Presentacin de PowerPoint

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Psycological Assistance in Disasters Paradoxes
and Challenges Prof. Dr. (Moty) Benyakar Prof.
Dr. Carlos Collazo Dr. Raquel Cohen
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DISASTERS AND CATASTROPHES

• A challenge to psyichiatry due to the
• external world impact

• Characteristics
• Conditions
• Requirements

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I Paradox

• The pathogenic character of a disruptive
  situation lies in the situation itself

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DISRUPTIVE SITUATION

• It concerns the pathogenic quality of a
  factual event imploding into the psyche

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DISRUPTION
From the latin disrumpo
Destroy, ruin, interrupt, disorganize, burst (of
rage, of pain), which tends to interrupt
continuity
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DISRUPTION

• - 1979 Benyakar Disruption in Mental Health.
• - 2001 Benyakar Anxiety by Disruption. WPA
  Madrid.
• - 2001 Benyakar Collazo Anxiety by
  Disruption.
• - 2002 Anxiety by Disruption International
  Research Team.
• - 2003 Benyakar Disruption Individual and
  Collective Threats. The book.

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Characteristics of the event and the psychic
experience

• Disruptive Event
• Different types of psychic experience

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Disasters and Catastrophes
Events which cause Physical and/or Psychic damage
to a large number of people.

• Foreseen or Unforeseen.
• Sudden or Preannounced.
• Only once or Recurrent.

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Causes of Disasters

• Natural earthquakes, floods, etc.
• Human wars, terrorism, etc.
• Combined.

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Disruptive Situation
Dr. Mordechai (Moty) Benyakar
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II Paradox

• Assisting and assisted persons are under the same
  threats

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Characteristics of threats

• Agressions The threat is open, visible and
  traceable.
• - Wars, natural disasters, conflicts.

• Violence The threat is hidden, conceiled
  and untraceable.
• - Terrorism, rape.

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AIM OF TERRORISM

• To use surprise as a constant, diffuse and
  untraceable threat.
• To cause psychic damage.
• To turn the daily environment into a threatening
  surrounding.
• To use all of these as political pressures.

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CHARACTERISTICS OF THE THREATIN
VIOLENCE(terrorism, market or politics, etc.)

• Difusse
• Impersonal threats
• Permanent confusion between internal or
  external threat

• Of human origin
• Difficult to detect as a signal
• Cannot be approached in a defensive way

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III Paradox

• People undergoing a disruptive event can be
  damaged persons but not necessarily patients

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IV Paradox

• From damaged to victim
• a) The one causing the damage, damages.
• b) Victims are a product done by harmed groups
  or collectives who need them to guarantee the
  memory of the harming event.

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Victim
Damaged
The subjectivity of the person depends on the
society.
Person who has suffered a damage. His
subjectivity is in danger and our function is to
assist to recover the integration ability and
functioning inside his familiar and social
environment.
He feels the demand to adapt to the domineering
image and keep in a stereotyped roll, that is
useful to the society
The subjectivity is despised and it is not
recognized
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Some ways to characterize human suffering due to
the environment

• Survivors syndrome
• Stockholm Syndrome
• Reactive Disaster Syndrome (Toxic Oil Syndrome)
  (López Ibor)
• Gaza Syndrome
• PTSD

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Psychic Consequences of Violence

• New expressions of psychic human suffering in
  this historical and social context lead us to
  reconsider the classification of the diseases as
  we have accepted it until today

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V Paradox

• PTSD as a single diagnose fails to acknowledge
  the variety of psychic impacts due to disasters

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ABOUT PTSD

• Establishes the impact of the factual event.
• Vague and unspecific concept.
• It does not differentiate between Stress and
  Trauma.
• Comorbidity 88.3 in men
• 79.0 in women
• (Shalev)
• Patients do not have good responses to
  pharmacological and psychotherapeutic treatments.

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Traumatic Experience
External Object
Experiencing (Process)
Affect
External Object
Action
Relation
Representation
Traumatic Experience (Disarticulation)
Psychic Apparatus Diagram
by PHP Solutions
Dr. Mordechai (Moty) Benyakar
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GENERAL RESPONSES FACING THE THREAT

• Personal uncertainty increased by collective
  uncertainty.
• Feeling that beliefs, certainties, safeties,
  protection and the rules of the game collapse.
• Loss of belief in an organized world based on
  morals and ethics.

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FACING THE THREAT

• The diffuse threat unables the development of
  adequate coping defenses.
• Anxiety is not produced by psychic incapacity.
• The vague threat requires a constant alertness
  process.

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Anxiety by Disruption

• In this historical and social context we can
  observe the appearance of new ways of psychical
  suffering. This leads us to reconsidering
  nosology as we know it until today

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ANXIETY BY DISRUPTIONAbD
The radical distortion of the human environment
implode into the human psyche, confronting us
with a new nosological entity We have labelled
it A b D
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ANXIETY by DISRUPTIONAbD
Psychical malfunction produced by the disruption
of the environment Its main feature is that there
is no psychical deficit in advance It is a
response not sharp nor spectacular
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Disruptive Disorders
- Traumatic Experience
Event
- Traumatic Experiencing
Process
- Stress Experience
Event
- Stress Experiencing
Process
- Anxiety by Disruption
Process
Dr. Mordechai (Moty) Benyakar
por PHP Solutions
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VI Paradox

• The ratio between personnel to assist physically
  injured individuals and psychologically damaged
  people during disasters is 20 to 1

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The Paradox of Mental Health Assistance in
Disasters since II War to the present time
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VII Paradox

• The disorganizing effects of disasters also
  encompass those who assist.
• Professionals usually isolate in small groups who
  can even rival one with the other.

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10 W s10 key concepts on which to base
psychological assistance methods during
disasters Prof. Dr. Mordechai (Moty) Benyakar

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10 principles in the course of action

• Warding Off
• Why
• What
• Who
• Whom

• Whose
• When
• Where
• Ways
• Wholeness

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WARDING OFFWarding off the psychological
stability

• Be prepared for the unpredictable, such as
  tornado, hurricanes, etc.
• Mental Immunity
• 1-  Recognize the menace and its characteristics.
• 2- Use psychological capacities to cope with
  threatening situations.
• 3-Take preventive and objective measures in case
  threaten becomes a fact.

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WHY Why are mental health professionals
necessary during a disaster?

• To reduce the potential disasters have to cause
  traumatic experiences or other pathologies.
• To serve as a bridge between the disruptive
  external world and the inner world of each
  person.
• To diminish pain and avoid pathology by allowing
  elaboration through contention and holding.
• To screen main pathological reactions.
• To decide what kind of interventions should be
  carried out, adequating them to actual needs,
  time and places.

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WHAT What is our objective while assisting
during disasters?

• Endangered or actually harmed psychological
  abilities for processing are the core of our
  interventions
• Two concepts to be stressed
• a) The recovery of the individuals subjectivity.
• b) Maintenance of the ability to elaborate the
  inner-outer world relation.

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WHO Who must intervene to ensure the peoples
psychological stability?

• Being the ratio between available practitioners
  and people in need of mental health care so
  inadequate, the population as a whole must become
  a resource.
• Mental health professionals should recognize
  peoples abilities to assume responsibilities
  among the members of the community.
• Build a network including people as health agents
  and coordinating it.
• People integrating the net need to receive the
  necessary holding and supervision

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WHOMWhom are we going to assist?

• Mental health care is usually given to those
  showing their needs spectacularly.
• But, we need to be sensitive in order to take
  notice of those who remain silent, apart or
  make-believe that nothing happened to them .
• Notice groups that are special targets children,
  the elderly, pregnant women, disabled people,
  etc.

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WHOSE Whose responsibility is at stake?

• This question concerns individuals and social
  institutions in two different aspects
• Mere presence makes human beings feel
  subjectively responsible.
• Necessity and Chance.
• Communities must have institutions accountable
  social and legally for disasters. A group of
  political authorities, institutions and effecters
  as legitimating recognizers to assume the
  assistance is essential.

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WHEN When do we have to intervene?

• Four different stages during disaster
  intervention
• Pre-impact phase
• Impact phase
• Immediately after the occurrence of the event
• Assistance in the long-term

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WHEREWhere do we have to intervene?

• Health professionals will need to be flexible,
  creating adequate therapeutic milieus even in
  completely inadequate environments
• Any place can become a suitable place for therapy
  if it is signified as such
• From the couch to the stones

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WAYS In which ways are we going to intervene?

• Assistance can resort to individual, family group
  or institutional intervention.
• Professionals must stick to the core of their
  theoretical frameworks while adapting techniques
  to the circumstances.
• Intervention by presence vs.Intervention by
  demand.
• Functional leadership vs. Structural
  leadership.

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WHOLENESS An integrative approach based on the
previous 9 Ws

• The complexity of disasters requires to intervene
  in an integrative way.
• It needs as well knowledge about social,
  political, economic and cultural processes.
• We must be flexible with the contributions of
  other disciplines.
• This does not mean that we will take care of all
  aspects of the problem.
• We must restrain the interventions to our
  specific role.

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The specificity of mental health intervention in
disasters

• 1) Assisting normal people in an abnormal
  situation
• 2) Coping with a complex situation
• 3) Reducing its complexity
• 4) Disruptive situation with high pathogenic
  potential

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Minimal Professional Requirements

• Clear conceptions about the situation dealt with.
• Trained teams to intervene in each area and phase
  of the event.
• Adequate assistance approach techniques.
• Warmth, flexibility, capacity to cope with the
  unpredictable.

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Training Programs to face Disruptive Situations

• General population
• Social agents
• Community leaders
• Health professionals in general
• Mental health professionals

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Specific and adecuate approach of mental health
in disasters

• Reduce human pain provoked by natural impacts
• Reduce human pain provoked by man
• Reduce the iatrogenic potential of the
  professional interventions.