Psychosocial Capacity Building in Response to Disasters

Joshua Miller

• Editorial: Columbia University Press
• Año: 2012
• ISBN:
  9780231519762
• Categoría: Psychologie
• Categoría: Histoire et théorie en psychologie

Disaster responders treat more than just the immediate emotional and psychological trauma of victims: they empower individuals and families to heal themselves long into a disaster's aftermath. This requires helping survivors to rebuild their ability to meet their emotional and psychological needs, not only for themselves but also for others, which necessitates a careful consideration of survivors' social, economic, and political realities as their communities heal and recover.

This comprehensive book integrates Western mental health approaches and international models of psychosocial capacity building within a social ecology framework, providing practitioners and volunteers with a blueprint for individual, family, group, and community interventions. Joshua L. Miller focuses on a range of disasters at local, regional, national, and international levels. Global case studies explore the social, psychological, economic, political, and cultural issues affecting various reactions to disaster and illustrate the importance of drawing on local cultural practices to promote empowerment and resiliency. Miller encourages developing people's capacity to direct their own recovery, using a social ecology framework to conceptualize disasters and their consequences. He also considers sources of vulnerability and how to support individual, family, and community resiliency; adapt and implement traditional disaster mental health interventions in different contexts; use groups and activities to facilitate recovery as part of a larger strategy of psychosocial capacity building; and foster collective grieving and memorializing. Miller's text examines the unique dynamics of intergroup conflict and the relationship between psychosocial healing, social justice, and peace and reconciliation. Each chapter ends with a mindfulness exercise, and a section reviews practitioner self-care.

1

THE SOCIAL ECOLOGY OF DISASTERS

A HURRICANE SWEEPS across the Florida Keys, damaging homes, businesses, and roads, injuring and killing people. In northern Uganda, a civil war rages for more than twenty years, resulting in many deaths, maimings, and the forcible abduction of children as soldiers and concubines. The majority of the population is relocated to internally displaced persons camps (IDPs). In Sichuan Province, China, an earthquake levels villages, collapses schools, and triggers avalanches, leaving nearly one hundred thousand people dead and many more displaced. The Asian tsunami kills nearly a quarter million (World Health Organization, 2005) in more than ten countries, some at peace and others enduring ongoing armed conflicts.

After a high school senior prom, a car accident kills four students. Another survives but is left partially paralyzed. In a small city, a fire destroys an apartment building and twenty-five residents are displaced, losing their belongings and, in some instances, their pets. A man murders his estranged wife and then kills himself outside a courthouse after she obtains a restraining order against him.

What is a disaster? Most would agree that the natural disasters and Ugandan civil war cited here constitute disaster, but what about the other examples? If all of the examples fall into the category of disaster, then what qualities and attributes do they share? What is not a disaster?

And how do we respond to disasters? Who responds? What activities do they engage in? What are the consequences of disasters, and what helps individuals, families, and communities to recover from them? How universal are these reactions, and how are they influenced by culture and social structures? Are there interventions that are harmful or that make things worse? Can the same people, using the same skill sets, respond to all kinds of disasters, no matter what they are?

These are among the questions that this book seeks to explore. It considers a range of disasters and applies a variety of concepts and techniques to illustrate how professionals and volunteers in the helping professions (social workers, community psychologists and psychiatrists, teachers, counselors, clergy, and public health workers) can work effectively with individuals, groups, and communities to support them in their recovery from disaster. This book focuses not on rebuilding physical structures, such as homes and businesses, but rather on restoring people (reconstructing meaning, reconnecting people with one another, revitalizing hope), linking life before the disaster with the consequences of the disaster, and looking to the future. This is not to say that the repairing of infrastructure is distinct from the renewing of psyches, spirits, and a sense of collective community efficacy—using a social ecology framework, I emphasize how interconnected these processes are. But the primary focus of this book is how people responding to disaster can effectively work to develop the psychosocial capacity of those living and working in the affected community. In so doing, responders can help those affected by disaster help themselves and others to feel empowered and to regain control over their lives, as they rekindle hope for their futures.

DEFINING DISASTER

Disasters come in many sizes, some affecting entire regions or nations, others upsetting small communities or subcommunities. Some disasters are considered acts of God, or natural events, such as earthquakes, tsunamis, and floods, while others are the result of either bad intentions (terrorism, war) or incompetence and human error (chemical explosions, mining disasters, train crashes). The length or duration of disasters varies considerably—some occurring in the tremor of an earthquake or flash of a gunshot, others staggering on for years, such as an ongoing civil war.

Rosenfeld, Caye, Ayalon, and Lahad (2005) have identified the following six characteristics of disasters. While these characteristics are relevant and helpful, they still raise a number of questions and merit further investigation.

1. Has a footprint of a certain size. Loss of life and destruction of property are certainly hallmarks of a disaster. But how does scale factor into the characterizing of disaster? If a one-family home burns to the ground and the inhabitants are displaced to temporary housing in an otherwise unaffected community, is this a disaster? Does the situation change if an entire apartment building or a nursing home burns? What about an entire block? Does it matter if the fire was caused by a faulty fuse box or a bomb?

2. Has an identifiable beginning and end, occurs suddenly, and has long-lasting effects. When does a disaster begin or end? With Hurricane Katrina, for example, did it begin with the hurricane gathering force over the Atlantic Ocean and Gulf of Mexico? Did faulty engineering and maintenance of levees sow the seeds of the disaster? What about the risk factors amplified by racism, which left many low-income African Americans living in areas of higher risk than wealthier white residents? These social and group vulnerabilities have a history that extends back hundreds of years (Park & Miller, 2006).

3. Negatively affects large numbers of people. The examples presented in the first part of this chapter clearly involve large numbers of people. But what of those mentioned that are not natural disasters or atrocities of war? If an adult dies in a single car crash because of icy conditions, is this a disaster? Does it matter if the driver was drinking? What if the car hits a group of schoolchildren waiting for the school bus? How many people need to be affected directly, or indirectly, for something to be deemed a disaster?

4. Affects more than one family in a public arena. Is the boundary between private and public always that clear? If a child’s parent dies of natural causes, is this a public event? What if the child needs to be taken into custody by the Department of Social Services because there is no other caretaker? Does it matter if the parent was a drug user? What if the parent was the victim of domestic violence? What if many children in a neighborhood are taken into custody? At what point does a private tragedy become a public disaster?

5. Is out of the realm of ordinary experience. This is an important, although subjective, criterion. Disasters are not everyday occurrences, although their impact is mediated by many factors, such as culture, beliefs, spiritual practices, and other value systems. The varied experiences of people determine whether an event or series of events is outside of the realm of ordinary experience. People living in hurricane zones or tornado alleys are more familiar with powerful storms than those living in less tempest-prone areas. Even acts of terrorism are more usual for some and abnormal for others.

6. Has the power to induce stress and trauma in anyone who experiences the event. This statement heralds one of the most controversial debates in the field of disaster mental health. When there is a disaster, do many people experience stress that is clinically considered trauma? Those trained in Western psychology are more likely than non-Westerners to answer this question in the affirmative, although there is not a consensus on this. One question that the trauma criterion raises is this: If the majority of those who experience the event do not develop severe stress and trauma, can it still be considered a disaster?

I return to many of these questions in chapter 3 and explore them in greater depth. Although it is important to define a disaster, both for the purposes of planning responses and for researchers studying this phenomenon, what constitutes a disaster is contested terrain. Some researchers would not see the small-scale set of examples as disasters but rather as “emergencies,” while also viewing very large-scale disasters as “catastrophes” (Quarantelli, 2006). Conceptual clarity is always helpful, but I have found in my practice that there are areas of similarity and overlap between small- and large-scale events, as well as differences, and that the realities of practice involve the existence of some measure of ambiguity in what is always or sometimes present in a disaster.

CRITICAL INCIDENTS

A concept related to disaster is that of a “critical incident” (Mitchell, 1983). Although this notion originally evolved from a peer-driven movement to assist emergency responders, such as police, firefighters, and ambulance drivers (Armstrong, O’Callahan, & Marmar, 1991; Bisson, McFarlane, & Rose, 2000; Conroy, 1990; Everly & Mitchell, 2000; Mitchell, 1983; Mitchell & Bray, 1990; Solomon, 1995), its application was widened to include many different kinds of populations (Dyregrov, 1997, 2003; Miller, 2000, 2003; Raphael, 1986) and many of the responses of affected people, and suggestions about how to help them overlap with disaster mental health. A critical incident, like a disaster, leads to strong reactions and makes it difficult for a person to continue to exercise normal responsibilities and functions (Mitchell, 1983) and results in a heightened sense of vulnerability and loss of control (Solomon, 1995). Critical incidents are sudden and unexpected and may involve one’s life being threatened. They can lead to psychological and emotional wounds, undermine one’s sense of how the world works and of what is fair and normal, and challenge a person’s sense of self-worth (Solomon, 1995), all of which have been described in the disaster mental health literature (Halpern & Tramontin, 2007; Rosenfeld et al., 2005).

THE COLLECTIVE CONTEXT OF DISASTERS

An important dimension of disaster is, what happens to individuals and families occurs within the context of collective wounds and losses as well as public policies. As Kaniasty and Norris (1999, p. 26) have put it: “Individual suffering unveils itself within the parameters of other people’s suffering.” It is in the nature of disaster that there is a collective context for individual suffering and a public dimension of private loss.

Thus, the example of the car crash after the senior prom, with multiple deaths, involves personal and private losses, but the crash also has public consequences. The incident may overwhelm other students in the school who were about to graduate, as well as the school personnel who taught the students or who were chaperoning the prom. Law enforcement officers may feel a sense of guilt and inadequacy over having failed to check for alcohol and drugs before the students left the prom in their cars. First responders may have a particularly strong reaction to being called to a scene where a number of young people have died. Other families who knew the teenagers may be devastated, and the event may trigger evocative reactions for parents or siblings who have suffered similar losses in the past. But there are also policy issues that arise from such events. Should the school continue to hold a prom? Are there psychoeducation programs that can reduce the inclination of teenagers to drink and drive? Are there cultural norms about drinking that need to be interrogated? Is this a community in which tragic events are more likely to happen?

The interaction of individual and collective, private and public, also applies to a large-scale disaster, such as 9/11. There are those who are directly affected, such as families who lost loved ones or those who escaped from the World Trade Center. First responders have a strong sense of fraternity and camaraderie, which was put to the test with 9/11, where there were massive casualties and injuries, particularly among firefighters. Rippling out from this core were numerous other affected groups: eye-witnesses, children evacuated from schools, residents cleared from their neighborhoods, and neighbors living in communities that lost residents in the attack. Local businesses in adjacent neighborhoods as well as workers who served the World Trade Center were also affected. Construction workers who responded to Ground Zero, both in the immediate aftermath and in the long months of clearing the debris, subjected themselves to health and mental health risks (Miller, Grabelsky, & Wagner, 2010). Schools that served children who lost parents were impacted, and thousands of therapists absorbed painful and tragic stories that put them at risk for disaster distress, compassion fatigue, or secondary trauma. New York City as a collective entity was affected in many ways, ranging from the cordoning off of streets and neighborhoods to the collective loss of safety, self-esteem, and a sense of basic trust in the world. At the time, people did not know whether this was a single attack or the beginning of a series of assaults. As we now know, the attacks led to two wars—in Iraq and Afghanistan—and many other military encounters and skirmishes and attempts at future terrorism.

In Washington, DC, similar processes were at work, as they were in Boston and Newark from which the planes had departed, and in Shanksville, Pennsylvania, where one of the planes crashed. Airline employees were distraught, as were travel agents who had sold tickets to passengers on the airplanes. Modern media brought scenes of the disaster into millions of living rooms, and people all over the nation and the world watched the coverage of the events. Among those most at risk from this exposure were people with their own psychological vulnerabilities and especially those who had previously experienced terrorism or armed conflict. Both the initial attacks and subsequent responses involved policy decisions at many levels of government and between many state and nonstate actors.

Did the disaster of 9/11 end after the initial attacks? It certainly did not for the people of Afghanistan and Iraq or for the soldiers and their families. Should the subsequent bombings in London and Mumbai be seen as a continuation of this disaster or as new and discrete disasters? There are many different perspectives on and social constructions for the 9/11 disaster. In many ways, this disaster is still in process ten years after the original event, although the specific phases and the impact of these on individuals and communities have varied over time. And was 9/11 the opening salvo in this disaster or were there earlier events that are part of this disaster narrative? The answer depends on one’s social and political positioning and accompanying disaster narratives, a theme that is explored in subsequent chapters.

The examples illustrate the contingencies and instabilities involved when trying to define disaster. Any disaster narrative comprises numerous perspectives and diverse and varied players. What is most salient for disaster responders is having an understanding, within a sociocultural context, of the subjective experiences of individuals, groups, and collectivities that have lived through disaster and recognizing the many stories, meanings, reactions, and needs engendered by a specific disaster.

We can therefore say that certain qualities constitute a disaster, but they are contingent and subjective criteria and need to be applied flexibly and situationally. While a disaster contains an event, or series of events, that affects multiple people, groups, and communities and has a public dimension as well as private suffering, it is more helpful to think of a disaster as a process (Oliver-Smith, 2002). A disaster does not always have a clear beginning or end, and, yet, it is socially constructed as an event outside of ordinary experience that overwhelms a group’s individual and collective coping capacities, destabilizing and disrupting everyday life and normal functioning. Disasters lead to horizontal and vertical disruptions. They interrupt social connections and relationships. They sever people and their communities from past sources of strength and wisdom and from their vision of a h...

Índice

• Cover
• Title Page
• Copyright
• Contents
• List of Boxes, Figures, Tables, and Appendices
• Preface
• Acknowledgments
• 1. The Social Ecology of Disasters
• 2. Responding to Disasters: The Field of Disaster Mental Health and the Role of Helping Professionals
• 3. Conceptualizing Disasters
• 4. The Phenomenology of Disasters: The Impact on Individuals, Families, and Communities
• 5. Sources of Resiliency
• 6. Vulnerable Populations: Risk, Resiliency, and How to Help
• 7. Discourses of Disaster Response and Recovery
• 8. Psychosocial Capacity Building
• 9. The Use of Groups and Activities
• 10. Responding to Disasters Caused by Intergroup Conflict
• 11. Collective Memorializing
• 12. Disaster Distress and Self-Care
• Conclusion
• References
• Index