By James Bradshaw, Associate Editor
The National Psychologist, July/August 2013
Any disaster creates psychological problems, both among direct victims and onlookers. But the psyche differentiates between natural disasters, such as the Midwest tornadoes in March and April, and those caused by human malevolence, such as acts of terrorism or mass shootings.
The latter create the most trauma related symptomatology, according to an experienced disaster response psychologist.
“Perhaps (it’s) because this kind of disaster is seen as preventable, as compared with natural disasters,” said Lisa Livshin, Ed.D., an instructor in psychiatry at Tufts University School of Medicine and a member of the steering committee of tl1e Massachusetts Disaster Response Network.
She was gracious enough to respond to an email interview with The National Psychologist between stints of’ working directly with victims of the April 15 Boston Marathon bombings and tending to her regular duties.
Livshin is a disaster mental health psychologist with the American Red Cross, teaches disaster mental health at Lesley University and consults to several crisis management agencies. Her instruction comes from first-hand experience, having provided 0n-site disaster response for more than 20 years, including working with victims of the 2010 Haitian earthquake.
General symptoms of trauma occur in victims of both kinds of disasters — loss of appetite, difficulty sleeping, becoming anxious and irritable and often drawing away from loved ones — but “manmade” disasters, such as the Dec. 14 Newtown, Conn., school shootings that left 26 dead, 20 of them young children, and the marathon bombings that killed three people and wounded more than 170, many requiring amputations, add another layer, Livshin said.
”These acts of violence are more likely to produce feelings of mistrust, anger and betrayal,” she said. “People ask themselves, ‘How could someone do this?’ “
Livshin said response teams employ a triage strategy in attending to disaster victims, tending first to physiological needs — making certain they are safe, reuniting loved ones with families, meeting the basic needs of food, water, clothing, shelter, medications and access to bathrooms.
“Disaster psychologists are very active in walking around, going to the people and evaluating what is needed. At a disaster site, we offer psychological first aid, which involves providing support and helping to normalize victims’ and onlookers’ emotional and physical reactions to the traumatic event. We do this by educating them on traumatic responses and what they can expect in the days and weeks following the critical incident.”
Next, Livshin said, the teams help victims connect with social support agencies and further mental health services, evaluating those most in need of further help and making sure they arc connected with those services. “Our goals are to stabilize and contain psychological distress and arousal caused by the traumatic event, to mobilize supports and to provide education on normal reactions to abnormal events.”
The work is tailored to age if youngsters are involved, Livshin said.
“Of course children are less verbal than adults, so those or us who work with children at disaster sites often carry crayons and stuffed animals to give out. These can be very grounding and normalizing to children and can be used as a means to allow them to express their feelings.”
Livshin said it is also important to work with the parents, alerting them on anticipated symptoms, such as clinginess, regressive behaviors and sleep disruptions.
“We always advise to keep children away from television coverage. Our research from 9/11 informed us that young children who were exposed to the news thought dozens of planes crashed into buildings over and over again— their concept of’ a video being replayed was not yet formed.”
Psychologists not involved in disaster response are being asked to help two victims of the Boston bombings. Patrick Downes, a Psy.D. student at the Massachusetts School of Professional Psychology, and his newly wed wife, Jessica, were severely injured in the explosions and each had to have a leg amputated. A fund to help them with medical costs has been established at the GiveForward website, which can be located by searching “Patrick,” “Jessica” and “giveforward.”
Psychological needs from the Marathon bombings continue to grow. The Boston Globe published an article in which Superintendent-in-Chief Daniel Linskey of the Boston Police Department said many members of the force will need mental health support for weeks, months “and the next five years down the road.”
Linskey said in the days following the bombings 600 officers were ordered to attend debriefing sessions and the New York city police sent 18 officers, retired or active, who were trained in counseling to help Boston’s Critical Incident Management Team, which is made up or 45 officers trained in peer counseling.
Family members who saw officers responding on television also experienced terror and may need counseling, as well as many officers not directly involved who felt guilt or frustration from not being able to give direct assistance, Linskey said.