Monday, June 25, 2012

Recognition is the First Step

In the last post, we discussed the concepts of Vicarious Trauma and Secondary Shock. At a conference I attended last week, a presenter called it Compassion Fatigue. That is a lot of names for the same issue. But what is it? And what does it have to do with you? Most importantly, how can we know if it is affecting us?

As I mentioned before, I had not heard of this concept until after I graduated from law school. I loved law school (seriously, I did), but I find it unconscionable that I managed to graduate never having heard of this concept. Lawyers are four times as likely to be depressed as the general population. I knew that statistic, but I did not understand why. Of course, part of the problem is the hours, but I think it actually has more to do with Vicarious Trauma and Compassion Fatigue.

This is burnout on an entirely different stage. Burnout is not a lesser form of vicarious trauma, but it is something different. The difference between them is what causes each of them. Burnout comes from overwork or from a lack of support. It comes from stress that never dissipates. Vicarious trauma originates in the repeated interactions with people experiencing trauma. While some of the symptoms may look similar between burnout and vicarious trauma because they are both stress responses, the symptoms of vicarious trauma also include those  associated with PTSD.

I am not, in any way, minimizing the effects of burnout. It is painful and difficult and can be just as awful as vicarious trauma. My point is simply that they are different in kind. It is possible, and common, to suffer from both, but recognizing how each is different helps us recognize how best to overcome them on their own terms. And here we are focusing on vicarious trauma. In many ways, this entire blog is about burnout. In this series, however, I want to stay focused on the issues associated with vicarious traums.

What makes vicarious trauma unique is the trauma. It is the constant, repeated exposure to other peoples’ trauma. The person experiencing vicarious trauma gets there by being empathetic. Too empathetic. Empathy is the ability to put yourself in someone else's shoes, to put yourself in their situation. Too much empathy is wearing those shoes until the soles fall off. One of the first stages of compassion fatigue is an overzealous need to change the world. Sound familiar? That was the last post.

But overzealous leads to something else when we realize we cannot change the world overnight. And that’s the vicarious trauma. The symptoms follow many of the signs of primary trauma, though they are not always as intense . . . at first. Zealous excitement to change the world becomes cynicism, hopelessness and despair at the belief that change is possible. This leads to changes in our underlying belief structures, of ourselves, our family, our friends, and even our spirituality. Instead of believing we can change the world, we start believing we cannot change anything. 

Physiological signs include sleeplessness, irritability, guilt, anger, disgust, and fear. The downward spiral of email is a common side effect. Interestingly, someone with vicarious trauma experiences some PTSD-like symptoms including hyper arousal (at noise or startling events) and increased sensitivity to violence and other kinds of pain in the world. Watching the news becomes not mildly depressing but painful and nearly impossible.

And then this parade of horribles leads to relationship problems, social withdrawal, issues surrounding trust, and the favorite among lawyers – substance abuse! When your entire worldview is shattered by feeling that you cannot change anything, substances can numb the pain (alcohol) or keep you going long enough to keep on working, hoping you can get it back (cocaine and other stimulants). It starts to feel as though you never have time for yourself. You know you have to take care of yourself, but there is simply no time. There are other signs and symptoms, but these are the big ones.

But why? Where does all this originate? Why do these particular symptoms occur?

Cortisol! Once again, we are back to the fight-or-flight response. As I learned while being chased by a sea lion in New Zealand (hey, I had to add a bit of humor to this post), the fight-or-flight response is necessary to survival. We only exist because we respond to trauma with hypervigilance and what feels like superhuman strength. But we are not supposed to live in that state constantly. Cortisol and adrenaline shut down what are non-essential bodily functions. You know, digestion, rational thinking, creative thinking, and immunity. They do not sound too non-essential, do they? In their place, we get an increased heart rate, speedy and shallow breathing, and tensed up muscles. The natural cycle is to come down from that state, but vicarious trauma does not allow that natural cycle to occur. Instead, we live in that state of hyper-vigilance. And on top of the stress response, there is the fear response. Every sound freaks us out, and news reports bring us to tears. 

When our bodies live in that state, and continue to experience vicarious trauma, there is no coming down from it. And then it becomes a downward spiral. The lack of sleep precludes our bodies and minds from releasing the trauma, and then we need more stimulants to get us through each day, and then we retraumatize throughout the day, do not sleep, cannot release the trauma from the day before, and on, and on, and on.

Sound like someone you know? If you are interested, here is a link to a self-test you can take to see where you stand. Maybe you are not as bad off as you think. Maybe you are in a more heightened state of trauma. The key is knowing. Recognition is the first step.

The next post will be less of a downer and will offer some tips for overcoming vicarious trauma. But until then, do you see this in yourself? Do you see it in others?


"Recognition is the First Step" is part of the series, "Overcoming Crisis Mode," in which we discuss the second-hand trauma associated with being a lawyer and specific ways to overcome it.

© Rebecca Stahl 2012, all rights reserved. 

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