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Defining Crisis
Crisis may occur in different environments and from a variety of circumstances. Also,
there are a variety of responses coming in various forms, causing a variety of difficulties that
may or may not include trauma. However, Jackson-Cherry & Erford (2018) suggest three
pertinent components that are presented as a crisis: “1.) a precipitating event, 2.) a perception of
the event that leads to subjective distress, and 3.) diminished functioning when the distress is not
alleviated by customary coping mechanisms or other resources” (p. 1). Furthermore, according to
the readings during this course, many definitions of crisis can be drawn from the literature. Some
theories suggest disequilibrium from stressful events of individuals, and others take the
perspective of a contextual stance that concerns developmental crises that are expected during
one's lifespan. Still, the disequilibrium gives insight into an individual's cognitive behaviors after
the crisis, competencies, and mental structures.
The Neurobiology of a crisis involves a real or perceived threat to one’s life, liberty, or
shelter. The reaction to the danger can be emotional and physical, leading to a stressful state and
the brain entering crisis mode (Brooks, 2017). This flight, fight, or freeze mode is the
physiological response that activates an individual's reaction to the actual or perceived threat.
Brooks (2017) states that this condition is hyper-vigilant/hyper-reactive, where normal cognitive
abilities are aborted for a more primal instinctual reaction. This distressed mode is a temporary
state of disequilibrium, the neurobiology of crisis affecting the brain from a situation or event
that leads a person to perceive danger, whether real or not. This is not the usual response of an
individual, so stabilization of the individual through assessment and the essential provision of
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food, clothing, shelter, or mental health services may be needed to achieve re-stabilization from
crisis intervention.
Risk factors of crisis: In addition to the emotional and psychological stress, a crisis may
present some safety concerns for individuals or a community. Crisis counselors must assess
suicides and homicides, and crisis interventionists must learn to recognize and treat them because
of their prevalence in society. Some individuals may experience grief and loss of someone or
something, which can be a risk factor from a crisis event. Two major risk assessments involve
acute and chronic risks (Cherry-Jackson & Erford, 2018). The acute risk factor may show
evidence of an individual wanting to hurt themselves due to bereavement and loss of a loved one
or property, leaving them feeling life is not worth living, which is an immediate factor or chronic
risk (Jobes, 2008; as cited by Jackson-Cherry & Erford, 2018) is described as long-term
difficulties from loss or a loved one, divorce, and may reveal thoughts of suicide with less
specificity. Counselors may underestimate encounters with clients with homicidal ideation,
especially clients with a history of specific mental health disorders, but clients with a history of
violence can present an elevated risk to a counselor (Cherry-Jackson & Erford, 2018). This risk
presents itself to a crisis counselor and the public while treating the client. Interpersonal discord
appears to be the driving force of school shootings, mass shootings in public spaces, and
workplace homicides, which in recent years, according to the FBI (Cherry-Jackson & Erford,
2018), have become a significant crisis in our communities which prevention, intervention, and
postvention in crisis assessment.
The signs of someone in crisis could include the recent loss of a relationship, humiliation
ideation, current self-harming, excessive use of drugs/alcohol, anger, aggression, rage, and
interpersonal issues. A history of mental disorders such as acting out of anxiety, schizophrenia,
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and a history of violence toward others or self (Cherry-Jackson & Erford, 2018). A client is
discussing hopelessness and admitting that death is better than living with suicide and homicide
ideation with a history of attempts. An abrupt change in mood, depression, and the purchasing of
a gun or weapon with a history of violence and mood disorders (bipolar disorder, personality
disorders) due to self-harm or violence in a client’s past. Displaying feelings of loneliness,
having no support system, and depending on whether the risk is low, mild, moderate, severe, or
extreme will also factor in the immediacy of response to the signs of someone in crisis.
The long-term neurological effects of the untreated trauma or distress of a crisis impair
the Triune brain; according to Van der Kolk (2015), the prefrontal cortex, where planning,
anticipation, sense of time, context, emphatic understanding, and appropriate actions. The limbic
system is where emotional regulation and perception occur, and the brainstem houses arousal,
sleep/wake, hunger, and one’s breathing. These compartments of the human brain are affected by
the trauma of a crisis. However, humans handle trauma differently (Van der Kolk, 2015).
Untreated neurological effects of the prefrontal cortex, whether right or left hemispheres,
underdeveloped neural highways, and emotional impairment. Also, the limbic system is taken
hostage with symptoms of PTSD and RAD, which are from traumatic-related experiences
(Brooks, 2017). Conversely, trauma-related experiences during a crisis, if undetected, can
over/under-stimulate the brain stem, causing insomnia, overeating, and inability to attend to
stimuli long enough to learn (Van der Kolk, 2015). The phenomenon of an underdeveloped or
inactive relational brain demonstrates a lack of empathy or emotional intelligence, “which is the
ability to be aware of, control, and express one’s emotions, and to handle interpersonal
relationships judiciously and empathetically” (Brooks, 2017, p.34).
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Community Crisis Event
Crisis News Story
Hurricane Hugo devastated Charleston, South Carolina, on September 22. 1989, being a
category IV hurricane, leaving Charleston and surrounding towns in terror and devastation. It
took first responders six days or more after the storm to come to neighboring McClellanville, 12
miles from Charleston, to provide intervention ( Weinrich et al., 1990). Charleston and the metro
area streets and county roads were cluttered with toppled trees and debris, leaving residents
without electricity, phone service, and water. City and county buildings were destroyed, and
homes were demolished. According to media reports, the estimated damage was 5 to 8 billion,
with a stench of decaying fish, raw sewage, and rotten food permeating the atmosphere and
gaping holes in mobile homes covered with thick mud. The marinas were destroyed, with boats
scattered at least 100 ft from their original docks, and it was declared a state of emergency in
Charleston, South Carolina, and surrounding areas. According to Weinrich et al. (1990), at least
46 counties in South Carolina were declared disaster areas, and over 18,000 miles of roads were
devasted by the class IV Hurricane Hugo; Category IV Hugo produced 139 mph winds and a 19
ft ocean surge that devasted Charleston. Many residents narrowly escaped severe flooding
downtown, leaving first responders unable to distinguish where the roads end and the ocean
begins.
Crisis Explanation
The death toll was 26 persons, determined by first responders from the initial assessment,
sending nursing students, counselors, and psychologists door-to-door to homes, emergency
shelters, and gymnasiums housing victims of the hurricane. The physiological crisis residents
suffered from diabetic reactions, allergies, hypertension, high fever, and infectious diseases that
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needed medicine and medical treatment. The psychological crisis resulted in many survivors
suffering from grief and loss of property and life while suffering from guilt for not evacuating,
thinking this was just another storm they could ride out. Some survivors displayed signs of being
a danger to themselves and others, so law enforcement officials got involved in those cases. The
physical devastation and extreme frustrations encouraged some survivors to cry, expressing
feelings of anger, guilt, and fear from the traumatic experiences of Hurricane Hugo. Conversely,
there were some survivors severely stressed, some grieving the loss of pets and loved ones, loss
of homes, and the communication of some assessed as suicide ideation, as well as post-traumatic
responses, being assessed as severe stress developed from the experiences from the devastation
of Hurricane Hugo.
Treatment Plan
(Brooks, 2017, Kolski & Jongsma, 2014, Young et al. 1998 )
Problem 1 (mental): George, a survivor, has been experiencing symptoms of severe anxiety.
Goal 1: George will reduce the severity of the anxiety so that daily functioning is not
impaired for six weeks, and he will journal about what he spends his time thinking about, telling
himself, and believing.
Intervention 1: The counselor will assess the focus, uncontrollability, and frequency of
George’s worry and the type, intensity, and duration of his anxiety symptoms.
Problem 2 (physical): George has diabetes with hypertension and minor injuries sustained as a
victim of the disaster.
Goal 2: After the initial assessment, George will comply with an evaluation by a
physician and psychiatrist for psychotropic medication for his anxiety. He will also maintain a
proper diet and exercise for six weeks.
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Intervention 2: The counselor refers George to a physician to identify and treat any
medical conditions that may be contributing to his anxiety.
Problem 3 (emotional): George displays tearful outbursts when speaking about his traumatic
experiences from the storm's trauma, which caused him to lose his property, home, and pet.
Goal 3: George has agreed to attend an anxiety support group twice a week for six
weeks.
Intervention 3: The counselor refers the client to a support group for people who suffer
from anxiety as victims of Hurricane Hugo and encouraged George to share honestly how their
anxiety manifests to help others, and himself find ways to cope better with his anxiety by
listening to others share their experience, strength, and hope.
Problem 4 (social): George has isolated himself due to his anxiety.
Goal 4: George will maintain involvement in work, family, and social activities while
recording in his journal for six weeks any symptoms of anxiety while self-monitoring any
triggering circumstances.
Intervention 4: Support the client in following through with work, family, and social
activities rather than escaping or avoiding them to focus on anxiety symptoms.
Problem 5 (spiritual): George constantly complains and worries that God abandoned him
during this crisis.
Goal 5: George agrees to identify, challenge, and replace biased, fearful self-talk for the
next six weeks with affirmations of his faith, God’s love for him, and empowering self-talk.
Intervention 5: The counselor examines the client’s thinking process and self-talk to
challenge his faith and assists him in replacing the distorted messages with faith-based biblical
principles that will increase his faith in God in coping with the trauma from the crisis.
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References
Brooks, J. (2017). Crisis intervention: The neurology of crisis. Elani Publishing.
Jackson-Cherry, L. R. & Erford, B.T. (2018). Crisis assessment, intervention, and prevention (3rd
ed.). Upper Saddle River, NJ: Pearson.
Kolski, T.D. & Jongsma, A. E. (2015). Crisis counseling and traumatic events treatment with
planner-DSM-5 updates. Hoboken, NJ: John Wiley & Sons, Inc.
Weinrich, Sally., Hardin, Sally. B., & Johnson, Maggie (1990). Nurses respond to Hurricane
Hugo victim’s disaster stress. College of Nursing, Columbia, South Carolina.
Van der Kolk, B. (2015). The body keeps the score: Brain, mind, and body in the healing of
trauma. NY.NY: Penguin Books.
Young, B.H., Ford, J.D., Ruzek, J.I., Friedman, M.J., & Gusman, F.D. (1998).
Disaster mental health services: A guidebook for clinicians and administrators
National Center for Post-Traumatic Stress Disorder.
