Harry C. Holloway

Psychological impact of the animal-human bond in disaster preparedness and response.

The authors present an overview of the impact of the animal-human bond on disaster management and highlight the need to further examine the relationship of animals and humans in disaster response. The human connection to animals influences compliance with individual and community evacuation plans. Search and rescue teams with canine units confront physical and emotional demands that affect both handler and animal. The culling of animal populations on a scale such as occurred during the recent foot-and-mouth epidemic in the United Kingdom affects every member of rural society. Livestock farmers and their families endure enormous emotional losses, and veterinarians and government officials who must implement these programs suffer as well. A familiarity with and understanding of these issues is important for psychiatrists and other mental health professionals who are involved in disaster preparedness and response.

Telemedicine and international disaster response: Medical consultation to Armenia and Russia via a telemedicine spacebridge

UNLABELLED The Telemedicine Spacebridge, a satellite-mediated, audio-video-fax link between four United States and two Armenian and Russian medical centers, permitted remote American consultants to assist Armenian and Russian physicians in the management of medical problems following the December 1988 earthquake in Armenia and the June 1989 gas explosion near Ufa. METHODS During 12 weeks of operations, 247 Armenian and Russian and 175 American medical professionals participated in 34 half-day clinical conferences. A total of 209 patients were discussed, requiring expertise in 20 specialty areas. RESULTS Telemedicine consultations resulted in altered diagnoses for 54, new diagnostic studies for 70, altered diagnostic processes for 47, and modified treatment plans for 47 of 185 Armenian patients presented. Simultaneous participation of several US medical centers was judged beneficial; quality of data transmission was judged excellent. CONCLUSION These results suggest that interactive consultation by remote specialists can provide valuable assistance to on-site physicians and favorably influence clinical decisions in the aftermath of major disasters.

The Vietnam Veteran: Memory, Social Context, and Metaphor

Post-traumatic stress disorder has become a syndrome of particular importance in the study of the Vietnam veteran. The symptoms of this disorder highlight the role of memory in psychiatric disorders. In this paper, case studies are presented to illustrate the active generative role of memory and the importance of the role of social context and metaphor in understanding memory. This perspective has significance both for clinical work with the Vietnam veteran and for future research on this population.

Disasters: Psychologic responses in health care providers and rescue workers

Health care providers and rescue workers are often the hidden victims of trauma. To investigate the psychologic responses of these groups to traumatic stress, we studied health care and rescue workers involved in the 1989 air show disaster at Ramstein Air Force Base, Germany. We review reports from descriptive questionnaire data. The reports identified two types of disaster experience that were prominent: exposure to the grotesque, and no participation in the disaster relief efforts. Responses to debriefing are examined. The reports identified three characteristic responses: identification, sense of helplessness and inadequacy, and psychologic distancing. Further empirical study of these areas is needed.

Book Essays and Reviews

The editors of Psychiatry are committed to reviewing books of interest to the community of professionals that deal with the human condition and its biology, psychology, anthropology and sociology. Reviewers are encouraged to develop points of interest to the interdisciplinary community of the readership of Psychiatry. Harry C. Holloway, M.D. Professor of Psychiatry and Neuroscience Book Review Editor, Psychiatry: Interpersonal and Biological Processes

Coping with HIV Disease in the Army

This chapter discusses challenges inherent in helping soldiers cope with HIV infection. We describe the history of HIV disease in the military and the development of a special HIV ward at the Walter Reed Army Medical Center. Ways in which we assist soldiers to adapt to the constraints of HIV infection are explored.

Training Issues in Combat Psychiatry

Training Directors of Army Residency Programs must ensure that their graduates are not only clinically competent, but also knowledgeable about the aspects of their specialty unique to the practice of military medicine. Psychiatrists, in particular, must be prepared for the unique demands of both the peacetime field environment and the combat environment.

Pandemics: Health Care Emergencies

Introduction Pandemics have a global reach of mass destruction and historically have been more devastating than any other type of disaster. Over many centuries, only the humanmade disasters of war and the intentional extermination of ethnic groups have competed with the lethality of infectious disease outbreaks. Th e history of the infl uenza pandemic – occurring about every 10– 30 years – has marked global reach and concern for mass illness, chronic disability, and death. In centuries past, this concern included the plague, polio, tuberculosis, and smallpox. Th e Spanish Infl uenza pandemic of 1918– 1919, during which an estimated 20– 40 million people died (more people than died in World War I), is a reminder of the deadly potential of this global disaster ( http:// virus.stanford.edu/ uda/ ). Th ough prevention, early detection, and treatment interventions appear to be lowering the number of people infected, there has been a steady rise in human infectious disease outbreaks over the past three decades (Smith et al., 2014 ). In the past decade alone, outbreaks of Severe Acute Respiratory Syndrome (SARS), H1N1 “swine” Infl uenza, and Ebola resulted in significant concern throughout the international community. Middle East Respiratory Syndrome (MERS) and, more recently, the Zika virus have caused signifi cant morbidity and mortality. Th ese outbreaks all represented signifi cant threats to global health security and highlighted the mental health issues that are relevant to a pandemic outbreak. Expanding world populations produce urbanization with increased population density that favors disease transmission, and climate change modifi es global ecologies that infl uence the likelihood of transmitting infectious organisms (Morse, 1995 ). Th e largescale migration of animals and people creates a growing public health concern of epidemic risk. Th e global mobility of people and various disease vectors are primary mechanisms by which new infectious agents spread rapidly to a population with no previous exposure and no immunity, bringing disease vectors (e.g., certain species of mosquitoes) to new environments. Th ese factors have been essential elements in the genesis of all global infectious disease outbreaks since the turn of the century. For example, at the time of the Hajj each year in the 12th month of the Islamic (lunar) calendar, more than one million people travel to Mecca – nearly half from nonArab countries. Similarly, for the smaller ritual Umrah, more than 2.5 million traveled in 2004 to Mecca. Th is mass migration raises the potential for major public health and infection control problems (Ahmed et al., 2006 ). Other times of human migration – holidays and vacations – and the “human migratory patterns” are routes of transmission as well. Pandemics and other infectious disease outbreaks result in psychological stressors and behavioral responses. Unlike other natural or humanmade disaster events, infectious organisms cannot be perceived with the naked eye. Most people do not know they have been impacted until they are infected with potentially lethal consequences. Th e protracted and evolving nature of these events can result in escalating worry and distress. Like other disasters, the media plays a signifi cant role in shaping public perception. Trust in government authorities and perceptions regarding their ability to manage an outbreak directly impact the degree to which the public participates in health risk behaviors designed to avoid infection, treat illness, and prevent spread of disease. Th e use of infectious outbreaks to inspire fear by political fi gures, community leaders, and the media to further unrelated agendas has colored the overall experience of these events by the population. Th e ability of governments to eff ectively respond is complicated by the fact that infectious diseases may fi rst emerge during political unrest, revolution, or war. Empirical data is more limited regarding the mental health impacts of pandemics than for other Pandemics: Health Care Emergencies

All My Friends Are Dead, by Avery Monsen and Jory John

This is a cartoon-with-captions book, about the size of your hand, that concerns the universal and ambiguous nature of death, aging, loss, transformation, and friendship-small book, big topics. Some will observe how clever it is. Others may praise the way it cuts through defenses like denial, avoidance, isolation, and rationalizing. Others may experience it as insensitive to the sense of fearful expectation and the experience of loss that accompanies aging and approaching death, and being a transient survivor. Those who deal with the challenge of loss and death, by utilizing the assurances provided by dogmatic beliefs and faith, may be offended by the approach represented here. Does the authors’ use of humor, clever cartoons, and art and design, combined with allegory, paradox, and ironic connections, provide enough pleasure to facilitate the management of rage and hopelessness captured in this book? Will the book prove to be instructive and helpful for some? It does encourage a meditation on the challenges presented by the inevitable, universal experience of loss and loneliness that confound all that live and are sentient. Grim, yes; and yet I confess I found the book original and amusing. At age 77, after having taken care of many friends and strangers as they lost their capacities and later died, the paradoxes highlighted here seem like a mix of old friends and old enemies. The boundary between these categories is not very distinct for me. Considering the usual categories, this raises a question for this review. This is a book for the general reader. It contains no analysis of clinical experience. There is no data validated here by scientific examination. So, should this book be reviewed in Psychiatry? This is a metaphoric and artistic book that intends to entertain and to challenge thought in its readers. The authors leave to our imagination who those readers should be. Perhaps the authors think everyone should experience their book, with its combination of verbal and visual metaphors and stimuli. However, caregivers for people dealing with the problems associated with death and disability (e.g., the families and medical staff caring for the elderly or HIV patients) need to consider whether this book might be of value. They may want to examine it as a stimulus to thought and feeling as they examine their role as caregiver and the needs of their patients. It is worth noting that control of medical costs will inevitably depend on how the structure of the social network and the medical care system assists individuals and families in managing the problems of the last year of life. Perhaps the material presented in this book will help caregivers build better holding environments for those who face nearterm loss of health or life. The reduction in anxiety and fear may facilitate the development of a more rational care plan for dealing with the opportunities and vicissitudes of that last year. As suggested, some may not find the approach of this book helpful. Many of my dying patients--and some of my colleagues (particularly those in the habit of taking what they hear and read very literally)--may experience this book as making fun of the very difficult plight of the elderly or others threatened with death. I doubt that this book will be helpful to them. I think I would have used this book in my case conferences with oncologists (both on staff and in training) and other medical staff caring for patients threatened with se-

Interpersonal Psychotherapy and Neuroscience

iors requires discipline and training. While David McKenzie Rioch understood that not a believer in a particular analytic approach, dogma, and the acceptance of wishful thinkDavid was convinced that developing one’s ing, would always be more reassuring to most skills of observation and reporting in collabopeople than a disciplined operational process ration with a supervisor was essential to develfounded on the careful conceptualization of a oping the skills of a true participant–observer. problem. Such a process uses strict measurable In David’s scientific world there were parameters to formulate a problem, followed both explorers and scientists, each fulfilling by experimentation to accept or reject assumpsomewhat different roles. Explorers are obtions. David was attracted to Chestnut Lodge servers who seek out experiences that occur from Washington University in St. Louis by in the uncontrolled real world. They make Dexter Bullard’s, Harry Stack Sullivan’s, Frieda observations and report those observations as Fromm-Reichmann’s, and their talented colaccurately as they can. Their narratives are leagues’ serious interest in understanding the frequently emotionally and cognitively comtransactions between the patient and the phypelling and may be formulated in language sician. He was impressed that these colleagues that seems operational.Unfortunately, explornot only described how the patient manifested ers frequently lack control over chance events and illness, but also how the actions of physicians can misperceive the elements of experience, influenced the ways in which the patientmaniso that their report contains sociocultural asfested illness. He recognized that the therapist sumptions, illusions, and errors. Still, these as a participant–observer could not achieve reports may have great credibility with various the control available in the laboratory, nor the practitioners of the healing arts. Explorers do same operational analytic power. But David their work in the world where healers practice saw the participant–observer as critical to the and patients live and suffer. operational explication of science, the formuScientists work in a more protected enlating of useful questions and the description vironment and attempt to formulate the probof phenomena, which challenged often-misleadlems that interest them in terms of strictly