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‘Good neighbor’ therapy best after disaster 

by Dick Peterson
Public Relations
Pictures of Gulf Coast devastation are served up nightly on television. Worse yet are the expressions of human suffering and the nightmarish stories of survival that make viewers wonder how these victims of Katrina’s wrath could ever return to a normal life.
 
To those who think it would take an immediate rush of trained counselors to restore victims’ mental and emotional health, Department of Psychiatry’s Ron Acierno, Ph.D., would tell them to think again. The reactions to disaster you see played out on television are actually normal under the circumstances, he said.
 
“It’s normal to be very upset after a disaster, and that doesn’t necessarily mean you need formal psychological treatment,” Acierno said. “If there’s one lesson we learned from the four hurricanes that hit Florida last year, it’s that you don’t force formalized debriefing and counseling on disaster victims, particularly in the immediate aftermath.”
 
As a member of MUSC’s National Crime Victims Research and Treatment Center, Acierno investigated how hurricane disaster victims coped emotionally following the four successive storms in 2004. The study was funded by a grant from the National Institute of Mental Health.
 
“What we found was encouraging.” Acierno said. “We found generally people, especially older adults, are very resilient. And most did not need psychological treatments.”
 
So just what do these disaster victims need in the wake of such horrific experiences?
 
Acierno says they need “good neighbors.”
 
That’s not to say that there are not increases in emotional problems as a result of disasters. There are, Acierno said, but they shouldn’t be considered as such until later. “We found that about 3 to 8 percent of the focally affected population eventually developed an emotional disorder.”
 
In the meantime, the best anyone can do is to help them meet their needs for food, shelter and clothing. Work with them to help them rebuild their lives. And if they want to talk, just listen.
 
“I call that the good neighbor approach,” he said.
 
He said that when severe emotional problems do arise, they are most likely to occur among middle-aged people with very low income, and among people faced with a long or permanent displacement from home, loved ones or family ties. The emotional problems most likely to occur are post traumatic stress disorder, generalized anxiety disorder or major depression.
 
He said that the warning signs of post traumatic stress disorder are anxiety bordering on panic, an edgy jumpiness and significant sleep problems, a functional impairment that keeps a person from doing normal activities and an unreasonable avoidance of activities reminiscent of the traumatic event.

“While it’s common to have symptoms, most people recover. Those who develop a disorder and leave it untreated will find it’s likely to persist for years,” Acierno said.
 
The studies that the Crime Victims Research and Treatment Center conducted in Florida last year were put to good use in Katrina’s wake. Acierno said that under another grant to Crime Victims Center director Dean Kilpatrick, Ph.D., by the National Institute for Mental Health funding, the Crime Victims Center’s Disaster Research Education and Mentoring Project assists researchers who are local to a disaster site conduct high quality assessment, research and treatment rather than relying completely on outside experts. 
 
“We’re working with former MUSC residents and faculty members now at the Mississippi Medical Center in Jackson. They are adopting the Florida assessment strategy and expanding it to fit their needs,” he said.

PTSD in children could be ‘epidemic’

Of the 1.2 million children caught in Katrina’s path as it slammed into Louisiana, Mississippi and Alabama, an estimated 60,000 will have significant post traumatic stress three to six months from now, said clinical social worker Benjamin Saunders, Ph.D., with the MUSC National Crime Victims Research and Treatment Center.
 
While the percentage is low, the numbers are huge, Saunders said.
 
 “We’re working fast and furious with other centers doing consultation and training around the issues with kids who went through the hurricane or were evacuated to strange surroundings.” Saunders said that the effort now is to “ramp up” mental health staffs now so they can respond to the likely outcome.
 
As with adults, children are resilient and most bounce back. But Saunders’ concern is for the expected 5 percent who will present with clinically significant post traumatic stress leading to an inability to function in school, among their peers and within the family.
 
“We have children who have been separated from their parents and have survived horrendous experiences. Once their needs are provided for, most will recover,” he said. Saunders said that the children should be allowed to talk about their experiences, but not forced. Getting them back into school and providing stability is important.
 
Saunders decried the apparent lack of attention state and federal health agencies pay to the impending mental health epidemic he predicts will appear in three to six months once people’s physical needs are provided for. “Then we will begin identifying the kids with the problems.
 
“If they find one case of West Nile virus, I suspect the CDC (Centers for Disease Control and Prevention) will sweep in with plane loads of Malathion. But here we have a psychiatric epidemic affecting 60,000 children. Do we have the same sense of urgency?”
 
Saunders said that while the news appears bleak, “the good news is that we have good medicines, several very good treatments for people with post traumatic stress.”
 
For information on the MUSC National Crime Victims Research and Treamtent Center, visit http://www.musc.edu/cvc/.

Friday, Sept. 30, 2005
Catalyst Online is published weekly, updated as needed and improved from time to time by the MUSC Office of Public Relations for the faculty, employees and students of the Medical University of South Carolina. Catalyst Online editor, Kim Draughn, can be reached at 792-4107 or by email, catalyst@musc.edu. Editorial copy can be submitted to Catalyst Online and to The Catalyst in print by fax, 792-6723, or by email to petersnd@musc.edu or catalyst@musc.edu. To place an ad in The Catalyst hardcopy, call Community Press at 849-1778.