Dr Jo Stubley, is a Consultant Medical Psychotherapist, Psychoanalyst and Lead Clinician for the Tavistock Trauma Service. She speaks to quite a few aspects of what people might be feeling at the moment, and the need for that experience to be recognised, validated, and for there to be some sense that there is interest, support and understanding for what this situation demands of you on our behalf.
Wellbeing Quiz Profile: #RelivingTrauma
Hello, my name is Jo Stubley. I’m a psychiatrist and psychoanalyst, and I run the Tavistock Trauma Service. This podcast today is aimed at NHS and social care frontline staff thinking about what they are facing as the numbers have dramatically increased and it’s likely that we are facing a second wave in the COVID-19 pandemic. I want to say a little bit about what people might be facing in the return to the front line and what might be helpful in coping with this. This would come under several headings.
The first of these is that there is the reality of the threat of the virus that persists either to the threat to staff themselves, or the significant anxiety that they may, through their workplace transmit it to their loved ones. Now, we know a lot more about the reality of this infection. And this might for some increase or reduce anxiety. But we also know that the threat that is continuing creates a bodily response of autonomic arousal where people can feel in a kind of fight flight state for most of the time and this can feel very difficult to cope with. And I think that it has been important for us to acknowledge that that has had a long cumulative effect for many, and has been part of what’s led to the general sense of exhaustion that many frontline staff are facing.
The other area that the threat of the virus can stir up is a reactivation of what we call reliving, or re-experiencing symptoms. When you have faced significant threat or the potential for trauma, those experiences often don’t get processed in an ordinary way so that they stay around and when they get triggered by similar situations, they can get back again, either as nightmares or intrusive images or flashbacks to past experiences. And the triggers are often around being in a similar context. So it might well be that that these kinds of reliving events are more likely to occur, particularly for those who are going back into redeployed areas that they had left for some time.
There’s also often a cumulative effect of these threats, and potentially traumatic incidents so that they can build up over time and make us feel as though one more could be the straw that broke the camel’s back. Coupled with this as if there’s already been significant trauma in your background that can create a potential vulnerability. Now, one thing that we know from a lot of study is that if traumas can be processed, then that vulnerability is reduced. And one difficulty that many people have faced over the time of the pandemic and working on the frontline is that there hasn’t been much time for processing. What I mean by processing is having a space with another, to be able to talk about what has happened, and to feel the emotional response to this. And a lot of that emotional response is linked to grief. There’s been an enormous amount of loss that many people have faced over this time, and grieving for what has been lost, whether that’s been, you know, bereavements of loved ones, or the many losses that we’ve faced in terms of changes to our environment, to our psychosocial situation, and even in the view of our world as something that we can control. All of these losses require grieving. And that takes time, and it takes effort and feeling the emotional responses of sadness, anger, guilt, distress, and so on. And it might well be that coming back to the front line, you start to activate some of those feelings again, and recognising as with the reliving experiences that these are ordinary responses to what you’re facing is important.
We have also had to potentially deal with the reality that for many moral injury and institutional betrayal have complicated the processing of potentially traumatic incidences and the processing of grief. By moral injury, I mean circumstances in which there has been an ethical or moral situation that has felt wrong, but in which one has either had to witness or be engaged in it. An example of this is for many people having to work without sufficient PPE early on. This created a lot of guilt and anger and that often made it more difficult to process what had been happening. Coupled with this, for many, there’s been an experience of institutional betrayal being let down either by the institution or authorities in which we work or at a higher level in terms of our politics and so on. And this also is something that requires working through the feelings that get stirred up.
The other area that I think has been important for frontline staff is the question around the public support. And although early on this felt very present, I think that there is a sense for many that the current rhetoric is more around the pandemic causing an inconvenience in relation to Christmas. For me, this links in with a thought I have about how much the public needs to disavow the reality of the seriousness of this condition and the number of deaths that have occurred, in order to protect itself from the painful emotional work which you as frontline staff are required to do. This puts you in a more difficult position potentially, as it makes it harder to feel that you are being supported adequately, at times. And I hope that this will change as things continue.
It is understandable, therefore, for all of these reasons that many of you may be having feelings of fear, reluctance, distress, anger, guilt, grief, or shame, in terms of what you are having to face in your day to day work at this time. We no longer have the hyperarousal, fight flight response activating us in a positive way that I think many people felt at the start of the pandemic, now I think it’s causing more fatigue, and what we’re having to rely on much more psychological stamina. But all that we learned about how to increase our resilience comes into play in this case. What we learned in terms of the need for self-care, the need for compassion, and containment of our feelings all apply equally at this point.
The area that I want to particularly focus on though, is the need for social connection. I have emphasised throughout this talk that the way in which things get processed is by talking about them to someone else, or feeling that you can feel these feelings in the presence of another. And in the workplace this might mean a good buddy system, a supportive team, or a psychologically savvy manager who can help you with that. I would like to suggest that the description of social distancing, we think about more as physical distancing, and focus instead on social connection. Because connecting with family, friends and community during this difficult time is going to be really important to help see you through.
I would also just want to come back to what I have really been saying throughout this talk, which is that it is fine to be feeling what you’re feeling, validation of your own experience and the emotional responses to it is vital as a part of working through what has happened and finding a way to move forward.
I wish you well in that journey and I hope that you have learned something helpful in this talk.