Disasters and mental health: new challenges for the psychiatric profession.

Articles published in the Viewpoint section of this Journal may not meet the strict editorial and scientific standards that are applied to major articles in The World Journal of Biological Psychiatry. In addition, the viewpoints expressed in these articles do not necessarily represent those of the Editors or the Editorial Board.A disaster is the consequence of an extraordinary event that destroys goods, kills people, produces physical or psychological harm but, above all, which overcomes the adaptive possibilities of the social group. Disasters have strong political background and consequences. They shake the life of a community and raise questions about safety, social organization and the meaning of life. Disasters confront psychiatrists with challenges far beyond regular clinical activities or research strategies. During early interventions after a disaster, psychiatrists often have to work out of their usual clinical premises, in contact with unfamiliar professionals (i.e. rescue personnel) and with individuals who should not be considered as 'cases', and therefore without keeping regular clinical records. In the latter stages they have to confront many factors which tend to cause the clinical consequences of those affected and who developed a psychiatric condition to be chronic. Reactions to stress occur in stages, each one characterised by a specific psychological mechanism. Symptoms include flashbacks, difficulties in remembering, avoidance of stimuli, blunting of responses, high arousal level and obsessive ruminations. The strong biological and psychosocial factors which are unchained after a disaster should be recognised and chanelled. The experience of psychiatry with the bio-psycho-social model can help to understand what disasters are, how some negative aspects of them could be prevented, and how their consequences, both clinical as well as social, can be reduced.