IT IS OKAY TO BE HUMAN...
Is It Inevitable?
Have you ever stopped to think about the paradox of being expected to demonstrate empathy whilst attending the aid of people in the most devastating moments of their life, yet expecting yourself to remain unaffected by those same events?
The amount of transference a front line worker receives from each patient, victim or person they meet is completely dependent on an individual's life experiences. As a result. there is realistically no way to anticipate the emotional load any one individual will sustain compared to another responding to identical incidents.
Spin Dragon incident, Royal Adelaide Show 2000. Metal fatigue in a show ride resulted in a collapse injuring 37 people. I was a mere first aid volunteer at the time. It was my first major incident and it was all quite overwhelming.
My Story
When I was 18 years old, I woke up very early one morning. I was agitated. I needed to be somewhere urgently.
I looked around my dark bedroom trying to find some clue as to what I was supposed to be doing. Why I felt so decisively that I had to be somewhere.
It took about a minute for me to come to my senses, I glanced at my digital clock, it was 3:36am. There was nowhere I could possibly need to be at this time, and that I could relax. I rested my head back on the pillow, closed my eyes and slept the rest of the night.
I didn't give it anymore thought the following day, went about my business, and then that night, went to sleep as usual. Suddenly I woke with a start. I had to be somewhere urgently.
My eyes darted around my dark room, everything was quiet. I glanced at my bedside clock. It was 3:36am. I squinted at the clock wondering whether this was real. Two nights in a row I had woken at exactly the same time, completely convinced that I needed to be somewhere in a hurry. I didn't get back to sleep quite as quickly this time but just like the night before, I finally relaxed, drifted back to sleep, and didn't think about it for the remainder of the morning or the following day.
Then it happened again, and again, and again. Every single morning, 3:36am on the dot I would jump awake ready to race out the door. This went on for over three weeks like clockwork.
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I found myself talking with someone about it one day, both how fascinating it was but also that it was starting to bother me somewhat. It was in the process of discussing this that I had a 'holy crap' moment. Upon unclipping my pager from my belt and looking back through the history did I find something amazing. You see, the morning before this problem began, I had responded as a volunteer firefighter to a truck accident. The driver had fallen asleep at the wheel on approach to a T-intersection, had driven straight across the highway and into a large concrete catchment on the other side. The cab was devastated by the b-double trailers, with the driver managing to somehow survive climbing out of the window from a barely large enough cavity that had remained despite being folded around steel piping in reinforced concrete. Despite his miracle egress, he still needed to be rescued from inside the chained off catchment where his truck was now fully ablaze.
The driver survived. Unfortunately, it became apparent later that morning when the driver properly regained consciousness, and was able to recall despite what he'd told us earlier that there was someone in the sleeper at the time of the collision. They had died instantly. It was the first fatal attendance of my career. The pager had sounded at 3:36am that morning. The moment I realised that, never did I wake at 3:36 again.
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The funny thing is, up until that realisation, I had no idea that I even had issues with the incident. I knew it was a big thing. I knew it was a horrible thing. I knew that it occupied my thoughts as any large incident would, but I didn't know it had affected me. My mind had other plans though. And that, was the first example that resounded to me the power of the human mind, and how it works through problems in its own way, at its own pace. It also demonstrated to me very early on, the disempowering effect that offloading can have on that which is affecting us.
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Personal Safety
Just like transference is variable between individual front line workers, so is the the impact on the threat to personal safety and the coming to terms with one's own mortality or morbidity. This can be as simple as a minor but permanent injury all the way up to experience of the intentional attempt on one's life by another.
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It is innate that trauma negatively affects us to avoid future safety issues however the severity of that negative affect can be severe. A complex set of thoughts need to be worked through to contextualise and deescalate the severity where what should be a learned experience becomes incapacitating.
Mental Health Stigma
Photo: NT Police - The image depicted was actually a fun video created by members of the service in response to being left out of the Running Man Challenge
Despite attempts to change the narrative around mental health in front line service personnel, there is still a stubborn culture of mental health as being a 'strength based' capacity. Or the notion that if one can't 'hack it' then they aren't cut out, like being emotionally numb is a skill or aptitude, or that it is even desirable.
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As mentioned above, empathy is in fact a desirable trait as it assists in comforting, supporting and information gathering. Even in confrontational situations it allows one to find common ground and deescalate or for effective interrogation. So empathy in itself is not a weakness but it is a double edged sword.
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By definition, empathy is the notion of 'putting ourselves in the shoes of another' for the aim of better understanding the experience of another. This unfortunately leaves us open to a form of lasting transference and increases our emotional load. The severity of which is dependent on our experiences and values as mentioned above.
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By the same notion, the experience of trauma is not going to affect individuals the same way. An individual who has always taken their life and health for granted, for example, can often be affected far more at the notion of loss thereof, than someone who has already been through permanent injury or illness. Quite similar to the loss of a loved one, the grief response to the loss of health or underlying belief of immortality or more correctly 'it won't happen to me,' is an enormous set of emotions to work through.
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So we head back to the first question I asked, 'Is it inevitable?'
Yes and no. Our experiences will definitely change who we are as a person but it won't necessarily lead to debilitating depression. The grizzled veteran who seems emotionally numb to everything wasn't always that way, and whilst it is easy to become envious of seemingly being unaffected (assuming they actually are rather than being adept at putting on a convincing mask as such) with that emotional numbness will likely carry an inability to effectively engage with individuals like they used to be able to.
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It is okay to be human. It is human to be affected. Being affected is not weakness or failure and it certainly does not make you worse at the job.
Isolation as a Solution
One of the most common failed approaches I see to mental health maintenance is the 'isolationist' approach.
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Before I discuss the isolationist approach, I want us to think about the classical image or presentation of the depressed person. Most people will think about an individual that becomes more quiet, becomes a loner, engages in less social activity, less enjoyable activities and generally starts keeping well to themselves.
Take this to the extreme, with a depressed individual who becomes suicidal, the internal rationalisation for the harm that such an action has on friends and family is that 'they will be better off without me'.
Now we return to the isolationist approach to mental health maintenance.
"I will bottle it up."
"I don't want to trouble my partner/friends/family with my problems."
"I don't want to expose my partner/friends/family to that which is affecting me."
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The parallels with the depression pathway are extraordinary. Furthermore whilst the "They will be better off without me." makes sense to the suicidal individual, you would agree that generally everyone else would disagree with that thought process. I would generally call it a 'defective thought process,' when I am working with struggling individuals.
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Our mind is an incredibly powerful organ which can work for us, striving and pushing us towards amazing goals, reinforcing good, strong thought processes that keep us jumping out of bed in the morning and pushing towards the unimaginable...
Or it can work against us, persuading, accepting, reinforcing and self actualising, negative, destructive thoughts and ineffective or damaging coping strategies, i.e. drinking, drugs, self harm (scratching, cutting, burning, etc) or worse.
Either way, our mind works as chief editor, and the best way to check the health of our mind is by outsourcing our thought processes for review by a third party. That way if you tell me or another that you think the best way to deal with your issues is to drink three bottles of wine at night, your partner, friend, therapist, doctor can tell you that this thought process is rubbish. Understandable why you'd have chosen it, so don't beat yourself up. But definitely worth replacing as a coping strategy with something more sustainable.
Now, noone wants to be criticised or judged so here we can check the validity of the notion that dealing with problems by bottling it up demonstrates more strength than divulging your thoughts to another. Given the vulnerability you open yourself up to by putting your thoughts out for other people to consider and respond to, I would not suggest the measure of strength is actually the individual avoiding that risk.
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The last notion I would like to address in this extremely complex and enormously time consuming topic, is to address the notion of exposure. Now, for the majority of things, discussing issues with partners, friends, and so on is probably not as catastrophic for them as one can make it in their mind. Further more, chances are pretty good they want to be there for you and that includes allowing you to release the pressure valve on the things which are beginning to take their toll.
The caveat to this however is the notion of 'details.' As anyone reading this who has long lasting memories or has been affected by an incident or event would know, it is often the details that our mind fixates on or finds distressing. It's often those details that when released give our minds the consent to reduce the fervour in which it holds those details and the severity of the effect over us. BUT, it is also those details which have caused an experienced front line worker to become distressed so it is likely that anyone else is likely going to find those details distressing as well. For the non-professional listener, it is going to be important to fire a warning shot of that which it is that you wish to offload before saying it.
If your partner/friend/other does not want to hear the details then this is where a professional comes in. Contrary to the common belief that a doctor/psychologist can't possibly know what you're going through, there are a number of people such as myself who have worked in areas where we have had to come to terms with horrible things and have front line experience. There are plenty of ex or currently serving emergency volunteers, professionals and or soldiers who work within mental health for our colleagues. We will give consent to hearing the horrid details which are affecting you so much as we have our own strategies to help us deal with the trauma of that which you need to offload. Many hands makes light work in the task of carrying such horrible psychological burdens.
I can't give an example of 'details' of trauma without divulging my own triggers, of which may unnecessarily affect readers of this page but again, I am almost certain that anyone experiencing bottled trauma with which they're desperate to expound, it will be those specific 'details' which are the most desperate to be offloaded.
Your Support Team
The greatest achievers in the world all use support teams. You should too.
Daniel Kalisz Photographer
As an occupational doctor, I highlight the necessity to build a treatment team early. A team of mixed health workers who will work cohesively to get an individual back to a pre-injury condition as quickly as possible. This team is dependent on the injury but this mantra can and should also be applied to mental health and maintenance.
Mental health maintenance is hugely multifactorial and is affected by holistic health as well. Assuming your approach to your career longevity is to be well prepared, then your team should consist of at least a good General Practitioner, Physiotherapist and Psychologist. This team can address most of your health maintenance and any general concerns you may have. Extending your team to include more specific input could include an Occupational Doctor, Exercise Physiologist and a Dietician.
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The aim of the game is to assume that you can always do better to keep yourself in peak condition. Your team can regularly 'check under the hood' and make sure things are running smoothly for you, as well as to help you address issues before they become a major problem. However, if you do end up with a major problem, as mentioned before, your team can ensure that this is not a path you have to walk alone. Particularly as it pertains to mental health, your team will be with you, to help you work back to health and contentedness, where you deserve to be.
