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Book Reviews   |    
Trauma Practice in the Wake of September 11, 2001
Reviewed by Anthony T. Ng, M.D.
Psychiatric Services 2005; doi: 10.1176/appi.ps.56.2.225
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edited by Steven N. Gold and Jan Faust; Binghamton, New York, Haworth Press, 2002, 170 pages, $14.95 softcover

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In the aftermath of the horrific events of September 11, 2001, a tremendous body of literature has been written about the issues of the psychological sequelae of major traumatic events. Various papers have also described the more specific effects of the September 11 disaster. The Journal of Trauma Practice (JTP) compiled a special issue that focused on aspects of the September 11 disaster and on the effects of terrorism in general.

Trauma Practice in the Wake of September 11, 2001 pulls together some of the relevant articles from JTP, aimed at frontline clinicians who may be involved in providing postdisaster mental health care. The book is edited by Steven N. Gold and Jan Faust, who are both psychologists with tremendous trauma experiences. In addition, many of the book's contributors are renowned experts in the field of disaster mental health and terrorism, including Charles Figley, Jerrold Post, and Betty Pfefferbaum.

I was impressed by how the book addresses issues that are pertinent to the mental health clinicians who provide care in the acute to even subacute phases of disasters. The chapter by Charles and Kathleen Figley and James Norman provides a nice account of how the Green Cross Project, a disaster mental health organization, responded to the World Trade Center disaster. More uniquely, this chapter focuses on the operational aspects of delivering acute disaster mental health care. The chapter provides a detailed description of the Green Cross response, including the use of incident command structure, an emerging operational concept in the mental health community that has been in use for a long time by many emergency and disaster response entities. This chapter reinforces quite well that amid the chaos after a disaster, effective disaster mental health involves the knowledge of not only what to do but also how to deliver that care in an organized manner.

Another chapter that I found very poignant is J. Eric Gentry's description of compassion fatigue. Providing disaster mental health care is an extremely challenging and overwhelming experience for any mental health clinician. Much disaster mental health training was conducted after the events of September 11. However, without an appreciation of the danger of doing such work, any benefit provided by the work of disaster mental health clinicians is offset by the effects of adverse psychological sequelae on them.

The book also includes several interesting chapters, such as one that describes the effects of September 11 on people around the world. This chapter is in the format of interviews with various international clinicians and highlights the fact that traumatic psychological effects from disaster, especially on the scale of the World Trade Center, can and do resonate across cultural lines. There are also two chapters that describe the psychological effects on two populations that have been exposed to chronic violence, the Palestinians and the Israelis. Although an excellent chapter describes the effects of terrorism among children through illustration from the Oklahoma City bombing, perhaps including other special populations would have made this book more encompassing of issues encountered by disaster mental health clinicians.

The psychology of terrorists is reviewed briefly in the chapter by Jerrold Post, again in the format of an interview. Given that much of disaster mental health writing focuses on the effects of terrorism on the victims, it is important for clinicians to recognize what drives terrorists and what results terrorists are trying to accomplish in society with their actions. An appreciation of this question can help clinicians address special challenges encountered by victims and the community, including living under continuous threats and the altering of behavior under that threat. The only shortcoming of the chapter is that it could have addressed more directly how an understanding of the psychology of terrorism can complement the delivery of disaster mental health care. Finally, there is a chapter that discusses the findings from the use of cognitive processing therapy in the World Trade Center disaster.

In general, Trauma Practice in the Wake of September 11, 2001 is fairly easy reading. The chapters are nicely written and provide readers with some new perspectives on disaster mental health. The book highlights some relevant and practical information for any clinician who may be interested in providing disaster mental health care. All in all, Trauma Practice in the Wake of September 11, 2001 is a nice complement to any reader of disaster mental health literature.

Dr. Ng is chair of the American Psychiatric Association's committee on psychiatric dimensions of disasters and assistant professor of psychiatry at the Uniformed Services University of the Health Sciences in Bethesda, Maryland.




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