Tuning out the suffering and destruction around us is as easy for some people as switching off their phones and disengaging from the news cycle. For others, however, who work in close proximity to death, destruction and other trauma, it's nigh on impossible to get distance, and this can wreak havoc on their mental health.
If you regularly meet trauma survivors or encounter upsetting incidents, torture or other devastation in your work, you may be experiencing 'vicarious trauma', also known as secondhand trauma. Defined by the British Medical Association as "a process of change resulting from empathetic engagement with trauma survivors," symptoms can include intense emotional involvement with your patient, client or the issue at hand; a lingering anger and/or irritation with the situation(s) you're encountering; bystander guilt, shame and self-doubt; a loss of hope, pessimism and cynicism; and difficulty sleeping.
LA Times journalist Sonali Kohli went viral on Twitter on Thursday with a thread in which she revealed she was taking three weeks off work to recover from the mental health impact of writing about mass shootings and deadly fires. "About a year ago, after covering two mass shootings and deadly fires across California, my therapist told me I had post traumatic stress symptoms and I should take a month away from work to address them, before they became PTSD. I did not listen," she wrote.
Her logic, as an office-based journalist, was that her "secondary trauma couldn’t be as bad as it was for the journalists in the field, or the people living it." So she took on "a new project on the high schools surrounded by the most homicide". Needless to say, reporting on further killings of children and mass shootings, while already showing PTSD symptoms, was the wrong decision for Kohli's mental health.
Again, my therapist told me to take at least three weeks off. Ever the haggler, I took one, then worked 12-16 hour days for weeks covering the L.A. teachers strike with my brilliant colleagues. Then I jumped straight back into the project about killings near schools. /6— Sonali Kohli 🙆🏾 (@Sonali_Kohli) March 7, 2019
For the next three weeks I’m deleting slack and outlook (and maybe twitter? TBD) and turning off my work phone. If you have recommendations for L.A. hikes, fun day trips, books to read and dogs to adopt, send them my way. /8— Sonali Kohli 🙆🏾 (@Sonali_Kohli) March 7, 2019
Secondary trauma is a real thing and it can happen whether you are reporting from the field or a computer. Self care for me is therapy, puppies, exercise, cooking, baking, reading, time with my family and friends. /10— Sonali Kohli 🙆🏾 (@Sonali_Kohli) March 7, 2019
Anyway, if you have read this very long thread then props to you, here is a trophy 🏆, and if you work in a field that is difficult, take care of yourself, take breaks, don’t feel bad about them.— Sonali Kohli 🙆🏾 (@Sonali_Kohli) March 7, 2019
Many more journalists, who have covered stories ranging from sexual assault and misconduct to terror attacks, showed their support and said they could empathise. But vicarious trauma is by no means confined to journalism – sufferers can include doctors and other health professionals, as the BMA highlights, as well as counsellors, social workers, charity sector workers, and more.
Leonie Harvey-Rolfe, 30, was signed off work for a month by her GP last June while working as a service coordinator at Golden Key in Bristol, where she would regularly meet women who had endured daily violence, abuse, poverty, homelessness and addiction. Her work was what is described in the sector as 'holistic', meaning she was expected to support women in potentially every element of their lives.
It's only now, months later, that she's begun referring to the experience as vicarious trauma. "No one person assigned it [the term] to me, it has been a gradual process of recognising the impact my previous work has had," Harvey-Rolfe tells Refinery29, adding that she found it difficult to "establish [her] boundaries" when dealing with such complex issues. "When do you say 'no' when potentially everything could be argued to be in your remit? And services around you are being cut so severely that your role is needed more and more every day, not just by clients but by professionals, too."
I felt a sense of failure – that by being off sick I was weak.
Leonie Harvey-Rolfe, 30
Harvey-Rolfe's symptoms wouldn't have been immediately obvious to those around her. "I wasn't coming home every day in floods of tears. The best description I found was a sense of feeling 'full'. My head couldn’t take anymore. I also noticed that my threshold for what was shocking or risky had all but disappeared." From being exposed to so many horrific stories of sexual violence, exploitation and chronic hopelessness on a daily basis, "[her] sense of what was too much for me was very warped. My response initially, was just to pile more work on myself and keep going."
Like Kohli, this took a toll on Harvey-Rolfe's mental health and she eventually required a break. "Taking the decision to go off sick was absolutely necessary. It gave me time to reflect and to really look at what might officially be referred to as 'vicarious trauma'. I felt a sense of failure – that by being off sick I was weak and, despite all the supervision I was getting, I still couldn’t manage it.
"Outside of work, I taught and practised yoga, I had lots of hobbies, I worked hard to have a good work/life balance. But I realised that no matter how much supervision you have or hobbies you do, it's not about getting to a point where you suddenly become immune to your clients' experiences. It is always going to affect you and if it doesn’t, then there is almost more to worry about."
Even today, Harvey-Rolfe still feels "uncomfortable" with labelling herself as having experienced vicarious trauma, "mainly because I was working with women who had experienced so much trauma, [and] it was far too easy for me to get into comparison and minimise the impact it was having on me." Now a research officer at Barnardo’s, Harvey-Rolfe is more aware of the need for charity sector workers, like herself, to look after themselves.
"In team meetings, commissioning and professional forums, client need is, quite rightly, almost always the focus," she says. "We know staff wellbeing is an important issue, but all too often these discussions are placed last on the agenda – and subsequently missed when we run out of time – or only really considered in reaction to visible signs of burnout like staff sickness or lower productivity."
This is despite vicarious trauma being widespread in many sectors. A study carried out in 2013 found the following prevalence rates of vicarious trauma: 15.2% among social workers, 16.3% in oncology staff, 19% in substance abuse counsellors, 32.8% in emergency nurses, 34% in child protective services workers, and 39% in juvenile justice education workers, clinical psychologist Dr Mimi Goess-Saurau points out.
In her experience, a lack of social support from family, friends and at work is the biggest risk factor for developing symptoms. "Time spent in the field and the workload over that time make a big difference; creating a manageable workload – which will be different from clinician to clinician – is vital."
Dr Goess-Saurau recommends reaching out to social support systems if you're suffering, which she says, are associated with reduced levels of vicarious trauma symptoms and burnout. "Starting a self-care routine early on in your career is vital for long-term mental health," she also advises, regardless of whether or not you work with trauma, but especially if you do. "Self-care can be as simple as taking a walk in nature regularly, playing with your children, or getting a massage and regular breaks away." Taking time to recover from emotionally intense work only boosts your performance when you return.
Leonie Harvey-Rolfe is part of a community of professionals who work with women experiencing multiple disadvantage, set up by AVA (Against Violence and Abuse) and Agenda, the alliance for women and girls at risk, as part of the National Commission on Domestic and Sexual Violence and Multiple Disadvantage.