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Wisdom is a complex trait, and previous research has identified several components of wisdom. This study explored the possible impact of a diagnosis of a terminal illness on the conceptualization and evolution of wisdom while facing the end of life.
Design and Participants:
Semi-structured qualitative interviews were conducted with 21 hospice patients aged 58–97 years who were in the last six months of their life.
Hospice patients were asked to describe the core characteristics of wisdom, as well as how their terminal illness might have impacted their understanding of this concept. The interviews were audiotaped, transcribed, and coded by the research team using a grounded theory analytic approach based on coding consensus, co-occurrence, and comparison.
Broad concepts of wisdom described by the hospice patients align with the extant literature, thereby supporting those general conceptualizations. In addition, hospice patients described how their life perspectives shifted after being diagnosed with a terminal illness. Post-illness wisdom can be characterized as a dynamic balance of actively accepting the situation while simultaneously striving for galvanized growth. This delicate tension motivated the patients to live each day fully, yet consciously plan for their final legacy.
The end of life offers a unique perspective on wisdom by highlighting the modulation between actively accepting the current situation while continuing the desire to grow and change at this critical time. This paradox, when embraced, may lead to even greater wisdom while facing one's own mortality.
This chapter reviews results from studies that have focused on the effects of disaster on individuals with disabilities. The International Classification of Functioning, Disability and Health (ICF), created by the World Health Organization provides perhaps the most ecumenical definition of disability and uses a biopsychosocial approach to disability. Rooney and White's study of consumers with mobility impairments is one of the few that have obtained data directly from individuals with disabilities. Individuals with sensory disabilities include those who are visually impaired or blind, representing approximately 3% of the U.S. population and those who are auditorally impaired or deaf represent approximately 2.4% of the U.S. population. Individuals with cognitive disabilities include those individuals who are labeled as having autism, developmental disabilities, traumatic brain injury, learning disabilities, or intellectual disabilities. Individuals with preexisting psychiatric disorders may be at additional risk due to events that occur postdisaster.
Within one month (March 2001), two separate incidents of school shootings occurred at two different high schools within the same school district in San Diego's East County.
To examine community-wide expressions of post-traumatic distress resulting from the shootings that may or may not fulfill DSM-IV criteria for post-traumatic stress disorder (PTSD), but which might interfere with treatment and the prevention of youth violence.
A qualitative study was undertaken using Rapid Assessment Procedures (RAP) in four East San Diego County communities over a six-month period following the two events. Semi-structured interviews were conducted with 85 community residents identified through a maximum variation sampling technique. Interview transcripts were analyzed by coding consensus, co-occurrence, and comparison, using text analysis software.
Three community-wide patterns of response to the two events were identified: (1) 52.9% of respondents reported intrusive reminders of the trauma associated with intense media coverage and subsequent rumors, hoaxes, and threats of additional acts of school violence; (2) 44.7% reported efforts to avoid thoughts, feelings, conversations, or places (i.e., schools) associated with the events; negative assessment of media coverage; and belief that such events in general cannot be prevented; and (3) 30.6% reported anger, hyper-vigilance, and other forms of increased arousal. Twenty-three (27.1%) respondents reported symptoms of fear, anxiety, depression, drug use, and psychosomatic symptoms in themselves or others.
School shootings can precipitate symptoms of post-traumatic stress disorder at the community level. Such symptoms hinder the treatment of individuals with PTSD and the implementation of effective prevention strategies and programs.
Previous studies have reported ethnic differences in the prevalence of post-traumatic stress disorder (PTSD), but the reasons for these differences remain unclear.
Ethnic differences in the prevalence of PTSD may reflect ethnic differences in (1) exposure to traumatic events; (2) appraisal of such event as traumatic; and (3) culturally-determined responses to standardized diagnostic instruments, reflecting differences in cultural meanings associated with physical symptoms and idioms of distress.
Ethnic differences in risk factors and factor structures of PTSD symptoms were examined in 188 Alaskan Natives and 371 Euro-Americans exposed to the Exxon-Valdez oil spill in 1989.
High levels of social disruption were associated with PTSD one year after the oil spill in both ethnic groups. However, low family support, participation in spill clean-up activities, and a decline in subsistence activities were significantly associated with PTSD in Alaskan Natives, but not in Euro-Americans. Factor analysis of the Diagnostic Interview Schedule PTSD subscale revealed five factors for both ethnic groups. However, the items comprising these factors were dissimilar.
These results suggest that social disruption is sufficiently traumatic to be associated with symptoms of post-traumatic stress, but that a diagnosis of PTSD must take into consideration local interpretations of these symptoms.
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