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Book Forum: Diagnosis and Management of Specific Disorders   |    
Trauma and Disaster: Responses and Management
LAURA L. POST, M.D., Ph.D.
Am J Psychiatry 2004;161:1319-1319. doi:10.1176/appi.ajp.161.7.1319
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Edited by Robert J. Ursano, M.D., and Ann E. Norwood, M.D. Arlington, Va., American Psychiatric Publishing, 2003, 169 pp., $34.95 (paper).

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In this post-9/11 era, as the world struggles to cope with novel and unanticipated forms of attack on the existence and practice of multiple cultures, the field of disaster preparedness has very rapidly expanded. This small paperback, part of volume 22 of the American Psychiatric Publishing’s Review of Psychiatry series, provides a concise overview of existing trauma responses and several concrete suggestions for system-wide improvements in known protocols.

The primary subdivision of the book is somewhat unexpected in that neurobiological mechanisms of reaction to and psychiatric epidemiology of psychologically devastating events comprise the first two chapters and discussion of the World Trade Center attacks does not emerge until chapter 3. I would have placed the topical issue at the beginning and developed symptoms and statistics subsequently. The final two chapters properly address early intervention strategies and the role of organized mental health in helping the populace deal with the ever-present threat of weapons of mass destruction.

Other than the aforementioned relatively minor quibble, this volume is quite helpful, if basic. In keeping with other offerings in this notable series, this text draws on the formidable resources of experts within this professional arena to describe how the human organism answers when stressed to the point of distress: chemically molecularly to group-wise; in adults and subadults; acute and chronic manifestations; and individual vulnerabilities and resiliences. In a readily accessible and logical manner, the ideas flow in a workmanlike way, touching on familiar concepts such as the notion that previously traumatized individuals will most likely be those most immediately requiring clinical intervention on exposure to fresh trauma and the assertion that the greater the global loss, the greater the injury to the population. The pragmatisms that chaos disrupts young children more than mature individuals and that family-focused interventions are most beneficial, although worth revisiting, are also not radical.

Most of this straightforward book reiterates, within a sensible framework, abstractions known to practitioners treating survivors or involved in government debriefing teams. The most applicable sections are in chapter 5, which is the most technical. I would have liked more evidence-based discussion of real obstacles to smoothly synchronized implementation plans, such as catchment areas inhabited by persons speaking multiple languages, geographically inaccessible regions, or remote rural jurisdictions in which total infrastructure collapse might predictably occur. Cutting-edge theoretical competence notwithstanding, the proof of this pudding will be in the numbers reached and effectively counseled and not in the cognitive abilities of the responders.

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