“Sock Drawer Stories” – PTSD and Frontline Providers

Painting of a woman looking at the viewer Brian Goldman is a veteran ER physician who hosts a weekly show on CBC Radio called White Coat, Black Art. During each episode, he describes — and illuminates — the health care system from “my side of the gurney.”

A few weeks ago, I listened to Goldman’s powerful piece about incidences of post-traumatic stress disorder (PTSD) among frontline/emergency responders called Sock Drawer Stories: Portraits of Hope and Healing. One of the paramedics he interviewed described the impact of witnessing daily traumas as “dirty socks.” The metaphoric sock drawer is the place they “stuff in all the experiences until it is ready to spill over.”

Inspired by the idea of the sock drawer, and struggling with PTSD herself, visual artist and paramedic Teresa Coulter created a series of striking portraits of her colleagues to raise awareness about PTSD among first responders.  (To view the portraits see the artist’s website at:  http://www.teresacoulter.com).

For Coulter, these “intimate, vulnerable” portraits are a way of acknowledging the emotional toll of dealing with trauma day in and day out. The portraits are an attempt to “crack open” the isolation and stigma of first responders with PTSD.

While PTSD is often ignored within the professional community, the process of painting also opens up a space for dialogue between herself and her portrait subjects. The ensuing dialog provides a place for the first responders’ stories “to land.” In doing so, the painting transforms their stories as her “brush is writing their story differently.”

Since hearing the show, I’ve been thinking about the cumulative effects of witnessing difficult situations on other members of the helping professions such as therapists, counselors, psychologists, nurses and physicians. There are many names for this problem in the literature: secondary stress, vicarious trauma, compassion fatigue and (ultimately) burnout.

While this is an important issue and deserves our attention, I don’t particularly like this language. The idea of “burning out” implies that our compassion is limited; and once it’s depleted, it’s gone. These images don’t offer much hope.

I’m more interested in how we cultivate an ability to bear witness to extreme distress without permanently depleting our resources. It’s not to deny the emotional impact, but rather to try and engage in new conversations focused on promoting resiliency and well-being. I like to think about compassion, for example, as a renewable resource.

I’ve been thinking about this issue from within the field of narrative healthcare, and am  reminded of Arthur Frank’s work on the impact of stories in the world. Viewing stories primarily as “social actors,” the central question he poses is, “What can we do with the stories we hear?” And this brings me to one of the questions I’ve returned to many times over the years: “What do we do, as therapists, with the stories we hear?”

In the book Stories We’ve Heard, Stories We’ve Told: Life-Changing Narratives in Therapy and Everyday Life, Jeffrey Kottler describes therapists, doctors and clergy as the designated “story listeners” of modern culture, whose job it is to hold the painful or unresolved narratives that others often don’t want to hear.

This resonates with the cultural analysis of illness stories, which suggests that people can’t make sense of illness or disability stories that don’t have a positive resolution. We want a clear trajectory and a neat or happy ending. It is those unresolved “chaos” stories that are the hardest to hear.

This dynamic often leaves frontline providers (and therapists) with nowhere to put the stories they’ve heard or the events they’ve witnessed. The metaphoric sock drawer just gets fuller. As one of the paramedics Goldman interviewed, it’s not useful (or fair) to burden your family or friends with the terrible things you’ve seen. Even sharing with colleagues can sometimes feel like burdening them with disturbing details.

So who will listen, and where should one put the stories? I think the need to make visible the stories we carry partially explains the growing field of narrative medicine and the rise of reflective writing by healthcare providers and therapists. The arts are creative containers for these stories – and powerful outlets for expressing what we hold onto.

Unlike the sock drawer that keeps things hidden and in the dark, the arts allow these stories to emerge into the light where they can stimulate deeper conversations.

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