Sunday, November 28, 2010

Vicarious Trauma

The subject of vicarious trauma has been on my mind lately.

It's always on the back burner anyway, because of my profession. Health care workers, social workers, clergy members, humanitarian aid providers, counselors, and other individuals who confront human suffering on a regular basis are at risk for it. Unlike countertransference (the redirection of a service provider's feelings or unresolved conflicts toward the person being served) and compassion fatigue or burnout (the blunting of empathy and increase in apathy and negative feelings in response to chronic exposure to others' suffering), vicarious trauma indicates a fundamental change involving the caregiver's physical, psychological, and spiritual health. It includes symptoms similar to, but less severe than, those of PTSD, such as hypervigilance, sleeplessness, an increased startle response, nightmares/flashbacks/other intrusions, and avoidance of potential triggers of these intrusive symptoms.

I can only speak from my experience as a physician but I would bet this applies to most professionals whose job involves witnessing or tending to the pain of others. I believe physicians have to strike a pretty precarious balance: feeling and showing enough empathy to provide care that is felt to be good care, with a personal connection, and maintaining enough separation of self to be able to function and provide care that is competent, prompt, and unencumbered by personal difficulties or emotional hang-ups. It's very easy, I think, on the one hand to be too distant, and to fail to connect on a human level for the sake of the work being done, and on the the other hand to get too personally involved, to over-identify with the sufferer - literally what the word patient means - and to be hampered in your caregiving because you have to run to the locker room and cry. A good doctor has to be able to cry, with or for others, but also to be able to postpone crying till later so that good work can be done. It does my patients absolutely no good if I am too busy sobbing for them to be able to hook up a syringe full of pressor and save them from their own shock. I also serve them ill, however, if I feel nothing for them whatsoever.

So to any patients or future patients out there: please don't judge physicians and nurses for staying calm while your life is falling apart or your loved one is in agony. As long as they are calm without being cold, caring without falling apart, and doing the right thing for your safety, they are serving you as best they can. When the time is right, and the work is done, they will allow time and space for that ache in their heart to remind them of you, and of why they strove to be there for you in the first place.


Outrider said...

There is much discussion of compassion fatigue in the veterinary profession.

From Vet Clin North Am Small Anim Pract. 2007 Jan;37(1):123-34; abstract ix:

"Although the term "compassion fatigue" is often used interchangeably with the term "burnout", they are two different concepts. Compassion fatigue stems from an overcommitment to work that involves caring for others and is considered by some to be a kind of secondary posttraumatic stress disorder..."

I've never heard the term "vicarious trauma" but then again, I'm a veterinarian, not a social worker or psychologist. I suspect they're related problems.

Kyla said...

I think that is a very important balance. As a parent of a medically-needy kid, I appreciate calm, yet caring medical professionals. As a future doc, I hope I'll be able to strike that balance myself.

Anonymous said...

Thank you for this - as a patient it had never occured to me that the dr might need to put aside her feelings temporarily in order to properly address my medical issues. GREAT POST!

Betty Scandretti said...

What a lovely post! I teach metaphor and poetry at a medical school and it's always a challenge to navigate between compassion and professionalism. Thanks for sharing your thoughts!