CAPÍTULO 2. ANALISIS Y DISEÑO
2.3. ANALISIS DE REQUERIMIENTOS
2.3.1. DIAGRAMAS DE COLABORACION
War is a tragic aspect o f competition for control and dominance or the results o f revenge and jealousy and has several negative consequences on the psychological health o f children and adults. Several studies were designed to determine the prevalence o f psychological problems in combat veterans and to identify risk factors associated with an increased likelihood o f developing a stress-related syndrome. Most o f these studies have focused on South East Asian veterans.
A co-ordinated major research survey authorised by the U.S. Congress in 1983 examined the current and lasting impact o f the Vietnamese War on U.S. Veterans, conducted by a team o f researchers (Kulka et al., 1990) at Chicago University, addressed as the "National Vietnam Veterans Readjustment Study (N.V.V.R.S.)". They considered variables, and measured the long-term and permanent factors. Results showed strong evidence o f indications of emotional, physical and psychological
reactions to stress. Some veterans showed signs o f PTSD. The study also revealed a high level o f mood disturbance, i.e., liability, grief, sadness and non-specific distress in addition to problems with re-adaptation to normal life after war and also confirmed that the family reflected the suffering o f the Vietnam Veteran. This was seen in the father or one o f the children or brothers. Researchers also found, that the Vietnam war veterans, their wives and families needed comprehensive care and attention and recommended that counsellors, health specialists, lawyers, psychologists, and associated professional decision-makers join forces to offer remedial and rehabilitative services to the Vietnam war veterans, and their families.
Davidson et al., (1990) investigated and compared the long-range impact o f war experiences o f nineteen World War II and twenty-five Vietnamese war veterans, who were diagnosed with PTSD. Study findings revealed that the two groups had similar symptoms o f PTSD, which stayed with them for a long time. Vietnamese war veterans showed severe PTSD symptoms and scored higher points on the Hamilton Depression as well as Hostility and Psychosis scales. It was also found that those veterans had deep feelings o f guilt because they survived the war and were still alive. Moreover, they suffered work disorders and reduction o f interest and avoided irritability, which reminded them of the trauma. They had feelings o f estrangement, terror responses and tendencies to commit suicide. The Vietnamese war veterans were characterised by other patterns of symptoms like panic disorder, alcoholic or substance abuse at an early age.
Green et al., (1990) conducted a study on 191 Vietnamese male war veterans to investigate the war stressors that are correlated to probabilities o f PTSD occurrence. The Stressful Events and PTSD scales were used and findings revealed that some experiences, like bereavement and injury, could help us understand PTSD after the
war experience. Other experiences, such as exposure to events of sudden death, can help predict current (permanent) PTSD. Analysis of the findings revealed that the more profound the stressful experiences are, the more probable that PTSD will develop, and that their symptoms will be persistent.
Bradshaw et al., (1991) discussed the phenomenon o f “war love” in their study, which was identified in a group o f traumatised Vietnam veterans. It was evident that many veterans who were being treated for PTSD kept their experiences alive in their minds because they held a special meaning for them. Military events and war battles combined positive and negative experiences. Some were viewed as positive because they were associated with the identity o f a hero, at the same time they considered it a negative experience because their memories led to (or caused) them to suffer. The study also showed that veterans suffer from PTSD because they keep the war experience alive in their recollections. Vivid memories help to organise their thinking around the idea that the war experience had special meaning in a way that made their lives meaningful to them.
Several researchers tried to determine if emotional disorders were one o f a cluster o f symptoms associated with exposure to war experience. In this context, the studies investigated some forms o f sleep disorders o f those who were subjected to stressful experiences during the war. Experiments and physiological investigations proved that the trauma due to war causes serious psychological suffering including
sleep disorders. The studies also revealed the occurrence o f emotional disorders as
one o f the long-range conditions, due to exposure to stressful traumatic events.
Southwick et al., (1991) investigated 45 male war veterans for symptoms of
PTSD and basic depressive disorder. Emotional components and symptoms of
Hamilton Depression Scale, Depressive Experiences Questionnaire and Emotional Disorder and Schizophrenia Inventory. Study findings revealed that the PTSD cases scored higher points for most symptoms revealed by the Hamilton scale, particularly anxiety and insomnia (sleeplessness). This group also had high scores with statistical significance on the self-criticism scale, but did not have high scores on the self- dependence and effectiveness scale, (included in the questionnaire o f depressive experiences). Correlation coefficients between the Self-Dependence and Criticism scales were negative.
World War II veterans (62) living in long term residential institutions for the elderly ranging in the age from 66 to 90 years were investigated by Hermann and Eryavec (1994), for PTSD and other psychological disorders correlated to it. Their past and future psychological disorders, including PTSD were assessed. Findings indicated that 57% o f those with PTSD were having experiences o f chronic symptoms, 37% suffered basic depression and 53% were alcoholics. The finding also revealed a strong correlation between the severity of exposure to war stress in battles and the development o f PTSD. Statistically significant correlation was also found between PTSD and some variables that go back to the pre-war period such as past family history o f alcoholism, existence o f past family bereavement, and instability o f work or working conditions.
Wolfe et al., (1994) discussed the relationship between PTSD and physical problems experienced by a sample o f one hundred and nine female veterans who were not in treatment. A psychological health scale was administered in addition to tools, to assess the exposure to traumatic experiences in the war. Findings from this study, conducted after the war experience for more than twenty years, revealed that both PTSD and exposure to traumas of war experiences are correlated with symptoms and
indicators o f physical health problems. These symptoms and indicators decreased when the variable o f PTSD is controlled, but they are present when the exposure to trauma (as a variable) was not controlled. Therefore, findings from this study proposed that the impact o f traumatic exposure on physical and mental health development, as perceived by the sample individuals, partially interact with the
increase o f PTSD after traumatic exposure. This means the females who were
exposed to traumatic events showed increased psychophysical suffering due to that exposure whenever symptoms o f PTSD rose in them.
Besides studies concerning the effects o f war in South East Asia, there are several studies concerning the effects o f war in other areas o f the world. For example, in the Balkans, Bilanakis, et al., (1996) investigated the mental health o f war refugees in one collecive centre in Serbia. The representative o f the medical rehabilitation centre for torture victims from loannina visited the Centre for Psychological Support to the victims o f Traumas and Tortures caused by war in Pozarevac (HR Yugoslavia). In cooperation with them, they tried to detect and record the mental health o f 58 refugees (aged 18-64 years) in one camp using the GHQ scale and Harvard Trauma Questionnaire. 70-8% o f the sample had personal experiences o f traumatic events because o f the war, while a possible prevalence of psychiatric disorder according to the GHQ was found in 64.1%. Statistical analysis o f the data showed that traumatic events and age are the main factors related to the mental health conditions o f the war refugees. The older refugees who were subjected to stressful events were more affected. Another example is Northern Ireland, a well known war and conflict areal, for which there are several studies. Foster et al., (1997) investigated mental disorders and suicide in Northern Ireland using Diagnostic and Statistical Manual for Mental Disorders-lll-Revised (DSM-Ill-R) axis 1 (clinical syndrome) and axis II (personality
disorders) among suicide victims (aged 14 years and older) in Northern Ireland during a one year petiod. A psychological autopsy study based on a variety o f documentary sources and interviews with bereaved informants and health care professionals was used to collect data. 90% o f suicides had a current axis I and/or on axis II mental disorder. At least one current axis I disorder was diagnosed in 86% o f suicides, and at least one axis II disorder was diagnosed in 44%. Suicide victims under 30 years o f age were less likely to have a current axis I disorder (68%) than those 30 years old and older (95%). Psychiatric cormobidity was present in 55% o f suicides. The time between the last contact with a health care professional and death was greater among males and under 30 years old suicide victims.
Muldoon and Trew (2000), invesigated children’s experiences and adjustment to political conflicts in Northern Ireland. The study examined 354 males and 355 female school-age (8-11 years old) children’s self-reported experience o f a number of negative life events, including a number o f conflict-related events in relation to gender, age, socioeconomic status, and religious affiliation. Measures included an experience o f negative events sale and Harter’s Self-Perception Profile for Children. The reports suggest that children’s experience o f conflict-related event is considerable. The study showed that one quarter o f the sample had witnessed shooting and street riots. The in-depth analysis showed that children reporting lower behavioural competence are more likely to report experience o f conflict-related events whereas lower global self-worth was related to experience o f nonconflict-related negative events.
Summary
This chapter discussed definitons and effects o f trauma and stress. From the above mentioned information it can be seen that stress can be a long drawn out
condition, whereas trauma usually relates to a brief and very frightening event. There is a relation between trauma and stress. Both have a negative impact on the person’s behavioural, emotional, social and cognitive dimensions. Traumatic and stressful events are common in the circumstances o f war, which generally have a negative impact on both adults and children.