Questions & Answers with Joyce Boaz & Dr. Frank Ochberg

Read “Survivor Psalm” by Frank Ochberg

Relationships: Workplace Issues.

Q: Dear Frank, A support pal asked me if you had any suggestions for low stress
jobs, for people with PTSD. After a long while of doing really well, she is feeling
totally overwhelmed.

A: Dear Joyce, “Are there low stress jobs for PTSD people?” a GFW writer
asks. This reminds me of a time nearly 30 years ago when I was investigating
hostage situations. I spent a week in Holland during a tense episode in which
terrorists controlled a school and a train. Preparing for the worst, the Dutch
authorities set up an emergency hospital in a tent near the train, with cots, IVs,
ambulances, and a rather young retired surgeon in charge. He explained to me, “I
had a triple by-pass operation a few months ago and my doctor told me to retire
to limit my stress.” I looked him, there in the shadow of a train with armed
assailants, scores of passengers, the whole country watching, no telling what would
happen. This was a dangerous, difficult job for a man on medical retirement. I
finally said, “Aha. I see. You couldn’t stand the stress of NOT being here.” He
grinned in agreement.

Some jobs are stressful because of time pressure, responsibility, and heavy
consequences of failure. Some are stressful due to boring repetition. Most job
stress comes from lack of respect and understanding from those in charge. In
PTSD cases, any reminder of the original trauma can be a source of stress. My
friend, the plucky Dutch retired surgeon, probably thrived on responsibility and
was bored by inactivity. If you are looking for a low stress job, you need to think
carefully about the conditions that push your buttons. Are they related to people-
-coworkers or bosses who make life miserable? Or are the environmental conditions
stressful–noise, close quarters, distraction?

Has a job become stressful because it seems too demanding? That could mean
concentration difficulties are limiting your performance, and trouble concentrating
is part of PTSD. It could also mean that fatigue associated with depression or
with a medical disorder is the underlying cause. Burnout is a non-medical term that
describes a condition of relentless responsibility, with little positive feedback for
loyal effort. When a worker is “burnt out” the job is no fun, humor is gone,
coworkers are unhappy with you, and a change, if at all possible, is healthy.

Workers with simple, straightforward PTSD – a result of an obvious and
overwhelming traumatic event – often need time off to recover, to learn coping
skills, and to receive expert help from a qualified therapist. They may need a job
change. (I’m working right now with a trucker who was involved in a multi-vehicle
fatal accident. In my opinion, he can never be a trucker again. He is highly
motivated to become a nurse and I’m working with enthusiasm on that plan.)

Workers who find they have difficulty long after a trauma or a series of stressful
events may be suffering from conditions that are different from PTSD. High in
the list is dysthymia – a continuous low grade depression. Therapy, with or without
medication, may be very helpful. A switch to a less demanding or less demeaning or
less boring job may also be indicated. But choosing the right job is a matter of
careful analysis. One persons stress-free job could be very difficult for another
person. Work with a mature, sympathetic advisor to figure out what are your
personal job-related stressors, and seek employment opportunities that eliminate
those particular conditions.

Relationships: Workplace Issues.

Q: Dear Frank, I recently received this question:

“I can’t afford to lose my job, but I have PTSD after a serious injury and now
that I am physically healed my boss wants me to return. I’m afraid I’ll be
awkward around people and below par in handling responsibilities. I have a
demanding job and a demanding boss. What can I do?”

A: Dear Joyce, thank you for this question. Here is my response to Mrs J.

You need a doctor’s letter to your employer that spells out the situation, making
your needs abundantly clear. Although every case is different, most PTSD patients
require accommodations as they return to work. In almost every state, there are
laws that require employers to accommodate medical conditions. This arose recently
with a new patient who was injured with a deadly weapon by a drunk and delusional
husband. Fortunately and amazingly, her physical wounds were minor, healing in a
matter of weeks. Had the wounds been an inch to the right or left, she would not
be alive today. After seeing a therapist for a month who meant well, but didn’t
have much experience with this type of trauma, she came to see me. We discussed
her symptoms, her family and her work history. Within two weeks she made
enough progress with emotional issues to consider resuming her job. But she knew
she couldn’t handle all the demands as effectively and efficiently as before. It
was up to me to help her return to work on her terms. We agreed to the following
letter (altered slightly here to protect privacy):

To Whom it May Concern:

Mrs. J. has Post-traumatic Stress Disorder (PTSD) due to stab wounds to the
neck and chest, an assault that could have killed her. She is under the care of a
specialist in treating her condition and is progressing well. Disabling symptoms are
in remission. It is time to return to work, on or about May 8, with
accommodations: (1) avoidance of social circumstances that may trigger flashbacks;
(2) limited duty to assure slow and steady mastery of tasks and return of
confidence. The pace of return to full duty should be gradual, over a six-week
period, but may be more rapid if well tolerated by Mrs. J.

This is a highly motivated, experienced and dependable worker who may push
herself or allow herself to be pushed to full employment prior to full recovery from
PTSD. PTSD may return to disabling levels under stressful circumstances.

Let there be no doubt about the severity of PTSD in conditions such as this one.
The medical disorder affects mood, memory, concentration and morale. Despite
widespread public familiarity with the condition, it is still stigmatized and
misunderstood. With appropriate support from friends, family and workplace
colleagues, the recovery period can be relative short (within a year). This
individual will have a recovery complicated by the stress of criminal and civil legal
proceedings, financial concerns, publicity, family stress, and the need for weekly
therapy visits.

My prognosis is good, based upon the experience, intelligence, work ethic and
support system of this patient. I thank the intended recipient of this letter, Mrs.
J’s employer, for care and concern and willingness to work with this plan for
gradual return to full employment.

Yours truly,

Frank M Ochberg, MD

A letter like this, written with a firm but friendly tone, supports the patient and
gives guidance to the employer. Some employers will object to a plan that seems
reasonable to the doctor and patient, but they risk a costly lawsuit if they do.

I can’t assure that you will find a doctor who is both expert in PTSD and willing
to write this type of letter. But if the facts fit Mrs. J’s situation, you are well
advised to look for the professional who can meet your needs as both therapist
and advocate. I try to teach the medical students and psychiatric residents at my
university to step up to their obligations (and opportunities) as physicians. They
carry clout. They should not be afraid to use it when their patients face legal,
financial and vocational challenges.

Relationships: Workplace Issues.

Q: Dear Frank, several support pals have asked about dealing with co-
workers who do not understand PTSD and may say things that trigger bad
memories or that invite discussion about traumas – private memories that the
support pal is not ready to reveal. How should these situations be handled?

A: Dear Joyce, when well meaning colleagues at work ask the simplest of
questions, even a friendly, “How are you today?” a survivor might feel
choked-up, anxious or confused. The rush of feelings to the surface can be
embarrassing. This is not the time or the place for an intimate, revealing
conversation. Sometimes we can sense a person’s kindness and willingness to
listen, but we are not ready to reveal details. In fact, we are trying hard to
push a bad memory down where it doesn’t disturb us, so we can appear in
control and we can get on with business at hand. The feeling is different
-and perhaps easier to handle- when someone is a bit pushy or rude, asking
inappropriate questions. Then our anger kicks in and we are better defended.
We still do not like the awkward situation, but we are more in control of our
space. PTSD does this. It reveals itself to us and to others when we do not
want it to.

The hallmark of PTSD is “intrusive re-experiencing.” Who wants an uninvited
guest like that, appearing at work? In most larger work places there is a
person, or several people, who are natural helpers and healers. I call them
“the indigenous rabbis.” They may be a bit older. They usually avoid higher
managerial positions. They are respected and liked by most, if not all. When
you have such a person at work, you might risk asking them for help. You
could say, “I have a problem and I think you could help. Is there a time when
we can talk?” You could ask them to read the GFW essay that I wrote for
partners of people with PTSD: You needn’t spell out details of your trauma, but you could enlist the aid of a colleague who could quietly spread the word in a way that preserves your dignity and privacy,
without mentioning any details.

Some work places have employee assistance programs with specialists who are
very good at this. GFW senior advisor Angie Panos has a lot of experience in
that role and could add her insights, if you write to Joyce with a specific
job-site problem. Journalists are facing the issue since they are often
traumatized and their culture requires a very stiff upper lip. Visit and wander around that site to learn how journalists face
PTSD on the job and deal with co-workers and managers.

But you are under no obligation to share any aspect of PTSD with someone you
do not trust at work. These experiences belong to us who have them. We own
our minds and our personal histories, just as we own our bodies. We can
choose to reveal and we can choose to keep our own counsel. Often, it is our
traumatic experience that makes us who we are – less innocent, less
carefree, but wiser and more able to appreciate others.