Biomedical Engineering Reference
In-Depth Information
or anxiety in anticipation of exaggerated potential
threats are far more readily managed than terror,
because terror combines anxiety and fear as well
as a sense of horror, disbelief, helplessness, and
profound and permanent loss [8]. The challenge
to healthcare practitioners and organizations posed
by terrorism is how to help victims, families, and
providers themselves to understand and recover
from the shock of psychological terror. Meeting
this challenge does not require psychotherapy and
cannot be done solely by pharmacological treat-
ment (although strategic use of targeted pharma-
cologic agents may play a role, see below). The
key is to replace terror with a sense of control
and the real possibility of a future that is not
poisoned by prolonged suffering and almost certain
death. The “cognitive appraisals” (beliefs, inter-
pretations) that people exposed to terrorism have
about their
culpability
in and
ability to manage
the “damage” they are actually or dread experi-
encing, and to
regain a life worth living
, can make
the difference between experiencing a psycholog-
ical breakdown or coping effectively in the face
even of catastrophic harm and loss [9]. Not only
psychiatry and social services providers but all
healthcare providers can contribute to the restora-
tion of hope in the face of terror. However, this
cannot be done by simply exhorting people to be
positive or to believe that somehow things will
get better, because terror overrides such superficial
encouragement. Instead, it is essential to tangibly
increase the person's ability to predict and control
immediate aspects of their lives by making threats
visible, intrusions preventable, and losses grieved.
that re-focuses victims, family members, and first
responders on the aspects of the situation that are
predictable. Information about the mechanisms of
action and likely physical effects and signs asso-
ciated with a variety of toxic agents is widely
available. However, this information may inadver-
tently increase the sense of terror for some persons,
unless they also are given information relevant
to other concerns which are more basic and yet
tend to be lost in the panic when terror strikes.
For example, knowing when and how it will be
possible to make contact with loved ones from
whom one has been separated, or that food and
shelter can be depended upon while the crisis is
being dealt with, can restore the sense that there
are some ways in which important aspects of life
still are predictable despite other as yet unresolved
threats.
11.1.1.2 Uncontrollability
Being able to anticipate a near- and long-term
future that is manageable involves knowing how
to take practical steps that restore not only
predictability but also the sense of being able
to exert meaningful control. Terror forces people
to live with uncontrollability, and the ability to
exert control often cannot be quickly or completely
restored. Toxic exposure can lead to physical reac-
tions that often cannot easily or immediately be
reversed, but the steps that not only the health-
care provider but also the patient or other persons
concerned can take to manage and mitigate the
harmful sequelae can be described and formed into
a plan that restores some sense of control. Here
too, it is important to focus not only on dealing
with the direct source of threat, managing the
effects of toxic exposure, but also to regaining a
sense of control over other background concerns
that reconnect the individual with “normal” life.
Without denying or minimizing the severity of
the threat and the importance of immediately
addressing basic health concerns, getting help in
gaining control of concerns such as basic bodily
nourishment, privacy, communication with family
and key support persons, and being able to make
a difference by helping and protecting others, can
11.1.1.1 Unpredictability
The ability to exert meaningful control in any situ-
ation depends upon being able to predict both what
is likely to happen next and what can be done
in the form of “course corrections” that increase
the likelihood of positive outcomes and reduce
the chance of negative outcomes. When certain
aspects of a crisis are unpredictable or not known
(e.g., the extent of exposure to toxic chemicals
or gas, and the degree of toxicity conferred by
exposure), it is essential to provide information
