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

Unspoken Epidemic

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.