MIND MOVES Marie MurrayIs it possible to be traumatised by exposure to someone else's trauma? Could you, in some extraordinary vicarious way, experience the shellshock of war, that "carnage incomparable", as if you yourself were on the battlefield? Could your ears hear the "stuttering rifles' rapid rattle" and your eyes witness the grim grotesque grimaces of death?
The answer is yes: secondary exposure to trauma brings susceptibility to sharing some of the suffering and psychic pain of the traumatised, a condition known as Vicarious Traumatisation (VT).
This new landscape of psychological susceptibility is particularly significant in a world that has recently experienced relentless ravages of terror, atrocity and geopolitical gloom. We inhabit this world.
We are all vicarious voyeuristic victims, technological intruders and consumers of the minutiae of misery all over the world on our screens, in our ears, in the immediacy of this information age. And it is making us miserable, excavating our atavism, increasing our pessimism and shaking sacred certainties in the concept of civilisation. As a result, many of us are suffering from VT.
VT is the cumulative impact of repeated exposure to secondary traumatic material. Research has shown that the recipients of traumatic narratives, secondary witnesses of traumatic events, may develop many of the signs and symptoms of Post-Traumatic Stress Disorder (PTSD) or Prolonged Duress Stress Disorder (PDSD), particularly if they form an enduring empathic engagement with the traumatised.
These PTSD signs include vivid flashbacks and re-experiences of the event, distressing dreams, physical reactions, feelings of detachment and estrangement from others and hyper-vigilance which entails suspicious scanning of the world for signs of danger, each sign a flashback signal of potential threat. Which of us cannot recall 9/11 in forensic detail like some "consensual hallucination" or fictitious filmic fragment played back again and again both by media and in our minds. What "memories" do we retain even of times before our time: the concentration camps, the naked living dead pressed against wire fences in flickering black and white cinematic clips. Were we not there? We were. We share the transgenerational transmission of that trauma.
Among those who are "there" daily and who are particularly susceptible to VT are mental health workers at the coalface of human suffering. These are the people who work in the terrible terrain of sexual abuse, rape and violence; those who work with refugees, the homeless, the dispossessed, the tortured, the imprisoned or people demented by injustice, deranged by drugs, overwhelmed by grief or betrayed in childhood at the mercy of their memories, rewound and replayed in an eidetic effluent of horror.
Researchers Pearlman and Saakvitne suggest therapists may emphatically experience a parallel trauma influencing multiple aspects of their personal and professional life. VT may induce anxious and avoidant behaviour, anger, cynicism and sadness, compassion fatigue, psychic numbing, emotional anaesthesia and a sense of isolation from family, friends and colleagues.
Of course, the notion of potential occupational trauma is not new. In the 1970s, Freudenberger's concept of "burnout" identified the physical and emotional depletion that can result when workers chronically experience critical incidents and traumatic events with subsequent psychological aftershock. Service providers are particularly predisposed: brave peace guardians like our Garda Síochána, fire brigades, ambulance crews, mountain rescue teams, the lifeboat service, coroners service, indeed our entire Seirbhísí Rialtais and the men and women in A&E who repair the ravages of living, dignify dying and deliver our dead.
While this work is not new, the context is new and the scale is stunning; summed up in the familiar figures of our State pathologists carrying their bags to the latest disfigured, dismembered cadaver casualties of crime.
What is also new is the choice of vicarious violent occupations for our children: video visions of viciousness on a scale we would never permit them to view in "real" life, games dependent on the ability to annihilate an arbitrary enemy, expertise in the "entertainment" of killing "where death becomes absurd and life absurder".
Surely, we cannot continue these vicarious cruelties, desensitise the young, or, to paraphrase Wilfred Owen, cauterise their senses so that with hearts "small-drawn" they can "laugh among the dying unconcerned".
Through VT the map of our psychological world, our cognitive schemata have been disturbed, reshaped and redrawn as surely as the map of Europe and of the world now contains unfamiliar spaces and places. We have acquired a new nomenclature that says the opposite to what it means, a disembodied vocabulary that hides the reality of what it names in surgical strikes, collateral damage, smart bombs and friendly fire.
We are caught in emotional polarities: material wealth versus spiritual bankruptcy, evil acts against the axis of evil, innocence and guilt, liberation and occupation, war on terror and the terror of war, dictatorship versus democracy, democracy versus dignity. We straddle the political polemics of war and peace, east and west, north and south while the refugees of recent wars stream into our cities to uncertain welcome, racist revulsion, compassionate care or extreme exploitation.
Psychological understanding of the emotional milieu of war began with recognition in the first World War of war neurosis and shell shock. Vietnam veterans introduced us to PTSD. The accumulated impact of subsequent local, national and international conflicts, allied to our media exposure and engagement with the intimate strangers on all sides of conflictual divides, now conscripts us into VT with combatants in "eternal reciprocity of tears". This is our Apocalypse, now.
Marie Murray is director of psychology at St Vincent's Hospital, Fairview, Dublin.
mmurray@irish-times.ie