Siddharth Ashvin Shah, M.D., M.P.H.
Founder and CEO
Trauma. We encounter it just about everywhere we look these days. We absorb it through news stories of victims and witnesses of violent plots, shootings, and cruelty. We feel it through natural disasters, poverty, and homelessness. You don’t have to be someone’s mother to ache with empathy and compassion for those suffering from such horrific experiences.
For many, news stories trigger memories of their own direct traumas. Unfortunately, most people have experienced some form of trauma at some point in their lives. However, what we may overlook is that a vast number of people must withstand psychological trauma within their own jobs – especially those in “helper, protector and healer” occupations.
In a prior blog, we shared a simple definition: trauma is the negative effects on our emotions, psychology, or behavior due to an event or multiple experiences. It means that someone is suffering from at least a trace of stress to which the mind — for whatever reason — has not coped. Trauma burrows into people’s psyches. It’s distress that still aches.
Trauma has myriad causes and potentially long-term effects
It comes in many shapes, sizes, and forms – big traumas, little traumas, vicarious trauma, sub-threshold trauma, Adverse Childhood Events (ACEs). In addition to those very public and blatant causes mentioned above, private traumas are commonplace from emotional neglect, accidents, illnesses, addiction, medical procedures, hunger, homelessness. Another hidden source for trauma? Bullying at work. Though it’s impossible to cover the full gamut, here’s a high-level list of occupational traumas:
- Acutely disturbing work experiences without adequate interpersonal support
- Chronic work stress overwhelming one’s adaptive capacity
- Violent incidents
- Bullying, abusive treatment, sexual misconduct
- Excessive exposure to the trauma of others
- Mismanaged breaches of psychological safety
More than ever, we understand what trauma does to the mind, body and, relationships. We can trace such changes to increased activity in the amygdala, volume decreases in the hippocampus and medial pre-frontal cortex, and a dysregulated release of cortisol.
How does this neuroscience-speak show up in real people’s lives? A person doesn’t need all the symptoms of PTSD – an actual disorder that results in broken lives – to qualify for true traumatic suffering. Just having a few of the following trauma symptoms from workplace trauma is enough to warrant steps for remediation:
- Continual state of high alert
- Difficulty sleeping
- Negative view of self
- Helplessness, guilt, and shame
- Emotional detachment
- Negative worldview
- Relationship dysfunction
Many in high-risk occupations are missing the signs and impacts of trauma
Consider people in occupations that require exposure to others in traumatic situations or, in many cases, where workers are more likely to have traumatic experiences themselves. Physicians and nurses, humanitarian aid and international development teams, military personnel, employees at social services and other non-profits, journalists, and trauma counselors.
These occupations heroically operate under a tremendous amount of direct and vicarious trauma exposure as well as fear and anxiety about upcoming traumatic events – and their exposures are only getting worse as violence becomes more commonplace. Yet, few high-risk employer organizations are taking actions to help their people better prepare for, respond to, and heal from trauma. Remarkably, even just basic awareness of trauma as a given fact in the occupation varies greatly among high-risk sectors and organizations.
One of the reasons for overlooking trauma is that it is jarring to accept. Individuals frequently find themselves taking years to label their past experiences as traumas. And it is painful to take a close look at the significant suffering traceable to personal trauma. For organizations that are sustaining hit after stressful hit, it is all the harder to step back and take stock of all the traumas its people have sustained and worked through.
Lack of trauma awareness is causing even more problems for traumatized employees
Organizations in high-risk sectors cannot afford to ignore the costs of psychological trauma to their workforces, missions, and overall enterprises. Healthcare is a notable example. Hospitals do a great deal to protect their staffs from infectious hazards – today no one questions why we have protocols for gloves and masks. However, we overlook psychological hazards in the enterprise that naturally cause extreme stress – knowing that some will walk away traumatized from that extreme stress.
Of course, many in healthcare have an intense focus on burnout – a systems-based condition with distinct causes, no agreed-upon brain changes, and institutional solutions. Dealing with burnout is critical, but its remedies will not do much for occupational trauma. Of course, in many cases employees are suffering from both burnout and trauma.
Because awareness and acceptance of workplace trauma are so low, it’s easy for leaders and managers across high-risk sectors to be confused about persistent difficulties in their workplaces. In some cases, employees may seem to display incompetence or attitude problems when the behaviors are really manifestations of psychological trauma. Some desperate bosses write up employees, unknowingly giving them performance improvement directions that miss the target and won’t help resolve the issues at all.
To be clear, knowing the signs of how trauma manifests as performance issues does not mean that everything gets re-labeled as trauma. But it expands the aperture on different types of stress exposures and their impacts so that the right remedies are implemented.
Trauma-Informed Design is the path to improved wellbeing
How do organizations address the noxious plume of accumulated traumatic stress in a diverse group of otherwise ultra-capable, altruistic, technical experts?
Today, academics and service providers, including Greenleaf, have advanced “trauma-informed” principles for which organizations can learn competencies. Trauma-informed design can counteract unnecessary suffering, mitigate risk, and secure positive change. To start, an organizational assessment can reveal the trauma vulnerabilities that slowly sap resources, or in other cases lead to dramatic distress. Effective solutions must be customized to the related missions and operations. Trauma-informed design gives organizations “Do No Harm” processes and systems as well as enabling staff knowledge, appropriate care, new behaviors, and emotional resilience.
In some people, traumatic stress can resolve naturally over time. Others find help to be critical. Either way, studies and experience show that recovery – and post-traumatic growth – are accelerated when we take an active approach based on good sense and evidence. Organizations, particularly high-risk and high-exposure organizations, will always have some people who are coping reasonably well, other struggling greatly, and many in the middle. These organizations cannot afford to hope for the best and ignore the risks of untended trauma. Taking action – trauma-informed action – holds forth considerable rewards for growth, productivity, and wellbeing. It protects the selfless worker, as well as the enterprise as a whole.
As always, we’d love to know your thoughts and invite you to reach out.