Between harm reduction, loss and wellness: on the occupational hazards of work

Harm Reduction Journal

Benjamin C Shepard¹ 

[1] Human Services Department, New York City College of Technology, City University of New York, 300 Jay Street, Brooklyn, NY, 11201, New York

关键词: Overdose;    Wellness;    Vicarious trauma;    Secondary trauma;    Self injury;    Suicide;   

Others  :  809916
DOI  :  10.1186/1477-7517-10-5

 received in 2012-05-30, accepted in 2013-03-12,  发布年份 2013

【 摘 要 】

Those working in the fields of harm reduction, healthcare, and human services must cope with a range of stresses, including post traumatic stress and vicarious trauma. Pain and loss are just a part of the job. So is dealing with premature death as a result of HIV, hypertension, and even overdose. Faced with a range of challenges, some workers in the field even turn to self-medication. For some, it is about pleasure; for others it is about alleviating suffering. In recent years, several leaders in the AIDS and harm reduction fields have died ahead of their time. Some stopped taking their medications; others overdosed. Rather than weakness or pathology, French sociologist Emile Durkheim saw self-destructive behavior as a byproduct of social disorganization and isolation, as a way of contending with a breakdown of social bonds and alienation. There are any number of reasons why such behavior becomes part of work for those involved with battling the dueling epidemics of Hepatitis C, HIV, and related concerns. Forms of stress related to this work include secondary trauma, compassion fatigue, organizational conflict, burnout, complications of direct services, and lack of funding. Faced with day-to- day struggles over poverty, punitive welfare systems, drug use, the war on drugs, high risk behavior, structural violence, and illness, many in the field are left to wonder how to strive for wellness when taking on so much pain. For some, self-injury and self-medication are ways of responding. Building on ethnographic methods, this reflective analysis considers the stories of those who have suffered, as well as a few of the ways those in the field cope with harm and pain. The work considers the moral questions we face when we see our friends and colleagues suffer. It asks how we as practitioners strive to create a culture of wellness and support in the fields of harm reduction, healthcare, and human services. Through a brief review of losses and literature thereof, the essay considers models of harm reduction practice that emphasize health, pleasure and sustainability for practitioners.

【 授权许可】

   
2013 Shepard; licensee BioMed Central Ltd.

【 参考文献 】

• [1]Lunstrum T, Pugliese G, Bartley J, Cox J, Guither C: Organizational and environmental factors that affect worker health and safety and patient outcomes. Am J Infect Control 2002, 30(2):93-106.
• [2]Freud S: Beyond the pleasure principle. Edited by Strachey TJ. New York: Norton; 1961.
• [3]Marcuse H: Eros and civilation: a philosophical inquiry into Freud. Boston: Beacan Press; 1955.
• [4]Race K: Pleasure consuming medicine: the queer politics of drugs. Durham and London: Duke University Press; 2009.
• [5]Castilla J: Self ethnography of My disease. Harm Reduction Communication. 2001, 2001(12):25-9.
• [6]Chou L: Harm reduction and heroin were his life. Poz Magazine. May. Retrieved from http://www.poz.com/articles/214_10013.shtml webcite 1999
• [7]Shepard B: Queer politics and political performance: play, pleasure, and social movement. New York: Routledge; 2009.
• [8]Durkheim E: Suicide: a study in sociology. New York: Free Press; 1951.
• [9]Rofes E: Reviving the tribe: reviving Gay Men’s sexuality and culture in ongoing epidemic. New York: Harrington Park Press; 1996.
• [10]Facs.org: Risk-taking behaviors. Accessed 23 January 2013 from http://www.faqs.org/health/topics/15/Risk-taking-behaviors.html#ixzz2Ip22Dtt0 webcite
• [11]Rofes E: A radical rethinking of sexuality and schooling. Baltimore, MD: Status Quo or Status Queer \Roman and Littlefield; 2005.
• [12]Anonymous: Another Day, another dollar: working and using. Harm reduction communication. 3rd edition. New York, NY; 1996:7.
• [13]Moore L: Forging New workplaces: occupational health for harm reduction workers. Harm reduction communication. #3. P. 1 1996. New York, NY; Retrieved from http://harmreduction.org/wpcontent/uploads/2011/12/Communication3.pdf webcite
• [14]Vail K: How many more deaths before We come together? #3. P. 9 1996. http://harmreduction.org/wp-content/uploads/2011/12/Communication3.pdf webcite
• [15]McClean R: Tales of a housepunk nothing, or I was a twenty-something outreach worker.Harm reduction communication #13 p. 16–20 2002. Retrieved from http://www.harm-reduction.org/ru/images/stories/doc/Sekc/RU_Principles%20and%20practices%20of%20harm%20reduction/Harm%20Reduction%20Communication.pdf webcite
• [16]Remembering Michael Carden: 1971–2012, Harm reduction communication. 2012. http://harmreduction.org/publication-type/newsletter/communication-issue-seventeen/ webcite
• [17]Torruella R: Correspondence with the author. New York, NY; 2013.
• [18]Carey CA: Correspondence with the author. New York, NY; 2012.
• [19]Whitlock JL, Knox K: The relationship between suicide and self injury in a young adult population. Arch Pediatr Adolesc Med 2007., 161(7)
• [20]Incite: The revolution will Not Be funded: beyond the Non Profit industrial complex. Boston: South End Press; 2009.
• [21]Bell H, Kulkarni S, Dalton L: Organizational prevention of vicarious trauma. Fam Soc 2003, 84(4):463-70.
• [22]Cain R: Devoting ourselves. Devouring each other. Tensions in community based AIDS work. J Progress Hum Serv 2002, 13(1):93-113.
• [23]Niles L: Social workers facing stress and the coping strategies they use: a secondary analysis. City University of New York: PhD in Social Welfare; 2011.
• [24]Des Jarlais D, Marmor M, Paone D, Titus S, Shi Q, Perlis T, Jose B, Friedman SR: HIV incidence among injection users in New York city syringe exchange programs. Lancet 1996, 348:987-991.
• [25]Shepard B: Housing works, shelter kills: an oral history of housing works. Reflections: A Journal of Professional Helping 2008, 14(1):4-14.
• [26]Butters S: The logic of inquiry of participant observation. In Resistance through rituals. Edited by Hall S, Jefferson T. London: Hutchinson; 1983:253-73.
• [27]Butters S: The logic of inquiry of participant observation. In Resistance through rituals. Edited by Hall S, Jefferson T. London: Hutchinson University Library; 1983:253-73.
• [28]Carden M: Harm reduction. Group: Encyclopedia of Prostitution and Sex Work. Greenwood Publishing; 2006:201-202.
• [29]Raymond D, Michael C: Another fallen hero. Hepatitis support. http://hepatitissupportnetwork.org/Michael%20Carden.html webcite 2012
• [30]Wilkerson Funeral Homehttp://www.wilkersonfuneralhome.com/obituaries.php?page=0&op=view&id=1787 webcite 2012
• [31]Brannon A: Mother speaks out to losing a son to heroin overdose. WCTI12 5 February Accessed 8 Feb 2013 from http://www.wcti12.com/news/Mother-speaks-out-about-losing-son-to-heroin-overdose/-/13530444/18424714/-/l7b9vpz/-/index.html?utm_source=Join webcite+Together+Daily&utm_campaign=9eeca31764-JT_Daily_News_Smoking_Rate_70_Percent&utm_medium=email
• [32]Lyon J: Back to the old neighborhood: the founder of a needle exchange dies from dose, needle exchange renegade Brian Weil helped transform public health in New York. City limits. November. Retrieved from http://www.citylimits.org/news/article_print.cfm?article_id=2561 webcite June/July 1996
• [33]Smith R, Brian W: Brian Weil, photographer who founded needle exchange. New York times. 8 February. Retrieved from http://www.nytimes.com/1996/02/08/nyregion/brian-weil-41-photographer-who-founded-needle-exchange.html webcite 1996
• [34]Delgado R, Zamora JH: John Watters made syringe swap real. P. A: San Francisco Chronicle; 1995.
• [35]Kretkowski P, Kretkowski PD: Sudden death: needle exchange pioneer john Watters’ interrupted journey. SF weekly. December 20. Retrieved from http://www.sfweekly.com/1995-12-20/news/sudden-death/ webcite 1995
• [36]Pace E, Rod S: 30; Championed needle swaps. New York Times; 9 February. Retrieved from http://www.nytimes.com/1999/02/09/nyregion/rod-sorge-30-championed-needle-swaps.html webcite 1999
• [37]Weber B, Spencer C, AIDS Activist, Dies at 44: New York times. http://www.nytimes.com/2012/12/21/nyregion/spencer-cox-aids-activist-dies-at-44.html?_r=3 webcite
• [38]France D: Another AIDS casualty. New York magazine. 2008. http://nymag.com/news/features/45785/ webcite
• [39]Aparecida Da Silva E, Noto AR, Formigoni MLOS: Death by drug overdose: impact on families. J Psychoactive Drugs 2007, 2007:2007.
• [40]Velasco N: Nelly is in control. Harm reduction communication. #3. P. 5, 7 1996. 1996. Retrieved from http://harmreduction.org/wp-content/uploads/2011/12/Communication3.pdf webcite
• [41]Berman E: Obituary / addendum “Nelly is in control” harm reduction communication. #3. P. 7 1996. Retrieved from http://harmreduction.org/wpcontent/uploads/2011/12/Communication3.pdf. Retrieved from http://harmreduction.org/wpcontent/uploads/2011/12/Communication3.pdf webcite
• [42]Anonymous: On the death of Nelly valasco. Harm reduction communication. #4 P. 10. 1997. Retrieved from http://harmreduction.org/wp-content/uploads/2011/12/Communication4.pdf webcite
• [43]Anonomous: Letter to the editor. 1997. http://harm.live.radicaldesigns.org/downloads/fall97letters.html webcite
• [44]Miller C, Kerr T, Strathdee S, Li K, Wood E: Factors associated with premature mortality among young injection drug users in Vancouver. Harm Reduction Journal 4:1. Retrieved from http://www.harmreductionjournal.com/content/4/1/1 webcite 2007
• [45]Wheeler E: “Community-based opioid overdose prevention programs providing naloxone-united states, 2010. Morb Mortal Wkly Rep 2012, 61(6):101-104. Retrieved from http://www.cdc.gov/mmwr/pdf/wk/mm6106.pdf webcite
• [46]Braine N: Correspondence with the author. New York, NY; 2012.
• [47]Hughes C: Correspondence with the author. New York, NY; 2013.
• [48]Schindler P, Keith C: AIDS activist: Co-founded housing works. Villager. 14 March. Retrieved from http://thevillager.com/villager_50/keithcylar45.ht webcite 2004
• [49]Scheck J: Heroin Program’s deadly toll. Needle exchange save lives but May imperil workers. Wall street journal.10 January. Accessed from http://online.wsj.com/article/SB123154657089469819.html webcite 2009
• [50]Saakvitne K, Pearlman LA: Transforming the pain: a workbook on vicarious traumatization. New York: WW Norton; 1996.
• [51]Stamm B, Hudnall : Secondary traumatic stress. Lutherville, MD: Sidram Press; 1995.
• [52]Thorpe D: Charles king has a dream. Poz Magazine; September. Retrieved from http://www.poz.com/articles/341_2104.shtml webcite 2005
• [53]Warner M: “Why gay men are having unsafe sex again,” The village voice. New York, NY; 1995:32-3.
• [54]Freud S: Remembering, repeating and working through (further recommendations on the technique of psycho analysis II). Standard Edition 1914, 3:47-156.
• [55]Weber M: The protestant ethic and the spirit of capitalism. London: Unwin Hyman; 1905.
• [56]Dyer K, Loss G: Bereavement. Ud. Retrieved from http://www.squidoo.com/grief-loss-bereavement webcite
• [57]Shepard B: Harm reduction as pleasure activism. In Queering anarchism: addressing and undressing power Edited by Shannon D, Rogue J, Daring CB, Volcano A. 2013, 101-114.
• [58]Colletta J, Jon Paul H: Prevention point co-founder, 50. Philadelphia Gay News; 10 November. Philadelphia Gay News. Retrieved from http://epgn.com/view/full_story/10434412/article-Jon-Paul-Hammond--Prevention-Point-co-founder--50 2010
• [59]Lynch P: Harm reduction communication: talking to each other when It matters. Harm reduction communication #13 p. 2002. Retrieved from http://www.harm-reduction.org/ru/images/stories/doc/Sekc/RU_Principles%20and%20practices%20of%20harm%20reduction/Harm%20Reduction%20Communication.pdf webcite
• [60]Sisario B, Amy Winehouse: British soul singer with a troubled life, dies at 27. NewYork times. 27 July. Retrieved from http://www.nytimes.com/2011/07/24/arts/music/amy-winehouse-british-soul-singer-dies-at-27.html webcite 2011
• [61]Swarbrick P: Wellness: a model of personal and professional practice. Mid Atlantic consortium of human services. Mid Atlantic Consortium of Human Services. Lincroft, NJ: Brookdale Community College; 2009.
• [62]Grant M, Hazel J: Gods and mortals in classical mythology. Great Britain: Dorset Press; 1979.
• [63]Bernstein J: Not waiting to Say goodbye. New York Times; 2012:ST1. 11 April
• [64]Poveledo E, Carvajal D: Increasingly, Suicide ‘by Economic Crisis’ Is a Symptom of the Downturn in Europe. New York Times. 15 April. New York Times 2012, A6.
• [65]Kristoff ND: A Veteran’s death, the Nation’s shame. New York Times 2012.
• [66]Bérubé A: “Caught in the storm: AIDS and the meaning of natural disaster” in D’Emilio. In My desire for history: essays in Gay, community, & labor history. Edited by John F, Estelle B. Chappell Hill, NC: University of North Carolina Press; 2011:158. 147–60
• [67]Raffi B, Raffi Balian R, White C: Harm reduction at work: a guide for organizations employing people Who Use drugs. New York, NY: Open Society Foundation; 2010.
• [68]White C: From pain to pleasure. A personal account. Bangkok: Harm Reduction Conference; 2009.
• [69]Northwood A: Secondary traumatization and stress management. Minneapolis, MN: Center for Victims of Torture; 2003:465. http://www.cvt.org/file.php?ID=5718 webcite Bell, Kulkarni and Dalton
• [70]Favero J: Panel discussion on mutual Aid. New York City: New York City Anarchist Bookfair; 2008.
• [71]Grove D: Correspondence with the author. New York, NY; 2012.
• [72]Shepard B: Harm reduction outreach services and engagement of chemically dependent homeless people living with HIV/AIDS: an analysis of service utilization data to evaluate program theory. Einstein Journal of Biology and Medicine 2007, 23(1):26-32.
• [73]Ollman B: Alienation: Marx’s conception of Man in capitalist society. New York: Oxford University Press; 1976.
• [74]Favero J: Correspondence with the author. New York, NY; 2012.
• [75]Sheaprd B, Spencer C: HIV, and the problem of memory. Play and ideas. 2012. http://benjaminheimshepard.blogspot.com/2012/12/spencer-cox-hiv-and-problem-of-memory.html webcite
• [76]Mermain CDC: Releases data on New cases of AIDS. Blog AIDS.Gov. 19 December. http://blog.aids.gov/2012/12/cdc-releases-data-on-new-cases-of webcite hiv.html?utm_source=feedburner&utm_medium=email&utm_campaign=Feed%3A+aids%2Fgov+%28Blog.AIDS.gov%29
• [77]Garrett L: The End of AIDS? No I Don’t think So! Laurie Garrett blog. 21 December 2012. http://www.lauriegarrett.com/index.php/en/blog/3285/#&panel1-1 webcite
• [78]Shepard B: AIDS activism and the places it takes Me. Play and ideas. http://benjaminheimshepard.blogspot.com/2012/12/aids-activism-and-places-it-takes-me_2.html webcite
• [79]Shepard B: Play, creativity, and social movements: if I Can’t dance its Not My revolution. New York: Routledge; 2012.
• [80]Foucault M: The hermeneutics of the subject: lectures at the college de Frances 1981–82. Trans. Edited by Graham B, Frederic G. New York: Palgrave, Macmillan; 2005:131.
• [81]Merton R: The unintended consequences of purposive social action. Am J Sociol 1936, 1(6):894-904.
• [82]Poz Magazine Unsigned Article: Milestones and deaths. March 2000. Retrieved from http://www.poz.com/articles/199_10489.shtml webcite