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I was greatly moved by the information
shared by members of ASCR throughout the conference
last September. In the wake of Katrina, Rita and
Wilma, stress management has become vital to the
functioning of employees doing cleanup and restoration
after these hurricanes. Disaster, death and violence
are incidents that are directly linked to Posttraumatic
Stress Disorder. The reduction of long-term effects
and hidden emotional damage caused by such incidents
should be an issue addressed by all companies involved
in trauma response. It is easy to say that our employees
will "get over it" in time, but all of
us are prone to Posttraumatic Stress Disorder if
the circumstances are right. Psychological distress
can be hidden, leaving us exposed to cumulative
stress reactions. If the stress continues to build
up, our bodies develop stress-related symptoms and
physical illness results.
We normally deny, ignore or minimize all kinds
of stress: however, disasters, acts of terrorism,
death of colleagues and death of children all disrupt
our basic belief that we are safe and secure. We
want to believe that we can face any situation and
that we have all the tools we need for coping. Therefore,
it is easier to deny stress than to admit that our
tools do not fit the situation or our needs. When
we are suddenly confronted by a traumatic and shattering
experience, our safe and secure world can collapse,
resulting
in: fear and confusion, the loss of our belief systems,
self-worth and value as human beings.
If our equilibrium is not restored, depression,
a sense of pointlessness and even suicide can result.
If our response to stress continues to build up
over time, we develop cumulative stress reactions,
resulting in stress-related symptoms and illnesses.
Untreated stress can cause a slowing of the immune
system. Organs give way to progressive destruction.
The results are manifested in a range of disorders
and diseases ranging from heart attacks to cancer.
We live with general stressors and stress symptoms
from the moment we wake until we go to bed. Stress
is brought on by the events and demands in our lives
and our actions and reactions to these events. Stress
has its inception both outside of us -in the
work we do- and within us-our response
to work. The management of stress involves
working with our selves and these events and demands.
The focus of incident stress management is to change
our thinking and reactions to stressful events so
that stress can work for us in a positive way.
Understanding the stress response can help employers
recognize when an employee is in trouble. I have
encountered four stages to incident stress.
Stage of Anticipation comes right
after we are notified of the incident. Anticipatory
stress deals with the unknown. We have no idea of
what we are facing and no idea of what to expect.
In this stage, we doubt ourselves and our ability
to be able to do the job.
The media plays an important part in this stage
and can often terrify our psyche into believing
we are incompetent because the incident is "too
overwhelming". We forget that the media plays
up the worst events, leaving us to believe that
the critical incident is earth shattering.
Stage of Reality Shock develops
when we arrive at the site. Often we are overwhelmed
by the task at hand. This stage brings anxiety,
a sense of shock, a feeling that we cannot do enough
to help. Also, this stage can lead to the need to
work feverishly. A fireman who worked after 9/11
told me he was driven to dig with his hands, since
he did not have a shovel. It was only after he saw
that his hands were bleeding that he realized what
he was doing. This stage defines the abnormal event
in terms of mental traumatization.
Stage of Desperation/Stage of Acute Reactions
develops after the job is completed. It is normal
to push physical and psychological stress out of
the way until the job is done. After we complete
a difficult task, withdrawing, feeling abandoned
or "different", and having thoughts that
no one understands are all normal perceptions of
an abnormal situation. Feelings of depression, anguish,
remorse and sadness can result. Talking about the
incident becomes difficult, and we become introspective.
We start questioning our belief systems, our lives,
our faith and who we are. We feel guilty because
we did not do enough. We become vulnerable, and
our world as we knew it has collapsed. These post-traumatic
stress reactions are normal responses to abnormal
events.
However, in this stage we can lose a purpose for
living, and this sense of pointlessness can lead
to suicide. It is also this stage that can lead
to affect disintegration: chronic illness emerges,
psychotic episodes develop, loss of trust shatters
meaningful attachments, chronic guilt and self-blame
becomes intrusive. Relative, friends and colleagues
do not want to hear about the incident and we feel
that they no longer are giving support. As a result,
loneliness and isolation can develop. What can emerge
is Posttraumatic Stress Disorder (PTSD). The degree
of stress experienced is proportional to these five
factors:
1. The amount of empathy one possesses
2. Past traumatic events one has experienced
3. Unresolved traumatic conflicts one may harbor
4. The amount of exposure to family, children's
or friends' trauma
5. The degree of maladaptive responses one uses
as a survival strategy
Number two addresses cumulative stress. Cumulative
stress compounded by a catastrophe can cause emotional
and physical breakdown. Cumulative stress is subtle
and often ignored, denied and minimized because
the stress starts to feel normal. Unfortunately,
major life changes develop. Marital problems rank
first as the inducing factor to a cumulative stress
response. It is often easier to blame an event than
to make life changes. If our response to stress
continues to build up, our bodies develop stress-related
symptoms and illness results.
Stage of Reconciliation/Stage of Acute
Posttraumatic Stress is when we live through
and learn from our stress. The underlying attitude
an individual brings to a stressful situation largely
determines whether the stress will be used for growth
or be debilitating. In this stage we can grow from
the traumatic event and incorporate it into our
psyche, or we can develop acute Posttraumatic Stress
Symptoms. Distress during the days that follow the
incident resemble those of PTSD; however, it is
difficult to differentiate between normal responses
to an abnormal incident and responses that develop
into PTSD.
Terrorism is a new form of incident stress that
demands more than adaptation and coping. The stress
of terrorism necessitates a confrontation with the
threat of helplessness, death and mutilation. Another
element to the entity of trauma is the way the incident
and past incidents become a way to haunt the individual's
functioning in the present. The results are fear
and uncertainty because the sequential stressors
have a cumulative effect. Oklahoma City, Columbine
and September 11 represent an assault on our sense
of personal safety and belief in humanity. This
shattering of beliefs can traumatize the individuals
in the restoration field to a greater degree than
what is experienced by a primary victim because
it is cumulative, group related, ongoing, affects
the functioning of a group, and is often viewed
as individual pathology and not as an "event
that happened to the United States of America".
There is a cost to caring and the price can be individual,
as well as large group disintegration.
In short, it is easy for every one of us to set
ourselves up for stress reactions. Without normalizing
the situation, we have no idea that the symptoms
we exhibit are symptoms the normal population would
express. We cannot always change the events and
demands in our daily lives, but we can change our
way of looking at those events and our reaction
to stressful demands.
In my book, Cumulative Stress Management for
Search and Rescue: A Workbook for all Emergency
Personnel, the premise is simple: We all
need to practice ways in which we can define ourselves
by our typical moments and not our worst moments.
This key to surviving incident stress is paramount
to our functioning because it puts us in control.
The acceptance and insight into who we are and how
we respond to stress are keys to our mental health.
In other words, learning to grow from stress reactions,
finding ways to deal with uncertainty, meditation
and relaxation, coming to terms with death, taking
care of our bodies physically, and helping our loved
ones cope with the stress are all critical "defusers"
to stress management for emergency workers. Since
I believe that every one of us needs to take responsibility
for our ongoing health, having tools to reduce our
stress is the key to prevention.
So, what is the answer? Studies have shown that
training for stressful events protects individuals
from the effects of stress. Ongoing training can
reduce uncertainty, increase one's sense of control,
and teach automatic responses. Training is effective
in generating positive response outcome. * Reading
positive affirmations concerning one's abilities
enroute to the incident can also have the same effect
in reducing uncertainty. **
The urgency to prepare our personnel for future
man-made disasters and acts of terrorism so that
psychological effects will be minimal is paramount.
We need to reexamine our procedures so that our
employees are protected from environmental harm
during and after their work. Since interventions
concerning man-made disasters are different from
natural disasters, we need to focus on this new
frontier: terrorism and human-constructed disasters.
Oklahoma City and September 11 were America's largest
man-made horror shows. The very thought that we
could become a battleground to terrorism devastates
the normal American concept of good will. Let us
use what we have learned from these events and develop
positive scenarios for the future. Hopefully time
and and preparation will increase our knowledge
and lessen the impacts of future disasters.
Marilyn Neudeck-Dicken, Ph.D. is a pioneer
in the area of traumatic stress and has decades
of experience based on extensive research and firsthand
knowledge. She has been involved in incidents such
as the Oklahoma City bombing, four Mobil explosions,
the Columbine shootings, and the Cerritos and San
Diego plane crashes. She can be reached at drmend2@yahoo.com.
References:
*Chemtob et al.1990; Hytten 1989'
**Neudeck-Dicken, 1997
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