I am a psychiatrist and I work at the Roseburg VA hospital in Roseburg, Oregon. Everyday, I treat combat veterans, many of whom suffer Post-traumatic Stress Disorder, or PTSD. Following the news of the horrific acts of violence performed by Army psychiatrist Maj. Nidal Malik Hasan at Fort Hood, there has been a great deal of discussion about how mental health providers might themselves be affected by treating soldiers returning from Iraq and Afghanistan suffering PTSD. It has been suggested that Dr. Hasan's behavior may have arisen from a "nervous breakdown" he suffered due to the stress of treating so many young soldiers returning from war. Phrases such as "secondary" or "vicarious" PTSD are being tossed around. This is the notion that seeing how war has ravaged the bodies of young soldiers, witnessing their emotional agony, and hearing their descriptions of the horrors of war exposes mental health workers to trauma so severe that they themselves can begin to develop PTSD. Let me be very clear about this, it is no more possible to get PTSD from listening to soldiers tell their tales of their traumatic war experiences than it is to catch gonorrhea from hearing one talk about an unfortunate sexual experience.
PTSD develops in a context of extreme fear, emotional intensity, adrenaline release, and a genuine sense that one's life or the life of another is in peril. I have treated soldiers with PTSD who have seen friends blown apart by explosions or disemboweled by machine gun rounds. Many have been wounded or terrified while lying exposed in the midst of a barrage of mortar shells. PTSD can also develop in victims of rape, particularly when threats of violence, torture or death are part of the crime. PTSD can arise after high speed car accidents or house fires that tear and burn flesh and threaten life. It does not occur in true form under other circumstances.
There is a condition that can develop when a mental health care provider or anyone else listens to one after another story of horror, pain, and emotional devastation. Some self-serving psychotherapists have tried to make it more than it is by referring to it as Vicarious Stress Disorder, or Secondary Traumatic Stress Disorder. Compassion Fatigue is another term bandied about to explain the inability to handle the next difficult case of emotional trauma when litanies of pain and loss are heard day after day. However, while Compassion Fatigue may be useful to explain why charities suffer from loss of contributions during extended runs of natural disasters or prolonged economic downturns, it must not be seen to explain failures of mental health professionals to provide skilled treatment. Although compassion may lead an individual to pursue a career in mental health care, it can never serve as the basis of treatment or be depended upon to sustain interest and capability in practice. The term "burnout" has been used, and may come close to what can occur after months of immersion in a difficult occupation. However, burnout is not unique to psychiatry. Burnout is equally likely to be seen in hair stylists, mechanics, special education teachers and librarians. The answer to burnout is a pleasant vacation, not psychiatric diagnosis and treatment.
The best characterization of the condition that arises from treating sufferers of trauma, loss, and pain is, weltschmerz. This word simply means world pain, that is, the wretchedness and despondency one can feel in seeing the misery that existence in this world can bring, particularly in regard to the brutality and the horrors we heap upon one another. As Philip Larkin noted in "This be the verse", his dark ode to weltschmerz, "Man hands on misery to man. It deepens like a coastal shelf." None of this is new.
If a therapist is already depressed from his or her own life struggles, then being bombarded by endless stories of loss, pain, hopelessness, horror, and despair can certainly exacerbate the emotional distress. It can precipitate Major Depression and anxiety disorders if allowed to progress. This is where training, maintenance of good therapeutic boundaries with patients, and conferencing and mutual support among mental health professionals is so important. Providing care to those with scarred and broken minds can be painful and difficult for even the most experienced professional. However, a well trained psychiatrist or psychologist is not driven into violent frenzy by dealing with the trauma of soldiers, nor do they acquire those soldiers' emotional wounds vicariously. The very notion is an insult not only to mental health professionals, but to the men and woman who have actually experienced the horrors of war and gone on to develop the anxiety, depression, hypervigilence, nightmares, and flashbacks of genuine PTSD. To return to my opening thoughts, I do not think for a moment that Major Hasan's being a psychiatrist had anything whatsoever to do with the despicable acts he committed. Stress from dealing with the emotional trauma of returning soldiers does not explain and certainly does not excuse his behavior.
Dr. Mendelson is the author of the new book, Beyond Alzheimer's (http://BeyondAlzheimersBook.com).
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