Tuesday, August 18, 2009

When is a Disaster Actually Over?

We have passed our first anniversary living here as a home owner a block from the Lake Pontchartrain-Lakeshore levy. What other place but New Orleans, so shattered and shaken by the levy system failure on the heals of a terrible storm, is able to mobilize supporters and the shear will of its people to rise up from the waters and bring back the City? What I have also witnessed is a huge case of shared trauma but also shared tenacity. Collectively, this shared survival is helping to enable a wonderful City to thrive in the face of destruction.

Shared Trauma

This issue represents an array of important contributions to the field with the overriding theme of “shared trauma.” Shared trauma is when we and one other person (e.g., student, supervisees, client, or family member) experience the same troubling, extraordinary event.

It is less than a month before the anniversary of 9-11. I have been asked to speak at a special conference is by the School of Social Work at the New York University on Shared Trauma. Carol Tosone, editor of the Clinical Social Work Journal and NYU professor, is the Conference Chair who has written more than anyone on the topic. I have seen a lot of shared trauma in New York starting on the Sunday following the Tuesday attacks in New York.

Social Support Building

Shared trauma makes sense according to a new social science theory of Broaden and Build. This theory, I prefer to call this theory simply a theory about the urge to develop social support; that building social support is a survival instinct. The Social Support (Broaden and Build) Theory predicts that (a) pleasure feelings are represented by certain areas of the brain lighting up that soft wires the brain to replicate the pleasure sensation; (b) humans mostly seek happiness and other pleasures; (c) pleasures tend to be accrued when there is a robust social support network (e.g., a family, clan, girl’s softball team, religious fellowship, a fraternity) (d) feeling pleasure (or the absence of negative emotions),[1] and (e) there is a tendency to build networks of friends, colleagues, neighbors, family members, and others who require feeling happiness and other pleasures for mutual aid.

Here is a great illustration: Maternal Social Support Predicts Birth Weight and Fetal Growth in Human Pregnancy, by Feldman, Dunkel-Schetter, Sandman & Wadhwa (2000) which was published Psychosomatic Medicine: Journal of Behavioral Medicine. The authors who carried out the study provide support and an illustration of universal social support theory. These findings suggest that maternal support is stimulated by the fetus kicking and other signs of maturity and development; that fetal growth affects and is affected by the increased social support is associated with infant birth weight through processes involving fetal growth; The baby is literally kicking the mom into being supportive!

In summary, Social Support Building (Broaden and Build) Theory is the human tendency to embrace positive emotions and social relationships for many reasons with survival being the most basic of motivations. Social support network building also includes self care: attending to, maintaining, repairing, and improving interpersonal relationships. This, of course, requires considerable skill. Thus, this area deserves and requires a careful research program that would help us understand the strategies of those most successful in social support behavior and prowess.

So the experience of Shared Trauma might be an opportunity for generating and retaining social support because that one thing in common could lead to a job or a volunteer, or someone else that helps build your social networks. Thus, Twitter, Facebook, Linkedin, and other social networking sites and activities are predicted and illustrate by the Social Support Building Theory, including those still hurting form a past trauma that reach out to others with their Shared Trauma.

Fellow Survivors

We “professionals” who interact with the public who survived a particular trauma, such as Hurricane Katrina, have a special bond with survivors; a brotherhood/sisterhood of sorts based on being at the same place at the same time to experience a trauma; or experiencing it at different times and locations but the thoughts and feelings are sufficiently similar to feel sharing of the same event.

Kathy and I love New Orleans. It is the very best place I have ever lived and never want to leave here. An added advantage of living here, we discovered, is being a resident of a city that sustained the massive failure of a Federal structure, the Corps of Engineering Levy System that resulted in most of the significant losses in the wake of the natural disaster of Hurricane Katrina. That was four years ago. New Orleans has endured being under water for weeks and related failures all around. Through sheer will and disaster management leadership, the City is well on its way back, though lessons help us understand how the way back could be smoother and straighter.

When is Disaster is Over?

Fellow survivors are touchy about outsiders responding to their disaster. On the one hand they are glad they are here but, after a time, they are expected to go back home. That is when the disaster is over.

A colleague from out of state, a physician contractor working for a prominent consulting corporation that is based in New Orleans, suggest to me on a conference call that “we visitors need to be respectful of those who are in charge.” I said to him: Wait! I am not a visitor. I live here and will live here for the rest of my life. And I would not be a good citizen of New Orleans if I did not speak up and say: Let the people (professors) from New Orleans collaborate with other academics to do everything visitors are doing. This is especially important since Tulane’s eight sister institutions deserve a place at the table to collaborate on improvements in the health and mental health of the community.

New Orleans (and the other recovering communities) need at some point in their “recovery” to declare that “the disaster is over, the rebuilding is underway, let us handle it from now on.” During this post-disaster period affected communities welcome visitors who are more students than volunteers or at least both. Come and learn from our hard-won experiences. Learn, for example, how nine university/educational institutions somehow did it: Got back open and made sufficient adjustments to survive.

So my main message, based on our experiences so far in disaster management leadership is to more and more take charge. This tendency four years after a major traumatic event for a community affected to wish to take back their community is expected. New Orleans, New York, Oklahoma City, Miami, and others now have learned from their trauma and are now well enough on the way to recovery to mark a new place in their history.

So, moving to the site of the worst disaster in US history is extremely instructional for a long-time disaster mental health researcher. Despite more than 30 years of experience I learn nearly every day that I have much to learn about post-disaster community adjustment, accommodation, and “recovery.” The New Orleans Times-Picayune shows up on my door step and provides new lessons nearly daily. So, I know that I am as an outsider, new to these parts, ignorant of context, culture, and history. It is not uncommon, therefore, when sharing my insights about indicators of good or ill here following Katrina that my neighbors or colleagues would say: “Oh that was here (or happening) before Katrina.” The shared knowledge of a remarkable city is what I am still missing, among other things. When will this disaster be over? When the people act as if it is.



[1] According to a large number of laboratory studies, creativity, intelligence, social support, emotional intelligence, and trait resilience are most associated with stress management acuity and self care generally.

Sunday, July 26, 2009

Example 9: Doug Thornton, Disaster Management Leader

Doug Thornton

Shared via AddThis

Tuesday, July 21, 2009

Repression is a self care tool

NOTE: There will be another free Webinar this Thursday, July 22, 2009 in the afternoon from 3-4pm our time here in New Orleans. It is from 4-5pm in New York; 2-3 Mountain Time and it is 1-2 LA time. Go to FigleyInstitute.com for the info.

It’s July 21, 2009. I am wiser now. I have learned lots over the years. One thing is how thoughts can be stressful and invent ways to lower stress.

I thought that I would someday be able to dunk a basketball. I had hope. I thought that I might die in Vietnam as a US Marine corporal at 19 years old. I didn’t. We realized on September 12th that some people really don’t like Americans. Memory lapse?

How do we stay so calm? We lie to ourselves. We convince ourselves that we are not that close to being dead. Take for example when we drive down the road going 45 MPH and the person’s car is driving equally as fast and bad things could happen if either steering wheel shifts just a little bit. We come that close to dying every day and delude ourselves into believing we are safe.

All of us repress, suppress, depress, or impress nearly daily for some. This is a form of self care and when it is in the shadows of fear, it can be called trauma management; managing the trauma’s impact on us; making us feel safer. Tom Pyszczynski, Sheldon Solomon, and Jeff Greenberg are social psychology professors. They invented trauma management theory over the course of their long collaboration. In their 2002 book, commissioned by the APA Publications Committee in the wake of 9-11, they suggested that we have good reason to be worried – not from the terrorists but from those who fear “their kind.”

They suggest that trauma management theory accounts for why people behave as they do when it hits them that they are vulnerable. We can die at any time. Out of this fear people formulate certain realities that lead to behavioral change. It was their insight that led me to believe that, far from bad, repression is a good thing; it is the ultimate self care tool.

The Topic of my next Webinar is Repression. It will again be free of charge; you just need to register before the lines are full.

I am suggesting that repression is a self care tool because of the results of a study Joe Boscarino and I did and just got our first paper about its findings published in one of the most impactful and well-established mental health journal, the Journal of Nervous and Mental Disease. Read this story about it. Much of the Webinar is my telling about what the research and clinical literature say about repression after talking about how bad PTSD can be for those diagnosed with it. I talk about the study and its findings. If you are a practitioner over the age of 40 you will probably be surprised about repression and may want to reevaluate how it is measured and noted in psychotherapy. That should soon change, I hope.

So, if you are interested in getting a place for my live, Webinar on Repression, go to FigleyInstitute.Com. You can follow me on Twitter, Facebook, and some other network to be announced soon.

Monday, July 6, 2009

Leave Governor Palin Alone

Hasn’t she suffered enough? I have been spending a great deal of time focusing on stress injuries. She has been injured.

In 2007 William Nash and I produced a book, Combat Stress Injuries. It called upon our colleagues in the mental health professions to shift their attention to finding, assessing, preventing and treating post-traumatic stress disorder (PTSD) associated with combat veterans to a combat stress injury. It applies to the current controversy with Governor Palin.

We need to recognize that Governor Palin, elected by the citizens of Alaska, has been injured by the stress associated with being selected as the Republican Vice President. She lost the election and now she is resigning as Governor. It is time to back off.

Everyone who is speculating about her motives needs to revaluate their own motives. By continuing this discussing you add to the demands on her and her family. This is not appropriate.

Monday, June 29, 2009

New Orleans-Style Celebration of Michel Jackson's Life

Being a trauma specialist I appreciate the way death is observed in various cultures. After all, funerals are more often for those who survived; enabling them to feel comforted.

What a wonderful New Orleans experience. Only here would you fine "second lines." It is a parade complete, often, with mourners not part of the first line (e.g., family and close friends of the deceased).

The New Orleans Times-Picayune alerted readers about a Second Line for Michael Jackson to be held Sunday, June 28th at 430pm. The newspaper encourages readers on line to comment on the article. Postings about that story included those who were skeptical that it would be peaceful.

They were wrong. I was there and spoke with many people and took lots of photographs.

As the Times-Picayune reported later that day
("Huge second-line honors King of Pop Michael Jackson" by Danny Monteverde, The Times-Picayune, Sunday June 28, 2009, 10:22PM) the crowd exceeded 1500. Everyone was peaceful and had a great time.

It was very hot. But everyone was peaceful. Not just peaceful, the crowd was down right celebratory and seem to have a great time with good amounts of food, drink, and T-shirts of MJ to sell.


I spoke with Mary at the start of the procession. I asked her how many times she has joined a second line. “Millions!” she said with a grin on her face. I waited. “It’s to show respect and to help the family smile, dance, and sing with the music.” I smiled. “And it’s like Twitter: The more you show up for others, they more they show up for you.” Wow. I was not expecting that analogy.

See all of the photos and appreciate what a wonderful city I am fortunate to live within.

Thursday, June 25, 2009

An Encyclopedia of Trauma Planning Book


The time is right for an expanded concept of trauma and an encyclopedia to suggest the elements. These folks to the left are attending the International Society for Traumatic Stress Studies. This is the learned Society of the new field that is about to get broader.

I was the Founding President of the Society and the Founding Editor of its premier journal, the Journal of Traumatic Stress. So after I left the editorship of that Journal I founded another a few years later. It is now time to consider expanding the concept of trauma and there is no better way than to produce an encyclopedia on the topic.

The production of the encyclopedia (E) comes at a time of growing appreciation for this expanded conceptualization of trauma and at a time in history where interdisciplinarity is appreciated and sought. Out of tragedies in the wake of such trauma as the Virginia Tech shootings, the NYU Story of 9/11, Tulane and Katrinia, and Israel emerge insight, leadership, and invention. These are special issues of Traumatology, the International Journal of Trauma (Sage Publications). Collectively, these autobiographies published in Traumatology led to this Encyclopedia. The published autobiographies were reviewed at least two and often more reviewers blind to authorship.

They were the voices rarely heard among writers in Traumatology. For Christopher Fox, a Virginia Tech computer science professor, he noted in an email that it was one of the most rewarding studies he ever done and reported on (2008). They were written by professors and doctoral students of Sociology, English, Agronomy, Psychology, and a brave reporter.

The essence of E is clarity; thinking more clearly. The development of this Encyclopedia is part of a growing movement in the sciences and social sciences to clarify languages and other barriers to greater understanding.. As a result of the role E and other efforts, if they succeed, will elevate the importance of considering multidisciplinary and interdisciplinary thinking and collaboration (i.e., actually doing something about it) that may lead to important scholarships, conference presenting, networking, and publishing.

The purpose of the E is to educate a generation about the costs and benefits of trauma. Trauma happens suddenly without warning. E will it is hoped will be educate through a systematic collaboration that brings scholars and experts in trauma together. These scholars will be from all over the world and from specialties you might not think of who would be writing entries to an Encyclopedia of Trauma. Though we have provided a one-stop resource on trauma, we have tried to be aware and good citizens as we moved across disciplines, specializations, and other categorizations that can hinder collaboration if not properly managed.

We will succeed in our purpose if we can document that trauma can be found throughout our scholarly books, journals, and other bodies of knowledge. Trauma begs for our scholarly and professional attention to make changes; the old way is not working. Nearly anywhere you look there is someone who knows a trauma well. These trauma stories are the most important and enduring genre in films and faction. They are popular because they remind us of ourselves or a loved one in such a terrified state. These would be questions game show producers would ask It was also important to know about the score cards of everyone trauma survivors: How are they doing now? What can we learn from the experience that will enrich the rest of their lives (not that you want to go through that again for something as valuable)?

A surgeon tells of her experience in the House of Medicine (Dr. Lamp) (Producer: The name and identity of Dr. Lamp is not meant to apply to a real person but rather comprise elements of more than a dozen patients). Attracted to the adrenaline rush of doctoring, she quickly rose to the top of someone who could size up and solve a medical problem and even a relationship problem along the way. These may be considered benefits from a trauma; a traumatic event that cause some to step up others to step back; some to favor hero status and others without such a flavor. She kept stepping up until this one patient… who happened to be at the right/wrong place and the right/wrong reasons.

A social worker tells of her experience in the House of Crazy People. Mindy always wanted to help people. Her mother was a social worker, though she did not have the requisite degree, an MSW. She wondered about that often when she felt so overwhelmed her first year. They were taking back this 2 year old, again after being back with her mother for just a week, due to fear of abuse by the mother, who they feared had PTSD and could not properly care for the children. Eventually Mindy learned how to fight back the emotions and compulsions that explode in inexperienced workers. If they are unable to be taught, at least we should show them representations of the lessons in the classics, language, poetry, music, or just singing.

Trauma as a Broad Concept

Trauma is an extraordinary and potentially dangerous and life-changing event linked to human response. If there is no response there is no trauma at the time.

The trauma definition emerged from a colloquy involving more than a dozen colleagues. We all agreed that for the sake of interdisciplinarity within the academy it is important to recognize a single scholar’s leadership. She or he can be replaced at any time by the consensus of the faculty who will be responsible for the knowledge reflected in the curriculum. Therefore, the Encyclopedia defines trauma broadly and to extend the scope equally broadly to encompass nearly every element within the academy.

Thus, the definition of trauma is a fear event; an event that registered fear upon the body and psyche years after the event happened.
= Extraordinary means that the event was most often unplanned, suddenly overwhelming, out of the ordinary, and often shocking—either physically or emotionally and often both.
= Potentially dangerous means that the event activated the sympathetic nervous system associated with neurological activity that may be reactivated with certain memories of the traumatic event and has, therefore, certain psychoneuroimmunological implications for health and wellness as well as behavior.
= Potentially life-changing event means that the traumatic event may lead to a cascade of human reactions—both individual and systemic—that can be either positive or negative or a combination of both—long after the initial impact of the traumatic event.
= Human response is the immediate and long term direct and indirect reactions in the forms of neurobiological, behavior, intellectual, emotional, social, interpersonal, cultural, societal, global, other reactions, and any combination of these responses.

Purpose of the Encyclopedia of Trauma

Consistent with the global scope of the definition of trauma, the purpose of the Encyclopedia of Trauma is threefold:
= First, the purpose is to be an authoritative reference for students of trauma, a comprehensive compendium of meanings about all aspects of trauma.
= Second is to increase interest in the concept of trauma among serious scholars to generate a more comprehensive appreciation that will lead to new knowledge that may be applicable across all AFDs.
= The tertiary purpose of the encyclopedia is to stimulate new ways of identifying and helping the traumatized through our expanded knowledge.

Justification
The trauma encyclopedia is proposed now as a result of the confluence of several factors:
= The major, worldwide incidents of traumatic events due in part to climate change, the world economic crisis, and the consequent increase in political unrest.
= The maturing of the various fields and sub-fields that study, assess, and treat trauma-related mental health disorders (e.g., post-traumatic stress disorder).
= Finally, there is an extraordinary increase in important scientific breakthroughs in detecting the neurobiology of trauma. This effort is connecting biology with human behavior, which, in turn, is applicable to all fields involving human thought and response, including but not limited to psychiatry, medicine and the health sciences, the social and behavioral sciences, the humanities, law, and more.
Researchers within such varied fields can contribute to a universal understanding of immediate and long-term consequences—both good and bad—of trauma, both for individuals and for broader communities and institutions.

Reader’s Guide

Although the encyclopedia will be organized in A-to-Z format, the general editor will prepare a Reader’s Guide that also groups entries around themes and broad topic areas that would allow readers interested in specific topics to find relevant related entries more easily. There will be as many as 20 such themes or topics in this Reader’s Guide, which will be a part of the front matter. Following is a tentative draft of potential Reader’s Guide themes along with representative entries.
Agriculture
1. Trauma in Agricultural Settings
2. Farming-Related Trauma Medicine
3. Droughts, Fires, and Floods and the Farming
Community
4. Farming Disaster Management
5. Medical and Mental Consequences of Farm
Injuries
6. Political Disharmony and Farming Displacement:
The Zimbabwean Case
Archeology and Anthropology
1. The Iceman and the Battles in Bones: Evidence
of Trauma in Recovered Human Skeletal
Remains
2. Forensic Archeology: Traumatic Deaths in
Bosnia, Troy, and Cambodia
3. G enetic Evidence of Physical Trauma
4. Anthropologists in War: The Human Terrain
Team Experiment
5. Trauma Among Nonhuman Primates
6. Anthropological Views of Trauma
7. Forensic Anthropology
Architecture
1. Post-9/11-Informed Architecture
2. Memoralizations Architecture: Balancing the Needs
of Survivors and the Rest of the Community
3. Trauma-Informed Architecture: Preparing for
Earthquakes and Floods
4. Traumatized Architects: Case Examples of
Traumatic Stress-Induced Genius
5. Architecture Firm Trauma From Law Suits
6. Architectural Strategies for Calming the
Traumatized
7. The Architecture of Trauma: Memory, Time, and
Place
Arts and the Humanities
1. Poetry and Trauma
2. Trauma and Dance
3. The Literature of Trauma
4. Traumatized Artists and Performers
5. Trauma in the Classics
6. Trauma Stories in Screenplays, Movies, and
Novels
7. Trauma Images in Photos, Paintings, and
Drawings
Business and Economics
1. The Business of Trauma
2. Business Plans for Natural Disaster Recovery
3. The Traumatized Business: Company Strategies
for Human Power Recovery
4. Trauma Economics and Economic Modeling in
Trauma Care
5. Financial Crises and Meltdowns: Depressions
and Hyperinflations
6. Foreclosure, Bankruptcy, and Other Personal
Economic Traumas
Children and Families
1. Childhood and Adolescent Trauma: An
Overview
2. Children and Adolescent Assessment and
Treatment
3. Family and Couples Trauma: An Overview
4. Family and Couples Trauma and Treatment
5. Posttraumatic Stress Disorder Assessment and
Systemic Treatment
6. Combat, Deployment, and Military Family
Effects
Crime and Law
1. CSI, Criminalists, and the Archeologist of Crime
Scene Analysis
2. Trauma, Stress, and the Law
3. Work-Related Stress and Secondary Trauma
Among Lawyers
4. Work-Related Stress and Secondary Trauma
Among Judges
5. Work-Related Stress and Secondary Trauma
Among Law Librarians
6. Veterans Court: Effectively Weighing the
Consequences of War on Criminal Behavior
Crisis and Disasters
1. The Psychobiology of Crisis
2. The Social Psychology of Crisis
3. Crisis Theory and Intervention
4. Disaster-Related Trauma
5. Disaster Management
6. Postdisaster Community and Family Resilience
Culture and Ethnicity
1. Ethnicity, Culture, and Disaster Response
2. Ethnic and Culture Variation to Conceptualizing and Responding to Traumatic Events
3. Adapting Humanitarian Assistance with Respect to Cultural Context
4. Racial Variations in the Psychobiology of Trauma
4. Racism-Induced Trauma
6. The Role of Trauma in Ethnic and Cultural
Identity
Ethics and Philosophy
1. Trauma-Related Ethical Dilemmas
2. The Ethics of Research Involving Memories of Trauma
3. Assisted Suicide and the Ethics of Ultimate Pain Management
4. Traumatic Inventions and the Ethics of Scientific Discovery
5. The Philosophy of Trauma
6. The Philosophy of Trauma Nursing
7. The Philosophy and Ethics of Trauma Treatments and Preventions
History
1. The History of War
2. The History of Disasters
3. The History of Terrorism
4. Traumatized Historians
5. Trauma in Autobiographies
6. The History of Trauma Caregivers
Internet and Information Technology
1. Internet Terrorism
2. Media-Induced Trauma
3. Internet-Assisted Trauma Therapies
4. Twitter and Trauma: The Role of Technology in Inducing and Reducing Distress
5. Trauma.org
6. Trauma and Modern Information Technology
Entertainment and the Media
1. Trauma as Entertainment
2. Traumatized Entertainers
3. If It Bleeds, It Leads: The Role of Sensationalism and the Economics of News Media
4. The Role of Media in Managing Disasters
5. Trauma in Movies and Plays
Medicine
1. Traumatology, Trauma Medicine, and Orthopedics
2. Traumatized Nurses
3. Traumatized Physicians
4. Disaster Medicine
5. Combat Medics and Corpsmen
6. Trauma, Medication, and Psychiatry
Natural Sciences
1. Traumatized Scientists
2. Astronomy and the Trauma of Giant Impacts
3. Biological Effects of Physical and Psychological
Trauma
4. Immediate and Long-Term Biochemical Effects of Trauma
5. Trauma Geology
6. Trauma and Physics: Explosions, Blasts, and
Sound Effects
Psychology
1. Trauma Psychology Research
2. Clinical Trauma Psychology
3. Military Psychology and Combat Stress Injuries
4. Theories of Psychological Trauma
5. Combat Psychologists
6. Psychoneuroimmunology and Trauma
Social Work
1. Trauma Social Work Research
2. Trauma Social Work Practice
3. Military Social Work and Combat Stress
Management
4. Homelessness and Trauma
5. Domestic Violence Trauma
6. Secondary Trauma of Social Work
Spirituality and Religion
1. Trauma, Meaning Making, and Spirituality
2. Secondary Trauma of Chaplains and Other Faith
Community Practitioner
3. Religious Responses to Trauma
4. Traumatization in the Name of Religion
5. Combat Chaplains
Plans are underway to recruit eight members of an internationally acclaimed editorial board who will assist the editor in finding more than 320 entries to the encyclopedia of varying lengths by first recruiting as many as 35 colleagues who will become members of the editorial advisory group. This group will be familiar with at least one and often two above mentioned themes and who will not only know those qualified to write entries but who can also serve as ad hoc reviewers for the encyclopedia.
Those interested in contributing to E or being either a member of the editorial advisory group, a contributor, or have recommendations are urged to contact me at Figley@Tulane.Edu. Or call 504-872-3473 and leave a short message at.

Wednesday, June 24, 2009

Iranian Inspiration: We fight for our right to be free

Iranian Inspiration: We fight for our right to be free

We fight for our right to be free and that our vote counts.

"Live free or die" is part of our heritage. Iranians are giving us a real lesson in freedom and how governments' natural bent is "preserving law and order."

Thank God for patriots all over the world who stand up for the rights of people. There are a lot of freedom loving people there in the world and we saw lots of them this past week in Iran.

God Bless America and keep our votes safe for counting,

Charles