Emotions and crisis management

Emotions are what move us to action. Almost always they have to do with people and what we want from or did not obtain from people. We may get angry at someone because of something he has done or failed to do. We may feel shame in connection with some person because of what we ourselves did or thought.

 There is only a handful of specific emotions: fear, shame, anger, guilt, sadness, joy, sexual desire, grief." Going on to explain how he tries to help, the psychiatrist tells us: "I am interested in what the client is experiencing when he is with me, and I may put it to him just like that: 'I'm curious about what you are experiencing right now.' Then I see how well he is able to discern his own feelings. Most of us have not been taught this skill. 

We have learned how to keep our emotions vague. We have learned all the imprecise words for feelings: tense, nervous, upset, disturbed, bad, frustrated, bothered, agitated, aggravated, overwrought, tired, and lousy, depressed, and so on. "Either the client's present emotions are giving him distress, or the automatic constraint (repression) of these emotions is producing distress of a second order. There is a reduction in distress from both sources when he can acknowledge the constraining actions and put the emotions into thoughts and words.

This starts a benign circle-thought, verbalization, sharing, new perceptions, augmented coping resources-e-replacing the vicious circle of increasing tension and further demoralization." Crisis intervention today is being practiced at most general hospital- that has psychiatric units. It is available through many private psych: artists. There are storefront clinics in many areas, an increasing number of them. Some indication of the value of crisis intervention is to be found ill the experience of Los Angeles County Hospital, which used to admit 95 percent of patients coming in or brought in for emotional disturbances, better than 1,500 a month, and had to send many to mentalinstitutions. 

Now, employing crisis intervention, the hospital help'; 65 percent as outpatients, and the 35 percent admitted stay an average of 5.2 days instead of 180 days as before; very few go to mental institutions.

There is also the experience of San Francisco where the annual commitment rate to state mental institutions dropped from 2,887 to 119 in the first four years in which the city had an expanding complex of emergency treatment centers. 

Grady Memorial Hospital in Atlanta now treats 5,000 psychiatric emergencies a year in its crisis center; and its 36-bed mental ward, previously inadequate to meet the need, is seldom completely occupied today. Crisis centers are staffed by teams which include nurses, social workers, lay therapists, and clergymen as well as professional psychiatrists. Certainly, crisis intervention is no panacea for all mental illness".It could be important in your life or the life of someone close to you to be aware of the availability of crisis intervention and of the likelihood that it can help in seemingly desperate situations. 

Crisis handling, emotional stress management

The individual is now trying even harder to solve the problem. And at this stage, the situation may improve, perhaps because the added problem-solving methods help, or the problem is seen in a new light, or certain goals are given up. In the fourth phase, the individual suffers major disorganization when the problem continues and cannot be solved, avoided, or freshly defined. In this framework, crisis intervention makes use of several important principles. 

First, because the person is teetering, in painful and pre- carious disequilibrium, a small influence may produce a great change quickly. The intervention of another person-a physician or other professional, a family member, a sensitive friend-may significantly affect the outcome for the better. And the first six weeks are key weeks. Another principle is that the outcome of the crisis is not determined by previous experiences alone but by current psychological and situational forces.

 And a third principle is that if the person can be helped to find his equilibrium again, the new equilibrium may be at a better adaptive level than before; he will not only be over the hump of the present crisis but perhaps better able to deal with future crises. Just how does crisis intervention work? Consider a seemingly extreme case. Mr. A was brought almost forcibly to a crisis clinic by his worried wife and brother-in-law; he was seemingly on the verge of complete mental breakdown. 

He had been acting strangely, talking agitatedly of wild business schemes, getting up in the middle of the night to make "vital business calls." Asked by the therapist at the clinic why he was there, Mr. A said he had no idea; there was nothing wrong with him; and he insisted upon talking jovially about his business schemes.

Finally, upon being pressed, he admitted that he had had a back injury recently, had lost some time from work, and that, he supposed, had worried his wife and was why she had brought him to the clinic. But the therapist was quickly able to establish that the back injury, though not severe, had triggered emotional upheaval in Mr. A, causing him to feel that he was getting older and losing his vigor; and to try to bury such feelings, he had launched into wild overactivity. 

Quietly, the therapist pointed out to him what had been going on. He needed, first, to calm down, stop feeling tense, and a sedative would help. And he was to come back in a few days for a consultation; they would then examine his problem further and try to find a solution.

He returned for that consultation and for another a week later. And after the second consultation, his wife reported that he was acting normally again. Crisis intervention does not attempt to make over an individual, to delve deeply into events that may have formed character. And yet, often, it can be helpful not only as first aid but as long-lasting aid. 

In crisis intervention, an effort is made to encourage people to actually "experience" their emotions-to examine them and feel them fully-rather than to merely have vague, unexamined emotional stirrings and to try to block the stirrings.