[Winter 1996; Vol. 23 No. 4]
On Saturday, September 28, 1996, The Maryland Psychiatric Society, in conjunction with The Manfred S. Guttmacher Forensic Educational Fund and The American Psychiatric Foundation presented a symposium entitled “Psychiatric Aspects of Disaster." The program was held at the Education Center of Sheppard Pratt Hospital and was attended by 60 mental health professionals, 2/3 of whom were psychiatrists. The goal of the program was to generate interest for the development of a Maryland Psychiatric Society Disaster Committee whose members will be provided comprehensive advanced training to coordinate with the Red Cross. In November 1995, the American Psychiatric Association signed a Statement of Understanding with the American Red Cross to assist both organizations in coordinating psychiatric aspects of disaster response.
Dr. Robert Ursano, Professor and Chairman, Department of Psychiatry, Uniformed Services at the University of Health Sciences in Bethesda discussed “Individual and Community Responses to Trauma and Disaster: The Structure of Human Chaos." Dr. Ursano is current Chair of the APA Committee on Psychiatric Dimensions of Disasters and shared with the audience his broad experience with civilian and military disasters. Dr. Ursano’s discussion included his experiences with major airplane crashes such as Sioux City, Iowa and Gander, Newfoundland, the U.S.S. Iowa naval disaster, Hurricane Andrew, Desert Storm, and the Viet Nam War. Dr. Ursano reported that there are many indirect victims of disaster, including rescuers, “heros" who receive much media attention and experience guilt if performance is judged less than superior, and body handlers who may be exposed to much mutilation and the stress of handling many victims. Chronic stress may result from a disaster and an example provided was that of the Three Mile Island nuclear accident; the major stressor in that event was markedly diminished property values which prevented many residents from changing jobs or selling their homes.
Dr. Ursano advised that the vast majority of individuals exposed to a disaster will fare well and not manifest significant long-standing psychiatric illness; many individuals will reorganize their life values and goals in a constructive manner. Individuals who come to experience more distressing long-term effects may come to be diagnosed with Post-Traumatic Stress Disorder, Major Depression, Generalized Anxiety Disorder, and Substance Abuse. Studies of disasters have revealed that the greater the severity of the stressor, the higher the rate of psychiatric disturbance. Studies of POWs in World War II and in Korea revealed the greater the severity of physical illness, the higher the rate of psychiatric disorder. Various studies, including Viet Nam POWs, reveal that pre-existing emotional illness or symptoms does not correlate with severity of psychiatric morbidity subsequent to a disaster such as being a POW. Individuals injured in combat are at greater risk for psychiatric illness compared to combatants who have not been injured.
Raquel Cohen, M.D. discussed “Developing Mental Roles and Participating in Disasters." Dr. Cohen is a Professor in the Department of Psychiatry at the University of Miami School of Medicine and Past Chair of the APA Committee on Psychiatric Dimensions of Disasters. Dr. Cohen has a vast international experience with disaster assessment and consultation, and discussed how characteristics of specific cultural and racial groups affect post-disaster intervention. Dr. Cohen emphasized the importance of socially and culturally appropriate interventions so that differences of custom and language are implemented in emergency relief operations. Dr. Cohen advised that many minority-group survivors do not seek help, partly because of culturally-biased perceptions towards mental health and partly because of the inappropriateness and inaccessibility of services. Thus, when minority group individuals finally do seek assistance, their problems are likely to be serious. Dr. Cohen informed the audience that successful services for these culturally-sensitive populations are best comprised of bilingual staff with the services being channeled through representative or facilities within the subcultural group.
Dr. Cohen discussed role behavior of mental health professionals in working with Red Cross personnel. She noted that the objectives of post-disaster intervention is to mitigate the long-term debilitating effects of post-traumatic reactions through crisis counseling, consultation, and education. A major goal is to assist survivors in organizing and receiving needed services and resources that will assist them in achieving pre-disaster level of functioning and equilibrium. Crisis counseling is targeted to restore the survivor’s capacity to cope and handle stressful situations while reorganizing their world; education and interpretation of overwhelming feelings produced by the disaster are to be made available to assist in restoring a sense of capability and hopefulness. Dr. Cohen stressed the importance of education and consultation subsequent to the disaster. Providing advice and guidance through the mass media, as well as disseminating educational materials, help inform the survivors of “normal reactions in an abnormal situation." Mental health professionals need be accessible to the media to respond to questions and provide consultation to emergency workers who are experiencing much stress related to their assisting survivors.
Michael Blumenfield, M.D. discussed “Recognizing and Working with Secondary Victims of Disasters." Dr. Blumenfield is Professor of Psychiatry, Medicine and Surgery at New York Medical College in Valhalla, New York. Dr. Blumenfield discussed vulnerable secondary victims in disasters and how they become subject to traumatization. Vulnerable individuals include the following: physicians and nurses; emergency medical service workers; medical examiners staff, funeral directors; telephone operators (airline and hospital staff); corporate personnel designated to work with primary victims; teachers, principals, and guidance counselors; Red Cross workers; social workers, and the press. Dr. Blumenfield reported that the police as well as firefighters are subject to much ongoing work stress, but in New York City a group even more traumatized from chronic exposure are emergency medical services. Dr. Blumenfield provided a five-minute tape demonstrating the psychological impact of emergency medical services work on the average New York City emergency medical technician. These workers have a 9.3% incidence of post-traumatic stress disorder and predisposing work factors include increased time of service on the EMS work force, higher rank, and working overtime.
Dr. Blumenfield discussed various psychological interventions for groups involved in disasters. He discussed the Critical Incident Stress Debriefing (CISD) which allows for participants to understand what has happened to them and what to expect. The goal of this group intervention is to reduce anxiety and hopefully subsequent PTSD. Dr. Blumenfield discussed components of the group, including how to run a group with a group leader who, hopefully, has background group experience as well as preferentially having a psychiatric background. Dr. Blumenfield also showed a five-minute video on news media staff with a reporter speaking about the emotional impact of her coverage of a highly stressful situation- even years afterward, the reporter recalled vivid details of the trauma. Dr. Blumenfield reported that news reporters frequently do not acknowledge their vulnerability due to their competitive nature and often resort to heavy drinking at day’s end.
Bruce Sklarew, M.D. presented “The School-based Mourning Project in the District of Columbia: Understanding and Preventing the Cycle of Inner City Violence." Dr. Sklarew is a member of the Baltimore-Washington Institute for Psychoanalysis, as well as Clinical Associate Professor of Psychiatry at Howard University.
Dr. Sklarew focused discussion on the loss and abandonment experienced by the youngsters in his clinical research project. Intra psychic dynamics contributing to a repeated cycle of violence were highlighted by a ten-minute sequence from the recent movie “Boys in the Hood." In the video a youngster is gunned down by a local gang and retaliation by the victim’s friends is set in motion. The father of one of the boys intent on retaliation attempts to intervene and keep his son from going out in search of the assailants. The youngster climbs out of his bedroom window to join with his friends in the effort for revenge. However, en route the teenager requests that his friends let him out of the car, while at home the anxious father fears for his son’s life. Having a caring parent impacting on inner controls with a sense of responsibility and guilt for eliciting pain and suffering in the father should the teenager be killed appeared to be a significant factor in averting tragedy at that point. Dr. Sklarew pointed out that many of the youngsters do not expect to live beyond their teenage years; many of their peers have died a violent death and there has developed much fantasy about their own funeral.
The symposium, hopefully, has sparked further interest in the development of a MPS Disaster Committee. The American Psychiatric Foundation has allocated funding for representative from 17 District Branches to attend a course conducted by the APA Committee on Psychiatric Dimensions of Disasters. The MPS has been requested to nominate two Fellows to attend the course, Psychiatric Training for Disaster, to be held during the 1997 APA meeting in San Diego; the fellowship covers tuition for the course, but not travel or lodging. Any MPS member interested in attending should inform the MPS office. Additionally, the Committee on Psychiatric Dimensions of Disaster has provided us with resource materials available for loan to any of our members. Materials include a selection of readings, video tapes, audio tapes, and slides relating to disasters.