Occupational Stress and Peacekeepers

In the words of former UN Secretary-General Perez de Cuellar, 'peace-keeping involves the deployment of military personnel by the United Nations ...to use their international status and military skills...to help the parties control and eventually resolve their conflicts' (foreword to The Blue Helmets, 1990, p xvi). In detail, it involves:

If originally the plan was to create an independent standing military force to ensure the compliance of member countries with Security Council directives, instead the member countries empowered Secretary General to request them to provide personnel for such assignments, and to contribute on an agreed basis to the financial costs. The service became operational in 1948, and in its first 22 years it responded to 54 requests for assistance (United Nations Department of Public Information, 2000, p.1).

From the outset, the very existence and deployment of peacekeepers was a matter of contention. Political scientists questioned the legitimacy of the mandates they were given (Bertram, 1995), pacifists strove to get politicians and strategists to resolve issues through peaceful means before rather than after armed conflict (Suter, 1995), and pragmatists tried to clarify the criteria for the deployments, the priority of issues to be addressed, the selection of countries to supply personnel, the size and ethnic mix of the contingents, the duration of different deployments, the additional training and support the peacekeepers should receive, the logistics and finance ^{(See Endnote 1)} to sustain their operations, the multi-national and multi-linguistic chains of command, and the evaluation of their efforts.

Amid such a confusion of roles, functions, and marginal support, it is not surprising that for many years there was no stipulated programme for the selection, training, and follow-up evaluation of peacekeepers and their performance ^{(See Endnote 2)}. Instead in the beginning, military personnel that had been selected and trained to fight with weapons either to defend themselves or to advance the territorial ambitions of their Governments were left to their own devices. They did not necessarily have the required interpersonal skills for establishing ground rules for dialogue between bitter opponents for whom truce was often a brief interlude in an historical saga of mutual combat, nor any training in conflict resolution, mediation, moral persuasion, and community restoration, together with practical experience in unraveling complex cultural and political tensions. They were also not necessarily fluent in foreign languages and sensitive to the different religious beliefs and customs of the cultural groups they encountered, and they might not previously have come across first hand the duplicity of politicians whose actual ideological commitment and self-interest was often at variance with that which they declared. Nor necessarily were they imbued with the high international ideals that might help them identify with the command structure of a large amorphous and remote multi-national organisation like the UN to which they had been assigned.

Initially their specific task, with the consent of the parties in conflict, was to act impartially and to use force only in self-defence – in short, their main job was simply to open the road for political peacemakers, while personally being at best at risk either of being ignored, or at worst of being injured, taken hostage, or killed. The hope was that their neutrality, and paradoxically their readiness to intervene forcefully, would command respect and enable them to use non-violent means to calm the belligerence of warring factions ^{(See Endnote 3)} .

Once the conflict situations between warring factions became less volatile, it was clear that the peacekeeping job of dealing with turbulent civilian populations was more akin to that normally performed by the Police. In these circumstances the UN began to recruit contingents of Police for the humanitarian and resettlement functions of peacekeeping, and at the end of year 2000 when 15 peacekeeping operations were in existence, some 7 310 civilian Police were on active duty with 30 690 Military personnel (United Nations Department of Public Information, 2000, p.1) ^{(See Endnote 4)} .

However, if the uniformed services managed to collaborate, serious clashes arose between the systems of authority, control, and co-ordination of the peacekeepers and the humanitarian aid-agencies that impeded the efficiency of both kinds of organisation (Gordenker, 1999, Ch.1). Invariably a multitude of dedicated aid-dispensers from different agencies arrived in post-conflict situations with their own pre-determined short-term programmes, and while requiring the protection of peacekeepers they acted with a degree of initiative that at times seemed to border on the incomprehensible to those accustomed to more orthodox chains of command.

In the latest appraisal of such organisational chaos, Whitman (1999) ^{(See Endnote 5)} affirmed that the normal role for peacekeepers on active service was difficult, and he considered it became even more so when

In these circumstances it is not surprising that peacekeepers often satisfied nobody but became scapegoats for criticism from all quarters. Their job was also increasingly fraught with danger, with the records showing that from 1948 to 2000 they incurred 844 fatalities, of which 814 occurred in the last decade, some 286 – i.e. 35.14% - were caused by hostile action (United Nations Department of Public Information, 2000, p.10). But it also has to be said that at times their own severe indiscipline attracted opprobrium ^{(See Endnote 6)}

Training and Application

In 1994 the UN created a Peacekeeping Operations/Training Unit to remedy the unacceptable situation and prepare peacekeepers for the difficult work they faced (United Nations, 1995). The Unit soon became aware of the psychological risks of peacekeeping, and advised different countries to present their potential peacekeepers with ‘accurate, appropriate, sensitive, and pragmatic’ information, and to take ‘utmost care to avoid rigid generalisation or the application of purely pedagogical, professional or personal concepts of what constitutes a normal v abnormal response to the unique problems that plague’ them. It warned that peace-keepers might experience three broad types of psychological strain (United Nations, 1995, Pt. 2): the first being from the typical occupational stressors, discomforts, and deprivations of active service assignments in foreign cultures and climates, the reactions to which vary according to a complex of factors involving personal vulnerability, group cohesion, family situations and support, and routine counter-measures for self-management. The second, arising from the cumulative effect of occupational strain that is too heavy, could lead to ‘flame-out’ if too acute, or could lead beyond distress to exhaustion and burn-out if long-lasting. The third, and often the most severe type with symptoms that could be either mild or severe in form, either immediate or delayed in onset, and either of short or long in duration, arising from either the direct experience of some extraordinary life- threatening or horrific event, or the close identification with someone who has had just had such an experience.

The UN Training Unit made no estimate of the proportion of peacekeepers that might fall into each of the three groups, but it thought the number sufficient to seek a range of self-help and peer-supporter remedies for the first two categories, and the help of health professionals for the third. It also emphasized that any traumatic stress counseling must ‘never embarrass, antagonize, humiliate or be the source of additional misery to an already over-stressed peacekeeper’ (United Nations, 1995 p. 3). But it was ready to discuss such matters, as well as to conceptualize stress as an interaction between the strain imposed and the ability of peacekeepers to respond with the training and support available (private communication, Col. Peter Leentjes 16 January 1996: Taylor, 2002).

However, despite the best endeavours of the Training Unit and the careful attention paid to the performance of peacekeepers, the continuing inability to fulfill the often impossible mandates led the Secretary-General to appoint a panel ‘to offer frank, specific and realistic recommendations’ for ways in which to enhance the capacity of UN peacekeeping operations’ (Report of the panel on United Nations peace operation. 2000, p. iii – the ‘Brahimi Report’).

The outcome led to a comprehensive and speedy review that addressed issues of policy, strategy, field operations, and supporting organizational infrastructure (Comprehensive Review of the whole question of peacekeeping operations in all their aspects. 2001, UN A 55/977). With refreshing candor the Brahimi Report drew attention to the central bureaucracy’s organizational deficiencies, and the need for a ‘doctrinal shift’ in the use of civilian police in a team approach to upholding the rule of law and respect for human rights. It chided parties in conflict for being not seriously committed to ending confrontation, and criticized the UN for making ‘best-case’ planning assumptions for countries exhibiting ‘worst-case’ behaviour. It highlighted many tasks that peacekeepers should not be asked to undertake and described many situations to which they should not be sent, and it criticized peacekeepers for being reluctant to differentiate between victims and aggressors.

In the light of that Report, Secretary-General Kofi Annan (2000, pp. 28-31) reaffirmed the multidimensional challenges for peacekeepers as:

The Brahimi Report also led Annan to establish a separate Peacebuilding Support Office to coordinate inter-agency cooperation on a wide range of issues, the lack of which was found to be behind so much armed conflict and would inevitably reappear after initial peacekeeping operations had restored the semblance of order. The aims of peacebuilding were to prevent the resurgence of conflict, to create the conditions necessary for sustainable peace in war-torn societies, and to recognize the complexities involved in the process of ‘democratization’.

Accordingly, the latest UN statement shows that the original two categories of peacekeeping – i.e. a) small groups of unarmed officers monitoring ceasefires, verifying troop withdrawals, and patrolling borders or demilitarized ones, and b) armed contingents acting as a buffer between parties – have been extended to cover the present complex operations of combined military and civilian staff ‘mandated to help create political institutions and broaden their base, working alongside governments, non-governmental organizations and local citizens’ groups to provide emergency relief , demobilize former fighters and reintegrate them into society, clear mines, organize and conduct elections and promote sustainable development practices.’(UN Peacekeeping in the service of peace, 2003).

Psychological Studies

Despite the thinly veiled public perception of role ambiguity, conflicting demands, external threats to peacekeepers, and at times their own indiscipline, until the mid 1990’s peacekeeping received little attention from health professionals and researchers. For example, Gal and Mangelsdorff (1991) in their most recent and otherwise comprehensive textbooks of military psychology was silent on the topic except for one brief mention by Taylor (1991), and Wilson and Raphael (1993) in their comparable study of traumatic stress said nothing. Similarly an on-line database search of Current Contents, Medline, and PsychLIT in January 1996 yielded only Birenbaum’s (1994) description of peacekeeping, and Suedfeld and Granatstein’s (1995) application of the Integrative Complexity Scoring technique to biographical material in a single-case study of a peacekeeper. And a Sociofile web search about the same time produced only 7 abstracts on various attitudinal, emotional, and mental effects of peacekeeping, five of which were from the same University of Maryland research group. However, subsequently Litz (1996), McDonald, Chamberlain, Long and Mirfin (1996), and Weisaeth, Melhlum, & Mortensen (1996) made up some of the deficit.

Taken chronologically, in the first of those abstracts Moskos (1975) referred to the ‘constabulary ethic’ and military professionalism adopted by officers from seven countries serving in Cyprus. In the subsequent batch, Segal, Harris, Rothberg, and Marlowe (1984) differentiated between the ‘action-orientation’ and the ‘constabulary ethic’ of US paratroopers in the Sinai; Segal and Meeker (1985) commented on the professional attitudes of troops in their acceptance of peacekeeping duties; Harris and Segal (1985) drew attention to their boredom from ‘underutilization, cultural deprivation, lack of privacy, and loss of control of personal time and space’; and Meeker and Segal (1986) to the experience of ‘low-intensity’ military operations which helped them to discriminate between different levels of current combat. Following this, Segal, Furukawa, and Lindh (1990) confirmed the importance of training peacekeepers to recognise the ‘low-intensity’ combat component of their missions. Finally, Stretch (1990) surveyed 121 Canadian peacekeepers with previous experience in the Vietnam War, and found a minority to have developed symptoms of posttraumatic stress disorder ^{(See
Endnote 7)} .

Then Litz (1996) drew attention to the changing face of peacekeeping from the benign to the extremely stressful, and warned that exposure to the increasingly dangerous conditions created a ‘unique class of potentially traumatizing events’ for which effective interventions should be developed. The same year McDonald, Chamberlain, Long and Mirfin (1996) presented the features of New Zealanders deployed as peacekeepers, and they related them to the duration, tension, and volatility of particular missions. For front-line peacekeepers as distinct from those in more settled areas, difficulties arose from having to remain neutral in the face of strong provocation, being frustrated through witnessing atrocities and being unable to intervene, being unfamiliar with having civilian women and children as casualties, with the retrieval and disposal of human remains of civilians, and with the distribution of food to the hungry. But even then, only about 3% of them peacekeepers were found to be in need of clinical referral, and and at greatest risk were the inexperienced, the younger and the immature personnel from dysfunctional family backgrounds. Also, as typical of personnel on many overseas postings, there was evidence of heightened anxiety in many before and after the postings – the one caused by apprehensions about the uncertain task ahead in the field, and the other about readjusting to personal relationships and family resettlement afterwards when back home.

The same year Weisaeth, Melhlum, & Mortensen (1996) presented a six-year follow-up study of a stratified sample of nearly 16 000 Norwegian soldiers former peacekeepers. They made the point that working abroad was not the problem for their countrymen and women, but witnessing atrocities, and being subjected to harassment without the right to retaliate. As the authors said, ‘in a nutshell the traditional soldier expects war and gets peace, but the UN peacekeeper expects peace and gets war’. While the vast majority of the Norwegians completed their service as planned, some 3.3% or 530 individual had to be repatriated for medical, social or disciplinary reasons, with a higher percentage of them recording symptoms of PTSD and accident-proneness than their controls. They found these adverse reactions comparable to those reported by Canadians, French, Dutch, and American peacekeepers, but not from a Swedish contingent in Cyprus. Overall they commented that among the more severe stressors were the lack of military structure, the multi-national teams, disparity between the age and military rank of some personnel, the task of investigating civilian casualties, searching for bullets in dead bodies, and being targeted when unarmed.

Such studies demonstrate that in the last decade the interest of clinicians and researchers in peacekeeper stress has grown, but their output remains modest in comparison with that of clinicians who were concerned with other groups under different types of stress. For example, on 18/3/2003 a web search on ‘peacekeeping and stress’ brought only 34 entries on Medline, 41 on Currentcontents, 120 on Sociofile, and 459 on PsychLit. But in comparison, the word ‘stress’ brought an astronomical figure on Currentcontents that exceeded the allowable display, 214,716 entries on Medline, 7,351 entries on Sociofifle, and 31,120 on PsychINFO (the successor to PsychLit)! In the ensuing year the differences remained.

Standing out from a sample of recent clinical appraisals, was the Shigemura and Nomura (2002) review that reiterated the paucity of attention given to the psychiatric problems of peacekeepers. They referred to the ‘peacekeeper’s stress syndrome’ that Weisaeth had identified in 1979 as ‘rage, delusion and frustration, feelings of impotence and helplessness when confronted with violence and atrocities to which the peacekeeper is unable to respond’. They also highlighted the Bartone, Adler, and Vaitkus 1998 study of peacekeeping operations that nominated isolation, ambiguity, powerlessness, boredom, and threat/danger, as the major dimensions of psychological stress, and they used the term ‘rudimentary’ to describe the prophylactic and therapeutic programmes that had been designed to manage the condition.

Other recent papers to command attention were those by Segal, Read and Rohall (1998) and Kaffes (1998). In the first paper, with his colleagues Segal continued his long-term interest in peacekeeping by comparing the attitudes of the regular forces as compared to the reserves, and confirmed that while both kinds of soldier felt that peacekeeping was appropriate military work, the reserves had more of the desirable ‘constabulary attitudes’ than the regulars. For his part Kaffes (1998) dwelt on the ‘non-military use of the Greek Army for which training in sociology had been introduced.

If more researchers were attracted to the topic, they might care to reflect on the industrial/organisational models of behaviour in which responsible employers work with their employees to improve staff selection, provide appropriate training, and apply group support techniques to maintain efficiency (Cartwright & Cooper, 1996) ^{(See Endnote 8)} . The analogy would help them to understand that in the best of scenarios employers work with employees to reduce potential hazards where possible, minimise exposure to hazards that remain, monitor individual performance before/during/and after exposure, and prepare interventions for restoring the equanimity of those whose responses are less than satisfactory (cf. Health & Safety in Employment Act 1992 & Amendment 2000 in New Zealand).

Conceptually and pragmatically, employees bring to the equation their abilities, aims, ambitions, capacities, cultural beliefs and values, defensive styles, personality characteristics, education, expectations, experience, histories, and training. Their personal environment provides the sum total of their physical and socio-cultural frameworks of demands and expectations, and their employment environment provides the necessary organisational support for them to accomplish the output. The dynamic interactions generate a level of performance that can range from providing satisfaction to inducing traumatic stress. It follows that such stress can be defined as the substantial imbalance between demands that are made and the ability of individuals to respond with the support available.

The Brief Talking Cures

If at one time the military displayed its ignorance by punishing the vulnerable, and even sentencing them to death for cowardice if they were in an extreme state of emotional shock from combat stress, it has come to develop more appropriate ands sophisticated types of psychological intervention. Since the pioneering work of Rivers (1918) in World War 1, the therapeutic focus after successive major campaigns has been on eliciting perceptions of terror (Marshall, 1944 - 1982 reprint: Williams, 1983: Jones, 1985; Martin & Belensky, 1993). The purpose is to allow fragments of traumatic events to be expressed, reprocessed, integrated and transferred from the non-declarative to the declarative stores of memory (van der Kolk, 1994). To some extent all of the studies just mentioned, used strategies of proximity, immediacy, and expectancy ^{(See Endnote 9)} in the talking treatments together with the restoration of group and community bonding to support the recovery of affected individuals (Glass, 1969: Milne, 1979: Hoiberg & McCaughey, 1982).

For example, Marshall (1944-1982 reprint) was a military historian who initiated a procedure called Historical Group Debriefing, in which he required combatants from the front-line to make a combined, comprehensive, and detailed chronological reconstruction of their stressful experiences. The elucidation generated what was called a helpful ‘spiritual purge’ – but no doubt had Marshall the resources, and a less volatile situation in which to monitor the more specific psychological, psychophysiological, and psychosomatic after-effects of debriefing, he might have found similar improvements on those more objective measures as did Pennebaker and Susman (1988) in their later University-based laboratory debriefing study of civilians who had suffered a variety of extreme life stress experiences.

Williams (1983) was a nurse whose clinical experience and theoretical knowledge of traumatic experience led her to think that the intrusive and recurrent thoughts, nightmares, and flashbacks experienced by many Vietnam Veterans served as an ‘adaptive pathway’ until they were able to give better account for the losses, the atrocities, and their actions in guerilla warfare.

David Jones (1985) was an US Airforce neuropsychiatrist who used the mnemonic BICEPS to describe the key elements of those post-combat trauma interventions – i.e. Brevity, Immediacy, Centrality, Expectancy, Proximity, and Simplicity – the implications of which are readily understood, except for Centrality that concerns the need to bring individuals together in a setting away from a hospital to dispel any fear of their being stigmatised as ‘patients’. Martin and Belensky (1993) were military historians who applied the Marshall technique with tank crews that had been involved in a tragic front-line accident in the 1991 Gulf War, and they described how the immediate and collective recall of events had beneficial effects.

Intervention Results

According to Hales, Cozza, and Plewes (1991) the global outcome of the BICEPS debriefing procedure reduced the incidence of US psychiatric casualties from 101 per 1 000 troops in WW2, to a remarkable 12 per 1 000 in Vietnam, and, when special Combat Stress Teams (CST) were assigned to debrief combat divisions in the field during Operation Desert Storm, to a phenomenal 2.7 per 1 000. O’Brien (1994) also confirmed the value for other nations of having mental health teams available in war zones for the early treatment of acute stress disorder, with reported recovery rates between 60-90% and a small unspecified number of later relapses.

However, when using more specific criteria and a sophisticated rating-scale method to measure the outcome with a small group of British military body-handlers after that same Gulf War, Deahl, Gillham, Thomas, Searle, and Srinivasan (1994) found no significant differences between those who had received psychological debriefing and those who had not. Yet using similar rating-scales, Shalev (2000) found to the contrary that Marshall’s Historical Group Debriefing technique reduced the levels of anxiety in the most anxious in a group of 39 Israel soldiers involved in border skirmishes in Lebanon, and it raised the levels of self-confidence in the least confident.

Discrepant results not uncommonly arise from different research projects, and they challenge social scientists to seek explanations in terms of differences in the models, aims, design, methods, parameters measured, samples, scope, types/ times/ and duration of intervention, skill of the therapists, use of comparative controls, follow-up appraisals in the studies (cf. Zeidner & Endler, 1996, part 2). In short, it is unreasonable to think that trauma counseling of any sort is a standard medicine to be applied to everyone regardless of need. Were it to be used so indiscriminately, for some it would be quite unnecessary, and for others it would create antagonism, confusion, and bring complications in the form of secondary traumatisation imposed by the would-be therapists: McNally, Bryant, and Ehlers (2003) intimated as much after their comprehensive appraisal of the effects of critical incident stress debriefing in the wake of the September 11 2001 bombing of the World Trade Center in 2000 in which the provision of such services seems to have been excessive.

But a single study has yet to be designed to assess the effects of psychological debriefing in such a way as to satisfy conventional methodological criteria (cf. Raphael, Lundin, & Weisaeth, 1989: Raphael, Meldrum, & McFarlane, 1995). As a result there is endless controversy among clinicians and researchers, some of whom might be prejudiced for the psychological as distinct from the biological components of human behaviour (or vice versa).

In fairness, it has to be said that psychological debriefing was construed originally as a preventive rather than a therapeutic measure, particularly as applied routinely to emergency personnel after assignments. But whatever the aims, there is a substantial weight of evidence to show that the typical one-session debriefing after a traumatic event is clinically ineffective (van Emmerik, Kamphuis, Hulsbosch, & Emmelkanp, 2002). With regard to that matter, Orner, King, Avery, Bretherton, Stolz, & Ormerod (2003) found that coping and competence rather than psychopathology and dependency were the focus of emergency personnel in the aftermath of exceptional incidents. Their respondents listed their preferred adjustments as ‘wait and self-monitor changes in evoked reactions’, ’rest and relaxation’, ‘find relief from somatosensory sequelae’, ‘re-establish personal routines and sense of subjective self control’, and ‘graded confrontation of memories of critical event’.

As a result, the Department of Health in Britain (Guidelines Development Group, 2001, s. 3.15) went far as to say that ‘routine debriefing shortly after a traumatic event is unlikely to help prevent post traumatic stress disorder and (it) is not recommended’ – but they make no reference to Foa and Meadows (1997) who reached much the same conclusion about the application of a number of more orthodox therapies to PTSD, nor to the regrettable history of a number of organic therapies that seemed to have had the most flimsy of justifications when they were confidently introduced (Surawicz, & Ludwig, 1980), nor to the great number of patients each year that are admitted to hospital as a result of wrong or inappropriate medical treatments (Davis, Lay-Yee, Briant, Schug, Scott, Johnson, & Bingley, 2001) and for whom in the US the Agency for Healthcare Research and Quality has launched a monthly web-based medical journal. None-the-less, it has to be admitted that a comprehensive study of the major issues involved in early psychological intervention is far from encouraging.

Yet others defend the practice of psychological debriefing vigorously (if primarily because of the positive self-reports it engenders from the participants), and they declare deficient the strategies and procedures their critics use to examine the effects (Dyregrov, 1998: Everly & Mitchell, 2000).

In some quarters, the tone of the debate is reminiscent of the many fierce interchanges about the efficacy of psychotherapy that took place between behaviourists and humanists that have since subsided – the latest summary of which is that interventions seem to do the most good and the least harm if practiced by mature therapists with a keen sense of professional concern and accountability (cf. Seligman, 1995: Sherman, 1999). Parry, in her preface to the report of the Guidelines Development Group (2001) on the topic, makes the point that researchers have yet to moderate ‘the most prevalent interventions’ that are ‘more pragmatic and eclectic… with a judicious mix of techniques drawn from varying theoretical frameworks…(as distinct from)…‘standardised interventions of pure types of therapy’.

A sage might say much the same for the outcome of early post-traumatic treatment procedures that have received appropriate scrutiny, been applied with discretion, monitored in their application, modified to suit individual needs, and followed-up to ensure that no complications arose to require further attention. Certainly such a conclusion would be consistent with the policy adopted by the Australasian Critical Incident Stress Association (1999), and with reviews on the subject by Litz, Gray, Bryant, & Adler (2002) in the United States, and the Professional Practice Working Party on Debriefing (2002) in Britain. For its part, the World Health Organisation (2003, p.4) went so far as to say that ‘most mental health problems during the acute emergency phase were best managed without medication following the principles of ‘psychological first aid’ (i.e. to listen, convey compassion, assess needs, ensure basic physical needs are met, do not force talking, provide or mobilize company from preferably family or significant others, encourage but do not force social support, protect from further harm)’.

However, practicing health professionals cannot rely exclusively on any such authority, because they are obliged under their ethical codes to be accountable for the treatments they prescribe. In fulfilling their obligation they could expect their research-minded colleagues to offer their help, so long as the consultants did not use the gold standard of trials with clinically and psychometrically robust methods of assessment of specified conditions, randomly allocated trial and control groups, and independently applied follow-up procedures (Lizt, Gray, Grant, & Adler, 2002, Future research: Point 1) – the application of which might bring rigor mortis rather than more rigor in the procedures under review – whereas a more relaxed alternative would seem to allow compromise according to the ‘non-laboratory’ circumstances presented (cf. Cox, 2002). Certainly the most comprehensive review of empirical research on such post-disaster intervention points to the need for ‘carefully conceived and theory driven studies of basic processes that are longitudinal in design…with more collaboration between researchers and practitioners who think ‘ecologically and design and test societal-and community-level interventions for the population at large and conserve scarce clinical resources for those most in need’ (Norris, Friedman & Watson, 2002a; 2002b). Subsequently Norris became involved in the design for a study of the aftermath of the impact of terrorist attacks on the civilian population in America for the US Office for Behavioral and Social Sciences Research (2003) that might give a lead for other researchers. Similarly Hoge, Engel, Orman, Crandell, Patterson, Cox, Tobler, and Ursamo (2002) prepared a promising 17item questionnaire for the use primarily with employees and the military at Pentagon after the 9/11 terrorist attack on their building, but it has yet to be applied to those that took part in the brief and pragmatic debriefing programmes developed to help their recovery (cf. Military Medicine, 2002).

Research Orientation

The worst that can be said about the debriefing controversy is that it either represents an evangelical creed (cf. Gist & Woodall, 1998) or a vestigial remnant of medical hegemony, and the best that it reflects the position of different researchers on the epistemological spectrum – a reconsideration of which led Seligman (1995) in an appraisal of the effects of counseling and psychotherapy, to ignore the various individual/social/and organisational vulnerabilities and buffers of stress, and simply to differentiate between those researchers with either a subjective orientation who sought to establish effectiveness, or an objective orientation who sought to establish efficacy. The effectiveness seekers are those who feel obliged to conduct studies which, as in real life, allow their respondents some choice over the kind of help they prefer for as long as they think necessary – while the interveners, also as in real life, retain the right to exercise their professional judgment with regard to the focus and intensity of their procedures – n ot that consumer preferences and satisfactions, nor the modification of procedures, are necessarily the determining features of satisfactory intervention, but that in the absence of evidence to the contrary, they are factors to be considered.

The efficacy seekers, on the other hand, are those who feel obliged to hold fast to the application of pre-determined operations and procedures to randomly selected traumatised clients for times specified in advance, simply to comply with the routine specifications of conventional research protocols.

Thus following Seligman, the appraisal of a given form of post-traumatic stress debriefing might depend more on the qualitative changes for the better in the behaviour of individuals, than on the quantitative changes of their measurable responses. Conceivably the appraisal might even depend on a combination of both the qualitative and the quantitative, with a combination of non-parametric techniques for the evaluation of reflective discourse analysis (Parker, 1992) and of conventional parametric techniques for the processing of numerical data. Such methods of data gathering and handling would appear suitable for use with the proposed Joseph, Williams, and Yule (1995) cognitive-behavioural model for the integration of key psychosocial stress factors to determine a) the appraisal of specific stressors, b) the particular perception and reappraisal of them in the light of previous associations and current search for meaning, and c) the measurement of personality attributes, significant emotional states, and particular coping activities adopted.

Among such a cluster of variables, the search for meaning is an important subjective existential drive that Frankl (1964) applied successfully to help himself tolerate the daily trauma of his concentration camp existence. Subsequently from his association with similar victims, Antonovsky (1987) invoked the concept of a sense of coherence (SOC) to account for the survival themes of comprehensibility, manageability, and meaningfulness in their lives. He used comprehensibility to refer to the cognitive sense that individuals made of their traumatic situations, manageability to the extent to which they found resources to meet the excessive demands being made of them, and meaningfulness to their ability still to construe life as emotionally challenging and worthy of investment despite the horror and torture they had experienced. Such triumph over adversity has yet to capture the attention of researchers, although Tedeschi, Park, and Calhoun (1998) have made an impressive start.

Final Observations

While the Brahimi Report on peacekeepers spurred UN to prepare further standard protocols of stress management and systems of delivery (cf.http://www.un.org/depts/dpko/training/sgtm/sgtm.htm), the hope is that more psychologists in the clinical, community, environmental, health, organisational, and political divisions of the discipline will lend a hand. For example they could help to operationalise and monitor the key behavioural and environmental variables of peacekeeper service, help to design and apply interventions to maximise positive peacekeeper response, and perhaps even help to make the operational environments for peacekeepers more conducive to satisfactory outcomes. Their endeavours might also answer some of the outstanding clinical questions that obtain generally about what kind of debriefing is appropriate for what kind of people with what kind of histories who have encountered what kind of trauma. In the process they might also begin to consider broader questions about the functional prerequisites of society that rarely appear in the curricular of psychology courses.

The prospect should be a stimulus and a challenge for academic, applied, and research psychologists who cherish accountability in the quality of their post-trauma work, as well as for those who want to underpin their practice with robust research and theory.

References

Annan, K.A. (2000). Preventing war and disaster: A growing global challenge. New York: United Nations.

Antonovsky, A. (1987).Unravelling the mystery of health: How people manage stress and stay well. San Francisco: Jossey-Bass.

Australasian Critical Incident Stress Association. (1999). Glenelg Declaration: Guidelines for good practice for emergency responder groups in relation to early intervention after trauma and critical incidents. pp.11.

Bartone, P.T., Adler, A.B., & Vaitkus, M.A. (1998). Dimensions of psychological stress in peacekeepiong operations. Military Medicine, 163, 587-593.

Bertram, E. (1995). Reinventing governments - the promises and perils of United Nations peace building. Journal of Conflict Resolution, 39, 3, 387-418.

Birenbaum, R. (1994). Peacekeeping stress prompts new approaches to mental health. Canadian Medical Association Journal, 151, 10, 1484-1489.

Cartwright, S., & Cooper, C.L. (1996). Coping in occupational settings. In M. Zeidner & N.S. Endler. (Eds.). Handbook of coping. (pp. 202-220). New York: Wiley.

Comprehensive Review of the whole question of peacekeeping operations in all their aspects. 2001, UN. A 55/977.

Cox, S. (2002). Tools and techniques for evaluating psychological debriefing. In Professional Practice Working Party. Psychological debriefing (ch.3). Leicester: British Psychological Society. pp. 76.

Davis, P., Lay-Yee, R., Briant, R., Schug, S., Scott, A., Johnson, & Bingley, W. (2001). Adverse events in New Zealand Public hospitals: Principal findings from a national survey. Occasional Paper #3: Wellington NZ: Ministry of Health. pp.88.

Deahl, M.P., Gillham, A.B., Thomas, J., Searle, M.M., & Srinivasan, M. (1994). Psychological sequelae following the Gulf War – factors associated with subsequent morbidity and the effectiveness of psychological debriefing. British Journal of Psychiatry, 165, 60-65.

Diagnostic & Statistical Manual 111R. (1987). Washington DC: American Psychiatric Association.

Diagnostic & Statistical Manual VI TR (2000). Washington DC: American Psychiatric Association.

Dyregrov, A. (1998). Psychological debriefing – An effective method? TRAUMATOLGYe, 4:2, Article 1 - http//www.fsu.edu/~trauma/

Everly, G.S., & Mitchell, J.T. (2000). The debriefing 'controversy' and crisis intervention: A review of lexical and substantive issues. International Journal of Emergency Mental Health, 2, 4, 211-225.

Foa, E.B., & E.A, Meadows. (1997). Psychosocial treatments for post traumatic stress disorder: A critical review. Annual Review of Psychology, 49, 449-480.

Frankl, V. (1964). Man's search for meaning: An introduction to logotherapy. trans. Ilse Lash. (revised & enlarged). London: Hodder & Stoughton.

Gal, R., & Mangelsdorff, A.D. (Eds.). (1991). Handbook of military psychology. New York: Wiley.

Gist, R. & Woodall, J. (1998). Social science versus social movements: The origins and natural history of debriefing. Australasian Journal of Disaster and Trauma Studies, 1. http://www.massey.ac.nz/~trauma/issues/1998-1/gist1.htm

Glass, A.J. (1969). Introduction. In P.G. Bourne. (Ed.). The psychology and physiology of stress. (pp. xii-xxx). New York: Academic Press.

Gordenker, L. (1999). Clash and harmony in promoting peace. In J. Whitman. (Ed.). Peacekeeping and the UN Agencies. London: Frank Cass.

Guidelines Development Group. (2001). Treatment choice in psychological therapies and counselling: Evidence based clinical practice guideline brief version. London: Department of Health.

Hales, R.E., Cozza, K., & Plewes, J.M. (1991). Normality in the military. In D. Offer & M. Sabshin. (Eds.) The diversity of human behavior. (pp. 121-163). New York: Basic Books.

Harris, J.J., & Segal, D.R. (1985). Observations from the Sinai: The boredom factor. Armed Forces & Society, 11,2, 235-248.

Health & Safety in Employment Act 1992, & Amendment 2000. Wellington: Government Printer.

Hoge, C.W., Engel, C.C., Orman, D.T., Crandell, E.O., Patterson, V.J., Cox, A.L., Tobler, S.K., & Ursano, R.J. (2002). Development of a brief questionnaire to measure mental health outcomes among Pentagon employees following the September 11, 2001 attack. Military Medicine, 167, Supplement 4, 60-63.

Hoiberg, A. & McCaughey, B.G. (1982): Collision at sea: The traumatic aftereffects. Report 81/39. San Diego: Naval Research & Development Command. pp.25.

Jones, D.R. (1985). War psychiatry: Combat stress-related disorders. USAF School of Aerospace Medicine, Brooks AFB, Texas. Private circulation. pp. 9.

Joseph, S., Williams, R., & Yule, W. (1995). Psychosocial perspective on post-traumatic stress. Clinical Psychology Review, 15, 6, 515-544.

Kaffes, G. (1998). The necessity of teaching sociology in the Military Academy: The Greek example. Sociology Express. Abstr.

Litz, B.T. (1996). The psychological demands of peacekeeping for military personnel. National Center for PTSD Clinical Quarterly, 6, 1 accessed 17 July 2003 from http://ncptsd.org/publications/cq/v6/n1/litz.html

MacDonald, C., Chamberlain, K., Long, N., & Mirfin, K. (1996). Psychological effects of peacekeeping deployments on military personnel. Palmerston North, NZ: Massey University. pp. 77.

McNally, R.J., Bryant, & Ehlers, A. (2003). Does early psychological intervention promote recovery from Posttraumatic stress? Psychological Science in the Public Interest, 4, 2, 45-79.

Marshall. S.L.A. (1944-1982 reprint). Island victory: The battle of Kwajalein. Washington, DC: Zenger.

Martin, J.A. & Belensky, G.L. (1993). Operation Desert Storm: After action stress debriefing. Unpublished paper presented to Military Testing Association, Williamsburg, VA. pp. 6.

Meeker, B.F., & Segal, D.R. (1986). Soldiers' perceptions of conflict intensity: The effects of doctrine and experience. American Sociological Association paper.

Milne, G. (1979). Cyclone Tracy: Psychological and social consequences. In J.I. Reid. (Ed.). Planning for people in natural disasters. (pp. 116-123). Brisbane: University of Queensland Press.

Mitchell, J.T., & Everly, G.S. (1993). Critical incident stress debriefing. Ellicott City, MD: Chevron.

Moskos, C.C. (1975). UN peacekeepers: The constabulary ethic and military professionalism. Armed Forces & Society, 1, 4, 388-401.

Norris, F.H. (2002). Assessing the effects of the attacks on America. Office of Behavioural and Social Science Research, October 15. http:www.obssr.od.nih.gov/Activities/911/attack.htm - accessed 5 May, 2003.

Norris, F., Friedman, M.J., & Watson, P.J. (2002a). 60 000 disaster victims speak: Part 1. An empirical view of the empirical literature. Psychiatry, 65, 3, 207-239.

Norris, F., Friedman, M.J., & Watson, P.J. ( 2002b). 60 000 disaster victims speak: Part 11. Summary and Implications of the Disaster Mental Health Research. Psychiatry, 65, 3, 240-260.

O'Brien, L.S. (1994). What will be the psychiatric consequences of war in Bosnia ? British Journal of Psychiatry, 164, 443-447.

Orner, R.J.,King, S., Avery, A., Bretherton, R., Stolz, P., & Ormerod, J. (2003). Coping and adjustment strategies used by emergency services staff after traumatic incidents: Implications for psychological debriefing , reconstructed early intervention and psychological first aid. Australasian Journal of Disaster & Trauma Studies, 1. http://www.massey.ac.nz/~trauma/issues/2003-1/orner.htm

Parker, I. (1992). Discourse dynamics: Critical analysis for social and individual psychologists. London: Routledge.

Pennebaker, J.W., & Susman, J.R. (1988). Disclosure of trauma and psychosomatic processes. Social Science & Medicine, 26, 3, 327-332.

Professional Practice Working Party. (2002). Psychological debriefing. Leicester: British Psychological Society. pp. 76.

Raphael, B., Lundin, T., & Weisaeth, L. (1989). A research method for the study of psychological and psychiatric aspects of disaster. Acta Psychiatrica Scandinavica, 80, suppl.353.

Raphael, B., Meldrum, L., & McFarlane, A.C. (1995). Does debriefing after psychological trauma work ? British Medical Journal, 310, 1479-1480.

Segal, D.R., Furukawa, T.P., & Lindh, J.C. (1990). Light infantry as peacekeepers in the Sinai. Armed Forces & Society, 16, 3, 385-403.

Segal, D.R., Harris, J.J., Rothberg, J.M., & Marlowe, D.H. (1984). Paratroopers as peacekeepers. Armed Forces & Society, 10, 4, 487-506.

Segal, D.R., & Meeker, B.F. (1985). Peacekeeping, warfighting and professionalism: Attitude organization and change among combat soldiers on constabulary duty. Journal of Political & Military Sociology, 13, 2, 167-181.

Segal, D.R., Reed, B.J., & Rohall, D.E. (1998). Constabulary attitudes of the National Guard and regular soldiers in the US Army. Armed Forces & Society, 24, 4, 535-548. Abstr.

Seligman, M.E.P. (1995). The effectiveness of psychotherapy: The Consumer Reports study. American Psychologist, 50, 12, 965-974.

Shalev, A. Y. (2000). Stress management and debriefing: Historical concepts and present patterns. In B. Raphael & J. P. Wilson, (Eds.) Psychological Debriefing: Theory, Practice and Evidence. (pp. 17-31). UK: Cambridge University Press.

Sherman, J.J. (1998). Effects of psychotherapeutic treatment for PTSD: A meta-analysis of controlled clinical trials. Journal of Traumatic Stress, 11, 3, 413-435.

Shigemura, J. & and Nomura, S. (2002). Mental health issues of peacekeeping workers. Psychiatry & Clinical Neurosciences, 50, 5, 483-491.

Stretch, R.H. (1990). Effects of service in Vietnam on Canadian Forces Military personnel. Armed Forces & Society, 16, 4, 571-585.

Suedfeld, P., & Granatstein, J.L. (1995). Leader complexity in personal and professional crises - concurrent and retrospective information processing. Political Psychology, 16, 3, 509-522.

Surawicz, F.G., & Ludwig, A.M. (1980). Miscellaneous organic therapies. In H.I. Kaplan, A. M. Freedman, & B. Sadock. (Eds.). Comprehensive textbook of psychiatry. (vol 3, sec.31.8). London: Williams & Wilkins.

Suter, K. (1995). UN peacekeeping operations – what is going wrong ? Conference paper, Auckland University, 28 June. pp. 7.

Taylor, A.J.W. (1991). Individual behaviour in extreme situations and environments. In R. Gal & A.D. Mangeldsdorf. (Eds.). Handbook of Military Psychology. (pp. 491-505). New York: Wiley.

Taylor, A.J.W. (2002). The clinical concept of traumatic stress: The 2002 Hudson Lecture. New Zealand Journal of Clinical Psychology, 12, 4, 12-17.

Tedeschi, R.G., Park, C.L., & Calhoun, L.G. (Eds.). (1998). Posttraumatic growth: Positive changes in the aftermath of crisis. Mahwah NJ: Lawrence Ehrlbaum Associates.

The Blue Helmets: A review of United Nations Peace-keeping . 2nd edn. (1990). New York: United Nations.

United Nations. (1995). Tips for trainers: Stress management for United States peacekeepers. New York: DPKO/Training Unit. pp. 37.

United Nations Final Report on the in-depth evaluation of peace-keeping operations: Start-up phase. E/AC.51/1995/2. (1995). New York: Committee for Programme Coordination. (1995).

United Nations Department of Public Information. (2000). United Nations peacekeeping from 1991-2000: Statistical data and charts. 77889-DP 1/2175. December 10-M. pp.10.

United Nations Economic and Social Council. (1995). Programme questions: Evaluation. E/AC. 51/1995/2. New York. pp. 33.

van der Kolk, B.A. (1994). The body keeps the score: Memory and the evolving psychobiology of posttraumatic stress. Harvard Review of Psychiatry, 1, 5, 253-265.

van Emmerik, A.A.P., Kamphuis, J.H., Hulsbosch, A.M., & Emmelkamp, P.M.G. (2002). Single session debriefing after psychological trauma: a meta analysis. The Lancet, 360-771.

Weisaeth, L., Mehlum, L., & Mortensen, M.S. (1996). Peacekeeper stress: New and different? National Center for PTSD Clinical Quarterly, 6, 1 accessed 17 July 2003 from http://ncptsd.org/publications/cq/v6/n1/weisaeth.html

Whitman, J. (Ed.). (1999). Peacekeeping and the UN Agencies. London: Frank Cass.

Williams, C.C. (1983). The mental foxhole: The Vietnam Veteran's search for meaning. American Journal of Orthopsychiatry, 53, 1, 4-17.

Wilson, J.P., & Raphael, B. (Eds.). (1993). International handbook of traumatic stress syndromes. New York: Plenum.

World Health Organisation. (2003). Mental Health in emergencies: mental and social aspects of health of populations exposed to extreme stressors. Geneva: Department of Mental Health and Substance Use Disorders.

Zeidner, M., & Endler, N.S. (Eds.). (1996). Handbook of coping. New York: Wiley.

Endnotes

Endnote: 1 However, a pie chart on page seven of the brochure gives the total sum of arrears as US$3.5 billion, and a list shows the United States to be at the top of the table as owing almost a third of this, but no mention is made of the indebtedness in the accompanying text.

Endnote: 2 A United Nations Final Report (1995, para 93) revealed that in 77 countries specialized training in peacekeeping was at only a minimal level for over 50% of the military personnel involved, while for 85% of civilians involved on such work the training was non-existent.

Endnote: 3 The complexity and enormity of peacekeeping gives little confidence that the job could be undertaken by private companies that are subject to the vagaries of a free-market economy - as currently seems to be suggested in some quarters.