Here
I am focusing on PTSD and PDSD resulting from bullying, primarily in the
workplace.
In
the Armed
Services,
bullying is behind harassment, discrimination, prejudice and persecution. This
insight about bullying is therefore relevant to more serious issues including
physical abuse, repeated verbal abuse, sexual abuse, violent crime, kidnap,
abduction, rape, war, torture, and denial and abuse of human rights.
PTSD, PDSD and bullying
Until
recently, little (or no) attention was paid to the psychological harm caused by
bullying and harassment. Misperceptions
(usually as a result of the observer's lack of knowledge or empathy - or both)
still abound: "It's something you have to put up
with" (like rape or repeated sexual abuse?) and "Bullying
toughens you up" (ditto) and "You've
got to be tough to live in a man's world"
Armed forces personnel faced threats of being labelled with "cowardice" and "lack of moral fibre" (LMF) if they gave in to the symptoms of PTSD. Many British and Commonwealth soldiers were shot as "cowards" and "deserters".
Since Andrea Adams first identified workplace bullying and gave it its name in 1988, recognition of adult bullying has grown steadily.
Mapping the health effects of bullying onto PTSD and PDSD
Repeated
bullying, often over a period of years, results in symptoms of Prolonged
Duress Stress Disorder (PDSD). How do the symptoms resulting from bullying meet the criteria in
ICD-10?
A.
The prolonged (chronic) negative stress resulting from bullying has lead to
threat of loss of job, career, health, livelihood, often also threat to marriage
and family life. The family are the unseen victims of bullying.
1.
One of
the key symptoms of prolonged negative stress is reactive depression; this
causes the balance of the mind to be disturbed, leading first to thoughts of,
then attempts at, and ultimately, suicide.
2.
The
target of bullying is unaware that they are being bullied, and even when they do
realise (there's usually a moment of enlightenment as the person realises that
the criticisms etc are invalid). The
target of bullying is bewildered, confused, frightened, angry - and after
enlightenment, very angry.
B.
The target of bullying experiences regular intrusive violent visualisations and
replays of events and conversations; often, the endings of these replays are
altered in favour of the target.
1.
Sleeplessness,
nightmares and replays are a common feature of being bullied.
2.
The
events are constantly relived; night-time and sleep do not bring relief as it
becomes impossible to switch the brain off.
3.
Fear,
horror, chronic anxiety, and panic attacks are triggered by any reminder of the
experience, e.g. receiving threatening letters from the bully, the employer, or
personnel about disciplinary hearings etc.
4.
Panic
attacks, palpitations, sweating, trembling, ditto.
Criteria
3 and 4 manifest themselves as immediate physical and mental paralysis in
response to any reminder of the bullying or prospect of having to take action
against the bully.
C.
Physical numbness (toes, fingertips, lips) is common, as is emotional numbness
(especially inability to feel joy)
1.
The
target of bullying tries harder and harder to avoid saying or doing anything
which reminds them of the horror of the bullying.
2.
Work,
especially in the person's chosen field becomes difficult, often impossible, to
undertake; the place of work holds such horrific memories that it becomes
impossible to set foot on the premises; many targets of bullying avoid the
street where the workplace is located.
3.
Almost
all callers to the UK National Workplace Bullying Advice Line report impaired
memory; this may be partly due to suppressing horrific memories, and partly due
to damage to the hippocampus, an area of the brain linked to learning and memory
.
4.
The
person becomes obsessed with the bullying experience which takes over their
life, eclipsing and excluding almost every other interest.
5.
Feelings
of withdrawal and isolation are common; the person just wants to be on their own
and solitude is sought.
6.
Emotional
numbness, including inability to feel joy (anaerobia) and deadening of loving
feelings towards others are commonly reported. One fears never being able to
feel love again.
7.
The
target of bullying becomes very gloomy and senses a foreshortened career -
usually with justification. Many targets of bullying ultimately give up their
career; in the professions, severe psychiatric injury, severely impaired health,
refusal by the bully and the employer to give a satisfactory reference, and many
other reasons, conspire to bar the person from continuance in their career.
D.
Sleep becomes almost impossible, despite the constant fatigue; such sleep as is
obtained tends to be unsatisfying. On waking, the person often feels more tired
than when they went to bed. Depressive feelings are worst early in the morning.
1.
The
person has an extremely short fuse and is often permanently irritated,
especially by small insignificant events. The person frequently visualises a
violent solution, e.g. arranging an accident for, or murdering the bully.
2.
Concentration
is impaired to the point of precluding preparation for legal action, study,
work, or search for work.
3.
The
person is on constant alert because their fight or flight mechanism has become
permanently activated.
4.
The
person is hypersensitive and unwittingly and inappropriately perceives almost
any remark as critical.
E.
Recovery from a bullying experience can take between 2-5 years, perhaps more.
Some people never fully recover.
F.
For many, social life ceases and work becomes impossible; the overwhelming need
to earn a living combined with the inability to work deepens the trauma.
Associated
symptoms
Survivor
guilt: Survivors of disasters often experience abnormally high
levels of guilt for having survived, especially when others have died. Survivor
guilt manifests itself in a feeling of "I should
have died too".
In
bullying, levels of guilt are also abnormally high. Many survivors of bullying
cannot gain further employment and are thus forced into self-employment;
excessive guilt may then preclude the individual from negotiating fair rates of
remuneration, or asking for money for services rendered. The person may also
find themselves being abnormally generous and giving in business and other
situations.
Shame,
embarrassment, guilt, and fear: are
encouraged by the bully, for this is how all abusers - including child sex
abusers - control and silence their victims.
Marital
disharmony:
the target of bullying becomes obsessed with what is happening and the
experience takes over their life; partners become confused, irritated,
bewildered, frightened and angry; separation and divorce are common outcomes.
The UK has the highest divorce rate in Europe.
Breakdown
The
word "breakdown"
is often used to describe the mental collapse of someone who has been under
intolerable strain. There is usually an inference of "mental
illness". All these are lay terms and mean different things to
different people. I define two types of breakdown:
1.
Nervous breakdown or mental breakdown
is a consequence of mental illness
2.
Stress breakdown is a psychiatric injury, which is a normal
reaction to an abnormal situation
The
two types of breakdown are distinct and should not be
confused. A stress breakdown is a natural and normal conclusion to a
period of prolonged negative stress; the body is saying "I'm not designed
to operate under these conditions of prolonged negative stress so I am going to
do something dramatic to ensure that you
reduce or eliminate the stress otherwise your body may suffer irreparable
damage; you must take action now".
A
stress breakdown is often predictable days - sometimes weeks in advance - the
person's fear, fragility, obsessive ness, hyper-vigilance and hypersensitivity
combine to evolve into paranoia (as evidenced by increasingly bizarre talk of
conspiracy or MI6). If this happens, a stress breakdown is only days or even
hours away and the person needs urgent medical help. The risk of suicide at this
point is heightened.
Often
the cause of negative stress in an organisation can be traced to the behaviour
of one individual. I believe bullying is the main - but least recognised - cause
of negative stress in the workplace today.
Unfortunately,
the person who suffers a stress breakdown
is often treated as if they have had a mental breakdown;
they are sent to a psychiatrist, prescribed drugs used to treat mental illness,
and may be encouraged - sometimes coerced - into becoming a patient in a
psychiatric hospital. The sudden transition from professional working
environment to a ward containing schizophrenics, drug addicts and other people
with genuine long-term mental health problems adds to
rather than alleviates the trauma.
Words
like "psychiatrist", "psychiatric unit" etc are often
translated by work colleagues, friends, and sometimes family into
"nutcase", "shrink", "funny farm",
"loony" and other inappropriate epithets.
The
bully encourages this, often ensuring that the employee's personnel record
contains a reference to the person's "mental health
problems". Sometimes, the bully produces their own amateur diagnosis
of mental illness - but this is more likely to be a projection of the bully's
own state of mind and should be regarded as such.
During
the First World War, British soldiers suffering PTSD and stress breakdown were
labelled as "cowards" and "deserters".
During the Second World War, soldiers suffering PTSD and stress breakdowns were
again vilified with these labels; Royal Air Force personnel were labelled as
"lacking moral fibre" and their papers
stamped "LMF".
It's noticeable that those administrators and top brass enforcing this labelling were themselves always situated a safe distance from the fighting.
The
person who is being bullied often thinks they are going mad. They are not; PTSD is an injury,
not an illness.
Sometimes,
the term "psychosis" is applied to mental illness, and the term
"neurosis" to psychiatric injury.
The
main difference is that a psychotic person is unaware
they have a mental problem, whereas the neurotic person is aware
- often acutely.
With
targets of bullying, I prefer to avoid the words "neurosis"
and "neurotic", which for non-medical
people have derogatory connotations. Hypersensitivity
and hyper-vigilance
are likely to cause the person suffering PTSD to react unfavourably to the use
of these words, possibly perceiving that they, the target, are being blamed for
their circumstances.
A
frequent diagnosis of stress breakdown is "brief reactive psychosis", especially if paranoia and suicidal thoughts
predominate.
However,
a key difference between mental breakdown and stress breakdown is that a person
undergoing a stress breakdown will be intermittently lucid, often alternating
between paranoia and seeking information about their paranoia and other
symptoms. The person is also likely to be talking about resolving their work
situation (which is the cause of their problems),
planning legal action against the bully and the employer, wanting to talk to
their union rep and solicitor, etc.
More information about bullying in the work place can be found on the following web site:
or
www.bullyonline.org/stress/ptsd.htm