Trauma during humanitarian work: the effects on intimacy, wellbeing and PTSD-symptoms.

Background: Organizations assisting refugees are over burdened with the Syrian humanitarian catastrophe and encounter diverse difficulties facing the consequences of this massive displacement. Aid-workers experience the horrors of war through their efforts to alleviate suffering of Syrian refugees. Objective: This study of Syrian refugee aid-workers in Jordan examined work-stressors identified as secondary traumatic stress (STS), number of refugees assisted, worker feelings towards the organization, and their associations to PTSD-symptoms, wellbeing and intimacy. It also examined whether self-differentiation, physical health, and physical pain were associated with these variables. Method: Syrian refugee aid-workers (N = 317) in Jordans NGOs were surveyed. Univariate statistics and structural equation modeling (SEM) were utilized to test study hypotheses. Results: Increased STS was associated with lower self-differentiation, decreased physical health and increased physical pain, as well as elevated PTSD-symptoms and decreased intimacy. Decreased connection to the NGO was associated with lower self-differentiation, decreased physical health, increased physical pain, and with decreased intimacy and wellbeing. Lower self-differentiation was associated with increased PTSD-symptoms, decreased wellbeing and intimacy. Elevated physical pain was associated with increased PTSD-symptoms, and decreased wellbeing. Diverse mediation effects of physical health, physical pain and self-differentiation were found among the studys variables. Conclusions: Aid-workers who assist refugees were at risk of physical and mental sequelae as well as suffering from degraded self-differentiation, intimacy and wellbeing. Organizations need to develop prevention policies and tailor interventions to better support their aid-workers while operating in such stressful fieldwork

War can harm intimacy: consequences for refugees who escaped Syria.

BackgroundSyrians seeking refuge have been exposed to atrocities and trauma beyond comprehension. This study examines how personal, interpersonal, displacement and war-related factors have impacted married refugees' intimate lives.MethodsData included 158 married Syrian refugee individuals who live in the host communities of Jordan. Refugees reported on their personal, interpersonal, current-displacement and past-war related experiences. Traumatic impacts were assessed using the Harvard Trauma Questionnaire (HTQ), K6 screening scale for serious mental illness (SMI), The War Events Questionnaire (WEQ), and Personal Assessment of Intimacy in Relationships (PAIR). Stepwise multiple regressions were used to determine the factors associated with refugees' intimacy-total score and its six dimensions.ResultsMost refugees (94.2%) experienced war events, and 34% screened positive on the PTSD-HTQ scale. Overall intimacy scores were low, scoring M (±standard deviation) = 2.4 (±1.1) of a possible five on average. Intimacy scores were lower for refugees who screened positive on the PTSD-HTQ (M = 1.95 ± 65) compared to the ones screening negative, respectively (M = 2.23 ± 66). Furthermore, the higher the PTSD symptoms reported, the lower the couples' intimacy. PTSD and forced marriage were the strongest factors to predict decreased total-intimacy scores (β = -0.23, P = 0.002; β = -0.32, P < 0.001), and decreased scores on four dimensions of intimacy (emotional, sexual, intellectual and recreational). Whereas gender was the second strongest factor associated with decreased total-intimacy scores (β = -0.29, P < 0.001), and decreased scores on three dimensions of intimacy (emotional, social and anger), meaning that women reported suffering more than men from deteriorated intimacy in their marital relationships. Other displacement and war-related factors associated with intimacy were: decreased sexual intimacy associated with having been raped; increased intellectual intimacy associated with escaped from Syria with one's spouse; decreased recreational intimacy associated with the number of family members lived with; decreased sexual, emotional and total-intimacy scores associated with number of children; and years of education as a seemingly personal protective factor associated with increased intellectual and recreational intimacy.ConclusionsAddressing Syrian refugees' intimacy issues in interventions is essential, as well as raising the awareness of stakeholders and community leaders to the negative impacts of PTSD, forced marriage, rape, and displacement difficulties endured by the already challenged and distressed married refugees

Narcissism, Nationalism and Philosophy in Heidegger

This paper contrasts the notion of “willing” in Heidegger’s politics with the notion of “dawning” in Heidegger’s philosophy. It argues that, in the political text, the attunement of Dasein to what-is is centred in the notion of Dasein’s “willing” of what-is, while in the philosophical text it is centred in the notion of what-is “dawning” on Dasein. It maintains that the attitude to anxiety essential to a “dawning” of what-is is not reached in Heidegger’s “The Self-Assertion of the German University”. It concludes by maintaining that, rather than being attuned to what-is, the will in the “The Self-Assertion of the German University” is attuned to its own relationship to what is in a narcissistic rather than a philosophical way; that is, it territorializes “dawning” as a relation to “what is”, and makes “dawning” of “what-is” its “own” in the same way as any nationalism makes a culture, a language or a geographical region its own. In contrast to the narcissism of nationalism, philosophy, as outlined by Heidegger in the essay “What Is Metaphysics?”, is the experience of allowing what-is to “dawn” on Dasein rather than a preoccupation with “willing” of “dawning” as one’s own relation to Being. Indo-Pacific Journal of Phenomenology, Volume 5, Edition 2 December 200

Review of \u3cem\u3eThe Impact of Managed Care on the Practice of Psychotherapy: Innovation, Implementation and Controversy.\u3c/em\u3e Richard M. Alperin and David G. Phillips. Reviewed by Steven Segal, University of California, Berkeley.

Richard M. Alperin and David G. Phillips, The Impact of Managed Care on the Practice of Psychotherapy: Innovation, Implementation and Controversy. New York: Brunner/Mazel, 1997. $31.95 hardcover

The Utility of Outpatient Commitment: I. A Need for Treatment and a Least Restrictive Alternative to Psychiatric Hospitalization.

ObjectivesThis study examined whether psychiatric patients assigned to community treatment orders (CTOs), outpatient commitment in Victoria, Australia, have a greater need for treatment to protect their health and safety than patients not assigned to CTOs. It also considered whether such treatment is provided in a least restrictive manner-that is, in a way that contributes to reduced use of psychiatric hospitalization.MethodsThe sample included 11,424 patients first placed on a CTO between 2000 and 2010, and 16,161 patients not placed on a CTO. Need for treatment was independently assessed with the Health of the Nation Outcome Scales (HoNOS) at hospital admission and at discharge. Ordinary least-squares and Poisson regressions were used to assess savings in hospital days attributable to CTO placement.ResultsHoNOS ratings indicated that at admission and discharge, the CTO cohort's need for treatment exceeded that of the non-CTO cohort, particularly in areas indicating potential dangerous behavior. When analyses adjusted for the propensity to be selected into the CTO cohort and other factors, the mean duration of an inpatient episode was 4.6 days shorter for the CTO cohort than for the non-CTO cohort, and a reduction of 10.4 days per inpatient episode was attributable to each CTO placement.ConclusionsCTO placement may have helped patients with a greater need for treatment to experience shorter hospital stays. Whether the CTO directly enabled the fulfillment of unsought but required treatment needs that protected patient health and safety is a question that needs to be addressed in future research

The wisdom of conversations: Existential Hermeneutic Phenomenology (EHP) for project managers

© 2017 Elsevier Ltd, APM and IPMA This paper introduces Existential Hermeneutic Phenomenology (EHP) as an approach to reflecting on and studying the lived experience of project management practice. We argue that an EHP way of being is an effective approach for any practitioner confronted by significant existential disruptions to their practice. We develop our proposition of ‘the wisdom of conversations’ as an EHP enabled way for project managers' practical coping with otherwise potentially inhibiting existential disruptions. We understand EHP as a holistic philosophical practice which: 1. allows making the ‘lived experience’ of project management practice explicit for reflection, and 2. is available and useful to practitioners in the field. Heidegger provides the theoretical base through a language of existential categories, which are dimensions of being-in-the-world. Gendlin offers a practical method for accessing the states of being that Heidegger describes. Rorty offers promise, the ability to disclose new possibilities or ways of being-in-the-world through irony and practices of re-description

An existential hermeneutic philosophical approach to project management

The philosophies of Martin Heidegger and Richard Rorty are used to redescribe the fundamental assumptions underpinning project management. Rather than viewing project management as merely a science, the significance and value of philosophy for project management are developed. The philosophical practice of redescription as a way of responding to existential disruptions of the lived experience of managing projects is seen as vital not only to being a project manager but to describing project management

VEGF-A and Semaphorin3A: Modulators of vascular sympathetic innervation

AbstractSympathetic nerve activity regulates blood pressure by altering peripheral vascular resistance. Variations in vascular sympathetic innervation suggest that vascular-derived cues promote selective innervation of particular vessels during development. As axons extend towards peripheral targets, they migrate along arterial networks following gradients of guidance cues. Collective ratios of these gradients may determine whether axons grow towards and innervate vessels or continue past non-innervated vessels towards peripheral targets. Utilizing directed neurite outgrowth in a three-dimensional (3D) co-culture, we observed increased axon growth from superior cervical ganglion explants (SCG) towards innervated compared to non-innervated vessels, mediated in part by vascular endothelial growth factor (VEGF-A) and Semaphorin3A (Sema3A) which both signal via neuropilin-1 (Nrp1). Exogenous VEGF-A, delivered by high-expressing VEGF-A–LacZ vessels or by rhVEGF-A/alginate spheres, increased sympathetic neurite outgrowth while exogenous rhSema3A/Fc decreased neurite outgrowth. VEGF-A expression is similar between the innervated and non-innervated vessels examined. Sema3A expression is higher in non-innervated vessels. Spatial gradients of Sema3A and VEGF-A may promote differential Nrp1 binding. Vessels expressing high levels of Sema3A favor Nrp1-PlexinA1 signaling, producing chemorepulsive cues limiting sympathetic neurite outgrowth and vascular innervation; while low Sema3A expressing vessels favor Nrp1-VEGFR2 signaling providing chemoattractive cues for sympathetic neurite outgrowth and vascular innervation