims and discussed 3
models for planning service delivery.
Joh (1997) studied disaster stress resulting from the 1995 Kobe earthquake in Japan. He examined the
mental and physical stress disorders among 748 victims (aged 4-88) in the first month after the
earthquake. These were analyzed according to refugee conditions, gender, age/generation, and
degree of housing damage. Results showed that:
1. people sheltered in public or private shelters felt more severe stress than people sheltered in other
places;
2. women in their sixties felt more severe mental and physical stress than other people;
3. victims suffering completely collapsed housing and partially collapsed housing had higher stress
degrees than the victims in housing needing repairs.
This suggested that losing a house is a great mental burden.
Canino, Bravo, Rubio-Stipec, & Woodbury (1990) examined effects of the 1985 floods in Puerto Rico
on mental health symptoms and diagnoses to determine the extent to which such effects were influenced
by demographics and previous symptoms. They studied 912 people between the ages of 17-68 using a
Spanish version of the Diagnostic Interview Schedule. They found that the onset of depression, generalized
anxiety and PTSD was significantly more common among those exposed to a disaster than among those
not exposed. They suggested that the increase in stress-related disorders in exposed Ss indicated that
the stress of disaster increased their mental morbidity.
In another study, Escobar, Canino, Rubio-Stipec & Bravo (1992) interviewed 375 individuals before and
after severe floods and mudslides in Puerto Rico. They used a Spanish version of the Diagnostic Interview
Schedule to study the prevalence of somatization symptoms. 139 individuals were classified as having
been exposed to disaster and 236 as not exposed. They found that exposure to disaster was related to
a higher prevalence of medically unexplained physical symptoms. The most prevalent symptoms were
gastrointestinal (abdominal pain, vomiting, nausea, excessive gas) and pseudoneurological (amnesia,
paralysis, fainting, unusual spells, etc).
Guarnaccia (1993), in the first community based study of ataques de nervios (attacks of nerves), discussed
the issue of categorizing it as a culture-bound syndrome. He conducted a psychiatric epidemiology
survey using 912 subjects between the ages of 17-68 in Puerto Rico. This study was performed in 1987 to
measure the psychosocial effects of a disaster which occurred on the island in 1985. He also had access
to earlier data from a survey done in 1984. Guarnaccia identified stressful situations surrounding
ataques. They were correlated with other psychiatric diagnoses and it was found that Ss who reported
ataques de nervios were more likely to meet criteria for depression, dysthymia, generalized anxiety
disorder, panic disorder, and PTSD. Guarnaccia suggests that the term "popular illness" is a better
descriptive term for the syndrome than is "culture-bound syndrome".
The 1985 floods and mudslides in Puerto Rico caused considerable damage and death. As part of a
major study (Guarnaccia, Canino, Rubio-Stipec, & Bravo, 1993) an additional question was added
to the Diagnostic Interview Schedule/Disaster Supplement concerning ataques de nervios. Using this,
researchers studied the category using a representative, community based sample of 912 people. 145
reported an ataque de nervios. Of these most were female, older, less educated, and formerly married.
They were also more likely to meet criteria for anxiety and depressive disorders than those
who had not experienced an ataque.
In summary, it appears that the most common symptoms displayed across the cultures sampled in the
above studies of victims of various disasters were those associated with the diagnoses of depression,
anxiety and PTSD. They manifest themselves in different ways within cultures, but the symptoms tend to
fit the general diagnostic criteria for depression, anxiety disorders and PTSD. How to approach dealing
with these in a culturally relevant counseling context is the task faced by the cross-cultural counselor
providing disaster mental health services and psychological first aid.
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REFERENCES
Canino, G.J.; Bravo, M.; Rubio-Stipec, M,; & Woodbury, M. (1990). The impact of disaster on mental
health: Prospective and retrospective analyses. International Journal of Mental Health, 19: 51-69.
de la Fuente, R. (1990). The mental health consequences of the 1985 earthquakes in Mexico. International
Journal of Mental Health, 19, 21-29.
Escobar, J.I.; Canino, G.; Rubio-Stipec, M.; & Bravo, M. (1992). Somatic symptoms after a
natural disaster: A prospective study. American Journal of Psychiatry, 149: 965-967.
Guarnaccia, P.J. (1993). Ataques de nervios in Puerto Rico: Culture-bound syndrome orpopular
illness? Medical Anthropology, Apr, 15: 157-170.
Guarnaccia, P.J.; Canino, G.; Rubio-Stipec, M.; & Bravo, M. (1993). The prevalence of ataques
de nervios in the Puerto Rico Disaster Study: The role of culture in psychiatric epidemiology.
Journal of Nervous and Mental Disease, 181: 157-165.
Joh, H. (1997). Disaster stress of the 1995 Kobe earthquake. Japan Psychologia: An International Journal
of Psychology in the Orient. 40: 192-200.
Lechat, M.F. (1990). The public health dimensions of disasters. International Journal of Mental
Health, 19: 70-79.
Lima, B.R.; Santacruz, H.; Lozano, J.; Chavez, H.; et al. (1990). Disasters and mental health: Experience
in Colombia and Ecuador and its relevance for primary care in mental health in Latin America.
International Journal of Mental Health, 19: 3-20.
Lima, B.R. & Pai, S. (1992-1993). Response to the psychological consequences of disasters in Latin
America. International Journal of Mental Health, 21: 59-71.
Zhang, Hou can; Zhang, Yi zhong (1991).Psychological consequences of earthquake disaster survivors.
International Journal of Psychology Special Issue: The psychological dimensions of global change, 26:
613-621.
To search for books on disasters and disaster mental health topics, children and disasters
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
