LONDON (Thomson Reuters Foundation) - When Cat Carter interviewed young victims of torture on the Syria-Jordan border for aid agency Save the Children, she spent long days with her mind filled with one horrifying story after another.
She got so wrapped up in her work that she found it difficult to switch off at the end of a grueling day.
“I knew that bad things happened, but I had never seen torture scars on nine-year-olds (before),” she said.
Carter, Save the Children’s head of humanitarian information and communications, was developing vicarious trauma, a mental health condition which few aid workers are aware of.
“I became almost fixated on the Syria crisis, and nothing else really mattered. At the time, one of my dearest friends was getting married and I couldn’t really get involved. Even the basic decisions like what to have for dinner really threw me.”
It is well known that people risk developing long term mental health problems if they are tortured, sexually abused or see someone killed in front of them.
However those who simply spend lots of time talking to trauma survivors can also suffer serious harm.
Aid workers are particularly vulnerable to vicarious trauma, whose symptoms include difficulty managing emotions, making decisions and maintaining relationships, according to the Headington Institute, a California based charity which helps aid workers.
Laurie Pearlman and Lisa McCann, two American psychologists, coined the term vicarious trauma in 1990.
It affects people who help traumatized survivors of violence or abuse by conducting in depth consultations about their experiences.
Aid workers are at risk of the condition because they are often emotionally and socially isolated, living and working in difficult environments far from home, friends and family, and often lacking adequate training and healthcare.
It is not necessarily confined to humanitarian workers - Pearlman came up with the name after she herself developed symptoms interviewing abuse survivors in the United States.
“I was dispirited, disconnected, I had lost my joie de vivre,” she told the Thomson Reuters Foundation.
People like Pearlman and Carter are trying to make more aid agencies aware of vicarious trauma, and encouraging them to offer psychological support to their staff.
Since Carter’s experiences in 2012, Save the Children has made counseling mandatory after deployments which involve sustained exposure to traumatized people, and is piloting a scheme to screen staff members before they go into the field.
Carter found taking proper breaks between interviews, and moving somewhere safe and quiet to process the grim information she hears, help lessen the impact of trauma.
Working in teams to counter solitude, maintaining clear boundaries between work and personal life, and limiting working hours can all help, said Pearlman. “If we feel connected, we do better in life.”
A 2013 survey of over 1,500 aid workers carried out by the United Nations’ refugee agency found 6 percent of aid workers had had suicidal thoughts, 47 percent had unusual sleep patterns, and 57 percent had symptoms of depression.
Vicarious trauma, also known as secondary stress, was a significant contributor, though hard to measure, the survey authors said.
Most mental health interventions focus on acute incidents, like helping those exposed to a bomb blast, the U.N. study said.
Pearlman said chronic factors, like exposure to trauma survivors, can cause just as much harm.
Aid workers who come from the affected community experience trauma in different ways to foreigners, she said.
Local staff may lose loved ones or have their property damaged in a disaster or war, piling on stress factors which foreigners living in a compound with other aid workers tend not to face.
However local workers can benefit from an emotional support network outside the workplace which foreign workers often lack, leaving them less isolated, said Pearlman.
After Nepal was hit by two devastating earthquakes earlier this year, Lex Kassenberg, Nepal country director for aid agency CARE International, encouraged his staff to talk openly about what they were going through. “Sharing the experience makes you feel less alone.”
He also encouraged staff to take proper breaks, leaving the district to get away from it all every so often, and to undergo counseling.
“One of the things that you really have to be careful about in a humanitarian operation is burnout. There is a point where because of lack of sleep, because of depression, people don’t produce any more,” he told the Thomson Reuters Foundation.
Lynne Cripe of the KonTerra Group, a U.S. firm which helps companies which work in challenging environments, said the last decade has seen a “really dramatic increase” in aid agencies asking for help managing the mental health of their staff.
Cat Carter welcomes the increased attention.
Anyone who is trying to help extremely traumatized survivors for a prolonged period of time will inevitably face some degree of vicarious trauma, she said, yet many aid workers, especially men, are reluctant to admit they need help.
Many people affected, including Carter, manage to keep doing their job well, so are not always diagnosed by superiors. This makes compulsory counseling vital, as developing some trauma symptoms is inevitable if exposure levels are high, she said.
“I think it’s a case of when, not if. It’s just the sheer volume and weight of the emotion.”
Reporting By Joseph D'Urso, editing by Alex Whiting; Please credit the Thomson Reuters Foundation, the charitable arm of Thomson Reuters, that covers humanitarian news, women's rights, trafficking, corruption and climate change. Visit www.trust.org