university of south africa Learn without limits. Post-Traumatic Stress of Employees Working as Slaughterers Karen Victor Antoni Barnard karenvictor2@gmail.com barnaha@unisa.ac.za Introduction Workplace factors and the psychological health of employees are inextricably linked as work conditions or job demands may signifcantly impair employee wellbeing and afect employees’ coping and general psycho-social adjustment (Lowman, 1993; Schaufeli, Bakker, & Van Rhenen, 2009). Negative workplace factors such as high job demands, low autonomy, long hours, work-related stress, negative management style, low income, insecurity, workplace violence, injury and discrimination have been shown to lead to poor psychological health (Hillier, Fewell, Cann & Shephard, 2005; Kleiner and Pavalko, 2010; Kopp, Stauder, Purebl, Janszky & Skrabski, 2007). Violent work conditions, as found in the slaughterhouse environment, therefore pose a potentially serious threat to employee wellbeing and formed the primary concern of this qualitative study. The Slaughterhouse Work Context Slaughterhouse work is unpleasant, labour intensive, repetitive, dangerous, and physically demanding and was previously reported to result in very high personnel turnover ranging from 20 - 98% per year (Broadway, 2007; Dalla, Ellis & Cramer, 2005). Moreover, the underlying work assumption is violent in nature, because employees witness and engage in the killing of hundreds of animals per day (Barmak, 2010; Broadway & Stull, 2006; Dalla et al., 2005; Human Rights Report, 2004; Olsson, 2002). Slaughterhouses have been reported to have the highest injury-on-duty rate in any manufacturing industry (Beirne, 2004; Broadway & Stull, 2006; Human Rights Watch, 2004). Reported injury rates range from 20 - 36% per annum (Dalla et al., 2005; Dillard, 2007; Human Rights Watch, 2004; Olsson, 2002) and according to Broadway and Stull (2006) this is at two and a half times the overall manufacturing injury rate. Injury risk factors include working long hours at high production speeds with sharp knives and hooks in a cold and wet work environment (Human Rights Watch, 2004). The work is physically demanding involving thousands of repetitive and awkward motions of heavy lifting, pushing, pulling, stretching and cutting. Unavoidably, employees are consistently in contact with blood, grease, faeces and intestines and succumb to injuries such as carpal tunnel syndrome, trigger fnger, back problems, trauma disorders, tendonitis (Pearson, 2004) sprains/strains, cuts, punctures, back pain (Broadway & Stull (2006)), cumulative trauma disorder, ( Dalla et al., 2005), white fnger and cut wounds (Dillard, 2007). A comprehensive study by the Human Rights Watch (2004) added musculoskeletal disorders, claw hand, ganglionic cysts, bursitis and arthritis to the injury list. This is often exacerbated by the lack of proper training as well as the shortage of, or inadequate safety equipment (Human Rights Watch, 2004). As violence against animals has been linked to mental health problems in people (Beirne, 2004; Daly & Morton, 2008; Dillard, 2007; Flynn, 2002; Green, 2002; Henry, 2004), some have applied spillover theory to argue a relation between slaughterhouse work conditions and deviant employee behaviour in and outside of the work setting (Baron & Straus, 1987; Baron, Straus, Jafee, 1987; Fitzgerald, Kalof & Dietz, 2009; Flynn, 2002; Green, 2002; Marshall, Panuzio & Taft, 2005). A constant threat of dismissal for refusing to work exacerbates the physical burden carried by employees (Dalla et al., 2005; Dillard, 2007; Human Rights Watch, 2004; Pearson, 2004). Focusing on individual coping and adjustment, Kristensen (1991) emphasised that workers in slaughterhouses display very high rates of somatic and psychological symptoms such as locomotive symptoms, fatigue, stress, and back pain. Similarly, Dillard (2007) note that employees often sufer from psychological trauma as a result of serious physical health hazards, violence against animals and the daily witnessing of animal deaths. Post-Traumatic Stress Symptom Framework Behaviour becomes abnormal when it deviates from positive mental health and causes physical and psychological discomfort, faulty perceptions of reality, dangerousness, personal distress, dysfunction and maladjusted behaviour (Lowman, 1993; Nevid, Rathus & Greene, 2008; Sue, Sue & Sue, 2003). Workplace ill-health have been related to feelings of strain, loss of control, anger, fear, emotional numbing, exhaustion, physical illness, depression and anxiety, leading to work-life imbalance, poor performance, loss of confdence and concentration and workplace accidents and absenteeism (Els & De La Rey, 2006; Hardy, Woods & Wall, 2003; Kopp et al., 2007; Loretto et al., 2005; Peeters & van Emmerik, 2008). Post-Traumatic Stress Disorder (PTSD) is classifed as an anxiety disorder with prolonged characteristics symptoms that develop after direct experience of a traumatic event (Nevid et al., 2009). Diagnostic symptoms of PTSD can be clustered according to three main types of symptoms as defned in the DSM IV-R (APA, 2000) namely, persistent re-experiencing of the trauma, psychological and behavioural avoidance symptoms, and heightened arousal (cf. Balducci, Fraccaroli &Schaufeli, 2011; Lang & Stein, 2005). Characteristic PTSD symptoms of emotional distress and/or emotional numbing (Nevid et al., 2009) are clustered as avoidance symptoms. The three-tier PTSD symptoms framework is depicted in Figure 1: Figure 1: Post-Traumatic Stress Symptom Framework Research Objective To explore the prevalence of PTSD symptoms in slaughterers’ narratives of their experience of working on the slaughter foor of a national abattoir in the South African meat industry. Research Methodology Research Orientation From a constructivist epistemology and ontological assumptions underlying critical realism, participants’ lived work experiences were initially phenomenologically explored. A phenomenological-hermeneutic interpretation of the data followed by applying a post-traumatic stress perspective to our understanding of participants’ narratives. Research Context and Participants This study was based on a single case design, namely the slaughter section of a leading abattoir in the meat processing industry in South Africa. The selected population included staf involved in the actual killing process, namely the stunners and bleeders. In terms of slaughterhouse terminology, a stunner is the person that shoots the animal with a captive bolt on the forehead to render it unconscious. A bleeder is the person that fnally kills the unconscious animal by cutting the jugular vein in the throat of the animal. About 15 employees were employed permanently or occasionally as stunner and/or bleeder at the time of the study. Purposive, non-random sampling was used to select six stunners and fve bleeders to participate in this study. To triangulate the source of data and enhance credibility, two managers (not stunners or bleeders) and two supervisors (also occasional stunners) were further selected and interviewed. Only one of the two managers was a woman. All the other participants were men. Entrée and Researcher Roles Entrée was facilitated by the primary researcher’s employment as an HR manager in the abattoir and all the participants were familiar with her. Written consent was obtained from abattoir management to conduct the study on site. Data Gathering Data were collected through direct observation of employees on the slaughter foor, recorded semi-structured interviews and a review of personnel records. Recorded interviews were transcribed and data were supported by researcher feld notes. In some cases employees were interviewed a second time. After 16 interviews it became sufciently evident that no new themes were emerging. Personnel records revealed a higher than average staf turnover, high rates of injuries and higher than average disciplinary records for misconduct including substance abuse, aggression and tardiness at work. Data Analysis Thematic data analysis involved immersion in the data, refection, obtaining a sense of meaning, determining recurrent or unique themes and categorising and describing the data according to the PTSD symptom framework. Each line or comment in the transcribed text was given a meaningful label or descriptive. These initial labels and descriptives were scrutinised for similarities, diferences and common meanings and a number of signifcant themes started to emerge. Themes were further clustered and fnally scrutinised in terms of the three-tier PTSD symptom model. In congruence with the research objective, themes that did not have bearing on the characteristics symptoms of PTSD were discarded. Ensuring Quality and Ethical Research Ethics: Due to participants’ level of literacy informed consent was obtained by explaining to participants the nature and purpose of the study, by emphasising voluntary participation and the freedom to withdraw. These aspects were reiterated during interviews and follow-up interviews as well as with regard to the taking of photo’s during periods of observation. Participants were ensured that their identity would not be disclosed in any photograph. Design coherence: Findings were submitted for quality peer review at various stages in the research process to ensure that the research design was aligned with the research objective and that conclusions drawn from the data are appropriate to the initial research objective. An audit trail was established by keeping all memos, feld notes, data records; by describing the research design and methodology in detail, as by grounding our interpretations in the data and lived experiences of employees. A Pilot interview was done with slaughterhouse employees to ensure the interview questions were designed in a manner that would elicit in-depth rich descriptions congruent to the research objective. Method triangulation: Data were gathered via semi-structured interviews with slaughter foor employees as well as supervisors, and managers, by scrutinising absenteeism and disciplinary records; also by direct observation and photos and video-clip recordings of these observations. Management validation and participant reviews were done. Consistent self-refection is imperative – not only because of the study being a qualitative one based on the assumption that the researchers are the primary research instruments, but also because it becomes necessary to debrief our emotions and experiences of working with people in this context. We write about our experiences and also have frequent refective discussions with one another. Research Findings Being psychologists our initial naïve reading of the data and the emergence of several initial themes were infuenced by our preconceived knowledge of anxiety disorders and in particular PTSD. As such the themes that emerged were interpreted within the theoretical PTSD framework below: Re-Experiencing: Nightmares and Recurring Thoughts All respondents sufered from bad dreams at least initially and most experienced recurring nightmares representing feelings of fear, guilt, and revolt in relation to their job. RP13: “... you see eyes, I saw, eyes of the animal, it’s like it’s watching me. That thing, that dream, I didn’t feel well even when I came back to work, but I keep on checking the eyes to see it’s watching me, because I saw it in the dream”. RP10: “... Some of the days I dream about the cattle, when you stun it, it just fall down, after falling down, when you open the door it will ask you ‘Why are you killing me?’”. RP3: “One day I dream that the cow get out at the stunning box. It was alive. Then, I think that I am crying and running, and that time I am not running. Down here, down here! (Motioning that he fell down), my heart becomes scared. Yes, and the cow is coming and you fall down. You fall down”. RP4: “I got many nightmares. I dream I walk on the slaughter foor, and suddenly an animal comes to you, or a bull chases you”. RP9: “In my dream I see the bleeding line, just the cattle hanging on the line, all whose heads are of. I get this picture often. It’s not nice to dream about blood; you wake up wet with sweat”. RP12: “Myself, I had nightmares about the blood, and the slaughtering of animals”. RP1: “I was dreaming the same way of the blood and killing the cattle. I see a lot of blood. And I see this kind of job, how it afects my mind”. Psychological and Behavioural Avoidance through Substance Abuse, Self-harm, Emotional Blunting, Feelings of Guilt, Shame and Sadness All respondents admitted to regular alcohol abuse and evidence of some dagga abuse was evident. One respondent witnessed another stunner inficting self-harm. All respondents reported on the initial traumatic or shocking experience of either stunning or killing an animal. Their initial experiences elicited feelings of pity, shock, fear and revulsion. Within time those who are still employed on the slaughter foor seem to become used to it, yet some report an abnormal loss of emotion whilst others retain feelings of guilt, shame and sadness. Substance abuse RP10: “I’ve got a stress of the whole week, working early until late. I’m tired. Maybe if I can get a glass of alcohol to release the stress”. RP4: “There are guys who smoke dagga to get strength to do the job... guys are so aggressive, every afternoon after work they go drinking”. RP9: “...lately I want to go after work to drink something, it feels I must as if I want it”. RP14: “Some will take dagga or alcohol every week”. RP8: “Dagga gives them a lot of energy. Yes, it makes them hard working and strong”. RP15 describes slaughter foor employees as: “... they are notorious hard drinkers and drug abusers”. Flashbacks and vivid memories Concurrent physical reaction Recurring dreams/nightmares Anxious thoughts Irritability Anger outbursts Sleep problems Exaggerated startle response Concentration difculty Emotional numbness Guilt Depression Worry Loss of interest Memory loss Re-Experiencing Avoidance Hyper-Arousal Self-harm RP8: “There are people who injure themselves on purpose, just so they don’t need to work... I watched while he took the knife out of the steriliser, and saw how he stabbed himself in the knee, very deep, so much that the knee burst open, just not to work”. Emotional blunting RP9: “In the beginning I felt sad, but lately I feel nothing. You really feel less and less every day. The more you do it, the easier it gets. The more you kill cattle I think something inside slowly dies. Like yesterday, it looked at me; I walked to it, shot it, turned around and left. I felt nothing”. RP12: “Today I’m very used to it. I even play with the blood with my boot, moving it around. The emotions you had before, the feeling, the mercy that you had on that animal goes, you know, it is becoming less and less”. RP8: “As time passes, you get used to it. You feel nothing. You can imagine, if you kill a thing a 1000 times over and over, you wouldn’t have feelings after a while. It kills you on the inside, an abattoir, it kills you. You can be full of blood, it will not bother you”. RP15: “The frst time I went into an abattoir it was quite horrifying for me. And the longer I’ve worked; it’s a fact of life, that you, you become blunt”. RP9: “...we had an incident last night; someone was cut in the stunning area, by one of his friends. It was an accident, but he simply felt nothing. He didn’t even say sorry. He said it was an accident, turned around and continued cutting open the cattle. I thought it was his friend, that he would apologise, but he just turned around...”. Guilt, shame and feelings of sadness RP2: “Sometimes you feel so sad; you just ask yourself so many questions...Why? Is it because of the money? On the other hand I think, I have kids, I have to support my kids, so I don’t have a choice”. RP5: “...when you kill the animal sometimes you feel ashamed to the animals. When you die, all the animals you killed, they are going to kill you in heaven. Sometimes you think how many animals I have killed since I’ve been here; I think maybe thousands or millions. I am going to stand before these animals... ”. RP10: “Some of them, if you stun them they just look at you and cry. When it cries and then it gives me another thing, of eish. I like animals and now I am killing the animals”. RP4: “In the beginning I was ashamed to tell people where I work. You rather lie than say where you work because immediately they don’t like you anymore. My uncle told me you never say where you work. I was very ashamed, working with blood”. Evidence of Hyper-arousal: Sleep Disturbances, Aggression and Irritability Many respondents sufer from sleep disturbances. Some linked to nightmares. All participants told various tales of their own irritability and aggressive behaviour or of that of other stunners and bleeders. Sleep disturbances RP8: “I talk and shout in my sleep, so bad that my wife wakes up”. RP9: “It’s not nice to dream about blood; you wake up wet with sweat”. RP13: “... my brother, he used to laugh at me because I was, I keep on screaming. Okay, he asks me, what’s wrong? I tell him I’m dreaming of killing cows. Eish... it’s not easy”. Aggression and irritability RP9: “...I lose it quickly; I don’t know why, if someone just messes with me a little bit, then yes, the fsts swing”. RP10: “Sometimes if you argue with the guys, I’ve got the short temper. When I am alone, sitting, thinking maybe if I could fght with my wife, when am I going to do it, I am not afraid anymore. I’m killing thousands of cattle at (name of organisation). Kill 800 or 900 cattle, it’s nothing that’s gonna stop me to shoot only one person.” and “...actually, I like to use weapons, I don’t want to fght with my hands, because I will waste a lot...I will waste a lot of energy. Maybe I can take something, hit you then case closed, I will see the consequences after”. RP8: “...you go to the shebeen, see if you can fnd black people to beat up...” and “it’s complicated to me... it can infuence you so that you start beating your wife, assault children, such things, kick animals, hurt animals, it happened to me... I can kick it if I want, because I kill cattle, sheep, pigs, horses every day... you kick this cat or dog so that it fies, just because you can, you don’t worry, see... it feels like I must hurt this other animal”. RP12: “One of the slaughterers fought with a supervisor and chased him around with a knife, it has happened in this company. He was suspended from, you know, expelled from the company. I don’t know if he was doing it because he was having that problem before or maybe it was the work that made him do that.” RP4: “...if you push him any further he will stab you with a knife. I had an incident with my eldest brother. He jumped over the paunch conveyer and attacked the director and the supervisor. He lost his job”. RP5: “What I was wanting was just to hit, I need to hit, especially my girlfriend, but after you have done it, you feel sorry for that”. Discussion Evidence of PTSD symptoms in the work-experience narratives of slaughter foor employees is overwhelming and seems to echo research fndings in other countries highlighting the traumatic nature of work on the slaughter foor. Rohlf and Bennett (2005) found evidence of hyper-arousal, emotional detachment and guilt feelings amongst people who euthanize animals. More specifc to the slaughterhouse context, various psychological problems, similar to this study, has been found: Detached afect (Daly & Morton, 2008; Dillard, 2007; Henry, 2004), doubling (splitting self into two personalities) (Dillard, 2007), substance abuse (Pearson, 2004), loss of concentration and awareness (Human Rights Watch, 2004), child neglect (Human Rights Watch Report, 2004), nightmares and sleep disturbances (Hillier, et al., 2005) and depression (Dillard, 2007; Human Rights Watch, 2004). Slaughterhouse employees have been reported to lose the ability to empathise with animals, leading to a general insensitivity towards the wellbeing of other people (Daly & Morton, 2008; Dillard, 2007; Henry, 2004). Aggression to the point of violence as a form of pleasure are reported elsewhere (Dillard, 2007) as in this study where some participants related a need for violent behaviour towards others, even close loved ones. Few consider the stressful impact of being the perpetrator in a stressful event, such as being a killer, torturer, war veteran and slave catcher (MacNair, 1999), or in this case a slaughterer. Dillard (2007), however, found slaughterhouse employees to sufer from symptoms related to PTSD and coined the condition Perpetrator Induced Traumatic Stress (PITS). Recommendations According to Nevid et al (2008) trauma in life is common and many people remain resilient in the face of traumatic life experiences. Cumulative exposure to killing animals may, therefore, either increase stress symptoms or decrease stress symptoms through learnt resilience, detachment or desensitising as noted by Rohlf and Bennett (2005). Despite the notion that employees develop coping skills in this manner, the traumatic experience of working as a stunner or a bleeder cannot be ignored and requires special attention in terms of employee support. In light of research highlighting factors that increase a person’s risk of developing PTSD in the face of traumatic experiences, more research is needed to identify factors that will decrease the experience of prolonged trauma and to facilitate employment of resilient stunners and bleeders. With an acute awareness of the limitations inherent to qualitative studies and small samples in general, this study may not be generalised to the wider meat production industry. The fndings are of such disconcerting nature that further research and pragmatic interventions seems imperative in view of enhancing the wellness plight of stunners and bleeders in this company in particular. Research needs to be extended to a bigger population, to include other abattoirs and to compare experiences across diferent sections of an abattoir. The psychological impact of slaughter work from a traditional African perspective may further elicit insightful conclusions. Operational and organisational support in the form of wellbeing interventions, psycho-social development interventions, counselling, debriefng sessions, job rotation and even recreation should be explored as possible facilitators of resilience in this work context. References Some pertinent references are included here; the full reference list is available from the authors. Beirne, P. (2004). From animal abuse to interhuman violence? A critical review of the progression thesis. Society & Animals, 12(1), 39-65. Dillard, J. (2007). A slaughterhouse nightmare: Psychological harm sufered by slaughterhouse employees and the possibility of redress through legal reform. Georgetown Journal on Poverty Law & Policy, 15(2), 391-408. Fitzgerald, A.J., Kalof, L. & Dietz, T. (2009). Slaughterhouses and increased crime rates: An empirical analysis of the spillover from “The Jungle” into the community. Organization and Environment, 22(2), 158-184. Lang, A.J., & Stein, M.B. (2005). An abbreviated PTSD checklist for use as a screening instrument in primary care. Behaviour Research and Therapy, 43, pp. 585-594. DOI: 10.1016/j.brat.2004.04.005. Rohlf, V. & Bennett, P. (2005). Perpetration-induced traumatic stress in persons who euthanize nonhuman animals in surgeries, animal shelters, and laboratories. Society & Animals, 13(3), 201-219. Open Rubric