Descriptions of post-traumatic stress disorder (PTSD) appear in literature dating back to Homer (The Iliad, 9th century B.C.), Shakespeare (Henry IV, 1597), and Dickens (A History of Two Cities, 1859). Everyone wrote about traumatic experiences to the characters and symptoms that followed those events.
Over the years PTSD has been described as shock, war neurosis (World War 1), combat fatigue, combat stress response, or CSR (World War 2). In 1952, the American Psychiatric Association (APA) created the first Diagnostic and Statistical Manual for Mental Disorders (DSM-I) containing a “Gross Stress Response”. The diagnosis has been suggested for people who were generally mentally normal but had symptoms of traumatic events such as disaster or fighting. The diagnosis was based on the assumption that responses to the trauma would resolve relatively quickly after 6 months, and if present after that time, another diagnosis should be made. In 1968, despite growing evidence that exposure to trauma was linked to a constellation of psychiatric problems, the diagnosis in DSM-II was eliminated. It contained a section on “Adaptive Response to Adult Life” which limited itself to three examples of trauma, unwanted pregnancy with thoughts of suicide, fears related to military fighting, and a specific syndrome related to prisoners facing a death sentence. This diagnosis was clearly inadequate.
Prior to the publication of the DSM-III in 1980, the APA reviewed and confirmed the research that involved Vietnam veterans, Holocaust survivors, victims of sexual trauma, and others who had suffered major traumatic events. Links between war trauma, civilian life after the military, and the non-war traumatic events in a life in which PTSD affected the civilian population. DSM-6.2, released October 2017, reflects the continued research and development of knowledge about the causes and effects of PTSD. An important finding over the years has been that PTSD is relatively common. Exposure to a traumatic event is not uncommon, according to a study cited by the Job Accommodations Network. Approximately 7-8% of the American population will develop PTSD at some point in their life. Approximately 8 million adults suffer from PTSD in any given year. This is only a small fraction of those who have been through trauma. Almost 10 in 100 (10%) of women will develop PTSD at some point in their life, compared to about 4 in 100 (4%) of men. By adding PTSD to the DSM, the APA merely coined a new term for an ancient disease. While it is often viewed as a war disorder, it has also affected civilians involved in natural disasters, mass catastrophes, or major accidents – events we are seeing more and more on the news but which have been around as long as humans.
PTSD is quite common in veterans due to the risk of daily traumatic events. Data from the National Center for PTSD (2015) suggest that approximately 11 to 20% of service members returning home from deployments in Afghanistan and Iraq have symptoms of PTSD. Statistics show that PTSD occurs in approximately 15% of Vietnam veterans and 12% of Gulf War veterans. In looking at these statistics, an employer needs to recognize that workers or potential workers with PTSD, veterans and non-veterans alike, are employed and may need workplace accommodation.
PTSD and the ADA
Title I of the Americans with Disabilities Act of 1990 (ADA) prohibits private employers with 15 or more employees, state and local governments, employment agencies, and unions from discriminating against qualified persons with disabilities in application processes, hiring, firing, and promotions, compensation, professional training, and others Conditions and privileges of employment. (42 USC)
The ADA is not limited to a list of conditions that constitute a disability, but provides a general definition of disability that each person must meet on a case-by-case basis. A person has a disability when they have a physical or mental impairment that significantly limits or is considered to be impaired in one or more important life activities, a record of such impairment. (EEOC regulations, 2011). According to the EEOC, the individualized assessment of virtually all people with PTSD due to their inherent nature will result in a disability determination under the ADA. The main life activities of learning, reading, concentrating and thinking, as well as the main body functions of the brain and neurological function, are included in its definitions. In fact, PTSD is explicitly included in the definitions of the ADA implementing rules as they severely limit brain function.
PTSD in the workplace
If an applicant does not need accommodation to support him with the application or the interview, he does not need to state a disability in an application. An employee is only required to disclose his or her disability if he or she needs accommodation to perform an essential function of his job. Otherwise, an employer may not know that an employee has PTSD unless the employee discloses or provides information that has been diagnosed with post-traumatic stress. Applicants with PTSD (or a disability) do not need to undergo a medical exam or answer medical questions until they are offered a job under certain conditions. If the need for a medical examination is job-related and consistent with the business need, an employer can request the examination. This can occur when an employee with PTSD has an incident in the workplace that would lead the employer to believe that the employee cannot complete the job, or when it is determined whether the employee can return to work safely and whether or not there is accommodation is required at work.
The National Center for PTSD lists four types of symptoms a sufferer may feel:
- Experience the evet through nightmares, flashbacks, or “triggers,” which can be sights, sounds, or smells that bring the event back.
- Avoidance – The person can avoid people or places that trigger the memories. This may include avoiding the crowds because they feel dangerous, avoiding the news or entertainment programs depicting the traumatic event. The person can be very busy so as not to have to think about the event.
- Negative changes in beliefs and feelings like avoiding relationships with others or simply feeling that no one can be trusted.
- Feeling empowered (hyperarousal) – The person may feel tense, excessively afraid, unable to concentrate, or easily startled. This indicates an increased alarm condition.
Symptoms of PTSD can manifest themselves in a number of ways in a person in the workplace. Memory problems, lack of concentration or poor interaction with employees and absenteeism are just a few examples.
Accommodations
The ADA requires an employer to make reasonable accommodation for the known disability of a qualified applicant or worker if doing so would not impose “undue hardship” on the operation of the employer’s business. Reasonable arrangements vary based on the needs of the individual. These are adjustments or modifications made by an employer to give people with disabilities the same job opportunities. Accommodation is not a waiver of an essential function of the job. Housing for people with PTSD can take many forms, depending on the needs of the individual. Accommodation ideas from the Job Accommodations Network include:
If you have difficulty concentrating, reduce the distractions of devices with white noise or ambient noise, headsets with noise cancellation, changes to lighting and allow for a flexible work environment or schedule.
Provide both written and oral instructions, checklists, wall calendars, electronic organizers or apps, additional training time or refreshments for people with storage problems.
Provide daily, weekly and monthly to-do lists for people with organizational problems, assign a mentor or coach and use electronic organizers or apps.
For those with time management issues, daily to-do lists and completed review tasks, pre-recorded electronic aids, regular meetings with supervisors or mentors to see if goals are being met.
For people with stress or emotional issues, highlight stress management techniques, allow a support animal, employ a mentor to warn the employee if behavior becomes unprofessional, provide EAP support, and / or enable a flexible work environment.
If you’re struggling with employee interaction, encourage the employee to break away from frustrating situations and confrontations, allow part-time work from home, ensure more privacy at work, and provide disability awareness training to supervisors and employees.
This is not an exhaustive list of potential issues and customizations. The Job Accommodations Network can provide assistance in recommending accommodation for employees who are also in distress due to PTSD.
It is right to recognize the needs of our returning veterans and those of us who have suffered trauma as a result of the actions of others or of nature. If the trauma leads to PTSD, Americans with disabilities require that these workers be recognized and accommodated. Supporting a person with PTSD should be a common goal for management and staff. With a little help and understanding, every employee can be a valuable asset for the work environment.
© 2020 Heyl, Royster, Voelker & Allen, PCNational Law Review, Volume VIII, Number 72
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