MENTAL HEALTH MOMENT
MENTAL HEALTH MOMENT
November 17, 2000
"If you want creative workers, give them enough time to
play." - John Cleese
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History of Psychology Web site
http://elvers.stjoe.udayton.edu/history/history.asp
This site provides links to more than 1000 Web sites on the history
of psychology in a variety of subject areas, including people,
courses, writings, historical artifacts, organizations,
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serve as an entry to other search engines. The site also
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neuroscience, forensic psychiatry cases and evolution.
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January 25-26, 2001: National Multicultural Conference
and Summit II, Santa Barbara, CA. This APA-sponsored
event will look at "The psychology of race/ethnicity,
gender, sexual orientation and disability - intersections,
divergence and convergence," focusing on addressing the
unique as well as the overlapping issues in several
important areas of diversity. Contact: National
Multicultural Conference and Summit II at the APA address;
(303)652-9154; fax: (202)218-3987; Web site:
http://www.apa.org/conf.html
* * * * *
China Cultural Tour
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BASIC CONCEPTS IN UNDERSTANDING DISASTER BEHAVIOR
The key constructs used to understand how individuals
respond to disaster include stress resulting from the
crisis, social supports at time of crisis, and
coping skills of the individual victim.
* Some of the most significant work about individual
response to disaster comes from theoretical formulations
about stress. Dohrenwend and Dohrenwend (1981)
linked stressful life events, mediated by social situations
and personal dispositions, to health and mental health
consequences for individuals. The authors offered
several interpretations about these linkages. One
interpretation is straightforward cause and effect:
stressful life events result in adverse health changes.
Other interpretations concern the intensification of
stressful life events by social and personal dispositions.
These combinations of factors result in adverse health
change.
Several theories relate stress to specific disaster
situations, focusing on the event itself, and on
individual, social, and cultural responses to such
emergencies. Frederick (1980) and others theorized
that technological disasters create more mental stress
than do natural disasters because they are defined,
not as originating from God, but as originating from
man. Other theoreticians considered the phases of a
disaster. Baker (1964) differentiated between more
frequent immediate psychological effects of the
disaster experience and less frequent long-term
consequences of disaster for the individual. Others
looked at the magnitude of the disaster. Kastenbaum
(1974), for example, hypothesized a significant
difference between disasters that affect the individual's
whole environment and those that affect only a part
of it.
* Human service workers have little control over factors
in the environment that cause stress among clients.
Their efforts, therefore, are focused on increasing
the social supports and coping skills of these persons
so that they are better equipped to manage the stress
and are less at risk for emotional problems. With regard
to social supports, Taylor (1978) showed the
importance of political, economic and family supports
in disasters. Political supports referred to functions
served by public figures at disaster sites. Economic
supports were defined as financial institutions that
provide funds in aid of recovery of the community.
Family supports referred to the functioning of family
members in warning system evacuation and extended
family assistance.
Barton (1969) pointed to the existence of a two-part
emergency social system. The first part is identified
by exploring individual patterns of adaptive and
nonadaptive reactions to stress, particularly the
motivational basis of various types of helping behavior
(e.g., altruism and close relationship to the victim).
Barton concluded that discrete patterns of individual
behavior can be conceptually aggregated to reflect the
community's informal mass assault on disaster-generated
needs. The second part of the system is the community's
formal organization. Barton broadened his initial
discussion of the individual basis of helping behavior
by examining a community model of the same.
* Formulations that relate individual coping responses
to mass disasters focus on perception, personality
characteristics, and social behaviors. Slovic et al
(1979) looked at the perception of risk in disaster
situations. They stated that those persons who perceive
the risk as great are more likely to heed warnings and
to take some individual action to avoid or ameliorate
consequences than those who do not. In the case of
technological risks, those who perceive the risk as
great are also more likely to blame the Government
for politics that allow the risk to occur.
Cohen and Ahearn (1980) pointed out that coping is
partially dependent on emotional or psychological tools,
those personal characteristics of individual strengths
and weaknesses. These individual resources include
ability to communicate, sense of self-esteem, and
capacity for bearing discomfort without either
disorganization or despair.
Lystad (1985b) stated that coping also depends upon
one's ability to seek support, understanding, and aid
in problem resolution. Her work shows that disaster
victims are better able to handle the losses of loved
ones and property if they are well integrated into a
social matrix of family, friends, and neighbors who
are able to provide immediate assistance of comfort,
food, clothing, housing, and physical care at times
of crisis.
Phases Of Disaster-related Behaviors
The experiences of mental health professionals have
shown that the postdisaster period consists of several
phases related to the emotional responses of victims
as they experience and cope with crisis (Cohen and
Ahearn, 1980; Farberow, 1983).
* The first phase occurs at time of impact and immediately
afterwards. Emotions are strong and include fear,
numbness, shock, and confusion. People find themselves
being called upon and responding to demands for heroic
action to save their own and others' lives and/or
property. Altruism is prominent, and people cooperate
well in helping others to survive and recover. The most
important resources during this phase are the family,
neighbors, and emergency service workers of various
sorts.
* The second phase of disaster generally extends from
one week to several months after the disaster. Symptoms
include change in appetite, digestive problems,
difficulties in sleeping, and headaches. Anger,
suspicion, and irritability may surface. Apathy and
depression may occur, as well as withdrawal from family
and friends and heightened anxiety about the future.
On the other hand, survivors, even those who lost loved
ones and possessions, develop a strong sense of having
shared with others a dangerous experience. During this
phase, supported by the influx of local, State and
Federal agencies who offer all kinds of help, the
victims clear the debris and clean out their homes of
mud and wreckage. They anticipate that considerable
help in solving their multiple problems will soon be
available. Community groups that develop from the
specific needs caused by the disaster are especially
important.
* The third phase of the disaster, generally lasting up
to a year, is characterized by strong feelings of
disappointment, resentment, and bitterness if delays
occur and hopes for, and promises of, governmental
aid are not fulfilled. Outside agencies may pull out,
and some of the indigenous community groups may
weaken or disappear. During this phase, victims may
gradually lose the feeling of shared community found
earlier as they concentrate on solving their own
individual problems.
* The last phase, reconstruction, may last several years
if not the remainder of the lives of some victims.
During this time, the victims of large-scale disasters
realize that they will need to solve the problems of
rebuilding their homes, businesses, and lives largely
by themselves, and they gradually assume responsibility
for doing so. The appearance of new buildings replacing
old ones, the development of new programs and plans,
can serve to reaffirm the victims' belief in their
community and their own capabilities. When such positive
events are delayed, however, emotional problems which
do appear may be serious and intense. Community groups -
political, economic, religious, fraternal - with a
long-term investment in the community and its people
become crucial elements to successful reconstruction.
Postdisaster Intervention Strategies For Mental
Health Problems: Acute Phase
General
1. Dealing with extreme emotional stress caused by the
emergency: The symptoms of extreme stress reactions
include clear signs of fear, anxiety, disorganized
speech, and the inability to be consoled or quieted
down. A mild sedative might be used, accompanied by
an attempt to find a "victim-companion" to help for
a limited time. Most acute, severe reactions are
short=lived when the victim is surrounded by other
individuals in similar situations who offer role
models with good coping skills to deal with the
present situation. If the victim has received a
physical trauma, then the reactions will have to be
evaluated in terms of pain dependence, fear of
abandonment, and central nervous system functional
status as a reaction to trauma and/or medication.
2. Relocation factors likely to increase/reduce stress:
One of the most painful experiences for a victim is
a sense of disorientation and lack of control in his/
her life. This experience is aggravated by the further
relocation activities that most victims find necessary.
The process of preparing, supporting, and assisting the
victims in all location changes can intensify or
ameliorate their discomfort. Consideration of the
fears, anxiety, and lack of knowledge about the
"authorities" who are doing all the discussing and
making all the decisions will guide professionals
in their behavior. Any support or information that
can be given to the victims to enhance their sense
of control over their choices, which in turn will
moderate their anxiety and elevate their self-esteem,
will be helpful. Keeping closer to their support
systems - friends, clergy, and family - will be
beneficial for recovery of psychological health.
Communicating to the victim information concerning
imminent changes will also help.
3. How to lessen the stress of hospital setting and
relocation: Starting with the premise that people
housed in a hospital setting have been relocated and
may face further relocations, it follows that some
effects of the stressors will be manifested by
psychophysiological reactions. Lessening the stressor
impact on these populations at risk is the objective
of planners and disaster workers. Two major areas are
important: (1) reactions to the event itself, including
the rescue, and (2) reactions to hospital conditions.
With regard to the first source of stress, helping
victims share their stories and ventilate some of
their pent-up tensions is very valuable. With regard
to the second source of stress - the living conditions
in the hospital - some flexibility could be instituted
by providing information about their physical status,
prognosis, plans of care, and guidance and support in
relation to schedules of medical intervention. Daily
bulletins with clear information and methodes for
dealing with rumors about what has happened to their
neighborhood are helpful.
Identification of problem-solving hospital teams that
can expedite simple requests or explain to victims
when some of their problems cannot be solved or
attended to immediately is useful. This type of
education can diminish expectations that could, if
unchecked, culminate in further painful disappointments.
Most victims would prefer to be busy, active, and
helpful, so functions that realistically could be
assigned to them will prove to be morale boosting.
Household and clerical tasks, organization of
recreational activity, and group exercises are
examples.
Personnel trained to absorb painful, emotional, angry
expressions of distress without reacting personally
and becoming defensive, or without promising immediate
solutions, are a most valuable resource in lowering
effects of the stressor and mitigating victims'
reactions.
4. Guidelines for the use of psychotropic medication
with disaster victims: Basic medical precautions
are needed when prescribing medication to victims.
In general, the approach should be conservative in
dealing with anxiety and psychophysiological reactions
(headaches, stomachaches, and sleeplessness), which
are the primary manifestations during the first few
days. Although the victim may wish to short-circuit
very uncomfortable emotions, some consideration
should be given to first trying some reassurance and
counseling, with attention to the living conditions,
to test if the anxiety ameliorates without medication.
If this does not happen, and psychological efforts are
ineffective or the anxiety is overwhelming, then
anxiolytic medication may be necessary.
Medication for pain should be provided as needed. Pain
itself is a major cause of stress./
Appropriate medication should be used for individuals
with a history of severe mental disorder, for example
those diagnosed as suffering from schizophrenia, who
are living in the community. Also, patients with
dysthymic disorders (mania or depression).
Medication usage has to be continually monitored as
victims' judgement may occasionally become dysfunctional.
5. How to mobilize social support systems after an
emergency: An outpouring of interest and resources
is characteristic of individuals in the community during
and after a disaster's aftermath. The problem of support
systems is not the quantity, but the quality. That is,
the appropriate fit between the needs of the victim (age,
sex, culture, socioeconomic status, health, etc.) and
the presence of interested, available human support groups.
The matching of assistance to victims has to be organized
in some professional manner, which could be flexible and
simple, but with genuine and serious attention to
motivation, consistency, and appropriateness.
Many organized groups exist in different regions of the
United States whose objectives are to assist individuals
in crisis. Also, religious groups are available from the
different denominations if the victims ask for special
religious affiliation.
A list of available groups could be identified on regional
bases. The informational support groups (nonfamily),
while generally generous and enthusiastic, may need some
management and organization to genuinely assist the victim.
6. How to coordinate with mental health professionals:
Ideally, predisaster planning at the State level should
incorporate mental health components in emergency
situations. A direct line of communication to mental health
professionals potentially available for disaster work
should be already established. When this is the case, once
the decision to participate and the plan of action is in
effect, mental health professionals can assist in the
triage operations, in crisis counseling, and in debriefing
of disaster workers. To smoothly coordinate all these
efforts the administrative design should include the
mental health professional in decisionmaking, logistics,
schedules, and function priorities. When this is not the
case, local community mental health centers and mental
health associations should be contacted for assistance.
7. Use of mental health professionals in the initial post-
disaster period - how they can assist in triage:
Disaster triage operations are the procedures used by
mental health professionals to evaluate behavior, ascertain
level of crisis, and supply information. This knowledge is
provided to the assisting team so that disaster planning
can alleviate the severity of the psychophysiologic
reactions of victims. Since victims become cognitively
and emotionally impaired for a short interval of time,
intervention focuses on increasing awareness of the
emotional effects of disaster and improvement of the
ability to cope.
The mental health professional has begun to enhance the
disaster emergency efforts by bringing knowledge that is
needed to deal with behavior patterns not only of the
victim but of the helpers as well. The knowledge base of
mental health professionals working side by side with
medical teams is continually increasing as more begin to
practice at a field level.
8. Use of mental health professionals in the initial
postdisaster period - How they can assist in crisis
counseling to victims:
Postdisaster crisis counseling is a mental health
intervention technique that seeks to restore the
capacity of individuals to cope with and resolve stressful
situations as well as to provide assistance for individuals
in reordering and integrating their new circumstances.
This is accomplished by a process of education about
and interpretation of the overwhelming feeling which
results from postdisaster stress. It is designed to
instill a greater sense of self confidence and hope.
Postdisaster intervention offers a unique model for
mental health services by broadening the perspective of
service providers and offering the possibility of a
resolution to crisis reactions for victims. To be
effective, however, the mental health component of the
intervention program must prove useful to the victims and
comfortable for the community service providers.
9. Use of mental health professionals in the initial
postdisaster period - How they can assist in debriefing
disaster workers:
A mental health debriefing is an organized approach
to the management of stress responses following a traumatic
or critical incident. It is a specific, focused intervention
to assist workers in dealing with the intense emotions
that are common at such times. It teaches them about
normal stress responses, specific skills for coping with
stress and providing support for each other. A debriefing
involves a one-to-one or group meeting between the worker(s)
and a trained facilitator. Group meetings are recommended,
as they provide the added dimension of peer support.
A debriefing is not a critique. A critique is a meeting
in which the incident is discussed, evaluated, and analyzed
with regard to procedures, performance, and what could
have been improved. A critique is a valid and important
meeting. It can help workers to sort out facts, get
questions answered, plan for what to do in the future. A
debriefing, though, has a different focus, that of dealing
with the emotional aspects of the experience.
10. Use of mental health professionals in a later post-
disaster period - How can they help in long-term referrals
of victims or disaster workers:
Although most disaster victims do not suffer adverse
mental health effects, a conservative estimate is that
10 percent experience mental health consequences over
time. Larger percentages are found in disasters that are
sudden and unexpected, where many deaths and injuries
occur, when the potential for recurrence is higher, and
where the affected population is high risk. Mental health
professionals can evaluate those individuals who continue
to appear emotionally stressed and unable to cope in
order to refer them to appropriate community mental
health facilities for longer term care.
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SELECTED REFERENCES
Baker, G. (1964). Comments on the present status and the
future direction of disaster research. In: Grosser, G.,
Wechsler, H. and Greenblatt, M., eds. The threat of impending
disaster. Cambridge: Massachusetts Institute of Technology
Press.
Barton, A. (1969). Communities in disaster. Garden City:
Doubleday and Company.
Cohen, R. and Ahearn, F. (1980). Handbook for mental health
care of disaster victims. Baltimore: The Johns Hopkins
University Press.
Dohrenwend, B. and Dohrenwend, B., eds. (1981). Stressful
life events and their contexts. New York: Prodist.
Frederick, C. (1980). Effects of natural vs human-induced
violence upon victims. Evaluation and Change. Special Issue:
71-75.
Kastenbaum, R. (1974). Disaster, death and human ecology.
Omega 5 (1): 65-72.
Lystad, M. (1985a). Innovative mental health services for
disaster victims. Children Today 14(1): 13-17.
Kystad, M. (1985b). Human response to mass emergencies: A
review of mental health research. Emotional First Aid 2(1):
5-18.
National Institute of Mental Health (1986). Training manual
for human service workers in major disasters. by Farberow, N.
DHHS Pub. No. (ADM) 86-538. Washington, D.C.; Supt. of Docs.,
U.S. Govt. Print. Off.
Slocic, P.; Lichtenstein, S.; and Fischoff, B. (1979). Images
of disaster. Perception and acceptance of risks from nuclear
power. In: Goodman, G. and Rowe, W., eds. Energy Risk
Management. London: Academic Press, pp.223-245.
Taylor, V. (1978). Futures directions for study. In: Quarantelli,
E., ed. Disasters: Theory and research. Beverly Hills, CA:
Sage Publications, pp. 251-280.
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Contact your local Mental Health Center or
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therapists, and other Mental health Professionals in
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