Monday Morning Crisis Quarterback

Yesterday on NPR, Fresh Air had on Chris Cramer. He was a reporter for the BBC in 1980 when he was applying for a visa at the Iranian embassy in London. You may recall that there was a hostage siege at the Iranian embassy in London that year, and lucky Mr. Cramer happened to be there when the terrorists showed up. He was held captive for a day and a half.

Following that experience, he decided that perhaps he did not want to be covering war and conflict and went into management. He was an executive at the BBC, president of CNN International, and is now Global Editor for Multimedia at Reuters. More interestingly, at least for the Quarterback's purposes, Cramer is President of the International News Safety Institute.

I, for one, had never heard of INSI, but they look pretty cool. They are committed to having safety standards for journalists. Very controversially, Cramer was among the first to say that, "no story is worth a life." INSI also trains journalists who are going into conflict areas on things like battle first aid, how to survive a kidnapping, and other light topics.

From a CISM point of view, all that training not only gives journalists the skills that they need if they're going to be in the middle of a war zone, but it also serves to inoculate them against the stress of the experience, at least to some degree. You may recall the Quarterback's recent speculations about New York Times columnist David Rohde and how he might be doing following his recent escape from the Taliban. It might be interesting to know if he had gone through INSI training.

Cramer talked a lot about how journalists know when to take a break, and about the need for managers to tell them when it's time to come home because they don't always see the situation clearly up close. He also talked about how some journalists immediately go see a counselor when they come back from an assignment, and others have trusted friends they talk to.

This is a poster child advertisement for Critical Incident Stress Management. The original idea behind CISM is that first responders would be more comfortable talking to another first responder -- a peer -- than to a counselor, so it was important to train the peers in early crisis intervention and train the mental health professionals both in early crisis intervention and in working with peers. Seems like the same principle might apply to journalists: If folks are going to talk to their peers about traumatic experiences, let's train the peers.

The Quarterback has no idea whether there are journalists out there -- a few or a lot -- who are trained in CISM. It sure sounds like there should be. And if they need a Quarterback to train them, I know just the person!

New York Times reporter David Rohde escaped from 7 months of captivity in Afghanistan on Friday night. He had been kidnapped by Taliban and, if you are like most people, you had no idea. The New York Times decided not to publish the story out of fear for Rohde's safety.

Certainly being kidnapped by the Taliban qualifies as a "critical incident," and I think we could all forgive Mr. Rohde if he has some critical stress reactions in the next several months. But his is an interesting case. You see, he'd been abducted before -- several years ago in Bosnia.

The Quarterback certainly has no way of knowing what either experience was like for Mr. Rohde, but the fact that he continued to work as he did in dangerous, kinapping-prone areas after the first time suggests that he was doing OK. How is he doing now?

There are a number of possibilities:

1. For whatever reason, Mr. Rohde is fairly well inoculated against the traumatic stress of being kidnapped. That doesn't mean he likes it, mind you, but that it doesn't give him nightmares and flashbacks and depression. This is the phenomenon that allows most first responders to stay on the job and only be impacted by the most grisly and shocking events -- day-to-day violence and blood become part of the job.
2. The first kidnapping was indeed traumatic for Rohde, but he got good intervention and the experience largely inoculated him against the distress of the second one.
3. Both kidnappings were traumatic, independent of each other.
4. Rohde's reaction to the second kidnapping is big, and as much about the first incident as the second one. He is reliving the previous traumatic stress while trying to process the current.

Of course we hope that the first one is true. Not that being used to being kidnapped is something we would wish on anyone, but it certainly would be useful if you were going to be kidnapped anyway. And, from an interventionist's standpoint, the last one would be the most complex. Traumatic events always trigger, to some extent, past losses and traumas, but this would be huge.

In fact, the Quarterback knows a lot of responders who wouldn't touch Mr. Rohde with a ten foot pole. I participated in a training once where we planned a response to a workplace hostage situation which ended in a fire and the police shooting the perpetrator. The question of what should be done for the person who was taken hostage, who was the estranged wife of the perpetrator, got about 30 seconds of attention, with everyone (except the Quarterback) agreeing "she gets a referral" to psychiatric intervention. We don't like to work with people who are smack dab in the middle of the trauma. The next concentric circle out is more comfortable.

Certainly there are times when working with the most impacted people is not advisable. You should never be doing intervention with people who are still injured in the hospital, because they are still getting their physical needs met and can't yet attend to their safety and security or belonging and love needs. And it is absolutely the mantra of CISM providers to do what you know you can do well and get out of there -- doing nothing is preferable to doing it wrong, and if you really don't think you can handle this, then you shouldn't be doing it at all.

The problem is, the standard of care for the treatment of traumatic stress, as contrasted by the intervention in traumatic stress, is to wait 30-60 days after the event. And if no one intervenes with the primary victim during that time, it can be a truly hellish couple of months. It's the equivalent of breaking your arm and having the ER say, "We can't operate for a week until the swelling goes down, so go home and wait" without putting it in a splint. The splint isn't going to heal it, but it will make the waiting more bearable and hopefully prevent the injury from getting worse.

But before we go rushing in to hypothetically assist Mr. Rohde, one last caution is in order. Critical Incident Stress Management does not respond to the critical incident. It responds to the critical incident stress. So before anyone does anything, they need to assess what exactly is going on for Mr. Rohde, and don't forget his family and colleagues. If everyone's doing OK, we can go find another trauma to intervene with -- there are plenty. And if not, let's do what we know we can do well, and get out of there.