Professor Figley Polemics

13 NATO Troops Killed in Afghanistan Suicide Attack

2011-10-30T13:49:00.000-07:00

13 NATO Troops Killed in Afghanistan Suicide Attack

LTCOL. Dave Cabrera, PhD, my friend and collaborator was killed. I am sick about it. I will reach out to his wife, August and their two sons. Dave volunteered for this deployment because it was the right thing to do; to be in harms way helping soldiers as he has done all through his distinguished career. I am even more committed to helping the healers, like Dave. He would have wanted it that way.

Justice is Coming

2011-10-26T07:06:00.000-07:00

http://www.nola.com/crime/index.ssf/2011/10/employment_didnt_muzzle_fired.html

Charles R. Figley, Ph.D. | NCFR

2011-10-13T16:49:00.000-07:00

Charles R. Figley, Ph.D. | NCFR

2011-10-12T07:33:00.000-07:00

Greetings Readers,

It's getting even nicer here in New Orleans with milder temperatures both outside and, in the case of the Occupy Wall Street influx to the City, inside many who live here feel united and reaffirmed in their struggles by this crowd.

Today I received a letter from Sheila Watson from Caregiver Village and a nice opportunity to fund raise for your favorite charity. She writes:

The founders of Caregiver Village, an online community designed exclusively for those who provide care for anyone with special needs, have just put aside a portion of the launch funding to support caregiving organizations. For every person that joins Caregiver Village, they will donate $1 to that persons organization of choice. I thought you'd like to share this news with the readers of Professor Figley Polemics. I've created a page which explains everything:

http://www.caregivervillage.com/social-media

Caregiver Village members connect with friends, participate in book clubs with celebrity authors, journal, play mystery games, solve puzzles, and learn valuable information about caregiving. I would love it if you would join Caregiver Village and let your readers know about it. If you are able to post or tweet about this, please let me know. I am here if you need any help or have any questions.

Thanks so much,

Sheila
_
Sheila Watson
caregivervillage.com
facebook.com/caregivervillage
twitter.com/cgvillage

This sounds like a good deal for everyone, including the donors.

Happy Memorial Day to my Fellow Combat Veterans

2011-05-30T09:00:00.000-07:00

Today we honor those who died while in service to their country. There are lots of men and women who died because of this service that often go unnoticed. Add to that the thousands and thousands of combat vets who need a hand to get through the disorienting emotional fog of post-military adjustments.

Today and on Veteran's Day, November 11th, we acknowledge a universal truth: “No one knows better than a buddy who’s been there.” Thus, buddies have a special responsibility for helping fellow vets.

How can you help?

Reach out to a fellow vet and remind them you are their buddy. Volunteer for a veterans service organization. If not, donate money to the many deserving, veteran service-centered charities such as the National Veterans Foundation (http://www.nvf.org/), lead by my good friend, Shad Meshad.

Jeff Negy, a recently released Army combat medic who was in Iraq a few years ago. Without warning -- I mean nobody suspected -- a soldier buddy from his unit ended his own life. Jeff was among the 18 buddies from the same unit who showed up for the funeral. These soldiers decided right then and there to start an organization to support a reunion of the unit each year in honor of those who did not survive and to help those who did. I will keep you posted on how to help this new organization.

So I say to other vets: Happy Memorial Day and thanks for your service and thanks to the Shads and Jeffs of the world who care for veterans.

Charles Figley

USMC Sgt E-5

Secondhand Trauma (ST)

2011-03-30T05:14:00.000-07:00

Secondhand Trauma

Like secondhand smoke we are often dosed with a slight amount of tar and nicotine. So it goes with other’s miseries. Our heart goes out to them. This process I call “secondhand trauma” or ST[1]. There are at least three categories of ST:

· Family-related ST has been called in industrial/organizational psychology as crossover stress, and associated with the phenomenon of couvade, systemic trauma, interpersonal distress, marital or family crisis, post-deployment family syndrome, military family trauma, family burnout, caregiver burden, and other terms that represent the impact on group relations functioning, cohesion, and general morale of the family unit.

· Work-related ST has been described variously as being the cause of compassion fatigue, secondary traumatic stress reactions, vicarious trauma, other terms that represent the impact on worker performance, wellbeing, functional group relations, cohesion, and general morale of the work unit.

· ST from Others has been called bystander distress, mass hysteria, sympathy, compassion, empathy for those who have been directly exposed to trauma.

If we are able to understand the complexities by which we react to another’s distress and trauma -- both in the long and short-term -- we will be more able monitor and perfect our responses to secondhand trauma in all three domains simultaneously. As research emerges in one domain such as work-related ST, informs our understanding of secondhand trauma in other domains and what works best to effectively manage ST.

[1] Not to be confused with “second-hand shock” discussed by Ellie Izzo and Vicki Carpel Miller in their important book, SECOND-HAND SHOCK: SURVIVING & OVERCOMING VICARIOUS TRAUMA (available at the ViveBene Bookstore at the Vicarious Trauma Institute), which focuses on helping professionals or specifically vicarious trauma impact. My perspective is neurobiologoically based and more in line with the field of Psychoneuroimmunology and secondary trauma. Secondhand trauma is about the mechanism that explains who becomes debilitated and who becomes empowered.

The Triple Disaster in Japan

2011-03-23T08:30:00.000-07:00

Editorial Note: As of today, March 21, the official death toll in Japan stands at 8,600. But the final toll may get as high as 20,000, since more than 13,000 people are listed as missing. My friend and colleague, Takashi Fujioka, wrote the following at my request. He is a member of the faculty of the highly respected Japan College of Social Work. He is a highly respected, published, and influential researcher in the area of traumatic stress impacts including compassion fatigue. During his trip last year he talked about how pleased he was that Japan contributed to the recovery of New Orleans; that the Disaster Resilience Leadership Academy and the School of Social Work at Tulane University are now collaborating to respond to the triple disaster in Japan. This essay was written at a point in history long enough after the triple disasters of earthquake, tsunami, and the nuclear reactor crisis to have some idea of the extent of the damage and how Japan is responding as a society and as a government. Please direct your questions to me and I will direct them on to Takashi. -- Charles Figley

^*^*^*^*^*^*^*^*^*^*^

The Triple Disaster in Japan

Takashi Fujioka

22^nd March 2011

Appreciation to USA

Regarding the disasters affecting my country of Japan, I would like to express deepest appreciation to President Obama and many people of USA who are sending us Japanese warm words and great support.

The expressions and efforts of support of among staffs, professors, and student in the Tulane University is a wonderful expression of great support to Japan. Thank you from a country thankful for outside help.

Three Big Disasters in Japan

As for our disasters, we have three, which happened at the same time. The many earthquakes, Tsunamis and the accident in nuclear power plants in Fukushima started on March 11th.

Quickly we recognized that these triple disasters stressed the Japanese well beyond the range of our planning. Most of the destruction from earthquakes and Tsunamis were experienced from Tohoku and North Kanto area. Fortunately in these areas are mostly those Japanese who have the most advanced disaster prevention plans and offer many training programs to prepare them for natural disasters.

We were not prepared for an earthquake of this magnitude (9.0 MMS), one of the highest records on record and the worst disaster in Japanese history. The resulting Tsunami overwhelmed our capacity to prevent the destruction. For example, although we constructed levees that far exceed our standards, this Tsunami was like no other and far more than the assumptions we made when they were planned. The Tsunami destroyed many houses and buildings over the embankment and the levees.

The first big earthquake occurred at about 2:46 pm on March 11 leaving little time to evacuate. The first waves of the Tsunami occurred about 3:00 p.m. and were between 6 and 10 meters (20-32 feet) high. The second wave came at 4:30pm but it was rarely more than 6 meters.

There are many places where water soaked in on the roof of the third floor of buildings and houses. People and things in its path appear to be rolled up in the tsunami while they tried to escape, most often with the help of others who slowed down to help. The water was indiscriminate; it washed patients from hospitals, beds and all. Most Japanese houses are built of wood and why they were swept away by the water with only the foundations left.

The Nuclear Power Plant Disaster

The third disaster emerged Sunday, March 12^th with destruction of portions of the Fukushima Daiichi Nuclear Power Station caused by the multiple waves from the Tsunami. Subsequent explosions and leaks of radioactive gas took place in three reactors at the one Station. No one was harmed by the radioactive gases since the dosage was so very low. The reactors suffered partial meltdowns, while spent fuel rods at another reactor overheated, and a very, very small amount of radioactive materials escaped. But, no one was harmed. Many efforts were made to keep the Plant under control, especially in efforts to resupply the nuclear fuel with water to keep cool and avoid further disaster.

One part of fire engines using for drainage is one of US military forces. Thank you very much for U.S.A. nation! Inhabitants living near the Plant were moved to shelters. Some were urged to stay in their home until it was safe to move to the shelters.

Triple Disaster Consequences

The total extent of the damage will not be known for some time. However, widespread speculation is that more than 90% of those who died of Tsunami-related drowning. Most everyone in Japan has either suffered or sacrificed. Food and fuel shortages were reduced thanks to the sacrifices of those from less affected areas of the country. Those who suffered most are those throughout the region most affected by the Triple Disaster. Public officials are especially distressed. In addition to their own personal suffering, they most take responsibility of policies that may have cost the loss of lives and property or dispatched more help more quickly to those most affected.

Making matters worse, families in the disaster area became separated. Because family members were separated when the earthquake and Tsunami hit in the middle of the day, it complicated efforts for families to reunite. This caused considerable distress until family members were reunited. Japan is very family oriented.

In addition to being separated from family members, the triple disasters also caused wide spread failure of the use of telephones for several days. This added to the anxiety of family members trying to reach loved ones in the affected areas. This confirmation process lasted well over a week after the earthquake and subsequent disasters.

Most of the shelters for those affected by the triple disaster were large buildings including gymnasiums of elementary school and junior high schools nearby, senior high schools. Not surprisingly, life went on in Japan in an orderly and rational manner. Soon supplies arrived at disaster refuge place one after another from many prefectures, the capital and whole country.

However, supplies were unable to reached some stricken areas easily due to block roads and lack of fuel. Only recently have tanker carrying fuel for cars and heating arrived to the areas most in need, along other critical supplies of water and food.

Water is especially welcomed in the disaster zones. To the Japanese water for life such as drinking water, cooking "takidashi" in Japanese: This means such activities as bathing, toothpaste, washing face and hands.

Other items that were in short supply in shelters were dry milk for babies, and paper diapers. In addition there were many in shelters that were ill and required medical attention and fresh supplies of medication for those who had to abandon everything to seek shelter from the disasters, such as in Tohoku. The same is true regarding the needs of survivors missing eyeglasses, contact lens, hygiene supplies, and even underwear. The stricken areas like Tohoku continue to experience very cold, wintry weather that requires blankets and warm clothing.

New Construction and Beginnings

My friend still in Tokyo told me today that aftershocks were felt frequently today. There is still much danger and worry. There has been an extraordinary outpouring of assistance to the disaster areas from all parts of Japan. Many prefectures (regions) and cities have sent aid or preparing to do so in order to better care of people who need help most. In addition, there are many welfare institution and child welfare facilities have plans for assisting various survivors find longer-term needs, especially the elderly and children.

The Japanese people and the citizens of the world are collaborating to help the people and areas affected by the historic multi-disaster. There is every reason to believe that Japan will survive this situation and go forward united and moving toward the future step by step.

On a personal note, I wish to express deep appreciation to the many people who care about Japan and its people.

Launch of Phase II - The Big Uneasy

2011-03-13T17:42:00.000-07:00

Everyone needs to see this documentary. You will laugh, you will gasp, and you will wonder about why this story still needs to be told: It's was the failure of the Federal Levee System that flooded New Orleans not Hurricane Katrina.

News | The Office of His Holiness The Dalai Lama

2011-03-05T08:08:00.000-08:00

News | The Office of His Holiness The Dalai Lama

The shock of traumatic events and their cascading, ripple effects on human development is well known. There is far less known about trauma and the role of spirituality, growth, resilience, and thriving on human development.

Ron Marks (Tulane Social Work School Dean) and I intend to establish a trauma conference in New Orleans next May (2012) focusing on meaning making in the wake trauma. Among our invited guest will be the Dali Lama and the leading experts on psychological trauma, who are good friends.

We hope to further advance our understanding of human adaptation of adversity and the best was of matching what survivors need to transform stumbling blocks into stepping stones!

If you are interested in such a conference

Let the planning begin!

Some Hits and Several Misses for Combat Veterans with the Supreme Court Decisions Today

2011-03-02T13:24:00.000-08:00

Supreme Court Decisions Affect Service Members, Vets
Wed, 02 Mar 2011 12:57:00 -0600

Supreme Court Decisions Affect Service Members, Vets

By Jim Garamone
American Forces Press Service

WASHINGTON, March 2, 2011 - The U.S. Supreme Court has issued three decisions with military connections over the last two days.

In what may be the most contentious of the cases, the court ruled that members of a Westboro, Kan., church have the right to picket at funerals for service members killed in action.

Yesterday, the court reversed a lower court decision and decided a reservist had been the victim of bias due to his military service. Also yesterday, the court ruled that Veterans Affairs Department deadlines for veterans applying for benefits do not have "jurisdictional consequences."

In the first case, Albert Snyder, the father of Marine Corps Lance Cpl. Matthew Snyder, who was killed in Iraq, sued the Westboro Baptist Church for picketing his son's funeral. A jury found the Westboro group -- which says it conducts the protests because God hates the United States for its tolerance of homosexuality -- liable for inflicting emotional distress on the Snyder family, intrusion upon seclusion and civil conspiracy.

The Supreme Court voted 8-1 to reverse the lower court ruling, saying the Constitution's First Amendment shields the group. The First Amendment states, "Congress shall make no law respecting an establishment of religion, or prohibiting the free exercise thereof; or abridging the freedom of speech, or of the press; or the right of the people peaceably to assemble, and to petition the Government for a redress of grievances."

In one of yesterday's decisions, the court ruled in favor of Army reservist Vincent Staub, who was fired in 2004 from his civilian position as an angiography technician at Proctor Hospital in Peoria, Ill., because of his military obligations.

Staub sued the hospital under the Uniformed Services Employment and Reemployment Rights Act of 1994, which forbids employers from denying employment, re-employment, retention in employment, promotion or any benefit of employment based on a reservist's military obligations. A jury found the hospital liable, but the 7th Circuit Court reversed the decision.

The Supreme Court reversed the reversal yesterday, holding that if a supervisor motivated by antimilitary hostility performs an act intended to cause an adverse employment action, the employer is liable under the law.

In yesterday's other decision, the court found that the deadline set up by the VA Department for filing supplemental disability benefits does not have jurisdictional consequence. The case -- brought by David Henderson, who since has died -- hinged on Henderson missing a 120-day deadline by 15 days. The court found for veterans, saying Congress regarded the deadline as a claim-processing rule.

Spectrum of Resilience: Highly resilient people should be studied.

2011-03-01T12:50:00.000-08:00

A Spectrum of Resilience is a way of quickly determining if a leader is appropriately resilience following a significant, adverse event. It’s a kind of resilience barometer. It is a quick read on a group of people, such as disaster resilience leaders.

Spectrum of Care is becoming a useful way to focus attention on monitoring and helping men and women in combat who are at risk of debilitating injury, including combat stress injuries. This kind of spectrum of care was suggested by to Navy psychiatrists and full Navy Captains, William Nash & Richard Wesphal. They have worked since 2003 to transform US Navy Medicine to focus on functioning rather than diagnoses with the emphasis on injuries are away from diseases. They were successful in getting top to bottom endorsement within the US Marine Corps because of the importance of and trust in Navy Medicine. This includes Navy Corpsmen (Green Side) attached to the Marines and everyone else who provides medical care.

When the focus is on leadership, particularly that rare breed of leaders in times of disaster who functions in ways that facilitate resilience in people, relationships, and social systems. Our research team offers the following Spectrum:

Disaster Resilience Leader Resilience Spectrum After an adversity, there is an assessment of each leader. Spectrum can be useful in determining who needs what type of attention.
5	4	3	2	1
Highly Resilient	Resilient	Challenged in 1-3 Functions	Challenged in 4 Functions	Not functioning in 4 Functions
Study! Source of Inspiration Initiate an investigation of how this leader - the predictive variables	Go! Not Challenged but continue to monitor and support each of the 5 functions	Observe and Test: Challenged but Functioning. Draw in DR Leadership Academy for assistance	Challenged and needs rest and relaxation	Take off Duty and Treat

____________________________________________________________

Functions:

1. Executive Functions (EFs) are required to carry out the duties of office to the satisfaction of the office manager and supervisor. A way of measuring this is determining the level of functioning by their answer the following question: “My leaders is present and enables things to run smoothly” with either the answer 4 satisfied or 5 very satisfied.

2. Source of Support Functions (SoSFs) are required that includes direct and regular contact with the led to staff and volunteers identifying their answers to the question: “My leader supports me” with either the answer 4 satisfied or 5 very satisfied.

3. Source of Inspiration and Morale Building (SoI&MB) Functions are required and can be determined by determining the level of functioning by their answer the following question: “My leaders is present and enables things to run smoothly” with either the answer 4 satisfied or 5 very satisfied.

4. Sustainability Leadership Functions (SLFs) are important and can be determined by their answer the following question: “This leader has thought through the directions and has chosen sustainability for the community and organization that includes the triple bottom line. The level of functioning is determined by being answered by those in the best position to observe the leader’s behavior and would answer the following question: “I am satisfied that this leader understands the importance of the Triple Bottom Line of value but also concerned about the environment and equity,” answers 4 satisfied or 5 very satisfied.

5. Planning Functions (PF) are required that includes a careful and extended analysis of the current and past data and reports -- both internally and externally and are determined by what the leaders did. When asked they will respond to the question: How much time did you spend in studying the data about past efforts and current efforts? The answer would more likely be 4 or 5 hours (The Options are 5 hours, 4 hours, 3 hours, 2 hours, 1 hour, 0 hours).

Compassion Fatigue An Expert Interview Charles Figley PhD Pdf

2011-02-24T14:44:00.000-08:00

Here is an interview with MedScape in 2005 but apparently this is one of the most read interviews since. See Compassion Fatigue An Expert Interview Charles Figley PhD Pdf

Babies' Squeal's of Laughter

2011-02-22T08:27:00.000-08:00

A squealing baby, the highest level of baby laughter, is a giant tonic for human stress: The tonic ripple effect of babies.

Thus, when dealing with disasters, a treatment for distress is a baby’s squeal.

Cold Weather in NOLA

2010-12-28T08:48:00.000-08:00

The interesting thing about cold weather in New Orleans is that we are reminded why we live here, in addition to the food, people, music, history, culture.

Tulane University - New Ph.D. Program Focuses on City, Culture , Community

2010-12-01T10:07:00.000-08:00

Tulane University - New Ph.D. Program Focuses on City, Culture , Community

Please pass the word that our new PhD Program is accepting applications for the first cohort of doctoral students. The deadline is January 1, 2011. See the Program's website for more information: www.tulane. edu/ccc.

President Obama: Stop TSA from Gaping and Groping!

2010-11-12T07:42:00.000-08:00

Are we fed up yet? Are we fed up yet with our liberties being compromised?

These two questions were obvious to my wife, Kathy, as she was forced to experience the new security rules that went into effect between the US and Canada on our return trip from Montreal.

It was Thursday, November 4, 2010. Kat’s jaw dropped when she saw that they had installed the new supersensitive human scanners that create a photograph without outer garments.[1] She knew instantly that her choices were to not fly home or to go through a device that she believes is a sexual violation: a violation of her person without her permission. Her apprehension was written all over her face, and she started to ask questions of the female TSA guard. A male guard stepped forward in a confrontational posture and threatened Kat with a full body pat down. Kat old me: “Fortunately the female TSA officer intervened and defended my need for more information. I was horrified on several fronts!”

We returned from a lecture tour of Australia in which Kathy had to endure a female TSA officer patting her down. “I was groped, no matter which way you look at it. American business women are being subjected to this form of sexual assault and no one is objecting!”

No one is angry at anyone or anything or any law. It is the new more aggressive measures: The Gape and Grope TSA Security System employed at airports. It is wrong and should be replaced IMMEDIATELY.

[1] As a specialist in work-place stress, burnout, and secondary trauma, someone required to look at naked people all day needs my help.

Funny how we think we are training our dogs, but actually they are training us.

2010-11-07T20:20:00.001-08:00

Cleo is a smallish female dog who is a bit stocky by build. Her coat, some might say, looks like a Jersey cow (black and white patches). Cleo’s coat is composed of two large, solid black patches. One is around her head and the other section goes from her chest to her tail with either leg, indeed all her legs, are white. She is rather beautiful if you look at her as a piece of art. What gives her look such distinction is the white slice between her eyes that starts at her nose and to the top of her head. And she smiles a lot. Not only is her tail up high most often, she also has her mouth open widely as she pants; as if to saw “I’m happy.”

Cleo’s coat is matched only by her ability to communicate with us. She has perfected getting our attention and responding to simple questions such as “go out?”

I wondered out loud to Kathy that perhaps others have experienced their pets training THEM. If you have such a story, comment and we will try to edit them together as another blog.

“Criticizing the Eating Habits of Your Spouse Doesn’t’ Work.,” Duh.

2010-10-24T14:25:00.000-07:00

My wife, Kathy, politely pointed out an article in a Journal that I had not read yet. She was interested in my reading it because it touched on what she has been saying to me for years: Be part of the solution not part of the problem. This study demonstrated this point well when it is applied to marital support for a spouse trying to manage dietary restrictions.

Mary Ann Stephens and four other professors (mostly psychologists) recruited 109 couples to help them determine which helps most: Warnings or encouragement. Both worked in helping the spouse follow the recommend diet provided by a physician. However, encouragement was far more effective.

The study authors noted in the brief overview of the study: “. . . it was the spouses’ perceptions of their own influence attempts, and not patients reports, that were consequential for patients’’ adherence. Patients’ dietary behavior, and ultimately disease management, appears to be best served when the spouse uses more positively toned and less coercive influence attempts."

So, have a conversation with your spouse and ask the following questions to see if you should read this article carefully:

1. Have you ever tried to be helpful to your spouse or has your spouse ever tried to be helpful to you by providing warnings noted by a physician?

2. Are you pleased with the support from your spouse or the support you provide to your spouse regarding the matter of dietary management?

If your answer to 1 is yes or 2 as no, go to http://www.ncbi.nlm.nih.gov/pubmed/20939625 and read for yourself.

If you don’t you will be sorry and will hate yourself. Oh, wait a minute. Let me rephrase that: You might find it helpful in understanding why you both end up arguing rather than being mutually supportive.

Source: Stephens, M. A., Rook, K. S., Franks, M. M., Khan, C., & Masumi I. (2010). Spouses use of social control to improve diabetic patients’ dietary adherence. Families, Systems, & Health, 28:3,

THE EARLY SHOW ON SATURDAY

2010-09-18T04:00:00.000-07:00

THE EARLY SHOW ON SATURDAY

This morning Ron Ruden, a friend and colleague, will be on the nationally televised CBS morning program, the Early Show on Saturday. Check your local listings. Ron will talk about his new method, called Havening, that helps the traumatize "forget" the emotional reactions to past traumatic events. I highly recommend that you see this. I will try to publish the link to the tape of the show once it is shown.

The importance of Ron's work, Ruden is a physician in New York City and highly qualified to discuss the neurobiology of psychological healing from traumatic events. I just returned from Ft. Hood and interviewing combat medics participating in our three year study of their resilience, despite multiple combat deployments.

Our research team will be reporting our preliminary findings in Montreal in November at the International Society for Traumatic Stress Studies. It is the 26th Annual Conference of a learned society I helped start after my youngest daughter was born (1985).

What Ron has done is apply what he has learned from his more than 20 years of experience with his patients seeking relief from somatic pain that can be consider psychosomatic and his review of alternative methods for relieving the pain to develop an extraordinarily efficient traumatic stress treatment approach. It was reported in his new book,

When the Past Is Always Present: Emotional Traumatization, Causes, and Cures

in my Psychosocial Stress Book Series published by Routledge.

Other Things I Learned in the Last Month

2010-08-07T08:51:00.000-07:00

#3. I learned in New Zealand from two fire fighters who are trained as peer support for fellow fire fighters that spotting traumatic stress indicators of injury (not illness) and doing something about it at the right time has been a skills set honed over many, many years and experiences; that it is superior to any canned program and especially applied by those outside the ranks.

#4 Also in Auckland that it is less important if one uses either DSM or ICD. What’s more important is making sure that the traumatized get the help they need when they need it as long as they need it. And sometimes it requires workarounds to help the client find support.

#5 Being in a large auditorium (such as the room we used in Auckland) is a challenge to connecting with the audience. Add to that the mix of firefighters who want facts and information and they can use as peer supporters with an equal number of psychotherapists who want the same thing but with the theory and evidence to back up and guide their practice. It was a challenge but the evaluations were excellent because the audience was patient in hearing from those different than themselves – fellow audience members – and building upon it.

2010-08-07T07:05:00.000-07:00

Things I have noticed during the last month:

On July 7, 2010 was the day before we departed for my lecture tour to four Australians and New Zealand cities in 17 days.

8July we arrive at the New Orleans’ Louis Armstrong International Airport and were informed that we required visas to enter Australia and instructed to make contact with the Australian on-line visa-processing center. Kathy did this and we boarded our flight at 945am. This was the first of four flight legs to Brisbane to our hotel at 2pm local time (midnight in New Orleans) making it around a 15-hour journey. Quite a fast journey! Fly to four cities in different parts of the world and country and end up in their winter season. Among my observations:

1. Never fly to Sydney because you cannot count on your return flight being available if you fly Delta. We arrived at the Sydney International Airport 2 hours early to insure we made our flight. Kat was informed that our Delta flight #16 to LAX was cancelled. We were very disappointed and, although Delta return our frequent flier upgrade points and even gave us credit for the Quantas flight (approximately 50K) no one from Delta has ever taken the time to say they are sorry and how it will never happen again. . Kat and I recommend Qantas. We have flown twice now from Australia and they are an extraordinary airlines that is an excellent fit with Australia. Delta is not an excellent fit. Yet.

2. Our time in New Zealand was wonderful. The opening ceremony the pōwhiri. According to eHow and my host in Auckland, my sixth and seventh lecture days, we were treated and honored by Peter Huggard, friend and colleague had arranged a traditional Māori tradition in which the hosts welcome visitors. Pōwhiri is conducted in Maori - the beauty and grace of the native language underlie the whole event. Read more at How to Perform a Maori Welcome Ceremony | eHow.com http://www.ehow.com/how_2203258_perform-maori-welcome-ceremony.html#ixzz0vvd9rWLxa http://www.ehow.com/how_2203258_perform-maori-welcome-ceremony.html.

Soon I will share the third, fourth, and fifth lessons I learned from the last month.

Tulane University - India Trip Is Compassion in Action

2010-07-15T12:04:00.000-07:00

Tulane University - India Trip Is Compassion in Action
This cultural immersion program is a wonderful opportunity for our students to experience another culture and is literally worlds apart from what they know and understand as MSW students.

2010-07-07T09:03:00.000-07:00

Blaine Everson and I just completed a book that is due to be release next month that was at least four years in the making. When Blane earned his PhD at Florida State University he continued to practice family therapy near the large US Army based at Ft. Stewart. His dissertation focused on the wives of deployed soldiers. The book is the first, as far as we know, to guide practitioners in helping military families who can benefit from systemic therapy and wish to understand more fully the military context. As we explain in the book, the Marines are quite different from all other branches and I am sure that the Army, Navy, Air Force, and the National Guard are equally different.
This is the latest volume in a collection of books designed for military caregivers that have been published within Routledge Psychosocial Stress Book Series that I edit. The most recent before this is the 2007 book, Combat Stress Injuries (Figley & Nash). The first book in the series was Stress Disorders Among Vietnam Veterans, published in 1978.
Yet, we still know far too little about families of those who high stress jobs that take them away for long periods of time that require interpersonal and system adaptation upon return. We hope this book will provide practitioners with a practice guide and helping these families and the feeling of satisfaction that helping them.

Reuniting with a Former US Marine Corps Buddy

2010-07-01T13:29:00.000-07:00

Something great happened Tuesday. At the end of a community meeting in Pensacola about the oil catastrophe and community agency joint action, I was able to talk to a Marine Corps buddy I had not seen in 44 years (when I departed Vietnam a few days before his). We have exchanged emails and in my last one I asked Denny what the same or different now compared to the years before and during Vietnam. Here is his response:

Chuck,
Other than the obvious that we have aged a bit and our hair is silver I'll do my best. We weren't together long enough yesterday but I still believe you have your mischievous side. I can recall that in those final days before we shipped out to Vietnam we had to leave base in uniform. For some reason you didn't. Weaver and I were in uniform and we were walking to the apartment. All the way you kept running around us poking fun at us in uniform until we were all laughing to the point of tears. I can tell that you love your work and continue to meet new challenges. You have accomplished much in your career and love to teach. I saw glimpses of the serious side in Hawaii and more in Vietnam.
We were much younger then and more carefree. I think, like me that the highs and lows of life and the experiences we have faced have made you more introspective. You are very proud of your daughters. . I could tell that you are proud to be a Grandpa.
I could still see that glint of humor in your eye although we didn't broach much in humorous subjects. Give me a few more days to digest our conversation and I will e mail any more observations I might have. I just want you to know that it was great to see an old friend after 44 years.
Dennis
p.s. One think that is the same your caring for others. I can still remember how much you worked and helped the youngsters at the orphanage in Da Nang.

I need to see more of Dennis.

THE OIL CRISIS: Tulane University - Moment of Truth

2010-06-25T07:07:00.000-07:00

Tulane University - Moment of Truth

This is an important article in a series about how Tulane's faculty, students, and programs are helping to understand and provide resilience leadership. Here Mark Davis, who heads the Law School's Institute of Water Resources Law and Policy. Among other things, Mark views the current situation (spewing oil) as a "moment of truth" in getting our costal policies and priorities clear and plans carefully crafted. In effect, he recommends to everyone to calm down, get focused on sustainability and equity of impact-- financially and otherwise (i.e., distribute the burden and wealth).

Kathy and I are focusing on little Franklin County. They have a large area of Gulf of Mexico coast and state forests. They are poor but representative of Florida counties in the "panhandle" (northwestern east section of Florida that is among the most rural and untouched in the State). We are gathering information for a series of reports that will be published as editorials in Traumatology in the coming issues that will compare this and other coastal communities with those in southern Louisiana.

Among the findings so far is that BP is utilizing the Coast Guard regions to set up claims and community outreach in all the counties within the affected region (with headquarters in Mobile). The southern and eastern most counties within this district is Jefferson (Monticello) and Wakulla (Crawfordville) have had these offices since May 18th, after the employees (mostly temporary workers) were hired and oriented. We are trying to get a sense of the "pulse" of the people in these rural communities and enable them, eventually, to get the help they need and learn from costal communities to the West.

Gulf Coast Indian Tribes

2010-06-12T08:54:00.000-07:00

The Academy is launching an important study that will focus on three distinct communities, native Americans (see
Gulf Coast Indian tribes – among those hit hardest by BP oil disaster – face aid crisis, too), oil industry workers, and commercial fisherman. The intent is to understand the perspectives of each and find common ground, such as the characteristics of disaster resilience leadership. We will use a version of the common Delphi method to find consensus within and among the three groups.
Anyone interested in participating in the study are urged to contact me. If you are interested in collaborating on other projects, go to https://sites.google.com/site/figleycolleagues/.
This page is for my colleagues who may wish to collaborate with me on one or more of the following active projects:
o Combat Stress Injury not Illness -- research collaborator
o Combat Medic Mettle Study -- research collaborator
o Encyclopedia of Trauma -- be a reviewer and contributor
o Disaster Resilience Leadership Academy -- be a student, research collaborator, identifier of leaders in humanitarian and disaster work
o Traumatology -- be a reviewer or contributor for this Journal.

The Gulf Coast response to emerging BP disaster requires bold leadership. When will it emerge? Let us look at past catastrophes to discover where we might find disaster resilience leadership.

Nationalize BP

2010-06-09T15:35:00.000-07:00

Now is the time to consider this option. It is a matter of national security that we (the United States of America) ask our President and Congress to uphold the Constitution and take over BP until the crisis is over.

Just kidding. Leadership in times of crisis?

Just kidding. There are lots of leaders in times of crisis....

Building a Bridge to Neuroscience

2010-04-07T09:21:00.000-07:00

I have always had a soft place for applied research, though my dissertation research was not. Science is addictive and leads one in directions not necessarily toward application and improving the world. It is true today that there is a growing gap between basic and applied sciences and between science and practice.

However, I am encouraged by efforts to narrow these gaps and help poor practitioners doing the best they can. An example of this is a book (Shiromani, Keane, & and LeDoux I reviewed (Figley, 2010) for the American Psychological Association that is being published in PsycCritiques, their journal of book reviews.

In my review I called the book a milestone but that it failed to provide the promised connection between scientists and practitioners. In the book, Post-Traumatic Stress Disorder: Basic Science and Clinical Practice, edited and partly written by (Eds.). Humana Press published it late last year. [ISBN 978-1-60327-328-2 (hardcover); ISBN 978-1-60327-329-9 (e-book). $89.95, hardcover).]

Let me quote (italics) below from my review (Figley, 2009):

On the good side, Post-Traumatic Stress Disorder: Basic Science and Clinical Practice is from a good publisher, and the editors are eminently qualified to complete this project. This book is one of the first of its kind, and any first product is challenging when one is merging two fields (neuroscience and behavioral health) and different specializations (researcher and practitioner); thus doing it successfully is all the more important.

On the neutral side, after chatting with my friends and colleagues who practice the basic science of treating PTSD and related disorders, I can say the book hits the marks regarding basic science. However, for many of us, the science is “lost in translation.” The fact that only 22 percent (4 out of 18) of the chapters are dedicated to treatment strategies suggests that the audience is primarily neuroscientists and libraries. What is desperately needed in the assessment and treatment of PTSD is a more evidence-based and thorough understanding of the psychoneurological implications for clinical practice that would assist practitioners in helping clients understand their condition and enhance practitioners’ abilities to assess, prevent, and treat PTSD, as well as protect clients against relapse.

Another shortcoming of the book is the complete absence of discussion about the field of psychoneuroimmunology (PNI). This is the field that takes psychobioneurological data and finds links with not only immunological functioning but also the behavioral health consequence indices that start with stress reactions from some adversity, traumatic or otherwise. I am certain Humana Press and the editors will correct this significant omission when a subsequent edition is published.

The editors of the next edition of Post-Traumatic Stress Disorder: Basic Science and Clinical Practice should also consider inserting a transition chapter between the basicscience and the clinical practice portions of the book. Such a chapter would serve to note what basic science findings are relevant to treating PTSD and speculate on the critical components of effective treatments. The chapter could also discuss the treatment approaches available (e.g., in the current edition, two exposure-based therapies are discussed—guided imagery and virtual reality exposure) and offer a critique of the state of the clinical outcome research literature, which is, to date, unimpressive.

In the end, however, despite these limitations, this is a worthwhile volume that will surely be useful in being part of a trend to narrow the gaps between neuroscience and helping others by identifying and applying basic and applied science to the treatment of PTSD. Although, as this book illustrates, such contributions may not lead to immediate clinical practice breakthroughs, they may ultimately result in more reliable ways of measuring stress injuries that improve the effectiveness of diagnosing and treating PTSD.

Post-Traumatic Stress Disorder: Basic Science and Clinical Practice represents a growing and welcomed interest in PTSD among fields outside mental health practice, and it is consistent with the movement toward viewing traumatic consequences in terms of injury and recovery rather simply in terms of illness and medication.

References

Figley, C. R. (2010). Now We Know Much About the Neurobiology of PTSD: So What? A review of Post-Traumatic Stress Disorder: Basic Science and Clinical Practice by Priyattam J. Shiromani, Terence M. Keane, and Joseph E. LeDoux (Eds.) PsycCRITIQUES, Vol. 55, Release 14, Article 8 (April 7, 2010)

Shiromani, P. J., Keane, T. M. & LeDoux, J. E. (2009). Post-Traumatic Stress Disorder: Basic Science and Clinical Practice. NY: Humana Press.

Human and Animal Medicine-related Stress and Resilience

2010-02-23T12:16:00.000-08:00

Editorial Note:
This is the second in a series of essays by a practicing and experienced veterinarian. These are raw descriptions and thoughts from the field in an effort to lead to better and more humane treatment of vets and student vets.
Charles

_____

Thoughts on Human vs Animal Medicine
By Dr. C

I have nothing but the utmost respect, even a reverence for my human physician colleagues and their support staff. They get to know all this awesome complicated stuff about our OWN species! I don't envy them the legal headaches, ethical entanglements and red tape, and I think their job is worth every penny they make and then some.

But occasionally I hear that we have it easy in comparison to them, and I beg to differ.

For me at least, my patients are like small furry children and their anxious owners are the parents. I don't see them as "just" a dog or cat . . . they are my patients that I must exercise all skills on to the best of my ability.

In fact, that is the best metaphor I can come up with . . . it's like working in a pediatric ward, in a country that you don't speak the language, and the children are all carrying blades of various sizes (biologically enhanced with bacteria). You cannot disarm the children, only anticipate the attacks and restrain them accordingly. The reason they aggress at you is fear and pain, and you will scare them worse if you over-control.

A lot of your patients are tremendously sweet and it's a pleasure to work with them and try to heal them. Many heartwarming moments filled with happy patients and parents. Then in between seeing your little patients, you have to step across the building to the orphanage and execute a whole family of pretty little children because there is not enough money to feed them. You actually have to be the one to hold them and administer them the lethal injection, too, not just give the orders.

No, it's not at all easy being a vet.

Veteranarians Are Affected by Compassion Stress Too!

2010-02-20T17:53:00.000-08:00

Editorial Note: As many of you know, I published a book, Compassion Fatigue in the Animal Care Community (available from the publisher, Humane Society Press) a few years ago. Since then I have received numerous email and calls about the challenges and solutions noted in the book. This includes practicing veterinarians. Recently I received an extraordinary essay from a practicing vet, call her Dr. Compassionate (Dr. C), that tells her story with great passion and elegance how stressful and challenging being a vet can be. I have spoken with her and exchanged emails with her prior to her sending me this. I have her permission to share this with you and I am counting on the fact that there will be more.

Please help us circulate this and future essays by Dr. C.

_______

The Secret of Life of . . . er . . . Medicine, that is.

By Dr. C

Here is a dirty little truth in both human and animal medicine . . . it is all a mind game. We all know how important a positive and confident attitude is when you are the patient, but if you had any idea how critical it is to your doctor you would be surprised.

We doctors are fighting a game that we cannot win, only keep postponing to endless overtimes. But it's just temporary until Death finally gets our guy with a sneaky pass action play. Only a supreme egotist or blatant fool would think that we can actually stay that dread Hand. And that is the key to practicing medicine, overcoming that realization. Whether it is by repression, outright denial, arrogance or being lucky enough to never ponder that fact . . . ignorance is truly a necessary bliss. If we remember that we will never win in the end, it paralyzes us before we start.

See, there is no easy answer for *any* symptom or complaint. Gut instinct, training, observation, response to treatment . . . these are all the things human and animal doctors use to decide which of the bajillion differentials for vomiting it might be. It could be an obstruction masquerading as a food intolerance. Or a food intolerance masquerading as an obstruction. Hmmmm, which would be worse, being gutted over a chipotle burrito or not getting surgery when it is needed??? Neither, you say indignantly. Figure it out and treat correctly. Ha ha ha!

My naive friends, that is what we are desperately trying to do. We don't EVER want to make mistakes. We try really super hard not to, but sometimes the Law of Large Numbers prevails and an innocuous problem turns into an Epic Fail. Now, we always want to learn from our mistakes, but if we hold on to them too tightly it is counterproductive because FAILURE IS INEVITABLE. No doctor is ever correct 100% of the time. We have to somehow make peace with mistakes we make, but at the same time remember to never ever, ever make them again. Or any other mistakes we might hear about. Or even imagine. If you worry too much you start seeing so many possible mistakes that you lose any sense of what needs to be done. The path to success lies in forging on gleefully and ignoring the theoretical missteps you might make.

Reminds me of one of the Cartoon Laws of Physics: Cartoon Law I
Any body suspended in space will remain in space until made aware of its situation.

If you run off the cliff and just keep running, you will be fine. You might even make it to your destination. I heard somewhere that is the ultimate secret to living life. Keep running and never look down.

But if you looked already and you are falling at 9.8 m/s2, how do you forget?

Shame on CNN

2010-02-18T13:14:00.000-08:00

This morning a disgruntled man purposefully flew his plane into an Austin building that housed IRS workers and many others. CNN appropriately reported and followed the story. However, they chose to read the suicide note the murder left on an internet site.

It is fundamentally wrong for CNN to provide a forum for this murderer – irrespective of our support for the views he expressed.

By reading his letter CNN implicitly condones his actions and worse: It can lead to copy cats.

As a trauma expert I assure you that there is sufficient research evidence that such actions by CNN will increase copy-cat behavior by others hoping to get the same attention to their complaints. Do we want that?

Go to http://bit.ly/d1Sewl as a quick example.

Konbit Help for Haiti

2010-01-19T17:22:00.000-08:00

Konbit Help for Haiti

What can New Orleanians do to help Haiti and its people? According to Haitian-American, Nesly Rodnique, it’s not food, water, clothes --- they might be needed much later. Go to http://www.youtube.com/watch?v=gNn28k5idwc.

What is needed now is “konbit” it is a word known to Haitians as working together to help Haiti. What Haitians are doing is continuing to send money to those back home. Now it is our turn.

We need New Orleanians who are familiar with what it is like to have a home, community, and City that is mortally wounded. We need, all of us here, to step up and join the Konbit effort; to donate to a fund that will guarantee that donations will go toward getting money to family members as soon as possible to help them survive.

And those of you who read this -- you dozens you -- do the same thing in your community. Search out Haitians through Catholic churches and offer direct donations for konbit: helping Haitians help themselves and their families.

How? Donate money to the New Orleans area church with the largest number of Haitians in the region that has already has a program in place to direct funds to those in greatest need and who can track these donations to insure donors that their donations are well spent. Helping Haitians help their families and friends makes sense.

St Katharine Drexel % Father John
2015 Louisiana Avenue
New Orleans, LA 70115
(504) 891-3172‎

Yes, if we are serious about helping Haiti, it is best to help them directly and immediately. Call it Konbit Pou Ayiti or simply "Help for Haiti with Coins for Konbit." My hope is that we can get everyone to donate what they can as soon as they can to help the St. Kathearin Drexel distribute money to families in need RIGHT NOW.

When is a Disaster Actually Over?

2009-08-18T05:45:00.000-07:00

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 supportis associated with infant birth weight through processes involvingfetal 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.

Example 9: Doug Thornton, Disaster Management Leader

2009-07-26T03:45:00.001-07:00

Doug Thornton

Shared via AddThis

Repression is a self care tool

2009-07-21T17:19:00.000-07:00

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.

Leave Governor Palin Alone

2009-07-06T17:54:00.000-07:00

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.

New Orleans-Style Celebration of Michel Jackson's Life

2009-06-29T12:06:00.000-07:00

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.

An Encyclopedia of Trauma Planning Book

2009-06-25T19:06:00.000-07:00

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.

Iranian Inspiration: We fight for our right to be free

2009-06-24T06:16:00.000-07:00

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

“Keeping Your War Stories Inside Will Kill You” is a Dangerous Myth

2009-06-15T05:22:00.000-07:00

When I first met Joe Boscarino (1) in 1979 and discovered we both fought in Vietnam at the same time, I was intrigued. It was unusual to meet a fellow combat veteran who also served at the start of the war (1965-1966). We shared a common experience: Except in limited operations we were ordered not to lock and load our weapons unless first fired upon. Both Joe and I shared limited details. I learned later that Joe did not like the effects of talking about his war experience. It led to nightmares and memories he would just as soon forget. We had that in common as well, although we did not talk about it.

Joe visited with me at Purdue University to discuss a large survey he wanted to do that focused on Vietnam veterans like us. Our meeting was the beginning of a long term personal and professional friendship. Joe was impressed with my first book (2), which had been published the year before. In it I had reviewed the research literature with special attention to the psychosocial adjustment among Vietnam veterans; how they might live their lives after the war. I noted that there is a “dichotomy of opinion about the psychological fate of the Vietnam veteran...” (p.59) and proposed that the stress evaporation perspective suggested that combat veterans suffer some psychosocial readjustment problems during and immediately following military service, but that residual problems disappear after returning home; that “time heals all wounds.” This perspective was in stark contrast to the residual stress perspective that combat-related stress reactions among combat veterans are inevitable and that significant numbers of veterans were trying to cope with severe psychosocial readjustment problems originating years ago in Vietnam.

We now know that both perspectives still exist among most combat veterans; that time can heal all wounds under certain conditions (e.g., strong social support, employment, contact with fellow veterans) but that it takes more time than most would predict; that many factors can affect “forgetting” or more accurately accommodating to or learning from the wounds. The latest evidence is now available.

Joe is now an acclaimed trauma scholar who discovered the psychoneuroimmunological (3) link between combat stress and life-shortening medical problems (4). One of the oldest and most respected journals in the mental health field, the Journal of Nervous and Mental Disease (5)just published an article (6)Joe and I wrote that reported the results of a study of the long-term mortality rates of more than 4000 Vietnam veterans who were evaluated in 1985 with follow up in 2000. We found that repression does not necessarily lead to premature death among those diagnosed with Post-traumatic Stress Disorder (PTSD).

So what?

Long before my book was published through to this day, psychotherapists have been taught that it is critical for the traumatized to “process” their memories or suffer stress-related problems. Therefore various treatment approaches have emerged to discourage “repression” of the traumatic combat memories and encourage recalling and thoroughly reanalyzing them. Exposure to such traumatic memories was believed to be the primary path to health and happiness. As stated by Joe, Sigmund Freud and psychiatrists and mental health experts since have suggested that repression of traumatic memories could lead to health problems, “yet we have found little evidence that repression had an adverse health impact on combat veterans exposed to psychological trauma many years later.”

Our findings are consistent with viewing combat-related depression, PTSD and other negative consequences of war as stress injuries rather than disorders or mental diseases. In the 2007 book, Combat Stress Injuries, co-edited with former Marine psychiatrist, William Nash, it was suggested that trauma is only one of several stress-related consequences of war (e.g., grief reactions and physical fatigue).

Repression is a self-regulator and a method of memory management. Therefore, based on the new paradigm of combat stress injury and the results of our latest research, ‘keeping your stressful memories in side or it will kill you’ is a myth.”

This study is a wake- up call to all those who care about and treat combat veterans. These men and women deserve our respect in recognizing that they often know better than we do in how to manage their stressful memories, in most cases. This is why some refer to repression as a common defense mechanism. It is human and humane way of managing the extraordinary, life-changing experiences of young men and women who risked their life for their country.
_____
Notes:
(1) Joseph Boscarino, PhD, MPH is currently a Geisinger Health System senior investigator
(2) Stress Disorders Among Vietnam Veterans (NY: Brunner/Mazel, 1978)
(3) See: http://en.wikipedia.org/wiki/Psychoneuroimmunology
(4) The more severe the PTSD diagnosis, the greater the likelihood of death from heart disease, the study showed. See: http://www.sciencedaily.com/releases/2008/07/080707081834.htm. He had previously found that people with PTSD had dramatically higher rates of chronic health problems such as psoriasis, arthritis and other inflammatory diseases.
(5) See: http://journals.lww.com/jonmd/Abstract/2009/06000/The_Impact_of_Repression,_Hostility,_and.14.aspx
(6) Entitled: The Impact of Repression, Hostility, and Post-Traumatic Stress Disorder on All-Cause Mortality: A Prospective 16-Year Follow-up Study

God Bless Nurses

2009-05-05T17:24:00.001-07:00

What would we do without them? There is no way. My oldest daughter, Jessica, is a doctor and agrees with me. My mother was a nurse all of my life.

There is a major shortage of nurses worldwide. This is not surprising. This shortage has existed for a long time for lots of reasons. Despite the worldwide economic crisis, the shortage continues. This is due, in part to the spiraling costs of health care and the need for a skilled health care delivery work force that often compromises pay increases for new equipment.

A recent article in NursingTimes provides a useful profile:
From Nursingtimes.net/whats-new-in-nursing:
The big issues in nursing
5 May 2009 | By Steve Ford
Nursing seems to be facing more changes and challenges than ever before. Earlier this year, Nursing Times held its annual summit at which the key issues affecting the profession were debated. Steve Ford reports on a special round-table meeting, held in April, to update this discussion
In the wake of cases such as that of Mid Staffordshire NHS Foundation Trust, there is now an onus on every nurse to be a role model for other nurses if the profession is to avoid criticism.
The fact that not all nurses want to be leaders but all are role models was one of the key messages to come out of a special round-table discussion between leading nurse stakeholders, held in April by Nursing Times.
The event acted as a forum on topics such as the Prime Minister’s Commission on the Future of Nursing and Midwifery, the NHS Next Stage Review and the Productive Ward series, as well as nurse leadership and nurse-led models of care.
The development of nurse leadership has been mentioned in both the Next Stage Review and the PM’s Commission. But Rosemary Cook, director of the Queen’s Nursing Institute, said she thought more nurses aspired to being a good role model for other nurses rather than being a leader, adding that it was essential that all nurses did set a good example.
‘There is that onus on every single nurse, because if one person ignores call bells or something, that gives “permission” to everyone else to ignore a call bell. So everybody has to be a role model,’ she said.
She added that what she often found most upsetting about examples of poor care was that the cause was often purely down to the behaviour of staff.
‘It’s too easy, a lot of the time, to blame policy, the ward environment, the fact that the trust is short of funds or whatever it is – that doesn’t mean you can have a conversation over the patient, that doesn’t mean you can walk by a dirty commode without doing anything about it,’ she said.
Pippa Gough, a nurse and assistant director of clinical quality at the Health Foundation, said that feedback and communication between colleagues – both nursing and medical – was key to acting as a good role model. For example, if a colleague began talking over a patient, you should not only discontinue the conversation but take them aside afterwards and explain why you had done so.
‘That sort of minute by minute, small, timely feedback is really important in terms of developing role modelling,’ said Ms Gough. ‘If everyone is able to give that very clear feedback, everyone – doesn’t matter if you are doctors, nurses or a multi-disciplinary team – is going to start behaving differently.’
Ms Cook added that to some degree being a role model was initially about acting the part. ‘You kind of pretend to be a nurse who knows what they are doing and eventually you grow into it,’ she said.
Ironically, there was also suggestion that the much-maligned Nightingale wards may have actually helped with role modelling and patient dignity.
Ms Cook said: ‘When you had Nightingale wards all the patients were watching – it discouraged ignoring one patient, being rude to a patient, being impatient with a patient because everyone else was watching you.’
Ms Gough agreed that, while modern wards and rooms provided more privacy, Nightingale wards had acted as ‘containers’ of both patient and nurse anxiety because nurses were visible and present all the time.
‘Patients could see that but also nurses could see one another and that things were in control,’ she said.
Ms Cook acknowledged that acting as a good role model in the modern NHS was not always an easy task. ‘The pressures that are on nurses in the working environment will make them more or less easily able to do this role modelling. And, yes, it does get damned difficult. I think it is much harder than it ever was when I was working on the wards.’
Howard Catton, RCN head of policy, development and implementation, also noted how hard it was working under the pressures that frontline nurses often had to cope with. Most of the time, the right people with the right values were being recruited into nursing, he said, despite suggestions that some presumed tenets of nursing, such as compassion, had been watered down.
Referring to the introduction of compassion testing for nurse recruits at some trusts, as previously reported by Nursing Times in April, Mr Catton said: ‘By and large we do get the right people in with the right values and the right ambition, and wanting to do well and all the rest of it, but they get ground down by “compassion fatigue”.
‘Many nurses go so far above and beyond [what is expected] because of their levels of commitment,’ he said.
Speakers suggested that with the right support good role models, if they wanted to, could go on to become good nurse leaders as well. ‘Part of being a role model is imparting confidence, which is hugely important again for leadership,’ said Ms Gough.
One initiative that has also helped promote nursing leadership by giving nurses at ward level more control over their service environment has been the Releasing Time to Care: Productive Ward programme. Launched in January 2008 by the NHS Institute for Innovation and Improvement, the ‘Productive’ tools and techniques are now being expanded into a range of healthcare settings.
Kristy Parnell, an associate with the programme, noted that feedback had been very positive. Nurses who had worked with the programme described it, she said, as ‘the biggest thing that had ever happened in nursing’.
‘Actually having a programme focusing on nurses that isn’t top down, that hasn’t been a policy drive, has been a massive pull and continues to be in the other areas that Productive’s are moving into,’ she added.
‘There has been a huge amount of enthusiasm and a change for a lot of people in their feelings about going into work – the control they have over their environment, understanding how they are performing, having access to improvement tools and meaningful real time information which allows them to increase the quality of patient care.’
But, Ms Parnell warned, the institute was now working to avoid the threat posed by the recession by identifying ways to encourage those in control of NHS finances to continue to invest in the Productive series.
‘We are now at the stage where, against the economic climate as it is the moment, SHAs will inevitably start wanting more for less,’ she said. ‘How do we engage and ensure that organisations continue with the programme and do not see ‘Releasing Time to Care’ as a project that they invest in for a limited amount of time, but as a vehicle for long term quality improvement and cultural change?’
Productive Ward was held up by the prime minister as an example of why nurses should be given more control over care settings when he announced his Commission on the Future of Nursing and Midwifery in March.
The creation of the commission, which had its first full meeting last week, has been mostly welcomed but a number of concerns were raised about its structure and remit.
For example, Ms Gough said: ‘I think to set up a commission on nursing separate from any other profession is complete nonsense – you can’t view one section of the workforce in isolation.’
Additionally, she said the membership of the commission should have been drawn from a wider pool that went beyond nursing and midwifery. ‘We know what the view of the world is as nurses. How do we get some new views?’ she said.
Mr Catton said the commission had to recognised as a ‘huge political opportunity’ but said he wanted to see ‘bigger ambition’ from its remit – such as looking at how nursing would be affected by the wider NHS quality agenda and the current economic downturn.
In particular, Mr Catton said he was disappointed that commissioning was not in the original remit of the commission.
‘My worry about commissioning not being given a specific name check is that the spending of £70bn of NHS money will be decided through commissioning, and nurses aren’t seen to be there,’ he said.
Ms Cook also questioned another part of the commission’s remit, which deals with the development of nurse-led services – and in particular the increased use of the social enterprise model, which was also highlighted in the NHS Next Stage Review.
‘It will be a challenge to avoid focusing on the exciting end around innovation and entrepreneurial practice and forgetting the whole main body of nursing, which is delivering the care on a day-to-day basis,’ she said.
‘Are we recruiting people who want to go into nursing to be by the bedside and look after patients or actually recruiting people to manage services, to organise things and be accountable for care?’ she said.
She said there were several questions to be answered around nurse-led services. For example, there needed to be a distinction made in the importance between innovation within the NHS and more risky independent ventures such as social enterprise schemes.
‘There is a different area of excitement, entrepreneurship and innovation, which we need, that happens within the profession and under the umbrella of the NHS. A lot of people we can enthuse to do that,’ she said.
‘If we want some of them to step out of there, then that’s a smaller group and different questions altogether,’ she warned.
‘Although it’s the minority and not the majority that will end up working outside of the NHS, the vision that this government has for lots of nurse-led services and social enterprises, that’s where you will get “naked professionalism”,’ she said. ‘They are not surrounded necessarily by the sort of team you would get in a hospital or NHS service, so there’s nothing between them and being struck off but their own professionalism.’
Ms Gough questioned the use of the term ‘nurse-led’ itself. ‘The problem for me with nurse-led models of care is this thing about autonomy – are they truly nurse-led or who else do they need to get in on the act to enable nurses to make decisions?’
Ms Cook agreed. ‘You could argue that autonomous practice is the emperor’s new clothes of nursing. Does it really exist? How autonomous are these people?’ she asked.
Ms Gough added: ‘The “real politic” is that not many nurses have total decision-making power in terms of the way care is organised – the reality is you need to be able to negotiate really skilfully and influence really skilfully to push through the ideas that you think are important and place those in the context of other people’s ideas.’
However, Ms Cook disagreed on this point. ‘I think nurses know that and do that – nurse-led practices are a good example,’ she said. ‘They employ the GPs, they employ other people. There is real pragmatism about that. I think the danger is when nurse-led is used as a slap in the face for doctors, and sometimes that is what it’s about. All this promotion that nurses can do everything is basically unhelpful.’
No doubt many of the issues discussed at the round-table will still be on the agenda at the next Nursing Times summit – as well as some new ones. The NHS may be facing the prospect of a new Conservative government, for example.
But, as Ms Cook said, perhaps what the profession needs most is a period of political stability to enable it to develop from within.
‘From an organisational point of view, we’ve had endless change and people are fed up of that sort of change,’ she said. ‘But we should be having endless, endless, endless change from within nursing focused on the patients.’
See http://www.nursingtimes.net/whats-new-in-nursing/management/the-big-issues-in-nursing/5001025.article.

Pandemic

2009-04-29T17:10:00.000-07:00

I have received dozens of inquiries about reactions to the Global Pandemic associated with the swine flu. Here is my response:
1.Humankind has never been in a better position than now. Our leaders, President Obama, the WHO, and others are working collaborative for the good of all of us.
2. Trust in our leaders is the the most important factor in surviving any threat to our health and survival.
3. We need to be reminded that all of us -- worldwide -- have been challenged to a far greater extent than how. Goodness knows that we in New Orleans have been tested. We have survived, despite the failure of Federally designed and constructed levees.
4. These challenges will make us stronger in the long run, as President Obama has stated today in a press conference.
Let us all work together -- all over the world -- to protect our families and all others.

Did Hurricane Katrina Affect The Incidence Of Acute Coronary Syndromes In New Orleans?

2009-03-25T11:59:00.000-07:00

Did Hurricane Katrina Affect The Incidence Of Acute Coronary Syndromes In New Orleans?

A recent study by my colleagues here at Tulane, Sandeep Gautam and Jonathan Menachem, of the School of Medicine and three others (Sudesh K Srivastav, Patrice Delafontaine, and Anand Irimpen, found some disturbing evidence of the long-term effects of Katrina.

As most everyone in the world recalls, New Orleans was hit by Hurricane Katrina at the end of August, 2005. It was and remains the biggest natural disaster in the United States in large part because of the failure of the Federal levy system that flooded most of the city and beyond. The flood waters remained for several weeks. The result of near total devastation in large sections of New Orleans, one of the oldest and most beautiful cities in the US.

Professor Gautam and his team were aware that previous studies have shown an increase in heart attacks -- acute myocardial infarction (AMI)-- in the immediate hours to weeks after natural disasters. Given the extraordinary and long-lasting devastation ushered in by Katrina, they wondered about the possible long-term effects on health -- especially AMIs after Katrina compared to AMIs prior to Katrina.

What Professor Gautam's team found was disturbing. Compared with patients admitted with AMI to Tulane University Hospital in the two years before Katrina, they found that fully two years after the hospital reopened -- which was 5 months after Katrina hit -- the incidence of AMI tripled! One explanation for this increase is the chronic stress citizens have endured in New Orleans trying to re-build the homes and lives. Because hospital records also indicate that, compared to pre-Katrina patients, post-Katrina AMI patients:
(1) had higher unemployment
(2) lacked medical insurance
(3) did not take their medication
(4) smoked more
(5) abused drugs more
(6) more likely hospitalized for the first time in their lives
(7) more likely to live in New Orleans and in temporary housing
Interestingly, they found no racial difference in rates of AMI and any of these other factors.
This study provides clear evidence that Katrina led to prolonged loss of employment and insurance, decreased access to preventive health services and an increased incidence of AMI. And consistent with other studies, disaster-related chronic stress leads to increased smoking and a decrease in medical compliance.

The research team noted that, even allowing for the loss of some local hospitals in the wake of the disaster, these results represents a significant decrease in overall population health, and supports the need for further study into the health effects of chronic post-disaster stress. It also suggests that the citizens of New Orleans requires substantially more health promotion services to prevent such life-threatening outcomes as AMIs.

Is Anyone Listening?

2009-03-02T01:21:00.001-08:00

The Obama Administration must fix the health care system starting with returning rural vets, especially the National Guard and their families.The recent article, Mental-health ‘tsunami’ forecast for Louisianians back from Iraq, by Advocate New Orleans bureau journalist, Allen M. Johnson, Jr., got it right. But this is only one of many but no one seems to get it or do something about it. Please correct me if I am wrong.

Dear Ty Inc., Thank you...

2009-02-04T03:23:00.000-08:00

-----Original Message-----
From: Charles Figley [mailto:CharlesFigley@gmail.com]
Sent: Wednesday, February 04, 2009 5:22 AM
To: 'yourfriends@ty.com'
Cc: 'figley@tulane.edu'
Subject: thank you

Dear Ty Inc.,

Thank you for announcing Tuesday that the dolls’ names of Sasha and Malia are retired. A very classy decision and I appreciate it very, very much.

Best wishes,

Charles Figley

__________________________________________________

Prof. Charles R. Figley, Ph.D., Editor of Traumatology: http://tmt.sagepub.com/ Fulbright Scholar, Tulane University Graduate School of Social Work Professor and the Paul Henry Kurzweg, MD Distinguished Chair in Disaster Mental Health Phone: 504-862-3473 Email: Figley@Tulane.edu Web: charlesfigley.com

Greed Attack on America

2009-01-25T12:18:00.000-08:00

America and Americans are urged to be vigilant but unafraid regarding a terrorist attack on our country. We are in a financial crisis in part due to selfish greed of a few. Yet, we are not adequately prepared for a Greed Attack on American’s First Family, Sasha and Milia. The attack was perpetrated by the Ty Company (http://ty-girlz.ty.com/). I completely disagree with those who assert that these children deserve no better treatment than celebrities. They are Presidential children who have until now been off limits to the media and especially those companies like Ty Dolls who place greed over principle.

Publicity helps sell their products or at least go to their web page. Americans who care about children and their privacy should fight back and boycott this company, all of their products, and those who sell them until this company removes and destroys these dolls. Also, those who own them should send them back for a refund.

A recent blog presented the issues well and generated a good range of discussion. I was quoted in an recent Boston Herald article in which I quoted also quotes Doug Wead, author of a recent book on children of the US Presidents: “Nothing the parents could do or say has stopped the public from demanding and getting a peek,” he said. “How can you blame the public? The reason we love kids, especially kids in the White House, is because they are spontaneous and none of the politicians are.” Imagine how the mom feels and why she released a statement condemning this exploitation of public interest by Ty corporate greed.

The time has come for Americans to stand up and stop the greed and help our First Family protect their children. Send an email to the firm and request that they stop exploiting the Obama children: http://www.ty.com/Talk2Ty_contactus.

2009-01-20T13:06:00.000-08:00

The Associated Press

Text of President Barack Obama's inaugural address on Tuesday, as delivered.

OBAMA: My fellow citizens:

I stand here today humbled by the task before us, grateful for the trust you have bestowed, mindful of the sacrifices borne by our ancestors. I thank President Bush for his service to our nation, as well as the generosity and cooperation he has shown throughout this transition.

Forty-four Americans have now taken the presidential oath. The words have been spoken during rising tides of prosperity and the still waters of peace. Yet, every so often the oath is taken amidst gathering clouds and raging storms. At these moments, America has carried on not simply because of the skill or vision of those in high office, but because we the people have remained faithful to the ideals of our forebears, and true to our founding documents.

So it has been. So it must be with this generation of Americans.

That we are in the midst of crisis is now well understood. Our nation is at war, against a far-reaching network of violence and hatred. Our economy is badly weakened, a consequence of greed and irresponsibility on the part of some, but also our collective failure to make hard choices and prepare the nation for a new age. Homes have been lost; jobs shed; businesses shuttered. Our health care is too costly; our schools fail too many; and each day brings further evidence that the ways we use energy strengthen our adversaries and threaten our planet.

These are the indicators of crisis, subject to data and statistics. Less measurable but no less profound is a sapping of confidence across our land - a nagging fear that America's decline is inevitable, and that the next generation must lower its sights.

Today I say to you that the challenges we face are real. They are serious and they are many. They will not be met easily or in a short span of time. But know this, America - they will be met.

On this day, we gather because we have chosen hope over fear, unity of purpose over conflict and discord.

On this day, we come to proclaim an end to the petty grievances and false promises, the recriminations and worn out dogmas, that for far too long have strangled our politics.

We remain a young nation, but in the words of Scripture, the time has come to set aside childish things. The time has come to reaffirm our enduring spirit; to choose our better history; to carry forward that precious gift, that noble idea, passed on from generation to generation: the God-given promise that all are equal, all are free and all deserve a chance to pursue their full measure of happiness.

In reaffirming the greatness of our nation, we understand that greatness is never a given. It must be earned. Our journey has never been one of shortcuts or settling for less. It has not been the path for the faint-hearted - for those who prefer leisure over work, or seek only the pleasures of riches and fame. Rather, it has been the risk-takers, the doers, the makers of things - some celebrated but more often men and women obscure in their labor, who have carried us up the long, rugged path towards prosperity and freedom.

For us, they packed up their few worldly possessions and traveled across oceans in search of a new life.

For us, they toiled in sweatshops and settled the West; endured the lash of the whip and plowed the hard earth.

For us, they fought and died, in places like Concord and Gettysburg; Normandy and Khe Sahn.

Time and again these men and women struggled and sacrificed and worked till their hands were raw so that we might live a better life. They saw America as bigger than the sum of our individual ambitions; greater than all the differences of birth or wealth or faction.

This is the journey we continue today. We remain the most prosperous, powerful nation on Earth. Our workers are no less productive than when this crisis began. Our minds are no less inventive, our goods and services no less needed than they were last week or last month or last year. Our capacity remains undiminished. But our time of standing pat, of protecting narrow interests and putting off unpleasant decisions - that time has surely passed. Starting today, we must pick ourselves up, dust ourselves off, and begin again the work of remaking America.

For everywhere we look, there is work to be done. The state of the economy calls for action, bold and swift, and we will act - not only to create new jobs, but to lay a new foundation for growth. We will build the roads and bridges, the electric grids and digital lines that feed our commerce and bind us together. We will restore science to its rightful place, and wield technology's wonders to raise health care's quality and lower its cost. We will harness the sun and the winds and the soil to fuel our cars and run our factories. And we will transform our schools and colleges and universities to meet the demands of a new age. All this we can do. All this we will do.

Now, there are some who question the scale of our ambitions - who suggest that our system cannot tolerate too many big plans. Their memories are short. For they have forgotten what this country has already done; what free men and women can achieve when imagination is joined to common purpose, and necessity to courage.

What the cynics fail to understand is that the ground has shifted beneath them - that the stale political arguments that have consumed us for so long no longer apply. The question we ask today is not whether our government is too big or too small, but whether it works - whether it helps families find jobs at a decent wage, care they can afford, a retirement that is dignified. Where the answer is yes, we intend to move forward. Where the answer is no, programs will end. Those of us who manage the public's dollars will be held to account - to spend wisely, reform bad habits, and do our business in the light of day - because only then can we restore the vital trust between a people and their government.

Nor is the question before us whether the market is a force for good or ill. Its power to generate wealth and expand freedom is unmatched, but this crisis has reminded us that without a watchful eye, the market can spin out of control - and that a nation cannot prosper long when it favors only the prosperous. The success of our economy has always depended not just on the size of our gross domestic product, but on the reach of our prosperity; on our ability to extend opportunity to every willing heart - not out of charity, but because it is the surest route to our common good.

As for our common defense, we reject as false the choice between our safety and our ideals. Our founding fathers ... our found fathers, faced with perils we can scarcely imagine, drafted a charter to assure the rule of law and the rights of man, a charter expanded by the blood of generations. Those ideals still light the world, and we will not give them up for expedience's sake. And so to all the other peoples and governments who are watching today, from the grandest capitals to the small village where my father was born: know that America is a friend of each nation and every man, woman, and child who seeks a future of peace and dignity, and that we are ready to lead once more.

Recall that earlier generations faced down fascism and communism not just with missiles and tanks, but with sturdy alliances and enduring convictions. They understood that our power alone cannot protect us, nor does it entitle us to do as we please. Instead, they knew that our power grows through its prudent use; our security emanates from the justness of our cause, the force of our example, the tempering qualities of humility and restraint.

We are the keepers of this legacy. Guided by these principles once more, we can meet those new threats that demand even greater effort - even greater cooperation and understanding between nations. We will begin to responsibly leave Iraq to its people, and forge a hard-earned peace in Afghanistan. With old friends and former foes, we will work tirelessly to lessen the nuclear threat, and roll back the specter of a warming planet. We will not apologize for our way of life, nor will we waver in its defense, and for those who seek to advance their aims by inducing terror and slaughtering innocents, we say to you now that our spirit is stronger and cannot be broken; you cannot outlast us, and we will defeat you.

For we know that our patchwork heritage is a strength, not a weakness. We are a nation of Christians and Muslims, Jews and Hindus - and non-believers. We are shaped by every language and culture, drawn from every end of this Earth; and because we have tasted the bitter swill of civil war and segregation, and emerged from that dark chapter stronger and more united, we cannot help but believe that the old hatreds shall someday pass; that the lines of tribe shall soon dissolve; that as the world grows smaller, our common humanity shall reveal itself; and that America must play its role in ushering in a new era of peace.

To the Muslim world, we seek a new way forward, based on mutual interest and mutual respect. To those leaders around the globe who seek to sow conflict, or blame their society's ills on the West - know that your people will judge you on what you can build, not what you destroy. To those who cling to power through corruption and deceit and the silencing of dissent, know that you are on the wrong side of history; but that we will extend a hand if you are willing to unclench your fist.

To the people of poor nations, we pledge to work alongside you to make your farms flourish and let clean waters flow; to nourish starved bodies and feed hungry minds. And to those nations like ours that enjoy relative plenty, we say we can no longer afford indifference to the suffering outside our borders; nor can we consume the world's resources without regard to effect. For the world has changed, and we must change with it.

As we consider the road that unfolds before us, we remember with humble gratitude those brave Americans who, at this very hour, patrol far-off deserts and distant mountains. They have something to tell us, just as the fallen heroes who lie in Arlington whisper through the ages. We honor them not only because they are guardians of our liberty, but because they embody the spirit of service; a willingness to find meaning in something greater than themselves. And yet, at this moment - a moment that will define a generation - it is precisely this spirit that must inhabit us all.

For as much as government can do and must do, it is ultimately the faith and determination of the American people upon which this nation relies. It is the kindness to take in a stranger when the levees break, the selflessness of workers who would rather cut their hours than see a friend lose their job which sees us through our darkest hours. It is the firefighter's courage to storm a stairway filled with smoke, but also a parent's willingness to nurture a child, that finally decides our fate.

Our challenges may be new. The instruments with which we meet them may be new. But those values upon which our success depends - hard work and honesty, courage and fair play, tolerance and curiosity, loyalty and patriotism - these things are old. These things are true. They have been the quiet force of progress throughout our history. What is demanded then is a return to these truths. What is required of us now is a new era of responsibility - a recognition, on the part of every American, that we have duties to ourselves, our nation, and the world, duties that we do not grudgingly accept but rather seize gladly, firm in the knowledge that there is nothing so satisfying to the spirit, so defining of our character, than giving our all to a difficult task.

This is the price and the promise of citizenship.

This is the source of our confidence - the knowledge that God calls on us to shape an uncertain destiny.

This is the meaning of our liberty and our creed - why men and women and children of every race and every faith can join in celebration across this magnificent Mall, and why a man whose father less than sixty years ago might not have been served at a local restaurant can now stand before you to take a most sacred oath.

So let us mark this day with remembrance, of who we are and how far we have traveled. In the year of America's birth, in the coldest of months, a small band of patriots huddled by dying campfires on the shores of an icy river. The capital was abandoned. The enemy was advancing. The snow was stained with blood. At a moment when the outcome of our revolution was most in doubt, the father of our nation ordered these words be read to the people:

``Let it be told to the future world ... that in the depth of winter, when nothing but hope and virtue could survive...that the city and the country, alarmed at one common danger, came forth to meet (it).''

America, in the face of our common dangers, in this winter of our hardship, let us remember these timeless words. With hope and virtue, let us brave once more the icy currents, and endure what storms may come. Let it be said by our children's children that when we were tested we refused to let this journey end, that we did not turn back nor did we falter; and with eyes fixed on the horizon and God's grace upon us, we carried forth that great gift of freedom and delivered it safely to future generations.

Thank you. God bless you. And God bless the United States of America.

01/20/09 14:50 © Copyright The Associated Press. All rights reserved. The information contained In this news report may not be published, broadcast or otherwise distributed without the prior written authority of The Associated Press.

ABC News: Age or Stress? The Graying of Barack Obama

2009-01-20T03:19:00.001-08:00

ABC News: Age or Stress? The Graying of Barack Obama

Posted using ShareThis

Inauguration Day

2009-01-20T02:53:00.000-08:00

November 20, 2009 is an historic day. It is Inauguration Day. Barack Obama is the first person of color to become President of the United States. I was talking to my daughter, Laura, yesterday and remarked that when I was stationed in North Carolina in the Marine Corps in the mid-1960s I was shocked to see signs marked “colored” at drinking fountains and toilets. Though faded and not relevant anymore with the state eliminating “Jim Crow” laws, it was a stark reminder of how things were not long ago.

I am so proud of my country to finally signal that we have come of age; that it is more possible now that anyone can do anything with sufficient effort. God bless America.

What is the Opposite of Steve Jobs?

2009-01-14T16:17:00.000-08:00

Few people earn being considered a great person. Steve Jobs is one of them. As he takes medical leave for Apple, I personally want to wish him well. In contrast, I hope that Osama's Been Lobin burns in hell. I don't understand why everyone is quivering over any message he sends. The whole point of his recordings is to terrorize. It continues to work because of our collective responses. Let us do the opposite! Let the free world (including Canada) make fun of the dumb ass. Stand up with stand up comics. Seinfelds of the world unite!

Read More:
http://www.nytimes.com/?emc=na

No, not of my rantings, but of Steve's leave of absence.

May Peace and Happiness Be With You (but *#!% Osama),

Charles

It's the Injury Stupid: Purple Heart for the Injured Combatant

2009-01-14T05:04:00.000-08:00

Recently the Department of Defense commissioned a study group to investigate if those with combat-related PTSD should qualify for a Purple Heart. They were against it and I agree with their decision. Here is why:
1. The Purple Heart is awarded to those who are physically injured (not psychologically injured) by the enemy (i.e., context of combat).
2. While clearly an individual decoration, the Purple Heart differs from all other decorations in that an individual is not "recommended" for the decoration; rather he or she is entitled to it upon meeting specific criteria.
3. It is not intended that such a strict interpretation of the requirement for the wound or injury to be caused by direct result of hostile action be taken that it would preclude the award being made to deserving personnel. Commanders must also take into consideration the circumstances surrounding an injury, even if it appears to meet the criteria.
4. By definition, PTSD is a mental disorder (e.g., American Psychiatric Association’s Diagnostic Manual of Mental Disorders (DSM-IV TR) and is caused by a traumatic stressor.
5. The Purple Heart is awarded to those have suffered a physical injury due to the enemy or while performing their military duties.
6. Some of those who were awarded a Purple Heart also were awarded compensation for their PTSD mental disorder but not because of it.
7. Veterans who were issued a Purple Heart should investigate if the same wounds that made them qualify for the military decoration may also qualify them for PTSD compensation or compensation for any other mental disorder.
8. A Purple Heart will be issued to the next of kin of each person entitled to a posthumous award. Issue will be made automatically by the Commanding General, PERSCOM, upon receiving a report of death indicating entitlement.
9. As with all physical wounds, a veteran with a stress injury with physical evidence must show that the injury was a direct result of carrying out her or his military duties and not caused by pre-military events.
10. Any member of the U.S. Army who believes that he or she is eligible for the Purple Heart, but through unusual circumstances no award was made, may submit an application through military channels.

Thus, our efforts should be twofold, at least: (1) seek the science needed to detect combat-relates stress injuries that are reliable and document the necessary paperwork requirements for the Purple Heart Award. (2) We need to make sure that every Purple Heart recipient receive a review to see if they qualify for a psychiatric disability, if they wish to be considered for one.

If you want more details about the Purple Heart see the file "It's the Injury Stupid" at
http://groups.google.com/group/combatstressresearch/files.

Coping with Sustained Traumatic Events: Some General Comments

2009-01-12T04:59:00.000-08:00

Because Katrina was a natural event, folks need to expect the emotional fallout from a phenomenon called the "second disaster." It is experienced by the Storm's survivors who believe that things should be far better than they are now in 2008.
Kathy and I come from Florida. Florida experienced their Katrina in 1992 with Hurricane Andrew. At the time it was by far the worst hurricane in memory and destroyed a large number of trees and other landmarks in southern Dade County. Just like after Hurricane Andrew, a call from a local disaster manager put it in perspective as she looked into a CNN camera and simply asked with exasperation in her voice: "Where's the cavalry!?!" Second disaster is the disaster about disasters. Sometimes second disasters are worse than the original. We Americans tend to be extraordinarily impatient. As a result, we probably experience second disasters more than other, slower paced cultures. And then we think of New Orleans. Some may be venting their anger and annoyance toward politicians-- the Mayor, the Governor, the President. Some may be frustrated with the pace of recovery. However the underlying emotion of those who survived a catastrophe is fear.
Anxiety in the aftermath of trauma is normal and expected but gradually go away on its own. Sometimes this anxiety can make residents and their communities better prepared for future hurricanes. Think of a mild state of stage fright when it makes us study our lines one more time. The trick is channeling that excessive anxiety into useful projects.
When anticipating a hurricane or any other predictable disaster, However, anxiety can reduce one's patience. Therefore, we all need to learn ways to manage our stress and avoid a kind of "Home Depot rage" -- people fighting over the last sheet of plywood, the last D batteries.
Being informed about -- but not obsessed with -- hurricane coverage can be therapeutic. It will motivate some people to more fully understand how and why people respond to disasters in the short and long term. For psychological and safety reasons, certain questions need answering: What happened? Why did it happen? How is it relevant to me and my family? Why am I so upset about this? What if this happens again -- will I be safe?
Hurricanes are acts of God, people can actually accept it more readily. But trauma caused by people on purpose is another matter completely. Most especially terrorist-induced trauma to frighten people is very different from natural disasters. Even Katrina with all its human-caused problems, then and now, they are more manageable knowing that we can fix what went wrong. It is comforting.
Now we know that managing the consequences is easier if you know what you are dealing with. Human reactions to disasters resulting in a stress injury can be one of four types: psychoneurological, exhaustion, grief, or a moral injury. Most often it is a combination of injuries. The worst assessment is a psychoneurological because high dosages are required of psychotherapy or medication or some combination.
--Charles Figley

Favorite Walks: Westchester Parkway along LAX

2009-01-12T04:54:00.000-08:00

I listened to Tom Petty's album, California, as I walked along the Westchester Parkway that started at the intersection with S. Sepulveda. This favorite walk takes me toward the Pacific Ocean. On Westchester I look south, I see the main, north south runway at LAX.

Not sure why I like it so much. I guess it is the auditory cues from planes arriving and taking off, in addition to being in beautiful, humidity-less, sunny LA. beyond being next to one of the most frequently used airports in the world.

The route was straight out and back. Take some water. There are no places to fill up along the way.

--Charles Figley

While I support the sentiment.... of PTSD qualifying for the Purple Heart....

2009-01-11T17:12:00.001-08:00

On Sun, Jan 11, 2009 at 4:52 PM, James Martin wrote:

While I support the sentiment - there are a number of problems:

In current practice PTSD still represents a classification (DSM classification) of a "psychiatric disorder" not a physical injury. How would you treat other combat-related psychiatric disorders? There is still lots of discussion/debate about the diagnosis itself, e.g., objective vs. subjective criteria for diagnosis; reliability/validity issues in how the diagnosis is determined; the fact that there are many individuals who enter the service / deploy who already bring significant risk factors - including previous trauma exposure(and/or already meet PTSD diagnostic criteria).

TBI is in a different category - the extent of the "injury" can be measured and it is defined as an "injury" not a "disorder" (of course there may be pre-exisitng risk factors like previous injury from sports etc).

Here are two "background" pieces for those interested in more detail

Best
Jim

http://www.defenselink.mil/news/newsarticle.aspx?id=52566
http://www.usmcvta.org/pheart/phcriteria.htm

James (Jim) A. Martin, Ph.D., BCD
Colonel, U.S. Army (Retired)
Associate Professor
Graduate School of Social Work and Social Research
Bryn Mawr College - Bryn Mawr, PA 19010
Cell (Best): 443.553.6745
E-Mail: jmartin@brynmawr.edu
FAX: (at BMC) 610.520.2655

NOTE: I check e-mail once a day. If you need an immediate response, please call me on my cell phone.

IT'S THE INJURY STUPID: PURPLE HEART

2009-01-11T16:05:00.000-08:00

Greetings,
Purple Heart for combat-related PTSD? No. Here is why:
1. The Purple Heart is awarded to those who are physically injured
(not psychologically injured) by the enemy (i.e., context of combat).
2. PTSD is a mental disorder caused by a traumatic stressor and often happens as a result of combat-type traumatic stressor.
3. The Purple Heart is rewarded to those with PTSD not because of the diagnosis but the causes of PTSD that was a physical injury.
4. It is possible to document the physicial injury using more
sophisticated measures used by the VA and the military today but not
yet.
Comments? Join the Combat Stress Injury research list free at
http://groups.google.com/group/combatstressresearch
Current email address: combatstressresearch@googlegroups.com

Best,
Charles

Kurzweg Chair Acceptance Remarks

2008-12-28T15:56:00.000-08:00

Acceptance Remarks by the Holder of the Paul Henry Kurzweg, MD Chair in Disaster Mental Health
Charles Figley

Thank you Dean Marks. And thank you and the University community for this resolution and certificate.

Board Member Pierson, President Cowen, Provost Bernstein, Dean Marks, Honored Guests and Colleagues, I accept the Paul Henry Kurzweg Distinguished Chair in Social Work with deep appreciation and great enthusiasm.

As I sat listening to the kind words of the Tulane leadership, I remembered the many scenes of places of which they were associated with trauma and disasters: South Africa, Tasmania, Kuwait, Scotland, Singapore, Japan, and elsewhere affected by disasters, including this city. At this point in my career, there is no where else I would rather be living than New Orleans.

Briefly I would like to make three points; the meaning of the gift that led to the Kurzweg Chair; the challenges of post-Katrina disaster mental health, and the opportunities here to learn and teach the world about trauma and recovery of impacted communities.

I too welcome the Chadwicks as we pay tribute to the generosity of Shirley Kurzweg Gouaux. Mrs. Gouaux could not with us today physically, I hope her sprit is here and I hope she would feel a sense of satisfaction. I hope she would feel a sense of comfort about her generosity and love for her brother through this Investiture and the Chair I will proudly occupy.

I make this commitment: I will thoroughly study Dr. Kurzweg’s career with deep appreciation for the Lafayette Charity Hospital he founded and directed. Like Dr. Kurzweg, much of my work has focused on the underserved and marginalized. I look forward to linking my work with Dr. Kurzweg’s efforts in Lafayette.

Now a few words abut post-Katrina disaster mental health. As our daughter Jessica and Laura, who is here, are aware, my wife Kathy and I have been involved in disaster recovery work for a long time. Many people do not know this but Kathy and I became colleagues at the (Florida) Governor’s Hurricane Conference. How many life-long relationships started at a conference on disaster preparedness?!

Over the years, Kathy and I have been involved – either as researchers or responders – in many more than three dozen disasters. Among the things we have learned first hand is that no matter how hard communities are hit, they recover eventually and for a range of reasons. Among the most consistent, however, is the sense of community and commitment to recovery. Equally important, however, is thoroughly studying what worked and did not work at each phase of the disaster and transforming the lessons learned into preparedness. Tulane and New Orleans are learning and applying the important lessons of Katrina, for example, how it responded to Hurricane Gustav.

My final point is about the opportunities here at Tulane and New Orleans to learn and teach the world about trauma and the community recovery process.

As Dean Marks noted, there will be a special issue in my Journal, Traumatology to be published in December. It is titled: Katrina and New Orleans: Identification and Applications of Lessons Learned by the Tulane University Community. It includes eleven articles written by members of the Tulane University faculty and one student. The lead article is by our own Tulane President Cowen entitled, “Life Lessons from Inside the Storm.”
He begins his essay this way:
On August 29, 2005, millions of Americans in the city of New Orleans and along the Gulf Coast experienced a physical and emotional crisis of a magnitude unprecedented in our nation’s history.

Later he notes:
I cannot pretend to be an expert in dealing with trauma or post-traumatic stress on any level, physical or emotional. What I hope to share on these pages are simply observations I have made after living through Hurricane Katrina myself and helping lead a university back to a point of strength despite almost overwhelming odds.
He goes on to explain what happened here and how he and his management team were able to cope with the crisis and then focus on the future.
What Scott Cowen did during this unprecedented crisis many view as one of the most inspiring and brilliant demonstration of academic leadership in modern university history. Because of this leadership students, their parents, faculty, staff, administrators, and alumni continue to view him as a true hero. In addition to making sure everyone was paid and connected to the University – no matter where they went to wait until the university reopened – he helped establish Tulane’s Renewal Plan.
On December 8, 2005, less than four months after Katrina hit New Orleans, the Tulane University's Board of Administrators approved a sweeping plan that strengthens and focuses the university's academic mission while strategically addressing its current and future operations in the post-Katrina era.

Tulane’s actions are represented through the Chinese character for “crisis.” The Chinese character for crisis, as is well-known in the disaster mental health community, is a combination of two words, the first is “danger,” for obvious reasons. However, the other word that comprises the Chinese character for crisis is “opportunity.”

President Cowen, during a period of crisis, saw recovery from Katrina as not just dangerous and a source of fear. His administrative team and the leadership of the University’s Board of Administrators seized on the unprecedented opportunity to re-think the university, its undergraduate and graduate education, its organizational structure, its relationship to its community. Just three years after Katrina and the levy-related floods and destruction, Tulane is now strong and getting stronger.

Yes, Katrina was the worst single disaster in American history in terms of lives lost, property damaged, and the breadth of geography affected. I know of no one who wishes such a disaster to be repeated. Our evacuation from the threat of Gustav represents the fear generated by Katrina. Both storms were very dangerous.

Katrina has provided extraordinary opportunities exist today and will remain for some time. I appreciate the opportunity to help build one of the strongest and most innovative Graduate Schools of Social Work with its emphasis on community-clinical practice, an emerging interdisciplinary Ph.D. program in Urban and Community Development, and an alumni and their faculty who are keenly aware of the importance of disaster mental health.

I appreciate the opportunity to be part of a revitalized and innovative University who is investing in interdisciplinary doctoral education; who understands and is interested in the concept of trauma as an organizing principle that connects each of the 10 Schools at Tulane.

I appreciate the opportunity to live in a community of New Orleans that has an opportunity to return to its position as the leader as city of roots connected to music, food, entertainment, and intellectual stimulation.

I appreciate the opportunity to be the first holder of the Paul Henry Kurzweg Chair in the Tulane School of Social Work.

I appreciate that Tulane University leaders know that opportunities also require work. So do I.

Speaking of opportunities and work, I will close with a quote from someone who had a similar background as I have and the same work ethic. Though he was born about 100 years before me, Thomas A. Edison, like me, grew up in the Midwest, was always encouraged by his mother, came from a working class family, and worked all his life from an early age. Edison once observed about opportunity:
Opportunity is missed by most people because it is dressed in overalls and looks like work. “
I believe that the Kurzweg Chair comes with “overalls” and I will work in them proudly. Thank you for being a part of this Investiture.

Compassion and the Practice of Social Work

2008-12-27T05:10:00.000-08:00

Compassion and the Practice of Social Work:

Commencement Remarks for the

2008 Tulane University PhD and MSW Graduates

Charles R. Figley, Ph.D.[1]

Justice will only exist where those not affected by injustice are filled with the same amount of indignation as those offended. --Plato (427 BC - 347 BC)

Preliminary Comments

Provost Bernstein, Dean Marks, my fellow members of the Graduate School of Social Work faculty, Graduating Doctoral Candidates, Graduating MSW Class of 2008 and ,Alumnae, and the Parents, Family and Friends of the Graduates, thank you all for being here at this historic and joyous event. In the next ten minutes I will share some thoughts with you that I hope you will remember as you begin your social work careers. My thesis is this: compassion is a vital requirement for effective social work practice and compassion must be noticed and nurtured to prevent compassion fatigue.

Background

I address you as graduates and soon-to-be alumni of the School. I congratulate you for your hard work and success which brings you here tonight. I want to make three brief points relevant to the title of this address: Compassion and the Practice of Social Work: FIRST I will talk about the capacity for compassion. SECOND, I will talk about the costs of compassion or compassion fatigue, and; THIRD I will talk about the satisfaction of compassion and the joy of helping others.

So, let me say a few words about compassion. It is a kind of tonic that both inspires the work of social work and makes the work more of an impact on the recipients of this special work. Compassion is a measure of humanity. It is defined in most dictionaries as a deep sense or quality of knowing or “awareness of the suffering of another coupled with the wish to relieve it.”

Compassion is synonymous with sympathy, empathy, and commiseration, all of which are synonymous with one another and are connected to another important concept I will return to later: Altruism. It is the “unselfish concern for the welfare of others; selflessness.”

Compassion is both the capacity and the interest of caring. It is captured in the phrase, “my heart goes out.” Like compassion, “my heart goes out” has a dual meaning and represents the primary thesis of this talk. Our hearts “go out” to those who touch our hearts. Yet, through our sustained compassion our heart can give out from fatigue. I have spent many years understanding and appreciating the hearts of social workers and want to share some of these discoveries. I hope they might be useful to you in your careers as social workers and they might help you to avoid any lasting hurt from helping.

What we are talking about, of course, is the essence of being a caring human being. This, as you graduates know, is what sets apart human service professions like social work from other professionals who work with the public. Social work practice has heart and soul; it is informed by ethical principles and carried out by passionate and inspired professionals.

My wife, Kathy, and I enjoyed attending your Poster Session last week. We were able to get to know you and your passion and compassion for helping others. Many of you talked about your heart going out to those clients you touched. These include, for example, children in foster care, mothers needing pre-natal care, children in Africa and throughout New Orleans, and many others.

The Fatigue of Compassion

My SECOND point is about the fatigue of compassion; the cost of caring. It makes sense that we feel distress in response to clients who are suffering and seek solutions to stop their suffering. Our heart goes out to them. As Horace Mann once said “To pity distress is but human; to relieve it is Godlike.” But at another level our distress is a reminder of our own vulnerability; a reminder that we are not God. So when does compassion become toxic for the caregiver social worker? It is when we become so obsessed with the suffering that we are unable to sleep well; unable to feel joy, optimism and hope; we lose our sense of perspective in knowing our role; our boundaries.

These reactions are career killers and I urge you to take the signs seriously and get help, starting with trusted colleagues, a caring supervisor, or your former professors here. Reach out, speak up, and begin to take better care of yourself. You will always deserve as good a service as you deliver. And the time to start this process is NOW.

So how can we be sensitive to the plight of others without such a high price? In other words, how can our heart go out to those who suffer without our heart giving out from the burdens of the suffering? An example is Gail Davies a Florida social worker who found such a balance.

The War Nurse Who Found this Balance

Gail was an MSW student at Florida State University (FSU) when I joined the School of Social Work in 1989. I hired her as my research assistant[2] and later as my project manager for a large grant. Gail and I became good friends. Gradually she opened up and discussed her experiences in the Vietnam War as a combat nurse.

The year she spent in war was filled with stress, blood, and suffering. She chose not to return for another tour. Gail felt guilt about not returning to Vietnam to continue her duties and be able to save more lives. She felt frustrated that so many lost so much for so little to show for it. Though she felt extraordinary compassion for the warriors, she knew she would fail them by forcing herself to return when she was in a depleted state.

Instead she worked as a nurse in her home state of Florida, started a family, and volunteered at the local VA. She was motivated to become a social worker to more effectively help others including but not limited to Vietnam veterans. She recognized the price of compassion and empathy as a nurse and anticipated the same vulnerabilities as a social worker. She developed and applied even in graduate school an unyielding set of self care rules and skills that included reminding herself every day of her own needs and limitations; to accept and appreciate every patient or client where she found them and hope that she could make at least some difference in their lives.

Thanks to Gail I had a renewed interest in this secondary effect from exposure to the traumatized and began to recognize that it was not limited to medical professionals and certainly not limited to nurses. We both discovered that there were a considerable number of colleagues who had gotten out of the business of working with veterans and other traumatized people, such as counselors working with rape victims or with survivors of domestic violence. They had abandoned the work out of concern about their OWN mental health and fear of the harm they might cause to themselves and their clients if they just soldiered on.

The Other Side of the Coin: Compassion Satisfaction

The THIRD point I would like to make is that Compassion satisfaction and the joy of helping others is the other side or compassion fatigue. Thanks to Beth Stamm and several of my other colleagues and my students, we know that one of the major factors in preventing and mitigating secondary trauma or compassion fatigue is detecting and reinforcing the sense of satisfaction of working with the suffering. Compassion Satisfaction is the sense of fulfillment and joy derived from seeing the suffering suffer less and witness the transformation from being a victim to being a survivor.

Let me share with you now a snapshot of what we know and the implications for all of us. Too often we focus on disorders, psychopathology, dysfunction, problems. It is important to recognize as the former President of the American Psychological Association Marty Seligman, father of modern Positive Psychology (1999) and others have asserted, that we must balance these negative elements with a focus on altruism, compassion, resilience, success, and thriving. This is why I wish to focus our attention to the social psychology of compassion and flourishing.

A few years ago, Will McGaghie and colleagues (McGaghie, Mytoko, Brown & Cameron, 2002) published an important article about altruism and suggested that it is grounded in what they call a person’s “compassionate core;” that physicians or anyone working with the suffering such as social workers, can retain their compassion and not suffer the psychosocial consequences. This compassionate core has two elements: The practitioner’s inner resources and capacities and the accumulated wisdom derived from one’s personal and professional experiences. They argue that this compassionate core is the key to maintaining our balance between caring for others and caring for ourselves. But how do you develop this compassionate core? Melissa Radey and I (Radey & Figley, 2007) have suggested in a recent article that the critical tool for developing our compassionate core is what we call “empathic discernment.” It is a collection of skills that enable us to be as discerning about ourselves as we are about our clients. Empathic discernment is constantly evaluating and making judgments about the welfare of the client and our own welfare. Empathic discernment also applies to one’s colleagues, a concept known as colleague care.

All of this leads to the importance of positivity. Part of empathic discernment and improving the life experience for ourselves, our colleagues, and our clients is choosing to be positive. This means feeling grateful, upbeat, the enjoyment of interacting with the client.

Thus, caregivers who appear predominately positive are more flexible, generative, and creative in solving problems. Adopting a positive attitude both enhances the compassionate core and the empathic discernment that prevents compassion fatigue; being positive just feels better and has a positive impact on the morale of clients and colleagues.

Conclusion

In conclusion, my dear students, you are members of a unique class. You graduated when Barack Obama became our President-elect. Throughout your time here, the news was dominated with one of the most exciting and important Presidential campaigns in our lifetimes. President-elect Obama has an extraordinary mandate not unlike that of social workers – including your class: This mandate includes bringing hope to the hopeless; bringing justice to injustices; bringing ethics and compassion to all human service efforts, and; being a good steward to our environment and communities.

In another commencement address, delivered on May 28^th at Wesleyan University our next President, Barak Obama, talked about another mandate shared by social workers: He noted that this year, this generation of graduates have a task of transformation. His words seem like a fitting ending to my brief remarks today.

He said: "At a time of war, we need you to work for peace. At a time of inequality, we need you to work for opportunity. At a time of so much cynicism and so much doubt, we need you to make us believe again. That's your task, class of 2008."

Go save the world, social workers! Over power the needy with your compassion while taking care of yourself and each other. And may God bless you in your important work. You will make us all proud.

Bibliography

Bolger, N., DeLongis, A., Kessler, R. C., & Wethington, E. (1989). The contagion of stress across multiple roles. Journal of Marriage and the Family, 51, 175-183.

Cooper, C. L., & Cartwright, S. 1994. Healthy mind; healthy organizations-a proactive approach to occupational stress. Human Relations, 47: 455–471.

Figley, C. R. (1980). Overview of the trauma of hostage families. Invited presentation at the annual meeting of the National Organization for Victim Assistance, Portland, Oregon, October.

Figley, C. R. (1989). Helping traumatized families. San Francisco: Jossey-Bass.

Figley, C. R. (Ed.) (1995). Compassion fatigue: Coping with secondary traumatic stress disorder in those who treat the traumatized. NY: Brunner/Mazel.

Figley, C. R. (Ed.) (1997). Burnout in Families: The systemic costs of caring. NY: CRC Press.

Figley, C. R. (Ed.) (2002). Treating Compassion Fatigue. NY Brunner-Routledge.

Figley, C. R. and Kleber, R. J. (1995). Beyond the “Victim:” Secondary Traumatic Stress. In R.J. Kleber, C. R. Figley, and B P. R. Gersons (Eds.), Beyond Trauma: Cultural and Societal Dynamics, 75-98. NY: Plenum.

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Fredrickson, B. L. and Losada, M. F. (2005). Positive affect and the complex dynamics of human flourishing. American Psychologist, 60:7, 678-686.

Gottman, J M. (1994). What predicts divorce? The relationship between marital processes and marital outcomes. Hillsdale, NJ: Erlbaum.

Hatfield, E., Cacioppo, J., & Rapson, R. L. (1994). Emotional contagion. New York: Cambridge University Press.

Joinson, C. (1992). Coping with compassion fatigue. Nursing, 22:4, 16-22.

Katz, J., Monnier, J., Libet, J., Shaw, D., Beach, S. R. H. (2000). Individual and crossover effects of stress on adjustment in medical student marriages, Journal of Marital and Family Therapy, volume, issue, and pages

McGaghie, W. C., Mytky, J. J., Brown, W. N. and Cameron, J. R. (2002). Altruism and compassion in the health professions: A search for clarity and precision. Medical Teacher, 24:4, 374-378.

Radey, M. & Figley, C. R. (2007). The social psychology of compassion. Clinical Social Work Journal, 35: 207-214.

Repetti, R. (1989). Effects of daily workload on subsequent behavior during marital interaction: The roles of social withdrawal and spouse support. Journal of Personality and Social Psychology, 57, 316-331.

Solomon, Z. (2005). Choices made, promises kept. In C. R. Figley (Ed.). Mapping Trauma and its Wake: Autobiographic Essays by Pioneer Trauma Scholars, pp. 232-249. NY: Routledge.

Solomon, Z., Waysman, M., Levy, G., Fried, B., Mikulincer, M., Benbenishty, R., Florian, V., & Bleich, A. (1992). From frontline to home front: A study of secondary traumatization. Family Process, Vol. 31, 289-302.

[1] The Paul Henry Kurzweg, MD Distinguished Chair in Disaster Mental Health at Tulane University and Graduate School of Social Work Professor

[2] for the Journal of Traumatic Stress. I was the Editor.

Earlier Efforts

2008-12-27T04:41:00.000-08:00

Greetings,

Before adding anymore to the blogisphere I thought it wise to note my previous blogs:

Amazon.Com starting with "For Starters," 1:03 PM PST, February 27, 2006

CharlesFigleyPhD starting Friday, September 28, 2007 (and ending) with Now I Have Done it!

CampusTrauma starting Monday, April 16, 2007 with Virginia Tech, the Columbine of College Campuses?

My hope is to continue this blog, breaking a record set with those above with 3 blog entries!

Let me know what you think of what I write or anything of relevance.

Best wishes,

Professor Figley