Post traumatic stress disorder, work, burnout and the spiritual crises in health and social care

Post traumatic stress disorder (PTSD) is now a well known condition recognised by several key factors including: the presence of one or more extreme stressors or traumatic incidents; flashbacks to the event; intrusive thoughts, often accompanied by imagery or sounds; intense distress and anxiety; disassociation or other avoidance behaviours.

This high state of arousal can result in incapacitating symptoms, such as panic attacks; irritability and aggressive or overly sensitive behaviours; disturbed sleep patterns marked by ruminations and/or nightmares and, unsurprisingly, a lack of concentration.

Such a complex picture does have profound impacts on the individual’s ability to function in everyday activities; strategies to support this incorporate a comprehensive range of person-centred approaches, including cognitive behavioural therapies, hypnosis, the building of personal resilience and the strengthening of relational networks.

Interestingly, whilst much of the research around the area of PTSD highlights the presence of specific traumatic events as the causal factor, a study by Mealer et al has identified how PTSD in health workers can emerge as a result of recurring daily events, like dealing with death and dying, excessive psychological demands and feelings of helplessness. Crucially, the study also identified that in this context, the diagnosis of PTSD always coexists with burnout, marked by psychological exhaustion and de-personalisation. When found in tandem, these dual diagnoses evidenced substantially lower levels of trust with colleagues and clients/patients, and higher levels of psychological symptoms and impaired functional abilities in terms of performance in both work and home environments to those individuals suffering from burnout alone.

These factors of course, impact not only the individual worker’s health and wellbeing and the efficacy of the outcomes for the employing organisation, but the ability to work effectively with others and to sustain the practical and emotional energy needed to care for clients/patients effectively. This in particular is evidenced in the inability to demonstrate compassion and to give of the self in a meaningful way. This is because it is not just the physical, emotional and psychological dimensions of the individual’s wellbeing that are disrupted, but also the spiritual, reflecting a breakdown in the core elements of the person’s existential essence or ‘being’ and thus their ability to connect meaningfully to self or others.

In terms of health care workers, this is a notable loss in an environment that now requires the abilities to be caring and compassionate as a prior skills to working in the health and social care sector and promotes the emotional use of the self as part of the therapeutic encounter.

To address this requires a pragmatic approach that not only requires the organisation to support the individual employee psychologically, emotionally and physically, but also at a spiritual level; only by working with this frequently overlooked dimension of human nature can health and social care organisations hope to support their staff to practice healthy and compassionate care for others.

This, of course is not easy and requires these organisations to tackle the roots of the problem, which includes an ‘illness model’ that indirectly enables them to place the fault of PTSD (and burnout) firmly at the feet of the employee, rather than as an outcome of the pressures and cultural context of the workplace. To confront this necessitates a reorientation of the organisation’s values, systems and practice at the most fundamental level in order to move from a performance orientation to a more caring and compassionate one; that in turn, requires a social structure and a political and public will that supports it. Only then can we address the growing problem of stress, burnout and PSTD in the heath and social care workplace.