index.php


悲嘆(グリーフ)とは
Required ability of professionals

Professionals who are involved in mental health care during and after a disaster should be open to the diverse realities and subjects that unfold before them. It is also important for them to observe how they are responding and cultivating the capacity to do so.

 

In order to continue working under physically and psychologically challenging circumstances without burning out, it is important to prioritize their needs, such as getting the rest they need, and establishing a teamwork system instead of putting everything on their own shoulders. At the same time, it is important to train themselves to identify what the survivor’s needs are, how to provide them and where to refer them, when necessary.

 

Therefore, when they notice strong ideas and thoughts in themselves, it might be helpful for them to be aware of their own energy, and to distance themselves from it while accepting it. They may develop their own way of restoring their own calm and open stance. It might also be a good idea to explore ways to relax themselves by paying attention to their own breathing and the weight placed on their soles, by practicing brief stretching, or monitoring their own physical balance while walking. They might be able to refresh themselves in a short time.

 

In order to best utilize altruism and compassion in order to be of service to others, they must first take care of and prepare themselves. It is important to be empathetic yet aware of their own and others’ differences, to stay calm while keeping their sense of being in the here and now, despite waves of uncertainty. It is also important to maintain the honesty and humility of a beginner while they hone their expert knowledge and skills. It is also important to stay humble enough to realize that they cannot be perfect while striving to be better. This is how to cultivate professional vessel as a human being. And within that vessel, various encounters will lead them to mutual growth.

Three experiences from disasters

Many of people’s psychological reactions to disasters can be viewed as “normal reactions under unusual circumstances.” Therefore, rather than treating or correcting psychological problems, such situations are more about conveying accurate information and adapting to the event. It is important to help people build strength and resilience, and to support them so they can cope with their situation. However, some mental health conditions may be more serious and require professional involvement and treatment.

 

Psychological reactions to disasters are caused by three experiences.

1.The experience of loss

It is caused by the “loss” experienced by the losing of a loved one or thing. Grief reactions to a disaster carry the risk of being prolonged or complicated (i.e., complicated grief). Grief is also known to result in depression, anxiety disorders, psychosomatic disorders, and actual physical illnesses.

 

2.Traumatic experiences

Stemming from a “traumatic experience.” This type of experience is one in which you or someone close to you is exposed to a threat on their life.  Traumatic experiences involve intense fear, helplessness, and a shivering sensation. Prolonged trauma reaction can lead to PTSD (Post Traumatic Stress Disorder), depression, and alcohol dependence, and treatment can become necessary.

 

3.Secondary stress

This is due to the stress that occurs secondarily after a disaster. Victims may be forced to live in shelters or change their environment due to the loss of their homes and/or household goods, losing their jobs, etc., as a result of a disaster, which creates a lot of secondary stress. These life stresses can be factors in mental strain, and in some cases, depression, psychosomatic disorders, and anxiety.

 

Therefore, when dealing with post-disaster mental health issues, it is important to not focus solely on PTSD, but to also focus on risk factors leading to complicated grief, depression, psychosomatic illness, and alcoholic dependence.

Transmitting information in disaster situations

Information is very important to survivors who have been separated from their families and close relatives who don’t know if they are alive or dead. It’s more so when the disaster has violent or uncertain aspects.

 

What follows are some tips for transmitting information during the acute phase of a disaster. However, how that information is communicated will depend on the nature of the disaster and the situation of confirming the safety of those missing.

 

1)Communication

〇Most survivors want to know what happened, where their family members and close relatives are, and if they are safe. They also want to know what kind of relief is being provided at that moment. During the acute phase of a disaster, many people’s emotions are heightened and they are very anxious. It is important for professionals to understand what the survivors are worried about and what they hope to find out, while showing empathy in regards to their plight related sorrow and concerns.

 

〇Be as clear and specific as possible about what you know. You should also describe what is not yet known, what activities are underway to resolve it, and what actions will take place in the future.

 

〇The needs of survivors vary from one disaster to the next. Multi-agency coordination and outreach efforts are needed to accurately understand the plight of those in the most difficult situations. By doing so, they provide information and psychological support to those affected by the disaster.

(See “Disaster Outreach”)

 

2)Information transmission

〇It is very important to provide information transmission channels to the survivors. A route should be established at the earliest possible stage after a disaster. That way, the survivors can find out when and how to get the detailed information they are looking for.

 

〇In instances such as man-made disasters and terrorism, it is also important to consider the possibility of criminal or legal action and establish communication channels regarding the complexities of these procedures.

 

〇Information transmission channels are crucial not only for the victims of a disaster but also for relief workers. During a disaster, relief workers may also be risking their lives, get severely injured or experience loss. So it is also very important to provide accurate information to these relief workers in order to respond appropriately to the victims. It is also important that the rescuers are supported by experienced and empathetic people and systems that are familiar with the disaster situation.

 

〇Public agency information must be widely publicized through a various means through multiple media, the Internet and paper media.

 

 

Much of the psychological support for the acute phase of a disaster is not interventional. The purpose of support is to accept any acute reactions without judgment: if they want to talk, you listen.  If they ask questions, you respond calmly. You also respond step by step to the needs of the survivor. In this context, providing information is an important way for survivors to gain perspective on the future.

For more information, please refer to the “Psychological First Aid” page.

 

* Source of this page: “Loss and Grief; Disaster deaths, their implication and management”, specially provided by Dr. Beverley Raphael.

Notes on Outreach

“Outreach” is one of the most important ways to provide support in the event of a disaster.  This includes going to the site and interviewing the victims or grasping the current situation and needs of the victims by telephone or letter.

Outreach includes setting up helplines, such as a telephone one, that can be accessed by victims in the early stages of a disaster. A helpline continued to play a major role in helping victims after the 2001 NY terrorist attacks.

When providing individual contacts, first introduce yourself and explain in detail what you can do to help.

(Example)

“I’m 〇〇, is there anything I can do to help?” “I’m ○○. If I can be of help, let me know any time.”

 

How to reach out is important. You are expected to:

1. Be caring and comport yourself in a helpful manner

2. Understand the diverse needs of disaster victims

3. Provide consistent advice and general assistance

4. Provide techniques for linking their complaints to the appropriate support vehicles as needed

(e.g. linking telephone calls to individual visits, linking high-risk people to specialized treatment facilities, etc.)

 

You need to be well trained before you can properly provide outreach. If possible, it is also useful to receive supervision after support activities and to also have a chance to share other supporters’ experiences in an informal manner.

 

Supporting victims who have lost family members or relatives requires an understanding of loss and grief of the bereaved family and sufficient expertise in the complex procedures that the bereaved family must perform. Survivor supporters also need some familiarity with the condition of severely damaged bodies.

 

Losing a close relative in a disaster is so stressful that it can cause trauma. It is not easy to engage with victims in such a severe situation, but by first actively responding to the high-priority demands of the victims, it becomes easier to see the direction of support.

 

Especially in the early stages of recognizing that a family member may have been killed, various behaviors such as “expressionlessness”, “behaving as if nothing has happened”, and “bursting into tears” may occur. It is important to understand both the trauma and grief reactions of the bereaved family and to respond appropriately to the resilience and pathology of the victim without guessing about either one.

 

 

* This page was created with reference to the manuscript of “Loss and Grief; Disaster deaths, their implication and management”, specially provided by Dr. Beverley Raphael.

Bereavement care long after a disaster

What makes disaster bereavement different from many other types of bereavement is that in the case of a disaster, many other experiences of loss can overlap, including damage to and loss of housing and household goods, financial loss, and disruption of community.

It is not uncommon for survivors who have lost their livelihoods, such as being forced to live in an evacuation center or temporary housing, to be so busy rebuilding their lives that they do not take the time to mourn their loss.  By not being able to take the time to do the work of dealing with grief, they often don’t feel the loss of undergo bereavement until many years later.

Please keep the following points in mind when supporting the bereaved in medium- and long-term care.

 

〇Establishing safety

Bereavement due to disaster is often accompanied by “trauma” as well, so it’s not easy for the bereaved to speak their minds unless they feel they have established safety and trust with the other person, even if with a “psychological care professional.” Therefore, the bereaved are unlikely to visit the experts themselves, and by the time they do, it may be many years after the disaster.

 

〇Beware of repressed grief

Grief may not follow a normal process, but appear in a repressed form, such as expressing itself as a physical symptom. For example, if someone complains mainly about physical symptoms, it is important to attend to the needs of the bereaved family without inadvertently trying to get to the heart of the matter.

 

〇Beware of anniversary reactions

Sometimes, a person’s mind becomes greatly disturbed around the date of a disastrous event.  This is called an anniversary reaction. Though the “anniversary reaction” is also common in bereavement, in cases of disaster, the anniversary date is often focused through mass media. In some cases, it increases the risk of secondary harm, such as being compared to other survivors who are further on the road to recovery.

Points about Bereavement Care

As mentioned in other pages of this website, keep in mind that supporting bereaved families in a disaster can be very difficult.

 

One of the reasons for this is that the length of time and methods of adjusting to loss vary greatly from person to person. Some people recover faster than others, while some people face problems for a long time. They exhibit these problems in a variety of ways, and some people adapt to some activities in a state of “hyperarousal”, while others are “immersed” in grief.

 

The bereaved move forward little by little in their own way. Some want to be left alone, while others want help from support networks and professionals. Some of the issues they present are not the individual’s, but rather “family related” or “isolation” from the community.

 

However, in every case and at every phase, bereavement supporters are required to provide the spirit “to understand the person’s harsh experiences and to coordinate the support that responds to their needs, vulnerabilities, and strengths.”  Because the grief experienced by the bereaved in a disaster is intense, painful, complex, and long-lasting, this support needs to be a long-term with follow-ups.

 

The following are some of the points that need to be considered when supporting the bereaved, especially in the event of a disaster.

 

1. Explanations of the cause of death must be particularly sensitive. Take into consideration the avoidance of shock as much as possible and providing the right information, which can affect the psychological recovery later on. Therefore, cooperation with the police may be particularly necessary.

 

2. In a disaster where many people die, families searching for the missing may witness a large number of bodies. This is a risk factor for exacerbating trauma, so care must be taken to ensure that survivors do not have to witness many bodies as can be avoided.  Post-mortem support is also important.

 

3. The images of the towers collapsing in the 9/11 NY terrorism attack affected many people’s minds. In particular, when an image of such a catastrophe is burned into the minds of the bereaved, the trauma makes it difficult to work on their loss. It is important to keep in mind that loss can often only be brought in conversation with them after a long period of time.

 

4. Questions about whether the deceased suffered frequently arise from the bereaved. Sometimes it is impossible to answer, but it is relatively easier to cope with the situation, if it is clear that he or she died instantly or became unconscious immediately. Supporters can help the bereaved work on this issue while they tell their “story,” if the supporter provides an empathetic and realistic dialogue and a safe place for the bereaved.

 

5. If the victim’s body cannot be found, it will be especially difficult for the family to recover.

For more information on how to help in such a case, please visit the Ambiguous Loss Information Website   https://al.jdgs.jp/e_top

 

 

* This page was created with reference to the manuscript of “Loss and Grief; Disaster deaths, their implication and management”, specially provided by Dr. Beverley Raphael.