Vicarious traumatization: PTSD is contagious and deadly
All the facts about the Fort Hood massacre are not in yet, and may not be for some time. The early facts left me horrified, and a little scared: Terrorism? Warriors run amuck? But when I learned that the likely shooter was an Army psychiatrist who treats PTSD, himself on the cusp of deployment, I thought, “I’m not surprised.”
One fact we do know is that treating PTSD is itself traumatic. Before you judge or maybe make a joke about some shrink wigging out–or indulge ugly racist fantasies–I want you to imagine a work day spent bearing witness to traumas so horrific media outlets won’t even show the videos. Imagine every day trying to help young men and women somehow put their lives back together despite their night terrors, flashbacks, and chronic sleeplessness. While you reach out to help, they mistrust your every move and respond with hair-trigger tempers, not to mention all the physical symptoms, alienation, and hopelessness. Surrounded by thoughts of suicide–and homicide–you try and keep faith with the honor and challenge of providing care.
But soon the line between their experience and yours starts to blur until, well, something like what happened at Fort Hood today becomes an all too real possibility.
The fact is treating soldiers traumatized by war experience is not just an honor and a challenge; it is itself a risky behavior. McCann and Pearlman, in a 1990 article in the Journal of Traumatic Stress were the first to identify
the problem of vicarious traumatization (VT), which they defined as the cumulative transformative effects upon therapists resulting from empathic engagement with traumatized clients. As part of their work, these clinicians must listen to graphically detailed descriptions of horrific events and bear witness to the psychological (and sometimes physical) aftermath of acts of intense cruelty and/or violence. The cumulative experience of this kind of empathic engagement can have deleterious effects upon clinicians, who may experience physical, emotional, and cognitive symptoms similar to those of their traumatized clients (Harrison, Richard L.; Westwood, Marvin J. “Preventing vicarious traumatization of mental health therapists: Identifying protective practices.”Psychotherapy: Theory, Research, Practice, Training. Vol 46(2), Jun 2009, 203-219.)
Early reports seem to suggest VT–also called compassion fatigue and secondary traumatization–as the most likely explanation for what happened.
Having counseled scores of returning soldiers with post-traumatic stress disorder, first at Walter Reed Army Medical Center in Washington and more recently at Fort Hood, he knew all too well the terrifying realities of war, said a cousin, Nader Hasan.
“He was mortified by the idea of having to deploy,” Mr. Hasan said. “He had people telling him on a daily basis the horrors they saw over there.”
New facts may change the contours of the story, but if events continue on anything like their current course then vicarious traumatization will end up part of the final version.
The shooter was himself wounded by war, perhaps fatally so, well before he first pulled a trigger (and at 9:15 PM we learn, correcting earlier reports, that the gunman-doctor was NOT killed). Those killed and wounded by his actions at Fort Hood are as much casualties of war as are all our other neighbors, friends, and family so far killed and wounded in Iraq and Afghanistan. Understanding what happened is not to excuse anything that was done, far from it, but understanding may help prevent subsequent and possibly preventable tragedies.