Psycological Assistance in Disasters: Paradoxes and Challenges Prof. Dr. (Moty) Benyakar

1. Psycological Assistance in Disasters: Paradoxes and Challenges Prof. Dr. (Moty) Benyakar Prof. Dr. Carlos Collazo Dr. Raquel Cohen

2. External World Inner World

4. DISASTERS AND CATASTROPHES • A challenge to psyichiatry due to the external world impact • Characteristics • Conditions • Requirements

5. I Paradox The pathogenic character of a disruptive situation lies in the situation itself

6. DISRUPTIVE SITUATION It concerns the pathogenic quality of a factual event imploding into the psyche

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

8. 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.

9. Characteristics of the event and the psychic experience • Disruptive Event • Different types of psychic experience

10. 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.

11. Causes of Disasters • Natural: earthquakes, floods, etc. • Human: wars, terrorism, etc. • Combined.

12. External Object External Object External World Internal World External World SOMA External World PSIQUE External Object External Object External World Disruptive Situation Dr. Mordechai (Moty) Benyakar

13. II Paradox Assisting and assisted persons are under the same threats

15. 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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17. 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.

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

20. III Paradox People undergoing a disruptive event can be damaged persons but not necessarily patients

21. 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.

22. Damaged Victim 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

23. Some ways to characterize human suffering due to the environment • Survivor’s syndrome • Stockholm Syndrome • Reactive Disaster Syndrome (Toxic Oil Syndrome) (López Ibor) • Gaza Syndrome • PTSD

24. 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

25. V Paradox PTSD as a single diagnose fails to acknowledge the variety of psychic impacts due to disasters

26. 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.

27. Experience (Articulated) Drive 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

28. 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.

29. 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.

30. 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

31. 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

32. 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

33. Disruptive Disorders - Traumatic Experience Event - Traumatic Experiencing Process - Stress Experience Event - Stress Experiencing Process - Anxiety by Disruption Process por PHP Solutions Dr. Mordechai (Moty) Benyakar

34. VI Paradox The ratio between personnel to assist physically injured individuals and psychologically damaged people during disasters is 20 to 1

35. 1 Physically Injured = 4 Psychically Damaged. • 1 Physically Injured = 20 Psychically Damaged. • 1 Physically Injured = 200 Psychically Damaged. • 20 Physically • Assistance • Professionals 1 Mental Health Professional. = The Paradox of Mental Health Assistance in Disasters since II War to the present time

37. 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.

39. 10 W ‘s10 key concepts on which to base psychological assistance methods during disasters Prof. Dr. Mordechai (Moty) Benyakar

40. Warding Off Why What Who Whom Whose When Where Ways Wholeness 10 principles in the course of action

41. 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.

42. WHYWhy 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.

43. WHATWhat 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 individual’s subjectivity. b) Maintenance of the ability to elaborate the inner-outer world relation.

44. WHOWho must intervene to ensure the people’s 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 people’s 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

45. 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.

46. 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.

47. 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

48. 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”

49. WAYSIn 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”.

50. WHOLENESSAn integrative approach based on the previous 9 W’s • 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.