Consideration of the operational conditions and peculiarities related to personnel
When performing psychological first help as part of crisis intervention after potentially traumatizing events one has to take into account the specific operational conditions of shipping. The following requirements, limitations, and difficulties have to be considered.
Limited culture of confidence
The multicultural and multilingual composition of a crew is an essential feature of today’s ship’s crews. Many crew members come from East Asia (Republic of the Philippines, Kiribati, Gilbert Islands, Burma (Myanmar)), others from Eastern and Southeastern Europe (Russia, Ukraine, Poland, Bulgaria, Kroatia etc.) (19). In a multicultural crew the development of a feeling of mutual confidence and reliance is impeded by the rather hierarchical organization on board, fixed roles, and, above all, the barriers against social contact and communication which are determined by different language and culture. For interpersonal communication requires a minimum in emotional concordance. There is only a slim chance for identification and social relationship, the cornerstones for a confidential community encompassing the whole crew. Identification, commitment and reliance are limited, at best, to the ethnic group on board. In particular, seamen from East Asia have a distinct tendency towards relationships within their group, strong collective identification, and a traditional mutual responsibility of the group members. Social imperatives focus on the affinity with each other, and the individual behaviour is aligned specifically to the expectations of the own social community (20). Due to different relief rhythms within the crew the seaman has to adjust repeatedly to changing social and communicative relationships. While nautical officers from Middle Europe usually are relieved after three to four months on board the foreign, crew members, in particular ratings, especially from East Asia, stay on board for nine to twelve months.
Caused by the different relief rhythms seamen from foreign countries may experience quite diverse superiors.
Differences in language competence and style of communication
Although the Standard Marine Communication Phrases, introduced in 2001, requires communication within the ship in English, there are in some cases considerable differences with reference to English language competence. In addition, in a multicultural and multilingual crew there are various culturally determined styles and execution of communication. In a more indirect and contextual style of communication, which is used by crew members from East Asia, answers and statements are given more nonverbally or paraverbally than verbally. Control of emotions and face-saving play a critical role in the Asian cultural cycle, in particular during emotionally stressing communication settings. People from Middle Europe, who are used to direct communication and unambiguous messages, may have difficulties to adapt to an indirect and contextual style of communication. The latter means to control the gaze behaviour, to pay attention to nonverbal reactions, and to consider taboos related to body contact.
Limited readiness to use crisis intervention after potentially traumatizing events due to fear of losing the job and of jeopardizing one’s career
Seamen from foreign countries, especially from outside Europe, usually have contracts of limited duration. After relief from the ship a renewed deployment with the ship’s company is not always granted. Even minor health impairments may put redeployment in their job on board at risk. Reports give account from suicides of Philippine seamen after having lost their jobs because of physical impairments. Knudsen’s (21) investigations of Philippine seamen confirm the job insecurity in seafaring. On the other hand, officers and cadets may feel that traumatic reactions may place their career in jeopardy.
Concerning crisis intervention this may lead to a refusal of the officers and the crew to admit psychological problems and to make use of beneficial crisis intervention activities.
Similar to the situation in shipping, in the military the refusal to utilize help after potentially traumatic events is frequently observed, even if traumatic reactions have already occurred.
Weller (22) asked military personnel who experienced traumatic reactions why they did not make use of crisis intervention which was provided. He got the following answers:
- 65 %: I don’t want to be rated as soft.
- 59 %: My comrades would no longer trust me.
- 51 %: My superiors would treat me differently.
- 50 %: It would jeopardize my career.
- 55 %: I could not go off duty.
- 22 %: I didn’t know where I could get help.
- 38 %: I have no confidence in psychiatric help.
- 25 %: Psychiatric support doesn’t help.
Image of masculinity in shipping
The still existing image of masculinity of the seaman requires to “swallow” experiences of traumatic events without any problem. This is true particularly, if one has a leading function on board. For a captain or officer in charge, who has endeavoured successfully to save the lives of his crew in case of a large damage, it is quite inacceptable to suffer from a trauma and to be a victim without being able to cope. McKay (23) mentions “Constructing Masculinities” in an investigation of Philippine seamen. These seamen have a self-image as “new heroes” (“Bagong Bayani”) because in their home country they enjoy high prestige on the basis of being the breadwinners of their family and being of great relevance to their country because of their money transfer.
Reduced possibilities of withdrawal or shielding of affected individuals
The 24-hours-operation of a ship requires a seaman to be constantly available for unforeseen, sudden demands or in critical situations. Personal life is completely subjected to operational requirements and is, consequently, determined by the work. In this environment a feeling of privacy and autonomy can hardly emerge. In the closed social system ship there is no clear division between working and living zones, and it is difficult to shield a crew member from the environment after an extremely stressing event. Likewise, practically all crew members are concerned in case of a potentially traumatizing event, such as damage or external violence, e.g. a pirate attack. However, this is also possible, if only one crew member is injured or killed in a severe accident. In the closed social system ship a secondary traumatization of crew members not directly involved cannot be excluded. The probability of this effect is the more likely the more the secondary victims (bystanders, rescuers) see things from the primary victim’s perspective, and, at the same time, are not able to help.
Impossibility of short-term Psychological First Aid
Worldwide operation of a ship and short stays in ports frequently preclude a Psychological First Aid, the more so as suitable support systems (e.g. crisis intervention teams) usually are not available. All the same, after a potentially traumatizing event a crew member showing traumatic reactions will not be relieved, due to the tight situation with reference to ship manning. This means that the crew members are on their own after an extremely stressing event (20).
Absence of support of family and friends
Caused by the occupational separation from family, friends and from the society at home the seaman cannot make use of these resources after traumatic events. This might hold particularly for Philippines who, according to McKay (23), depend on a pronounced traditional family orientation. Barnett and Hyde (24) state that a change between the work role and the family role is an essential psychogenic protective factor which fosters coping with stress and depressing emotions.
Cultural differences related to experiencing traumata and to coping with traumatic effects
Emergencies and damages to the ship are exceptional situation for the people concerned. The extent to which they have the feeling of having control of the situation themselves may have a strong effect on experiencing threat and showing stress reactions. This coping competence can be viewed in close relationship with locus of control (in the person) and control strategy. According to Antonovsky (12), manageability, comprehensibility, and meaningfulness of a potentially traumatizing event are important prerequisites for coping with trauma. However, in this connection cultural differences have to be considered. The cognitive control theory by Frey and Jonas (13) state that members of the East Asian circle prefer a secondary control strategy, i.e. they adapt by means of cognitive reframing to a seemingly unchangeable situation and they choose a rather fatalistic attitude. In many cases an increasing belief in fate emerges.
Development of systems for counceling and support
In spite of the above mentioned difficulties and limitations which a maritime crisis intervention encounters, the development, organization, and implementation of psychosocial support for seafarers after potentially traumatizing events constitutes a new challenge for the shipping industry (25). In these cases seamen should be provided a support which is comparable to that which is given to police men, firefighters and the military.
Dealing with traumatic events in ship operation depends to a great amount on the attitude and the behaviour of the shipping company. E.g. it is crucial, to which extent the company is prepared and willing,
-to render personal support to affected crew members after critical incidents,to express appreciation after accomplishment of a excessively stressing event
-to provide resources for preventive measures,overtly to deal with errors, and to deduce and implement appropriate measures.
In the context of first aid after severe damages, pirate attacks and hostage takings, respectively, the shipping company should provide for immediate crisis intervention. For this purpose well trained peers or disaster and crisis psychologists who are experienced in shipping are required. They should perform immediate crisis intervention on board or in appropriate locations in the next harbour. Similarly to the crisis intervention teams set up by the military, firefighting agencies and the police, shipping companies should take into consideration the establishment of a maritime crisis intervention team. To this effect they might cooperate with other shipping companies and/or with suitable maritime institutions, the radio medical service, seamen’s welfare agencies, and the ITF (International Transport Workers’ Federation). The members of such a maritime team should be enabled to be deployed fast and worldwide. Supervision of the team members should be provided after their mission.
In establishing an appropriate crisis intervention organization it should be taken into account that there may be considerable reservation and opposition on the side of the affected seamen
concerning psychological first help. They may be anxious to lose their contract or to place their career in jeopardy. In addition, the sometimes low culture of confidence has to be kept in mind. In these cases crisis intervention should be organized in a manner, which guarantees the seamen anonymity and data security.
Welfare agencies normally maintain good contact to seamen, and therefore, especially in their centres established throughout the world, their personnel can offer relieving talks to affected seamen. Their personnel often are trained in crisis intervention methods. These relieving talks may take place in context with a first crisis intervention on board or in the centres in the ports. In the Preliminary Guidelines for Post-Piracy-Care of seafarers, edited 2010 by the Seaman Church Institute in New York (26), measures for medical and psychological care of affected seamen during and after a pirate attack or hostage taking are described. In this guideline also the information and possible supervision of seamen’s families are recommended.
In cooperation with the German Seemannsmission and on the basis of a survey, the authors of this chapter are developing a concept for the organization and performance of crisis intervention of traumatized seafarers.
A further preventive measure with respect to potentially traumatizing events is the pre-incident preparation of the crew, especially of the ship’s officers. This preparation serves to give information on dealing with a critical incident. As mentioned in 4.1, the crew often is on their own immediately after a severe accident on board or a pirate attack. Therefore a reaction after traumatic events has to take place within the crew. For this reason, it seems necessary to train one or more qualified crew member so that they can give psychological first aid. Since the nautical officers are responsible for health care on board, the task of psychological first aid could be assigned to this occupational group, provided pertinent aptitude. In context with their medical training they could be prepared for psychological first aid, and through further training they could qualify for peer support personnel (peers).
For this purpose, as an example, Rademacher and Zielke (27) have proposed a curriculum for the preparation of ship captains and nautical officers for performing psychological support on board.
Another example was reported by Davies from Maersk Training Centre (32). He described a training for “Surviving Piracy and Armed Robbery” (SPAR) of which Psychological First Aid (PFA) was a part.
Recommendations concerning behaviour towards and communication with traumatized seamen
The Medical Guide for Ships (5) gives the following recommendations for taking care of seamen after potentially traumatizing events:
After an incriminating event each concerned crew member should
- Speak about the experiences, reactions and in particular about the feelings (by talking the consequences of a traumatic experiences can be diminished,
- Remain physical active,
- Exercise controlled breathing, breathe in and out slowly and deeply inhale and exhale,
- Find a support and security group or familiar one on one,
- Respect culture-specific norms and value system,
- Realize that they survived an emergency and recall what factor contributed to overcome the situation. Perhaps this will help in successfully being able to cope.
It is very helpful in dealing with acute load reactions after a traumatic event to use the application of learnt relaxation procedures; these can be like muscle relaxation, meditation etc.
Behaviour and conversation readiness toward crew members with acute load reactions:
- After a traumatic event the possibility should be available for a crew member to start speaking about their experiences. However such conversation is neither a consultation nor a psychotherapeutic treatment.
- No one should be pressured to speak about their experiences if they are not ready to do so.
- The offered one-to-one conversation should occur in an open and trusting conversation atmosphere without pressure of time and, perhaps, in a spatial distance to the place of event. Guidance of such conversation is to show interest, respect, openness and active listening.
- Point out to the fact that the physical and psychic symptoms are normal reactions after such a traumatic event.
- The subjective experience of the affected crew member, their reactions and particular their feelings must be taken seriously and not devalued, run through or even minimized.
- Put understanding questions, point out to the successful accomplishment of coping with the emergency situation and do not stress the “dreadfulness” of this incident.
- Adapt the language to the linguistic understanding of questioned crew member; this is a big problem with foreign crew members, because often, already in the normal work routine, language and communications problems exist.
- In spite of understanding pay attention to emotional distance of the affected person, i.e. refrain from statement and feelings of the crew member concerned and do not identify with their experience.
The behaviour towards one or several affected crew members and the conversation after a traumatic incident depend on the leadership and culture on board and the composition of the crew. Thus such an event can be experienced by crew members of different nationalities much more intensely and more threateningly and can lead to completely different behavioural reactions and feelings. In addition, cultural norms can hinder their reactions, also missing trust and hierarchical gradation hinders the conversation readiness of these crew members after traumatic experiences. Here the question is how to develop a bond of trust as a condition for a strain relieving talk after a case of distress or heavy accident on board.