Trauma support

By Charl Fourie (South African psychologist)

A journalist can develop Post Traumatic Stress Disorder if exposed to actual or threatened death or serious injury that resulted in an intense emotional response of fear, helplessness, or horror. Some of the following symptoms may also be present:

Intrusive, distressing thoughts or images that recall the traumatic event.
Disturbing dreams associated with the traumatic event.
A sense that the event is reoccurring, as in illusions or flashbacks.
Intense distress when exposed to reminders of the traumatic event.
Physiological reactivity when exposed to internal or external cues that symbolize the traumatic event.
Avoidance of thoughts, feelings, or conversations about the traumatic event.
Avoidance of activity, places, or people associated with the traumatic event.
Inability to recall some important aspect of the traumatic event. Lack of interest and participation in significant activities
A sense of detachment from others.
Inability to experience the full range of emotions, including love. A pessimistic, fatalistic attitude regarding the future.
Sleep disturbance.
Irritability.
Lack of concentration. Hypervigilance.
Exaggerated startle response.
Sad or guilty affect and other signs of depression. Alcohol and/or drug abuse.
Suicidal thoughts.

Research available on the Dart Center website indicates that:

Between 86% to 98% of journalists reported that they have experienced a work related traumatic event
Only 4.3% to 5.9% of journalists reported symptoms that met the criteria for PTSD.

The website also states that:

“A significant minority of journalists may develop mental health symptoms including symptoms of PTSD, depression, or anxiety.”

These relative low figures on the presence of PTSD amongst journalists might create the impression that journalists are in general resilient towards the adverse effects of trauma journalism and are relatively unaffected by these traumatic events. I believe, however, that is not the case.

In the case of PTSD, the link between the traumatic event and the symptoms thereafter is obvious. But continuous exposure to traumatic events can negatively impact on the mental health of a journalist in many other less obvious ways . Anybody who is exposed to traumatic events must deal with it in some way and will develop coping strategies (see below). But whilst a specific coping strategy, like excessive caution bordering on paranoia, might work perfectly whilst the journalist is in a war zone, the same behaviour may be problematic if it continues back home under normal living conditions. When the journalist returns to his or her family, the exposure to the traumatic event is over, but the person’s reaction to it is not.

An extremely useful website, RealMentalHealth.com, explains the dilemma. Survivors of repetitive trauma are likely to instinctively continue to use the same self-protective coping strategies that they employed to shield themselves from psychic harm at the time of the traumatic experience. Certain symptoms can also be seen as attempted adaptations. It is therefore useful to think of trauma “symptoms” as adaptations. Symptoms represent the journalists attempt to cope the best way he or she can with overwhelming feelings. When one recognizes “symptoms” (see list below) in a trauma journalist, it is always significant to ask yourself: what purpose does this behavior serve? Every symptom helped a journalist cope at some point in the past, in some way. These symptoms used to be or can continue to be – in the case of continuous redeployment to high trauma risk areas) survival tools.

A good example, as mentioned above, would be paranoia. It would be normal for a deployed war journalist to become paranoid after some time spent in conflict zones. Paranoia in a war zone would be normal, taking into account that more than 100 journalists were killed in 2006. Paranoia will assist to keep a journalist alive and out of prison in some countries. The paranoia will -after some time- become a more permanent disturbance in content of thought.

The same disturbance in content of thought will follow the journalist back home. At home such a disturbance can destroy a relationship.

Although I have not done any formal research on journalists in Africa, I have (as a psychologist working within the law enforcement environment) liaised with various journalists. I listened carefully to the way some journalists spoke about their exposure to traumatic events and enquired about the way their jobs affect them. The answer, which they had often internalized after first hearing it from their editors and other bosses, was clear – “If you can not stand the heat you must get out of the kitchen”. One journalist who covered horrific events of political violence in South Africa remarked jokingly, and cynically macho, to me that the most traumatic scene he ever witnessed was ‘when a truck transporting beer turned over and lost its cargo’. A coping strategy of cynicism was developed, and stayed with, this journalist as part of his character.

The Dart Center for Journalism and Trauma quotes one of the BBC’s former war correspondents, Allen Little: Little commented in 2001 how he’d once viewed PTSD as an “indulgent, nancy-boy thing.” He later realized how wrong he had been when someone he was working with was killed. After the incident he said: “I became very moody and paranoid, socially dysfunctional and unable to work. The idea that you can spend a decade swanning into war zones … and have a normal life and not be affected in any way really has got to be challenged.”

This maladaptive “macho man” or “iron woman” approach to life might be effective when the journalist is deployed in a war zone, but a significantly desensitized mother or father might struggle to display much needed tenderness when they have to comfort a child back at home.

The above mentioned maladaptive responses can be just as disruptive in the lives of journalist as PTSD. The problem is that the journalist might not recognize the causal relationship between his or her exposure to traumatic events and his or her impairment in social, occupational and psychological functioning. The above mentioned maladaptive responses might not even bother the journalist and is more likely to bother family members and significant others. The journalist might even be proud of these maladaptive responses! A pathological desensitized journalist might for example view him or herself as ‘tough’ , whilst remaining unaware of the negative impact of their behaviour on their families.

Some other maladaptive responses can include:

Social withdrawal and Isolation from others
Aggressive behaviour (which can include anger towards victims)
Distrust of others
Restlessness
Alcohol and/or Tobacco and/or Caffeine Abuse
Increase in Risk Taking
Inappropriate sick humor (towards victims)
Apathy
Cynicism
Depersonalization
Air of righteousness
Hypercritical
Sense of grounding and inner balance loss
Inability to separate professional and social life
Avoidance of close interpersonal contact
Overbonding with colleagues

Besides PTSD (a type of anxiety disorder) a journalist exposed to trauma can also develop the following Mental Disorders:

Mood disorders
Anxiety disorders such as phobias, panic disorder, acute stress disorder
Dissociative disorders
Sleep disorders
Dissociative Identity Disorder
Depersonalization Disorder
Substance related disorders
Adjustment disorders

Many journalists may also suffer from secondary trauma. Zimering, Munroe, & Gulliver (2003) explain that secondary trauma is caused by indirect exposure to trauma through a first hand account or narrative of a traumatic event. The often vivid recounting of trauma by the survivor and the journalist’s subsequent cognitive or emotional representation of that event may result in a set of symptoms and reactions that parallel PTSD. Secondary trauma develops without direct exposure to the traumatic event. Secondary trauma is the result of empathic engagement with other people’s traumatic experiences. Secondary traumatization is also referred to as Secondary Trauma Stress Disorder (STSD), compassion fatigue or vicarious traumatization. It is without any doubt present in journalists who have interacted with families of Aids victims and Aids orphans.

Secondary trauma or STSD is not a formal psychiatric disorder and does not reflect pathology or a weakness in the journalist. Secondary trauma is a long-term consequence of working with suffering people and more severe, repetitive and prolonged exposure will increase the likelihood of developing secondary trauma symptoms. Journalists suffer from secondary trauma may display general signs of stress. This can include:

Cognitive and Physical symptoms:

misunderstanding of what others tell you
poor judgment
thoughts of escaping, running away
problems with memory
inability to concentrate, shortened attention span
confusion
paranoia
repetitive or continual thoughts
inability to slow down thought process
loss of objectivity
periodontal disease, jaw pain
reproductive problems, such as missed periods
headaches
muscle tension and pain
sleep disturbances
fatigue
chest pain, irregular heartbeat
high blood pressure
hair loss
asthma or shortness of breath
digestive disorders
immune system suppression
sweatiness difficulty making decisions
skin problems
weight gain or loss

Emotional symptoms:

less interest in hobbies or fun
sudden shifts in mood
frequent uneasiness, restlessness
frustration
sense of being overwhelmed or swamped
anger, resentment
unwarranted jealousy
quick irritability with others
oversensitivity
overreaction to unexpected situations or events
anxiety
increased fear of failure
inadequacy, reduced confidence
desire to cry
depression
apathy

Behavioral symptoms:

eat more or less than normal
laugh or cry at inappropriate times
overdo activities such as exercising or shopping
become bossy or inflexible with others
sleep too much or too little
isolate yourself from others, including people close to you
stay home from work or stay at work extended hours
engage in nervous habits such as nail biting, hair twisting, pacing
grind your teeth
lose your temper
argue with people
become violent
take inappropriate risks
exhibit road rage
increase use of tobacco, alcohol, drugs, caffeine
have more or less sex than usual

The natural next question would be: How can the above mentioned disorders and maladaptive responses be prevented or treated?

The following actions might assist trauma journalists:

Develop self knowledge. Understanding your strengths and weaknesses can help you learn better ways to deal with day-to-day stress. Learn to recognize your trauma response. Think about how you have changed since you started doing trauma journalism. Discuss your behaviour and functioning with friends and family. Can you identify any signs of maladaptive behaviour or disorders mentioned earlier in this document in your self-analysis? Ask yourself what emotions you are actually experiencing. Learn to understand your emotions. If you are uncertain visit a counselor or psychologist.
Take some time off. There are times when one would not be able to take an extended holiday, but it is needed from time to time. You should at least give yourself a few days away from anything work related when you feel you need it. The change of environment will change your perspective on your work and might just save you.
Get enough sleep. Make sure you are getting the sleep your body desperately needs.
Play. Exercise and laughter are one of the best ways to deal with stress.
Eat healthy food most of the time, but you should also feel free to sometimes have really nice food, the kind that makes you feel guilty! Develop healthy eating habits, including having breakfast and high-protein snacks to help sustain your energy throughout the work day.
Try to create regular changes in your work. Work on something new or different. Try working on something you love a pet project or something new. Sometimes just breaking your routine will assist you to alleviate stress.
Have regular consultations with your doctor. Schedule a complete physical check-up with your doctor to discuss your concerns and any signs or symptoms you or family and friends have noticed.
Exercise. Increase exercise, join a gym or develop a exercise program that suits your practical situation. Jog, walk or cycle, learn new stretches or yoga. Just do some form or activity. Remember to consult with your doctor before you start a new exercise program.
Develop other new coping skills for dealing with stress. Ask your counselor or psychologist about progressive muscle relaxation techniques, mental imagery and positive self-talk.
Learn effective time management. Develop control over your work and home life from a time management perspective.
Do net set unrealistic goals. Realistic goals will improve motivation an will add focus. Divide your goals with reference to your job, relationships, intellectual development, spiritual development, financial development and physical development. Set long and short term goals, and include a role-out plan on how to achieve them. Reaching for new accomplishments will give you a real sense of purpose in your live.
Do things you enjoy on a regular basis. Diarize your activity and do it.
Take care of and maintain your closest relationships such as those with your partner, children or friends. These relationships can help restore energy and can provide you with support when you need it most.
Write about your experience. Write down your feelings thoughts and the events in detail. This can be just for yourself or you can do it to share your story with others
Talk about your experience.

The above strategies will certainly contribute towards the journalists efforts to reduce stress. Finding a balanced life is important. Grosch and Olsen (1995) state that, finding a balance in a person’s life is often overused as advice, resulting in very little change or prevention.

I would like to argue that – if at all possible – a trauma journalist should regularly consult a trained and registered mental health worker (psychiatrist, psychologist, counselor, social worker etc.). Such professionals will assist the journalist to define his or her problem. The journalist can not change what he or she can not acknowledge and understand. The therapist will provide the journalist with introspective skills. The therapist will also provide the journalist with support. The journalist can be sure of unconditional acceptance from a professional therapist. A therapist will help the journalist to examine alternatives. A wide array of appropriate choices the journalist has can be explored. Many times continuous trauma exposure has placed the journalist in an immobile state, making it impossible to adequately examine the best options. The therapist will help the journalist to make action plans. These plans will be directed towards restoring the journalist’s emotional equilibrium.

References:
Grosch, WN. & Olsen D.C. (1995) Prevention: Avoiding Burnout. In M.B. Sussman, (Ed), A Perilous calling: The hazards of Psychotherapy practice (pp. 133-154) Beverly Hills, CA. Sage Publications.
James, K.J. & Gilliland, B.E. (2001).Crisis Intervention Strategies. Stamford, USA, Thompson Learning
Zimering, R., Munroe, J., Gulliver, J. & Bird, S. (2003) Secondary Traumatization in Mental Health Care Providers. April, Vol. XX, Issue 4.

* Charl Fourie knows, and has assisted, a number of journalists who have had to deal with traumatic experiences in South Africa.

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