Caregivers’ Roles

Caretakers During Conflict

All caretakers, but especially psychiatrists and other psychological caretakers have an extremely important and unique role during times of conflict. Psychiatrists play an essential role in dealing with the consequences of conflict, and sometimes in influencing the process (Strous, 2013).

Caregivers and the Personal

In times of conflict, caregivers like psychiatrists, physicians, social workers, teachers and more, struggle with the effects of conflict like anyone else. They are members of families, they are working adults, and they see the effects of conflict often in closer detail than the general population.

Social Workers

Social workers, in particular, are often placed in emergency situations where they are exposed to people in danger or threatened. Many social workers in Israel are women, and mothers. It has been shown that mothers in Israel during the second Intifada period of chronic security threats from terrorist attacks and bombings would rate their anxiety for their children and partners significantly higher than anxiety for themselves (Cwikel, Segal-Engelchin, & Mendlinger, 2010).  There have been interventions with social workers using group support and coping skills acquisition, and one study using art therapy as a self-regulating tool (Huss et. al., 2010).

Physicians

A study by Haber (2013) studied physicians in Israel, who have to treat civilians and soldiers in addition to dealing with the stress of caring for themselves and their family. In addition, sometimes the physician’s own life is in direct risk. Many physicians themselves suffer from PTSD and its symptoms.  Haber’s study looked at various risk and protective factors and their associations with burnout, compassion fatigue, and compassion satisfaction. They found that higher levels of PTSD symptoms was related to higher levels of compassion fatigue (the stress that comes from wanting to help someone who is in trouble). The study suggested a complex interaction between the factors of negative mental health with compassion fatigue and burnout.

Ethics of Psychiatry During Conflict

Physicians and caretakers of all sorts, but especially psychiatrists, have a special responsibility to stay professional during times of conflict because the way they interact with patients can have large and harmful effects. Strous (2013) discussed in an article the ethical considerations that must be undertaken by psychiatrists during times of conflict. Here are some of the ethical challenges pointed out by Strous:

Social Contract: Psychiatrists have a “social contract” with the community that they will do their best to relieve pain and suffering, and to help their patients to manage disability and suffering.  Psychiatrists are sometimes more intimately and invasively involved in their patients’ lives than other types of caregivers, and that gives them a responsibility to use that knowledge and power to help instead of hurt their client.

Dual Loyalty: Psychiatrists might have difficulties balancing dual loyalties to the individual client and to the state or country. If asked to do something for the country, Strous says that psychiatrists must put the needs of the client first.

Boundary Crossing: Boundaries between the professional and the personal life of the psychiatrist “permit and foster safe interaction between the psychiatrist and the patient. However, it is often difficult in times of trauma to maintain the important boundaries between professional and personal life. Strous emphasizes that while one may have political beliefs on a personal level, it is important not to let those personal beliefs affect their professional life.

Involvement in Government Activities: This one is a big no-no for Strous. He talks about how psychiatrists are sometimes called upon to “make use of and exploit their unique skills and understanding of human behavior in order to control, punish or manipulate situations where psychiatrists are uniquely poised to assist.” This type of behavior goes against the Hippocratic Oath and the World Medical Association Declaration of Tokyo.

Confidentiality: In times of conflict, reasons sometimes arise that may tempt psychiatrists to breach confidentiality, but is important that they not do so.

Media Contact:  The media wants the inside scoop during acute conflict. Strous recognizes that it is important to maintain confidentiality and to be careful of boundary violations.

Conflict Resolution: Strous also posits that psychiatrists may have a role in resolving conflict. He says that psychiatrists have a moral obligation to try and prevent conflict and to utilize and create approaches to deal with conflict at both the individual, national and international level.