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The Origins |
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The Origins |
Author Note
The version of this article appearing in this journal has been substantially edited from the original. Any reader wishing to receive an unedited copy should contact Richard Gist (rgist@jccc.net)
Abstract
Recent attempts to characterize the growing academic controversy regarding debriefing and its conceptual cousins as "muddying waters" or "study wars" grossly misrepresent the seriousness and the consistency of findings emerging through the refereed press. Data-driven objective assessments and systematic reviews of the empirical base are repeatedly promulgating findings of no effect and, with disturbing frequency now, suggestions of iatrogenic harm to at least some participants - yet still, at least within the popularized movement, the band plays on. This article provides a review of the debate and a critical assessment of the quality of information proffered in the face of accumulating evidence of inefficacy and possible harm.
It is sometimes hard to escape the suspicion that those who shadow your every move with life nets may hold a
disturbingly vested interest in watching someone fall - it is difficult to see that as healthy. But babies can all too
easily be tossed with their bath water, and we are concerned that things which are truly important - things like
acknowledging and talking about the human impact of disturbing experiences - might stand discredited simply
because certain social movements and the pecuniary enterprises built upon them prove to be less than sterling. At
the same time, though, we must acknowledge that inadequately developed or inappropriately practiced intervention
and their pseudoscientific marketing and promotion are, to the ethical scientist or practitioner, as dangerous as they
may be disingenuous, and call for a searching analysis of both the efficacy of the interventions and the motivations
of the interventionists. "Psychological debriefing," and particularly the critical incident stress debriefing model
popularized in the emergency services, can be readily argued to display many of the characteristics definitive of such
phenomena, and examination of its emergence may shed some interesting light on a natural history as old as the
shaman's serpent.
When given information with a seeming ring of truth - when it seems consonant with our personal experience or at
least plausible from our own perspectives and observations - we easily accept it as reasonable. If we add to that
surface credibility the aura of presumed "scientific" endorsement, the simply plausible quite readily becomes the
definite. What better proof than scientific certainty?
Actual science, of course, is not about certainty at all. Indeed, the logic
of science proceeds through the disconfirmation of hypotheses.
We're neither equipped for nor disposed toward proving our theories "right"
- the whole process is built instead on a determined effort to keep proving
ourselves wrong. No assertion is ever left unchallenged; no finding
is ever left unquestioned.
Done right and done well, science is a humble and a humbling enterprise. The bolder the claim, the more skeptical the response; the more arrogant or self-aggrandizing the claimant, the less convincing the rhetoric begins to seem.
When push comes to shove, the issue boils down to sound testing of hypotheses through well formed questions and
cold, objective data - not to prove our theories right (it just can't be done!), but rather to find their flaws.
Many movements sputter and die at this juncture, since the very essence of those characteristics that sustain the effort
beyond its initial charismatic stage challenge precisely those elements that drew the movement together. The
transition from social movement to social institution dramatically alters the mechanisms through which stature,
standing, and credence are earned and afforded, evolving from charisma and persuasion as the principal vehicles of
influence, through progressively more contorted internal oligarchies, until such less malleable standards as formal
credentialing and empirically tested data eventually emerge as the dominant standard. By this time, such movements
have generally been absorbed into more established arenas, bringing immersion into established stratification systems
as well. Quite often, it seems, the very personalities, assumptions, and constructions that propelled a social
movement in its early charismatic and coalescent stages ultimately fall short of these new, more rigorous, and
certainly less fluid demarcations.
Social movements and their progenitors, of course, do not always or even ordinarily fade gracefully into history as
these transitions occur. Those who have ridden the crest of a movement to Andy Warhol's fifteen minutes of
veneration tend to have accumulated many interests, from the egoistic to the economic, that are rarely relinquished
with ease. Moreover, such movements attract in the process of their emergence an amalgam of individuals and
interests, many of whom are wont to display certain classic characteristics associated with the " true believer"
(Hoffer, 1951), and whose cohesion and conformity - especially as "establishment" forces begin to threaten those
roles, hierarchies, and belief systems that have lent them status within their movement - may become even more
entrenched through rubrics described by Janis (1972) as "groupthink." Paradoxically, it seems, such emotive
allegiance at the core of a movement may become its most vehement just as the objective mortar of the movement
begins, in fact, to crumble.
Leaders among fire service and emergency medical providers were beginning at that juncture to pay increasing heed
to the impact of major events on the well-being of their personnel. Certain experiences seemed to confront even
seasoned personnel with images and perceptions that were unusually difficult to reconcile. Almost everyone could
recall some such experience in his or her own career, and nearly everyone could recall someone whose career seemed
to unravel after exposure to some particularly poignant or gruesome experience. If we could help with these impacts,
the reasoning went, it was surely the right thing to do.
Perhaps even more importantly, both the rescue enterprises and those who performed their functions were undergoing
a quiet but truly profound revolution. The dominant activity of the fire service was shifting from fire suppression
to basic care in intimate personal emergencies - from episodic but dramatic examples of mob violence directed
toward inanimate objects to very proximal and personal intervention at life's most intimate and most vulnerable
moments. The investment in people and the events of their lives was constantly coming closer to the provider, and
the distance and detachment that had provided so much protection in the earlier enterprise was steadily eroding in
the process. Those who entered the profession under these new "rules" were ever more prone to feel these impacts strongly and personally, and ever more in need of the opportunity to talk them through as they occurred.
Those veteran to rookie chats had long been a part of fire service tradition, but were never formally prescribed and
were usually done very quietly and very privately; the support that one received depended pretty much on "the luck
of the draw" respecting officers and comrades. The notion that some step should occur to ensure that they were done
whenever necessary, done systematically, and done effectively seemed only reasonable; that they could be initiated
through organizational protocol and done in a structured group setting seemed not just plausible but inherently
sensible. "Critical Incident Stress Debriefing" (CISD) was born.
"Mitchell Model" debriefing and the Barnum Effect
A sound basic idea has an attraction all its own. But if carefully wrapped and cleverly marketed, it can easily
become much more than it ever was or ever should have been. Given the illusion of science and precision, through
claims of theoretical roots and empirical evaluation, it readily transforms into something with a life and momentum
all its own. Social psychologists have dubbed this the "Barnum effect" (Dickson & Kelly, 1985) after the master showman who built an empire on the premise that a little gullibility can be taken a long way.
A major distinguishing characteristic of the CISD movement has been its staunchly argued and oft repeated claim
that it is a "scientifically tested and proven" intervention scheme, backed by systematic research (cf. Mitchell, 1992). Though virtually unmentioned in the mainstream literature of the psychological disciplines throughout its first decade,
and though still considered a relatively untested approach by most serious commentators in those venues (cf. Bisson
& Deahl, 1994; Deahl & Bisson, 1995; Foa & Meadows, 1997; Kenardy & Carr, 1996; Meichenbaum, 1994; Raphael, Meldrum, & McFarlane, 1995), the claims made by CISD adherents in the less critical venues of trade
journals, trade shows, and proprietary gatherings held under the sponsorship of CISD principals and proponents have
proclaimed this alleged "scientific" standing. As studies have accumulated in the refereed academic press showing
no preventive effect (Deahl et al., 1994; Hytten & Hasle, 1989; Kenardy et al., 1996; Lee, Slade, & Lygo, 1996; Stephens, 1997) and even suggesting adverse outcomes (Bisson et al., 1997; Gist, Lubin, & Redburn, 1998; Hobbs et al., 1996), principals of the debriefing movement have attempted to counter their impact by producing counterclaims woven primarily of unpublished information, anecdote, testimonials, and rhetoric (cf. Mitchell & Everly, 1997). This pattern, unfortunately, has been inherent since the earliest days of the CISD movement and
permeates the fabric of its very foundations.
The "Rescue Personality"
Mitchell has long offered as a central construct in his "model" the contention that "emergency personnel have very special personalities" (quoted by Hopper, 1988, p.7). He goes on to make an incontrovertible claim of a definitive basis in research, to wit: "Our recent study using the Milan (sic) Personality Inventory clearly shows that the police officer/firefighter/paramedic personality is significantly, statistically different from the average population" (quoted again by Hopper, 1988, p. 7). This same contention has been repeated time and again in lectures, seminars, and
writings.
The only references ever directly cited, however, led to an unrefereed trade
magazine ( Firehouse; see Mitchell, 1986) and an "unpublished
study" that article was said to describe. The data, however, appeared nowhere,
although a string of pronouncements imputed to have derived from these measurements
occupied the next several pages: Firefighters were said to be risk-takers (cf
Anderson, Lepper, & Ross, 1980), perfectionist, activity driven, manually
skilled, and such - all basically plausible and easily rationalized. But how
could such conclusions have arisen from a scale designed for clinical diagnostic
work and linked directly to the diagnostic nomenclature, and just where could
these data be found?
Mitchell promised in his Firehouse piece to publish these data
within the year, but more than a decade passed and no such publication ever
appeared. Direct requests for the data were made after a paramedic instructor
completing a thesis project (Wright, 1993) derived conclusions diametrically
opposed to several of Mitchell's standing assertions. Several months of correspondence
led to the concession that the conclusions reported were not principally the
product of such a data base, but were personal speculations (Mitchell, personal
communication, 1993), and a denial by the purported co-investigator of any complicity
in the espousing of these "profiles" (Everly, personal communication,
1993). No data, however, have been produced and Mitchell (personal communication,
1994) has indicated that, despite both accepted academic convention and specific
ethical prescriptions regarding provision of data to support published claims,
no data should be expected. Explanations offered for their unavailability have
included "last seen in the possession of another" (Mitchell, personal
communication, 1993) and "misplaced in an office move" (Ostrow, 1996).
Although such claims have been greeted with rather blunt skepticism (e.g., Brown,
1996, p. 10), the "emergency services personality" construct continues
to occupy a principal position in the outline for Mitchell's basic CISD course
(International Critical Incident Stress Foundation, 1998).
Dickson and Kelly (1985), reporting a classic exemplar of the Barnum effect, offered a litany of examples in which
persons adhered to phony personality descriptions which, much like a horoscope from the morning paper, had a little
something to fit anyone but nothing so specific as to ever stand clearly erroneous - these were found especially
convincing when said (falsely) to have been derived from psychological tests. Indeed, when given the choice
between these phony descriptors and actual psychological profile data, people tended to report the bogus descriptions
as more accurate! It should come as little surprise, then, to observe that exposure of the questionable derivation of
this "construct" and the presence of directly disconfirming data have seemingly had no discernible effect on those
who purvey that information within the confines of the "CISD circuit."
Even if this were the only problem with the marketing of the movement, it would still be a very large one; accuracy
and adequacy of data and attribution are critical matters to scientific psychology, and even the appearance of
compromise or distortion in their respect must be staunchly avoided. When the exploration of a simple technique
takes on the proportions of a "movement," though, such compromise tends to become commonplace.
The "critical incident stress" movement was spawned and nourished far outside the critical and conservative waters
of scientific psychology, espoused instead through a trade magazines, proprietary conferences, and workshops. It can
be difficult in such venues to distinguish between rhetoric and research, and faith can sometimes hold more sway
than fact. Mitchell and Everly's (1997) trade magazine piece, published as a rejoinder to growing criticism an article
entitled, "The Scientific Evidence for Critical Incident Stress Management" (emphasis in original) has furnished an unusual opportunity to explore the veracity of the evidence cited to support claims for the effectiveness of CISD.
Not all data are created equal
The vast majority of pieces on "critical incident stress management" have appeared in trade magazines and non peer-reviewed publications, and have generally been devoid of data or hypothesis testing. These pieces have
predominantly relied on anecdote as evidence for the efficacy of the CISD (cf. Everly, 1995; Mitchell 1983 et seq.)
while other studies put forward by Mitchell and Everly (1997) cite data derived from "perceptions" of helpfulness
or similar subjective responses (e.g., Burns & Harm, 1993; Robinson & Mitchell, 1993) rather than on the controlled
or comparative assessment of psychological morbidity. Data derived solely from perceptions can be specifically
misleading and demand particular levels of caution.
We've compared this before (Gist & Woodall, 1996) to the customer service surveys one finds in the neighborhood
doughnut shop: One can determine very precisely that people (especially those who choose to frequent such
establishments) tend to like doughnuts - that tells us, however, absolutely nothing about their nutritional worth. Many
people like and even crave these deep fried confections for precisely those properties that render them nutritionally
undesirable. We certainly would not accept the spurious argument that preference of the palate translates somehow
into dietary superiority.
Those studies appearing in the primary scientific literature rely instead on objective, standardized measures of
outcome, administered under controlled conditions to test well defined and specified hypotheses. Findings reported
there give us yet another cause to take serious pause: Perceptions of benefit from those debriefed are generally found,
even where objective measures show neutral or negative outcomes. Perhaps even more significantly, some recent
studies report that those who perceived the greatest benefit were not necessarily any better in their emotional
adaptation (e.g., Lee et al., 1996), and may in fact have been those who showed the more negative objectively
measured impacts (Bisson et al., 1997; Hobbs et al., 1996). Taken in this light, many of the findings on which CISD
proponents have relied may demand some very serious reconsideration.
The largest contingent amongst the references cited is comprised of unpublished conference presentations,
dissertations, theses, and such - worth considering carefully, perhaps, but also very cautiously since none of the
checks, balances, or quality controls inherent in the refereed scientific press necessarily appertain. Studies in
mainstream scientific venues have generally been subjected to critical blind review before being allowed to seek
stature as theorematic assertions in the evolution of a topic or question - theses and dissertations in particular serve
quite another function and must be treated rather differently. Responsible assessment of thesis and dissertation data
demands that one retrieve the actual document and review it in critical detail before accepting any second-hand
proclamation regarding its findings or their implications.
This is not always a simple chore. Inadequate citation practice has made tracing several theses cited by Mitchell
and Everly (1997) difficult. We had earlier, for example, sought the Bohl dissertation given prominent play by
Mitchell and Everly (1997) after its author, presenting her report as derived of her doctoral dissertation in clinical
psychology, published similar contentions in a fire servcie trade magazine (Bohl, 1995). A written request for full
citation information was mailed, including a prepaid business reply envelope; no response was ever received. Further
investigation revealed that the author was not licensed as a psychologist, that the program to which the dissertation
was attributed was not accredited in clinical psychology, and that the dissertation was not archived in the international
system established for such documents. Those data have accordingly remained unavailable for proper scrutiny.
The Lanning (1987) dissertation, from the School of Family and Consumer Studies of the Texas Woman's University,
was reviewed to determine the extent to which the data reported supported its stated conclusions. The dissertation,
in fact, provided no meaningful assessment of intervention efficacy nor any contrast of treatment conditions - it
measured endorsements of a collection of qualitative statements by occupational and demographic groups, but lent
no empirical support for any conclusions about the effects of either treatment or its absence.
Nowhere in the refereed literature do the data from these dissertations appear; never have they stood to independent
scrutiny in actual venues of the discipline (both arose from ancillary and remote sources well outside the ordinary
boundaries of academic psychology). Contrast this with the dissertation findings of Redburn (1992), generated within
the confines of an APA designated community psychology program and later reported in Gist, Lubin, and Redburn
(1998). Here, direct comparisons were made on standardized measurements of symptoms and reactions between
defined and partitioned groups subjected to a singular, well defined set of stimuli (a prototypical "critical
incident") - no effects were found traceable to the event, no benefit was derived of debriefing, and some negative
impact was suggested.
The theoretical and scientific questions now active center on the implications of these findings for the fundamental
assumptions of immediate crisis response and "one off" intervention programs. Bisson et al. (1997) questioned
the principal assumption of immediate intervention, suggesting that such early intrusion may effectively inhibit
distancing needed in the immediate aftermath of traumatic disruption. Gist, Lubin, and Redburn (1998) have
similarly questioned this fundamental tenet, noting particularly that models who provide effective social comparison
and facilitate both social construction of the problem and selection of solution schemata may prove directly helpful
while attempts at emotional catharsis prior to such constructions gaining stable focus may, in fact, disrupt these
essential developments. Moreover, Charlton and Thompson (1996) reported that persons exposed to traumatic
experiences tend initially to attempt a very wide range of coping strategies, but found that only cognitive reframing
and psychological distancing - specifically contrary to early emotional venting and coping - tended to prove beneficial.
Gump and Kulik's (1997) demonstration of social contagion in settings characterized by shared traumatic exposure
may further suggest how early group intervention might as readily promote paradoxically maladaptive responses as
constructive resolution. Taken together, these point to but one ethically defensible position regarding the debriefing
movement: Apply the brakes to the runaway train this popularized movement has become, and explore instead the
enhancement of essential resiliency, informal and instrumental support, invisible interventions, and similar quiet but
effective approaches to organizational and community response to individual and collective challenge.
We have said elsewhere (Gist, 1996a; Gist, et al., 1997; Gist et al., 1998) that the most important lessons to guide
helping efforts in times of turmoil came more from Grandma than from grad school: People are resilient; friends are
important; conversation helps; time is a great healer; look out for others while you look out for yourself. Attempts
to translate such simple wisdom into proclamations of pathology and peril do no one any particular favor, and render
to some particular harm.
Science is, as noted before, a humble and a humbling enterprise. The scientist's role remains, as it has always been,
to fan away the fog and return the focus to those fundamental principles that underlie our enterprises; even when
functioning as practitioners, we are first and foremost defenders of science and its principles as the foundation of
our practice and the standard for its success.
Science is hard nosed and hard headed, but that should never be construed as hard hearted. Too often, it has been
noted (Myers, 1998), the kind hearted tend also to be soft headed - but soft headed "pseudoremedies" are, at the end of the day, anything but kind hearted in their effect. The most often repeated lament in our enterprise, one must
suspect, may be something along the lines of "It seemed like a good idea at the time" - hardly a compelling
rationalization when applied to such significant matters as drug abuse education (Stuart, 1974), driver safety programs
(Robertson, 1980a, 1980b, 1981), suicide prevention (Gist & Welch, 1989), or other life safety interventions where
programs intended to promote safety have been found instead to have jeopardized those they were intended to
protect.
"Fact" has never been some plural derivative of "anecdote"; repetition does not establish validity, nor is persuasion
a suitable substitute for precision. Science demands something much more from its disciples than faith or
fervor - science demands instead an absolute readiness to discard self-affirming beliefs in face of disconfirming data.
Myrmidons and sycophants may shoot at messengers and defend to the death their misplaced faith, but facts have
a life all their own. The message of science is as simple as it is clear:
Trust all who seek truth; doubt all who claim to hold it.
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Dr. Richard Gist is Director of Social Sciences and Social Services for Johnson County (Kansas) Community College, one of the top ten two-year institutions in the United States. He serves as Consulting Community Psychologist for the Kansas City, Missouri Fire Department, the Kansas City, Missouri Health Department, the South Metropolitan Fire Protection District, and has assisted a great variety of public safety and social facilitation agencies throughout the United States and Canada in developing programs to address organizational and community needs. He is widely known as an author and lecturer, and edited (with Bernard Lubin) the acclaimed Psychosocial Aspects of Disaster ( New York: Wiley, 1989) and the forthcoming Response to Disaster: Psychosocial, Ecological, and Community Approaches (Philadelphia: Taylor & Francis).
Captain S. Joseph Woodall has spent more than fifteen years in the career fire service, currently serving as captain of Ladder 193 in the Phoenix suburb of Peoria, Arizona. He is currently completing doctoral study in Human and Organizational Development, and serving as Director of the Public Safety Management baccalaureate program at Grand Canyon University . He received in 1997 the prestigious Outstanding Student Paper award from the Sociological Practice Association for his ethnographic work Hearts on Fire: An Exploration of the Emotional World of the Firefighter.
Richard Gist, S. Joseph Woodall © 1998. The authors assign to the Australasian Journal of Disaster and Trauma Studies at Massey University a non-exclusive licence to use this document for personal use and in courses of instruction provided that the article is used in full and this copyright statement is reproduced. The authors also grant a non-exclusive licence to Massey University to publish this document in full on the World Wide Web and for the document to be published on mirrors on the World Wide Web. Any other usage is prohibited without the express permission of the author.
