Recognizing Trauma and Distress in the Workplace: How to identify if you or your colleagues are struggling and ways to help

Working in the medical field can mean walking through an inherently stressful and often trauma-filled environment on the daily. Many of us (I am a clinician myself - a mental health counselor who works largely with clinicians) work regularly with people who are experiencing the worst days of their lives. It can feel jarring sometimes to go about our jobs, knowing that our patients’ worst days are often simply part of our normal work week. We all develop strategies to try to survive all the suffering; everything from adopting the “white coat as shield” mentality so as not to let the hurt in, to trying to help as much as possible while succumbing under the weight of feeling helpless, to dissociating and self-medicating to avoid the pain for fear it will sink us.

In short, working in the healthcare field can be incredibly difficult, even at the same time that it can also be incredibly fulfilling. Over the years I have come to recognize that an important part of maintaining our wellbeing as healthcare workers is to ensure that we are aware of the different kinds of stresses and trauma that working in the healthcare field can expose us to. While most of us are familiar by now with the concept of medical burnout and its symptoms, we talk far less commonly about the other forms of distress and trauma that many in healthcare experience.

An overload of stress and/or trauma can manifest in a host of different ways, including difficulties with executive functioning (memory, concentration, organization, etc), reduced efficiency, increased absences, and even trauma-related symptoms such as hypervigilance, emotional reactivity, and isolation. Efforts to support fellow healthcare workers who may be experiencing such struggles can be strengthened through gaining a deeper understanding of some of the different types of distress that they may be experiencing:

• Compassion Fatigue - Emotional exhaustion resulting from caring for individuals who are suffering, and in the process, absorbing their suffering. This can have a quick onset.
• Moral Injury - Traumatization that results from a moral betrayal of what is right, by a superior or a person in a position of authority, during an important or high stakes situation. This often is associated with feeling as though one has been made complicit in this betrayal of their morals.   
• Racial & DiscriminatoryTraumatic Stress - Traumatization and mental/emotional injury resulting from experiences with bias, abuse, discrimination, and/or hate crimes that are based on identity (racial, ethnic, gender, religious, ability/disability, etc).
• Secondary Victim Syndrome -  Traumatization that results from a medical error in which a patient is harmed. The patient is considered the primary victim, while the clinician who made the error (if they develop symptoms of traumatic stress, often centered around shame and doubt) is considered the ‘secondary victim’ of the mistake. 
• Secondary Traumatic Stress - Traumatization resulting from witnessing or experiencing the afteraffects of another person’s traumatic experience (common in first responders).
• Vicarious Traumatic Stress - Development of symptoms of traumatic stress after indirectly experiencing another person’s traumatic experience (often by listening to details being described). 

Having the language to name what we might be experiencing not only helps us to know that we are not alone, it also helps us to recognize signs in others and identify interventions and tools that might help. For instance, an effective strategy for combatting compassion fatigue is a combination of mindful listening and emotional regulation tools. When combined, these techniques can help us learn how to listen to and be present with others who may be having difficult feelings without taking them on or feeling responsible for them ourselves. Powerful connection and healing can occur simply by witnessing and being present with another person while they are struggling, especially in healthcare spaces. If we can learn how to be fully present with another person while respecting their autonomy, not absorbing their feelings, and regulating our own emotions, then our capacity to care for them without fatiguing can expand exponentially. 

In a different yet related vein, the cure for moral injury often lies in connection with others, particularly those who share values and a sense of purpose. That is why creating spaces for healthcare workers to connect, share their experiences, and offer support for one another can be a simple yet effective intervention for pushing back against moral injury in medicine. It can also be a valuable way of cultivating community and healthy relationships within the workplace, which are powerful protective factors against burnout. 

It is also important to acknowledge that stress from work can be compounded by stresses in our personal lives, or by communal turbulence and crises in the world around us. As we move forward in the coming days and work to support each other while we care for those who are sick and suffering, it is important to remember that none of us are alone. For more tips and tools to help support you and your fellow Minnesotans, please refer to the Bakken Center’s You Do Matter Minnesota Website.