The images are graphic, disturbing, and endless, says a former Facebook employee. Her job as a content moderator required that she review and remove disturbing posts. That work, she claimed in a lawsuit, caused her to suffer serious psychological trauma.
In September 2018, she filed a complaint with the Superior Court of the State of California.
"Every day, Facebook users post millions of videos, images, and livestream broadcasts of child sexual abuse, rape, torture, bestiality, beheadings, suicide, and murder," reads the complaint. "By requiring its content moderators to work in dangerous conditions that cause debilitating physical and psychological harm, Facebook violates California law."
In May, Facebook settled the case, agreeing to pay $52 million to content moderators to compensate them for the consequences their work had on their mental health. The settlement was the first to officially recognize the psychological toll of exposure to disturbing material resulting from online moderator jobs. It also highlights an emerging understanding of vicarious trauma.
Also known as secondary trauma, vicarious trauma can result from exposure to images, stories, or accounts that someone does not directly experience, says Françoise Mathieu, MEd, CCC, RP, a compassion fatigue specialist and executive director of TEND, a company in Kingston, Ontario, that offers resources and training for people who work in high-stress, trauma-exposed workplaces.
Secondary trauma can affect people much as any other kind of intensely stressful experience. "What I can tell you as a specialist is that trauma is trauma," Mathieu says. "Our brain doesn't necessarily know the difference."
The potential for vicarious trauma has long been recognized as a risk for journalists, healthcare providers, and anyone who watches television coverage of a disaster. Only recently, Mathieu says, have researchers started to investigate the psychological impact of jobs that require people to look at extreme, graphic, or disturbing images.
In a 2017 study of digital forensic examiners, researchers found that examiners who worked on cases involving sexual crimes against children were at elevated risk of developing secondary trauma.
However, the exploratory study did not quantify the risks, and the study investigators concluded that more research is needed to understand how best to help people deal with posttraumatic stress disorder (PTSD) resulting from working in the criminal justice system.
Content moderation requires sifting through upsetting images, and people can react in different ways to the task, says Anthony Ng, MD, a psychiatrist at Hartford Healthcare in Mansfield Center, Connecticut.
Ng says some individuals may become emotionally numb in order to protect themselves. Others might relate to what they are seeing, either because of their own life circumstances or because of experiences they have had in the past. For example, individuals might think, "I could see that kid being my son, I could see that woman who was assaulted as my wife who got beaten up," he says.
Vicarious trauma can cause a physical stress response — the classic fight-or-flight reaction — to a threat that ramps up activity in an area of the brain called the locus coeruleus, Ng says.
Heart rate rises. Breathing rate goes up. Muscles become tense. If a threat occurs once and then dissipates, the body can often recover a state of calm. However, when that threat is part of the daily workday, it can cause chronic harm to mental and physical health. Unlike with direct, or primary, trauma, he adds, secondary trauma can take a while to become symptomatic.
"Your heart is not designed to be constantly pumping at a high rate," Ng says. "We just can't sustain that for long periods of time without starting to develop stress reactions."
Under the Radar
Some types of work appear to confer greater risk for trauma than others. Overall, estimates show that up to 8% of the US population will develop PTSD at some point in their lives, Mathieu says.
For police officers, the rate is 15%. According to reporting by The Verge, lawyers in the Facebook lawsuit cited vicarious trauma rates of up to 50% among content moderators.
There are multiple reasons why content moderators suffer such high rates of mental health problems, Mathieu says. Content moderation is a low paying, thankless, and solo job that can seem never-ending, she says.
Furthermore, content moderators are generally uninformed about the psychological risks associated with their occupation. They aren't given the time to process what they are exposed to and generally don't feel recognized or appreciated for the work they do.
That makes their jobs different from those of people such as law enforcement officers who investigate Internet crimes. For people pursuing justice, a sense of unity can counterbalance the exposure to tough imagery and information.
Going forward, Mathieu says, the only way to make content moderation safer is to institute changes such as better pay, more flexible schedules to allow breaks from exposure, and access to mental health professionals who can help employees process what they have seen.
Climate of Fear
"This can't be a climate of fear where people are afraid to ask for help," Mathieu says. "They are really important jobs, but people need to feel that they are safe in expressing when it's impacting them so that they're not worried that they're actually going to lose their work."
It would help if content moderators received evidence-based guidance to help process their experiences, Mathieu adds. However, to avoid doing more harm than good, debriefing has to be administered correctly.
For example, a method called "critical incident stress debriefing," a long-standing approach that research has shown can do more harm than good, is still widely used in law enforcement agencies. The technique requires individuals to talk about their traumatic experience immediately after it happens, which can cause retraumatization.
Instead, Ng recommends a more self-aware approach called low-impact debriefing. The method involves strategies such as giving fair warning, asking for consent from listeners, and being selective about the details shared.
Employees should also be taught to recognize and report early signs and symptoms so that they can seek help before psychological distress becomes overwhelming, Ng says.
Plenty of moderators do not develop PTSD, he says, despite their exposure to upsetting imagery. This suggests an important avenue for research ― understanding what makes some people resilient, even in the face of graphic and disturbing stressors.
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Cite this: Facebook $52M Settlement Flags Need to Screen for Vicarious Trauma - Medscape - Oct 29, 2020.