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Overview

This title provides a comprehensive overview of clinical, epidemiological, psychobiological, psychosocial and service organization aspects of disaster psychiatry.  It takes a practical approach and includes a series of reports on significant experiences made in this field in various regions of the world. 

  • An Unbiased and reliable reference point, endorsed by the WPA
  • Includes contributions from internationally acclaimed experts
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Editorial Reviews

From The Critics
Reviewer: Patricia E. Murphy, PhD (Rush University Medical Center)
Description: This edited book addresses the complexity of assessing factors that contribute to mental health responses to different types of disasters. After examining general themes like vulnerability and resilience, the authors provide studies of several international examples of both natural and man-made disasters.
Purpose: The authors hope to take a field of knowledge that is continuing to develop and raise awareness of both answers and the limitations of answers about who develops pathology. By stimulating further study with improved designs, we should be better able to prevent and manage the mental health consequences of trauma.
Audience: The book is crucial for those who are involved in planning and policy development for prevention and response to disasters. It is also an important resource for any who hope to do further research in this area.
Features: The greatest value of this book is the perspective it can offer based on a growing body of literature about correlates of diverse psychological responses to trauma. It allows the information from specific situations to speak to other settings with an important goal of knowing how best to limit the psychosocial devastation from major catastrophes. An important asset of the book is its inclusion of studies from a variety of cultural and economic settings. This would be hard to find elsewhere.
Assessment: This book offers an excellent source of research in the area with well-defined questions that remain unanswered. This kind of broad perspective is vital for those who prepare prevention and response to local and international crises.

5 Stars! from Doody
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Product Details

  • ISBN-13: 9780470021231
  • Publisher: Wiley, John & Sons, Incorporated
  • Publication date: 11/22/2004
  • Series: World Psychiatric Association Series
  • Edition description: New Edition
  • Edition number: 1
  • Pages: 288
  • Product dimensions: 6.28 (w) x 9.13 (h) x 0.80 (d)

Read an Excerpt

Disasters and Mental Health


John Wiley & Sons

Copyright © 2005 John Wiley & Sons Ltd.
All right reserved.

ISBN: 0-470-02123-3


Chapter One

What is a Disaster?

Juan José López-Ibor Complutense University of Madrid, Spain

INTRODUCTION

It is almost impossible to find an acceptable definition of what a disaster is. Nevertheless, a definition is unavoidable if we want to be able to face disasters and their consequences. Quarantelli states that, if the experts do not reach an agreement whether a disaster is a physical event or a social construct, the field will have serious intellectual problems, and that defining what a disaster is does not mean becoming involved in a futile academic exercise. On the contrary, it means delving into what are the significant characteristics of the phenomenon, the conditions that lead to it and its consequences. On the other hand, a definition is also needed to guide the interventions following a natural event, for instance, when a government declares a region devastated by a flooding as a "catastrophe area". Furthermore, a definition is needed for understanding, because any concrete disaster poses the question of its meaning.

A danger is an event or a natural characteristic that implies a risk for human beings, i.e., it is the agent that, at a certain moment, produces individual or collective harm. A danger is therefore something potential. A risk is the degree of exposureto the danger, it is therefore something probable. A reef shown on a nautical map is a danger; but it is a risk only for those who sail in waters nearby. A disaster is the consequence of a danger, the actualisation of the risk.

The literature on disasters offers several definitions from different perspectives, as summarised in the following sections.

THE MAGNITUDE OF THE DAMAGE PRODUCED BY THE EVENT

Human losses, number of injured persons, material and economic losses and the harm produced to the environment are often considered in order to define a disaster. For some authors (e.g.,) the number of 25 deceased has to be exceeded; for others (e.g.,) this figure has to be higher, more than 100 deceased and more than 100 injured or losses worth more than one million US dollars; or even higher (e.g.,), an event leading to 500 deaths or 10 million US dollars in damages. According to Wright, experience shows that when an event affects more than 120 persons, except for cases of war, non-routine interventions and coordination between different organisations are needed, something which is already pointing out another important characteristic of a disaster. For German insurance companies, damages greater than one million marks or more than 1,000 deceased are needed: these figures are obviously given in order to limit responsibilities of insurance policies.

To define a disaster by the magnitude of the damage caused has many inconveniences. First, it may be difficult to evaluate the damages, especially in the initial stages. Second, such definitions are of no use for comparative studies in different countries or social situations and are affected by inflation. Third, disasters have a different impact in different environments: an earthquake of an intensity to cause a fright in California nowadays would have been a catastrophe before 1989 and would be a catastrophe in many developing countries at present. There may even exist disasters with zero harm. The best example of this was the broadcast in 1935 by Orson Welles of The War of the Worlds: more than one million persons showed intense panic reactions because of what they believed to be a Martian invasion. But, what is more important, these definitions fail to capture what is essential in a disaster.

EXCEPTIONAL EXTERNAL AGENT

Disasters are often considered as events from the physical environment which are harmful for human beings and are caused by forces which are unfamiliar to them. Disasters are normally unforeseen and catch the populations and administrations affected off-guard. However, there are disasters that repeat themselves, for example in areas affected by flooding, and others which are persistent, as in many forms of terrorism. In these cases a culture of adaptation and resignation to disasters develops.

Disasters are normally considered as events that occur "by chance" and therefore unavoidable. In the past they were ascribed to divine punishment, and even nowadays it is not unusual to read that an event "reached Biblical proportions", or that nature's powers have been unchained as they were when God had to punish the evildoing of human beings with the Flood. In fact, the etymology of disaster, from Latin (dis "lack" or "ill-", astrum "heavenly body", "star"), indicates bad luck or fortune.

An important characteristic of disasters is their centrality. Catastrophes are disasters of a great centrality. A total breakdown of everyday functioning takes place in them, with the disappearance of normal social functioning, loss of immediate leaderships, and the insufficiency of the health and emergency systems, in such a way that the survivors do not know where to go to receive help.

THE NATURE OF THE AGENT

Human-made disasters are normally distinguished from those which are consequences of the inclemency of nature. Among the first sort, some are not intended, i.e., they are the consequence of human error. In this case, the responsibility is considered to be institutional, and compensations from insurance companies are granted.

There are also human-made disasters that are the consequence of a clear intention, as in the case of conventional war. In these cases, individuals are able to start up more or less legitimate or efficient coping or defence mechanisms to confront the aggression. The First World War was a war of fronts that affected little the rearguard, while in the Spanish Civil War and in the Second World War there were as many victims due to combat actions in the rearguard as in the front (settling of scores, bombing of the civil population, and so on). Therefore the psychological and psychopathological reactions were different. During the First World War, those evacuated from the front came to a safe rearguard, in which they were assisted in an attentive way, favouring the appearance of very dramatic conversion symptoms. During the Spanish Civil War, those evacuated came to a rearguard which was also affected and they presented more psychosomatic symptoms, i.e., more internalised ones. The same happened during the Second World War.

On other occasions, violence is due to terrorist attacks, assaults by rapists or similar events. This is an anonymous violence whose goal is to cause harm to whomever, something that prevents the people affected from developing any kind of defence. This kind of violence may affect any person, in any place of the world, at any time.

In disasters produced by the inclemency of nature, the kind of disaster normally determines the way the pain is perceived and the quantum of guilt. Some are more foreseeable, as for example in hurricane areas, volcano eruptions or floodings, and other are not so foreseeable, as in some earthquakes or massive fires.

However, it is not possible to accept that there are purely natural disasters, since the human hand is always present. This is the thesis of Steinberg, who studied a large series of disasters in the USA. It has to be taken into account that the degree of development of a community is a determinant fact. Between 1960 and 1987, 41 out of the 109 worst natural disasters took place in developing countries, with the death of 758,850 persons, while the remaining 59% of disasters took place in developed countries, with the death of 11,441 persons. It is curious enough that these proportions are similar to those in famine, HIV infection or refugee status.

THREAT TO THE SOCIAL SYSTEM

Definitions of disasters based on the idea of an exceptional agent are not fully satisfying. In fact, when reviewing them, other elements appear which are related to social conditions. The flooding of an uninhabited non-cultivated plain with no ecological value is not a disaster; human presence is needed. Carr was the first to point out the importance of the social aspects: "Not every windstorm, earth-tremor, or rush of water is a catastrophe. A catastrophe is known by its works; that is to say, by the occurrence of disaster. So long as the ship rides out the storm, so long as the city resists the earth-shocks, so long as the levees hold, there is no disaster. It is the collapse of the cultural protections that constitutes the disaster proper."

Therefore, the impact of an event on a social group is related to the adaptive mechanisms and abilities that the community has developed. If they are efficient, we can speak of an emergency, not of a disaster. For instance, a traffic accident with ten victims is a disaster in a little village, but not in a city. Disasters have been defined from this perspective as external attacks which break social systems, which exert a disruptive effect on the social structure. The social, political and economic environment is as determinant as the natural environment: it is what turns an event into a disaster. Social disruption may create more difficulties than the physical consequences of the event.

The United Nations Coordinating Committee for Disasters stipulates that a disaster, seen from a sociological point of view, is an event located in time and space, producing conditions under which the continuity of the structures and of the social processes becomes problematic. The American College of Emergency Medicine points out that a disaster is a massive and speedy disproportion between hostile elements of any kind and the available survival resources. The same appears in a definition by the World Health Organization: "A disaster is a severe psychological and psychosocial disruption, that largely exceeds the ability to cope of the affected community". In the United Nations glossary we find the same: "A serious disruption of the functioning of society, causing widespread human, material, or environmental losses which exceed the ability of affected society to cope using only its own resources".

Crocq et al. point out the importance of the loss of social organisation after a disaster. For them the most constant characteristic is the alteration of social systems that secure the harmonious functioning of a society (information systems, circulation of persons and goods, production and energy consumption, food and water distribution, health care, public order and security, as well as everything related to the corpses and funerary ceremonies in cemeteries).

In summary, disasters are events affecting a social group which produce such material and human losses that the resources of the community are overwhelmed and, therefore, the usual social mechanisms to cope with emergencies are insufficient.

The impact of the disaster can be cushioned by the ability of those affected to adapt psychologically, by the ability of the community structures to adapt to the event and its consequences or by the quantity and kind of external help.

Therefore, three levels of disaster have been described: level I (a localised event with few victims; with local health resources available, adequate to screen and treat; and with transportation means available for further diagnosis and treatment); level II (there are a lot of victims and resources are not enough; help coming from various organisms at a regional level is needed - the definition varies according to the size and kind of territorial organisation of the country); level III (the harm is massive; local and regional resources available are insufficient; and the deficiencies are so significant that national or international help is needed).

Thus, a disaster is something exceptional, not only because of its magnitude. Mobilising more material and staff is not sufficient; unfamiliar tasks have to be carried out, changes in the organisation of the institutions are needed, new organisations appear, and persons and institutions which normally do not respond to emergencies are mobilised. Moreover, in some cases, the efficacy of teams and resources commonly utilised for emergencies decreases, and the normal processes aimed at coordinating the response of the community to the emergency may not adapt correctly to the situation.

Disasters induce huge social mobilisations and solidarity. Sometimes a great part of this help is counterproductive, creating the so-called problems of the "second disaster", when excessive and unorganised help arrives causing a slowdown in recovery and interfering with the long-term evolution.

Several things are needed in order to produce a disaster: an extraordinary event capable of destroying material goods, of causing the death of persons or of producing injuries and suffering, or an event in the face of which the community lacks adequate social resources to react. This leads to the need for intervention and external support, to a personal sensation of helplessness and threat, to tensions between social systems and individuals, and to a deterioration of the links that unite the population and that generate the sense of belonging to the community.

SOCIAL VULNERABILITY

Disasters do not only affect social functioning; they are also the consequence of a certain social vulnerability hardly perceived until they occur. They reveal previous failures.

Vulnerability decreases with the degree of development of civilisation, which in essence precisely aims to protect human beings from the negative consequences of their behaviour and from the forces unleashed by nature.

This social vulnerability is present even in the pathological reactions to disasters. Among the risk factors for post-traumatic stress disorder most often identified in the USA are: female sex; Hispanic ethnicity; personal and family history of psychiatric disorders; experiences with previous traumas, especially during childhood; poor social stability; low intelligence; neurotic traits; low self-esteem; negative beliefs about oneself and the world and an external locus of control. Curiously enough, there is a preventing factor which is political activism.

In the toxic oil syndrome catastrophe, social vulnerability was particularly evident since the toxin did not cross the haemato-encephalic (blood-brain) barrier and those affected did not suffer from symptoms due to a direct cerebral harm. The factors related to the appearance of psychopathological sequelae were female sex, low socio-economic level, low educational level, and the previous history of "nervous disorders" and of psychiatric consultations.

Continues...


Excerpted from Disasters and Mental Health Copyright © 2005 by John Wiley & Sons Ltd. . Excerpted by permission.
All rights reserved. No part of this excerpt may be reproduced or reprinted without permission in writing from the publisher.
Excerpts are provided by Dial-A-Book Inc. solely for the personal use of visitors to this web site.

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Table of Contents

List of contributors.

Preface (Lopez-Ibor et al).

1. What is a Disaster? (Lopez-Ibor).

2. Psychological and Psychopathological Consequences of Disasters (Fullerton and Ursano).

3. Psychiatric Morbidity following Disasters: Epidemiology, Risk and Protective Factors (McFarlane).

4. Reevaluating the Link between Disasters and Psychopathology (Yehuda and Bierer).

5. Psychological Interventions for People Exposed to Disasters (Benyakar and Collazo).

6. Organization of Mental Health Services for Disaster Victims (Crocq et al).

Mental Health Consequences of Disasters: Research Reports.

7. The Experience of the Kobe Earthquake (Shinfuku).

8. The Experience of the Marmara Earthquake (Gokalp).

9. The Experience of the Athens Earthquake (Christodoulou et al)

10. The Experience of the Nairobi US Embassy Bombing (Njeng and Nyamai).

11. The Experience of the New York September 11 Terroristic Attack (DeLisi et al).

12. The Experience of the Chernobyl Nuclear Disaster (Havenaar and Bromet).

13. The Experience of the Bhopal Disaster (Murthy).

14. The Latin American and Caribbean Experience (Caldas de Ameida and Rodriguez).

15.  The Israeli Experience (Shalev).

16. The Palestinian Experience (El Sarraj and Qouta).

17. The Experience of Bosnia-Herzegovina: Psychosocial Consequences of War Atrocities on Children (Husain).

18. The Serbian Experience (Lecic-Tosevski and Draganic-Gajic).

19. The Croatian Experience (Folnegovic Smalc).

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