State of shock

Violent attacks against security staff are on the rise, particularly in the Cash-in-Transit sector. And while it's true to say that most employers are receptive (and indeed sympathetic) to physical injury, the psychological consequences of an attack are often overlooked. An unacceptable situation.

As defined by the World Health Organisation (in 1984), health is "a state of physical, psychological and social well-being, not simply the absence of disease". Thus, it's perhaps surprising that these same sympathetic and supportive security companies react differently when faced with employees suffering from psychological trauma. And yet psychological trauma is not a new phenomenon...

History shaping the future?
Diarist Samuel Pepys gave an agonisingly vivid account of his experiences in fleeing the Great Fire of London in 1666. He wrote of his increasing fear, and of "...laying down exhausted on W.Hewer's quilt". During the American Civil War, reference was made to 'soldier's heart' or 'effort syndrome', and in World War I the term 'shell shock' was garnered (but, alas, insufficiently defined... hence the execution of many soldiers for cowardice).

Come World War II and the term 'battle fatigue' was introduced, but still the condition remained misunderstood. It was frequently dismissed by the military hierarchy – as infamously demonstrated by the late General George Patton, who berated and struck a victim he encountered in a Field Hospital (referring to him as a "goddamn coward").

Patton was subsequently forced to make an humiliating public apology. That said, he shouldn't be judged too harshly since it was (then) difficult for lay people to differentiate between a genuine clinical condition and apparent malingering. In this case, the victim was physically uninjured, ambulant and communicative, and – although distressed – contrasted markedly with other soldiers whose physical wounds were clear to see.

Professionals, too, lacked a clear diagnostic criteria for identifying the psychological effects of trauma... which were not formulated until 35 years after the end of World War II.

In 1980, the American Psychiatric Association published the 'diagnostic criteria' for what was called 'post-traumatic stress disorder'. Several criteria must be satisfied for a definite diagnosis. There must be a recognisable stressor. In addition, the individual(s) concerned must have intrusive recollections of the incident, dream about it or suffer from 'flashbacks' (ie he/she must not simply remember but re-live the incident).

There must also be a numbing of responsiveness (characterised by a loss or lack of feelings for family and loved ones, and a loss or lack of interest in normal or usual activities).

At least two of the following must be demonstrable... hyper alertness, sleep disturbances, guilt, memory/concentration problems, avoidance behaviour and symptom intensification (with reminders). The foregoing must be present for at least one month.

This is of particular importance, as many people who experience psychological trauma develop a sub-clinical, post-traumatic stress that will either normalise without intervention, or will normalise through a process called psychological debriefing.

Psychological debriefing explained
Psychological debriefing (also known as 'critical incident stress debriefing') was developed by Dyregrov (in Europe) and Mitchell (in the USA) in the 1980s, and is essentially a process whereby the victims of psychological trauma can be guided to discuss the facts – and their feelings – in relation to an incident, and can therefore be helped to move on and face the future with confidence.

Importantly, debriefing can prevent the onset of post-traumatic stress disorder.

Lay persons (eg security managers) may be trained to conduct debriefing sessions, although such training should always be under the guidance of a mental health professional. Such a person should always be available to lay debriefers for support and advice.

The treatment of post-traumatic stress disorder is entirely a matter for mental health professionals. Any debriefing sessions must be totally confidential in much the same way as an occupational health service, and must be entirely voluntary. A case was once related to me whereby an individual involved in a traumatic incident was coerced – by a well-meaning manager – into attending a debriefing session, only to become emotionally traumatised as a result. To paraphrase Florence Nightingale: "Debriefing, like hospitals, should do the patient no harm".

If the concept of debriefing is to become an accepted component of security practice then it must be included as part of the Basic Job Training for security officers, and of the operational procedures drafted by the security companies themselves.

What's most certainly true is that we cannot go on ignoring the prevalence of post-traumatic stress disorder as a by-product of rising attacks on members of security teams.

A study of some 1,600 Vietnam War veterans in 1988 showed that well over 30% had suffered some mild form of the 'disease'. In a study on Northern Ireland, half of the 1,500 victims of bomb blasts who've needed surgery on their wounds have also suffered from the disorder.

It's worth bearing in mind that emotional trauma can also give rise to serious physical conditions. The science of psychoneuro-immunology has identified a causal link between stress and a diminished functioning

of the body's immune system. Immune system deficiency is an established factor in predisposition to certain types of cancer. As long ago as the 2nd Century AD, the physician and philosopher Galen identified a correlation between mood and the onset of cancer.

Those of us who remember the Great Train Robbery of 1963 will recall the heroic efforts of driver Jack Mills, who sustained a head wound while tackling Ronald Biggs and Co. Mills never returned to duty, and died of leukaemia some six years later.

Even today, many people still trivialise Jack's injuries, and assert that they were irrelevant to his death. Looked at them from a psychoneuro-immunological perspective, however, and an altogether different possibility emerges.

Post-traumatic stress disorder has now been recognised as a basis for compensation in law. As a consequence, some of the bigger players in the contract security sector are beginning to recognise the psychological consequences of attacks carried out on their staff. In some cases, appropriate help is being provided.

Alas, many in the security industry still treat attack victims with contempt. Such sceptics, though, would do well to heed the forthcoming 'European Week for Health and Safety at Work 2002'. To be held in October and sub-titled 'working on stress', this event is being co-ordinated by the Health and Safety Commission and will provide security professionals with some sound advice. Much of it free.

Go on. Continue to educate yourself.