Devoted veterinary professionals around the world possess unique personality traits, whether is their radical love for animals, fervent dedication, their iron-clad resilience, or their burning compassion, because they chose to work in this very demanding, and at times unforgiving industry, so they can offer up a large part of their lives to care for animals.
As a veterinarian in Singapore, I see unsatisfactory pet nutritional, behavioural and medical management and practices that led to poor health, physical distress and even deaths daily.
I try to help as much as I can within my limited capacity.
For the past 18 years of my career, I have witnessed events, situations and wrong decisions made by owners that is traumatising and disconcerting to me, almost daily.
With the heavy caseload and a constant barrage of mental conflicts while working as a veterinarian, am I doomed to suffer from a continuously escalating chronic work-related stress disorder and low job satisfaction?
Or am I just basically swimming in a never ending, vicious cycle of mentally and emotionally traumatic episodes and post-traumatic stress disorder recovery?
Am I fully conscious of how I maybe silently drowning in my own ideology?
By definition, post-traumatic stress disorder (PTSD) is a mental health condition that some people develop after they experienced or witnessed a traumatic event (1) (2).
The traumatic event, traditionally, must be deemed life-threatening or pose a significant threat to the individual’s physical, emotional, or spiritual well-being (1).
These events conventionally may include natural disasters, serious accidents, terrorist acts, war, combat, rape, sexual assault, historical trauma, intimate partner violence and bullying (1) (3).
PTSD patients must then exhibit some symptoms that are recognised and stated in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5-TR) for at least a month (1) (3).
There are four recognised categories of symptoms in PTSD cases (1) (3):
A. Intrusion
B. Avoidance
C. Alterations in perception and mood
D. Alterations in arousal and reactivity
Then, in what context can I, a veterinarian in idle and peaceful Singapore, rationalize that my daily clinic work exposes me to traumatic events that posed a significant threat to my physical, emotional, or spiritual well-being, comparable to a war veteran that witness his comrade being killed in the war zone?
How do I then explain why these apparent traumatic events I claimed to be exposed to daily have not caused me to throw in the towel years ago and stop working as a veterinarian?
Based on human psychology, cognitive and behavioural studies, I should consequently suffer from repeated, intrusive, involuntary, distressing thoughts, memories or dreams and flash backs; develop avoidance behaviour at work towards owners, co-workers, surgical procedures, use of certain medications, etc.
Then suddenly be engulfed by amnesia and lose the ability to remember important things, develop distorted beliefs about myself or others, become paralysed in ongoing fear, horror, anger, guilt and shame.
I should show constant irritability with angry outbursts, coupled with reckless behaviour or do things in a self-destructive way; become suspicious of everyone and everything, easily startled and/or have problems concentrating or sleeping (1) (3) (4).
According to the experts in psychiatry individual diagnosed with PTSD, must have displayed some of the reviewed symptoms and these must last for more than a month and have caused significant distress or problems in the individual's daily functioning (1) (3).
I have been, and still am, going to work, diligently.
These PTSD cases can develop symptoms within three months of the trauma, but sometimes symptoms only appear much later and can persist for months and sometimes even years (1) (3).
I am not quite sure, in this case, where to place a starting or ending point to my supposedly daily traumatic stressors and symptoms progression.
PTSD also predispose the individuals to other related conditions, such as depression, substance abuse, memory problems and other physical and mental health issues (1) (3).
Am I depressed?
I like to drink a lot of coffee and eat loads of potato chips – can I consider that as a substance abuse?
I came across studies done on 359 US veterinary professionals in 2023 which used the narratives of their highly stressful work events to calculated the prevalence of PTSD (2) (4).
The results initially indicated that 21.1% of these veterinary professionals qualified to have been exposed to traumatic stressors in work-related events that can lead to PTSD (2) (4).
The numbers increased to 39.3% after the narratives were reevaluated under the expanded definition of traumatic stressors (2) (4).
Depending on how the traumatic stressor was defined and whether PTSD symptoms were linked to the same event or multiple events, another 3.6% (single event) to 13.9% (multiple events) veterinary professionals screened positive for PTSD (2) (4).
The American Psychiatric Association (APA) stated specifically for this study that the results “indicate that there are highly stressful events unique to the veterinary profession that result in PTSD symptoms although they do not meet the definition of a traumatic stressor in Criterion A of the DSM-5 diagnostic criteria for PTSD assessment. Without a Criterion A stressor, many veterinary professionals would not meet the criteria for PTSD, even though they have the requisite symptoms.” (4)
“Unique” is the keyword.
Based on APA’s opinion, large number of veterinary professionals may never be diagnosed with PTSD despite displaying various symptoms because the criteria set for traumatic stressors to diagnose PTSD was not designed adequately to assess veterinary professionals accurately.
I concur.
I do not think that I can successfully or effectively articulate the complicated emotion and attachment I have towards animals so people can understand the agony I feel when the animals look at me in distress, in pain or in hunger.
According to the psychiatrists, PTSD is classified as a mental illness. You can develop it after experiencing something that you find traumatic personally - this also can include seeing or hearing things that are traumatic (1) (3).
I find seeing sick, injured, poorly cared for animals traumatic.
But I still attend to them to my best ability daily.
I find euthanasia of animals traumatic.
But there are times when I have to do it.
I find witnessing of crying, screaming owners traumatic.
But I still have to counsel them.
I find incivility from clients traumatic.
But I still have to confer with them.
I find online bullying of veterinary professionals traumatic.
But I have no outlet to seek vindication.
Do you agree that few people can completely understand how a true veterinarian can becomes “so traumatically hurt that he/she develops a disorder so nerve-wracking that he/she become shell shocked” after witnessing an animal in distress?
Then compartmentalise the hurt and emotion, so he/she can still go to work the next day to face the same traumatic stressor(s) allover again because of the oath he/she made to the animals zillions of years ago?
Veterinarians all around the world face a torrent of work-related events that traumatise and torment them daily in order to serve, protect and defend the creatures they love.
Can any scientific research, study, survey or step-by-step instructional manual achieve any data, equation and/or solution to unravel our plight?
Despite my resilience, I may have, long ago, developed PTSD without being conscious of it.
So yes, I may have gone bonkers but I am still one of your uniquely, devoted veterinarians working in Singapore.
Author Contributions
Dr. Denise Ng BSC BVMS
Conflict of interest
The author declares that there is no conflict of interest.
Funding
The author received no specific grant from any funding agency in the public, commercial or not-for-profit sectors for the preparation of this review article.
Attribution/ References:
1. Substance Abuse and Mental Health Services Administration. Trauma-Informed Care in Behavioral Health Services. Treatment Improvement Protocol (TIP) Series 57. Rockville : HHS Publication. MD: Substance Abuse and Mental Health Services Administration, 2014., 2014. 13-4801.
2. Kramper, Sharon. The Impact of Usually Distressing Events on Veterinary Professionals. Auburn, Alabama : s.n., 2021.
3. Taylor-Desir, Monica, M.D., M.P.H., DFAPA. What is Posttraumatic Stress Disorder (PTSD)? APA. [Online] Nov 2022. [Cited: Nov 1, 2023.] https://www.psychiatry.org/patients-families/ptsd/what-is-ptsd.
4. Highly stressful events and posttraumatic stress disorder symptoms among veterinary professionals: Prevalence and associations with mental health and job-related outcomes. Sharon Kramper, Eric S Crosby, Sydney N Waitz-Kudla, Frank Weathers, Tracy K Witte. 2, US,DC : Psychological trauma : theory, research, practice and policy., 2023, Vol. 15. S275-S285.