Unspoken Epidemic

UBC Reports | Vol. 49 | No. 12 | Dec.
4, 2003

By Hilary Thomson

What is the effect of continued exposure to the suffering
of others?

That’s the question UBC researchers and international
trauma specialists will explore in an interdisciplinary workshop
to be held in 2004 at UBC’s Peter Wall Institute for
Advanced Studies (PWIAS).

Cumulative exposure to suffering may result in vicarious
trauma, also known as secondary trauma or compassion fatigue.
Affecting people working with traumatized survivors, the condition
is characterized by a transformation within the helper because
of their empathy with the survivor. The transformation often
means the helper develops similar traumatic stress reactions
as the survivor.

Dr. David Kuhl, of the department of family practice, along
with Assoc. Prof. Marla Arvay and Prof. Marv Westwood of the
department of educational and counselling psychology and special
education, are organizing a workshop to examine the scope
and severity of vicarious trauma and also look at prevention
and treatment strategies. Vicarious trauma affects both professional
and non-professional helpers, however, the workshop will focus
solely on the effect on professionals ranging from nurses,
doctors and humanitarian aid workers to lawyers and journalists.

“Vicarious trauma has been recognized for about 15
years but there is little research in the area and no prevention
or treatment programs exist,” says Kuhl, an expert in
palliative care and doctor-patient communication. “Left
untreated, caregivers can become cynical, disillusioned, even
intolerant and hostile toward everyone in their life — including
the person they are supposed to be helping.”

Listening to graphic descriptions of horrific events or witnessing
or hearing of people’s cruelty to one another are just
some of the experiences that can lead to vicarious trauma
— an occupational hazard for many professional helpers.

Symptoms of vicarious trauma can emerge without warning.
They include fatigue, heart palpitations, difficulty concentrating
and decision-making and feelings of anxiety, irritability
and a cynical, dehumanizing attitude. Other signs are intrusive
imagery and thoughts, depression or avoidance.

Often there is a significant disruption in identity, worldview,
or religious beliefs. Those with a prior history of significant
trauma or instability may suffer to a greater degree.

As symptoms progress, the helper can become less sensitive
to the victim’s concerns.

Dying patients have told Kuhl that the way the health-care
provider communicated with them caused more suffering than
the illness itself. The interactions start a downward spiral
of pain, unmet needs and additional trauma, for both victim
and helper. A Canadian Medical Association study recently
reported that 45 per cent of doctors show features of burnout
— a possible component of vicarious trauma.

“These people are paying the price for a job that needs
to get done,” says Kuhl.

As a physician, Kuhl is well aware of how health-care professionals
are often regarded as heroic or superhuman and unaffected
by the trauma they witness.

“Denying or trivializing feelings and leaving your
personal life at home becomes a matter of pride — but psychologically
it’s not possible.”

The phenomenon is also seen in military personnel who witness
atrocities, torture and death. Marv Westwood has worked extensively
with veterans and Canadian peacekeepers suffering from stress
reactions to trauma. Some of the counselling interventions
he has used, such as guided autobiography and therapeutic
re-enactment, may also be useful for those suffering form
vicarious trauma.

Marla Arvay, a specialist in the effects of trauma, has conducted
a national survey on vicarious trauma in Canada as well as
a narrative study on trauma counsellors’ experience
of the condition.

Funding for the workshop is provided by the PWIAS and UBC’s
Office of the Vice-president, Research.