Social reactions to decompression illness

What can sociological and psychological sciences do for divers? Studies of diver behaviour can reveal important factors that contribute to risk of injury and how we react to incidents involving injury and/or fatalities and can potentially inform changes to procedures that can influence social attitudes and individual attributions, and ultimately safety.

Several months ago I caught a very brief radio piece referring to research on social reactions and stigma surrounding decompression illness, by Jennifer C Hunt, a Sociologist and university professor. This online article outlines her research in this area. It appears to be from around 15 years ago, so this is not current research, but interesting themes include:

  • Immediate survival and post-traumatic reactions – “The immediate concern for the diver with DCI is the threat of death….. must face the reality that he or she is not invincible, bend victims may suddenly become aware of their physical vulnerability and lack of control over their bodies.”
  • Loss in terms of injury or social relationships – “If the diver survives, the threat of other physical losses becomes paramount. These include the loss of bodily functions that have previously been taken for granted”
  • Loss of diving – “Diving is not only a social activity but also a deeply private one. A fundamental concern of any serious diver who “takes a hit” is the loss of diving itself, a deeply meaningful experience which lies at the core of the person’s being and defines him or her as fully alive.
  • Defense reactions such as minimising shame by shifting of blame- “Denial is not the only defense divers use. Joking and excessive concern with a buddy provide other means of protection. Divers also try to minimize the guilt and shame associated with making mistakes by shifting the blame to something outside themselves. They may engage in attacks on the self in order to keep a lid on the rage they feel towards others. Admission of their own participation in an accident is particularly painful for some divers, because they recognize that there is a part of themselves they do not control which encourages them to take risks and suffer injury.”
  • Judgement of moral responsibility; “good victim” (e.g. inexperienced and not made aware of risks) and “bad victim” (e.g. exceeded limits and “deserving” of consequences). – “A recent article on computer dive accidents highlights this distinction. “Bends appear to fall into two distinct categories: 1) undeserved hits (mystery accidents), and 2) deserved hits (resulting from violations of safety procedures).” (Murphy, 1992). Categorization of the “bad” victim is subject to flux, depending on whether the diver admits a mistake and how he or she publicly handles the accident.”
  • Reactions of dive shop/employer and attitudes to injured staff – “Many shops depend on training agencies for their ratings, which they fear will be compromised if too many instructors get DCI. The shop’s public image is also at stake, and managers fear losing customers.”
  • Limits of responsibility – “There is great variation in policy and practices regarding diver safety. …vary in how they view their responsibility and the precautions they are willing to take.”
  • Concealment of symptoms of DCI – “diver experienced symptoms of DCI and did not discuss them with the divemaster because she feared his reaction. She continued to conceal her fear that she had DCI when they arrived on shore, despite some mild symptoms of paralysis.”
  • Social responses (e.g. degrading remarks) – “Joking and sarcastic remarks constitute another way that buddies often react to accidents. Some jokes are friendly; others are ambivalent or overtly hostile.”
  • Internal shame/guilt  vs external blame – “…continues to vacillate between blaming herself and blaming others. Sometimes she attributes her accident and/or physical disabilities to her computer, an irresponsible dive operation and a catheter. At others, she becomes involved in endless attacks on herself. Her defensive fluctuations, which alternately protect her from shame and humiliation or intolerable rage, provide no relief. This diver cannot forgive herself for what happened and has little understanding of why she put herself at risk of injury. She often feels as though she was punished and sometimes she thinks she deserved it.”
  • Impact of psychological and social reactions on behaviour and diving practices – “Some divers, feeling socially discredited and depressed after a prolonged illness, may go back to diving before they fully understand the dynamics of their accidents and resolved the trauma.In their minds, only diving can restore self esteem by proving to themselves and others that they are socially worthy members of the diving community.”

There appears to have been evidence from the participants in studies summarised here of DCI being socially stigmatising and triggering blame/shame.  The radio piece highlighted this as being a difference in how we respond psychologically to DCI than to injuries within other sports. The author concludes that “DCI is not a moral disease” and “victims should be treated with understanding”.   It is interesting to consider if and how this has changed at all over the years since the piece was written, as well as related questions around current attitudes to DCI and behaviour in relation to risk.

Hunt, J.C., (1993). Straightening out the Bends. AquaCORPS Magazine, (5)

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