How to Prevent Psychological Injury — at War and Work
Organizations need to help employees in stressful circumstances cope. War medics' experiences show the need for meaningfulness at work.
Only some of those who go to war develop Post-Traumatic Stress Disorder (PTSD) and related conditions. For example, 20-30 % of U.S. troops serving in Iraq and Afghanistan have returned with some kind of psychological injury.
Why them? What makes some soldiers susceptible to psychological injury and not others? And how can insights from battlefield PTSD inform the way organizations support their workers?
Historically, researchers thought PTSD sufferers were somehow less able to cope, psychologically or physically, than other people. But organizational ethnographer Mark de Rond (University of Cambridge) and management researcher Jaco Lok (University of New South Wales) found a different answer.
People's context — their workplace and professional community — affects whether they find experiences to be traumatic.
Many people look to their work for a sense of meaning and purpose. If their work feels senseless or futile, they suffer. The organizations they belong to shape their expectations and can help them make sense of what they see.
Researching Psychological Trauma on the Front lines
De Rond and Lok studied the causes of psychological trauma among British medics serving in Afghanistan in 2011.
De Rond participated in the medics’ pre-deployment training and joined them for a six-week tour of duty. Working in a 50-bed field hospital, the medics treated foreign soldiers and local Afghans. De Rond observed the medics and spoke with them about their experiences. He also reviewed hospital data and related reports.
Harm When Events Seem Senseless, Futile, or Surreal
De Rond and Lok found that the medics suffered when their experiences seemed senseless, futile, and surreal.
At the field hospital, Afghan children made up more than 10 per cent of the total patients. Seeing wounded children threatened medics’ sense of reason and hope. One medic shared a poem: “Take all my wages for the rest of my days/To stop these kids dying, to allow them to play.”
The military required Afghan patients be transferred to local Afghan hospitals as soon as possible. However, local hospitals rarely had adequate resources, and so patients often died following transfer. Delivering life-saving care to patients only to learn those patients died a short time later left medics without a sense of purpose or control.
One nurse, asked if she needed anything, replied: “Reason to live.”
Life in the field hospital marched on, posing a painful contrast between daily routines and tragic death. In one case, a service member walking to the incinerator with a human leg encountered a teammate dressed up as the Easter Bunny. The contrast makes familiar rituals seem strange and inappropriate — and makes painful experiences seem that much more unnatural.
Organizational Choices Have Individual Consequences
The experience of being a medic isn’t automatically senseless, futile, or surreal. Trauma arose because medics — like many people — have a sense of “calling.” They identify deeply as healers, who put patients first. When they were unable to do so, they suffered.
The medics’ organization — the military — made certain choices that likely increased medics’ sense of trauma. For example, the practice of turning Afghan patients over hospitals conflicted with medics’ commitment to patient care. Importing common rituals from home — holiday celebrations, fast food — may have made the environment feel even more surreal.
Lessons from the Battlefield for the Cubicle
Psychological injury is defined as a “stress-related emotional condition that results from real or imagined threats or injuries.” It’s easy to imagine military life providing both direct and indirect threats and injuries. But people in other types of work can also suffer psychological injury.
Many organizations and professions employ people with a strong sense of calling or purpose, say de Rond and Lok, including emergency professionals, social workers, and environmentalists. When these people experience limits on their ability to make a difference, they can face the same feelings of senselessness, futility, and surreality.
An environmentalist might see a mine go forward despite protests. A social worker might see addicted clients repeatedly overdose. Both might experience a deep sense of futility.
Such workers are trying to “turn…the never-ending tide of human suffering,” say de Rond and Lok. “We owe them our support through developing more effective ways to alleviate, or even prevent, the psychological costs in their work.”
Ways to Reduce Psychological Injury
Organizations can help people make sense of their roles, prepare them for what they will see, and develop ways to manage their emotions.
For the medics, little help was on offer. The military didn’t discuss what the medics – or the army – were trying to achieve. Medics didn’t talk about their feelings, partly because military and medical culture emphasize emotional control. And while the military does have mental health supports available, it didn’t advertise them widely.
De Rond and Lok are investigating ways organizations can better support staff experiencing a sense of futility or senselessness at work. Some possibilities:
Help people compartmentalize
People should recognize when they are in an unusual context. They can acknowledge that the experience is different from ordinary life and has a defined beginning and end. Compartmentalizing may help people separate those experiences, rather than trying to integrate what they see into their usual thought patterns and paradigms.
Setting such expectations can reduce their sense that things are surreal or strange, compared to “back home.” If people know they are in a situation with different rules, they may be able to redefine their goals for making an impact or achieving success. The medics in Afghanistan might recognize that, for example, they could set a goal of easing a patient’s suffering while under their care — but that they can’t control what happens after that patient leaves their care.
Prepare people for a different, stressful setting
For the medics studied by de Rond’s and Lok, the British army offered only 1.5 hours of cultural training before deployment. More knowledge about a new environment helps people anticipate what they will see or encounter. The new environment may still seem strange or different, but they can understand it better. Experiences will seem less surreal, and perhaps make more sense.
“None of these approaches is perfect,” says de Rond. “It’s a really big problem… trying to find coping supports that are more effective than what exists today.”
De Rond and Lok Receive Research Impact on Practice Award
De Rond and Lok’s research recently received Honorable Mention for the 2017 Research Impact on Practice Award. The award, sponsored by NBS and the Academy of Management’s Organizations and the Natural Environment Division, recognizes work on sustainability that has important implications for practice.
Find Out More
Video on the research (Academy of Management Journal)
Article: de Rond, M. and Lok, J., 2016. Some things can never be unseen: The role of context in psychological injury at war. Academy of Management Journal,59(6), pp.1965—1993.