PTSD

[Shawnee123]

Thank you SO much, wolf. You have helped more than you can know, and I will forward your expertise on to my mom. I feel so much better, and realize in my compassion for my father I was pathologizing him, as you said. Your perspective is just what I needed.

Thanks again.

[wolf]

I can give you a link to some printable brochures that will explain the CISM process and stress managment.

[Shawnee123]

That would be great. Thanks.

[wolf]

CISM Pamphlet from the International Critical Incident Stress Foundation (pdf)

Local version, similar info (word doc).

Some other resources

(just a note ... the resource page for the ICISF is good, but tends to be heavy on journal articles, which make most people's eyes glaze over, which is why I don't link directly to it.)

[Shawnee123]

Thanks wolf.

[Griff]

You rock Ms. Wolf.

[neofarmer]

Wolf has some really wise things to say -- especially about not pathologizing your dad. It's normal for people to have strong emotional and physical reactions when they see or are involved in something horrible -- what is called trauma.

Before going any further I should make clear that I have no official pedigree in this area. I'm not a therapist or a counselor or anything like that, much less a psychologist. I am, though, a journalist who for the past couple of months have been working on an article about PTSD and have talked to a lot of pros and read more of those eye-glazing articles than I care to think about.

One thing I've found out is that for every expert who says one thing, you'll find two or three others who say something else.

For example, Wolf says that there is no such thing as acute PTSD. Well, maybe so, maybe not. In the DSM -- the Diagnostic and Statistical Manual of Mental Disorders, the official handbook of the American Psychiatric Association -- there is something called Acute Stress Disorder (ASD).

According to the DSM, PTSD doesn't usually manifest until one to three months after the traumatic event. But some therapists think that a strong immediate reaction to trauma should have some sort of official DSM classification and so they have called it ASD. Sometimes, ASD is a forerunner of PTSD.

This ASD is probably what your counselor was referring to as acute PTSD.

Now, all of this stuff is very controversial within the profession.

Another controversial thing is the best way to deal with the immediate aftermath of trauma.

CISM or Mitchell debriefing was designed by a firefighter turned psychologist to help his fellow emergency workers. It has gained wide acceptance in a number of areas. Matter of fact, just about any time you hear about counselors going in to help people after various disasters, either natural or man-made, these folks are Mitchell-type debriefers of one sort or another.

At first glance, this seems like a really good idea. However, a number of studies -- usually done by folks associated with the Veterans Administration -- claim that debriefing causes more problems for more people than it helps. They say that debriefing, basically, implants the trauma more firmly in the patient's mind causing more intense and longer lasting problems down the line.

Many of these VA-connected therapists say that a bit of time -- say a month -- should be allowed to pass to see if the issue resolves itself naturally. The studies are all over the place, but usually anywhere from half to two-thirds of people exposed to severe trauma get over their problems without any intervention other than their own natural resiliency and support from family, friends and loved ones.

They seem to make a good argument, but not one that is absolutely convincing.

In any event, just about everyone seems to agree that if the patient (or victim or whatever term you care to use) is still having problems after a month or so, professional help is definitely called for.

[wolf]

Not to have this thread devolve into a defense of Mitchell Model CISM ... but the studies showing debriefing is harmful tend to be flawed ... not actually done using Mitchell Model CISM, incorrect study populations (burn victims), and don't all define 'debriefing' in the same way.

CISM focuses on emergency services providers. There has been some generalization beyond that population, such as involving industrial accidents, but it's not generally applied in instances of disasters, for example. The Red Cross has their own way of going about things, as does the Salvation Army.

Jeff Mitchell isn't perfect (although George Everly may be), but CISM, which is a comprehensive stress management system rather than a single debriefing session, isn't harmful.

[xoxoxoBruce]

Welcome to the cellar, neofarmer.

I'm no expert in anything, but that said, if I were to experience a traumatic experience I'd prefer the treatment be lots of sex. Physical exertion for good sleeping and it takes my mind off everything.

[Cloud]

life affirming activities, yeppers.

[Shawnee123]

Hi neofarmer, and thanks for the input.

Thanks to you all. We had a great weekend with Dad. His stuttering has lessened (unless he is talking about the event, which he doesn't like to do, or when his boss called.) Mom said he is staying home at least this next week, and will go back when SHE thinks he's ready (and you don't mess with the Mom!)

He finished the water balloon contraption and it worked marvelously. The nieces loved it. We all laughed and had a great day, and laughter is the best medicine.

Thanks again to you all for your concern and advice.

[Sundae]

Really pleased to hear he is finding ways to cope with it and has the support of a loving family.