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The symptoms that constitute PTSD are too vague to guide individual care in broadly traumatized and disorganized post-disaster populations. If preferential care and support were provided to individuals who fit the criteria for emotional trauma, an “epidemic” of PTSD might ensue as those who do not qualify, quite legitimately insist that they too have suffered and are scarred. This was the result in the Balkans, where traumatized war veterans and their families were offered disability payments. British psychiatrist Derek Summerfield has warned that the danger of setting a standard of desirable care for survivors who demonstrate a certain measure of trauma creates an absurd system in which western donors require that a disaster-stricken individual remain sufficiently traumatized in order to receive assistance. These concerns raise the question of whether it is appropriate for disaster relief agencies to divide an already shattered community into traumatized and non-traumatized groups, particularly when the aid in question might benefit anyone equally much. It is in response to these concerns that mental health efforts after the tsunami have focused on helping people at the community level, on bolstering resilience, and on counseling sessions in which mental health workers offer empathy, advice, and expressions of hope. In addition, Derek Silove of the University of New South Wales has recently stressed the importance of identifying people with schizophrenia, dementia, and other chronic mental conditions that had been treated before a disaster and ensuring that they are reconnected with medical infrastructure. In the context of well-orchestrated material aid, broader measures aimed at psychological recovery can help a community rebound from disaster. This strategy acknowledges that disasters produce suffering, sadness, and deep social problems that need to be addressed, but it reinforces the attitude that these problems need not, and ought not, be treated as diseases that require a psychiatric cure.
Additional Reading
RF, Lopes Cardozo B, Osofsky HJ, Raphael B, Ager A, Salama P. Mental health in complex emergencies. Lancet 2004; 364:2058–67.
Kamau M, Silove D, Steel Z, Catanzaro R, Bateman C, Ekblad S. Psychiatric disorders in an African refugee camp: interventions. Int J Mental Health Psychosoc Work Counselling Areas Armed Conflict2004; 2:84–89.
Tom Cannel is Co-Editor-in-Chief of PH
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