The mental health crisis that wasn't: how the trauma industry exploited 9/11

Reason, August-Sept, 2005 by Sally Satel, Christina Hoff Sommers

Trauma Tourism?

The International Critical Incident Stress Foundation (ICISF), based near Baltimore, is the largest psychological debriefing training outfit in the world. With a virtual monopoly on debriefing training, ICISF appears to be prospering both at home and abroad. Its clients include the FBI, the Coast Guard, the American Red Cross, and U.S. Air Force bases worldwide. It has training programs in Canada, Europe, the Caribbean, Central and South America, and Australia.

Anyone with a high school diploma is eligible for the foundation's course. In some circumstances, an ICISF certificate grants the bearer access to disaster sites that an advanced clinical degree does not. For example, in 1995 a group of psychiatrists from Yale that included respected experts in traumatic stress offered to help with victims of the Oklahoma City bombing. Emergency officials turned them away because they lacked certification from the International Critical Incident Stress Foundation.

The certificate, then, doubles as a coveted passport to disaster sites--even though it is awarded to anyone who has paid the $190 course fee and shown up for the lectures. Is it any coincidence that critics of the crisis management business have taken, tongue-in-cheek, to calling volunteer crisis counselors "trauma tourists"? There is no doubt that the volunteers are well meaning, but neither is it any secret that some of them have a voyeuristic urge to be part of a historic moment or a media event.

"Disaster vultures" was the name given to overly enthusiastic mental health professionals who rushed into the scene at the Oklahoma City bombing in 1995. "Their credibility in the future would be their claim to have worked in Oklahoma City," a dismayed local psychologist observed.

Psychological debriefing is an enterprise that has operated outside of conventional clinical boundaries and oversight. Richard Gist, a psychologist with the Kansas City, Missouri, fire department and an outspoken critic of the trauma industry, describes it as a prolific and parochial subculture of providers whose understanding of these highly complex issues is often limited to proprietary instruction in the form of traveling seminars, trade magazines, and paperback books, rather than the refereed venues of empirically guided professional practice.

In the summer of 2002, one of us (Satel) spent two days in a frigid hotel ballroom outside Baltimore with about 200 men and women--nurses, social workers, rescue volunteers seeking ICISF certification in the basics of crisis counseling. Much of what the instructor said was obvious: that routines should be preserved after a crisis, that too much alcohol is bad, that depriving yourself of sleep is unhealthy, and so on. The "experts" had appropriated common sense as if it were their own special province.

Then came a session on psychological debriefing, also known as critical-incident stress debriefing--the centerpiece of trauma counseling. Our instructor acknowledged that debriefing had come under attack, but promptly dismissed the critics, maintaining that psychological debriefing was proven to thwart the development of PTSD.