"Disaster mental health": lessons from Aberfan
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《英国医生杂志》
EDITOR—One aspect of the response to the Asian tsunami disaster is "disaster mental health."1 The tsunami prompted the Department of Health to circulate briefing papers on acute stress reactions and post-traumatic disorder throughout NHS trusts, and various experts have stated that as many as 25% of child survivors will develop "post-traumatic stress disorder" requiring professional intervention.
So too after the recent Beslan school disaster. A team of 48 psychiatrists, psychotherapists, and psychologists was assembled before the siege was over to address "profound psychological scars."2 A team of psychologists was still manning a 24 hour hotline three months later amid expectations that many surviving children still needed trauma debriefing or would carry longterm psychiatric problems in the shape of post-traumatic stress disorder.2
Disaster mental health rests not on medicopsychological discoveries but on Western cultural trends. The concept of a person, particularly children, now emphasises not resilience but vulnerability, and the culture is preoccupied with trauma and emotional deficit.3 Thus horror at what these children endured risks being transformed into assumptions about psychological damage.
These trends are comparatively recent, and it is instructive to compare Beslan with another school tragedy that shook the nation, the engulfing of 144 schoolchildren and teachers in 1966, when a coal waste tip slid into the Welsh village of Aberfan. Surviving children resumed school two weeks later so that their minds would be occupied. There was no counselling and no dire prediction of long term traumatisation and disability. Newspaper reports commended the villagers for getting back on their feet so admirably and with little need for outside help. A child psychologist noted some months later that the children seemed normal and well adjusted, and this seems to have remained true since.4
Literature reviews suggest that trauma debriefing should now be generally accepted as being ineffective, and even harmful. Professional intervention may unwittingly cement a preoccupation with what happened and thus retard natural recovery.
The recent consensus statement on post-emergency mental and social health endorses social assistance as having the primary role, and questions the public health value of post-traumatic stress disorder as a concept, particularly in non-Western, low-income countries.5 The longer term outlook for these children will depend on the possibilities for the resumption of ordinary life within the family and the wider community.
Derek A Summerfield, honorary senior lecturer, Institute of Psychiatry
HIV Mental Health Team, Maudsley Hospital, London SE5 8AZ derek.summerfield@slam.nhs.uk
See also p 262
Competing interests: None declared.
References
Abbasi K. Editor's choice. Death by tsunami and poverty. BMJ 2005;330: 0. (8 January.)
Parfitt T. How Beslan's children are learning to cope. Lancet 2004;364: 2009-10.
Summerfield D. Cross-cultural perspectives on the medicalisation of human suffering. In: Rosen G, ed. Posttraumatic stress disorder: issues and controversies. Chichester: Wiley, 2004.
Furedi F. Therapy culture: cultivating vulnerability in an uncertain age. London: Routledge, 2004.
Van Ommeren M, Saxena S, Saraceno B. Mental and social health during and after acute emergencies: emerging consensus? Bull WHO 2005;83: 71-6.
So too after the recent Beslan school disaster. A team of 48 psychiatrists, psychotherapists, and psychologists was assembled before the siege was over to address "profound psychological scars."2 A team of psychologists was still manning a 24 hour hotline three months later amid expectations that many surviving children still needed trauma debriefing or would carry longterm psychiatric problems in the shape of post-traumatic stress disorder.2
Disaster mental health rests not on medicopsychological discoveries but on Western cultural trends. The concept of a person, particularly children, now emphasises not resilience but vulnerability, and the culture is preoccupied with trauma and emotional deficit.3 Thus horror at what these children endured risks being transformed into assumptions about psychological damage.
These trends are comparatively recent, and it is instructive to compare Beslan with another school tragedy that shook the nation, the engulfing of 144 schoolchildren and teachers in 1966, when a coal waste tip slid into the Welsh village of Aberfan. Surviving children resumed school two weeks later so that their minds would be occupied. There was no counselling and no dire prediction of long term traumatisation and disability. Newspaper reports commended the villagers for getting back on their feet so admirably and with little need for outside help. A child psychologist noted some months later that the children seemed normal and well adjusted, and this seems to have remained true since.4
Literature reviews suggest that trauma debriefing should now be generally accepted as being ineffective, and even harmful. Professional intervention may unwittingly cement a preoccupation with what happened and thus retard natural recovery.
The recent consensus statement on post-emergency mental and social health endorses social assistance as having the primary role, and questions the public health value of post-traumatic stress disorder as a concept, particularly in non-Western, low-income countries.5 The longer term outlook for these children will depend on the possibilities for the resumption of ordinary life within the family and the wider community.
Derek A Summerfield, honorary senior lecturer, Institute of Psychiatry
HIV Mental Health Team, Maudsley Hospital, London SE5 8AZ derek.summerfield@slam.nhs.uk
See also p 262
Competing interests: None declared.
References
Abbasi K. Editor's choice. Death by tsunami and poverty. BMJ 2005;330: 0. (8 January.)
Parfitt T. How Beslan's children are learning to cope. Lancet 2004;364: 2009-10.
Summerfield D. Cross-cultural perspectives on the medicalisation of human suffering. In: Rosen G, ed. Posttraumatic stress disorder: issues and controversies. Chichester: Wiley, 2004.
Furedi F. Therapy culture: cultivating vulnerability in an uncertain age. London: Routledge, 2004.
Van Ommeren M, Saxena S, Saraceno B. Mental and social health during and after acute emergencies: emerging consensus? Bull WHO 2005;83: 71-6.