Providentia

Postconcussive Symptoms and PTSD in Veterans

Veterans with a history of mild traumatic brain injury (mTBI) are reporting postconcussive symptoms in addition to experiencing postdeployment physical and emotional comorbidities. The Veterans Health Administration has mandated specialized evaluation and treatment for veterans with a history of mTBI and has suggested widespread use of the Neurobehavioral Symptom Inventory (NSI) as a measure of postconcussive symptoms. A study published in a recent issue of Rehabilitation Psychology evaluated the NSI’s factor structure and assessed the impact of posttraumatic stress (PTS) on the scale at the item and factor levels. Five hundred twenty-nine charts of returning veterans who screened positive for traumatic brain injury were reviewed, and 345 who met criteria for mTBI were included in the study. The study results were examined and the resulting factor analysis on the NSI revealed a difficult-to-interpret factor structure that was inconsistent with the results of civilian studies. PTS explained 5%–38% of the variance in individual postconcussive symptoms, and after controlling for this variance, the factor structure more closely paralleled findings from the civilian literature. The authors conclude that posttraumatic stress is an important variable to account for when evaluating PCSx in veterans. The authors also discuss research and clinical implications for the measurement and interpretation of self-reported postconcussive symptoms.

For more information.

Chronic Pain and Traumatic Brain Injury

Chronic pain conditions are common sequelae of traumatic brain injury (TBI). Unfortunately, the incidence of TBI among personnel deployed for Operations Enduring Freedom and Iraqi Freedom (OEF/OIF) is significant, and there is growing evidence that ongoing pain, particularly headaches, will be a primary concern for these individuals. In a recent paper published in Rehabilitation Psychology, the authors examined empirical data from civilian and veteran populations and clinical experience with OEF/OIF personnel with multiple traumas to provide recommendations for the assessment and treatment of chronic pain among those with TBI. The available data signal the need for the incorporation of early and aggressive pain management strategies into existing treatment models. Challenges to providing effective pain management for OEF/OIF veterans are numerous and include comorbid cognitive, medical, and emotional impairments that complicate readjustment to civilian life. It is likely that the problem of polytrauma pain and associated comorbid conditions such as posttraumatic stress disorder and postconcussive syndrome will require the development of integrated approaches to clinical care which bridge traditional subspecialty divisions.

For more information.

After The Halifax Explosion

It's still considered the largest man-made accidental explosion in history.

Even during World War I, the city of Halifax, Nova Scotia was one of Canada's busiest ports. As the terminus of the St. Lawrence Seaway, its location made it the third largest port in the British Empire and a natural base of operations for Canada's navy. Thousands of tons of munitions passed through the port regularly with little thought of the potential danger involved. Until...

On December 6, 1917, a French ship, the SS. Mont-Blanc was carrying a heavy load of explosives from New York to Halifax. As the ship was proceeding into the harbour, a Norwegian ship, the S.S. Imo crossed into its path (it was carrying relief supplies). Though both crews attempted to avoid a collision, the Imo struck the Mont-Blanc on its starboard (right) bow.Attempts to disengage the two ships started a fire that the Mont-Blanc's crew was unable to get under control and they quickly abandoned ship under the captain's orders. Although the French-speaking crew attempted to warn authorities of the terrible danger, they were not understood as the burning ship drifted toward shore.

At 9:04:45 AM, the SS Mont-Blanc exploded. Its cargo, including 450,000 pounds of TNT, 2300 tons of picric acid, and 35 tons of benzol, exploded with a force of 3 kilotons of TNT. The Mont-Blanc was instantly destroyed and the resulting fireball rose 1.9 kilometers into the air. Hot metal rained down on the cities of Halifax and Dartmouth and the tsunami triggered by the blast sent the water rising 18 meters above the harbour's high-water mark. The force of the explosion also triggered fires throughout Halifax's North End and entire neighbourhoods were set on fire. The damage from the explosion affected buildings as far as 16 kilometers from the blast epicenter. An estimated 2000 people were killed in the explosion and resulting firestorm and over 9000 people were injured. Only the heroic actions of many of Halifax's emergency personnel and support workers kept the death toll from rising even higher (many of them were killed in the process). All told, more Nova Scotians died in the explosion than were killed in World War I.

To make matters worse, a massive blizzard struck the Halifax area on the day after the explosion, interfering with rescue efforts. Many of the survivors still trapped in wreckage were forced to deal with the severe cold and Halifax emergency crews were swamped trying to build shelters for all those left homeless. With more than 1630 homes being completely destroyed and an additional 12000 being seriously damaged, providing adequate housing was a critical necessity throughout the harsh winter.

Immediately after the disaster, medical relief trains began arriving from across Canada and the United States. The city of Boston provided a relief train that arrived within a day of the explosion (the city of Halifax still provides an annual Christmas tree to Boston in gratitude). Medical facilities were swamped with injured and even first-year medical students were drafted to treat patients.

Though the reconstruction would take decades, the Halifax Explosion represented one of the first modern disasters to be studied from a sociological and psychological perspective. Several years after the explosion, Samuel Henry Prince completed his Ph.D. at Columbia University.  His thesis, titled Catastrophe and Social Change: Based on a Sociological Study of the Halifax Disaster, represented the first systematic study of relief efforts following a major disaster. As a scholar, pastor, and social activist, Prince's own experience dealing with disaster was considerable. Not only was he part of the rescue effort following the Titanic sinking five years earlier, but he narrowly escaped being injured in the Halifax explosion himself (despite the risk of flying glass, he arrived on the scene just minutes after the blast to help with rescue efforts). After the explosion, Prince helped mobilize international relief efforts and continued to work on behalf of survivors and their families for years afterward.

In his book, Prince described the "shock and disintegration" that followed the explosion as well as the massive relief effort needed and the complex social issues that were linked to aiding survivors. He also emphasized the long-term consequences of the tragedy by stating: "The Halifax Disaster will leave a permanent mark upon the city because so many of the living have been blinded or maimed for life. But it is possible that the disaster may leave a mark of another sort, for it is confidently believed by those who took part in the relief work during the first few weeks that Halifax will gain as well as lose.  The sturdy quality of its citizens will bring "beauty out of ashes""". Prince also stressed the role that disasters can play in bringing about meaningful social change to prevent future loss of life.

Although there had certainly been previous disasters and major relief efforts, Catastrophe and Social Change represents one of the first attempts at studying disasters from a social science perspective and is still considered a classic in the field. While emergency management would eventually become a well-researched topic after World War II, the lessons learned from the Halifax Explosion continue to be applied in rescue efforts around the world.

To download Catastrophe and Social Change

New Orleans Mental Health System Still In Crisis 4 Years after Katrina

Despite ongoing efforts to restore emergency services to a city devastated by Hurricane Katrina in 2005, available resources for survivors dealing with serious mental illness remain at an all-time low. According to one recent report published in Psychiatric Annals, the number of inpatient psychiatric hospital beds has dropped from 487 pre-Katrina to 190. Since most of these remaining beds are reserved for psychiatric patients unable to live independently, only a fraction of those 190 beds are available for acute care.

The only state-operated mental health facility in New Orleans, the New Orleans Adolescent Hospital, is now scheduled for closing after Louisiana governor Bobby Jindal vetoed the 14 million dollars of funding needed to keep the hospital open. The hospital's closure on September 1 is expected to reduce the available number of beds to 133 leaving the city jail as New Orleans' largest psychiatric facility with 50 beds. Although state funding for mental health services has been rising, those funds have been earmarked for community-based services. Inpatient care services for the mentally ill continue to decline despite a rise in suicide rates and a sharp increase in the number of people with mental health problems, many who had been left homeless post-Katrina.

According to a World Health Organization study, the number of residents with serious mental health problems has risen from 6.1 percent pre-Katrina to 19.9 percent today due to the incidence of post-traumatic issues. The number with mild to moderate problems has risen from 9.7 to 19.9 percent. When the Federal Emergency Management Agency surveyed displaced families living in trailers and hotel rooms in February, 2006, it found that 44 percent of displaced persons suffered from some form of psychological distress. Since 2006, there have been 101 suicides and 726 suicide attempts in a population ranging from 200000 to 300000. In 2009 alone, there have been at least 24 suicides and 82 attempts.

Cecile Tebo, administrator of the New Orleans Police Department Crisis Unit that responds to 911 calls involving the mentally ill, has been outspoken in warning of the critical health care problems city has faced since Katrina.  "I've told people for so long, just don't come back [to New Orleans] right now. Don't come back if you have any kind of special needs; this is not the place to be if you have elderly that are really sick, if you have children with special needs or people in the family with mental illness or mental retardation; this is just not a good place to be right now." Mrs. Tebo added that her own staff of volunteers is just a little more than half the size it was before Katrina.

For more information.

For more information.

"John Doe" Identified

When the blond-haired man with an impressive mustache first wandered out of Seattle's Discovery Park weeks ago, he left Seattle police with a mystery. Although well-dressed and carrying $600 dollars hidden in a sock, he was unable to recall his name or any details about his life. All that he could say was that he was "totally lost and frightened". Appearing to be in his fifties, the man (later named "John Doe") was remarkably well-educated and fluent in English, French and German. Despite remembering that he is a widower and has traveled extensively, he is unable to remember anything before waking up in the park on July 30 with no wallet or other identification. Treated at the Swedish Medical Centre's Cherry Hill campus, doctors found no sign of obvious trauma but were confident that he wasn't faking his amnesia.

It was only after an extensive media campaign including social media and Internet chat groups that he was finally identified as Edward Lighthart. An international public relations consultant, Lighthart has three university degrees and worked as an educator in Slovakia, Austria, and China. Although "John Doe" has acknowledged his identity, there is still no "connection emotionally" between him and his name and he has still been unable to explain how he ended up in Seattle.

While cases of dissociative fugue are fairly rare, there are usually triggered by a previous stressful event and full recovery may not occur. In some extreme examples, fugue sufferers can lose their identity for long periods of time and even start new lives under a different name. Diagnosis usually involves ruling out other possible conditions that may be causing the amnesia and helping the victim regain lost memories with cues from their past.

Only time will tell whether Edward Lighthart will be able to return to his old life.

 

For more information.

Dealing with a Priest's Betrayal

"John Doe" wanted to be a priest when he was a young boy in Mexico.

After his family came to the United States and settled in Yuma, Arizona, the eight-year old boy's admiration for priests made him a natural choice to be an altar boy at his local parish. It was only after his pastor Juan Guilen molested him that his dream of priesthood ended. The molesting continued into John's high school years and his role as a trusted family friend ensured his victim's silence. John's parents even allowed Father Guilen to take their son on month-long vacations to Mexico where he could be molested freely. Although his trust was shattered by what Father Guilen had done, John remained silent even after his family moved to Salinas, California in 1989 and he became part of another parish. Whatever hope he had of forming a new trusting relationship when "Father John" Velez became part of that parish in 1991 ended after the second priest molested him as well.

It remains unclear exactly who evaluated Father Velez' credentials when he asked to become part of Christ the King Parish. He had left his previous parish in El Paso, Texas under a cloud of suspicion and another parish in Sacramento had refused to hire him after checking his El Paso references. When the allegations of abuse became known, John Velez reportedly admitted to the offenses and stated that he had been trying to "teach the boy to become a man".

In the extensive court documents which have been made public, the failure of the Church to launch a criminal investigation led to additional abuse of John Doe and his younger brother by Juan Guilen. Now 29, John Doe has received a $1.2 million dollar settlement with the Diocese of Monterey for the abuse that he had received from Father Velez. The deposition that John provided detailed the trauma, betrayal, and shame that his years of abuse had caused. Still plagued by nightmares, he keeps a baseball bat under his bed when he sleeps and still feels guilt over his brother's abuse.

 Although Juan Guilen is now serving a ten-year sentence based on John's testimony, Father John Velez was quickly moved out of his parish and is now believed to be in Colombia. He has not been formally defrocked.

Although the Catholic Church has since enacted stricter guidelines for priests including background checks, suspension of priests under investgigation, and mandatory reporting rules, these changes are far too late to help John Doe and the others like him.

For more information.

Looking at Torture

There has been considerable debate in recent years over the definition of torture but the controversy has focused primarily on the types of procedures used, and not the other factors that contribute to traumatic stress.  A  paper published in the April 2009 issue of the American Journal of Orthopsychiatry  examined the interaction between different stressors in dealing with torture.  The paper combined two studies: the first involving 204 former Turkish prisoners who had been tortured during detention  and the second dealt with 230 torture survivors in former Yugoslavia countries.  Information on background, political affiliations, and those factors that determined severity and psychological impact of captivity were collected through interviews.  An analysis of 46 captivity stressors measured by an Exposure to Torture Scale identified meaningful stressor clusters, which suggested that multiple detention procedures were used in combination to increase their impact. Captivity stressors included sexual torture, physical torture, humiliation, psychological intimidation techniques.  deprivation of basic needs, and sensory discomfort.  Perceived torture severity was found to be related to ’cruel, inhuman, and degrading’ treatments (CIDT) but not to physical torture.  Posttraumatic stress disorder related to war-related captivity, deprivation of basic needs, sexual torture, and exposure to extreme temperatures, isolation, and forced stress positions as opposed to physical torture.  CIDT increased posttraumatic stress disorder risk by 71%.  Fear- and helplessness-inducing effects of captivity and CIDT appear to be the major determinants of perceived severity of torture and psychological damage in detainees. Considerations on what constitutes torture need to take into account the contextual processes in a captivity setting that increase the risk of prolonged mental harm.

For more information.

Child Soldiers

When Charles Taylor goes into the docket at the International Criminal Court in the Hague, he will face charges of crimes against humanity for his brutalities both as a rebel leader and as President of Liberia. Among those looking on in their quest for justice will be Taylor's most innocent victims, the estimated 15,000 children who were forced to fight in Liberia's bloody regional war.

Starting in the 1990s, Taylor first developed a military model that was since exported over the border into neighbouring Sierra Leone: raiding villages, killing adults, and kidnapping children to be recruited into the military. Boys were taken to fight while girls were taken as sexual slaves. Prior to overthrowing previous president Samuel Doe in 1990, Taylor's National Patriotic Front controlled much of Liberia. His most feared battalions were made up of children as young as 11 which committed numerous atrocities.

After becoming president in 1997, Taylor's government was locked into perpetual warfare with rebel groups that copied his methods. He was eventually forced to step down in 2003. Although his son, Chucky Taylor has been sentenced to a 97-year sentence for his role in his father's brutal government. Charles Taylor himself faces 11 charges including the deployment of child soldiers.  He is currently being held in the United Nations Detention Unit in the Hague.

Many of Taylor's child soldiers continue to be stigmatized by their involvement in the civil war and are ostracized by many elements of Liberian society. Even those with surviving family members are typically rejected and many turn to prostitution or crime to survive. Relief agencies are attempting to aid former child soldiers although they admit that the legacy of psychological trauma and suicide will haunt the region for decades to come.

For more information.

For more information

Do Nightmares Relieve Tension?

While nightmares are typically seen as frightening to the dreamer, the role that nightmares play in stress has been frequently debated. Different theories have questioned whether nightmares enabled tension release and played a positive role in coping or simply added to the anxiety of the dreamer. A recent study published in Dreaming examines whether negative life events are associated with an increase or decrease in anxiety attributable to nightmares. The researchers used a sample of 624 adolescents between the ages of 12 and 19 who were recruited from public and private schools in Australia. The study participants were given a battery of questionnaires examining various aspects of dreaming and stress over a twelve-month period. The results showed no support for the hypothesis that nightmares reduced tension. There was also no evidence that reporting nightmares relieved anxiety. The researchers also found that the stronger the distress of waking (from nightmares), the more likely a person is to report anxiety, controlling for life events and the distress associated with life events. Overall, girls were found to be more likely than boys to experience nightmare waking distress, nightmare sleeping distress, and nightmare frequency. Adolescents who experienced frequent nightmares and nightmare distress were also found to have experienced more major negative life events and to experience greater anxiety overall. Although the researchers focused on major life events in shaping nightmare frequency and distress, they also suggested that "daily hassles" may also be an important factor in psychopathology.

For more information

Corporal Punishment and Brain Development

A study published in the March, 2009 issue of Neuroimage examines the role of harsh corporal punishment in later brain development. While harsh corporal punishment (HCP) during childhood has been identified as a chronic, developmental stressor associated with depression, aggression and addictive behaviors, there is little about the potential neurobiological consequences of HCP. The researchers used voxel-based morphometry (VBM) to investigate whether HCP was associated with discernible alterations in gray matter volume (GMV). By screening 1,455 young adults (18-25 years), 23 subjects were identified with a history of HCP (minimum 3 years duration, 12 episodes per year, frequently involving objects) as well as 22 age-matched controls. High-resolution T1-weighted MRI datasets were obtained using Siemens 3T trio scanner. The results showed that GMV was reduced by 19.1% in the right medial frontal gyrus (medial prefrontal cortex; MPFC, BA10) (P=0.037, corrected cluster level), by 14.5% in the left medial frontal gyrus (dorsolateral prefrontal cortex; DLPFC, BA 9) (P=0.015, uncorrected cluster level) and by 16.9% in the right anterior cingulate gyrus (BA 24) (P<0.001, uncorrected cluster level) of HCP subjects. There were significant correlations between GMV in these identified regions and performance IQ on the WAIS-III. The researchers concluded that exposing children to harsh HCP may have detrimental effects on trajectories of brain development although a causal relationship can not be clearly determined.

Click here for the abstract.