Imagine the scenario - a woman goes into work one day and a senior colleague acts in an abusive and malicious way towards her. This is so shocking that she spends the next two years suffering from the consequences of that incident. She cannot sleep at night, she has frequent flashbacks and nightmares, she turns into a different person. The way she has been treated by her colleagues at work creates an ongoing depressive condition that requires serious psychiatric support.
Is it right to talk about this as post traumatic stress disorder (PTSD)?
If it looks like a dog, if it barks like a dog, and if overall it behaves like a dog, then it is most likely to be a dog. In the case of PTSD caused by bullying and abuse at work, this is a particularly black dog.
But most of our images of PTSD come from much more 'obvious' and dramatic causes of such shock. When we think of PTSD we are most likely to think of the soldiers in Afghanistan who have suffered from exploding IEDs or have been subject to combat and personal loss.
In the cases of PTSD at work, then the obvious examples are of fire-fighters, on-patrol police officers, and other emergency workers who have had near death shocks in extreme circumstances. Each of these clearly are people who may be suffering from PTSD.
So is it fair to use a diagnosis of PTSD for someone whose mental health has been severely affected by bullying at work, rather than some more easily identifiable event or incident?
On the other hand, let's give some thought to how a person who has been subject to workplace bullying may feel about themselves.
If we are all used to thinking of PTSD only in terms of combat veterans and violent and near death experiences, then a PTSD sufferer is also very likely to feel that their own suffering and experience is 'trivial' in comparison to the more obvious triggers of PTSD. Unfortunately, someone with PTSD is already likely to have feelings of self-worthlessness - and somehow a diagnosis of their condition as PTSD may only serve to make them feel worse.
The starting point for this is to recognise the problem.
Thankfully, the issue of bullying, abuse and harassment at work has become firmly acknowledged in many respects in recent years. (Although it is shocking that it was only in 1988 that Andrea Adam gave us the term 'workplace bullying'). The psychological harm this can cause to someone at work is recognised, but it is still rare that such harm is understood in terms of PTSD.
It is becoming recognised that PTSD can be caused by abuse in non-extreme contexts. For example, Dr Thormod Idsoe of the University of Stavanger, Norway found symptoms of PTSD among 33% of a group of teenager school students who said they were victims of bullying. As Idsoe says in a report.
Indeed, the American Academy of Child and Adolescent Psychiatry have issued a policy statement recognising bullying as a serious medical and public health issue.
'Traumatic experiences or strains imposed on us by others can often hurt more than accidents.'
A psychiatrist put this to me very well: It is already recognised that PTSD can be caused by experiences that are outside of the extreme shock of a life-threatening situation (such as combat or an accident). That is, there are many people suffering from PTSD due to various forms of personal abuse - particularly domestic and/or sexual abuse. Such PTSD may have been caused by a single incident of abuse, or a series of events stretching over a period of time, even many years.
And so if domestic abuse or school bullying can cause a person to suffer from PTSD, it should come as no surprise then that PTSD can also be caused by abuse in the workplace.
We might like to think that the workplace is a safe enough place where people behave with respect and due care, as perhaps we used to assume was the case in the home and at school. Many employers would like us to think this. But this is simply not the case - people can be nasty at work to their colleagues, just as they can be at home with their families.
For many people, the workplace is a site of bullying and abuse by their own workmates and managers, and is not a safe place at all.
If we give this some thought, most of us can probably pinpoint one or more examples of such bullying we have seen in our own careers - either done to us or others. It might not always cause PTSD, but the consequences are always inevitably nasty.
The employment tribunal system has slowly begun to pick this up and use what powers it is given to redress some of the wrongs caused by employers against their workers.
The most high profile of these is Dr Eva Michalak, a consultant doctor at Pontefract Hospital, who was subject to a nasty campaign against her by her senior managers over a number of years. She suffered from this to such an extent that she was diagnosed with severe PTSD, and she received compensation of £58,000 in late 2011 from Mid Yorkshire NHS towards this personal psychiatric injury, as part of a larger award amounting in total to £4.5million.
In another employment tribunal case in 2011 involving the NHS, Elliot Browne was given £13,000 damages for personal psychiatric injury by Central Manchester University Hospitals NHS Trust in 2011 because of the discriminatory and unfair way he was treated by his managers - with an overall pay out of £933,000. And Licia Faithful won almost £25,000 damages for aggravated injury from AXA PPP Healthcare in March 2011. Her claim was that she had suffered post traumatic stress disorder and depression after being ridiculed by co-workers in the claims department of AXA PPP. The tribunal agreed, ruling that the way that her co-workers recorded her voice and played it back to her in a mocking way was an ordeal of racial bullying. Ms Faithful had had to endure a 'hostile and degrading' environment in a company which had 'lacked empathy'. It had left her in a state where she was unable to do the simplest of household chores.
In some respects, when it came to the tribunal process each of these people were fortunate (if we can use this term). The system was able to help them at this stage. They were all able to demonstrate that the abuse against them was based on racial discrimination. If there had not been that element to the abusive behaviour of their managers and colleagues, it would have been much harder for them to be compensated for the PTSD that their workplaces had caused.
But I think most would agree that although racial bullying is pernicious and nasty, there are many other forms of bullying and abuse that do not involve any particular discrimination.
It is estimated that at least one in ten people in the workplace suffer from bullying, but not all of them develop PTSD. If we can take the figures for the Norway school students as in some way indicative of the problem, then perhaps one third of these people may have some form of PTSD. This calculates as 3.3% of the working population suffering from PTSD caused by workplace bullying. With a workforce of around 30million, that means nearly one million people in the UK are perhaps experiencing PTSD caused by workplace bullying and abuse.
That is a lot of people, and a lot of time lost from work by the people suffering the terrible consequences of PTSD (and of course it also time lost from their normal lives). It is a complete waste for everyone, apart from those who do the bullying.
It is simply the case that many people suffer the terrible experiences of PTSD due to bullying and abuse in the workplace (as can also happen or at school or at home). Although this has been happening for years, and is likely to continuing happening in future, there needs to be much more recognition of this problem and the harm it causes.
Such recognition of workplace PTSD needs to be acknowledged particularly for the sake of those with the PTSD, and also for those around them, their families, their friends, and also their employers. It is no one's interest for someone to suffer from PTSD without recognition and support.
How Your Job May Be Killing You, From HuffPost US: