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Post-traumatic Stress Disorder
Managing the After-effects of Disaster Trauma –
The Essentials of Early Intervention
a report by
Trond Heir, Ajmal Hussain and Lars Weisæth
Norwegian Centre for Violence and Traumatic Stress Studies, University of Oslo
Although disaster traumas differ widely, they usually have some must shift towards public health. This calls for secondary preventative
common characteristics in terms of risk of developing psycho- psychiatry applied on a mass scale.
pathology. Bereavement, threat to life and integrity, witnessing death
and horror, suffering an emotional storm or psychic numbing, physical The World Health Organization (WHO) has defined disasters as a public
injuries, property loss and social disruption have all been found to health priority in large parts of the world. The smallest and poorest
affect mental health after a variety of disasters.
1
Stress reactions after countries are affected most severely by natural disasters, and the
a disaster may include the diagnosis of post-traumatic stress disorder poorest and most disadvantaged members of a disaster-affected
(PTSD), depression and anxiety disorders, as well as other psychiatric community are likely to experience the most serious consequences.
conditions such as prolonged grief reactions, somatisation and Poverty is both a cause and an effect of disaster.
3
substance abuse.
2
A stressful disaster exposure may exacerbate pre-
existing psychiatric conditions, trigger a latent disorder or cause The UN recognised the increasing impact of disasters on the world’s
psychic vulnerability to later stressful events. population and environment by declaring the 1990s ‘the international
decade for natural disaster reduction’. One must question the
During a disaster there will be a discrepancy between urgent needs effectiveness of this declaration: while the likelihood of dying in a
and immediately available medical resources. This lack of resources disaster was indeed reduced during the 1990s, the number of persons
results in reduced possibilities for high-quality individual psychiatric affected and the costs have increased profoundly.
4
After the South-
care. Normally, the mental health professional focuses on the East Asian tsunami in December 2004 in particular, the need to
individual and his or her family; however, after a disaster the focus systematically reduce the impact of disasters has been gaining
recognition and commitment among governments worldwide.
5
Trond Heir is a Specialist in Psychiatry and a Senior Researcher
at the Norwegian Centre for Violence and Traumatic Stress
Disaster Psychiatry
Studies, University of Oslo. Before specialising in psychiatry, According to the WHO’s programme of work, the master plan for
he was employed in primary healthcare services and military
dealing with the health aspects of disasters should include a mental
medicine. His research interests have included physical activity
and sport science, physical fitness and mental health in
health component. The WHO has described a model for a stepwise
military service personnel, psychotraumatology and disaster
development towards self-sufficiency, beginning with international
medicine. He is currently conducting research on survivors of
the 2004 tsunami.
reliance and moving towards national to local reliance.
3
However,
16 years later developing countries are dependent on international
E:
trond.heir@medisin.uio.no
disaster expertise in mental health.
Ajmal Hussain is a Research Fellow at the Norwegian Centre
for Violence and Traumatic Stress Studies. He graduated More than any other type of help-giving, disaster interventions need to
from the Medical Faculty of the University of Oslo in 2001.
be highly organised and co-ordinated, and they should be conducted
After residencies in internal medicine, surgery and district
practice, he specialised in psychiatry. As part of his PhD
in a collaborative atmosphere. Cross-disciplinary mental health
project, since 2006 he has been following up survivors of
workers are expected to work closely with professions to which they
the 2004 tsunami.
are not accustomed. Good basic training in general psychiatry is
necessary, but not sufficient. Psychiatrists must apply their knowledge
Lars Weisæth is a Specialist in Psychiatry and Research
and skills in situations that differ dramatically from their traditional
Director of the Norwegian Centre for Violence and daily work, which focuses on diagnosis and treatment. Often
Traumatic Stress Studies, and a Professor of
interventions are offered to people who have not asked for them or
Psychotraumatology at the University of Oslo. He is a
qualified supervisor in psychotherapy and a member of the
actively sought help.
Norwegian Psychoanalytic Association. Professor Weisæth
was Chief Psychiatrist of the Joint Armed Forces Medical
Services from 1984 to 2004, and is a past Board Member of
Similar to other disaster workers, mental health professionals should
the International and European Societies for Traumatic be pre-selected and pre-trained. It is important to have clinical
Stress Studies. Since 1975 he has been studying responses during and after danger situations
experience with trauma-related psychiatric disorders and to be familiar
in civilian and military settings among survivors, bereaved families and rescue personnel, and
was a member of the World Health Organization’s psychiatric teams sent to Kuwait in 1991
with principles of early intervention. Ideally, mental health workers
and to Croatia and Serbia in 1991–1992. Professor Weisæth is Co-Editor of Ursano et al.’s
should have taken part in large-scale disaster exercises. A recently
Textbook of Disaster Psychiatry, published by Cambridge University Press in 2007.
published textbook on disaster psychiatry provides an updated
knowledge base of the field.
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66 © TOUCH BRIEFINGS 2008
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