Compassion Fatigue - A result of traumatic public events

Kind & stressed

COMPASSION FATIGUE

By Gitanjali Chandrasekharan, Mumbai Mirror 

 

Compassion fatigue is common in times of public trauma, like with last week's rape.

Early this year, as the country reeled under shock after a 23-year-old New Delhi resident was gang-raped, and died of her injuries, Powaibased trauma therapist Hvovi Bhagwagar noticed her women clients were rescheduling their late evening appointments.

"Several said they didn't feel safe visiting the clinic that 'late at night'," says Bhagwagar, about appointments scheduled post 8 pm. This despite the fact that her clinic sits inside a busy mall. Another patient, a 17-year-old girl, stopped coming to the clinic altogether. "When I inquired, her mother asked me how could I expected the young girl to drive down alone to Powai when newspapers were buzzing with news of sexual assault," adds Bhagwagar, who has been practising for 13 years. It's no different this time around, after news of a 22-year-old photojournalist's gang rape last week.

While an increased sense of caution following news of this sort is normal, Bhagwagar says the behaviour her patients exhibited was linked to Vicarious Trauma (VT).

The empathy overdose

Dr Siddharth Ashvin Shah, medical director of Washington DC metrobased Greenleaf Integrative Strategies, says VT is a phenomenon in which people develop symptoms of trauma (numbing, hyper-vigilance, nightmares) when exposed to information concerning someone else's trauma.

While this is commonly seen in care-givers, social workers and counsellors, even those exposed to tragic news in the media are susceptible to it.

Dr Shah adds that the psychological reason for VT's occurrence is not completely understood. "Still, it would not be speculative to suggest that the following contribute to VT: the human capacity for empathy, the brain's mirror neurons and exposure." Empathy conveys the content of the exposure - people react because they imagine the suffering as if it were happening to them. Mirror neurons in specific regions of the brain fire as if an activity were being done physically (even though a person is aware of it happening to another). Exposure refers to the duration, frequency and depth of contact with the traumatic story.

Speaking about last week's incident, Bhagwagar says that those who identify with the girl - young working women or those who come from the same profession as her - are at higher risk. But even men can show signs. "Typically, husbands and fathers could become overprotective of women in their lives. They might suggest they take a different route back home from work, even if the road they walk on is busy and well-lit," adds Bhagwagar.

The symptoms

In 2008, Bhagwagar says, there were reports that students at city schools seemed withdrawn, and lacked focus in class. "This was after the 26/11 attacks in Mumbai, and we realised that the children had been exposed to terror via television for three days, and didn't know how to process their feelings," she adds. The parents had to be advised to stop watching news 24x7, or watch it on their laptops.

Immediately after witnessing a traumatic event vicariously, it's natural to suffer anxious moments. But if the symptoms persist for more than a month after the event, it's a sign that Post-Traumatic Stress Disorder (PTSD) is setting in. Shah and Bhagwagar say it's best to consult a therapist in this case.

Interestingly, there are enough people, who after exposure to news about war, natural disasters, accidents, terror attacks and sexual assault, don't react the same way.

Trauma can be layered one on top of another. Those who have faced a similar trauma in the past find themselves vulnerable to similar attacks - in the case 26/11, those who frequented the areas and hotels that were targeted by the terrorists - can experience both a retriggering of past trauma plus VT.

Dr Shah says, "For instance, journalists covering the 9/11 attacks experienced a triple layering of trauma. As journalists, they were present during the attacks and primarily affected; those who had experienced prior trauma faced a re-trigger; and those who continued to report on it found themselves vicariously traumatised by stories they were covering."

Dealing with it

While one would argue that after attacks like last week's, it would be normal for any woman in the city to be anxious and alert, Bhagwagar points out there's a difference between the two. "Alertness results in problem-solving behaviour, whereas anxiety leads to avoidance behaviour."

Reaching out for help is important. Speak to your friends and family about your emotions, and reach out for professional help if symptoms last longer than usual.

SIGNS YOU MAY BE SUFFERING FROM VT

» Hyper-vigilance (anticipating that something horrible will happen; increased obsession with bad news)
» Exaggerated startle response
» Emotional instability
» Depression
» Nightmares
» Flashbacks (visual, auditory or olfactory memories intruding the consciousness)
» Physiologic instability (racing heartbeat)
» Distorted thinking (confusion)
» Avoidance (staying away from reminders of the event; memory gaps; occupationally, this could mean extreme discomfort continuing to cover violent events)
» Loss of hope (believing that no one can make a positive difference)
» Emotional numbing (not enjoying socialising with others)
» Dissociation (decreased awareness of one's surroundings)
» Maladaptive behaviours (excessive alcohol use, over/under eating)

Aasra- IASP Suicide Prevention Day Sept 10th, 2013, Light a candle 8 pm

Invite for Aasra's Suicide Prevention Day/Week Activity (Refuse The Abuse with St Andrews College Students)

Aasra's Refuse the Abuse campaign with St Andrews College Students

Suicide Prevention Week 8th to 14th September 2013

Suicide Prevention Week
It's time for each of us to take responsibility for the suicides happening around us. Take the Pledge. Prevent Suicides. Suicide Prevention is Everybody's responsibility

Student suicide statistics (India)

Student Suicide Statistics

Suicidal tendencies among students have gone up as they are burdened with greater expectations from the parents coupled with academic pressure. Statistics show that more and more students are taking the extreme step of suicide in a bid to end their misery after failing in their pursuit of professional excellence. The causes are due to failure or rejection by the society and not for purely economic reasons as was in the past. Generation gap too has been playing a significant role in driving the youngsters to commit suicide. Parents are busy in their respective professions and hardly have time to deal with the problems of their wards. People, especially students are in need of support during examination period, but they seldom find moral support.

Indian scenario : 

Indian scenario Over 16,000 students suicides in the last three years. (Acc. to Health Ministry) Out of every three cases of suicide reported every 15 minutes in India, one is committed by a youth in the age group of 15 to 29. Every 90 minutes a teenager tries to commit suicide in India. Many of these attempts are half-hearted cries for attention, help and love. But every six hours, one succeeds Girls may be more likely to make suicidal attempts, but boys are more likely to make a truly lethal suicide attempt.

 Failure in Examination  

No of Suicides in 2009 = 2010

No of Suicides in 2010= 2479  

No of Suicides in 20011 = 2381

The number of

suicides due to ‘Divorce’, ‘Illegitimate

Pregnancy’ and ‘Professional/Career Problem’

have increased by 54.5%, 20.3% and 20.1%   respectively as compared to previous year.

It is

observed that 11.7% (355 out of 3,035) of

children (upto 14 years) who committed

suicides belonged to Tamil Nadu. 13.2% (1,419

out of 10,785) senior citizens (60 years &

above) also belonged to Tamil Nadu.

60.6% (20 out of 33) victims in Daman & Diu,

57.5% (88 out of 153) victims in Meghalaya and

57.1% (36 out of 63) victims in Daman & Diu

were young (15-29 years) as compared to the

national average of 35.4%. 39.4% of the victims

(13 out of 33) in Nagaland were middle aged

(30-44 years) against the national average of

34.1%.

In 2000, the suicide rate was six persons per lakh and in 2012 it has increased to 11 suicides per lakh. The age group that is committing suicide is between 15 and 35.

In 2006, 5,857 students — or 16 a day — committed suicide across India due to exam stress. And these are just the official figures

[Source: TOI, March 2008, Report]


A study (conducted 10 years back) had found that 16 per cent of Mumbai students were depressed - that is 2 per cent more than the students in Boston. It also found that 8 percent of these were suicidal.

Today, 10 years later, researchers say things could be worse.
- Statistics show that India has the highest suicide rate in the world, marginally behind China, but ahead of the west
- 95-100 people commit suicide in India every day
- And of these a whopping 40% are in the adolescent age group
[Source: CNN-IBN Report, Jan 13 2010]


Crime Records Bureau figures show India’s suicide rate has risen 8 per cent a year for 10 years. According to a 2007 estimate, 45 per cent of suicides involve people between 15 and 29. And WHO lists suicide among the top three causes of death in the age group 15-35.

The motive when students kill themselves is invariably academic pressure - this accounts for 99 per cent suicides in the age group 12-18 - but psychiatrists sought to assess why the trend has risen of late and put it down to three reasons: deprivation of sunshine, exam results, and the copycat syndrome.

Distressed teenagers account for 70 per cent of the phone calls to a helpline run by NGO Aasra, says founder Johnson Thomas.
The leading mental health institution in India, the National Institute of Mental Health and Mental Sciences in Bengaluru, has been involved in several studies to understand why the rates of people taking their own lives, particularly younger people, are on the rise.

In the last formal study conducted in 2007, the Institute found that 122,637 people ended their own lives and for every successful act, it estimated that 8-10 attempts go unreported.

Nearly three-fourths of those taking their own lives were aged 16-45 years.

Bengaluru topped the list of cities where the largest number had taken place, followed by Chennai. In New Delhi data collected from 1,205 adolescents (aged 12-19 years) in two schools revealed that, on average, one in seven adolescents had thought about ending their life.

A lack of methods to help identify youngsters at risk further hinders prevention efforts.

[Source: Guardian, Jan 28 2010]

Since the start of 2010, more than 20 students have killed themselves in Mumbai, India’s financial capital
Opportunities that have come with two decades of economic boom and open markets have also brought more job anxiety, higher expectations and more pressure to achieve, mental health experts said.

India has some of the world's highest suicide rates, with many believing the biggest risk group to be rural farmers facing debt after poor harvests.

However, the study - published in the Lancet medical journal on Friday - says suicide rates are highest in the 15-29 age group, peaking in southern regions that are considered richer and more developed with better education, social welfare and health care.

As per NCRB statistics, 1,35,585 persons committed suicide in the country in 2011. NCRB statistics from 2002 shows that the annual suicide cases in the country always stood above the 1 lakh mark and the highest number of cases was in 2011. In 2002, it was 1,10,417 cases.

That puts the young at high risk - a new phenomenon experts said has happened recently as more middle-class youths strive to meet achievement expectations, and new technologies like cell phones and social networking sites help break down traditional family units once relied on for support.

Overall, the report uses a national government survey of deaths in 2001-03 to estimate 187,000 suicides took place in 2010, making it the cause of 3 per cent of deaths that year.

Suicide rates in India are highest in the 15-29 age group:

Suicide rates in India are highest in the 15-29 age group: Report

Associated Press | Updated: June 22, 2012 22:17 IST

Young Indians are more likely to commit suicide than previously thought, especially those living in wealthier and more educated regions, according to a study on Friday that experts say suggests India's rapid development is driving many youths to despair.

Opportunities that have come with two decades of economic boom and open markets have also brought more job anxiety, higher expectations and more pressure to achieve, mental health experts said.

India has some of the world's highest suicide rates, with many believing the biggest risk group to be rural farmers facing debt after poor harvests.

However, the study - published in the Lancet medical journal on Friday - says suicide rates are highest in the 15-29 age group, peaking in southern regions that are considered richer and more developed with better education, social welfare and health care.

That puts the young at high risk - a new phenomenon experts said has happened recently as more middle-class youths strive to meet achievement expectations, and new technologies like cell phones and social networking sites help break down traditional family units once relied on for support.

Overall, the report uses a national government survey of deaths in 2001-03 to estimate 187,000 suicides took place in 2010, making it the cause of 3 per cent of deaths that year.

The WHO reports about 1 million suicides a year, which would be a rate of about 14 per 100,000 in a global population of 7 billion. By comparison, the U.S. had 37,790 suicides in 2010, or a rate of 12.2 per 100,000, while India's rate under the Lancet's projected suicide tally of 187,000 would be near 16 - far higher than earlier reports and estimates of around 10.

There has been little scientific examination of suicide motives in India.

While The Lancet study does not address the question of motivation, the report's authors, as well as experts not associated with the study, saw few likely reasons for the rise in suicide among young people beyond the increased pressure that has come with new economic opportunity and social fragmentation.

The higher rates may come from "the greater likelihood of disappointments when aspirations that define success and happiness are distorted or unmet by the reality faced by young people in a rapidly changing society," said Dr. Vikram Patel, one of the report's authors, in an editorial printed in The Hindu.

He also noted online social networking was making "loneliness more common." He admits his conclusion is conjecture, but says "I cannot think of any more plausible explanation."

Among men, 40 per cent of suicides were among people age 15-29. For women, it was nearly 60 per cent.

The numbers mean young men are nearly as likely to die from suicide as in traffic accidents, while rates of suicide among young women are nearly as high as the rate of death by complications from pregnancy or childbirth.

The revelation has shocked many in a country notorious for poor maternal health care statistics.

"We can only guess broadly at what might be behind it. People say partially the rapid changes on society that have come with globalization, the breakdown of the families," said Dr. Roy Abraham, president of the Indian Psychiatric Society.

There are few facilities in India for mental health problems, and stigmas prevent many people from seeking support. Telephone help lines are often not adequately staffed, and many schools do not have counsellors.

"Mental health is not a priority in India," he said. "It has to be a priority. Many people are not aware of the fact that mental health is behind suicide."

Courts are starting to mandate programs for educating people about public health issues including suicide, sexuality and drug abuse, experts said.

"The young face very high competition and pressure from families to succeed. Many parents think their child should come first in the class. Of course, that can't happen," said Dr. T.S. Sathyanarayana Rao, head of psychiatry at J. S. S. Medical College & Hospital in Mysore, 140 kilometers (87 miles) from the nation's technology centre of Bangalore.

When youths start to despair, they often don't think to seek help, or shun the idea because "they think psychiatry is only for crazy people," he said.

Many suicide cases still go unreported, expert said, as people hide what is still an illegal act in India, the report says.