Psychopathology and Resilience

I was recently asked to do a presentation about the Maine Resilience Program to a small group of psychotherapists who work with members of the military and their families. I was a little bit leery of doing this with “clinicians” who see themselves as being in the business of treating psychopathology. But having interned in the Veterans Administration during the Vietnam War and having worked with veterans over my 35-plus years as a clinical psychologist, I thought the skills and attitudes of resilience had a great deal of application to members of the military and especially to their family members as well as to the clinicians themselves and to the other clients that their community outpatient agencies served. I knew some of the concepts like post-traumatic growth might be in direct conflict with some of their ideas about the impact of trauma and adversity.
At the end of the presentation, I was sure that a number hadn’t really understood what I was talking about and really didn’t see very much relevance to what they were doing or ways in which they might adapt the material, the focus on coping skills and positive attitudes, to someone dealing with depression or post-traumatic stress. The idea of actually preventing these disorders from occurring through strengthening the skills and the attitudes of the individuals they were working with seemed quite foreign to a number in the audience. Although I was assuming this was the reaction that I might receive, I was still a little bit surprised, given the ability of many other groups, such as schoolteachers, firefighters, the elderly and others, to be very good at seeing the relevance of this material to themselves and their community. I had to sadly remind myself that the community mental health movement in the United States died in the 1980s, that prevention of any health condition in this country has usually been lip service at best (the Maine Smoking Cessation program funded by tobacco settlement funds being a bright exception to this rule) and that our mental health system, like the larger system it is a part of, is focused in general on illness, not on health. Their not getting it made complete sense.

Note: Granted, the material and the way in which it was presented would have to be adapted to this group, as it has been adapted for presentation to other groups.

Ron Breazeale, Ph.D.
Author, Duct Tape Isn’t Enough
www.reachinghome.com

I recently came across an article that surprised me considering the profession. It concerned doctors and how they are unlikely to flag troubled peers which oftentimes lead to a tragedy. Carla K. Johnson of the associated press reported that a new survey finds that many American physicians fail to report seriously troubled colleagues believing that someone else will handle the problem. A surprising 17 percent of doctors surveyed had direct personal knowledge of an impaired and or incompetent physician in the workplace. The result is obvious and frequently leads to destroyed lives and career ending mistakes. See Portland Press Herald, Wednesday July 14, 2010. In focus: Impaired Physicians.
I have observed this same phenomenon in my own profession and organization over the years. It exists especially in professions that foster self reliance, bravery and a stoic approach to serious and deadly matters. These jobs can be filled with unique stressors, intense pressure and emotional turmoil in rapidly evolving unpredictable situations. The effect it has on individuals and the organization is enormous. Peer Support, coaching and developing resilience skills can make an incredible difference and avoid tragic results.
Peer support in law enforcement is not a new concept. Officers have always relied on peers and friends during times of difficulty. I have also observed that people have a tendency to believe a serious problem will go away on its own even when they know tragedy is predictable. It doesn’t go away! A structured peer program with solid education and policies can make a tremendous difference on many levels and in fact save lives. Trusted, respected, identified co-workers can guide and teach individuals the necessary positive coping and resilience skills. They also serve to network coworkers confidentially to employee assistance and or professional help. Trust and confidentiality are the cornerstones to the success of the program. It works!
Peer coaches are formerly trained by professionals in basic counseling, crisis intervention, debriefing, emotional communication and resilience skills. Peer support can be described as a subtle network of trained and educated individuals within an organization where others feel comfortable in sharing their feelings about the job, personal problems or a particular event that affects their work.
Building resilience skills and developing positive coping mechanisms along with understanding the organization and occupational stress is important for this to work. Ongoing education in the workforce, developing clear policies and procedures is paramount to ensure success. Overall, the peer coach should provide a confidential outlet and function as a guide in referral to mental health professionals. This program can be customized to any organization. I can personally endorse with confidence the success of a structured peer support and resilience coaching program. I know for a fact that the program in my organization made a tremendous difference in many many lives, averted serious issues, numerous mistakes and career ending tragedies.
Peer Support has often been the critical intervention point that has made a difference, helped the organization and in the end the welfare and safety of the public. This peer resource is available to physicians as well. I hope the profession considers this approach as well as the other services available.

Joseph K. Loughlin
Deputy Chief, Portland Police Ret.
Author of Finding Amy

Why all the questions?

I am surprised that so many people ask questions about why more things were not done to prevent the oil spill in the Gulf. The answer to me seems relatively simple. To create a safe system that is resilient requires that redundancy be built into the system. In other words, it requires that a number of safeguards and backup systems be developed and be put in place to, first of all, prevent an accident, and to then allow a quick recovery from an accident if one occurs. Unfortunately, all of this requires money. And money spent on safety and prevention comes off at the bottom line. Companies that design and install these systems are not going to be as profitable as companies that do not. And given that spills like the one that is occurring now in the Gulf are a relatively low probability event, companies would prefer to take the risk. If they spend the money on safety and prevention, they will not be as profitable as other companies that do not. Greed is good. Right?

Resilience and the Unknown

The unknown is one of the biggest challenges to resilience. When we know what to expect, we can plan for it. If you listen to the people of Louisiana talk about the oil spill, they will tell you that for many of them, it is much more difficult than a hurricane like Katrina. When the storm was over, it was over. People knew what they had to do. They had been through other storms. They could file their insurance claims and rebuild their houses and go back to fishing, etc. With the oil spill in the Gulf, no one knows exactly what the final damage will be. Will the fishing industry and the tourist business be destroyed? Will people ever be able to get their lives back to “normal”? When will all of this end?


Ron Breazeale, Ph.D.
Author, Duct Tape Isn’t Enough
www.reachinghome.com

Glue

What holds our society and our communities together, especially during hard times? It certainly isn’t the foolish behavior on Wall Street that got our society into the present recession. The “Greed is Good” mantra does little to hold our society together and much to tear it apart. Those who support the “more is better” philosophy and oppose regulation and restraint are out front leading the band when things are going well, but often disappear from sight when things go south. Those who are left to try to pick up the pieces and put things back together are the folks who work in the public sector. They are the educator and the teacher who are increasingly playing the role of parent. They are the social services directors trying to provide more services with less money and fewer staff. They are the police officer playing the role of social worker/counselor because no one else will. They are the employment counselor trying to instill hope in a 55-year-old who has lost his job of 30 years. They are the glue that holds our society together.



Ron Breazeale, Ph.D.
Author, Duct Tape Isn’t Enough
www.reachinghome.com

Compassion Fatigue

I recently had the opportunity to conduct a resilience workshop with staff from 15 different social services agencies in the Portland area. The program focused on the skills and attitudes of resilience and how these could be integrated into the work that these individuals do with their clients each day. As the participants told stories about themselves and their clients, it was clear that they needed resilience as much as the people with whom they work. These are very hard times for people that provide social services in our society. It is a time when their services are needed more than ever, but there is less money and staff to do the job. What is most disturbing to me is the lack of understanding and support that they receive from the general public. Like the veterans coming back from the war in Iraq or Afghanistan, these people who are on the front line of the battle in our society against the forces that could destroy it, e.g., violence, drug abuse, poverty, ignorance, need the same kind of support and recognition for the hard and dangerous work that they do.


Ron Breazeale, Ph.D.
Author, Duct Tape Isn’t Enough
www.reachinghome.com

No Deposit, No Return

Dick Lumb and I recently conducted a workshop with correctional officers who work in Cumberland County. These are the men and women who work in the county jail, the correctional center and the Youth Center. The workshop focused on resilience. Given the level of turnover of staff in these facilities, the focus was clearly on the resilience of staff with some discussion of how these skills and attitudes could be applied to the rehabilitation of inmates. Dick and I were both impressed by the level of dedication and commitment of the participants in the workshop. Because these individuals are charged with caring for the human beings that our society throws away, they often do not receive the respect and support of our society. Like the sanitation worker who carries away the material garbage of our society, corrections officers are often paid a similar wage and their jobs are rated as equally undesirable. Hopefully, this will change some as corrections moves toward a rehabilitation philosophy again rather than a punishment philosophy. Corrections officers, like other public servants, e.g., sanitation workers, perform a vital function in our society and deserve respect and support.

Ron Breazeale, Ph.D.
Author, Duct Tape Isn’t Enough
www.reachinghome.com