MENTAL HEALTH MOMENT
June 30, 2000
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Advice is what we askfor when we already know the
answer but wish we didn't. - Erica Jong
The Human Genome Project has announced the completion
of the mapping of the human genome. To find out more
about it, go to the following URL:
http://www.nhgri.nih.gov/HGP
There are other sites as well that have information on
this project. They can be accessed through links that
are on the following site:
https://www.angelfire.com/biz3/news/genome.html
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ROLE OF THE MENTAL HEALTH PROFESSIONAL IN DISASTERS
In the course of their work, most mental health
professionals serve as consultants and supervisors to
other professionals, trainees, residents and paraprofessionals.
Disaster work almost always requires training, supervision,
and consultation of human service workers, many of whom
have little or no training. The professionals are likely
to find that one of their major responsibilities is
consultation.
Consultants are usually skilled in the clinical application
of help to people with mental and emotional disorders.
Consultees are individuals or groups of individuals
working in an agency or organization in the community
dealing with the specialized needs of people. Examples
of such individuals are volunteers, paraprofessionals,
school teachers, ministers, disaster agency workers,
social welfare workers, housing specialists, law
enforcement staff, and others. The primary role of the
workers is not to provide mental health services as
such, but to assist people whose reaction to stress is
emotional distress. Consultation is usually organized
around a current work problem identified by the consultees,
or it may be related to future planning within an agency.
Most of the time, consultation is done with a group rather
than with individual consultees. Consultants need to use
their group skills to encourage group involvement. When
case situations are presented, the consultants should
make sure that one person does not remain the focus of
the consultation and that others actively participate
so that the group becomes an educational process for all
members.
Purposes
In the initial steps of consultation, consultants have
two main purposes:
1. To explore the mental health needs of the children
as the consultees see them, and
2. To enhance the present system for more effective
service to the community.
The consultants should keep in mind that they are
outsiders in the consultee's system. They must be
willing to absorb negative as well as positive emotional
reactions to their presence. Any initial problems can be
overcome if:
1. the consultants demonstrate their interest and
involvement in the worker's situation;
2. the consultants invite and encourage the other's
participation and show consideration for the other's
feelings; and
3. the consultants maintain and demonstrate their
respect for the skills and "professionalism" of the
consultees.
Objectives
The consultants' basic objective is to provide the
disaster workers with knowledge they can integrate into
their own tasks. To accomplish this, consultants will:
1. Provide Information
The consultants need to provide the workers with
information about mental health counseling and
getting the client to participate in the process.
The workers need to be informed about the trouble
signs and to know of available help to which they
can send a child or a family. The consultants should
be as specific and clear as possible in any advice
they offer and avoid confusing the workers with too
many or too involved explanations.
2. Assist The Workers
The consultants need to help the workers to fulfill
their own responsibilities. For example, if the
workers' responsibilities are to extend outreach
services for case finding, the consultants try to
help them and, at the same time, to be sensitive
to the mental health of their clients.
3. Demonstrate Interventions
The consultants may see individuals or groups
within the workers' own systems and use the
opportunity to demonstrate helpful techniques.
For example, the workers may want the consultants
to see a disaster relief applicant who is tearful
and noncommunicative. The consultants may do so
and share techniques and supportive behavior with
the consultees. Another example is an evacuation
shelter where the Red Cross is assisting distressed
families and children. The consultants can lead a
demonstration group in a joint activity, with the
Red Cross workers as co-leaders.
BURNOUT
One of the primary responsibilities of the consultants
is to alert the workers to the possibility of burnout,
both in themselves and in their collegaues. Burnout is
a condition frequently experienced by workers involved
in disaster relief and related activities, often occurring
among those working wioth children and families. Burnout
is the normal result of increased demands and overwork
after a disaster occurs. It appears as physical and
emotional exhaustion, unrelieved feelings of fatigue,
and marked irritability, and it decreases the individual's
desire to work effectively.
Overwork and overcommitment are primarily responsible
for the occurrence of burnout. After a disaster, workers
make extreme demands on themselves as they try to help
the victims. Even after this emergency phase has passed
and they return to their regular jobs, many workers
continue their disaster relief work, exhausting themselves
in the process. Burnout may thus appear early or well
into the postdisaster period.
1. Symptoms
Symptoms appear in at least four areas. Some people
may develop just a few. Others may develop many.
* THINKING
Thinking ability slows, confusion appears, and
the workers connot seem to make their usual
good judgments and decisions, cannot set priorities,
nor evaluate their own functioning objectively.
* BODY SYMPTOMS
Symptoms include physical exhaustion and fatigue;
sleep difficulties (inability to fall asleep and/or
to sleep through the night); stomach and digestion
problems, such as loss of appetite or compulsive
eating; loss of energy; tremors; many minor
physical complaints.
* BEHAVIORAL SIGNS
Signs are: restlessness, agitation, nervousness,
inability to sit still, apathy, withdrawal, loss
of ability to move, loss of ability for self-
expression, either by talking or writing, slips of
the tongue, staggering gait.
* FEELINGS AND MOOD
Feelings include depression, irritability, anxiety,
easily triggered and excessive rage, guilt, ready
overexcitement.
2. MANAGEMENT
The first step is to be aware of, to be alert for,
and to recognize the symptoms when they begin to
appear. The earlier they are recognized the better.
All personnel need to be instructed about the early
symptoms so that they may recognize burnout not
only in themselves, but also in their fellow workers.
Any such observations should be reported to
supervisors who should then talk to the individuals
and try to get them to recognize the symptoms in
themselves.
The supervisors should first attempt to persuade
the helpers to take time off, but, if necessary,
they should order it. Guilt over leaving the
activity can be relieved by receiving official
permission to stop and by being shown how they are
no longer helping because of the loss of their
effectiveness. They can be reassured that they will
be welcomed on their return, their duties will be
covered while they are absent, and that they will
have improved greatly as a result of their short
interruption in service.
To search for further information and books and to
order and purchase books on this or other subjects,
go to:
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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I will be leading a number of cultural trips within the
next year to 18 months. One will be a 21 day trip to
China next spring or early summer. In order for the
trip to go, we need at least 15 people. To take a look
at the proposed itinerary, go to the following URL. It
will give you more information.
https://www.angelfire.com/biz3/odocspan/trip.html
If, after reviewing it, you are interested in further
more detailed information, please email me at:
larlion@usa.net
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George W. Doherty
O'Dochartaigh Associates
P.O. Box 786
Laramie, WY 82073-0786
MENTAL HEALTH MOMENT
June 23, 2000
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He who knows others is clever; he who knows himself is
enlightened. Lao-Tzu
* * * * * * * * * *
If you support the Patient Rights Bill, please contact
your Senators and let them know. Below is a phone
number that will give you an update and allow you to
call your senators. Also below is a suggested statement
you can use:
Phone Number: 1-888-218-3826
"I'm calling as a counselor/psychologist/etc. and
constituent to urge Senator ______ to vote for the
House-passed patient protection bill when it comes
before the Senate again this summer. This bill would
hold health plans legally accountable when they deny
or delay a promised benefit and the patient is harmed
as a result. Such protections must be extended to
people with mental as well as physical injuries and
non-economic damages should not be capped."
The House Bill number, if you are asked for it is
HR 2723
* * * * * * * * * *
Science & Pseudoscience Review in Mental Health
http://www.pseudoscience.org
This site offers a review of therapy techniques it
considers scientifically dubious - among them Eye
Movement Desensitization and Reprocessing, Thought
Field Therapy, aromatherapy and vision therapy. The
reviewers are from the Pseudoscience Review Special
Interest Group (SIG) of the Association for the
Advancement of Behavior Therapy.
* * * * *
ClinicalTrials.gov
http://clinicaltrials.gov/ct/gui
Visitors to this site will find information on 4,000
federal and private clinical trials at more than
47,000 locations nationwide. The studies - mostly
sponsored by the National Institutes of Health - involve
a wide range of diseases and conditions, from skin,
bone and brain disease to bulimia. The trials referenced
are evaluating new drugs and medical procedures for
diagnosing, treating or preventing diseases.
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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 scenarior 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 burn-out
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; lack 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 experienced some for 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 Viet Nam
and the Gulf War, Post-traumatic Stress Syndrome (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
lightning 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 a 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 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 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 relationships 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.
For more on Burnout, go to:
https://www.angelfire.com/biz/odochartaigh/burnout.html
For a relaxation script, go to:
https://www.angelfire.com/biz/odochartaigh/relax.html
For a relaxation technique using visual images, go to:
https://www.angelfire.com/biz3/news/relax.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.
*********************************************************
George W. Doherty
O'Dochartaigh Associates
P.O. Box 786
Laramie, WY 82073-0786
Cross-cultural Counseling in Disaster Settings
http://www.massey.ac.nz/%7Etrauma/issues/1999-2/doherty.htm
My eCode: nittany Web Biz Card:
http://nittany.eCode.com
Crisis Intervention Training
https://www.angelfire.com/biz2/dmhs/crisis.html
Traumatology-e
http://www.fsu.edu/~trauma
Australasian Journal of Disaster and Trauma Studies
http://www.massey.ac.nz/~trauma/issues/current.htm
Rocky Mountain Region Disaster Mental Health Newsletter
https://www.angelfire.com/biz3/news