SOC363: 11. Traumatic Historical Events Flashcards
1
Q
Terrorism
A
A¯o
2
Q
Terrorism
A
- Unanticipated
- Emphasizes& vulnerability
- Generalized& threat
3
Q
Terrorism
A
- Systemic& meaning
- Highest& level& of&context
- National& scope
4
Q
EFFECT OF 9/11: RESEARCH ON TERRORISM
A
after 2001, significant increase in terrorism research
switch to focus on macro events
5
Q
CHANGES IN THE CONDUCT OF SOCIAL LIFE
A
Homeland& Security&Act
• Airport& Security
• Incarceration& without& Cause& &(“Gitmo”)
6
Q
CHANGES IN THE CONDUCT OF SOCIAL LIFE
A
- New&Forms&of&War&(drones..)
- Lost&Beliefs& (Assumptions)& about& Invulnerability
- Generalized& State&of&Threat
7
Q
CHANGES IN THE CONDUCT OF SOCIAL LIFE
A
• Mistrust,& Paranoia& Reasoning
paris attacks reenergized discussion around issues
rationals for phobia
8
Q
PSYCHOANALYTIC UNDERSTANDING OF TERRORISM
A
What is terrifying about terrorism? (Twemlow, 2004):
Expression of unqualified power; taking power
Methods unusual, unanticipated, sometimes unprecedented.
9
Q
PSYCHOANALYTIC UNDERSTANDING OF TERRORISM
A
Completely unpredictable.
Randomness of targets — “innocent civilians.”
Absence of clear meaning or sense.
10
Q
PSYCHOANALYTIC UNDERSTANDING OF TERRORISM
A
The understanding gap between the perspectives of “terrorists” and the targeted population.
Loss of fundamental beliefs about security and sanctity of space.
Unsafe world where anything can happen.
11
Q
Terrorism and Its Consequences
A
Violent and often gruesome act intended to do physical harm to its immediate victims and psychological harm to those who witnessed it in such a manner as also to inflict extreme beer, indeed terror, among those were targeted usually for purposes of influencing public opinion or public policy
12
Q
Terrorism and Its Consequences
A
Includes:
Hijacking, Sabotage, Bombings, Kidnapping, Torture, Mass murder, and Assassinations
Mental Health consequences specific to the type of stress:
13
Q
Terrorism and Its Consequences
A
Post-traumatic Stress Disorder (primarily)
Depression
Anxiety
Distress
14
Q
PTSD Criteria (DSM-IV)
A
Criterion A:
Exposure to a traumatic event in which the “person experienced, witnessed, or was confronted with an event” involving “actual or threatened death or serious injury, or a threat to the physical integrity of self or others.” and “the person’s response involved intense fear, helplessness, or horror” (American Psychiatric Association, 2000, p. 467).
15
Q
PTSD Criteria (DSM-IV)
A
Criterion B:
Sense of re-experiencing the same event ( images, memories).
Criterion C:
Avoidance of things associated with the event.
16
Q
PTSD Criteria (DSM-IV)
A
Criterion D:
Generalized arousal in situations unrelated to the original event.
17
Q
PTSD Criteria (DSM-IV)
A
Criterion E: …for at least one month.
Criterion F: …..functional impairment
latency: occurs over time
18
Q
Research
A
Abenhaim et al., (1992):
Bombings in France 1982-1987
Seriously injured survivors had three times the rate of PTSD (30%) compared to moderately injured(8%) or noninjured (10%).
19
Q
Research
A
Hobfoll et al., (1994).
First Gulf War SCUD missile attacks on Israel from Iraq.
Depression higher during attacks than before or after. “Self-limiting”, therefore not serious.
20
Q
Research
A
Gidron et al. (1999).
Anxiety among bus commuters in Israel: important clues
Anxiety higher among those who commuted less often (resilience an issue?).
21
Q
Research
A
Problem-focused coping related to higher anxiety.
Suspicion, awareness of threat, increases anxiety
not deemed serious, self limiting (brief)
who avoided threat => increase anxiety
22
Q
Oklahoma City Bombing (1995)
A
Federal building bombed, 168 died, including many children.
Pffeferbaum (2002): typical emphasis on “dosage” of exposure (proximity, involvement in the event) not as relevant in very public events.
23
Q
Oklahoma City Bombing (1995)
A
Vulnerable populations (evaluate the event as threatening) may be affected whether or not proximal to the event. Trautman (2002) : Asian and Middle Eastern immigrants in Oklahoma City who had experienced previous trauma before immigration were highly affected, in terms of PTSD. Multiple Exposures multiply effects.
24
Q
Oklahoma City Bombing (1995)
A
Sprang (2001) : vicarious stress: symptoms of PTSD did not decline after event even if not directly exposed.
growth of media in communication of events internationally
accumulation of life traumas
ppl vicariously experience it through media and could get PTDSD even when haven’t experienced it ourselves
25
9/11
Galea et al. (2003):
| PTSD higher immediately after the attack, but declined at six months. Again: self-resolving. Implies a temporary change.
26
9/11
Shuster et al (2004):
| Immediate impact was national: exposure through media was enough to result in PTSD symptoms.
27
9/11
Knudsen et al., (2005)
A cross-sectional study with before / after scheduling of interviews around 9/11 to compare cases vs. controls on two outcomes. But, just 3 month follow-up.
Depression spiked and then returned to previous levels
28
9/11
Breslau (2005): “the mental health crisis that wasn’t.”
mental health problems only temporary issue
by month 3 returned to normal levels
findings suggest short term effect
crisis for those highly afftect
29
Key Issues
Issue of meaning of exposure:
Direct injury
Distance from attack
30
Key Issues
Length of time since attack
Life history of exposure
Media coverage : the equalizer that reduces distance.
31
Key Issues
The issue of growth from the experience:
Re-calibration of existing life conditions and relationships.
Breadth of outcomes: beyond PTSD?
32
Other Outcomes
```
Beyond the mental health outcomes, is there a package of “subjective welfare” that is affected broadly?
Psychosocial resources (social and personal):
Are they better or worse? Not clear from the research to date.
```
33
Other Outcomes
Post-traumatic growth:
“positive psychological change experienced as a result of the struggle with highly challenging life circumstances” (Tedeschi & Calhoun, 2004, p. 1).
34
Other Outcomes
Positive changes in the self, in philosophy of life, in relations with others.
BUT: It can represent actual psychological growth and resiliency or a hollow effort to believe something good must come out of the events as a way of justifying tragedy.
35
Other Outcomes
```
Beyond the mental health outcomes, is there a package of “subjective welfare” that is affected broadly?
Psychosocial resources (social and personal):
Are they better or worse? Not clear from the research to date.
```
36
Other Outcomes
Post-traumatic growth:
“positive psychological change experienced as a result of the struggle with highly challenging life circumstances” (Tedeschi & Calhoun, 2004, p. 1).
37
Other Outcomes
Positive changes in the self, in philosophy of life, in relations with others.
BUT: It can represent actual psychological growth and resiliency or a hollow effort to believe something good must come out of the events as a way of justifying tragedy.
38
Other Outcomes
subjective wellfare
grown since traumatic event
psychological and resilience growth
39
The Effect of 9/11 on the Subjective Welfare of Americans:
| Wheaton and Montazer (2011)
Subjective welfare df:
a constellation of both inter-related and independent subjectively defined states of experience, including affect, cognition, beliefs, and hopes, that together act as a comprehensive set of markers of the aggregate influence of social and economic conditions, interpersonal reality, and past biography. ”
40
The Effect of 9/11 on the Subjective Welfare of Americans:
| Wheaton and Montazer (2011)
Or: A comprehensive checklist of how we are doing.
Components:
Mental Health: Depression , Anger , Frequency of Drinking (monthly)
41
The Effect of 9/11 on the Subjective Welfare of Americans:
| Wheaton and Montazer (2011)
Satisfaction: Satisfaction with Public Life
Relationships: Arguments and Disagreements, Satisfaction with Relationships.
42
The Effect of 9/11 on the Subjective Welfare of Americans:
| Wheaton and Montazer (2011)
Psychosocial Resources: Giving / Receiving Social Support to / from Others, Sense of control, Self-esteem, Self-satisfaction (appearance, health, life achievements), Sense of Coherence (Hope, Purpose in Life)
43
The Effect of 9/11 on the Subjective Welfare of Americans:
| Wheaton and Montazer (2011)
sometimes diff parts of subjective experiecence don’t add up well
44
The Uniqueness of 9/11
An attack on fundamental institutional symbols, on a “way of life.”
Continental U.S. under direct attack.
45
The Uniqueness of 9/11
The enemy is not a state, but a group, geographically dispersed.
National scope of the event.
46
The Uniqueness of 9/11
New innovations in weaponry and methods used in the attack.
| Live real-time unfolding of the event.
47
The Uniqueness of 9/11
Fundamental shift in belief paradigms about vulnerability.
Expectations of repeated threat.
The enemy is external, not within.
Media imprinting (like the Kennedy assassination..)
48
The Literature on Terrorist Events and Disasters:
| Broad Tendencies
Many to study in recent years:
Columbine, Chernobyl, Oklahoma City, Katrina, 9/11, Virginia Tech, Haitian earthquake, Japanese earthquake and tsunami, Newtown shooting.
49
The Literature on Terrorist Events and Disasters:
| Broad Tendencies
Standard pieces of the epidemiological template:
| Standard mental health outcomes, esp. PTSD / anxiety, but also distress (which includes anxiety).
50
The Literature on Terrorist Events and Disasters:
| Broad Tendencies
Necessary reliance on after-only designs
Comparison rates to normative samples.
Dose-response perspective; proximity to the event a major issue.
51
The Literature on Terrorist Events and Disasters:
| Broad Tendencies
Few significant effects that last, other than suggestive evidence in after-only studies.
Widespread calls for the need for intervention whether there is a demonstrated impact or not.
52
The Literature on Terrorist Events and Disasters:
| Broad Tendencies
3. study of sudden events problematic because can’t anticipate it
only have after-only design, don’t know what population after event*
53
The Literature on Terrorist Events and Disasters:
| Broad Tendencies
proximity, length of exposure
| medical model research approach
54
Studying the Impact of 9/11 in the Three-Wave NSFH:
| a Unique Opportunity
The National Survey of Families and Households is a Three Wave Panel Study of U.S. adults
Wave 1: 1987-1988 N=13007
Wave 2: 1992-1994 N=10005
55
Studying the Impact of 9/11 in the Three-Wave NSFH:
| a Unique Opportunity
Wave 3: 2001-2003 N=4600
| Wave 3 interviews started on February 2, 2001 and continued until June 6, 2003.
56
Studying the Impact of 9/11 in the Three-Wave NSFH:
| a Unique Opportunity
The wave 3 follow-up included 1618 interviews (35%) before 9/11, and 2982 interviews (65%) after 9/11. Thus we have a treatment – control sample asked exactly the same set of questions.
57
What to Expect 1: Positive Consequences?
Simmel: conflict with an external agent increases internal solidarity.
Thus: external conflict useful for internal cohesion.
58
What to Expect 1: Positive Consequences?
```
From Coser (1956)…..:
“if the basic social structure is stable, if basic values are not questioned, cohesion is usually strengthened by war through challenge to and revitalization of values and goals which have been taken for granted.”
```
59
What to Expect 1: Positive Consequences?
Or, from Churchill on WWI:
“Life had been raised to a strange intensity by the war spell. Under that mysterious influence, men and women had been appreciably exalted above death and pain and toil.
60
What to Expect 1: Positive Consequences?
Unities and comradeships had become possible between men and classes and nations and grown stronger while the hostile pressure and the common cause endured.”
61
What to Expect 1: Positive Consequences?
positive consequences
Simmel - increases internal solidarity (collective consciousness)
Coser: makes the unconsciou, conscious
lead to acclimation response
62
What to Expect 2: Mixed Consequences?
After 9/11….
Strong pressure to support retaliation: pressure to conform
Reaffirmation of American principles.
Increased collective conscience.
63
What to Expect 2: Mixed Consequences?
Greater intolerance of multiple outside groups, not only “Arabs”, as evidence of global support for retaliation proved to be thin.
64
What to Expect 2: Mixed Consequences?
So the seeds of trouble exist even in the process of affirming cohesion.
focus on groups that are against us
65
What to Expect 3: Negative Consequences?
Simmel also argues that conflict with an external agent can indirectly …
Increase centralization of authority ()
Decrease tolerance for dissent ()
66
What to Expect 3: Negative Consequences?
Narrowing of acceptable sentiments ()
Prolonged uncertainty with high expectations of threat amount to a high level of collective chronic stress (Wheaton, 1997).
chronic stressors wear populations down over time
67
What to Expect 4: Potential for Change?
Even if the direction of responses is unclear, or mixed, or complex, the capacity for change in subjective welfare is clear.
68
What to Expect 4: Potential for Change?
Swidler (1986) argues that “unsettled times” bring the role of culture to the foreground, and that “cultural causation” is enhanced in those historical periods. In particular:
69
What to Expect 4: Potential for Change?
“Periods of social transformation seem to provide simultaneously the best and the worst evidence for culture's influence on social action. … In such periods, ideologies establish new styles or strategies of action. When people are learning new ways of organizing individual and collective action, practicing unfamiliar habits until they become familiar, then doctrine, symbol, and ritual directly shape action.”
70
What to Expect 4: Potential for Change?
The uncertainty following 9/11 results in markedly “unsettled” effects on subjective welfare, rather than simply a question of harm: involving a complex process of disassociation --- and re-association---precipitated among the elements of subjective welfare.
71
What to Expect 4: Potential for Change?
things we assume go together don’t necessarily have to go together
practice of public ritual
things that relate to each other suddenly don’t make sense
72
What to Expect 4: Potential for Change?
=
73
What to Expect 4: Potential for Change?
=
74
General Predictions
Dissociation: an unexpected disruption of the normal integration of a person’s conscious or psychological functioning.
75
General Predictions
Unprecedented nature of event suggests two kinds of possible consequences:
Shift in association patterns among components of subjective welfare.
76
General Predictions
Could be either loosening or tightening of association, making for either unusual coexistence of normally disparate elements, or the decoupling of normally bound components.
77
General Predictions
This may occur at the aggregate and/or individual level.
The direction of changes in specific outcomes may be the opposite of what is usually expected. In moments of high uncertainty and insecurity, responses will be sometimes be contradictory, at least on the surface.
78
General Predictions
Emotion-based responses may produce more expectable patterns than those involving beliefs and cognitions.
things start to change independently
things you normally assume are true, aren’t anymore
79
Response Profiles for Time Since Event
Need to be aware of the potential for different response trajectories, for immediate responses vs. responses with latency.
80
Response Profiles for Time Since Event
Three basic stages of response after 9/11:
The acute phase: After Shock
The chronic phase: Habituation / Normalization
Secondary events: Redirection / New Goals
81
Response Profiles for Time Since Event
short follow up
latency response - reappear down the road
acute: 3 months
chronic: adjustment to new reality - 3-12 months
82
Coding the Effect of 9/11
“Time” stands for the standard trajectory of outcomes tracked over 15 years up to and after 9/11. Includes negative values up to 0 (9/11), and positive values after.
83
Coding the Effect of 9/11
Then we track a variable called “Time after 911”, which was coded 0 until 9/11, and then increased by one for each month after 9/11. This variable shows the deviation from the path projected by “Time”, and thus the effect of 911.
84
Coding the Effect of 9/11
We also tested nonlinear trajectories after 9/11, taking into account the stages of response and differences in the types of responses measured.
85
The Effect of 9/11 on Anger
Here is the impact of time after 911 on anger, as plotted from the results:
Nonlinear representation is necessary --- and important.
And, the impact is not necessarily self-limiting or short-term.
86
The Impact of 9/11: Mental Health
positive effect on depression and declines
| entry into iraq, greater increase in depression than the events of 9/11
87
The Impact of 9/11: Mental Health
anger up in middle, declines a little at end
| little change on drinking, but increases toward iraq months
88
The Impact of 9/11: Social Support
negative: more support receiving than giving after 9/11
shifts so that by 18 months - iraq war - reporting more giving support
don’t report much receiving support
89
The Impact of 9/11: Personal Resources
increase in self of control - unsettledness lead to understandings of social world
self esteem increases
90
The Impact of 9/11: Personal Resources
resources are increasing, yet mental health got worse*
emphasis on national identity (patriotism) - locates personal identity into national identity
disatisfaction with achievements
91
The Impact of 9/11: Relationships
decrease in close relationships, but increases toward iraq war
more satisfaction in personal relationships
92
The Impact of 9/11: Relationships
loss of romantic relationship are most stressful, threatening to identity
93
Themes
The findings for mental health and satisfaction outcomes are as expected, but…..
The findings for resources are the opposite of what might be expected, especially in the area of personal resources:
94
Themes
control and self-esteem increase after 9/11, coherence holds on.
Relationships improve; evaluation of public life declines (results not shown).
95
Themes
Iraq War has more general and larger impacts than the immediate impacts of 9/11 itself!
96
OVERALL, WHAT HAPPENS AFTER 9/11?
Depression increases, then anger, then both, drinking is steady --- until the Iraq War, when it increases, BUT….
Social support increases, sense of control increases, and self-esteem increases, while sense of coherence, a sense of hope and purpose in life, decrease or holds steady.
97
OVERALL, WHAT HAPPENS AFTER 9/11?
Meanwhile, relationships get better. Religious involvement does not change, neither do fundamentalist leanings….
Effects on subjective welfare not short-term.
98
OVERALL, WHAT HAPPENS AFTER 9/11?
Did people feel worse or better after 9/11? This is the wrong question.
not clear that everything operates as usual
99
OVERALL, WHAT HAPPENS AFTER 9/11?
effects are not short term
| can follow up even after a year
100
A different kind of event: Hurricane Katrina
2005: One of the deadliest hurricanes in U.S. history (1836 deaths)
The costliest ever (108 billion dollars)
101
A different kind of event: Hurricane Katrina
53 breaches of levees, resulting in submerging 80% of the city of New Orleans
83% of the residents had to move away.. Over half a million people
102
A different kind of event: Hurricane Katrina
5 years later, 31,000 households still “unsettled”.
But: a natural event:
No clear enemy
Government failures implicated (funding withdrawn..)
103
A different kind of event: Hurricane Katrina
More dislocation
Return to pre-Katrina reality even more uncertain than in New York
Main issue more like a “loss of place”
104
A different kind of event: Hurricane Katrina
Multiplication of disadvantage: the worst hit were poor African-Americans and Latinos.
105
Kessler on hurricane katrina
50% of New Orleans had an anxiety or mood disorder 5 months after Katrina; 25% for people hit in other areas.
This rate was three times higher than the rate found from the same areas sampled in the NCS-R.
106
Kessler on hurricane katrina
But: lower suicidality in the post-Katrina group than in the NCS-R group.
Why? Optimism about resolution of problems in living…
107
Kessler on hurricane katrina
Very long term path to reconstruction and return to original residence or areas --- but they have changed also:
Not the same place..?
108
Kessler on hurricane katrina
Most studies of disasters show that the recovery profile for mental health lasts 1 to 2 years.
But the consequences may also be more short-lived …
109
Kessler on hurricane katrina
A detour or a new journey?
PTSD is also unique: it can grow over time, slowly..
chronic stress - dislocation, lack of funding for infrastructure
not the same place after even if they returned
110
Measures assessed
K6 is a special 6 item distress questionnaire, that maps to the chances of having a depression or anxiety disorder.
Trauma Screening Questionnaire for PTSD… next slide
111
Measures assessed
Suicidal ideation – thinking about suicide, plans, and attempts over the last 12 months.
Hurricane-related stressors : 29 questions , including death of a loved one, life threatening event happened to the respondent, homelessness, physical impairment resulting, financial strain, dislocation…
112
Measures assessed
Closely related to overall stress rating, so they use that..
113
Some results
The percent with any anxiety / mood disorder did not change over the 18 month follow-up – from 5 month to plus a year later --- the effect persisted.
But: serious mental illness increased in prevalence
PTSD increased in the New Orleans sub-sample
Suicidality is significantly higher at follow-up than at 5 months after.
114
Some results
Hope doesn’t last without encouraging news.
There are some obvious predictors of increasing response:
Older age for PTSD; youngest for suicidal ideation
115
Some results
Lower income – thus selected on individual social class
Living in a different place
More chronic stress that persists to follow up had a major impact on mental health responses:
116
Some results
Serious or greater stress: 35 x the odds of SMI
Serious of greater stress: 13 x the odds of PTSD
Estimates of effects here much stronger than in many previous surveys of disasters. Why?
117
Some results
Broad spectrum impact on lives: lives completely redefined – loss of jobs, home, maybe family or friends, familiar networks, identity.
118
Some results
Things slow to get better: chronic stress matters
| Can’t undo what was done -- a consistent problem in evaluating the consequences of macro-level stress.
119
Some results
life redefined by that day
lost job, home, family/friends, lost familiar networks
comes down to how do you rebuild an identity?
120
Some results
things were slow to get better
ppl underwent chronic stresses
can’t undo what was done
