Workplace Trauma

Concepts, Assessment and Interventions

Noreen Tehrani

• Publisher: Routledge
• Year: 2004
• ISBN:
  9781135445980
• Edition: 1
• Topic: Psychology
• Subtopic: Industrial & Organizational Psychology
• Index: Psychology

How can organisations defend their employees against psychological trauma? Post-traumatic stress is a topical subject of increasing importance. Yet much of the writing on this subject so far has concerned stress suffered by people exposed to serious turmoil such as war and ethnic conflict. Workplace Trauma is an extremely welcome presentation of the subject of stress in the workplace. This book explores the ways that traumatic events impact the psychological well being of organisations and their employees. The effects of disasters, accidents, crime, injury and death are examined alongside examples of organisational trauma care programmes and reviews of the current thinking regarding post trauma interventions. The insights generated are illustrated with case studies from the author's extensive experience of counselling victims of trauma at work. The theory, research and practical advice contained in this volume will prove a valuable resource for organisations and practitioners seeking guidance on reducing the impact of psychological trauma.

Part I

Post-traumatic
stress — history
and development

---

The idea that stressful events can produce enduring, negative psychological states would appear logical. However, despite the efforts of notable pioneers in the field, it is only in the past two decades that mental health professionals have come to acknowledge post-traumatic stress as a valid psychological condition (Briere 1997). Unlike other psychiatric disorders, a diagnosis of post-traumatic stress requires an evaluation of precipitating factors as well as symptoms. The development of the post-traumatic construct is an active process with the definitions having been refined several times since their introduction by the American Psychiatric Association (1980). Chapter 1 describes the historical development of the construct of traumatic stress, looking at the portrayal of the traumatic experience in literature and in science. Chapter 2 shows how the traumatic experience is underpinned by the psychobiology of stress and traumatic stress. The chapter provides illustrations of the similarities and differences between stress and traumatic stress. In Chapter 3 there is an exploration into the ways in which trauma in the workplace can affect the employees and their organisation. Chapter 4 uses casework to illustrate common employee reactions and responses to exposure to traumatic incidents. The development of the case law and legislation is discussed in Chapter 5 together with the negative impact that the legal process can have on the recovery of trauma victims.

Chapter 1

Post-traumatic stress: the
history of a concept

---

Introduction

This chapter describes how, throughout history, writers and historians have recognised that following exposure to extreme stress and trauma, people may develop long-term emotional and psychological responses. However, this view took a long time to become established in psychiatry and as late as the nineteenth century there were few psychiatrists who accepted the notion that fear and horror were sufficient to cause a psychological disorder. The experience of dealing with dead and injured soldiers in the First World War provided the background and impetus to the development of new ideas on the origins of psychological trauma. This increase in knowledge has led to the development of a classification of post-traumatic stress disorder (PTSD) that is accepted throughout the world.

Trauma in literature

The idea that people can develop physical and psychological disorders following an exposure to a traumatic event that caused them fear or horror rather than a physical injury is not new. Literature has provided us with a rich source of powerful accounts of the human responses to war, murder, rape and other personal disasters. Authors such as Homer in the Iliad and Shakespeare in Henry IVand Macbeth create central characters whose dramatic symptoms and behaviours would today be diagnosed as indicative of post-traumatic stress (Trimble 1981).

Graphic descriptions of human responses to disasters, accidents and wars can be found in many historical documents (Trimble 1985). Samuel Peyps’ Diary provides a good example of psychological trauma induced by a disaster. In Peyps’ case, the disaster was the Great Fire of London, which occurred in September 1666. Pepys described his feelings as the fire spread towards his home and gave a vivid description of the terror experienced by the citizens of the city, unable to protect their homes and property from destruction. Six months later Peyps writes of his difficulty in sleeping due to nightmares caused by his experience of the fire and his panic at the news of a chimney fire some distance away (Daly 1983). The author Charles Dickens was a passenger on a train that crashed at Staplehurst in Kent in July 1868. In a letter to a friend, Dickens described his distress at being trapped for several hours surrounded by dead and dying passengers. Following the incident Dickens developed a phobia about travel by rail and described himself as ‘not quite right within’ and as ‘curiously weak — weak as if I were recovering from a long illness’ (Forster 1969).

Wars over the centuries have affected millions of people. In an account of life in the trenches in the First World War a soldier (Fred White of the 10th Battalion King's Royal Rifle Corps) said:

It took years to get over it. Years! Long after, when you were working, married, had kids, you'd be lying in bed and you'd see it all before you. Couldn't sleep. Couldn't lie still. Many and many's the time I've got up and tramped the streets till it came daylight. Walking, walking — anything to get away from your thoughts … That went on for years, that did.

(MacDonald 1988)

The nineteenth-century view of trauma

In contrast to wide recognition in literary works, medicine and psychiatry were resistant to the view that traumatic emotional experiences can profoundly and permanently alter a person's psychology and physiology (Van der Kolk et al. 1996). If a physician of the nineteenth century were to be asked what caused traumatic shock, the most likely response would be that it was due to organic damage to the nervous system. Most physicians of the time rejected any suggestion that an individual's perception or beliefs about a traumatic event were capable of bringing about the magnitude of change in the functioning of the brain that could result in a psychiatric disorder. The common belief of the time was that concussions to the head, injuries to the spinal cord or small cerebral haemorrhages alter psychic functioning, thereby causing the psychological symptoms (Trimble 1985). An example of the views of the time comes from Herman Oppenheim who said, ‘functional problems are produced by molecular changes in the central nervous system, any suggestion that these difficulties could have an origin in an individual's perceptions of a traumatic event is incorrect’ (Oppenheim 1889). This belief regarding the physical origins of psychological symptoms resulted in a proliferation of terms being used to describe a psychological disorder relating to specific experiences of the victim. Examples of some of the most common diagnoses of the time included ‘spinal concussion’, ‘railway spine’, ‘irritable heart’, ‘soldier's heart’ and ‘shell shock’ (Parry Jones and Parry Jones 1994). The giving of different names to what appeared to be the same condition was slowly challenged and by the end of the nineteenth century attempts were made to utilise the single diagnosis of ‘traumatic neurosis’ (Seguin 1890).

During the same period, the French neurologists Charcot and Janet were developing a second challenge to the traditional physicist view (Van der Kolk et al. 1996). Janet had painstakingly observed his traumatised patients and discovered that they tended to react to reminders of their trauma with responses that were more relevant to the original traumatic threat than to their current situation. Janet also found that these patients had difficulty in integrating the traumatic experience with their earlier life experiences, and consequently sometimes entered dissociative states as a way of dealing with these distressing memories. The work of Janet had a profound effect on Breuer and Freud. In Studies on Hysteria they said, ‘hysterics suffer mainly from reminiscences, the traumatic experience is constantly forcing itself upon the patient and this is proof of the strength of that experience: the patient is, as one might say, fixated on his trauma’ (Breuer and Freud 1955). Freud's views on the impact of actual traumatic events were overtaken by his beliefs about the importance of repressed infantile sexuality. Consequently, he never pursued any investigations of the real traumatic events that had occurred to his patients, preferring to concentrate on the Oedipal crisis that he believed occurred in early childhood.

The First World War

The First World War exposed large numbers of soldiers to trauma, and provided doctors and physicians with extensive experience in dealing with traumatic stress. This exposure brought about an increased awareness of the psychological aspects of the traumatic experience and caused many physicians to question whether physical injuries had any impact on psychiatric disorders. While some psychiatrists continued to cling to the notion that physical injuries were the cause of psychological disorder (e.g. Mott 1919), others rejected this approach. This dramatic change of view is illustrated by Charles Myres who had introduced the diagnosis of shell shock (Myres 1915) but went on to find that many soldiers exhibited the symptoms of shell shock without coming under fire. Myres wrote, ‘my term shell shock is misleading … the true cause of the soldier's problems is the shock and horror of war’ (1940).

Some of the resistance to the idea that soldiers could suffer a psychiatric disorder without any physical injury can be found in the Public Records Office in Kew, London. In the First World War, a number of soldiers were shot for cowardice. The documents relating to these men strongly suggest that many were suffering from post-traumatic stress, and yet it is clear that those making the decision as to which soldiers should be shot for cowardice and which needed treatment preferred an approach that used objective evidence such as a ‘lesion of the brain’ or ‘damage to the heart’, rather than the subjective judgements of psychiatrists on the soldiers’ psychological symptoms (Moran 1945).

After the First World War, several war psychiatrists, experienced in dealing with the psychological impact of war trauma, left the forces and returned to civilian life. These psychiatrists recognised that civilian patients, who had been the victims of accidents or disasters, had symptoms similar to those they had seen on the battlefield (Merskey 1991). Unfortunately, there was little support for the view of these war psychiatrists that there was a ‘common trauma syndrome’. One notable exception to this was Abram Kardiner. Kardiner began his career treating US war veterans. After leaving the army, he studied psychoanalysis with Freud. In the light of the knowledge and insights gained with Freud, Kardiner re-analysed his extensive clinical data on war veterans. The results of the re-analysis were published in The Traumatic Neurosis of War (Kardiner 1941), which provided a detailed analysis of a psychological trauma syndrome which he named ‘psychoneurosis’.

The essential features of psychoneurosis were:

• persistence of startle response and irritability;

• proclivity to explosive outbursts of aggression;

• fixation on the trauma;

• constriction of general level of personality functioning;

• atypical dream life.

Kardiner claimed that war created a single syndrome, psychoneurosis, a...