Tuesday, March 22, 2011

The triple disaster in Japan, “Root Shock” and the route to Psychosocial Well-being

By Joseph O. Prewitt Diaz[1] PhD

In 2004, while planning for the psychosocial response in the tsunami affected countries of South Asia I became aware of the term “root shock” (Fullilove 2002) to explain the experience of disaster affected people after the tsunami. Today once again we revisit the term, as we try to make sense of the effect of the triple disaster experienced by the Japanese people.
The traumatic stress reaction experienced by the Japanese as a result of the massive destruction of their emotional ecosystem is best explained by the term “root shock”.  Fullilove (2002) indicates that root shock has important parallels to the physiological shock experienced by a person who, as a result of injury, suddenly losses massive amounts fluids. Such a blow threatens the whole body’s ability to function. Shock is the fight for survival after a life-threatening blow to the body’s internal balance (p. 11).
The disaster-affected people have a way of maintaining the external balance between themselves and the world. This way of moving in the environment maximizes the odds that the person will survive predators, find food, maintain shelter, and live in harmony with family and neighbors. When the external system of protection is damaged the disaster-affected person will go into root shock (Fullilove, 2002, p.11)
In the immediate aftermath of the tragedies, the support and direction from the first responders, in the form of providing shelter, food and ensuring shelter will stabilize the situation. But the experience of root shock does not end with the emergency phase, but will stay with the disaster affected people for a lifetime.
Five basic principles that have received broad empirical support for facilitating positive  adaptation following trauma guided the selection of PFA strategies and techniques: (a) promoting sense of safety, (b) promoting calming, (c) promoting sense of self- and community efficacy, (d) promoting connectedness, and (e) instilling hope (Hobfoll et al., 2007).

Promoting a sense of safety.  As much as possible bring the disaster affected people to a secure place. Help them understand that they are safe and are being cared for to assure their safety.  Provide timely and accurate information so that threat, and the perception of threat can be reduced. Educate parents and caregivers to monitor the type and amount of information being shared with their siblings so as to assure security.

Promoting a sense of calming. Engage the disaster-affected people in activities that may alleviate their concerns. Provide information regarding the well being of family and friends. Provide psycho education regarding the typical reactions to disasters, that these reactions are typical and normal. Suggest activities that will reduce anxiety and stress regarding incident specific new fears. 

Promoting self- and collective efficacy. Provide resources so that the loss cycle can be reversed. Involve disaster-affected people in decision making activities and rebuilding efforts. Promote activities that are planned and implemented by the community such as religious activities, and collective healing and mourning rituals. Promote activities in the affected community that encourage the well-being of the people. Assist community members in planning, and implementing rebuilding projects, and activities that restore order. Have the community members share their hope for the future and identify activities where they can volunteer and share of their goods, resources, and skills.  Include children and adolescent in the planning and implementation of community recovery activities.

Promoting connectedness.  Provide the mechanism for disaster-affected people to identify and establish links with loved ones. Facilitate reconnection of children with parents and caretakers. Increase the quantity, quality, and frequency of supportive transactions between disaster-affected people and the support systems. Address negative social influences through community wide activities.

Instill hope.  Provide services to disaster-affected people such as housing, employment, relocation, and replacement of household good, and clean-up kits. In as much as possible bring community groups together so that they can plan and implement the rebuilding of the community. Identify and assist those who lack strong support, who are likely to be more socially isolated, or whose support system might provide undermining messages. In cases of evacuation and destruction of homes and neighborhoods, or where informal social support fails, make it a priority to keep individuals connected,  and train people how to access support.

Re-establishment of Place as a tool CBPSP
The major activity of psychosocial support after a disaster to is begin community mobilization activities that will begin to re-establish place. The objective is to engage the disaster-affected people in a set of exercises that will identify vulnerabilities, resources and the adaptive capacities of the community. All affected people should become engaged in a dynamic and context oriented process to determine how internal conditions impact the response to the disaster. The disaster affected people explore:  (a) which behavioral components of a community weakens the ability to respond to the disaster sequalae, (b) what behavioral characteristic help the community to respond to the disaster, and (c) what are the communities abilities to change their behaviors to cope better with actual and anticipated social, psychological and ecological stressors.

 Community based psychosocial support as a platform for recovery supports rebuilding of local economies that allow individuals to resume their daily vocational activity, and prevent ongoing resource loss cycles. Existing community groups should be engaged in establishing systems that enable those in recovery from similar traumas to share their experience and hope with those struggling with recovery, accepting that their lives and their environment may have changed, and making more accurate risk assessments.

Fullilove, M.T. (2002). Root Shock. New York: Ballentine.
Hobfoll, S.E.  et al.(2007). Five essential elements of immediate and mid-term mass trauma intervention: Empirical evidence. Psychiatry, 70(4), 283-315.
Prewitt Diaz, J.O. (2011). Psychosocial support for disaster affected people:
An overview of a program to enhance resilience and improve well-being in disaster affected people. Rio Piedras: University of Puerto Rico Press.

[1] Dr. Prewitt Diaz is a humanitarian psychologist who served as the Functional Advisor for psychosocial support with the American Red Cross in the aftermath of the 2004 Tsunami in South Asia. He is the recipient of the 2008 APA International Humanitarian Award

1 comment:

  1. Nice article explaining the 'root shock' and five remedial measures.Congrutulations for putting it before us.


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