Psychosocial Capacity Building in Response to Disasters

Under his rather ungainly title, Joshua L. Miller offers a thoughtful and compelling alternative to what he terms “disaster mental health services.” In constructing an almost daunting compendium of approaches and resources, he attempts to construct a “comprehensive model of disaster response” located within an exploration of the social ecology of disaster.

Beginning with the book’s cover photo of a tent city in Haiti, the author establishes his street cred, noting his own extensive experiences beyond the earthquake in Haiti, such as Hurricane Katrina in the United States and other disasters in Sri Lanka, northern Uganda, and Sichuan Province, China. The structure of the book is such that the first six chapters describe the social ecology and phenomenology of disasters, and the remaining six chapters constitute how-to manuals for creating and implementing psychosocial capacity building. Each chapter concludes with a mindfulness exercise that parallels the chapter’s content and offers a specific avenue of self-care to disaster workers, although it seems somewhat unclear how these prescriptive exercises relate to the overall structure of the book.

Miller’s text is heavily referenced, and there are so many parenthetical references that they sometimes impede the flow of an otherwise articulate and clearly written narrative. This volume could serve as a textbook for a course related to disaster planning, a practical platform for informing proposed program development, or as an introduction to a more academic discussion of theories of disaster intervention, such as critical incident stress debriefing (CISD), critical incident stress management, and others.

Several sections of the book allude to the ongoing controversy about CISD, especially criticism leveled post–September 11. Although Miller notes the lack of evidence for inoculation against PTSD, he also argues for the subjective sense of relief which such debriefings deliver and their generally (although not completely) positive reception by disaster workers and victims.

One of Miller’s most consistent interrogations of current disaster relief models is that the models are very often Western and Eurocentric and therefore have limitations as to their universality in both specific locales within the United States (Katrina) and internationally. Moreover, Miller argues that unintended consequences could result in recreation of colonial and neocolonial attitudes, particularly when disaster services are supplied and directed from “other” (read “North American and European”) cultures.

There are some distractions within this text, such as a number of web- and wheel-designed illustrations summarizing Miller’s main points but not necessarily enhancing the text. However, his recurrent emphasis on disaster worker self-care and the role of collective memorializing and his emphasis on human resiliency do much to advance his overall goal of describing how to build psychosocial capacity for dealing with human disasters. If clinicians find themselves interested in vicarious trauma, PTSD, and secondary PTSD, they will be well rewarded with a close reading of this book, in which Miller essentially teaches how to prevent compassion fatigue and promote compassion satisfaction on both a personal and organizational scale.