Mark Gorkin, MSW, LICSW, "The Stress Doc" ™, a Licensed Clinical Social Worker, is an acclaimed keynote and kickoff speaker as well as "Motivational Humorist ...Read More
The other day I launched my inaugural workshop on “Combat Strategies at the Burn-in and Burnout Battlefronts” during a “Loss and Grief” program sponsored by the Psychiatric Institute of Washington, DC. The majority of folks in the audience were social workers and other allied health professionals. An issue from an audience member that resonated with many was the potential for “Vicarious Trauma” (VT). The literature has an international flavor, often speaking to the “humanitarian aid” employee involved with some wide scale, “man-made” or war-torn trauma or disaster, e.g., rape, pillage, “ethnic cleansing,” etc. However, vicarious trauma along with its conceptual and operational cousin, “caregiver burnout,” has a wider interpersonal reach and problematic scope. In addition to fleshing out the VT concept, this essay will examine how certain personality traits and tendencies can fuel the vicarious and vicious exhaustive and erosive “trauma-burnout” cycle.
Who Can Catch VT?
According to the Vicarious Trauma and Headington Institutes, “Vicarious trauma is the process of change that happens because you care about other people who have been hurt, and feel committed or responsible to help them. Vicarious Trauma is what happens to your neurological (or cognitive), physical, psychological, emotional and spiritual health when you listen to traumatic stories day after day or respond to traumatic [or emotionally maddening, discouraging, and disheartening] situations while having to control your reaction. VT is a process that unfolds over time. It is not just your responses to one person, one story, or one situation. It is the cumulative effect of contact with survivors of violence” and disaster. However, I believe Vicarious Trauma is not only the product of horrific drama; VT conditions need to be placed on a spectrum of distress and disruption. Other less sensational yet often no less demanding person-social situation contexts contribute to VT susceptibility, including continuously working with or caring for:
1) stateside military personnel and their caretakers – from VA personnel to spouses and parents – grappling with post-traumatic stress injury or traumatic brain injury and its personal and interpersonal effects; men and women who can’t help but compare their pre- and post-“down range” mind-body state: the lingering mental fog, the depression, the nightmares, the angry flashes, the reduced physical mobility, etc.; and, especially with military personnel or even family members, despite the high command’s systematic efforts to destigmatize mental health issues, the many individuals in a “macho culture” who remain ashamed to acknowledge or to discuss their vulnerable and/or compromised “head case” conditions,
2) people who are struggling with poverty or economic displacement, many warehoused by the criminal justice system, or grappling with environments (e.g., a tight job market or foreclosed housing market) that foster a sense of “learned helplessness,” hopelessness for the future, or angry resignation,
3) the victims of domestic, child abuse, sexual abuse, and bullying or other anti-social and destructive actions; intervening with substance abusers and those engaged in other self-defeating addictions and behaviors, including defiance and denial,
4) people whose disastrous, disruptive, demeaning, and/or self-defeating experience may result in a profound sense of loss of personal control and of trust, often contributing to a wariness with perceived “authority figures” and a resistance to accepting counsel; a clash of divergent cultures or conflicting cultural practices between providers and recipients of aid or service may exacerbate interpersonal contentiousness or distance,
5) the aged and infirmed, or being responsible for individuals struggling with profound physical, neurological, and cognitive-affective illness, disability, and/or dementia; not understanding the nature and limits of the condition may create unrealistic expectations and frustration for both parties,
6) a once strong family member or significant other who has now lost his or her bearings, balance, and/or bladder control; in their new “strong one” role, a caretaker who prematurely buries his or her grief regarding this loss and potential “role reversal” is inviting exhaustion if not drama or trauma,
7) teachers who can’t get through to young, irritated students who come to school hungry, or students from dysfunctional families whose hostile and hurtful patterns of interaction in the kitchen are invariably acted out in the classroom; or when a child’s chronic stress contributes to noticeable underachievement, attention deficit, and learning disabilities, if not a sense of shame and depressive tendencies; alas, hurt and hopelessness can morph into withdrawing inside a hardened protective shell,
8) a parent trying to reach, reason with, and restrain a forever angry or defiant, bingeing, texting or drinking while driving, living on the edge, thinking he or she is invulnerable teenager or young adult.
Clearly the potential for Vicarious Trauma and Caregiver Burnout cuts across a wide swath of essential and everyday roles and relationships. At the same time, depending on your personal sensitivity, ongoing stress levels, and the plight of those with whom you are engaged, “you can [eventually] come to question your deepest beliefs about the way life and the universe work, and the existence and nature of meaning and hope.” Such daunting and draining work may result in “existential angst” – the sense that one is constantly being pushed out of a comfort zone and is forced to question the meaning of events, one’s own and others’ actions and reactions. How could a benevolent “God” allow such atrocities, catastrophes, or unexpected and unfair casualties? Why were this person and these people targeted?
Being the witness, recipient, or active participant in distressing, disheartening, disillusioning, and disempowering life scenarios and stories, “day after day, and year after year” can take a profound toll on one’s mind-body-spirit.
So the numbing or alienating field of VT may not just be thousands of miles away; it may be as close as your professional office, a classroom, your living room, or the home of a family member.
Clearly, people who place their mind-body-spirit on the line, helping those fighting for post-traumatic survival or struggling to maintain some sense of economic and/or psychological stability, autonomy, self-worth, and competency in a “survival of the fittest” world rate a Purple Heart for passion and compassion. However, this “Vicarious Trauma” and “Caregiver Burnout” helping context is fraught with both subtle as well as the previously noted more obvious risks. If not sufficiently aware of one’s own psychological patterns and needs that can befog clarity and objectivity, purpose and boundary, the situational hazard may not be the sole or primary cause of the VT Syndrome. One must ask two critical questions: does Vicarious Trauma or Caregiver Burnout ever morph into (or, as likely, finally expose) Professional (or Personal) Codependency? That is, do cognitive beliefs, personality characteristics, and patterns of coping and caregiving increase the likelihood of getting VT? And do organizations or family-cultural systems themselves ever purposefully enable or unwittingly facilitate such trauma or burnout?
According to Wikipedia [and my own editing], Codependency is defined as a psychological condition or a relationship in which a person is:
a) controlled or manipulated by another [or who allows themselves to be controlled or manipulated],
b) is affected by or involved with a partner with a pathological[/medical] condition (as in an addiction to alcohol or heroin) or [caretaking a significant other with a traumatic injury or seriously disabling condition],
c) and in broader terms, it refers to the dependence on, [fear of,] or control of another,
d) it also involves placing a lower priority on one’s own needs, while being excessively preoccupied with the needs of [or the well-being, approval, performance, or success of] others, and
e) not surprisingly, codependent natures often attract individuals with narcissistic issues, that is people who feel entitled to the care, admiration, and service of others; [however, a subtle form of narcissism may also be present in this codependent dyad, that is, the self-sacrificing individual may also believe, albeit on a covert level, that the world owes him or her for such unselfish, accommodating, and altruistic attitude and behavior; such “fairness” and “heaven’s reward’ fallacies would invariably heighten susceptibility to Vicarious Trauma, both regarding unrealistic expectations in general with wary recipients of aid in particular].
Codependency can occur in any type of relationship, including family, work, friendship, and also romantic, peer or community relationships. Codependency may also be characterized by denial, low self-esteem, excessive compliance, or control patterns. More specifically, people who are codependent often take on the “martyr role”; they constantly put others’ needs before their own and in doing so forget to take care of themselves. [In fact, such individuals often use the role of “rescuer” to distract or lose themselves or deny and project their vulnerable emotions onto others’ problems.] This creates a sense that [there’s a serious issue for which] they are “needed”; they cannot stand the thought of being alone and no one needing them. Codependent people are constantly in search of acceptance. When it comes to arguments, codependent people also tend to set themselves up as the “victim.” When they do stand up for themselves, they feel guilty.
Codependency does not refer to all caring behavior and feelings or to normal kinds of self-sacrifice or caretaking, but only those that are excessive to [a dysfunctional] degree. For example parenting is a role that requires a certain amount of self-sacrifice and giving a child’s needs a high priority, although a parent could nevertheless still be codependent towards their own children if the caretaking or parental sacrifice reached unhealthy or destructive levels. [Such scenarios might include a child compelled to fulfill the unfulfilled fantasies of a parent, or one frequently parenting the parent, or prematurely and subtly yet fairly literally having to be the “man” or confidant in the household; or when a lonely parent needs to be “best” friends with a teenage son or daughter]. Generally a parent who takes care of their own needs (emotional and physical) in a healthy way will be a better caretaker, whereas a codependent parent may be less effective, or may even do harm to a child. Another way to look at it is that the needs of an infant are necessary but temporary whereas the needs of the codependent are constant.
Part I has examined the realm of Vicarious Trauma and Caregiver Burnout, illustrating its common occurrence among many roles and relations in contemporary society, and how the humanitarian if not heroic efforts of helpers and healers can without sufficient awareness and supervision, become a disguised, draining, and hazardous process of relating. Part II will begin to flesh out the bridge between codependency and Vicarious Trauma.