Well you've made it this far, self-care. You're going to say, I don't need this. I don't care for myself. I care for others. How about if I tell the best way of caring for others is to care for yourself. So we'll examine some very simple things that you might consider, because what we don't want is for you to be a victim. And you're going to say, well that's not going to happen. And again I've been doing this 40 years, and have seen many of my colleagues become victims to the process of helping. Let's start by some simple logistics. Sometimes, you will be deployed to do psychological first aid in areas far away from home. Sometimes not so much, maybe down the street. But if you look at the slide that says, questions to ask before deployment, I would suggest that as uninteresting, as potentially even offensive as this may sound that there is value in having this information. So prior to a deployment, ask the question, well, when am I deploying? How long will I be deployed? How am I getting there? How am I getting back? Specifically where do I report and to whom do I report? Do you have contact information on that person. Is there a cell phone? Are the cell phones working? What authority do we have, do I have? Who are we working for? Is this for the state? Is this for the federal government? Is this for a local agency? How about malpractice? What happens if I'm helping people, and even though I think I'm doing everything right, things don't turn out so well. Is there an issue around malpractice? Am I protected by good Samaritan laws? I'm not licensed as a physician, a nurse, a health care provider of any kind. Do I need to worry about malpractice? What specific duties will I be doing? Hey, how 'bout safety? Is it safe? Oh, and this last one's very important. How do I handle violence, suicidal, homicidal or acutely psychotic individuals? What resources are available for that? You do not want to be in the field, encounter someone who is suicidal, and realize at that point that you have no idea what resources are available. That's too late. So this is boring, perhaps. These questions are uninteresting. You want to get right to the intervention. If you haven't answered these questions, the intervention can go terribly wrong. Remember, primary civilian victims and survivors experience adverse reactions to disaster. But never forget that first responders and others in the helping professions may also be vulnerable to similar reactions. So one of the things that you'll consider is the first responders themselves. Should psychological first aid be available to first responders, the answer is of course yes. But aren't you a first responder? Shouldn't you be concerned with the well being of those you work with and your own personal well being. What are the consequences of poor self care? You're in the field. You're being asked to work days that are often consisting of hour upon hour of seeing things that are distressing to you. Well burnout, compassion fatigue, getting sick or injured yourself, abusing substances, I'm not mentioning, I'm not necessarily talking about illicit substances, but abusing caffeine, energy drinks, comfort foods. Believe it or not, I've seen many times over the course of my career, after deployment people come back and they do remarkably impulsive, risky things. Sometimes people come back from deployments and they just can't function effectively. It's like I've just come from one of defining disasters of this decade. How can I possibly go back to seeing patients, to teaching school, to driving the truck, to whatever my normal job was, because it seems so pedestrian in comparison to the work I was just doing. And sometimes people get so overwhelmed in the deployment itself, that they can no longer function effectively. We should also remember the guilt. Remember three types of guilt, guilt for doing something you shouldn't have, guilt for not doing something you should have and survival guilt. And we'll talk about that a little bit later. So what are the symptoms of burnout? How do you know you've burned out? Well, what is burnout? Burnout is a slow erosion of psychological and physical resources. What are the symptoms? Procrastination, fatigue, cynicism, lateness, difficulty experiencing anything resembling happiness, pessimism, a sense of a foreshortened future, loss of satisfaction in your career or your life, and questioning your faith. And the interesting aspect about burnout, it just doesn't happen in a heartbeat. It happens slowly over time, a slow erosion, that's why it's so hard to pickup, you don't feel the changes, you don't see the changes. But someone who hasn't seen you in awhile will say, oh my gosh, you've changed, something's different. You were never that cynical before, you were usually right on time, gosh you used to be such an optimistic person. Something that does happen in a heartbeat is vicarious trauma, the psychological trauma that results from listening to the trauma of others, of seeing the trauma of others. The bottom line is trauma, psychologically speaking, can be contagious. The term compassion fatigue has been applied to developing some of the signs and symptoms of post traumatic stress disorder simply by observing the traumas of others. Depression, difficulty sleeping, hyper-vigilance, nightmares, anxiety, obsessive thoughts of the trauma, PTSD and other symptoms of burnout can all be in a heartbeat in the twinkling of an eye substance abuse. Sometimes people will say in the field, the only way I can fall asleep at night is to have a few drinks. Sometimes people will say the only way I can get going in the morning is to have an energy drink or four cups of coffee. Some people have discovered that the sedating antihistamines, sometimes anxiolytics, and sometimes people rely on illicit drugs. First and foremost, you have to ask yourself, will using these substances, how do they change me, my behavior? Do they make me more inclined to make mistakes, and injure people. The other thing you look at is, why do I need these substances? Are there other ways of getting respite from the demands that are placed upon me? We mentioned guilt, the three types of guilt. Guilt for doing something you shouldn't have perhaps. Guilt for not doing something perhaps you should have. And survivor guilt, survivor guilt. Why did everybody else suffer and I didn't? It doesn't make sense. So what do we do about these forms of challenges to our psychological and physical well being? Stress management techniques can be used to meet psychological needs. For example, relaxation techniques. I've found that relaxation techniques can be useful. Sometimes breathing techniques can be very useful. They're rapid and they're very effective. We keep mentioning the importance of social support, having someone to talk to. Pick up a phone. Perhaps if you deployed with a group, make a point of having lunch together, or dinner together, or something. A gathering around the campfire, so to speak. Try to focus on what you're doing well, not on what else needs to be done, because there will always be something that needs to be done. If you focus only on what needs to be done, feel like a guinea pig on a treadmill, some positivity can be found in almost all adversity, but it does take time and energy to find it. I teach a class on stress management for relief workers. At the beginning of the class, I've been doing it more than a decade and a half now, at the beginning of the class I asked people what are you most afraid of when you deploy? And oftentimes this will be to developing nations where physical safety is certainly not assured. There are risks for sexual assault, physical assault, robbery. There are risks for death. And you know what is interesting is the number one concern is my greatest fear they will say, my students will say, is not being able to make a difference. And while I'm not trying to solve their problem, what I say is you must believe that simply being there makes a difference. You may never see the difference, but sometimes you will plant a seed. And you won't be able to watch it grow, but that seed will grow. It will change the trajectory of someone's life. You'll never know about it. You must simply believe that your presence matters. Could you have done more? Of course. We all can do more, but we should not burden ourselves with that form of guilt. You do the best you can every day. And you do it because you believe it matters. I've been to 32 countries on six continents, and I will tell you regardless of the country, the context, the religion, it's been my observation that those who believe in something greater than themselves tend to be more resilient than those who only believe in what they see. And some of this should be obvious. If all you believe is in what you see before you, and what you see before you has been destroyed, it's hard to get up the next day. Simple stress management techniques, relying on others, trying to see the glass as half full and knowing in your heart of hearts that your presence matters will help you have a longer and more successful career, I believe. However, if you are in insistent that you want to burn out, I can help you. I've provided on the next two slides some suggestions on what you can do to facilitate burnout. And it begins with being a perfectionist. Never accept excellence. Always go for perfection. Never exercise, it just makes you sore. Remember, the glass is always half empty. Eat as much fast food as possible. Only eat things that had faces. Chickens don't count, they don't have lips. Never eat breakfast. Blame all of your failures in life on your parents, your lack of friends, your coercive, unethical, money-grubbing, outsourcing, capitalistic boss or the great right wing conspiracy. Accept responsibility for everything and everyone all the time, you must make all disaster survivors happy. Engage in endless process of controlling everything and everyone, especially those people and things over which you have no actual control. Empathize, you must feel survivors pain, try to sleep as little possible, feel guilty when leaving a disaster at the end of a deployment. Never take vacations, if forced to do so feel guilty about it. And seek out a routine, sleep until you're hungry, eat until you're tired, use alcohol to relax and stimulants to get going. And if you practice these ten simple things, I can almost guarantee a short and tumultuous career in psychological first aid and crisis intervention. But on the other hand, if you hold all of these things up to a mirror and see their mirror images, the opposites, you also have a prescription for longevity and per, and success perhaps. You'll also see some resources. Some primary sources, some secondary review sources that may be of use to you. And I encourage you to go to primary sources whenever possible.
