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PTSD is not the problem. Burnout is.

When I worked for an INGO, I used to carry with me to my missions – and still do – a book called Comfortable with Uncertainty by Pema Chödrön. It was one of my supports when “the shit hit the fan”. I wish all aid workers were given a copy when leaving for a mission as part of their pre-deployment training.

After having invested over a year campaigning for the psychological preparation and awareness for aid worker, spending a good amount of time in Israel and Palestine – a place where uncertainty is the norm – I remain convinced that if we want to change how aid works, we need to change ourselves. Psychological awareness becomes a tool for social and political awareness, but before we get there we need to find ways to manage stress and avoid getting to a place of burnout.

In simple terms, personal psychological health matters, and does have an impact on how we carry ourselves in the world. Which in turns has an impact on our work and on the projects on the ground.

I know that when I am in an unhappy place, I carry with me that gloom and cynical outlook that resembles my inner discontent. Life in the field can be challenging even if we drive a 4×4, have a housekeeper, and can buy cheap wine at the expats’ store.

We are told again and again to be aware of trauma, we hear this word PTSD (Post-Traumatic Stress Disorder) thrown around as soon as disaster strikes, or critical incidents occur. The reality is that PTSD is not the problem.

There are still many misconceptions around the mental health of aid workers. Only between 5-10% develop PTSD following a traumatic event. That’s in line with the average population. This means that more than 90% of aid workers exposed to traumatic events have the resilience to cope. Rushing in with psychological interventions immediately after a critical incident is often unhelpful, this goes for both staff and so-called beneficiaries. So I was relieved to read this in the World bank Blog:

“Blanket intervention in the immediate aftermath of a potentially traumatic may be, at best, mis-targeted and, at worse, distract from more critical aid efforts”.

I would add that when applied to humanitarian professionals, blanket interventions tend to impose a one-size fits all model of talking therapy or verbal debriefing that may not work for everybody.

Staff care needs to build resilience and help people to make sense not just of shocking or challenging experiences. It also needs to foster self-knowledge, helping us to see strengths as well as shadow aspects of ourselves, acknowledging how messed up we can be as human beings – which often comes out in stinky team dynamics and in passive-aggressive communication –  even when we are trying to do good.

The way I see it is that there is no quick fix approach. Aid work requires heightened psychological awareness. Processing suffering and life’s ups and downs requires time.

In NGOs most people want to do something meaningful, but what is often missing is a crucial step: we cannot heal or help someone else if we are blind to our own inner conflicts and personal issues. We need to take a little care of ourselves and acknowledge our “shadow motivations for doing good”, in order to work with others who may be in need. Then our work may flow from a healthy place, which includes an awareness and an acceptance of my own needs in “helping the poor”, which have often to do with my own feelings of inadequacy, and my own anxiety, as well as with my desire to make a positive contribution to the world. Some of the posts that have been written around the KONY debate have beautifully highlighted this.

I am deeply convinced that the words used by Jon Kabat-Zinn are true for all of us:

“In order to do no harm, you have to be mindful. Without awareness, you are going to do harm right and left, because you will not be able to see what effect you are having on others.”

But, Jon Kabat-Zinn continues, we are often up against this:

“Some people have resistance to the whole idea of taking time for themselves. The Puritan ethic has left a legacy of guilt when we do something for ourselves. […] Even the degree to which you can really be of help to others depends directly on how balanced you are yourself. Taking time to ‘tune’ your own instrument and restore your energy reserves can hardly be considered selfish. Intelligent would be a more apt description.”

So if PTSD is not the problem, what is the problem?

Lack of awareness. That is the problem.

Stress which leads to burnout. That is the second problem.

The solution? For sure there is no one-size fits all. I have some suggestions that work for me when life does not go my way, when I get stressed, sad and lose sight of what’s meaningful in my work:

Searching within, taking some time alone, slowing down, having more fun and a sense of humor, relying on the friendship, support and feedback of loved ones, trying not to take myself so seriously, knowing that there is no quick fix and maybe no solution. Learning to be comfortable with uncertainty.

“We can try to control the uncontrollable by looking for security and predictability, always hoping to be comfortable and safe. But the truth is we can never avoid uncertainty. This not-knowing is part of the adventure.”  ~ Pema Chödrön

2 Responses to PTSD is not the problem. Burnout is.

  1. Alessandra Pigni Alessandra @Mindfulnext says:

    Thanks Liz this is very interesting. Organisations need to do more to implement a culture of care.

    A sense of humour is essential in the field, but it is rather sad to see that the (only) culturally accepted coping strategies are gallows humour, stoicism, emotional detachment and the likes.

    Individuals have the power to put in place healthier coping strategies for themselves if they are strong enough to go against the ‘mainstream’ humanitarian culture.

    But it’s for organisations to change the ‘structural culture’ from within, and develop ‘healthy empathy’, rather than a compulsory need to fix ‘the other’, while neglecting their very own staff, who are humans too.

  2. Liz Pycroft says:

    This is as summary of my recently completed MA thesis. I wonder what you think?

    Working in the field of international development assistance and humanitarian aid can impact a person’s mental health. Individuals have reported a range of somatic and psychological effects of their work. Traditionally, organisations have concentrated their resources on the physical security and health of their staff but more recently have begun to pay attention to the effects of both trauma and burn out.

    This Interpretative Phenomenological study explored the individual experiences of four aid workers currently at post in the Democratic Republic of Congo (DRC), this was done by carrying out semi-structured interviews with the workers in Kinshasa in the DRC. The aim was to get closer to understanding how these individual workers perceive the threats to their psychological well-being and mental health.

    The study shows that these aid workers are acutely aware of the effects of their work and that they draw on culturally accepted coping strategies, including gallows humour, stoicism, emotional detachment and adhering to a group identity. The culture of coping can be a barrier to care seeking; this barrier can have a detrimental effect on the mental health of those aid workers who may want additional support but feel prevented from accessing it.

    Therapists working with aid workers may find it useful to work from an existential perspective which aims at encouraging clients to explore their own unique combination of life’s givens and which facilitates an exploration of the paradoxes that they may encounter as part of this lifestyle. This approach can help clients come to know and understand the values by which they want to live their lives. When aid workers question the value of their work it can create a destabilisation in their sense of self and a crisis of identity. Facilitating individuals to make sense of their experiences by contextualizing them within their physical, cultural and psychological life may prevent distress from escalating into mental ill health.

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Mindfulnext by Alessandra Pigni is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.