HealthGlobal

Contact us at eHealthGlobalHealth@gmail.com

Beyond False Promises of Safety: Ideas for Psychologists, Educators, and Parents of Children in an Unsafe World

Invited Column by Jodie Kliman, Ph.D., Massachusetts School of Professional Psychology

 As someone with many years of experience with helping children cope with both personal and large-scale catastrophic events, I have been struck by a few things largely missing in the interviews and talking points of many psychologists interviewed by the press since Friday.  I think it would be useful to lay them out, especially for the many of us students and faculty who are directly working with children and adolescents and/or with people who have themselves previously experienced the sudden (especially violent) death of someone close to them:

  1. A collective trauma like the tragedy in Newtown is likely to trigger personal experiences of grief for one’s own loved ones, especially loved ones who died suddenly and/or violently — in individual acts of violence, or in war.  This is the case for people of all ages, but is especially important to address for children and adolescents who may have already lost family members in untimely and terrible ways, and for any youth living in areas with wide-spread urban violence, as well as for child refugees.
  2. Related to this point is the common wisdom among many psychologists that parents, teachers, and other caring adults need to reassure children that they will be kept safe.  This safety cannot be guaranteed in inner cities, including Boston, where the walk home from the school bus or the 7-11 can be fatal.  Let’s be more realistic in how we reassure children in such settings – helping children think about how to be safer, rather than absolutely safe.  We can and should give youth a sense of efficacy in self-protection and a sense of an adult protective presence, but false reassurances based on comfortable suburban experience will not be helpful – or believed.  My own work in inner cities and with children who have grown up in war zones tells me that children know from very early on that it is not wise to assume that they are safe or that all adults will protect them.  This is a terrible fact, and they must be helped to process it and be strengthened to navigate their world as safely as possible.
  3. Even some younger children, and many older children in such chronically unsafe conditions recognize that violent and tragic gun deaths in their communities, which happen one by one, rather than 26 at a time as in suburban schools, get less media attention and less compassionate and outraged outcry from the general public.  This is an issue of both race and class.  In the 1960’s, when African Americans were being murdered routinely in the South for trying to register to vote or for otherwise standing up for their rights, there was no outcry, and it didn’t hit the news.  Civil rights workers determined that the only way to get media attention and therefore social change was for many young white people, college students, to join local African American civil rights worker, and risk their own deaths.  Those deaths happened — and the media noticed, for the first time, and that led very quickly to the Voting Rights Act of 1964, signed weeks after the deaths of two white civil rights workers and one African American civil rights worker, Andrew Goodman, Michael Schwerner, and James Chaney. I raise this point because those of us working with children of color and children of any race in poor and violent communities can help youth who may grieve with all of America for the beautiful lives lost in Newtown — but who at the same time are very understandably angry that the 63 gun deaths in Boston alone last year, most of young people of color, don’t evoke the same grief and outrage across the country.  How can we help children (and ourselves) hold the complexity of that simultaneous grief and righteous anger at their own community’s invisible daily tragedy? We can’t avoid this question.
  4. We can’t realistically promise safety to children — but we can offer them tools to be proactive, compassionate, voices for the safety of all people.  Active mastery is key.  Even the youngest children can be asked if they want to draw pictures to send to the children of Newtown – or to the family of the latest murder victim in their own city.  Children feel better if they can do something to help others.  Children as young as 9 or 10 can be encouraged to write letters – to newspapers, congressmen and women, senators, mayors, governors, and the president, demanding real gun control — not just for the safety of children in schools, but for their safety on the streets and in their own homes.  This can make a big difference psychologically – and it makes a good electioneering story for elected officials who go for re-election.
  5. And finally, as health professionals, educators, and parents, we need to lobby for change on one of the worst public health crises in our nation, with 30,000 people a year killed and many more injured by guns.  We are well-placed to lobby for true gun-control and to ask: why are assault weapons so much easier to access than community-based mental health services, especially for children?

Filed under: Disaster, Emergency, Policy, psychology trauma, trauma

What If We Treated Gun Violence Like Cancer?

Invited Column by Matthew Katz, MD

In oncology, we get excited when we can improve survival modestly, 5% or more.  The stark difference in gun violence mortality and injury in the United States compared to other developed other nations with strict gun laws makes me wonder: why not eliminate violence with the same commitment we have for cancer care?

Violence is not a biologic cancer, but a societal one.  Unlike malignancies, it’s purely from human interaction.  This disease is more in our control than cancer; if we choose to act upon it.

Here are some possible ways to decrease the violence:

Prevention

  • Don’t buy ‘Halo 4’ or ‘Assassin’s Creed’ for your kids for Christmas.  Get a nice chess board instead.
  • Consider banning violent video games, which may promote aggression.
  • Don’t go to movies with gratuitous violence to ‘entertain’ you.
  • Screen new TV shows before your kids start watching them.
  • Expand mental health services available to get people help who are at risk of becoming violent.
  • Ban firearm use without robust registration.   If I have to register to prescribe medication, then people who want to hunt should register lethal weapons.
  • The media should stop giving any attention to the perpetrator.  It glorifies and may encourage others.  Social media doesn’t help; so this applies to all of us.

Detection/Screening

  • Train teachers to identify potentially dangerous situations and provide them with methods to respond to crises like Sandy Hook, Virginia Tech, Columbine and others. This may minimize the deaths when events do occur.
  • Research, develop and implement validated screening tools to assist with picking up on potential perpetrators before they can begin.
  • Involved process for weapons registration may need to include psychological profiling.
  • Registered weapons owners may need to provide ongoing proof that weapons are stored securely.

Treatment

  • No good analogy.  I do not see providing every teacher with a holstered gun as a solution.

Followup/Survivorship

  • Develop national resources for grief management, emergency medical care that are easily available to every fire department, police station and schools.

Cost of Care

There are also sound economic reasons to lessen violence:

I’m not an economist or health policy researcher, but you get the point.

If we reframe the United States’ culture of violence as a disease, maybe it will help get past some of the typical hyperbole.  May be not.  But until we act to ensure the safety of our children, expect more preventable tragedies like Sandy Hook to occur.

 

Any of these options, or others, can be evaluated and tested for effectiveness.  What are we waiting for?

Filed under: Disaster, Emergency, Policy

Clinicians are Citizens, Not Just Helpers: Let’s Work Upstream, Not Just Downstream

It is usual that reporters and media outlets contact mental health experts to address the questions of trauma after a massacre. The tragedy in Newtown is not different. What should we do as family therapists in response to those questions?

A lot of valuable documents (research, clinical, etc.), however, have been written about what to do, what to tell children and parents to assure them and normalize their grief responses. Most clinicians can speak competently about trauma after a tragedy like the ones we witness with so much frequency. Information for the public and the professionals is easily accessible via sites like the American Psychological Association, the American Academy of Pediatrics, the National Association of School Psychologists, the National Child Traumatic Stress Network, and SAMHSA, among many others. The evidence is there, no need for new statements about what needs to be done. Sadly, this is the new normal.

What we probably don’t do is to speak aloud about gun control, question the rights of citizens to kill others, of thinking really systemically about what our responsibilities are as citizens-clinicians and not as just helpers. We are to engage with our skills in changing the problem upstream not downstream. If we are really willing to struggle and collaborate in the transformation of this problem, we need to really not only be witness to the pain of the most recent victims.

the-number-of-landslides-and-other-natural-disasters-has-increased-by-70-percent-since-the-reservoir-filled-up-in-2010We invest too much in thinking about what can help traumatized families (we know that) and not changing the minds of those who continue to support policies that allow anyone to use guns to kill. Or, we think less about how to contribute our expertise to shape sound gun control policies. Let’s think progressively about this. It is tempting to jump on the need to resolve the pain or to ask for more mental health opportunities—we need them but it is not enough.

In all honesty, just being helpers is like pulling water with a cup out of sinking ship.

This is a public health problem and not a clinical one. We need the later, but we are to take more responsibility for entering the policy and political discussion to shift the upstream causes.

Gonzalo Bacigalupe, EdD, MPH

Filed under: Disaster, Emergency, Policy, psychology trauma

Ambiguous Loss and the Chilean Mineworkers: A Systemic Tragedy

Ambiguous Loss and the Chilean Mineworkers: A Systemic Tragedy

by Gonzalo Bacigalupe, EdD, MPH, Ikerbasque Research Professor, University of Deusto, Bilbao, Spain

For more than two weeks, 33 miners have been buried alive in the North of Chile.

The tragedy occurs at a mine that very recently has had other accidents and where the rescue operations have been frustrated by lack of accurate information about the mine and a general disregard for basic safety norms. Mine accidents happen but in this case the lack of real care for the lives of the mineworkers seems to be the real cause of the tragedy.

These two weeks have been full of political posturing on the part of the government mostly as well as the former governing coalition. Everyone is ready to blame the other although we silently know that this is the responsibility of business greed and government corruption that includes the whole governing spectrum. Chilean copper, gold, and other fine minerals extraction is the core of the country’s economy. In the case of medium and small mines, the overseeing of safety regulations is grounds for corruption and shortcuts, not so dissimilar from the causes of mines accidents or the BP spill in the Gulf of Mexico.

In Chile, inaccurate assessments of the situation have been packed with allusions to religion (God is mention by the President every day) and a general pretense of caring for the miners’ families has permeated the media. Tragedy sells. The fact is we know little about the people underground.  Psychologists called to the grounds provided misleading, inaccurate, and vague information about what should be expected and how families could be supported. A disaster of this nature should have been addressed with clear protocols in which the government, civil society and non-governmental organizations know exactly how to act in the aftermaths.

From a psychological and relational perspective, the tragedy contains all the ingredients of what has been coined as “ambiguous loss.” Ambiguous loss differs from ordinary loss in that there is no verification of death or no certainty that the person will come back or return to the way they used to be (Boss, 1999).  In Chile, with an unresolved past of disappeared citizens, the ability to resolve ambiguous loss is severely handicapped. Chile, as a society, is still unprepared to deal with the psychological and social sequelae of people suffering ambiguous loss. The anxiety, the loss of meaning, the ambivalence, and the hopelessness that this sort of catastrophe generates continues to paralyze the political establishment via blame games. Civil society and the media end acting in stereotypical and unhelpful ways to deal with ambiguous loss. Reparatory work is unseen in those circumstances. The tragedy of the mineworkers is also about trying to forget our past, to believe that simplistic solutions provide closure, and to think that one side is the one to blame for it all. It is irresponsible for political leaders and the media to continue playing the same game over and over again. We know how to address a loss of this magnitude; what we need now is the political leadership to implement those actions appropriately.

Filed under: Disaster, Emergency, global health, psychology trauma, public health, trauma, Urgent, , ,

Post-Disaster Efforts and Foreign Trauma Psychology Expertise: Reflections After Chile’s Earthquake

Post-Disaster Efforts and Foreign Trauma Psychology Expertise: Reflections After Chile’s Earthquake by Gonzalo Bacigalupe in Trauma Psychology Newsletter, Spring/Summer 2010

Soon after the first news made it into the mainstream, professional listservs were also buzzing with activity, and my colleagues began having discussions about what they could do. What would APA and the rest of us do to organize members to help Chile? Often, the underlying discourse included the possibility of of fering clinical ser vices in situ. Soon after reading these emotional shows of support and solidarity, I wrote a blog entry cautioning clinicians in how decisions are made when disasters occur. My blog entry at http://www.socialtechnologiesresearch.com provoked a lot of personal and public notes of support on the part of many of my colleagues as well as some Haitians and South Asian peers I have never met. They all expressed their agreement with what I was articulating in that first reflection, their disapproval of offers of help emerging from an emotional reaction rather than a thoughtful organized process. Obviously, some colleagues raised concerns in a different fashion. A few psychologists suggested that I was discouraging post-disaster efforts by mental health providers abroad. I offer these ideas here not to discourage solidarity but to encourage post-disaster aid that is:

  • carefullyplanned
  • informedbythebestevidence
  • culturallyaffirming
  • fullyaccountabletorecipients
  • empowering to all participants
  • sustainableovertime

Full Article: Post-Disaster Efforts and Foreign Trauma Psychology Expertise in Trauma Psychology Newsletter Spring-Summer 10 TPN_final_6.14[1]

Filed under: Disaster, Emergency, global health, psychology trauma, trauma

The More Who Die, the Less We Care: Confronting Psychic Numbing by Paul Slovic

The More Who Die, the Less We Care: Confronting Psychic Numbing by Paul Slovic

Editor’s Note: This article was invited by the 2009 Science Committee (chaired by Jennifer Freyd) for the Division 56 Newsletter.

Paul Slovic, PhD Decision Research and University of Oregon

Decisions in the face of risk rely upon two forms of thinking. Risk as feelings refers to our instinctive and intuitive reactions to danger.

Risk as analysis brings logic, reason, quantification and deliberation to bear on hazard management. Compared to analysis, reliance on feelings tends to be a quicker, easier, and more efficient way to navigate in a complex, uncertain, and dangerous world. Hence, it is essential to rational behavior. Yet it sometimes misleads us. In such circumstances we need to ensure that reason and analysis also are employed.

Although the visceral emotion of fear certainly plays a role in risk as feelings, I shall focus here on a “faint whisper of emotion” called affect. As used here, “affect” refers to specific feelings of “goodness” or “badness” experienced with or without conscious awareness. A large research literature in psychology documents the importance of affect in conveying meaning upon information and motivating behavior. Without affect, information lacks meaning and will not be used in judgment and decision making.

Continue reading at APA Division 56 Trauma Psychology Newsletter

Filed under: Disaster, global health, psychology trauma, trauma, ,

Precautionary Notes Before Sending Post-Disaster Experts to Work Abroad: My Chilean Earthquake Late on February 27, 2010 by @bacigalupe

Precautionary Notes Before Sending Post-Disaster Experts to Work Abroad: My Chilean Earthquake Late on February 27, 2010 by @bacigalupe

The situation in Chile is not easy, it is really sad, and it seems to be getting worst almost 24 hours after the earthquake today. The CNN coverage was not very accurate (alarmist at the start, inaccurate towards the end). The New York Times has been reporting about Chile with its regional correspondents in Brazil! For the most part, the best coverage has been accessible via Chilean TV (TVN 24 via ustream or radios accessible via the internet like Radio BioBio) and in particular via social media venues like Twitter and Facebook

The center-south coastal areas are the most affected, with several towns affected by real Tsunami events. The government and the private organizations seem to have reacted well to one of the worst earthquakes in world history (with an intensity hundreds of times more powerful than Haiti).

Chile is resilient, united, but this is a serious, traumatic, and truly dramatic natural disaster. Personally my direct family is healthy, a lot of destruction at homes; inside my parents’ apartment there are a lot of stuff destroyed, something we should expect, saw it at least once in my childhood; no water, it will probably be back tomorrow; some electricity, will probably be back off and on in the next days; spotty phone connection, some internet but almost back tonight. A few hours ago, I was informed that a cousin’s mother in-law died during the earthquake after a wall collapsed while she was sleeping. I still don’t know about some relatives but they should be OK is just that phones are not available. Being an immigrant under these circumstances it is probably one of the most difficult times an immigrant goes through, we will survive though. Being a professional or highly educated immigrant living abroad raises another layer of reflections for me too.

Read the rest of this entry »

Filed under: Disaster, Emergency, global health, Media, public health,

For people seeking to restore contact with family members after the earthquake in Haiti

As a result of the earthquake that hit Haiti on 12 January 2010, thousands of persons within Haiti and abroad have lost contact with their loved ones. The aim of the Family Links website is to accelerate the process of restoring contact between separated family members. It is managed by the ICRC, in cooperation with the tracing services of the Haitian Red Cross Society and of National Red Cross and Red Crescent Societies throughout the world. At this stage, the website offers the possibility for persons in Haiti and abroad to publish the names of relatives with whom they are striving to restore contact. It will progressively incorporate information offering responses to those queries. Entries published on the lists can be modified only by the ICRC. Therefore, should you like to make any modification on a name entered or delete a name completely, please send us an E-mail.

Filed under: Disaster, Emergency, global health, Urgent

Wanted: Surgeons, Nurses, and other medical personnel to help in Haiti

Partners in Health

Update: January 13, 2010, 7:30pm
Wanted: Surgeons, nurses, and other medical personnel to help in Haiti

We are deeply grateful for the multitude of people who have contacted us wanting to provide medical assistance. As patients flood to our sites from Port-au-Prince, we’re finding ourselves in need of both medical personnel and supplies. In particular, we need surgeons (especially trauma/orthopedic surgeons), ER doctors and nurses, and full surgical teams (including anesthesiologists, scrub and post-op nurses, and nurse anesthetists).

If you are a health professional interested in volunteering, please send an email to volunteer@pih.org with information on your credentials, language capabilities (Haitian Creole or French desired), availability, and contact information.

As phone lines in Haiti remain down and transportation and communication are difficult, PIH is still in the process of determining where we can set up operations in Port-au-Prince, and how we can transport patients and volunteers to our sites. We will be able to offer more concrete information after these logistical matters are resolved.
Once again – thank you for your support. Kenbe fèm.

Filed under: Disaster, Emergency, global health, Media, Urgent

Health Global Links

146_4696.JPG

healthglobal in twitter

Error: Twitter did not respond. Please wait a few minutes and refresh this page.

blood
Follow

Get every new post delivered to your Inbox.

Join 12,145 other followers