*Note: since this entry is so long, I have split it up into multiple paragraphs. Only the last one is my opinion on the matter.
While pointless war and unspeakable violence rage in Ukraine, we are waging our own war at home, argues a recent Slate article. Like soldiers on the front line, healthcare workers must battle a crafty, intricate, dangerous foe, and experience suffering and stress in the process. This enemy is COVID-19, and though we may now think of the pandemic as the status quo, our nation’s soldiers are bearing the brunt of the attack. In recent years, there has been an exodus of health care workers, with almost 1 in 5 quitting their job. The commonly offered explanation is burnout: before the pandemic, burnout rates were as high as 54%, and COVID-19 exacerbated the situation. However, the authors of the article seek to highlight other, subtler stress mechanisms at work behind the scenes, by comparing the battle against COVID-19 to actual war. For example, the decreased individual attention that patients receive due to limited availability of resources and personnel can cause health care workers to experience moral injury, or the feeling that one has failed due to the disparity between their idealized and actual jobs. In addition, the inconsistency of care standards and conditions across hospitals can make workers feel insecure, and the constant transitioning between the front lines of the pandemic and the home environment is disorienting and can cause people to cope by fixating on only one reality. Finally, health workers have had to fill the role of providing mental health care as well, adding even more emotional stress.
These stressors combine to produce a form of trauma. The type of disorder that is often associated with trauma is Post-Traumatic Stress Disorder (PTSD), in which a single extremely traumatizing event produces psychological aftereffects, but the trauma experienced by health care workers is closer to complex trauma, a type of trauma characterized by chronic exposure to stressful, unpredictable environments. The latter type has a PTSD equivalent, or c(complex)-PTSD, whose symptoms include dissociation, relationship issues, destructive behaviors, emotional dysregulation, and feelings of shame and guilt. No doubt health care workers are experiencing these symptoms as they struggle through the stressful environments of the front line. Granted, due to the lack of research on the mental struggles of health care workers during the pandemic, the exact nature of this trauma is unknown. However, understanding these challenges as trauma is important, and using this framework, we can copy the way the military deals with trauma. As a result of World War II, the military evolved to integrate mental health care into the fabric of its system. Ironically, though, the health care system stigmatizes mental health, as professionals are expected to stoically endure hardships. What’s worse, the stressors that health care workers experience during the pandemic are subtle and harder to notice than sudden traumas, such as the death of a patient.
To address these needs, the authors suggest a government-run professional mental health taskforce, carefully and equitably coordinated, with “a trauma-informed approach; an emphasis on interpersonal, family-based care; standardized criteria for recognizing those at risk; and more universal mental health screening.” In addition, the authors encourage continued research into the nature of health care-related trauma, not just in the pandemic environment, but in general as well.
Health care workers are hailed as heroes, yet they do not receive the support that heroes generally receive. To me, the system has failed to recognize the universality and intersectionality of mental health. Veterans suffering from PTSD (or “Shell Shock,” as they called it then) after World War I were very visibly afflicted, leading to the incorporation of mental health services into the military after the next World War. Apparently though, society has not deemed the daily grind as warranting sufficient attention. The ghastly statistic of 54% burnout even before the pandemic demonstrates just how little attention mental health had been receiving. Just as the world is experiencing the physical conflict between Ukraine and Russia and the subtler battle waged against COVID-19, so too in the United States are our health care workers and general populace fighting against the physical symptoms of the virus and the mental symptoms of the pandemic. The pandemic has stripped bare our country’s mental health care system and exposed the pitiful paucity of support. In my opinion, sending in health care workers without mental support is tantamount to sending soldiers to the front lines as suicide bombers. Of course, the pandemic front lines are not as dramatic as military front lines, but the essence is the same – sacrificing valuable workers by failing to invest in their long-term usefulness (i.e., providing mental support so that workers don’t quit). Health care workers care for us, but who cares for them? The answer is “nobody,” and that needs to change.