“Disastershock”: A free handbook for coping with disaster and trauma

Disastershock: How to Cope with the Emotional Stress of a Major Disaster is a free handbook (link here) for individuals and communities, co-authored by Drs. Brian Gerrard, Emily Girault, Valerie Appleton, Suzanne Giraudo, and Sue Linville Shaffer. First appearing in 1989, this valuable book has just been updated to include mental health challenges wrought by the coronavirus pandemic. Here’s a brief description:

This Disastershock book is intended to help families and communities to cope with disaster related stress such as that caused by the Covid-19 pandemic. Part I describes ten effective methods to be used to reduce stress. Part 2 describes 12 stress reduction methods to be used with children. Although Part 2 was written primarily for parents, teachers and other adults working with children will find it useful. A unique feature of Disastershock is that its practical stress reduction methods are described in an explicit manner making them easy to learn. 

You may freely download an English-language version of Disastershock by clicking here. It is currently being translated into languages of nations significantly affected by the coronavirus crisis.

Disastershock has been praised by mental health professionals and educators from around the globe. Practicality, accessibility, and brevity (under 50 pp.) are among its key strengths; you won’t feel overwhelmed by it. I became aware of the book from one of its co-authors, Dr. Brian Gerrard, emeritus faculty member at the University of San Francisco and chief academic officer and core faculty member at the Western Institute for Social Research, on whose board I serve. I recommend it enthusiastically.

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Along these lines, I’d like to reiterate my earlier recommendation of the John Hopkins University’s Psychological First Aid course (link here) taught by Dr. George Everly and offered for free by Coursera, a leading provider of online, continuing education courses. As I wrote in a blog post last September

Dr. Everly developed his PFA model to provide first responders who are not trained as counselors with knowledge and training to assist those who have experienced traumatic events, such as displacement due to wars, severe weather events, and other man-made and natural disasters.

In addition to completing the course myself, I assigned it to students in my Law and Psychology Lab course at Suffolk University Law School, and they responded very favorably to it.

How COVID-19 has placed health care providers at grave risk of moral injury

Obviously the coronavirus pandemic is squeezing the capabilities of our health care systems. It also is impacting the psychological health and well-being of health care providers on the front lines of treating COVID-19 patients, especially as they strive to provide life-saving treatment without adequate resources.

The ultimate nightmare scenarios include choices that may have to be made when the number of severely ill patients exceeds the number of intensive care unit (ICU) beds and ventilators. For example, here in Massachusetts, a task force of doctors and medical ethicists has developed a controversial protocol for determining who gets ventilators and other treatments and who does not, when demand exceeds availability. As reported by Adam Gaffin for Universal Hub, a local online news site (link here):

The “crisis standards of care” guidelines are designed for a hospital system in the process of collapse – too many sick people and not enough medicine equipment and healthcare providers to care for them all – possibly because they themselves might be knocked out by the virus.

When that happens, and patients are coming in faster than hospitals can provide intensive care for them, doctors will have to switch from trying to care for each individual patient to trying to maximize total “life years saved” for the community as a whole, the task force concluded.

To do that, a designated a triage doctor will assign patients scores based on such factors that include not just the severity of their Covid-19 infection but their age and preexisting conditions, with points added for each. Doctors, nurses and other healthcare workers, as well as patients who otherwise would be involved in “maintaining societal order,” however, would have points subtracted….In the event of a tie score between two patients, the younger one would “win,” because of the priority of maximizing total “life-years” saved.

…Patients with the lowest scores would then have their medical records color coded – so that ICU staffers know at a glance who’s next for a ventilator – possibly even if that means removing somebody with a higher score from one. Red-tagged patients would be first in line, orange next and then all the older, sicker patients would be marked as yellow.

The guidelines promulgated in Massachusetts are similar to those developed in other states and nations. Basically, if the swell of COVID-19 infections is overwhelming the availability of hospital resources, doctors and other health care providers are directed to institute a triage system that determines who gets potentially life-saving treatment and who does not. 

The specter of moral injury

The excruciating challenge of treating patients with inadequate supplies is placing health care providers at grave risk of moral injury. “Moral injury,” as defined by Syracuse University’s Moral Injury Project (link here), “is the damage done to one’s conscience or moral compass when that person perpetrates, witnesses, or fails to prevent acts that transgress one’s own moral beliefs, values, or ethical codes of conduct.”

As Dr. Wendy Dean, psychiatrist and co-founder of Fix Moral Injury, a non-profit organization, explains in Time magazine (link here):

If healthcare workers can’t provide the care they typically believe is medically necessary for their patients, they may experience a phenomenon known as “moral injury,” says Dr. Wendy Dean, a psychiatrist and the co-founder of the nonprofit Fix Moral Injury. Dean says that American healthcare providers are used to doing anything and everything to help their patients, but inadequate protective gear and triage procedures will force them to make “exquisitely painful” decisions, such as choosing whether or not to risk infecting themselves, their family and other patients in order to help everyone in their care.

The consequences of moral injury can be significant. According to the Syracuse Moral Injury Project:

Moral injury can lead to serious distress, depression, and suicidality. Moral injury can take the life of those suffering from it, both metaphorically and literally. Moral injury debilitates people, preventing them from living full and healthy lives.

The effects of moral injury go beyond the individual and can destroy one’s capacity to trust others, impinging on the family system and the larger community. Moral injury must be brought forward into the community for a shared process of healing.

The specter of moral injury is among the reasons why our health care providers will require ongoing help in dealing with the psychological burdens and health risks of working to save lives during this pandemic. This experience will leave its formative mark on current generations of health care workers for decades to come. We owe them our support for the short and long runs alike.

Twenty years ago, the U.S. workplace anti-bullying movement was born in Oakland

I’m a nostalgic sort of person by nature, and the imposed solitude of the current public health crisis has opened up memories as I spend some of this time sorting through personal and professional papers and mementoes. Among the work-related materials unearthed were these items from 2000 pictured above, a January 2000 certificate of appreciation from Drs. Gary and Ruth Namie, co-founders of the Campaign Against Workplace Bullying (which would evolve into the Workplace Bullying Institute), and a print copy of my first law review article on the legal implications of workplace bullying.

The certificate is from “Workplace Bullying 2000,” the first-ever U.S. conference on workplace bullying that Gary and Ruth organized and hosted in Oakland, California. It was my first opportunity to meet pioneering workplace researchers, educators, and advocates from around the world. Many remain dear friends and valued colleagues to this day. It was also where I first discussed the need for stronger legal protections against workplace bullying.

Although the Namies had done groundbreaking work by launching their Campaign in 1997, I consider their 2000 conference to be the true birth of a broader workplace anti-bullying movement in the U.S. Prior to this conference, many of us had been doing our work in relative isolation, with the Namies serving as points of contact in a sort of hub-of-the-wheel-spokes fashion. The conference enabled us to create connections with one another, which would lead to many future collaborations and partnerships.

The article is “The Phenomenon of ‘Workplace Bullying’ and the Need for Status-Blind Hostile Work Environment Protection,” published in the Georgetown Law Journal in the spring of 2000. (Go here to freely download a pdf.) In the piece, I explored potential existing legal protections against severe workplace bullying and concluded that they were wholly inadequate to provide relief to abused employees and to incentivize preventive and responsive measures by employers. I then went on to propose the basic framework of what eventually would become the Healthy Workplace Bill (HWB). A full draft of the HWB would come later, but all the seeds were planted in this article.

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Fast forwarding to today, we have made considerable progress. Spurred by the Namies early (and still continuing) work, workplace bullying has become mainstreamed as a term in American employment relations. Accounts of bullying, mobbing, and related behaviors are regularly reported in the media. Academic and professional conferences in fields such as organizational psychology, business management and human resources, and labor relations often feature panels on abuse at work. And as I wrote last November, we are nearing the day when the Healthy Workplace Bill starts to become law in various states.

The current public health crisis has put some of this work on hold, or at least on a slowdown. Among other things, state legislatures deliberating on the Healthy Workplace Bill are understandably preoccupied with policy responses to the coronavirus. This may well be the case through the current legislative sessions.

Nevertheless, this time provides us with opportunities to engage in thinking, planning, and strategizing for the future. Bullying and mobbing behaviors won’t suddenly disappear from the workplace after we regain some sense of normalcy, so the need for our public education and advocacy efforts will remain as vital as ever.

That said, I do find myself asking: When we re-open the heart of our economic and civic society, will the frequency of workplace bullying and mobbing increase, decrease, or remain roughly the same? Folks hoarding toilet paper and hand sanitizer and companies practicing price gouging for life-saving supplies suggest that the dog-eat-dog dynamic of many workplaces isn’t going away. On the other hand, we are witnessing extraordinary acts of courage, generosity, and grace during this crisis, including employers who are stretching their capacities to support their workers. I dearly hope that this shared experience will bring out more of the best of us, and that this will translate into how we treat one another at work for years to come.

Coronavirus: Timelines toward normalcy and choices for society

(image courtesy of clipartmag.com)

I’m neither a public health expert nor a physician, but whenever I hear people asking when life will return to normal, I keep coming back to three requirements regarding the coronavirus:

  • The availability of inexpensive, fast, and readily available testing — ideally accurate do-at-home tests;
  • Effective therapeutic treatments that can stop infections from turning into severe cases that require hospitalization and invasive ventilator treatment; and,
  • An effective preventive vaccine, hopefully one that provides blanket protection along the lines of the polio vaccine, but in any event more effective than seasonal flu shots.

Until we have these three pieces in place, I cannot imagine life regaining a strong semblance of normalcy. Instead, at best we will experience periodic outbreaks that require us to return to social distancing and shelter-at-home practices.

So what’s the timeline on these needed public health developments? Based on way too much surfing around for information and informed opinion about the virus, I think it’s reasonable to expect (1) widely available testing kits by the end of the year; (2) therapeutic treatments later this year or early in 2021; and (3) a vaccine available sometime in 2021.

If I’m right, it means that we’re going to be in this mode of living for some time. Accordingly, this increasingly will start to feel like wartime-style deprivation and sacrifice. The world of work will continue to be profoundly affected. Displaced workers and shut-down businesses will need ongoing public subsidies during this time.

I hope that I am very wrong. I hope that our heroic doctors and medical researchers will improvise miraculous treatments in the coming weeks. I hope they will make brilliant discoveries on the vaccine front that can be quickly screened for safety and provided to the public.

More realistically, I think we should hope for the best but prepare ourselves for a longer haul. Among other things, our planning should include creating a much stronger social safety net for supporting individuals, small businesses and non-profits, and our cultural and educational institutions. 

In other words, how we deal with the weeks and months to come — individually and collectively — will define the character of our society for many years, well after we’ve quashed this damnable virus. Let generosity, compassion, and care be our guiding lights.

Academic home work: Of Zoom and coronavirus

Law and Psychology Lab at Suffolk Law goes online

Well folks, my work as a law professor these days often boils down to one word: Zoom.

If you’re aware of what’s going on at colleges and universities around the world during the coronavirus crisis, then you’ve likely heard of a videoconferencing platform called Zoom. Zoom is a fairly easy-to-use system that allows us to hold classes, meetings, and seminars in real time. In order to safeguard public health, we’re experiencing a sudden, massive migration of instruction to online formats, and Zoom has been the most popular platform for delivering courses. Suffolk University here in Boston is no exception.

Yesterday I taught two classes, Employment Law and Law and Psychology Lab, on Zoom. I’ve included above the “class picture” I took of our Law and Psychology Lab session last evening — with the students’ kind permission, of course!

How does this compare with face-to-face teaching? Let me start by saying that I appreciate having a serviceable online platform that allows us to create a decent semblance of an in-person class session. Without Zoom and similar services, our only other option would be to record and post lectures. While some professors are doing this, I’m attempting, to the degree possible, to maintain a regular class schedule with live sessions.

Furthermore, I’m proud that our students are doing their best to navigate these very difficult and uncertain circumstances. Not only has the mode of instruction changed dramatically, but also important matters such jobs and summer internships, scheduling of bar examinations, and the like remain unsettled. A lot of plans have been thrown into disarray. I have long said that the classic Suffolk Law student is smart, hardworking, and not entitled. Those characteristics are being put to the test right now.

Of course, I’m grateful that I can work and receive a paycheck at a time when unemployment rates are soaring to stunning levels and businesses are taking a beating. While I am confident that we’ll see effective treatments and vaccines for this virus, until they arrive on the scene, our economy will be in upheaval. The process of re-opening our economic lives (not to mention our social and civic lives) will take time as well.

Indeed, I look forward to the day when we can return to our physical classrooms. I think a lot of our students feel the same way. I’m hearing that the experience of attending classes via video conferencing is proving to be tiring. Some of us are reporting headaches from so much time spent in front of computer screens. I think I will need to engage in healthier social distancing from my laptop during the upcoming weeks and months.

In any event, mine are but small adjustments compared to the challenges facing health care providers and other essential workers who are putting themselves on the line for us every day, as well as the millions who are scrambling to pay rent and basic living expenses. For those of us able to work from home, our jobs — our responsibilities, I’d say — include making the best of this situation, being generous when it comes to supporting others, and practicing safe health habits for the benefit of all.

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