To cope with the psychological fallout of the Persian Gulf war, mental health professionals are mobilizing a wide range of resources, from military family support groups to special pamphlets on stress in children.
"We have learned something from Vietnam, Korea and World War II," said John M. Hamilton, deputy medical director of the American Psychiatric Association. "We know the majority of casualties will be psychiatric -- people in combat, the families and friends of those in combat and people in the general population who feel the stress."
Thanks to television, the reality of combat has invaded people's living rooms with images of missile strikes, wounded civilians and captured U.S. pilots. "The nation is in a collective anxiety attack," said New York psychologist Ellen McGrath, president of the American Psychological Association's division of psychotherapy. "This is more of a psychological war than ever before -- a TV war."
"The better prepared we are . . . , the less psychological damage there will be," said Andrew Baum, a professor of medical psychology and psychiatry at the Uniformed Services University of the Health Sciences.
The mental health community's response to the war involves a variety of initiatives -- grass-roots and national, public and private -- that have proliferated since the U.S. and allied forces attacked Iraq nearly two weeks ago. They include pamphlets, hot lines and support groups, as well as referral networks for professional care. A sampling:
The American Red Cross, with 2,700 chapters, is helping to provide psychological support for affected families, often filling in the gaps in Department of Defense family service programs. In Lexington, Ky., more than 100 local residents are in a family support group set up by the Bluegrass chapter, while several hundred military family members are attending three support groups organized by the Canton, Ohio, chapter. The Ohio Psychological Association is recruiting local psychologists to work with the Red Cross in the state.
Many of the more than 500 affiliates of the National Mental Health Association, the nation's largest volunteer mental health group, are organizing support groups and other projects to help families cope. Last week, the group met with leading mental health organizations and military representatives for advice on preparing a new information packet on the war's psychological impact.
The American Psychological Association's division of psychotherapy, working with a nonprofit Arizona group called Project ME, Inc., rushed into print last week a guide for teachers and professionals on "How to support our children during Operation Desert Storm." It is one of numerous efforts to help children and families deal with the crisis. The APA is producing another brochure aimed at the general public.
Using a model recently developed in North Carolina, the American Psychiatric Association is asking psychiatrists at U.S. medical schools to assess the need and help coordinate private psychiatric referrals in areas hardest hit by wartime deployments.
The psychiatry division of Community Hospital North in Indianapolis set up a telephone "sounding board," with trained counselors, for Indiana residents to vent their emotions about the war. It is one of many 24-hour mental health hotlines around the country responding to war-related calls.
Community mental health centers readied their staffs to respond to increased concern about the war. One frightened patient at the New Haven-based Connecticut Mental Health Center, run by Yale University and the state, equated the war with Armageddon and the end of the world, said psychiatrist Howard Blue, director of the center's entry and crisis service.
The American Jewish Congress in New York plans to send a volunteer group of psychologists and psychiatrists to help Israelis cope with the daily threat of Iraqi attack.
U.S. military hospitals prepared for psychological as well as physical casualties. At the Department of Veterans Affairs Medical Center in West Haven, Conn., Vietnam vets who suffered "post-traumatic stress disorder" have volunteered to be "buddies" for returning Persian Gulf personnel, said chief of psychiatry Dennis Charney. Every patient admitted to the hospital will be screened for psychiatric problems.
The potential psychological impact will be greatest on the 474,000 American troops in Operation Desert Storm, particularly those in combat. Roughly 15 percent of Vietnam veterans experienced serious "post-traumatic stress disorder," said Susan D. Solomon, chief of violence and traumatic stress research for the National Institute of Mental Health.
The families and friends they left behind are also vulnerable to a kind of secondhand post-traumatic stress disorder, says Solomon. "The longer it goes on, the harder it is. Chronic stress is very debilitating."
Tucson child psychologist Dennis D. Embry notes that the impact on families is potentially greater since nearly 60 percent of the men and women deployed in the Persian Gulf are married, compared to only about 15 percent in the Vietnam War. There are 1.8 million children under 13 who are the dependents of active duty military personnel, noted Embry, the executive director of Project Me, Inc., and author of several psychological workbooks on the war for military families and schools.
Beyond immediate family members, the likelihood of a personal connection is quite high. A recent Washington Post-ABC News poll found that nearly 50 percent of those surveyed said they had a close friend or relative in the military stationed in the Gulf.
But, with blanket television coverage of the war, there is almost universal exposure to traumatic events, like the missile attacks on Israel and Saudi Arabia, as they unfold. "One of the incredible things is we're all practically there. We're seeing it as it happens," said Solomon. "We're used to a capsule version of the news, all cleaned up and distilled. This makes it much more real."
"This war is having an impact on people's mental lives and part of it is the information overload, the immediacy. We are all vulnerable to added stress," said Yale University psychiatrist Bruce Wexler.
People across the country are experiencing a variety of responses, with the severity often dependent on a person's emotional status prior to the war and the degree of personal threat they perceive. Signs of stress can include sleep disturbances, appetite changes, trouble concentrating, increased irritability, feelings of helplessness, anger, increased alcohol or drug use and increased problems in personal relationships. Children may act out their concerns with behavior changes at school or home.
If changes persist, a person may have crossed the line from a normal reaction to a problem in need of professional help, said psychologist McGrath.
If the Persian Gulf war becomes a long-term conflict, the psychological impact may "become more devastating for some, while others begin to go about life pretty much unaffected," said psychologist Brian Flynn, emergency coordinator for the National Institute of Mental Health.
He noted that "the vast majority of people will respond normally to what is an abnormal situation, while a small percentage will go on to develop a diagnosable problem. In a crisis, most people come out healthier and stronger than when they went in."
Where to Get Help
A community helpline, staffed by mental health professionals from George Washington University Medical Center, is taking calls about stress and other war concerns. 202-994-7775. 5-7 p.m. Monday-Friday. It is sponsored by GW and WJLA-TV.
The National Mental Health Association Information Center has a brochure on handling stress and referrals to local mental health associations. 1-800-969-NMHA. 9 a.m.-5 p.m. Monday-Friday.
For help dealing with children and the war, call 1-800-735-KIDS, 24 hours a day, seven days a week. Counselors from Century HealthCare Corp., in conjunction with Project ME, will provide information on ordering the American Psychological Association guide for schools and self-help workbooks for children of military families. ADD @ART: + @STORY TYPE: + @NAME: + @ORGANIZATION: + @BIO: + @ENHANCEMENT: + @SUBJECT: + @EDITION:f + @SECTION:z + @PAGE:z13 + @COLUMN NAME: + @SERIES NAME: + @SERIES NUMBER: + @HEADLINE: + @BYLINE: + @CREDIT: + @DATELINE: + Tactics to Manage Anxiety Strategies for coping with heightened stress vary, but mental health experts advise:
1. It's okay to be afraid, anxious or sad. Confront your fears, write them down, talk about them.
2. Seek support from family, friends, church, work or groups of people with similar concerns. Get professional help if the problem persists or magnifies.
3. Resume normal routines. Reduce television consumption to a reasonable level. Do something to express your feelings about the war -- write letters of support, blood donations or protest. But make time for recreational activities that help relax your mind and body.
4. Be sensitive to those who may be psychologically vulnerable: those close to someone serving in the Gulf; those with ties to Israel or to Arab countries; those with previous war problems or preexisting mental illnesses; those who recently lost a loved one or suffered a major loss unrelated to the war; and children, who are receiving their first exposure to war.