Charle Figleys, the pioneer in the field of traumatology, described secondary traumatic stress as being synonymous with compassion fatigue.

The experience of trauma actually leads to deep psychological injury at an unconscious level that entails loss of control, language, power, and self. Trauma is a wound that cries out, a silent wound that is articulated through re-enactments, such as flashbacks, nightmares which cause a contrasting feeling of anxiety or dread. As a result, traumatised individuals are vulnerable to repeating past traumas and remain in a crisis without being able to regain control over their current lives.

Getting to ‘know’ their trauma overwhelms them emotionally to the extent of rendering its cognitive processing impossible at times. Working in an environment that traumas of one kind or another are faced on a daily or regular basis causes this deep-rooted stress and compassion fatigue, it is insidious and builds into an all-consuming condition of the emotions, psychological and physical well-being. It can be initiated by a single event but is perpetuated through exposure to trauma and the suffering of others.

Suffering because of someone else

Secondary trauma stress, in the name it seems to be reduced in importance, stress related to somebody else’s suffering, but don’t be lulled into a false sense of security, there is nothing secondary about it. It is like having a boxing match with a moving train, The words trauma and stress also give you wiggle room, everyone suffers from stress, so I should be able to deal with it, I won’t make a fuss. The key to this whole monster is the word trauma.

If anyone with a physical trauma walked into any Emergency Department or was attended to by any emergency personnel, they would not bat an eyelid to deal with the traumatised area quickly, efficiently and effectively passing the patient on to whatever team was necessary for the most positive outcome. However, if the same patient has presented with symptoms of stress and anxiety, much less attention would have been paid to their area of trauma. As a caregiving professional person that you are, you were taught to deal predominantly with the physical and obvious trauma. Thinking that less visual trauma has lesser consequences, which is not true.

Why is a less visible injury, less important?

When you think of an individual in any type of incident where they are injured, in pain and feeling vulnerable, you do your best to reassure and reduce their suffering, but when it comes to their emotions of dealing with that situation you have less empathy and sympathy. That person has only gone through one trauma on that day, you may very well go through many and a wide variety in each day, so why would you not think that logically there could be consequences of what you go through, in the line of duty?

Now, the COVID-19 pandemic is amplifying all of the factors that lead to compassion fatigue. The pandemic demands an increased need for frontline and direct response workers to fulfil the medical, mental and social health needs of the families and communities impacted. 

In a short amount of time, we have been required to make abrupt changes to our personal and professional lives. These abrupt changes have evoked fear, anxiety and exhaustion across the globe, greatly affecting the work of health professionals. 

Feeling exhausted, deflated, empty at the end of a long 12-hour shift starts to become normal, cutting off social ties is easier than ever, going in behind your front door and being in tears, eating and sleeping poorly all have negative knock-on effects over time. Self-care for healthcare professionals has never been so needed but is not a priority when trying to keep yourself going in these demanding times. The sofa, a bottle of wine or something else, a pizza or junk food for quickness are unfortunately more comfortable options.

Emotional, psychological and physical damage is being done

This is a shift that needs to be addressed and broken, because the damage being done to the emotional, psychological and physical health of professional health workers is going to have a ripple effect for a long time to come. Valuing yourself to want to care for yourself is a big step, but one that is essential and pivotal in starting a new regime. Moving away from pain or towards pleasure are the only two motivators that ignite the desire to change, but making you a priority for yourself is your starting point. It is all too easy to feel you have lost yourself, your identity and become just a service. 

In all healthcare environments, there are constant clinical and non-clinical demands on every individual, but the bottom line of good patient care means that all care providers need to be the best they can be. If you are emotionally, psychologically and physically alert, you can provide much better care, fewer errors and not feeling like you have the weight of the world on your shoulders. 

As the lockdown gets longer, the demands on healthcare providers become more and more intense. It is time to be self-oriented, it is not selfish or egoistic, it is the best you can do for yourself and for others.

Tension relief tips

• Find a way that works for you to offload, with confidentiality issues and not wanting to burden family/friends/colleagues the use of a recording device, just putting into words, all the thoughts that are going around and around in your head is a release and dilutes the impact the words are having on you when they are bottled up.
• Do something you enjoy doing, that is not work-related, even if it is now virtually. There are many options, but you have to make the effort to find it. 
• Move. Yes, exercise. It may be the last thing you feel like doing after a long day, but you know a well as I do that chemical and endorphins are sent out to help us internally when we let them work. Put on a song or a piece of music and dance, music is very powerful and energizing, also offloading the negative thoughts and emotions, and replacing them before you go to bed, makes it a lot easier to get to sleep and sleep longer.

The choice is yours

There again, I am not saying anything you do not already know, but I knew it too though I still went down to the burnout pit, because knowing is not doing. 

Prevention of burnout is much preferable to recovery, I was one of the lucky ones, six years of oceans of tears, climbing many personal painful Everest size mountains, I used food as my crutch, but those with alcohol and/or drugs have even more demons to slay.

You have the knowledge, you have the experience, you have the opportunity, you just need to want to, That choice is always up to you personally, believe you are worth the effort and stop living in denial, it may be comfortable, but it is not practical or safe in the long term.

As an eminent criminal psychologist, Linda Sage had been working in most of the famous prisons in the UK.