The civilian population of southern Lebanon has endured military conflict, civil war, and two invasions since the foundation of the State of Israel in 1948. Currently part of the south is under Israeli occupation forming a buffer zone between Israel and the hostile forces of the Hizbollah and Amal militias. The Israeli Defence Forces are aided by the South Lebanese Army which is the remnants of a Christian militia. The Hizbollah is supported by Iran and Syria and is the dominant force outside the occupation zone. In the south of Lebanon there is a United Nations mandate force which is attempting to return Lebanese government control over the south, decrease hostilities, protect the civilian population and provide humanitarian aid. This is part of the humanitarian mandate of the United Nations Interim Force in Lebanon (UNIFIL) that I had the opportunity to observe and to treat the mental health problems of the civilian population who were living under long-term artillery bombardment and living with continuous fluctuating conflict. Under such circumstances, rigorous scientific methodology in assessing the mental health of the population is extremely difficult. In order to operate effectively, as well as my own rudimentary Arabic, a translator was required. A translator does more than just translate language they also translate custom, culture and provide a valuable source of local information. Utilising my own observations and those of my valued translator, Basima, I did my best to assess how the civilian population coped with what was difficult circumstances. These assessments are value laden and I suppose are in many ways personal. My position as a military psychiatrist in the United Nations allowed me access to both the occupation zone and unoccupied Lebanon.
Low serum and urinary Cortisol has been a consistent finding in post traumatic stress disorder (PTSD). Glucocorticoid receptor numbers are increased. PTSD patients have a significantly lower adrenocorticotropic hormone (ACTH) in response to corticotrophin releasing hormone (CRH) when compared to a control group of normal volunteers. The dexamethasone suppression test exhibits an exaggerated suppression response of Cortisol to dexamethasone, when the dose utilised is lower than that utilised to test patients with depression. Increased urine levels of noradrenaline and dopamine has been noted in patients with PTSD. This is believed to be related to the hyperarousal state of PTSD.
Fahy in relation to their editorial Debriefing for Acute Trauma-a Welcomed Demised As the major psychiatric advisor to the Military, Irish Marine Emergency Service and the Gardai in relation to when and where critical incident stress debriefing (CISD) should occur, I would like to make the following observations. CISD is only of use when a major incident has occurred, usually when there is a significant loss of life. It is very important that the critical incident stress debriefing only occurs after the operational debrief. The debriefers need to be highly trained particularly in relation to group dynamics. My major fear is the risk of scape goating. I am well aware of the negative findings of the Cochrane Review by Wesley Bedell 2 and more recent findings by Shalev in relation to the poor outcome from CISD. I would consider that CISD is an inappropriate intervention in relation to road traffic accidents even when there is major trauma. It is best kept for major incidents in which a number of personnel were involved and carried out by their own peers who are respected.
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