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对救援人员和幸存者的灾后心理急救

亲历危机事件的人，他们的应对能力可能会被冲覆。这些危机事件包括：对自己或他人现实或潜在的伤害或致死；受重伤；家、社区或财产被毁；与家人或密友失去联系。

汶川大地震显然构成了危机事件。此文介绍灾难对救援人员和受害人可能造成的心理影响，讨论个人或团体在灾难发生时和发生后应如何及时进行“心理急救”。本文帮助读者（1）描述灾难中和灾难后的心理环境；（2）描述救助者可采取的步骤以缓解他们自己和灾难幸存者的压力。

救援人员心理

在灾难中，可能看到或听到让人感到非常不适的事情。值得关注的是，救援人员可能会经历对幸存者同情而产生替代性创伤。救援人员不可过度认同幸存者；不能把幸存者的感受当作自己的感受。把他人问题当成是自己的会增加自身压力并影响工作效能。救援人员要提防自己和受害人的一些灾害创伤征象，以便采取措施减轻压力。

这些心理症状可能包括：

• 易怒或发怒

• 自责或责备他人

• 退缩和孤独

• 害怕灾难再发

• 感到晕眩、麻木或被冲没

• 感到无助

• 情绪波动大

• 伤心、沮丧和悲痛

• 否认

• 记忆力和注意力出现问题

生理症状可能包括：

• 失去胃口

• 头痛或胸部疼痛

• 腹泻、胃痛或恶心

• 活动过度

• 增加喝酒或使用毒品

• 做噩梦

• 不能入睡

• 疲倦或精力不足

急救队领导可采取一些步骤来保护队员在事发前、中、后的健康：

• 向整个团队提供压力管理培训

• 向队员通报可能会看到的场景，以及可能会碰到的幸存者或他们自己的情绪反应

• 强调救援是个团队。分担工作和情绪压力可以帮助减轻压抑情绪。

• 鼓励救助者休息和重组，以免队员过度劳累。

• 指导救助者到事发区外休息，以调剂救援的压力。

• 鼓励救助者在整个救援行动中适当进食并维持液体摄取。向队员解释他们应该喝水或其它电解质替代液，并避免喝含咖啡因或精制糖的饮料。

• 轮替团队，使队员得到休息或新的任务，比如从较高压力任务换到较低压力任务。队员可相互交流经历和体验。 这些对队员的心理健康很重要。
  

• 逐步撤出救援队员。将队员逐步从较高压力区转到较低压力区。

• 轮替后，与队员进行简短讨论。队员描述他们的经历并表达对此经历的感受。

• 在救援结束一到三天后，安排信息通报会，让队员更深入地描述他们的经历并表达对此经历的感受。

急救队领导可请受过紧急事件压力管理训练的心理健康专业人员进行一次紧急事件压力报告。紧急事件压力报告是一次在事发后一到三天之间举行的正式团体互动过程，它用来帮助紧急事件服务人员和志愿者应对创伤事件.

急救队员还应花时间考虑个人可以减少压力的其它方式。 只有你自己知道什么使你能够降低自身压力。在事情发生之前，很值得花精力去找到适合自己的降压方式。在日常生活中，你可以采取下列预防措施：

• 充足睡眠
• 积极锻炼身体
• 均衡饮食
• 平衡工作、娱乐、休息
  
• 就像你愿意付出帮助他人一样，允许你自己接受帮助。记住你不仅仅是个帮人者
• 与他人建立并保持有意义联系
• 使用精神资源，如导师、牧师、寺庙等
  

有 经验的救助人员会发现这些步骤对控制他们的压力水平较有帮助，但是，对一些案例来说，有必要向心力健康专业人员寻求帮助。紧急事件压力报告是更综合、多成 分、基于对团体或个体需求仔细评估的危机干预系统中的其中一类干预。紧急事件压力报告不应当作孤立的干预，它应于其它类型的干预协同使用.

一个紧急事件压力报告通常有七个阶段：

1. 介绍和描述这一过程，包括保证保密性；
2. 回顾、评论关于事件的事实性材料；
3. 分享当初对事件的想法/感受；
4. 分享对事件的情绪反应；
5. 回顾、评论参与者经历的压力症状；
6. 说明正常压力反应；
7. 进一步展开需求评估。
   

参与紧急事件压力报告应为自愿。若要安排一场紧急事件压力报告，你应联系红十字会、当地应急处理机构、或社区心理健康机构。若不知如何找到合适的联系人，你也可向消防局或警察局寻求帮助。

处理幸存者的创伤

一些研究指出，灾后幸存者经历若干情绪阶段：

• 在冲击阶段，幸存者并不恐慌，事实上有可能不会显示情感。
• 紧接着事件的是盘查阶段。在此阶段，幸存者评估造成的破坏，并试图找到其他幸存者。人们倾向于抛弃常规社会联系，而偏向最初反应行动（如，搜索和救援）所要求的更具功能性的关系。
• 在救援阶段，应急服务人员作出反应，幸存者心甘情愿地接受这些团队的指导。这是急救团队佩戴辨识标志（头盔、背心等）很重要的原因。
• 在恢复阶段，幸存者似乎会一齐反对他们的施救者。

急救队员应预期幸存者会显示出灾难造成的心理影响，一些心理战会指向你

创伤后压力可能会影响：

• 认知功能。遭受创伤后压力的人可能会不理智地行为，很困难作出决定，或以与其个性不符的反常方式行为。他们可能在分享或提取记忆方面有困难。
• 躯体健康。创伤压力可导致一些躯体症状–从疲乏到发热。
• 人际关系。幸存者可能经历暂时或长期人格改变，很难处理人际关系。

对救助队员来说，现场心理干预的目标应是通过稳定个体而稳定事发现场。要做到此，可采取的方式有：

• 评估幸存者的伤情和情绪震动。先处理医疗需要。观察他们以决定其响应水平，以及他们是否对自身或他人构成危险。
• 使未受伤人员参与救助。聚焦性活动有助于人们从震惊中走出来，所以应给他们一些建设性的事情做，如提供补给。这一策略对处理破坏性的幸存者特别有效。
• 以下列方式提供支持：（1）倾听他们讲述感受和生理需要。受害者常需要讲述他们的经历–他们希望有人听。（2）移情。做出反应表明你已听到他们的关切，以此来表现同情。受害者想知道有人分担他们的痛苦和悲伤感受。
• 帮助幸存者联系自然支持系统，如家人、朋友、或牧师。
  

对于表明有自杀倾向、精神错乱、或不能照顾自己的幸存者，应转荐给心理健康专业人员。

提供帮助时，救助人员应避免以下说法。表面上，这些短语意在安慰幸存者，但是它们并不表明理解对方的感受。

• “我理解。”在多数情况下，我们不能理解除非我们有过同样经历。
• “不要伤心。”幸存者有权感到不舒服，并需要时间来改变心情。
• “你真坚强/你会渡过这关的。”很多幸存者并不感到自己坚强，并怀疑自己能否从伤亡损失中恢复过来。
• “不要哭。”哭是允许的。
• “这是上天/上帝/神的安排。”向一位你并不认识的人赋予一事件宗教意义，可能会冒犯或激怒此人。
• “事情可以更糟糕”或“至少你还有……”应由个人来决定事情是否可能更糟。
  

这些类型的反应可引起幸存者强烈的消极反应或疏远与你的关系。 如果幸存者对你所说的作出消极反应，你可以道歉。

急救队员可能面对的一项令人不愉快地任务是怎样管理在死亡现场的家属。下列指导原则可助你处理这种情况：

• 盖住尸体；尊重逝者。包紧毁伤的尸体。
• 让一位家属看一下尸体，并让其决定其他家属是否应看一下。
• 允许家属与亡者一起度过一些时间。急救队员可待在一旁，但不要观看——试着在情感上拉开一些距离。
• 允许家属哀悼。不要处于需要减轻自己的不适而去安慰他们。

另外，在有些情况下，家属可能不知道家人已死亡，而急救队员被要求告知家属。建议急救队员可这样做：

• 将家属从众人中分离出来，并带到一僻静、私密的处所。
• 可能的话，请家属坐下。
• 进行眼光接触，用平静、亲切的语音。
• 用下列话语告知家人的死亡：“很遗憾，你的家人已经去世。我很难过。”

This type of biased report could lead audiences to form a negative image of China, stirring up anti-China sensation and collective misunderstanding of China.

The media may justify their unprofessional actions as providing moral support for the protesters who advocate Tibet independence. This justification is hypocritical. The fact is that Tibet has been part of China since 13th century and still is part of China today. ³ Whatever wrongs and new oppressions that may have been introduced by the Chinese government after 1959, the Chinese government did abolish slavery and the Tibetan serfdom system of unpaid labor. ⁴ Those who lost their privileges are the lamas and landlords. Today, Tibetans even enjoy more freedom than Han ethnic in China. For example, Tibetans are exempt from China’s one child policy. The Tibetan population growth is higher than national average since 1970. Tibetan life expectancy increased from 35.5 years in 1951 to 67 years in 2005.

Before you read another report about China, you may want to get the other side of the story.

For readers interested in learning more about Tibet, click here.

But some reports during this time are worth noticing since they implicate the original meaning of the tomb sweeping festival—emphasizing close family relation and filial piety. In a report, two sons do not want to take care of their widowed mother, refuse to meet her, and even do not phone the mother for months. The old mother expressed a thought provoking complain about her sons: “They do remember to sweep family tombs during Qingming. But why they could not have been nicer to me?” There are other reports that people compete in how many fireworks set and how much joss paper is burned.

Just like an old saying:” It would be better to consistently support the living than lavishly celebrating the dead.” The essential meaning of filial piety should be taking care of parents when they are living.  A better time to show respect and appreciation for parents would be when they are alive. People who focus on the formality of burning joss paper and setting fireworks in front of the tombs neglect the essential meaning of the festival. Their lavish behavior is selfish in that they only care about their own face, and it is unhealthy for a society in that it espouses waste of social resources.

First, robbery, theft and fraud reveal a robber’s intention to get desired things through illegal means. The young generation born in 1980s and 1990s faces far more material attractions, such as computers, cellphones, and mp3s, than the previous generations. And they are given more than former generations. They are used to asking for more and getting more. But their parents’ limited ability could not satisfy their children’s unlimited desire for more. The delinquents’ committed robberies suggest these kids did not acquire and act on the social values that encourage success through hard work.

Second, intentional injury and rape indicate a disrespect of the well-being of others, besides a serious crime. Those delinquents show an extremely self-centered view of the world, in thought and action. In the delinquents’ mind, they are the only people who have feelings and rights. They lack an adequate capacity for emphasizing with others.

Third, gang fighting shows a belief in solving problems through violence. Society should provide multiple paths for peaceful resolution of disputes. In addition, society, community and family should model settling disputes and venting emotions through peaceful means.

Further reading:

China Youth Crime ‘in Rapid Rise’ – BBC

Crimes by Juveniles rise, China says – New York Times

The moral models were selected in September and they were divided into five categories: helping another person, acting bravely for a just cause, being honest and trustworthy, working hard and “making great contributions”, and showing filial piety and love to their parents and family members.

While rewarding moral models are positive steps to form a social environment of recognizing honors and disgraces, upholding justice, and promoting harmonious society, we need to be aware of the reasons leading to immorality and morality in promoting the overall well-being of a society.

Common sense tells us — confirmed by research — that people’s behavior is normally guided by their thoughts. Moral behavior is also affected by moral reasoning. Kohlberg’s stage theory of moral development suggest stages are critical, as they consider the way a person organizes their understanding of virtues, rules, and norms, and integrates these into a moral choice.

The goal of moral education, it then follows, is to encourage individuals to develop to the next stage of moral reasoning. Kohlberg held that moral education required more than individual reflection, but also needed to include experiences for people to operate as moral agents within a community. Kohlberg and his colleagues developed the “just community” schools approach to moral development which entails full participation of community members in arriving at consensus and establishing collective norms which express fairness for all members of the community. When members are responsible for determining and enforcing rules, they will take pro-social behavior more seriously.

Studies also show that the authority must be perceived as legitimate to gain obedience for its claim. In an experiment, eighty percent of the participants refused to comply fully when a cleric instead of the experimenter assumed command. Similarly, a government official who is not perceived as legitimate leader would less likely to persuade people to follow what she of he espouses. Officials are natural models for common people. When they corrupt, they are bad models of benefiting only oneself.

Another question is why these moral models would be in such an impoverished situation in the first place. They are nice and hard working people.

Does a campaign really solve the moral problems in China?

Curious? Watch for future posts when Jun answers this question.

College entrance exams in China usually end in June and a new term starts at the beginning of September. But the anxiety among students and parents from college entrance exams is still lingering.

Students and parents not only care about whether they can enter college, but also whether they can enter a prestigious school. Anxiety, therefore, accompanies their expectations. For many students, once they get their scores on college entrance exams, they decide to enroll themselves at a school that focuses on preparing for the next exam.

In Shanghai, the Municipal Institution for Educational Testing reveals that more than 100 students who are not matriculated by the key universities refuse to go to other colleges that are considered common four-year schools, and that over 5,000 qualified students give up their opportunity to go to a three-year college. Most of these students will end up enrolling at schools that prepare them for next year’s college entrance exam, so that they can compete with other examiners for a spot in prestigious universities such as Beijing University and Qinghua University.

The market for remediation schools is prosperous. A small town called Shangdundu in Jiangxi province in southern China attracted nearly 10 thousand students from all over the country to attend the two schools there for exam preparation. The attraction is because of the two schools’ mystical success — 50 of their students, or 1/3 of their entire student body, entered Beijing and Qinghua University this year. The 20 students admitted by Qinghua University weren’t first-time test-takers. An influx of examiners into the town increased demand for housing, elevating rent and apartment prices there. Restaurants and internet cafes mushroomed within few years. The pedicabs and peddlers in the peasant markets are getting better business. Even selling boiled water around the schools becomes a thriving business.

A researcher at the Central Educational Science Research Institution analyzes that about 30% of the examiners every year are doing it at least the second time. In 2007, there are 3 million second-time examiners. Spending 3,000 yuan (~$400) each for enrollment fees in preparation school, these students feed a 1.2 billion-dollar exam preparation economy, not including the cost of living and learning materials.

Why would so many young students spend a whole year reviewing the same old exam materials, when they could be learning new things in college or doing something more worthwhile? One culturally related reason is the conformity among Chinese. People tend to blindly follow the main stream. The whole society identifies with the idea that going to key universities and choosing so-called hot majors is the sole bridge to becoming a valued talent. On job market, the primary criterion for selecting an employee is whether s/he graduated from a prestigious school. The concept of hierarchy is deeply rooted. Even in graduate school recruitment, the candidate’s undergraduate school is an important factor.

This unhealthy and unproductive aspect of Chinese culture is not left unnoticed. Just like an accomplished Chinese scholar puts it: when half of the students in China do not want to go to Beijing or Qinghua University, it will indicate a breakthrough in our educational reform and concept of talent.

References (Chinese news sources):

http://www.news365.com.cn/jj/200708/t20070816_1536794_1.htm

http://society.people.com.cn/GB/1063/6168738.html

This contemptuous attitude towards businessmen no longer exists in current China. Making money is given priority now.

However, problems come up when this priority may be the only consideration for many businessmen in China. Media reports that forced laborers are widespread in Shanxi province, and many of the victims are children. One brand of toothpaste from China contains diethylene glycol that can poison people. Gluten sourced from China was tainted with melamine that killed dozens of cats and dogs in the US.

Many businessmen in China are not well-educated. They are motivated by a single clear goal — making money. They have no idea how their products and business behavior would influence the health and well-being of other people. Many of them are not conscious about business ethics and social responsibility.

In China, due to the overall education level, the general public has limited knowledge about certain products, such as tools that may use harmful chemicals or foods that contain unhealthy ingredients. Many detrimental effects of the products are cumulative and not immediately seen. So monitoring from the public sector to the business sector is not so strong.

The supervision from the government to businesses is also weak. The government officials are not so fervent about the interest of general public. They care about meeting the economic development benchmarks set by their superiors. Those bosses — scrupulous or not — will help them attain the goal. Bosses and local officials are on the same boat. It is very unlikely local officials will trouble the bosses.

The law in China is also under development, which means that many areas of business are not regulated. When the law is underdeveloped, unscrupulous businessmen usually can take advantage of the weaknesses in laws. Even when the law is well-developed, such as in the USA, there are still examples of corporate fraud like Enron.

A better solution is to voluntarily adopt and practice business ethics and moral standards.

When doing business in China, you should assume social responsibility and adopt moral standards, especially when dealing business with Chinese counterparts. Sometimes it may be the only strong oversight available.

Why does entering Harvard make a girl so astoundingly famous in China?

Being admitted into an elite American school is definitely a piece of good news for Meijie. The vast press coverage of her can show how Chinese value education and how well-known Harvard is in China. Since few students in China can go to Harvard, she is really exceptional as the only one student in China admitted by Harvard during “early action”.

To Chinese, being in an elite school means far more than a degree. It means unlimited possibility for fame, power, wealth, respect and beyond. China has more than one thousand years’ history of such an elite scholarship, particularly in choosing officials through exams. Being an official in China always equals to being privileged in a society where people do not have equal rights. Officials enjoy free housing, travel, transportation, health care, and the right to make rules that serve their own interests. But only a few top examiners can be chosen to be officials, and only a few can go to Harvard. So, people are pressed to be the best–otherwise, you are worthless.

For too long, more than 2,000 years, most Chinese have lived an oppressed and exploited life. People always do not feel safe and are hence in dire need of safety. The long term suppressive rule seems to have demoralized the majority of Chinese people. They learn to cherish the only channel — the exam — to achieve a desirable life.

The individual is not valued just because they are alive. Under suppressive rule, people’s sense of equality has been destroyed. Everyone wants to be the few privileged, and to be superior to others.

Another serious problem that can be seen from this “Harvard girl carnival” is the lack of independent critical thinking among Chinese. Why are so many people so interested in becoming the only one who can be admitted. Most of them are playing a definite losing game. Why not change the rules for the game? Why not let most of our kids get a high quality education? If most of our kids pursue what they are interested in and good at, our society can be a very productive and happy one. We should stop superficially judging people by their educational brand.

At a society level, providing enough and, more importantly, equal opportunities for people to succeed is more pressing. It is a huge waste of human resources when more than 99% of students cannot get into prestigious schools abroad and are judged as failures. Everyone has his or her own talents and the society should provide opportunities for them to find their own place. A society in which the majority is not being taken care of is a failed society.

When the major Chinese media are finally in a frenzy about how to provide equal opportunity and diversified channels for many types of success — instead of the next “Harvard girl” — that will be a signal of a real big change in Chinese society.