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Healing the Psychological Wounds of Terrorism Researchers Speed up Efforts to Combat Threat of Bioterrorism
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Healing the Psychological Wounds of Terrorism"Demand for our services has increased substantially,
but we believe that we're only seeing the tip of the iceberg."
Terrorism's impact is overarching, and perhaps its greatest weapon is not the power to kill or hurt, but the ability to do psychological harm. Since the Sept. 11 attacks, mental health professionals across the country have been grappling with the myriad psychological consequences of this man-made calamity. Spencer Eth, M.D., medical director of behavioral health services at St. Vincent's Catholic Medical Centers in New York - the closest major hospital to Ground Zero - has witnessed the increased demand for mental health services in the city. "Within the first 10 days of the attacks, our hospitals saw 7,000 people who came for information and crisis counseling, and we responded to 10,000 phone calls," Dr. Eth says. "After the initial phase, we have continued to see people for crisis counseling as well as individual and group treatment for disaster-related issues." The recent staggering flow of mental health patients is probably just the beginning, says Dr. Eth. "Demand for our services has increased substantially, but we believe that we're only seeing the tip of the iceberg." The federal government has reacted to the current situation quickly, allowing the Substance Abuse and Mental Health Services Administration (SAMHSA) to release $27 million in emergency grants to support mental health and substance abuse services following Sept. 11. The grants have been awarded to Connecticut, the District of Columbia, Maryland, Massachusetts, New Jersey, New York, Pennsylvania, Rhode Island, and Virginia. Post-Traumatic StressPost-traumatic stress (PTS) is one of the psychological fallouts of terrorism, and it needs special attention, says Rona Fields, Ph.D., a clinical and consulting psychologist at Associates in Community Psychology, Inc.
"There is a difference between post-traumatic stress initiated by a natural disaster and the stress that is a consequence of a man-made disaster," Dr. Fields says. "In the latter, there's the problem of anger, so in the case of stress resulting from the latest terrorist attacks, anger is a large part of the syndrome. And as we know, anger has medical consequences." According to the American Psychological Association (APA), one of the warning signs of trauma-related stress is "feeling irritable, easily agitated, or angry and resentful." Depression, anxiety, sleeping, and appetite changes are among the many symptoms of PTS. An extreme reaction to trauma-related stress is suicide. In December, the first suicide connected to the Sept. 11 attacks occurred when Pat Flounders, whose husband died in the World Trade Center attack, shot herself after refusing to continue mental health counseling to treat her depression. While heavy depression and suicidal impulses might be a sign of PTS, there isn't a standard pattern of reactions, warns Dr. Fields. Some people react to stress immediately, while others might take months, or even years, to show PTS symptoms. PTS can also affect other psychological disorders already present by either delaying or emphasizing their symptoms. As an example of what could happen, Dr. Fields points to the possible scenario of an undiagnosed case of postpartum depression. "If a woman who had a child six months ago comes into a physician's office and tells him she's been depressed since Sept. 11, he might not think in terms of postpartum depression at this point," she says. "The physician could then prescribe this woman an anti-depressant and he would be missing the boat, because the woman would go home and kill herself and her baby." Conditions such as postpartum depression can, with the prolonged stress of violence and terrorism, turn into a violent depression that seems to have no specific connection to its actual origin, warns Dr. Fields. Adapting Curricula and Techniques to New RealitiesDoctors and those training them need to be on the lookout for hidden PTS symptoms as well as the effect of PTS on other conditions, Dr. Fields says. "These issues need to be included in the curricula of medical schools. Whether it's included in the curriculum dealing with trauma or in the section dealing with psychological and psychiatric issues is immaterial." Some schools are ahead of the game, having already implemented disaster mental health training in their curricula. The University of South Dakota has had a disaster track within its clinical psychology doctoral program since 1972. "We added a series of courses and capstones requirements to the standard Ph.D. program so graduates got out of it with specialty training in disaster psychology," says psychology department chair Randy Quevillon, Ph.D. "We are, to my knowledge, the only doctoral disaster mental health specialty training program in the country," he adds. "Our program includes courses in crisis intervention, disaster mental health, serving the diverse community in disasters, post-traumatic stress disorder, international disaster psychology, and management in disaster mental health."
Reacting to the latest terrorist attacks, the APA Board of Education Affairs passed a resolution encouraging "the education community to examine the teaching of psychology, the education and training of future psychologists, and the application of psychology to education in light of current national needs." APA's Education Directorate Executive Director Cynthia Belar, Ph.D., says that an important step schools can take is to include in their curricula what is known about psychological resilience. "A core part of understanding human behavior is understanding not just signs and symptoms of pathology but how to promote resilience in health," Dr. Belar says. Laura Barbanel, Ed.D., director of Brooklyn College's School of Psychology program and a member of the APA's board of directors, agrees. "Having a sense of community and being able to feel active are things that go into developing resilience," she says. "We saw this in the New York attacks. The people who felt that they could do something were able to cope better." The satisfaction one feels from doing something "useful" is a result of feeling in control, according to Dr. Barbanel. "All the volunteerism we saw here in New York, besides being wonderfully altruistic and giving, made people feel useful and more in control of their lives." To best deal with terrorism and disaster circumstances, university programs training mental health practitioners need to underscore community psychology, Dr. Quevillon suggests. "Community psychology emphasizes psychological support and education, as opposed to counseling and therapy, and that tends to stress outreach and community strength building," he says. "The difference here is that the community is taken into account, as opposed to a strictly individual perspective." Traditional clinical psychology has tended to focus on the psychological waiting mode of service delivery, waiting for patients to come to doctors with problems, Dr. Quevillon explains. Disaster models emphasize an outreach mode of delivery, with mental health professionals going out into the community and letting people know their services are available. "It's a rather different perspective, a plus for doing this kind of work in times like these," he says. "The longer-term, more traditional work can come later in the process. This constitutes a more continual type of care, with different types of assistance available at different times." Dr. Barbanel echoes Dr. Quevillon's opinion, saying that the initial phases of disaster psychological counseling calls for a different approach from traditional forms of counseling. "When you're working close to disaster, you don't really think of what you're doing as psychotherapy," she says. "You think about what you're doing as emotional first aid." The Cumulative Nature of StressDr. Fields has been working with patients in Washington, D.C., and has noticed that those who were exposed to terrorism and other types of systemic violence prior to Sept. 11, such as immigrants from war-battered societies in Central America, have reacted more strongly to current events. "People who have had trauma in the past are coming in, and many of them are in denial about the effects of Sept.11 on them," she says. "But the evidence points otherwise. Some have been very irritable with their children, sometimes abusive, and even the people referring them don't see the connection to Sept.11. But as soon as I question them, it starts appearing."
"A very important question for doctors and psychologists to ask their patients right now is whether or not they have suffered previous trauma," she adds. In addition to dealing with the threat of terrorism, people living in the Washington, D.C., area have to deal with the stress of rising unemployment. "There's a serious unemployment issue here in D.C. in the service and the high-tech sectors," Dr. Fields says. "I get patients from both areas, some of whom have had trauma before and are dealing with stress now in addition to being hit with the loss of paychecks." The impact of past stress, or concurrent stresses, can make things quite difficult sometimes, says Dr. Quevillon. "Stresses tend to be cumulative in nature. They have their impact, and then another stress can add an additional impact, and so forth," he says. "So folks end up thinking in terms of what's next." In times like these, when the trauma is obvious and undeniable, perhaps the best thing is to seek reassurance. Joseph Margolin, Ph.D., a psychologist who has worked and done research in Israel, says that a crucial component of dealing with terrorism and disaster is just that. "Families are tremendous aspects of this," Dr. Margolin says. "I am seeing the psychological importance of reassurance now in Israeli families I know living in the United States. The moment a terrorist attack breaks out in Israel, these families are on the phone calling Israel to make sure everyone is protected. No physical help can be offered, but they can reassure each other emotionally." Dealing with things as they come and keeping a flexible attitude are also important, Dr. Eth says. This means at times borrowing techniques from practices outside of medicine's mainstream. "One of the innovative services we have offered in St. Vincent's has been acupuncture," he says. "We've discovered that this particular technique is in great demand, and people find it very helpful for stress management." Psychologists also emphasize the importance of letting people know that what they're going through is normal. "Many of the symptoms people are having now are not symptoms of mental illness," Dr. Belar says. "They are normal reactions to unusual circumstances." |
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