Vicarious Traumatization (VT)


On November 6, 2017, CNN reported that of the 30 deadliest shootings in the US dating back to 1949, 18 have occurred in the last 10 years. Two of the five deadliest have taken place in just the last 35 days.

On Sunday, November 5, 2017, a gunman opened fire inside a small community church in Sutherland Springs, Texas, killing 26 people; the fifth-deadliest shooting in modern US history.

On October 1, 2017, a gunman opened fire from the 32nd floor of the Mandalay Bay Resort and Casino on a crowd of more than 20,000 gathered on the Las Vegas Strip for a music festival. He kills 58 people and injures more than 500; the deadliest shooting in modern US history.

The Las Vegas attack was 10 years removed from the 2007 Virginia Tech massacre (32 killed), and a year removed from the second-deadliest shooting in modern US history–the Orlando nightclub shooting, where 49 were killed and more than 50 injured.

Then, there’s the December 14, 2012 Sandy Hook Elementary School shooting in Newton, Connecticut, where 20 children (ages 6-7) and six adults were gunned down.

Etcetera. Etcetera.

I’ve been thinking a lot lately about the trauma survivors of these horrific events; the lives of their loved ones tragically and swiftly snuffed out. I remember watching a television interview with the bereaved family of the Sandy Hook Elementary Principal, Dawn Hochsprung. One of the daughters was asked the awkward question what she might say to her mom, if she could. The daughter tearfully replied: “Come back”; the precise sentiments of trauma survivors who’ve lost loved ones.

The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) defines the three main symptom clusters of posttraumatic stress disorder (PTSD) as: a re-experiencing of the event (for example, intrusive imagery or flashbacks), avoidance of event-related cues, and hyperarousal. While posttraumatic stress (PTS) most certainly threatens the health of trauma survivors, I’m thinking that the ubiquitous and real-time nature of social media exposes every person to a kind of secondary traumatic stress (STS); also known as vicarious traumatization (VT).

Secondary Traumatic Stress/Disorder (STS/D)—a.k.a. Vicarious Traumatization (VT)–is the emotional duress that results from seeing/hearing about the firsthand trauma experiences of others. As such, it primarily targets helping professionals, like myself, who work directly with trauma survivors. Its symptoms mimic those of posttraumatic stress disorder (PTSD). In her book, SecondaryTraumatic Stress; Self Care Issues for Clinicians, Researchers, & Educators (1999), Beth Hudnall Stamm, PhD, now retired research psychologist at Idaho State University, writes:

“Here we define secondary traumatic stress as the natural, consequent behaviors and emotions resulting from knowledge about a traumatizing event….It is the stress resulting from helping or wanting to help a traumatized or suffering person.

There is a fundamental difference between the sequela or pattern of response during and following a traumatic event, for people exposed to primary stressors and those exposed to secondary stressors. Moreover, not only are family and friends of people exposed to primary stressors (i.e., ‘victims’) vulnerable to secondary traumatic stress and stress disorders, so are mental health professionals and other helpers.

Therefore, STSD is a syndrome of symptoms nearly identical to PTSD except that the response to a traumatizing event experienced by one person becomes a traumatizing event for the second person….At the same time, we suggest that perhaps PTSD should stand for Primary Traumatic Stress Disorder, rather than Post Traumatic Stress Disorder, since every stress reaction is ‘post’ by definition.”

Dr. Stamm contrasts the symptoms of PTSD with the symptoms of STSD around the same threefold symptom cluster of: re-experiencing the traumatic event, avoidance and numbing of event-related reminders, and persistent arousal (mentioned above). The only difference between the two is the “vicarious” nature of STS/D; that is, hearing what happened to the “primary” trauma survivor.

Stamm observes that a “disrupted frame of reference” is the “hallmark of vicarious traumatization.” By “frame of reference,” she means one’s identity, worldview, and spirituality. While writing primarily to helping professionals, the disruptive nature of trauma on everyone is hard to miss:

“As a result of…trauma, (one) is likely to experience disruptions in their sense of identity (sense of oneself as man/woman, as helper, as mother/father, or one’s customary feeling states), worldview (moral principles, ideas about causality, life philosophy), and spirituality (meaning and hope, sense of connection with something beyond oneself, awareness of all aspects of life, and the sense of the non-material.”

Think about it. Can anyone honestly deny that their “frame of reference” (identity, worldview, spirituality) has been challenged–yet again–by the random violence of the last few days?

Stamm continues: “The other parts of the self impacted by VT are psychological need areas: safety, trust, esteem, intimacy, and control. Everyone possesses all the five needs, but specific areas are more important or central for each individual. One’s most important need areas are those most likely to be disrupted.”

Survey that fivefold list for a moment. Which “need area” has not been “disrupted”–yet again–by the random, violent acts of the past few days? Which “need area” do you personally feel most vulnerable? Safety? Trust? Social connectedness? What about control, or predictability? The Stanford University professor of biology and neurology, Robert Sapolsky, PhD (2004) talks about many of these same psychological variables needed—to some degree–to withstand the stressors of life; especially social connectedness, control, and predictability (See my October 8, 2012 blog).

Given the primary and secondary helplessness of traumatic events, Stamm asks if there’s anything we can do. “What antidotes can we create to these ‘disruptions’?” Citing research where trauma therapists were asked to identify self-care strategies, some of the activities mentioned include: travel, social activities, collegial support, pleasure reading, workday breaks, emotional support from family and friends, time spent with children, listening to music, time spent in nature, physical exercise, community involvement, rest and relaxation, gardening, spiritual life and practice, artistic expression, hobbies, to name just a few.

Perhaps some of these suggestions will prompt you to generate your own “antidotes” to a “disrupted frame of reference.”

This is the second time in six months that the expression, “frame of reference,” has surfaced in one of my blogs. On May 26, I posted thoughts from Irvin Yalom’s book, The Gift of Therapy (2002). The emeritus professor of psychiatry at Stanford University talks about his interpersonal and existential “frame of reference;” which strikes me as particularly apropos for thinking about “antidotes” to vicarious traumatization. Yalom discusses the need for developing and sustaining gratifying relationships (interpersonal frame of reference), as well as the “givens” of human existence (existential frame of reference); especially: death, isolation, meaning in life, and freedom. Yalom’s existentialist orientation reminds me–in the face of random violence and traumatization–that there is no such thing as absolute control or predictability in life. The shootings of the past 35+ days have reminded us of that. Rather, we are confronted with the inexorable “givens” of existence – and, how we choose to live life. There is no freedom to do otherwise.

One last thought. Several months ago, one of my colleagues brought a plaque to our office suite. I found myself mouthing the words on the plaque every time I saw it; a saying attributed to the renowned French painter Claude Monet: “For one’s health, it is necessary to walk in the garden and see the flowers growing.” In a world of primary and vicarious traumatization, that sounds like good advice.

Bill Bray, Colorado Springs, CO

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