Bioterrorism: Psychological and Public Health Interventions
http://www.100md.com
《新英格兰医药杂志》
In the relatively brief time since September 11, 2001, legions of articles have been published, grants submitted, journals launched, and textbooks edited on the subject of terrorism involving biologic agents. Much of the work has focused on the agents themselves or on policies and preparations for bioterrorism within health care systems. In Bioterrorism, the editors have attempted to address a fundamental deficiency in the existing database: less than 1 percent of the literature deals specifically with the psychosocial aspects of bioterrorism, even though psychological morbidity is likely to be among the most prevalent health issues in the aftermath of an event. The plausibility of this prediction is convincingly upheld by such recent episodes as the Oklahoma City bombing in 1995, the September 2001 attacks, and the subsequent postal shipments of anthrax. The editors succeed, in many aspects, in elucidating the ideas that "promote mental health and resilience in the face of bioterrorism."
The book's three main sections are designed to flow from the conceptual and philosophical to the operational. The first part deals mostly with historical lessons, which are interspersed with fascinating discussions of psychological aspects of terrorist groups; the second section moves into the clinical realm; and the third involves practical recommendations for incorporating plans to deal with psychological responses in the context of public health interventions.
Bioterrorism presents unique challenges. Attacks are likely to be insidious and, unless conventional weapons are also involved, may not even be suspected until clusters of victims present for medical attention. Illness may be fulminant, disfiguring, and transmissible, thus resonating with the most basic of human fears. Responders will not only have to cope with potentially large numbers of victims in the days and weeks after an attack but will also have to deal in the longer term with a much greater number of unexposed, psychologically damaged people, including their fellow health care providers. A range of illnesses in these victims, from situational anxiety to frank depression to post-traumatic stress disorder, will occur for years after a bioterrorist event and can be predicted to affect a much broader population than those actually infected. The editors of this book are persuasive in their contention that mental health preparedness is a critical aspect of public health, and they have provided a practical framework for planners.
As in any multiauthored textbook, some overlap in content inevitably occurs, and the integration of each chapter into the larger work is not always precise. The book would have benefited from a more succinct and focused introductory section, since the most useful parts of the work are the later chapters that deal with the psychosocial effects of bioterrorism on communities and intervention strategies for recovery. The authors are experts in their fields, and many of them are responsible for what scarce literature exists on the subject. I found myself reading this book in the immediate aftermath of a natural disaster of massive proportions — the tsunami in Asia in December 2004 — and was struck by the relevance of the book to that crisis. Credible bioterrorism scenarios have included casualty estimates on a similar scale to those witnessed in this recent natural disaster. The editors of this book have provided us with the requisite data to mitigate some of the worst effects of terrorism; it is incumbent on clinicians, policymakers, and those who are charged with protecting the public health to integrate this information into our response planning.
Andrew W. Artenstein, M.D.
Center for Biodefense and Emerging Pathogens
Pawtucket, RI 02860
The book's three main sections are designed to flow from the conceptual and philosophical to the operational. The first part deals mostly with historical lessons, which are interspersed with fascinating discussions of psychological aspects of terrorist groups; the second section moves into the clinical realm; and the third involves practical recommendations for incorporating plans to deal with psychological responses in the context of public health interventions.
Bioterrorism presents unique challenges. Attacks are likely to be insidious and, unless conventional weapons are also involved, may not even be suspected until clusters of victims present for medical attention. Illness may be fulminant, disfiguring, and transmissible, thus resonating with the most basic of human fears. Responders will not only have to cope with potentially large numbers of victims in the days and weeks after an attack but will also have to deal in the longer term with a much greater number of unexposed, psychologically damaged people, including their fellow health care providers. A range of illnesses in these victims, from situational anxiety to frank depression to post-traumatic stress disorder, will occur for years after a bioterrorist event and can be predicted to affect a much broader population than those actually infected. The editors of this book are persuasive in their contention that mental health preparedness is a critical aspect of public health, and they have provided a practical framework for planners.
As in any multiauthored textbook, some overlap in content inevitably occurs, and the integration of each chapter into the larger work is not always precise. The book would have benefited from a more succinct and focused introductory section, since the most useful parts of the work are the later chapters that deal with the psychosocial effects of bioterrorism on communities and intervention strategies for recovery. The authors are experts in their fields, and many of them are responsible for what scarce literature exists on the subject. I found myself reading this book in the immediate aftermath of a natural disaster of massive proportions — the tsunami in Asia in December 2004 — and was struck by the relevance of the book to that crisis. Credible bioterrorism scenarios have included casualty estimates on a similar scale to those witnessed in this recent natural disaster. The editors of this book have provided us with the requisite data to mitigate some of the worst effects of terrorism; it is incumbent on clinicians, policymakers, and those who are charged with protecting the public health to integrate this information into our response planning.
Andrew W. Artenstein, M.D.
Center for Biodefense and Emerging Pathogens
Pawtucket, RI 02860