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War Inflicts Broad Range of Mental Wounds

Discussion in 'News, Politics & Debates' started by anthony, Sep 3, 2006.

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  1. anthony

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    BEIRUT: Over the last three decades, the Lebanese people have grown accustomed to intermittent warfare interrupting their daily lives. Along the way they have also developed a famously thick skin to cope. As the country begins to piece itself back together again after yet another outbreak of war, its people will no doubt display their unparalleled resiliency. But like its predecessors, this conflict will inevitably take a heavy psychological toll.

    Post-traumatic stress disorder (PTSD), depression and drug and alcohol abuse immediately spike in any population after exposure to trauma, says Elie Karam, a leading psychiatrist and the head of the Institute for Development Research Advocacy and Applied Care (IDRAAC) in Beirut.

    Based on his studies of the relationship between war and mental health in Lebanon, Karam expects at least half the population in areas targeted by Israeli attacks to show short-term symptoms of PTSD, including edginess, depression, sleeplessness, loss of appetite and alienation from loved ones.

    Karam divides those who are psychologically impacted by the war into three groups: people with no history of mental health disorders who are suddenly exposed to trauma; those who are suffering from a psychological illness at the moment of exposure; or patients who have struggled with depression or mood disorders in the past but are in recovery at the time of the crisis.

    "If you fall [down the] stairs, some break [a] leg, some break [a] nail, some hemorrhage. The same thing happens with mental health," says Karam.

    Those with a history of mental illness are most vulnerable to reoccurrence when exposed to trauma, but everyone in affected areas is at risk of PTSD, he adds.

    "Flashbacks will occur against people's will, like a tape unfolding in their brain, showing them scenes that they experienced during the war. People become more distant and avoid their friends and family, and they startle very easily to sounds around them," he explains.

    Earlier research in Southern Lebanon conducted by IDRAAC showed that between 40 and 45 percent of young people in heavily exposed areas demonstrated acute symptoms within four to six weeks. Most recover within one year with limited treatment.

    IDRAAC offers counseling and support groups where trauma victims can share their experiences. But the institute holds off on pharmacological treatment. Karam only considers direct medical intervention for the 10 percent of the population who show signs of long-term mental illness.

    Though the prevalence of mental health disorders in Lebanon parallels that of Western Europe, the number of people receiving treatment is far lower. A 2002-2003 survey of mental health in Lebanon conducted by the World Health Organization concluded that 17 percent of respondents in affected areas suffered from a long-term mental illness - most of whom had experienced multiple war-related traumas.

    Less then half of this group sought some form of treatment, usually from general practitioners (85 percent). The rest went to religious or spiritual advisers, counselors, herbalists or fortune-tellers.

    But Karam insists that this is changing. The number of people calling IDRAAC's hotline has almost doubled over the past four weeks. He is working on assembling a crew of psychologists to offer direct counseling to people in affected areas, and to educate general practitioners about mental illness.

    Another indirect consequence of war is increased drug and alcohol abuse.

    Self-medicating pain is the most common reaction to trauma, according to addiction specialist Bob Lynne, who was hired by the government of the state of New Jersey, just across the river from New York, to design a treatment plan for addicts coping with PTSD after the September 11, 2001, attacks.

    "PTSD patients are continually re-exposed to the traumatic event through recollections that persistently interrupt their thoughts, actions and feelings, so they develop avoidance/numbing symptoms like drug and alcohol abuse to cope with intolerable emotions," he says.

    Often patients seeking treatment for trauma-induced mental disorders are also habitual drug abusers. Lynne says that more than 80 percent of Vietnam veterans exhibited symptoms of PTSD and addiction.

    Many people are unaware that they have a predisposition toward addiction until it is activated by a traumatic event. Furthermore, drug-dependent clients in recovery may be particularly susceptible to relapse as a result of trauma.

    "Trauma can easily push those with a potential for addiction into having a full-blown addiction. For others they are just self-medicating the pain. Understand that this is not that black and white and sits on a very broad continuum," says Lynne.

    Karine Yazbeck, a clinical psychologist at the Lebanese non-profit treatment and addiction center Skoun, says six new patients have enrolled since the center reopened in Beirut last week. Skoun, in turn, has increased its activities to three group-therapy sessions per week to accommodate the rise in demand.

    "Substance abuse patients have a very low threshold for stress, so some of the patients we've been treating for a while have relapsed from war," Yazbeck says.

    Many of Skoun's returning post-war patients have said that drugs were more available than ever during the hostilities because dealers were able to operate with relative impunity.

    Yazbeck says that addiction has become less of a dirty word lately, but adds that the mean age of their patients has consistently declined to 27 years old, most of whom are struggling to overcome addiction to heroine. Their susceptibility to relapse depends largely on how functional their lives are at the outbreak of trauma.

    The Beirut-based Umm al-Nour Rehabilitation and Drug Prevention Center treats clients with similar profiles.

    Mouna Yazigi, Umm al-Nour's general manager, says it is still too early to determine how many former patients have relapsed or the number of new-onset addicts due to the recent conflict.

    "We thought we would have a rush because young people would have trouble getting drugs and start experiencing physical withdrawal symptoms, but this never happened," she says.

    Yazigi says the center focused mainly on supporting the 75 girls and 16 boys who were already in the midst of treatment when the war started.

    "Addicts are the most at risk because they are sensitive and marginalized," she says. "We try to teach them that there is something to live for and that the world outside is a worthwhile place. This is difficult when people start dying outside."

    Source: Daily Star
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