Fighting hero syndrome: watch out for the punch line!

Covid-19 arrived in France in a hospital environment that had deteriorated dramatically, with extremely difficult working conditions and a growing feeling of non-recognition by the public and, even more so, by the authorities.

Florence Nande, University of Montpellier and Marie-Laure Weber, University of Montpellier

All this is contributing to a growing malaise among healthcare personnel. And yet, in the face of this unprecedented health crisis, hospital staff are standing up and mobilizing in the field, day after day, in the service of the whole nation.

We rediscover these men and women who fight at their peril for others: yesterday's forgotten men and women become today's heroes. They are the subject of many tributes, not only from anonymous French citizens, but also from the highest levels of government. The French President's martial speech on March 16 ("We are at war"), announcing the start of the generalized confinement of the population, turned care workers into fighting heroes. At the height of the health crisis, the French applauded them from their windows at 8pm every evening, a sign of recognition for these admired behind-the-scenes workers. And every day, the media relayed messages of support from the entire population.

Loss of psychological resources

Yet donning the costume of the fighting hero can prove dangerous in both the short and long term for these caregivers. Their daily lives are extremely stressful, and they are already weakened by past battles. Their anger at the lack of resources has not been heard by the public authorities, as evidenced by the protest movements by hospital staff at the end of 2019.

The fighting hero in mythology is a superman, a demigod who stands out for his exploits, his extraordinary courage, his great self-sacrifice and his sense of sacrifice; he goes into battle and suffers in silence without asking for any help.

Although the medical profession is self-sacrificing and courageous, their daily lives are also marked by: fear for themselves and their families, stress induced by shortages of protective equipment, the brutality of this disease which generates an exponential influx of patients and day-to-day reorganizations, the fear of having to make choices that are not in line with their values, incivilities and violence on the part of some of the population, fatigue that accumulates in a daily life that has become anxiety-provoking in the extreme. All this contributes to exhausting their psychological resources.

This approach to the fighting hero may seem rewarding and encouraging in the short term, but without strong support conditions and additional resources, it runs the risk of failing to compensate for the loss of personal resources that these extreme circumstances provoke, with short- and long-term consequences for the psychological health of caregivers.

Hobfoll 's(1989 ) Resource Conservation Theory (RCT) provides an insightful reading of this situation. It states that individuals continually strive to obtain, conserve, protect and foster the resources they value (e.g. health, family, etc.). Stress arises when these resources are threatened or actually lost, or when events make it impossible to gain new resources despite considerable individual effort.

Availability and access to these resources enable individuals to achieve or maintain their goals. Situations that jeopardize access to these resources generate stress and can have longer-term consequences for an individual's psychological health. It is therefore important to put in place conditions that enable the medical profession to protect and nurture their reservoir of resources - conditions that Hobfoll calls resource caravan passageways.

When individuals live in enriched and stable contexts, they have fertile ground to develop richer resource networks and to maintain their "resource caravans" (in other words, their resource reservoir); whereas in deleterious circumstances, individuals may struggle or fail to develop or maintain them.

Recognition is not enough

In the light of this theory, there is a strong risk that these caregivers, who live in an unprecedented situation where their core resources (health, family, meaning of life) are continually under threat, will develop a sense of chronic stress that can have consequences for their health. In this case, the resource "recognition" does not in itself constitute a weapon of resistance against stress. In the short term, it will keep us going, but it won't be enough if it isn't accompanied by other material, financial and human resources to compensate for the loss of resources experienced by our caregivers.

This is all the more relevant as, following circumstances of chronic stress, people tend to see their resource pool increasingly depleted and will be more vulnerable to combat future losses. Hobfoll emphasizes the primacy of loss: individuals overweight the loss of resources and underweight the gain. In other words, every individual has a sensitivity to loss, i.e. emotional responses are stronger to negative experiences than to positive ones. It is therefore important to put in place sustainable conditions to maintain a level of available resources, at the risk of witnessing the emergence of increased work-related ill-being when the spotlight fades on these professions.

The massive plan to invest in hospitals and upgrade careers announced by the French President on March 25, in the midst of the crisis, must therefore put in place sustainable conditions that provide, enrich and protect caregivers' resources. This could be the beginning of a response to neurologist François Salachas's now viral challenge last February: "You can count on me, the opposite remains to be proven...".

Florence Nande, Temporary Teaching Assistant Research (ATER) - MRM Laboratory and IUT de Nîmes, University of Montpellier and Marie-Laure Weber, PhD student in Management Sciences, MRM Laboratory, University of Montpellier

This article is republished from The Conversation under a Creative Commons license. Read theoriginal article.