Bruno Lima Award Essay on Disaster Psychiatry
By Allan H. Rabin, MD
Application of ALLAN H. RABIN, MD for BRUNO LIMA AWARD OF AMERICAN PSYCHIATRIC
ASSOCIATON for 2005- draft of Feb 24, 2004
"Public distress was such that all laws whether human or divine were ignored." [Giovanni
Boccaccio, describing the Florence Bubonic Plague of 1348] (see attached ref.)
My trajectory in disaster psychiatry began as an interest in large-group functioning and
organizational behavior. I was a young resident in Topeka, Kansas in the 1960s when I
became involved in mediation after a walkout supporting African American students at a
local high school (c.v.). Between 1984 and 1998, I worked in debriefing and mediation with
substance abusing adolescents and their parents in large weekly multi-family group
meetings. From 1990 onward, and after certification and re-certification in Critical Incident
Stress Management, I provided mental health debriefing for disaster first responders. From
2001 until now I have been a member of Disaster Medical Assistance Team-SD CA 4 Team.
In 1994, I became a ringside physician for U.S. Amateur Boxing, Inc. arising from my
interest in having a role to provide alternatives from street gangs and mitigate street
violence of young people. This gave me important triage experience in an environment
involving ringside officials, the boxer's corner people and the crowd.
Disaster incidents in a modern multi-ethnic society can arise from the exploitation of
hostilities between groups. Propagation of racial bias incidents may arise from modeling of
aggressive role models within groups of youth. If improved social structure and support and
positive alternatives are not provided, increased incidents of bias and hate crime become
likely (see ref.)
A U.S. Department of Justice-sponsored local Committee on Rehabilitation of Youthful Hate
Crime Offenders encouraged me to join an East County support group dealing with bias
incidents in a court mandated school. The Lakeside, CA, Hate Crime Prevention Task Force
was formed in response to a series of hate crime incidents and a general atmosphere of
bigotry toward minority people in San Diego's East County in 1999. Two young adults who
identified as white supremacists had been charged with a hate crime murder of a Mexican
immigrant in East County. After the murder, incidents of bias against minorities increased
on school campuses. The juvenile court mandated school took referrals of white power
students who had been suspended from several East County High Schools. Subsequently,
parents and other adults identified with white supremacy began to verbally and physically
harass two teachers at the storefront school and to goad students to intimidate the teachers
as well.
The Lakeside Hate Crime Prevention Task Force provided a forum for community networking
and support for the teachers, and students at the school. I brought my experience in
disaster debriefing of public safety personnel. The task force met between 1999 and ran
through 2002 on a monthly basis and included approximately 15 adults. Some participants
had been targets of life threatening hate crime and institutional racism in the recent past.
The group debriefed hate-bias incidents. A mob chased a minority adult with a noose in the
vicinity of the storefront schoolrooms. A local tattoo shop was making racist tattoos readily
available to students. The teachers of the storefront school discussed incidents of threats
made toward them when the task force convened. I arranged a consultation with an
experienced member of the San Diego Critical Incident Stress Management Team. He
determined that incident debriefings during the group meetings or on a one-to-one basis
would be appropriate. I drafted a protocol for debriefing for the task force. Social support
for East County students, encouragement of diversity and positive networks became a
central aspect of the task force. A documentary, "Culture of Hate: Who Are We?", dealt with
the murder of the Mexican immigrant and the trial of the perpetrators. Students and
teachers at the court-mandated school were interviewed in the documentary. It aired on
public television in February of 2002.
The use of disaster incident debriefing helped the teachers and community members
involved with the Lakeside Task Force. In spite of the charged atmosphere of danger and
intimidation, education of the white power youth was maintained. In my future community
work and in my mentoring of other psychiatrists I plan to encourage the use of disaster
debriefing for community members and organizations involved in bias incidents and hate
crimes. Simulations were a significant aspect of my training in critical incident debriefing
and on the Disaster Medical Assistance Team. They are an important part of preparation in
this area of need. Application of lessons learned in local terrorism may be useful for large
scale threats of terrorism where psychogenic casualties often predominate (Advanced
Disaster Medical Response, 2003, see ref.)