Nearly 30 years ago, I went to the doctor with a bad sore throat. I talked manically at her for five minutes and she prescribed me antibiotics. Then she said: "You seem very stressed. Do you feel stressed?" I shrugged and said: "Not really." As I walked home I wondered if the fact that my war correspondent father had been killed in Central America two months earlier, that my final exams for university were pending, and that I had recently had an abortion might, in fact, might be causing to me feel stressed. I was, I admitted to myself, drinking a lot. It was another five years before I got help.
For people who have chosen a life of extremes, who witness the suffering of others on a daily basis, and who — far from getting help for themselves — are looked to for help day after day, it can be difficult to recognize incipient mental health problems. And, once you have recognized an issue, it might be very hard to know what to do about it. For humanitarians, the fact that you choose to live with conflict and famine, to put the lives of others before your own, may point already to a defense against a real examination of personal issues. In the drama of a life or death situation, your early experiences, perhaps lived out in relative comfort, may drift into insignificance.
But the mental health of development workers and volunteers is of vital importance both to themselves and to the people they serve. There is a lot of talk about burn out after one disaster zone, and of trauma after too many posts or a very long stretch in a hardship post. There is the very real difficulty of life on a compound with all its attendant issues, not excluding sexual harassment. You might experience survivor’s guilt and chronic problems readjusting to a "normal" life that doesn't feel normal anymore. People working in danger zones in any capacity famously struggle to maintain long-term relationships with partners, but also, in many cases with family and friends.
Psychologist Lisa McKay, who has written extensively on this subject, suggests that those posted overseas likely "entertain a higher chance of experiencing significant mental health problems, marital challenges and substance abuse issues than those who remain on home soil." This is not to mention anxiety, depression, insomnia, mood swings, and feeling distant or disconnected.
Yes, there might be a great deal of valuable camaraderie among colleagues, but they are unlikely to be able to let their own defensive guards down enough to provide real help. One aid worker just back from Southern Sudan said to me: "I was really looking for therapy on Skype because I was only able to see my therapist back home about once a year, and I needed more."
So, what do you do when you think you need help? Many might choose of three options. First: giving up and going home. Perhaps taking up a soothing hobby and brushing issues under the carpet. Second: the route of a descent into promiscuity, alcohol, and/or drug addiction, and other oblivion-providing activities that will serve to keep you in a state of lifelong denial, while also significantly shortening said life.
And third, getting some actual help.
The best thing to be said about therapy, online or offline, is that it works. It isn't a quick fix. It's tough to really face ourselves and look in the mirror. It can be very intense — but it vastly improves quality of life.
Distance therapy (via video call or email) is still controversial in the psychotherapeutic community, with many traditionalists feeling that the vital intimacy of the setting is lost without physical proximity. However, even they largely agree with U.K. psychoanalyst David Morgan; "It's second best, but something is always better than nothing."
And for many development workers, people witnessing catastrophe and desolation firsthand, nothing is what's currently on offer. There are a huge number of aid professionals in the world who simply are not able to pop into their local therapist's soothing consulting room every week over a sustained period of time. It's just not possible. But it is possible to make that mental space for ourselves online wherever we are.
Of course, there are other clear advantages to remote therapy: the privacy of seeing a therapist in our own convenient space completely removes any perceived stigma about visiting a public office for treatment. There is no time-consuming travel involved. Some people who might be uncomfortable face to face with a therapist find it easier to open up online. Clients who might feel very isolated in an inhospitable and possibly frightening environment feel comforted by the fact that they can email their therapist at any time of the day or night and know someone is out there listening to them.
This kind of distance treatment is now widely available and many therapists offer regular therapy remotely via Skype or email. Two colleagues and I will soon be rolling out The Mind Field, a website aimed at maintaining the mental health of frontline development workers, which, among other things, will provide referrals to online therapists.
For people who spend their lives looking after others, it is vitally important that they also look after themselves.
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About the author
Anna Mortimer
Anna Mortimer is a practicing therapist with a master's in psychoanalytic theory from the Tavistock and Portman NHS Trust. She writes on psychotherapy for Prospect Magazine and is a former Moscow correspondent for The Times (London). She is also the author of the Faith Zanetti quintet of novels, two further thrillers including The Oligarch's Wife, and a memoir about her war correspondent father, Every Time We Say Goodbye. She lives between London and Italy with two black labradors. You can reach her at annacbmortimer@gmail.com.
