Mind Field Blog

On World Humanitarian Day 2018, the Overseas Development Institute held an event called Breaking the Silence: Promoting action on aid worker mental health. Two key areas were highlighted as particularly problematic for aid worker well-being; trauma, due to the environments and events they are exposed to, and; stress or burnout, arising from the particular cultures inside many aid organisations.

As a counsellor working with international aid workers, and an ex aid worker myself, I recognised both these issues all too well. But I also noticed that there was a third factor missing from the discussion – loneliness. I would say that loneliness is up there at the top of the list of challenges facing my clients. I recall one of my first aid worker clients describing feeling lost and alone. With multiple missions under her belt she felt exhausted and less motivated to make new friends. She felt she was beginning to withdraw and lose sight of who she was. It was easier to work than socialise. She felt family at home didn’t understand her any more. She didn’t know where she belonged. She felt increasingly anxious, lonely and desperate. Her confidence hit rock bottom. She felt stuck, overwhelmed and uncertain which way to turn. Since then I have heard these same words repeated by many other clients; alone, isolated, lonely, lost, alienated, anxious, desperate, stuck, empty, hopeless.

Aid workers are necessarily an independent, adaptable and resilient lot, signing up to a life of constant challenge and change, and – when necessary – hardship. But this lifestyle has some pretty heavy side effects. Constant transitions between countries mean building relationships, moving on, losing relationships, being left, time and time again. Repeatedly familiarising oneself to a new place, a new culture, new people. This seems to have a direct impact on how people connect and maintain relationships and therefore on their mental health.

In her book “Counselling the Globally Mobile”, Lois Bushong, observes this very phenomenon. Her experience shows that the combination of loss (of people/place/culture) and increasing difficulty in making intimate connections combine to potent effect. Although she is largely describing the Third Culture Kid community, I see strong parallels in both myself and my clients. Over the years, the inevitability of leaving seems to be anticipated earlier and earlier, and less effort is put into building emotionally intimate new relationships. There may be many close friends from previous missions, so why go through the effort and pain of making and losing new ones? The loss of numerous places and people silently grow and is carried within, as a new job and context absorbs all the attention and energy. And so, the emotional boundaries built to protect start to turn into barriers which in turn can cause withdrawal and isolation. Yes, there are old friends, but generally they are now in other countries and it is hard to see them. Social media can help to maintain connections, but the bottom line is that these friends are not present. I notice in my clients that they have become increasingly lonely at a deep emotional level, isolated from people and places they know at a physical level. And while loneliness is not a mental health condition in itself, it is recognised as having a huge impact on well-being, lowering self-esteem and sense of emotional security, and if left, it leads to depression and anxiety. It also reduces our ability to be able to deal with trauma and stress, ever present features of the aid world, and hastens the onset of burnout.

Aid workers can suffer from loneliness at any stage of their career. But I notice it becoming more problematic as the number of missions grows and people get older. The energy and drive that originally got them into the field is ebbing, and the desire for stability and intimate connection has grown. People find themselves increasingly isolated and unsure of where they belong. They seem to feel stuck and unable to find a way forward, holding tight to what is often the one constant in their life – their work. And so, the pattern continues, the loneliness and isolation deepen, and despair can begin to set in.

Being an aid worker is an exciting, interesting, rewarding, worthwhile job, but it is also extremely challenging. Increasing attention is being paid to its impact on mental health and there is a lot of talk about trauma, stress and burnout. Intimate supportive relationships however are crucial to our emotional well-being and the aid sector, unwittingly, conspires to put us and our relationships under serious strain. Given the demands of the job, there is no easy answer to reducing loneliness amongst aid workers, but it does feel important to be able to acknowledge that this has a huge impact on their mental health. Maybe with this awareness we can start to take steps to reduce it.

—Helen Arthy, Therapist

My father was a war correspondent (killed in El Salvador in 1989). He used to call me from the American Colony Hotel bar in Jerusalem and I could hear the voices and laughter, the heavy clink of ice in glasses, and almost feel the heat sweeping in from the pool area, sense the relief in the abandon of all the journalists at the bar – they’d survived another day. He once called me from the Commodore Hotel in Beirut and played me a tape recording he’d made on the roof of the shelling, explosions, buildings descending into rubble, shouts and screaming. The eight-year-old me was worried about him, but he laughed; ‘I’m fine!’ he said. ‘Just having a gin martini up with a twist at the bar.’ I heard a woman’s voice there with him. Older now than he ever was, I’ve been to both those hotel bars myself, sat there with a drink half hoping he’ll walk in. 

But all that is a child’s view of a smoky, boozy, sensual, war-ravaged scene – a huge romanticisation of those frenzied evenings after a day reporting on extreme violence, all heavy drinking and guaranteed sex. I thought it was so glamourous, that the women must be so intrepid and exciting, beautiful and far, far more interesting that I would ever be. And it’s not hard to glamourise that life. Actually, I’ve written five novels doing exactly that! But there is another side, of course, to a need for booze and sex. And that is trauma. 

Clearly, there is a high octane kind of fun in it all, at least for a few nights. But seeking oblivion night after night over months or years as a way of processing chronic fear, anxiety, trauma and ultimately depression, gets quite a lot less fun as life slips by. If you’ve seen the horrors of war (and everyone who has witnessed the results of terrible violence knows this is not just a phrase), and you then find yourself relatively safe and sound in a hotel, it is easy to fall into promiscuity and oblivion-seeking as a way of self-soothing, of quelling the fear. And if you’re not safe and sound in the hotel, if threat is omnipresent, then sex can stand in for the comfort and intimacy all of us need when we’re scared out of our minds. 

Everyone knows that promiscuity in the field is pretty ubiquitous. [NB. I am not talking here about abuse or assault]. At first it may seem like one of the perks of the job, but with time it tends to become a grubby and depressing feature of an increasingly rootless life. It often involves cheating on someone left back home, someone who is perhaps taking care of the children, and it always involves loss. 

Sex as a defence against mortality is pretty classic stuff – many mid-life crises are based in it, and the kind of people who seek much younger lovers are obviously trying to ward off the inevitable process of ageing and dying. But when death is a very real and present threat, in war and disaster zones, things feel much more urgent – tomorrow really might never come – and people cling to each other in desperation for fear of being alone. 

Because there is a large element of genuine enjoyment and some fleeting intimacy in these encounters, it can be hard to see them as red flags for mental health. But they are. Any kind of oblivion-seeking is a way of staving off the effects of trauma, anxiety and depression, but it is ultimately unsustainable. I’m not trying to be pious or to tell anyone what they should or shouldn’t do of an evening – I’ve certainly tried these anaesthetics myself in a big way. But what I would say is that when it’s not working any more, when it’s getting you down and it’s hard to see a way out, there are people you can talk to about it, people who have been there too and can help you recalibrate things and work with you towards thinking stuff through instead of acting stuff out.  Work with you towards some peace of mind. 

If you recognise yourself in any of this, please be in touch.

—Anna Mortimer, Therapist, Journalist and Co-founder of the Mind Field

My aunt often tells us: “yo no estoy loca!” This translates into “I am not mad/crazy”, which is her response when we suggest she should seek professional help to deal with her chronic anxiety. Salvador Dali used to say the same thing and although we may be tempted to question the validity of that statement, the reality is that most people don’t want to hear they need therapy even if their daily lives have been crippled by stress and other mental health issues. Yet sometimes you might need a reminder that help is out there for when you come to your own decision to seek it out. 

Now as I work to raise awareness on the impact of our type of work on our mental health, I often hear in my head “ellos no están locos!”, which is how I interpret employers’ tendency to push back on the word counseling and focus instead on coping or managing strategies. While there may be good approaches to promote our own mental wellbeing much like eating fruits and vegetables can improve our physical health, there is no guarantee individuals will have the same response or the ability to avoid something going wrong. It is not an employer’s role to decide whether anyone working for them needs counseling neither to determine what is the best avenue for coping or treatment. Employers should focus instead on providing access to as many reliable resources possible so individuals can find their best fit solution or simply be heard, which is one of the main roles of therapy. Because at the end of the day, the truth most likely is that “we are all locos!”

–Raquel Fontanés, Aid Worker & Co-Founder of The Mind Field

I recently wrapped up a project that I’ve been consulting on for over two years – a project working with Syrians displaced from their homes, their lives, their families, their futures. I know I’m not alone in working on a project like this where you spend time getting to know people, working with them, eating in their homes, seeing them get married and have children, demonstrating throughout it all this kind of hard core resilience that most of us will never have to exercise in our lives.

But instead of feeling good about completing the project, I find myself with that sinking feeling. I’m alarmed by the fact that we are no closer today than we were years ago to helping the Syrian people. We’ve done all sorts of “supporting” and “advising” but has it really changed the reality? No – it’s not even scratched the surface. And now the project is ending, the donor is feeling good about “results” and is shifting attention elsewhere. And I feel like screaming “but now what?” How can you move on when help and money and service is still needed?

On past projects, the sinking feeling has stuck with me for a few weeks and then slowly faded away as something else occupied my attention. After all, I could actually walk away. For me, it was a job, it wasn’t my life in the balance. But for those few weeks, I feel guilt. I feel anger. I feel frustration. I feel depressed. I feel tired. And I have to keep reminding myself that it was worth it to be there with people. Even if I didn’t accomplish anything I would label a “result” – I built relationships, I listened, and I cared.

If you find yourself with that sinking feeling – do not be afraid or embarrassed to ask for help. Just because we can leave a project, a country or a job behind, doesn’t mean we have to ignore how it affects us. And it doesn’t mean we have to just get back on the horse either – find another project, find another country. In fact, I’m sure my Syrian friends would be the first ones encouraging me to do what I need to do to get back to myself. And if that is seeking help and getting therapy, then do it.

–Elizabeth Reiter Dettmer, Aid Worker and Co-founder of the Mind Field

The short answer: if you have experienced or witnessed a traumatic event, let alone a catalogue of traumatic events, then to some extent – yes. Post-Traumatic Stress Disorder is a huge collection of symptoms that might manifest as a syndrome, but very many of us are on the spectrum, if only to a small degree. It would be very odd to witness or experience a traumatic event and not to have any reaction. It would be inhuman not to be distressed by something distressing.

Patients often come into therapy wondering why things in their childhood, so long ago, should still affect them now. Some are dubious about it and find the idea ridiculous. But, really, wouldn’t it be more ridiculous if you had a whole childhood filled with all sorts of things and none of it had any effect on the adult person at all? It’s easy to understand that a severely abused child, kept in a dark room, beaten and tortured for years will grow up to be an adult with enormous difficulties. So, all of us are necessarily affected by the things we see and the things that happen to us.

Sometimes witnessing horror can have worse after-effects than experiencing it firsthand. To witness something terrible can leave a person with a feeling of helplessness as well as with the trauma of the event itself. (Freud noticed that it was the soldiers who returned from World War I without obvious physical injury who suffered most from what they then called Shell Shock). Of course, this silent witnessing can build up, particularly in a profession where observing some level of trauma becomes relatively routine.

I would argue that people do not get desensitized to violence or distress, but they learn how to repress it, how to switch themselves off and this has long-term effects on that person’s mental health because these (and any) unexpressed feelings haven’t gone away, they are just lying dormant. It’s often when the drama is over and we have relaxed again (or tried to) that the feelings take their chance to make themselves known.

Also, PTSD can be an unhelpful label. We have become accustomed to the term as describing intense flashbacks, sleepless nights, constant terror and an inability to function in the civilian world. Many people do suffer all those symptoms, but far more people suffer one or two of them, just sometimes. Those people don’t think they have PTSD.  Someone who drinks a few glasses of wine every night wouldn’t label themselves an alcoholic. But, just because you aren’t an alcoholic, doesn’t mean it wouldn’t be a good idea to think about why you need to drink so regularly, and what the issues are that you’re trying to ignore by drinking. And it doesn’t mean you have to stop drinking either – it just might be useful to think through it.

So, PTSD is really a short-hand for the way people tend to feel after very traumatic stress. The feelings can be varied, short-lived or long-term, constant or sporadic. You might not need a lifetime of medication or a period of hospitalization. You might simply need to talk to someone, even for as little as an hour, about how you are, ideally before you repress it and before it comes back at you as a symptom.

A more useful question might be: Have you witnessed or experienced something traumatic and might it be a good idea to talk to someone about it? Do you feel anxious or depressed, are you plagued by thoughts and images about a horrific event? There’s no need to slap a label on ordinary human reactions (again, it would be very weird if you didn’t react) but there might be a need to tell someone in complete confidence, someone who will get it.

Mightn’t there?

—Anna Mortimer, Therapist, Journalist and Co-founder of the Mind Field

The suicide of someone who appears to have everything the rest of us dream of is always particularly unsettling. There is a persistent fantasy in most of us that if we were impossibly rich and successful, beautiful and vibrant then we would, of course, be blissfully happy. The fact that this is not true is underlined in such a tragic way by the suicide of Anthony Bourdain, Kate Spade, Avicii and so many others whose lives have spiraled out of control under the pressure of pretending (and this doesn’t only apply to celebrities). They turn out, to our great horror, to have been troubled and lonely people, feeling, perhaps, that nobody could really understand them or bear them.

Although I would suggest that those seeking fame and fortune may go into these glittering professions with pre-existing mental health issues (something we know to be true of Bourdain who battled addictions) but, whether or not this is always the case, celebrity status certainly does not help. How can somebody rich and famous tell someone who is not that they are suffering, lonely and desperate, dark and scared?

These individuals might fear it would seem rude or insulting to say they are troubled, but also it would shatter an illusion. And people in the business of maintaining illusions for whatever reason are likely to be in trouble. Aid workers maintain the illusion of calm control, a haven of help in a world of horror. Journalists maintain an illusion of intrepid interest, sangfroid in the face of terror. Performers and celebrities maintain whatever illusion it is they are promoting – laid back, cool and wicked in the case of Avicii, perfect glamour in the case of Kate Spade, winning charm in the case of Anthony Bourdain. Of course, this is an over-simplification but, nonetheless, if you need to put a face, a mask on for any reason then it is very easy to lose the real person behind that face and end up feeling lost, misunderstood and actually incomprehensible. Suicide is often an attempt to kill off the desperate person behind the mask, the one holding the glittery fantasy person back.

Suicide is the last desperate act. (And not a simple one, for it is also a terrible attack on those left behind. The worst punishment in our arsenal, for one can’t attack oneself without attacking others).

The truth, thank God, is that there can always be hope. Nobody is too terrible to bear, too complicated to understand or too miserable ever to be happy again. Very many people from every background, the rich and famous included, have had successful analysis or therapy and come out the other end stable, more authentic and calmer. With patients who feel they have to wear a mask because the person under the mask is too boring, stupid, depressed, anxious, sad or mad, always feel an enormous sense of relief when they take the mask off. Even when it’s to face the underlying depression and despair. Then we can work through it. Then we can get out the other side. Alive. It’s possible, but it takes a lot of courage to take the first step. To get in touch and say; “I’m not okay.”

—Anna Mortimer, Therapist, Journalist and Co-founder of the Mind Field