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| Crossing the Psychological Barrier |
| Feature Articles - Mental Health | |
| Friday, 30 November 2001 | |
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"Nothing would be what it is, It didn't happen in America - until now. The shocking events in Washington, D.C. and New York on September 11 illustrate society's inappropriate focus on high-tech weapons and the deadly exclusion of other issues. Maxwell Taylor, PhD, Head of the Department of Applied Psychology at University College Cork, Ireland, and an international expert of terrorism, told Counselor "although terrorism develops through escalation, with each new event raising the bar, I think the most frightening thing about these recent events is that a barrier has been crossed. The prospect of further destruction in the United States has become very real. "I don't know whether my comments should be considered clinical or philosophical," states Edward J. Khantzian, MD, Clinical Professor or Psychiatry, Harvard Medical School. "What to call what has befallen us is a good question. One word probably does not do it. "A national crisis/tragedy/wound of catastrophic proportions" is what comes to mind. .... These events are going to heighten any sense of vulnerability we harbor so even the most secure of us feel more vulnerable. ... What gets transmitted is both a sense of enmity and special vulnerability ... we need to be especially sensitized to individuals who have suffered directly or indirectly from traumatic life experiences and a national catastrophe could precipitate a resurgence of symptoms, including our patients resorting to self-medicating their pain and distress with drugs and alcohol." As immediate shock and terror dissipate, longer-term effects will appear. The events that occurred on September 11 challenge our basic assumptions and beliefs. John H. Ehrenreich, PhD, states, "Although the precise figures vary from situation to situation, up to 90 percent or more of victims can be expected to exhibit at least some untoward psychological effects in the hours immediately following a disaster. In most instances, symptoms gradually subside over the following weeks. By twelve weeks [Inventory Phase, see Figure 1] after the disaster, however, 20-50 percent or more may still show significant signs of distress" (Ehrenreich, 1999). However, considering the magnitude of the recent tragedy, several experts believe the number of individuals showing sign of PTSD in the following weeks may be as high as 55-75 percent. The view from abroad Based on his own experience with violence in Ireland, John Horgan, PhD, a forensic psychologist at the Department of Applied Psychology, University College Cork, Ireland offered American counselors this viewpoint: "I am certain we will see rises in absenteeism related to depression and PTSD. ... [and] I think we are also likely to see an increase not only in PTSD incidence, but in the extent of a variety of dissociative disorders. Dr. Horgan concludes, "In such a diverse country as the USA, I think most trauma specialists would probably agree with my argument for the need for availability of professional formal and informal therapeutic interventions combined with a variety of cross-cultural techniques. I emphasize the cross-cultural nature because there are a lot of less obvious American workers who will face enormous psychological challenges, such as students, immigrants, or refugees. People of diverse backgrounds and religions may face unnecessary hardship as a result of that background." Indeed, in this time of need, America must remember what constitutes our very core - diversity. Counselors must be ready to custom tailor their therapeutic interventions. In this post-disaster period, many of us have already witnessed either first-hand or on the television, Americans of Middle Eastern descent suffering discrimination. We must all remember it is "united we stand." As Counselor goes to press, America collectively heads into the "Inventory" Phase. Many people will not be receptive to psychosocial interventions or feel they need them. Others, however, may welcome the chance to talk through their reactions (see Figure 2). Anxiety, sadness, irritability, frustration, and discouragement now combine with disaster-produced losses and post-traumatic stress effects to produce a relatively high level of need. Many counselors feel the events of September 11 are unique and therefore the fear instilled by the concept of terrorism arriving with full force on American soil may extend the duration of the Inventory Phase and delay the Reconstruction Phase. Gary Reece, PhD, a psychologist who has specialized in trauma and addiction treatment for more than 30 years, explains to Counselor: "Catastrophe of any kind changes lives forever. Catastrophe which is deliberate, designed, executed, and performed with military precision by hands that intentionally want to harm, maim, and create chaos is so much more traumatizing ... We now exist in a post-trauma world. A world that is radically different. We now feel vulnerable, fear and chaos are unleashed by unknown, "faceless enemies" - our usual coping skills are not relevant ... The events of September 11 fit the criteria for the worst kind of trauma - the "trauma triad" - horror, terror, and helplessness...That is the magnitude of this event... Ground zero radiates out to the farthest corners of the globe. The concentric circles of victimization spread throughout the world and has made indelible prints on our psyche. There must be healing at the individual as well as national level." Rapidly changing times Indeed, the psychology of terrorism has rapidly changed in just a short period of time. Michael Farmer, a top executive at Mobil Corporation gave a speech on the psychology of terrorism at the University of Virginia only a few years ago. His words are eerie and show how world psychology has changed: "Terrorism is one of a number of risks that international business faces on a daily basis, and in most places at most times it's not a major risk or concern. It's geographically focused. Most lethal attacks are against government targets, not against business targets. Private citizens and business people that are killed are usually killed incidental to an attack on a government target" (Farmer, 1999). This is no longer the case. Dr. Alberto M. Goldwaser, a psychoanalyst and forensic psychiatrist who specializes in PTSD in the NJ/NY area and is on the faculty at NYU concludes, "The raid overwhelmed the capacity of our mental apparatus to respond, hence our normal first response is disbelief: "I can't believe it." ... No one will ever feel safe, anywhere. Everyone will develop some "routine" to make him/her feel ready to escape another attack; a drill that consciously or unconsciously the worker will go over, daily, as soon as getting to the workplace. ... We are all, in degrees, greatly predisposed from now on, to stress decompensation in the future." John A. Call, PhD, JD, ABPP, is a forensic psychologist in Oklahoma City, president of Crisis Management Consultants, Inc. He was instrumental in designing and administering Project Heartland, America's first community-based program designed to deal with the mental health needs of a metropolitan population post-terrorist event. Dr. Call told Counselor, "September 11 is a watershed moment in history. The world has always been a dangerous place, but for most Americans the danger has always been somewhere else, impacting someone else - not us. It will be difficult, if not impossible for those who lived in such denial to continue maintaining such beliefs. ... In the science of psychology we know that the best prediction of future behavior is past behavior. Given the fact that terrorism has in-creased over the last several decades, I think we can only expect more acts of terror ... our illusions of security have been shattered and people are forced to ask the question "What can I do to be safe?" and then they are faced with the reality that they don't know the answer ... Dr. Gordon Turnbull, Consultant Psychiatrist to the Civil Aviation Authority (UK), Clinical Director, The Traumatic Stress Unit, The Prior Ticehurst House, England, contacted Counselor to lend his international slant: "Our challenge must be to process the event collectively so that we are not governed or characterized by it. There are obvious examples in the world of whole nations who have been sucked into the "black hole of trauma." One glaring example would be my own country, the UK. We still struggle with non-acceptance of the validity of the concept of traumatic stress reactions and a collective denial that views trauma victims as being responsible for their own predicament. This is a time to revolutionize thinking and set the score right. No final solution Tian Dayton, PhD, Director of Program Development at the Caron Foundation in New York City offers a positive slant: "If terrorists have cells that can operate independently than together we can mobilize and sustain "healing cell" that can also operate independently lessening the negative effects of trauma. In a final thought, Dr. Jessica Stern, a faculty member at Harvard's Kennedy School of Government e-mailed Counselor the following: "I have met some of these "Osamas." They appear in many countries and subscribe to many religions ... Operatives I've interviewed describe the emotional satisfaction of their work. Ironically, one long-term operative told me, "A person addicted to heroin can get off it if he really tries, but a mujahed cannot leave the jihad. I am spiritually addicted to the jihad."" References Ehrenreich, John H. (1999). A Guidebook to Psychological Intervention prepared for Mental Health Workers without borders. Retrieved September 12, 2001 from www.mhwwb.org Farmer, Michael. (1999). The Terrorist Threat to the American Presence Abroad. Retrieved September 12, 2001 from http://faculty.virginia.edu/ciag/terr_biz.html figure 1 The Stages of Psychological Response n Disastersychological Response 1. The Rescue Stage: In the first hours or days after the disaster, most relief activity is focused on rescuing victims and seeking to stabilize the situation. 2. The "Inventory" Stage: Once the situation has been stabilized, attention turns to long-term solutions. In the first weeks after the disaster, victims go through a "honeymoon" phase, characterized by relief at being safe and optimism about the future. But in the weeks that follow, individuals must make a more realistic appraisal of the lasting consequences of the disaster. Disillusionment may set in. The effects of the "second disaster" are felt. During this phase, any of a wide variety of post-traumatic symptoms appear as well as Generalized Anxiety Disorder, Abnormal Bereavement, Post-Traumatic Depression, and Culture-Specific Disorders. 3. The "Reconstruction" Stage: A year or more after the disaster, the focus shifts again. A significant number of people who were not symptomatic earlier may now exhibit serious symptoms of anxiety and depression. The risk of suicide may actually increase at this time. Other characteristic late-appearing symptoms include chronic fatigue, chronic gastrointestinal symptoms, inability to work, loss of interest in daily activities, and difficulty thinking clearly. "Survivor syndrome" may also appear where individuals walk though life without a "spark" and seem to have lost all joy in life. Source: John H. Ehrenreich, www.mhwwb.org figure 2 Specific Basic Techniques for Responding to Disaster 1. Talking: Simple but effective. People need to make sense of the events. Telling a story about what happened is a way of creating meaning and "externalizes" thoughts and feelings, subjecting them to examination by oneself and others. Note: While talking about experiences is generally healthy, "rumination" (repetitive, obsessive retelling of a story) is associated with higher levels of depression and should be discouraged by engaging the victim in alternative activities or diversions. 2. Communication of Information: Uncertainty increases victims' level of stress. Provide victims with accurate and full information as quickly as possible. Combat rumor mongering. It is essential to have a single source of information which victims can rely upon. 3. Empowerment: One of the most psychologically devastating aspects of a disaster is the victim's sense of having lost control over his or her life and fate. Interventions that help those affected by the disaster change from feeling themselves as "victims" (i.e., passive, dependent, lacking control over their lives) to "survivors" (who have a sense of control and confidence in their ability to cope) are central to preventing mitigating subsequent emotional difficulties. For adults, a return to work helps increase their sense of control and competence. 4. Normalization: While unfamiliar emotional responses are normal following a disaster, victims may find their own reactions distressing. The best antidote is education. Reassure victims that their responses are not a sign that they are "going crazy." Explain the typical time course of feelings. Warn that the anniversary of the disaster, and other events such as funerals may lead to a brief return of symptoms that had faded. Victims should also know that not everyone experiences the same symptoms, or even any symptoms at all. 5. Social Support: Recovery from disaster is inherently social. Restoring or creating networks of social support is essential in dealing with the extreme stresses created by disaster. Avoid breaking up existing communities. Combat isolation of individual victims. Reuniting families has the highest priority. 6. Relief of Symptoms: Anxiety, depression, exaggerated stress responses, and other symptoms are both distressing and may lead to difficulties in adapting to what is intrinsically a stressful situation. For those with pre-existing psychiatric disabilities, efforts should be made to restore their previous treatment (e.g., therapy, medication). For those without prior histories of psychiatric disorder but who show acute distress, medication may be a useful short-term response. Deborah G. Mitnick, MSW, LCSW-C is a private practitioner who specializes in treatments aimed at rapid emotional healing. She is also a national consultant to numerous crisis-management companies and has experienced tremendous drug-free success using Emotional Freedom Techniques (EFT), Traumatic Incident Reduction (TIR), Tapas Acupressure Techniques (TAT), Be Set Free Fast (BSFF). For detailed information on these techniques, please visit www.trauma-tir.com. In addition, The National Center for Post Traumatic Stress Disorder's web site, www.ncptsd.org, offers counselors a wealth of information. Source: John H. Ehrenreich, www.mhwwb.org              |
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