HELPING OTHERS

by Irina Kagan, teacher at the Harmony Institute of Psychotherapy and Victor Kagan, professor, and vice president of the Independent Psychiatric Association of Russia

[This is a brief summary of the third part of their article.]

There are three possible approaches to helping people who survive stress. The first is to improve medical assistance overall: the search for new drugs, the organization of special clinics, consulting rooms, rehabilitation centers, and so forth. This is very important, but the authors do not consider this approach to be the only good way, for the following reason. There is evidence that the stress trauma itself accounts for only about 40% in the development of poststress disorders. The other 60% - is the result of adaptation strain afterwards, and a social rather than a medical approach is the way to combat this kind of tension. It helps a person to hold his or her ground -- find a job with a decent wage and a dwelling place. Finally, there is the approach of psychological support -- the authors give major attention to this -- which helps a person surviving stress to live in harmony with him or herself and with other people, and helps in realizing his or her abilities and in developing as a personality.

These three approaches must be in the right balance. The authors draw on their experience working with a team of men who cleaned up at Chernobyl after the nuclear power-station accident. These people received a comparatively low dose of radiation, they were put under steady medical observation, and they got sufficient social support. But since they did not receive the necessary psychological support, five to eight years later the psychological condition of most of the men from that group had greatly worsened.

On the whole, psychological support must come not from professionals - psychologists or psychiatrists -- but from people who are close to stress survivors, that is to say, family, relatives, and friends. There are a lot of pitfalls along the way, the main one being one's wish to resolve all problems with one blow. Some helpers act themselves instead of allowing the stress victim to do so or act together with him or her but in a wrong manner, wherein the helper treats the victim as a small child and takes over all responsibility for actions and behavior, as though the person cannot do anything by him or herself. Overcare and overtutelage can have the opposite effect of stimulating protest and the desire of the survivor to avoid this kind of help. Sometimes another result is that the person concludes that he cannot do anything without some help.

Another type of pitfall is a "frontal attack". The helper tells the stress survivor what he should and should not do. Any instructions, warnings, attempts to appraise his actions (even positive ones) put the stress survivor into the position of a child or subordinate whose behavior a parent or chief has the right to evaluate.

Talking is an intricate and strong instrument. It is very important not only what you say but how your partner apprehends it. There is a vast literature about this subject and also about what is known as "nonverbal" dealings with other people, meaning such things as intonation, loudness of voice, poses, gestures.

Encourage the person to discuss his or her feelings and emotional experiences. Although very painful, it will help the person look into his emotions as he moves away from them. Stress emotions are normal feelings about abnormal situations. Do not be afraid to speak about your own feelings and your sadness about what happened to the person. Each stress survivor has his or her own opinion why it happened. Your opinion might be quite different but do not impose it. The earlier and the better we help each other overcome stress, the less the possibility of later disorders requiring a psychologist or psychiatrist.

The authors highly evaluate the "debriefing" process which was developed in the US military in the l970's and is now widely used, wherein the participants in stressful events get together on the day after and discuss with the help of specialists the event and their feelings and experiences related to it. They could be policemen after carrying out a difficult job, firemen after extinguishing a dangerous fire, hostages just released, or survivors of natural disasters.

Life is impossible without stresses. The question is how to deal with them in such way that stress will, at the very least, not destroy us and hopefully will make us stronger and wiser.