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Medical Whistleblower Advocacy Network

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“All human beings are born free and equal in dignity and rights. They are endowed with reason and conscience and should act towards one another in a spirit of brotherhood.”

 Universal Declaration of Human Rights

Article 1

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Complex PTSD

DSM-IV diagnostic criteria for Post Traumatic Stress Disorder (PTSD)

The diagnostic criteria for Post Traumatic Stress Disorder (PTSD) are defined in DSM-IV as follows:

A. The person experiences a traumatic event in which both of the following were present:

1. the person experienced or witnessed or was confronted with an event or events that involved actual or threatened death or serious injury, or a threat to the physical integrity of self or others;
2. the person's response involved intense fear, helplessness, or horror.

B. The traumatic event is persistently re-experienced in any of the following ways:

1. recurrent and intrusive distressing recollections of the event, including images, thoughts or perceptions;
2. recurrent distressing dreams of the event;
3. acting or feeling as if the traumatic event were recurring (eg reliving the experience, illusions, hallucinations, and dissociative flashback episodes, including those on wakening or when intoxicated);

4. intense psychological distress at exposure to internal or external cues that symbolize or resemble an aspect of the traumatic event;
5. physiological reactivity on exposure to internal or external cues that symbolize or resemble an aspect of the traumatic event.

C. Persistent avoidance of stimuli associated with the trauma and numbing of general responsiveness (not present before the trauma) as indicated by at least three of:

1. efforts to avoid thoughts, feelings or conversations associated with the trauma;
2. efforts to avoid activities, places or people that arouse recollections of this trauma;
3. inability to recall an important aspect of the trauma;
4. markedly diminished interest or participation in significant activities;
5. feeling of detachment or estrangement from others;
6. restricted range of affect (eg unable to have loving feelings);
7. sense of a foreshortened future (eg does not expect to have a career, marriage, children or a normal life span).

D. Persistent symptoms of increased arousal (not present before the trauma) as indicated by at least two of the following:

1. difficulty falling or staying asleep;
2. irritability or outbursts of anger;
3. difficulty concentrating;
4. hypervigilance;
5. exaggerated startle response.

E. The symptoms on Criteria B, C and D last for more than one month.

F. The disturbance causes clinically significant distress or impairment in social, occupational or other important areas of functioning.

The focus of the DSM-IV definition of Post Traumatic Stress Disorder is a single life-threatening event or threat to integrity. However, the symptoms of traumatic stress also arise from an accumulation of small incidents rather than one major incident. Examples include:

  • repeated exposure to horrific scenes at accidents or fires, such as those endured by members of the emergency services (eg bodies mutilated in car crashes, or horribly burnt or disfigured by fire, or dismembered or disembowelled in aeroplane disasters, etc)
  • repeated involvement in dealing with serious crime, eg where violence has been used and especially where children are hurt
  • breaking news of bereavement caused by accident or violence, especially if children are involved
  • repeated violations such as in verbal abuse, physical abuse, emotional abuse and sexual abuse
  • regular intrusion and violation, both physical and psychological, as in bullying, stalking, harassment, domestic violence, etc

Where the symptoms are the result of a series of events, the term Complex PTSD may be more appropriate. Whilst Complex PTSD is not yet an official diagnosis in DSM-IV or ICD-10, it is often used in preference to other terms such as "rolling PTSD", and "cumulative stress". See the National Center for PTSD fact page on Complex PTSD.

PTSD and Complex PTSD sufferers report experiencing the following symptoms:

  • hypervigilance (feels like but is not paranoia)
  • exaggerated startle response
  • irritability
  • sudden angry or violent outbursts
  • flashbacks, nightmares, intrusive recollections, replays, violent visualizations
  • triggers
  • sleep disturbance
  • exhaustion and chronic fatigue
  • reactive depression
  • guilt
  • feelings of detachment
  • avoidance behaviors
  • nervousness, anxiety
  • phobias about specific daily routines, events or objects
  • irrational or impulsive behavior
  • loss of interest
  • loss of ambition
  • anhedonia (inability to feel joy and pleasure)
  • poor concentration
  • impaired memory
  • joint pains, muscle pains
  • emotional numbness
  • physical numbness
  • low self-esteem
  • an overwhelming sense of injustice and a strong desire to do something about it.

Associated Symptoms of Complex PTSD

Survivor guilt: survivors of disasters often experience abnormally high levels of guilt for having survived, especially when others - including family, friends or fellow passengers - have died. Survivor guilt manifests itself in a feeling of "I should have died too".

Shame, embarrassment, guilt, and fear are encouraged by the bully and those retaliating against the whistleblower, for this is how all abusers - including child sex abusers - control and silence their victims.

Marital disharmony: the target of whistleblower retaliation and workplace bullying becomes obsessed with understanding and resolving what is happening and the experience takes over their life; partners become confused, irritated, bewildered, frightened and angry; separation and divorce are common outcomes.

It seems that Complex PTSD can potentially arise from any prolonged period of negative stress in which certain factors are present, which may include any of captivity, lack of means of escape, entrapment, repeated violation of boundaries, betrayal, rejection, bewilderment, confusion, and - crucially - lack of control, loss of control and disempowerment. It is the overwhelming nature of the events and the inability (helplessness, lack of knowledge, lack of support etc) of the person trying to deal with those events that leads to the development of Complex PTSD.  Situations which might give rise to Complex PTSD include bullying, harassment, abuse, domestic violence, stalking, long-term caring for a disabled relative, unresolved grief, exam stress over a period of years, mounting debt, contact experience, etc. Those working in regular traumatic situations, for example the emergency services, are also prone to developing Complex PTSD.

A key feature of Complex PTSD is the aspect of captivity. The individual experiencing trauma by degree is unable to escape the situation. Despite some people's assertions to the contrary, situations of domestic abuse and workplace abuse can be extremely difficult to get out of. In the latter case there are several reasons, including financial vulnerability (especially if you're a single parent or main breadwinner)  unavailability of jobs, ageism (many people who are bullied are over 40), partner unable to move, and kids settled in school and you are unable or unwilling to move them. The real killer, though, is being unable to get a job reference - the workplace bully will go to great lengths to blacken the person's name, often for years, and it is this lack of reference more than anything else which prevents people escaping.

 The law is inadequate because the better a person qualifies to pursue a claim for personal injury by satisfying PTSD DSM-IV diagnostic criteria B4, B5, C1, C2, C3, D3, E and F, the more they are, ipso facto, frustrated from pursuing the claim.

B4. intense psychological distress at exposure to internal or external cues that symbolise or resemble an aspect of the traumatic event;
B5. physiological reactivity on exposure to internal or external cues that symbolize or resemble an aspect of the traumatic event.
C. Persistent avoidance of stimuli associated with the trauma and numbing of general responsiveness:
C1. efforts to avoid thoughts, feelings or conversations associated with the trauma;
C2. efforts to avoid activities, places or people that arouse recollections of this trauma;
C3. inability to recall an important aspect of the trauma;
D3. difficulty concentrating;
E. The symptoms on Criteria B, C and D last for more than one month.
F. The disturbance causes clinically significant distress or impairment in social, occupational or other important areas of functioning


Medical Whistleblower acknowledges Tim Fields, an English advocate for persons who experienced workplace bullying, as the pioneer of this work on the effects of psychological violence in the workplace. Much of this material came from the wonderful research he did on the topic.  There is additional information on his website  Stress Injury to Health and Trauma




 

"We believe that the people are the source of all governmental power; that the authority of the people is to be extended, not restricted."

-Barbara Jordan

Effects of Whistleblower Retaliation


Whistleblower Retaliation is a form of abuse or assault (psychological violence),which has serious and devastating consequences not only for those targeted, but also for any organization within which it is allowed to prevail.  Although it can be an overt form of abuse, in the workplace the perpetrators usually act covertly and systematically to undermine, control, and (if they deem it necessary) to "see off" their targets.  It has been observed that elements of psychological abuse in the workplace correspond with elements of torture and have similar emotional outcomes for the target.  The perpetrators are often superficially charming and may appear to others to be an asset to the organization.  In the workplace, the underlying cause of retaliation or bullying is usually power abuse, with the perpetrators choosing as their targets anyone whom they perceive as a threat to their assumed power. When those targeted resist the perpetrators' attempts to control and intimidate them, the perpetrators will simply intensify the abuse until the targets either leave or break down under the stress of what is happening.  Anyone may be a Whistleblower if they attempt to tell truth to power about a situation of medical fraud, abuse or neglect (nurse, pharmacist, doctor, veterinarian, researcher, government worker, attorney, police officer, therapist, patent officer, nurses aide or CPA).

Integration of Traumatic Memory

“Normal Memory, like all psychological phenomena, is an action, essentially it is the action of telling a story….A situation has not been satisfactorily liquidated…. Until we have achieved, not merely an outward reaction through our movements, but also an inward reaction, through the words we address to ourselves, through the organization of the recital of the event to others and to ourselves, and through putting of this recital in its place as one of the chapters in our personal history.”   

Pierre Janet, Psychological  Healing, 1919



  Worry Free Rest Needed

Medical Whistleblowers are usually workers who have attained professional competence in their field.  Medical Whistleblowers have access to information at a high enough level to be able to detect medical fraud, abuse and neglect but also brave enough to alert others to the problem.  Because they often are in the healing profession, Medical Whistleblowers often provided comfort to others and were the strength that others rely on.  Most Medical Whistleblower’s are originally of a very strong constitution.  They are usually self confident adults who have good self esteem and were fully capable of handling difficulties in their own lives.  Therefore Medical Whistleblowers have many coping mechanisms to hide the emotional damage the retaliation has caused them and just try harder.  But under extreme or prolonged stress even very emotionally strong people often undergo an apparent personality change.  It is inappropriate and even dangerous to make long term assumptions about a person by observing their reactions under stress.  It is also important to remember that there needs to be intervention from outside to protect the whistleblower and prevent further retaliatory abuse.


“Public forgiveness and private vengeance suffer from the same vice;  They depreciate the victim.  Respect for those who suffer requires that no one usurp the victim’s exclusive right to forgive his oppressor.  Similarly, it requires that the duty to punish be assumed by everyone other than the victim.  That is what is meant by the rule of law.”   

Aryeh Neier, 1981

Retraumatization

Psychological violence can eventually lead to Post -Traumatic Stress Disorder (PTSD) which is a normal reaction to abnormal circumstances.  PTSD is not usually an indication of long term or underlying problems in those who suffer from it.  Whistleblowers who are being bullied should be encouraged to seek support sooner, rather than later, and should be able to do so with the assurance that they will be believed and effectively supported,  rather than be treated as if they themselves were the problem.  These competent whistleblowers under the effects of workplace bullying and  whistleblower retaliation may become unassertive, overanxious, compliant and even unable to cope with even the most trivial of stressors.  The symptoms of stress breakdown and PTSD are frequently misunderstood (by family, friends, co-workers and employers) as those of inadequacy or inefficiency.  There is a danger that stressed and/or bullied Whistleblower could find themselves facing disciplinary proceedings when what they really need is rest and support.  Some typical human reactions to severe and persistent stress are the loss of emotional control, apparent over-reactions to seemingly trivial stimuli, showing hypervigilance, and being on constant alert for further abuse.  Being targeted for Whistleblower Retaliation almost always leads to feelings of powerlessness in those targeted.  Those who are being retaliated against usually feel ashamed of what is happening to them, and by the time they seek help are likely to be already showing signs of stress breakdown.  At the point these competent Whistleblowers finally admit they need help, they are likely to present as over -emotional.  In these circumstances it is all too easy believe the person's account of workplace psychological violence or bullying as over-reacting when in fact the symptoms of emotional stress should be recognized as actually corroborating what they are saying.


Secondary Traumatization


The persons whose misdeeds the Whistleblower is reporting, often retaliate by fabricating complaints against the Whistleblower.  These fabricated complaints do not need to even have the appearance of truth in order for the bully to be protected by the Good Samaritan Laws and their false allegations protected by governmental immunity under Peer Review standards.  People may also disbelieve the Whistleblower, and side instead with those in power or authority.  Coworkers may ridicule him/her, abandon, blame, ostracize, sabotage, threaten, and betray him/her.  These painful and dangerous reactions can come from family, friends, and authorities as well as from people associated with the  perpetrator.  Co-workers may fault the Whistleblower for the hostility in the workplace.  The Whistleblower may be unable to recover until they leave the stressful position, but may be unable to find a new position until they have recovered.  Employers, therefore, need to be aware of the potential for compounding the problems of stressed/bullied Whistleblowers by unjustly disciplining them.  Where the stress has been caused by workplace bullying,  it also allows the perpetrators to switch the focus of attention away from their own abusive behavior by inferring, (usually under the guise of sympathy and support), that the person they are targeting is mentally ill, andthat it is their "mental illness" which is responsible for the current problems.  Whistleblowers need ongoing reassurance that they are not to blame forwhat has happened. Referring stressed people for work-based counseling helps perpetuate the myth that it is the person who is the problem, rather than the working environment.  It is important that employers and service providers take stress reaction seriously and remove the Whistleblower from the stress before the damage becomes more serious or permanent.  Medical professionals, who are generally highly committed people, are particularly likely to ignore their own symptoms and struggle on,  since seeking help is too often regarded as an admissionof weakness or professional inadequacy.  It is crucially important that those providing help andsupport to the Medical Whistleblower, do not mimic the effects of the trauma and inadvertently cause secondary trauma to the victim of retaliation.  If the support offered is too directive and/or controlling, however well-intentioned, there is a danger that itwill be perceived as replicating the whistleblower retaliation or bullying, so reinforcing feelings of powerlessness and causing further stress and distress.   Do not put stressed/bullied whistleblowerback into the same stressful/bullying situation and expect them to "prove" themselves.   Long term solutions require the full involvement of the stressed person, but should wait until he/she is first rested and reassured.

“Too often we underestimate the power of a touch, a smile, a kind word, a listening ear, an honest compliment, or the smallest act of caring, all of which have the potential to turn a life around.”
 
― Leo Buscaglia

Medical Whistleblower Advocacy Network

MEDICAL WHISTLEBLOWER ADVOCACY NETWORK

P.O. 42700 

Washington, DC 20015

MedicalWhistleblowers (at) gmail.com

CONTACT

"Never impose on others what you would not choose for yourself."  Confucius

"It is not the critic who counts; not the man who points out how the strong man stumbles, or where the doer of deeds could have done them better. The credit belongs to the man who is actually in the arena, whose face is marred by dust and sweat and blood; who strives valiantly; who errs, who comes short again and again, because there is no effort without error and shortcoming; but who does actually strive to do the deeds; who knows great enthusiasms, the great devotions; who spends himself in a worthy cause; who at the best knows in the end the triumph of high achievement, and who at the worst, if he fails, at least fails while daring greatly, so that his place shall never be with those cold and timid souls who neither know victory nor defeat."

Theodore Roosevelt- Excerpt from the speech "Citizenship In A Republic", delivered at the Sorbonne, in Paris, France on 23 April, 1910