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Tsunami
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Before the
Tsunami devastated many of the countries that the Aid corporations
are now clamoring to get into, corporations had kept them poor.
So poor that one could ask which was the cause of the trauma
spoken about in the following article. Eye movement therapy is
not going to be of much use to them, I think. Nor are hugs and
teddy bears from abroad.
Caring for the survivors:
Tourists caught up in the Asian disaster and bereaved relatives
may need support
By Christine Doyle, THE
DAILY TELEGRAPH(LONDON), January 14, 2005
As the colossal scale of the
Indian Ocean disaster unfolds, the emotional impact on the survivors
and those who have lost relatives and how they can best be supported
are becoming critical issues.
Fifty-one Britons are confirmed
dead, and a further 352 are highly likely to have been killed,
according to the Foreign Office. A further 582 are believed to
have been in the immediate area and remain unaccounted for.
In an attempt to make sure
that the survivors, the bereaved and those desperate for news
about a missing relative receive early emotional and psychological
support, the Department of Health plans to write to all GPs within
the next seven days. The letter is expected to give detailed,
practical advice on how to make sure that those who have been
caught up in the tsunami disaster receive the most appropriate
support.
The advice will include referral
options for vulnerable patients needing bereavement or psychological
counselling as well as early warning signs of acute stress reactions,
and psychological techniques that can help.
Many survivors will relive
the horror in their minds. Feelings of guilt that they have survived
may be overwhelming. How was it, they may ask, that they were
able to cling on to a palm tree or find a place of safety, only
to see a child or friend swept to their death?
Many of the bereaved also face
the emotional anxiety of not knowing when, or if, they will be
able to bury their dead. Although DNA science is now extraordinarily
sophisticated - thanks, partly, to advances made as a result
of attempts to identify fragments of body tissue in the aftermath
of September 11 - it could take months, if not years, to identify
everyone. "To have your loved one missing, probably dead,
is an incredible emotional challenge when added to dealing with
your grief," says Pamela Dix, co-founder and vice-chairman
of Disaster Action, a charity which campaigns for changes to
disaster response. Her brother died in the Lockerbie explosion.
"Emotional and psychological issues are pushed to one side
as the practical issues are addressed, but they will soon emerge
as very important."
They may also be experienced
by friends and relatives undertaking the search of mortuaries
and examination of photographs of those feared dead. Research
following Lockerbie, Dunblane, Hillsborough and September 11
shows that, when given prompt social and psychological help,
people are far less likely to develop chronic depression, long-term
anxiety attacks or post traumatic stress disorder.
"A study, 30 years on,
shows, sadly, that 30 per cent of the children who survived the
Aberfan disaster still had serious stress reactions," says
William Yule, professor of child psychology and an expert in
childhood trauma at the Institute of Psychiatry in London. He
has been advising the Department of Health on the letter to be
sent to GPs. "The idea that children are so resilient that
we do not need to bother is nonsense. The sooner we get services
running to give both adults and children a sense of normality
and safety, the better.
"During the first year,
it is going to be sheer hell for many who have lost loved ones.
You cannot speed up the bereavement process. We recommend people
to see their GPs, and the GPs to keep a close eye on how patients
are faring for at least four weeks. With many people, grief reactions
may be exacerbated by their reaction to the trauma of a disaster.
"We know that in response
to trauma of any kind, acute stress symptoms decline over six
to eight weeks, but there is usually a substantial minority of
people who need further help. Referral to a bereavement agency,
such as Cruse Bereavement Care, might help. We will also draw
the attention of GPs to two techniques - trauma-focused cognitive
behavioural therapy and eye movement desensitisation therapy
(see below). We now accept that these make a big difference for
some people."
Prof Yule is a member of a
National Institute for Clinical Excellence committee which has
drawn up guidelines, to be announced in full in April, on how
the NHS should treat patients after a trauma, such as the murder
of a loved one, a traffic accident or a disaster. By writing
to GPs now, the Department of Health is, in effect, bringing
forward the guidelines.
"We must ensure that those
who work with patients recognise disaster stress reactions as
early as possible," says Yule.
The social, practical and emotional
support for returning Britons, orchestrated by the Foreign Office,
is designed to swing into action as soon as passengers leave
the plane.
The ambulance service offers
help at airports and, where necessary, takes people to hospital.
Inside special reception centres at Heathrow, Gatwick and other
major airports, police family liaison officers meet returning
passengers. They are co-ordinated by the Metropolitan Police
and are the key contacts for those seeking missing family or
friends. They liaise with forensic teams in Thailand and elsewhere,
advise on DNA sampling and stay in touch with families once they
return home. There are about 260 officers deployed in this role,
a number expected to rise during the coming weeks. "We do
not provide emotional or psychological advice, but we can suggest
who to contact," says the Met.
British Red Cross and Cruse
volunteers are available at airports and, where possible, spiritual
support is offered by a multi-faith chaplain. Even a locksmith
was on hand at Manchester airport to help those who had lost
their keys.
The Red Cross, funded by the
FCO, runs the national Tsunami Support Line 12 hours a day. "Callers
raise every possible question. For many, we are the first port
of call to find out who survivors and relatives can contact,"
says Martin Annis, who heads the support line, which was first
used after September 11. "Most call about tracing a missing
friend or relative, and many ask about how they can speed up
the process in Thailand or elsewhere. People do not want to leave
anything to chance. One person called four times to ask the same
question. However, although people may be distressed, they are
mostly in control. We can transfer the caller to a Cruse volunteer
if they want to talk about bereavement."
While counselling might help
some, disaster advisers are keen not to "pathologise"
the response to disaster, says Dr Stuart Turner, a leading trauma
specialist and director of the independent Trauma Clinic in London.
"Most people recover well. Reactions to grief and trauma
are often strong and unpleasant, but they are normal. How well
people recover can be influenced by the degree of trauma, the
presence of other stresses (including an existing mental disorder),
and by the quality of the support given by family and friends."
Pamela Dix, whose charity fights
for a more cohesive and sympathetic approach to the emotional
aspects of disaster, welcomes the Department of Health's letter
to GPs. "The involvement of police liaison officers has,
we know, transformed the experience of victims of trauma by providing
a point of contact. Early help from GPs and community health
workers could mean a lot less counselling will be required later
on. It may be that all the survivors need is a professional listening
ear. Relatives and friends can only do so much."
For details of UK specialist
trauma services, see: www.uktrauma.org.uk, or www.disasteraction.org.uk
Confronting
trauma can ease pressure
Learning
how to think differently
The memories of traumatised
people are often as vivid in their minds as if they are stuck
in time. The more they try to avoid the images, the more they
relive the disaster. Trauma-focused cognitive behavioural treatment
is a technique that aims to help people relabel what has happened
and put it firmly in the past.
"You do this with their
imagination," says Prof Yule. "You talk to them and,
say, get them to insert into their narrative that the tsunami
happened on Boxing Day, but it is not happening now. It is like
date-stamping a visual memory. Once that has happened, the image
is processed in a different part of the brain, where it is verbally
rather than visually stored. In follow-up sessions, the memory
begins to fade."
Prof Yule thinks some victims
of disaster may complete this process unconsciously by confronting
the memory themselves. "As they do this and realise they
are not being hurt, they learn to cope with it."
Eye movement therapy
An individual is asked to create
and hold in their mind a picture of the worst moment during the
disaster, while following the movement of their clinical psychologist's
fingers with their eyes. The psychologist instructs the patients
to "let the image go freely where it wants to". Astonishingly,
says Prof Yule, during up to 20 sessions, the feelings of distress
gradual fade.
"We don't understand how
it works. Patients do not go into a trance. Initially, there
was scepticism that it was some off-the-wall technique, but studies
show it works almost as well as the more structured cognitive
behavioural technique. We cannot get psychologists trained quickly
enough."
It can also be effective for
children, though there is less research to back this up.
Leaving the door open
When patients who have witnessed
a horrific disaster tell Prof Yule that they have good emotional
and social support from family and friends and do not need extra
help, he always agrees.
"But I leave the door
open," he says. "I always ask them to come back in
six months. If they are not doing so well, as happened with one
young man recently, I decide how to help them. If they are doing
well, I ask how they did it, because I want to let others know."
Mutual support
After September 11, many family
members felt that a formal association gave them a sense of a
community with people who understood what they had gone through.
Memorials and occasional meetings provide a focus for sharing
emotions. Disaster Action can help anyone who wishes to be involved
in a cohesive group for survivors of the tsunami disaster and
the bereaved (see: www.disasteraction.org.uk). Establishing an
association is likely to be handled initially by Tessa Jowell's
Department of Culture, Sport and Media, which will also arrange
a national memorial service later in the year.
_________________
Often, Time Beats Therapy for
Treating Grief
By JANE E. BRODY, The New
York Times, January 27, 2004
It is commonly assumed in this
therapy-oriented world that nearly every grieving person can
benefit from bereavement counseling or therapy. But both the
experience of psychologists who provide bereavement services
and a thorough review of the literature on the results of grief
therapy suggest otherwise.
Rather, the findings suggest,
a majority of people who suffer the loss of a loved one neither
need nor benefit from participation in a bereavement group or
from more formal grief therapy. These people experience what
might be called a normal grief reaction, and the symptoms of
it gradually diminish over 6 to 18 months.
"Feeling grief is the
burden we face because we're capable of becoming attached and
loving people," said Dr. Robert Hansson, a psychologist
and student of grief at the University of Tulsa. "It's a
natural process. It hurts, but most people can work through it
and go on."
A major new "Report on
Bereavement and Grief Research" prepared by the Center for
the Advancement of Health concluded, "A growing body of
evidence indicates that interventions with adults who are not
experiencing complicated grief cannot be regarded as beneficial
in terms of diminishing grief-related symptoms."
The report adds that there
is very little evidence for the effectiveness of interventions
like crisis teams that visit family members within hours of a
loss, self-help groups that seek to foster friendships, efforts
to show the bereaved ways to work through grief and a host of
other therapeutic approaches believed to help the bereaved.
In fact, the studies indicate,
grief counseling may sometimes make matters worse for those who
lost people they loved, regardless of whether the death was traumatic
or occurred after a long illness, according to Dr. John Jordan,
director of the Family Loss Project in the Boston area. Such
people may include the only man in a group of women, a young
person in a group of older people, or someone recently bereaved
in a group that includes a person still suffering intensely a
year or more after the loved one's death.
Further, the research suggests,
bereavement counseling is least needed in the immediate aftermath
of a loss. Yet it is then that most grieving people are invited
to take part in the offered services. A more appropriate time
is 6 to 18 months later, if the person is still suffering intensely.
Even when bereavement therapy
is needed, however, the benefit may depend on the approach used.
For example, most bereavement
groups focus on emotional issues. These are most helpful to women.
But men tend to grieve differently,
and they are more likely to benefit from an approach that focuses
on their processes of thinking.
Caring friends and relatives
often coax those who have just suffered the loss of a loved one
to seek professional help, either by taking part in a bereavement
group or through individual psychotherapy. But Dr. Robert A.
Neimeyer, professor of psychology at the University of Memphis,
editor of the scientific journal Death Studies and chairman of
the committee that prepared the new report, said in an interview:
"Not everyone requires the same thing. Dealing with grief
is not a 'one size fits all' proposition."
Fresh Approaches
Dr. George Bonanno, psychologist
at Columbia's Teachers College, has found that the bereaved who
naturally avoid emotions should not be forced to confront grief.
Even three years later, such people show no traumatic consequences
as a result of suppressing it, he reported.
In more than half the cases,
Dr. Neimeyer explained, far more useful than therapy to the bereaved
are the empathy and emotional and physical support that friends,
relatives and caring people in the neighborhood and at work can
provide in the first weeks and months after a death.
Only when grieving is "complicated"
-- intense and protracted, associated with deep unrelieved depression
and interfering with normal enjoyments, life tasks or an ability
to work -- is there a clear-cut need for grief therapy, Dr. Neimeyer
said.
Dr. Hansson of Tulsa observes
that many people who experience complicated grief have neither
faced their losses nor allowed themselves to work through the
emotions that naturally ensue.
If, months down the road, a
bereaved person is still grieving intensely, therapy should be
sought, Dr. Neimeyer said. Among the hallmarks of complicated
grief he listed are "intrusive thoughts about the deceased,
recurrent images of how the person died, a continual quest to
reconnect with the deceased, corrosive loneliness, feeling purposeless
and empty, difficulty believing the death ever happened and feeling
that the world cannot be trusted.
Treating people with these
symptoms is important because their unresolved grief can have
serious, even life-threatening health consequences, including
high blood pressure, stroke, heart attack, substance abuse and
suicide. "Such people can literally die of a broken heart,"
Dr. Neimeyer said.
Perhaps the most revealing
study of the varying courses of bereavement was undertaken by
Dr. Bonanno, Dr. Camille B. Wortman, a psychologist at the State
University of New York at Stony Brook, and six co-authors.
They evaluated 1,532 people
(all married, with at least one partner of each couple over age
65), then followed them for up to eight years. When a spouse
died, they assessed the bereavement experiences of the widow
or widower over time. This is what they found:
*Forty-six percent of the survivors
were "resilient." They experienced transitory distress,
but scored low in depression both before the death and at 6 and
18 months after losing their spouses.
*Eleven percent followed a
common grief course, with rather severe depression at 6 months
that had largely disappeared by 18 months.
*Sixteen percent, who were
not initially depressed, nonetheless were devastated afterward,
experiencing prolonged depression.
*Eight percent were chronically
depressed beforehand, with the depression worsened by the death.
*But 10 percent who had been
depressed before the death did very well afterward, perhaps because
they had been in bad marriages or were relieved from the burdens
of taking care of ill spouses.
*The remaining 9 percent did
not fit into any category.
No Single Pathway
"Clearly," Dr. Neimeyer
said, "the five stages of grief -- denial, anger, bargaining,
depression and acceptance -- don't necessarily fit. There is
no one pathway through grief. Depending on their grief reaction,
people may require very different therapy or no therapy at all."
Also new are professional beliefs
about the goals of resolving one's grief, which traditionally
focused on forgetting the loss and moving on.
"We are less wedded to
seeking closure, to the idea of saying goodbye to the one who
died," Dr. Neimeyer said. "We now recognize the importance
of finding healthy ways to sustain a relationship with a deceased
loved one, to maintain continuing healthy bonds, for example,
by carrying forth their projects.
"Closure is for bank accounts,
not for love accounts. Love is potentially boundless. The fact
that we love one person doesn't mean we have to withdraw love
from another."
- Counselling may add
to grief, expert says.
- Medical officer defends
Taber therapy process
Gloria Galloway National
Post, Tuesday, May 04, 1999
When one young man was killed
and another severely wounded by a shooter in the hallway of a
small Alberta high school last week, an army of grief counsellors
was dispatched to the scene.
But the presence of such counsellors
in the aftermath of tragedy may be unnecessary, and possibly
even harmful.
"We have studied what
people do when they're grieving," Dr. George Bonanno, a
research psychologist at Catholic University in Washington, D.C.,
said yesterday.
"And we find that the
more that people express their pain, the more they talk about
it, the more they focus their attention on it . . . the worse
the outcome."
The counsellors who descended
on the W.R. Myers High School in Taber, Alta., were brought in
from other schools in the area and had been trained to help students
deal with a variety of sad occurrences, from fatal motor vehicle
accidents to suicides.
Upon their arrival, they began
the process of "critical-incident-stress debriefing"
as prescribed in the manual governing such events.
Students were not permitted
to leave the school before the grief experts had given a preliminary
round of therapy.
Those who thought they needed
additional help were urged to seek it on an individual basis,
and some were phoned later at home to ensure they were coping
adequately.
News reports said 200 students
availed themselves of the service.
A similar process would have
been followed anywhere else in the country, said Dr. Paul Hasselback,
the medical officer of health for the Chinook Health Region.
Intervention
"is well known to prevent unusual behavioural reactions
such as has been occurring in other jurisdictions . . . as a
result of the collection of events which have occurred,"
he said.
The "collection"
includes the Taber shooting as well as the massacre of 13 people
in a high school in Littleton, Colo., which occurred the week
before.
Dr. Hasselback said young people
in Calgary and parts of Manitoba have reacted to the violence
in frightening ways -- with weapons and bomb threats.
"We know that sort of
thing is likely to happen after an event of this nature and that's
part of what the counselling process is all about," he said.
"We also know that individuals
faced with a severe, violent, traumatic death of someone nearby,
particularly if they (observed the violence) or if it was somebody
that they knew closely, have a much greater difficult time grieving
and coping with the reality of those events."
But Dr. Bonanno said there
is no evidence to support the belief that grief counselling is
helpful. Nor is there evidence that supressed grief will surface
at a later time, he said.
"This whole thing of going
in and treating everybody after a particular event . . . if people
are going to be doing that, there should be some evidence that
it's effective.
"In the absence of evidence,
I wouldn't advise doing that, because it could be harmful."
The standard grief-counselling
procedure is based on a notion by Sigmund Freud that people should
work through the memories and emotions associated with those
they have lost until they can let go of the bond.
"My research suggests
that the people who can minimize the amount of emotion that they
express -- the people who can shift their attention, who can
distract themselves, people who can laugh -- are people who are
doing better," said Dr. Bonanno.
In other words, it does not
pay to wallow in one's misery.
It would be wrong to dismiss
all grief counselling as inappropriate, he said.
"But people cope in differently
ways and I don't think there's one approach that can be applied
to everybody.
"The people that need
to talk about it can find therapy. There's plenty of therapists
out there. The people that don't cope that way should not even
be asked if they want therapy. They'll find it if they want it."
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Truth can never be
told so as to be understood, and not be believ'd. William Blake, The Proverbs of Hell
