For the purposes of this chapter crisis intervention is defined as encompassing all measures that may be offered as psychological help to individuals who are exposed or have been exposed to a disturbing event in which the usual coping mechanisms of the persons concerned have failed in the face of a perceived challenge or threat. Considerations of crisis intervention typically refer to terms such as traumatic events, critical incidents (1) or trauma . Critical incidents can be but are not necessarily traumatic in the sense of evoking traumatic stress reactions in survivors. Psychological reactions to critical incidents range from none to severly disabling with large variations depending on personal characteristics of survivors as well as the nature of the event to which they have been exposed.
Risks associated with seafaring presents those involved with significant risk of being exposed to critical incidents such as:
- Fire and explosions
- severe accidents with death or serious injuries
- destruction caused by collisions
- salvage of the dead
- near drowning
- abortive rescue of colleagues who have fallen over board
- suicide or sudden death
- sexual assault
- piracy and being taken hostage
- events in which feelings of fear, helplessness, loss of control or horror have occurred
Furthermore, being an observer of such critical events or listening to accounts of particular incidents may evoke what is referred to as secondary or vicarious reactions that may be akin to those of survivors with first hand experience of a major event. Moreover, news about disturbing events at home, such as death of a loved one, serious accidents of family members or friends, natural disasters, uprisings, may have traumatic effects on a seaman, all the more, if he cannot help.
Frequent attributes of critical incidents and other exceptionally stressful events are: 1) they come sudden; 2) they come without warning; so that the individual has no means to prepare for the event ; 3) they are outside the normal range of situations which the seaman encounters in his or her life; they imply a discrepancy between threatening factors of the situation and individual coping ability; 4) they are accompanied by feelings of helplessness and defenceless surrender ; 5) they may change the individual’s beliefs and self-understanding.
During the last decades, the understanding of traumatic stress after critical incidents has taken on greater significance. Focus has been laid more and more on developing measures to reduce the amount of traumatic stress and to mitigate its consequences.
The importance of providing appropriate crisis intervention to individuals who have experienced traumatizing events has been increasing since 1980. Then the diagnosis “post-traumatic stress disorder” appeared for the first time in the Diagnostic Statistical Manual (DSM-IV, 31) as a description of emotional and mental problems observed in veterans of the Vietnam War .
Crisis intervention was first introduced in the emergency services (medical, fire fighting). Soon it spread out practically all over the world and was used after various events with traumatizing potential for large groups, e.g. mass disasters, natural catastrophes and violence at schools .
It entered the catalogue of psychological methods in the military and law enforcement organizations . The United Nations introduced it for its peacekeeping operations (2). is a new system of helping methods in cases of psychological problems after potentially traumatic events crisis intervention met with considerable scepticism , especially in fields where “tough” men (and women) were convinced that withstanding adverse mental and emotional effects of critical incidents was part of their job. Police men, firefighters, military men, and emergency service personnel had to be convinced of the benefit to their health which crisis intervention provided . It took some time to bring to them the message that being psychologically disturbed after having experienced a potentially traumatizing event was normal and was not a sign of excessive softness or mental illness. Likewise, they have had problems to admit the aforesaid disturbances .
Similar to military and police, seafarers belong to a community of traditionally „tough“ men and women. It is not surprising that the introduction of crisis intervention into shipping is still in the beginning. Starting in the military navies of various countries regulations have been established for crisis intervention, e.g. German Navy (3), United States Navy (4). Also for the merchant navies and for maritime search and rescue units recommendations for crisis intervention were released. In the 5th edition of the German Medical Guide for Ships, edited by the German Employers’ liability insurance association, a chapter “Stress after an accident at sea” was inserted (5). The International Maritime Organization together with the International Civil Aviation Organization added sections on Critical Incident Stress Counselors and crisis intervention into their International Aeronautical and Maritime Search and Rescue Manual (6).
The progress in crisis intervention in seafaring is also indicated by the number of scientific conferences, popular and scientific publications, and guidebooks. Jensen (7) describes the various problems in providing psychological help on ships with multi-ethnical and multi-cultural crews, and Rademacher and Zielke (27 ) propose a curriculum for preparing captains and nautical officers for providing psychological help on board.
It is obvious that in many places, where the “ideal of masculinity” with its unlimited ability to suffer in particular from psychological stress, a “change of culture” is necessary, so that men as well as women consider traumatic reactions as “normal reactions to non-normative situations ”.
This chapter contains definitions of terms related to trauma and traumatic reactions, information on methods of crisis intervention, on possibilities of integration of crisis intervention in the maritime environment, and on some aspects of trauma therapy .