All kinds of cross-connections become evident as you work with people to try to improve the quality and safety of patient care, as we seek to eliminate preventable harm. But I never expected a psychiatrist's book about combat trauma to offer an insight. The book (recommended by Budd Shenkin), is Jonathan Shay's Achilles in Vietnam, Combat Trauma and the Undoing of Character. And a powerful book it is, a must-read to understand the devastating long-term impact on personality that can result from wartime situations.
At our Telluride Patient Safety Camp, it is not uncommon to see evidence of trauma in the faces and stories of our residents and medical students. A common theme is that they had witnessed a senior physician engaging in a practice that harmed a patient, followed by (at best) a lack of disclosure and (at worst) a lack of acknowledgment that such harm had actually occurred. The young doctor's shock is exacerbated by the feeling of guilt that he or she had not intervened in the procedure to stop the harm from taking place. Whether or not the resident had been required to participate directly in the actions being taken or was simply observing was not necessarily germane to the reaction.
There is a growing consensus among people that treat PTSD that any trauma, be it loss of family in a natural disaster, rape, exposure to the dead and mutilated in an industrial catastrophe, or combat itself, will have longer-lasting and more serious consequences if there has been no opportunity to talk about the traumatic event and those involved in it, or to experience the presence of socially connected others who will not let one go through it alone.
Griefwork encompasses the whole range of formal and informal social exchanges that soldiers at Troy and Vietnam practiced after a death.