TRAUMATOLOGYe, 4:2, Article 4, 1998, http://www.fsu.edu/~trauma/
By Charles R. Figley, Ph.D. Psychological Debriefing, Troubled Children, and Homophobia: Toward a Multidisciplinary, Multidimensional Field of Traumatology
AbstractThis article asserts that in order for the field of Traumatology, to thrive it must embrace a multidisciplinary approach that adopts a wide variety of methods of inquiry. An example of such diversity of inquiry is the latest issue of TRAUMATOLOGYe. Three papers are reviewed. It is noted that the Dyregrov (1998) article represents the latest assertion that psychological debriefing including, but not limited to Critical Incident Stress Debriefing (CISD) is valuable. The assertion is that no research has confirmed the lack of utility. Indeed, the fact that so many continue to use debriefings illustrate the utility of the approach. This article then focuses on the paper by Bedics, Rappe & Sansone (1998). Their study focused on the case records of children enrolled in a residency treatment program for children with conduct disorders, 11-16 years old. The investigators predicted and found that a substantial number of children in the program were exposed to considerable traumatic events and met the criteria for PTSD. The third paper by Daugherty and Esper (1998) reported the findings of an interesting study of reactions to male rape victims. Consistent with previous research, belief in a just world predicted greater victim blame and homosexual victims were accorded more blame than heterosexual victims. The final section of this article discusses the most recent history of the field of Traumatology. Among other things, it notes that these three contributions illustrate the diversity of theoretical and methodological orientations represented in the field. It is noted that in order to most effectively help traumatized people there must be a commitment to open discourse, the scientific method, and creative methods for achieving these goals.
Correspondence concerning this paper should be addressed to the author via email at:
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2407-C University Center,
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Psychological Debriefing, Troubled Children, and Homophobia:
Toward a Multidisciplinary, Multidimensional Field of TraumatologyThe the modern history of the field of Traumatology emerged from the exclusive focus on the physical wounds and disabilities of injury to one incorporates but is not limited to the study and treatment of traumatic stress. Donovan (1991) suggested that:
"traumatology is the study of natural and man-made trauma (from the 'natural' trauma of the accidental and the geophysical to the horrors of inadvertent or volitional cruelty), the social and psychobiological effects thereof, and the predictive-preventive-interventionst pragmatics which evolve from that study (p. 434)."In the same article Donovan suggested that the field cannot afford the territorialism and power struggles found in more established fields. He and others (cf., Figley, 1988) have asserted that because the field focuses on such complex issues it must, by necessity, draw from a wide variety of research and clinical areas and experiences.Historically, the field of Traumatology has very old roots. Hysteria, for example, was first discussed long before the Greeks named this syndrome. According to Veith (1968), Khun Papyrus, first known medical writings discovered in Egypt in around 1900 BC, asserted that highly emotional reactions were due to a "wondering womb" and that treatments were invented to move it back to its appropriate place. The modern era of the field was established with the American Psychological Association's (1980) third revision of the Diagnostics and Statistical Manual of Mental Disorders that included, for the first time, PTSD. This new designation consumed under one disorder a wide variety of syndromes that included rape trauma syndrome, concentration camp syndrome, combat fatigue, disaster syndrome, post Vietnam war syndrome, and others (Figley, 1985).
Perhaps because hysteria and PTSD is most often associated with psychiatry and the origin of traumatology is in trauma medicine, the general impression of the field was that it was a sub field of psychiatry. Indeed, much of the attention in the 1980s and 1990s has been on the incidence and prevalence of PTSD among various traumatized populations and what can be done to treat it. Certainly among the most widely studied treatments have been the use of various prescription drugs.
It is interesting to then consider the debate about the utility of psychological debriefing. The debate, suggests Dyregrov (1998), is far more than interpreting research results.
Secondary Prevention of PTSD in Emergency Responders and Others
One of the most debated topics in the field of Traumatology in the last five years has been the utility of psychological debriefings in general and critical incident stress debriefing (CISD) in particular. Atle Dyregrov (1998) reviews the available literature focusing on psychological debriefings (PDs) that he defines as "a group meeting arranged for the purpose of integrating profound personal experiences both on the cognitive, emotional, and group level, and thus preventing the development of adverse reactions" (1989, p. 25). In his review he first focused on those studies that failed to find any statistically significant effects of PDs. However, because of the numerous methodological weaknesses he concluded that additional research is needed that overcomes these weaknesses.
Perhaps the most interesting part the article is Dyregrov's (1998) assertion that politics and personal jealousies play a substantial role in the ongoing debate about the utility of debriefings. He notes that ". . . PD represented a threat to the psychiatric professional elite" (p.7) for at least two reasons. First there was the assertion by PD proponents that emergency responders were responding normally to an abnormal, critical incident and their stress reactions should not be pathologized. Therefore, mental health practitioners needed to change their approach before they would be accepted by this group of professionals. Second, CISD and other PD approaches were offered to non mental health professionals and were encouraged to use them with peers.
A third factor not addressed in the article, but related to the factors noted by Dyregrov (1998) is the enterprise of training and certifying debriefing teams. The International Critical Incident Stress Foundation (ICISF), co-founded by Mitchell and his colleague, George Everly, is one of the fastest growing professional associations in the world. The primary aim of the organization is to promote a better understanding of modern crisis intervention methods for emergency service providers and to train and certify teams to design and provide a program of critical incident stress management. As an organization, ICISF is a membership of professional fire fighters, law enforcement, paramedics, clergy, and a minority of mental health professionals. Collectively they feel deeply that peer support is a vital to avoiding compassion fatigue (Figley, 1995), vicarious trauma (McCann & Pearlman, 1993), and other problems associated with working with the suffering. At the same time, ICISF and its members are least equipped to conduct research and be able to verify the utility of peer support in general and CISD in particular.
In the great debates about the utility of CISD, this point is often lost: those who have attended a psychological debriefing "vote with their feet." They would never attend again and would not support its use again if they did not derive some benefit from it. Today, CISD and other forms of psychological debriefings are used, over and over again, all over the world. Until a series of high quality studies support or reject the utility of psychological debriefing such practices will and should continue.
Origins of Trauma in Troubled Children
Debriefing sessions are almost always with adults. Given the frequency with which children are subjected to critical incidents, group debriefings with children exposed to the same event is an obvious need. Certainly the findings of the Bedics, Rappe & Sansone (1998) study suggest that residential treatment programs for troubled youth are filled traumatized children. As the Dyregrov (1998) reported on the traumatology literature focusing on outcome research, the Bedics, et al study is an example of archival research. They sought and obtained permission to review the case records of residents of a residential wilderness treatment program. They expected and found that a substantial number of these children would be classified as having conduct disorder (70.8%), learning disability (62.5%), alcohol abuse (56.3%), and drug abuse (45.8%). They also expected and did find that quite a few children (48%) had parents with documented addition problems.
However, the importance of this study was that they found that all of the children in the study came from abusive families or families that were judged to be severely dysfunctional. Of special interest to traumatologists, however, is that 75% of the children had experienced at least one traumatic event. Specifically, 31 experienced actual or threatened death, serious injury, or threat to physical integrity; 8 witnessed such events and 6 had learned about an unexpected and violent death or harm experience by a loved one. Bedics, et al (1998) conclude that there is considerable potential of comorbidity of PTSD in children with conduct disorder, and depression. But it is also obvious that substance and alcohol abuse would be candidate diagnoses for PTSD comorbidity.
Returning to the issue of the field of Traumatology, it is vitally important that the study and treatment of traumatized children be at the forefront. Because it is so likely that traumatized children also suffer from other types of problems, there should be much more attention to issue of co-morbidity, effective screening for trauma exposure, and, of course, prevention and treatment programs that work.
The Role of Sexism and Homophobia on Attitudes Toward Rape Victims
Daugherty and Esper (1998) provide a nice replication and extension of the classic Whatley & Riggio (1993) study. The latter study they found that victims arrest record and belief in a just world accounted for why rape victims were more likely to be blamed than pitied.
In order to confirm these findings with a superior just world scale and to investigate the role of sexual orientation, Daugherty and Esper designed an experiment. The experiment utilized vignettes originally developed by Whatley & Riggio and presented to 173 males enrolled in an lower level psychology undergraduate course at an all-male military college. The investigators manipulated the vignettes to test influence of the research participants' attitudes toward the arrest record and sexual orientation of the male rape victim. As expected, they found that research participants assigned more responsibility of blame to the guy victim than to the heterosexual victim. Also, they found a positive correlation between belief in a just world and attributions of victim blame. They found no other relationship, in contract to other findings.
Apart from the utility of the study to the research areas of homophobia studies (Herek, 1994) and Belief in a Just World studies (Lerner, 1980), it emphasizes the utility of attribution theory, particularly Shaver's (1970) defensive attribution theory: Those easily distinguished (i.e., of a different sex, race, sexual orientation, nationality) are held to a higher level of accountability (i.e., blamed more readily) that those who are similar to the observer.
Traumatologists should be much more interested in the contributions of attribution theory in helping to understand how traumatized people are marginalized in their community and even in their families. Such theories could help understand how social support systems can be mobilized to help victims of rape and other events.Toward a Multidisciplinary, Multidimensional Field of Traumatology
The articles in this issue of TRAUMATOLOGYe illustrates, that the field is and should be multidisciplinary. As noted more than ten years ago (Figley, 1988), there are at least seven building blocks to a viable and vital field of study. First the field should have clearly defined historical roots. Second, there must be at least one professional organization that represents the field. Third, there must be a set of publications that report the contributions to the field. But the most vital elements of a field are associated with an identifiable set of theories and concepts that will guide the growth of knowledge. With this foundation, research methods and data analysis, methods of assessment and measurement, and strategies for developing and testing effective intervention methods to prevent and treat the unwanted consequences of traumatic events can emerge.
Unless the field is multidisciplinary and our methods multidimensional the field can not reach its mission. The mission is consistent with the mission of this publication: Study of the Traumatization Process and Methods for Reducing or Eliminating Related Human Suffering and Promoting Related Human Development.
References
American Psychological Association's (1980). Diagnostic and Statistical Manual of Mental Disorders, 3rd Edition. Washington, DC: Author.
Bedics, B. C., Rappe, P. T., and Sansone, F. A. (1998). Trauma of children in a residential wilderness treatment program. TRAUMATOLOGYe, Volume IV: 2, Article 2. <http://www.fsu.edu/~trauma/art3v4i2.htm>
Daugherty, T. K. and Esper, J. A. (1998). Victim characteristics and attributions of blame in male rape. TRAUMATOLOGYe, Volume IV: 2, Article 4. <http://www.fsu.edu/~trauma/art3v4i2.htm>
Donovan, D. M. (1991). Traumatology: A field whose time has come. Journal of Traumatic Stress, 4:3, 431-436.
Dyregov, A. (1998). Psychological debriefing: An effective method? TRAUMATOLOGYe, Volume IV: 2, Article 1. <http://www.fsu.edu/~trauma/art3v4i2.htm>
Figley, C. R. (Ed.) (1985). Trauma and its wake: The study and treatment of PTSD. Philadelphia: Brunner/Mazel.
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Figley, C. R. (Ed.) (1995). Compassion fatigue: Coping with secondary traumatic stress disorder in those who treat the traumatized. Philadelphia: Brunner/Mazel.
Herek, (1994). Assessing heterosexuals' attitudes toward lesbians and gay men: A review of empirical research with the ATLG scale. In B. Greene & G. M. Herek (Eds.), Lesbian and gay psychology: Theory, research, and clinical applications, 206-228. Thousand Oaks, CA: Sage.
Lerner, M. J. (1980). The belief in a just world: A fundamental question. New York: Plenum.
McCann, L. & Pearlman, L. A. (1989). Vicarious traumatization: A framework for understanding the psychological effects of working with victims. Journal of Traumatic Stress, 3:1, 131-149.
Shaver, K. G. (1970). Defensive attribution: Effects of severity and relevance on the responsibility assigned for an accident. Journal of Personality and Social Psychology, 14, 101-113.
Whatley, M.A. & Riggio, R. E. (1993). Gender differences for attributions of blame for male rape victims. Journal of Interpersonal Violence, 8, 502-512.
Veith, I. (1968). Hysteria: The history of a disease. Chicago: Chicago Press.