Medical Professionals Working with Forensic Cases: Self-Regulation, Freeze Responses, and Challenges in Relational Contact

Introduction: The Invisible Burden of Those Who Witness Trauma

Health professionals working with forensic cases encounter not only the biological reality of the body but also the traces left upon it by violence, neglect, abuse, death, and trauma. These encounters are often understood primarily through technical expertise, legal responsibility, and professional composure. Yet the nervous systems of professionals who are repeatedly exposed to forensic cases are also affected by these difficult encounters.

In the psychological literature, these effects are described through concepts such as secondary traumatic stress, compassion fatigue, vicarious traumatization, and burnout. Figley suggests that professionals working with traumatized individuals may develop trauma-related responses even when they have not been directly exposed to the traumatic event themselves. McCann and Pearlman, through the concept of vicarious traumatization, further propose that repeated engagement with traumatic material may alter a professional’s sense of safety, control, meaning, and ways of relating to others.

Forensic Exposure: The Embodied Cost of Witnessing

In forensic medicine, trauma is often not a single event but a recurring form of occupational exposure. Evaluating signs of abuse in a child, examining a suspicious death, documenting injuries on an assaulted body, or listening to a victim’s account is never merely a professional procedure. Each case may leave a trace within the worker’s psychological and bodily system.

These traces do not always emerge as an obvious breakdown. A person may continue performing their duties, making decisions, writing reports, and attending to patients or case files. From the outside, they may appear strong, controlled, and fully functional. Internally, however, sleep disturbances, irritability, avoidance, hyperarousal, emotional exhaustion, or a reduction in empathic engagement may gradually develop.

Research by Levin and colleagues on forensic science professionals suggests that secondary traumatic stress may be particularly pronounced among professionals working directly in the field. Such findings indicate that those working in forensic settings need protection not only through professional training and technical competence but also through psychological support systems.

Self-Regulation, Freezing, and Desensitization

For professionals who work with traumatic material over long periods, the issue is not simply whether they “feel too much” or “become emotionally numb.” At a more fundamental level, their capacity for self-regulation may become strained. Self-regulation refers to the ability to recognize intense emotional, bodily, and cognitive activation, tolerate it, and eventually return to a state of relative balance. When this capacity is weakened, a person may remain emotionally affected while still struggling to express that response directly, establish relational contact, or demonstrate care in an explicit way.

Within this framework, freezing should not automatically be confused with indifference. In some situations, a person may remain ethically sensitive, cognitively engaged, and emotionally affected, while the autonomic nervous system narrows their range of action in response to threat, intensity, or vulnerability. At such times, the individual may prefer more distant forms of communication or may attempt to maintain contact indirectly through third parties or mediated spaces rather than through direct interaction.

The depersonalization dimension described in Maslach and Jackson’s burnout model is particularly relevant here. Depersonalization may gradually lead professionals to perceive the person before them not as a subject but as a case, a file, a body, or a task. This shift does not necessarily arise from ill intent. It may emerge from the accumulation of prolonged occupational strain and unprocessed traumatic exposure. Yet understanding why it occurs does not mean that its consequences are harmless.

Conclusion: From Ethical Sensitivity to Direct Care

The psychological burden experienced by health professionals working with forensic cases cannot be reduced to a matter of individual resilience. For this reason, the solution cannot be limited to superficial messages such as “be strong,” “you will get used to it,” or “remain professional.” Regular supervision, psychological support, spaces for team-based reflection, and trauma-informed institutional practices are fundamental needs in this field.

At this point, the distinction between ethical sensitivity and the capacity for direct care becomes visible. A professional may be deeply committed to principles such as justice, nonmaleficence, the right to life, and the recognition of victimization. Yet the same person may struggle to establish direct contact when confronted with the concrete vulnerability of another living being. In the face of trauma, however, the most restorative intervention is not always a major solution. Sometimes it is a simple, clear, and direct act of relational contact.

A weakened capacity for self-regulation does not remain confined to the professional’s internal world; it may also affect the people with whom they interact. Ambiguous, indirect, or interrupted forms of care can produce insecurity, loneliness, and exhaustion from continually trying to make sense of the relationship. Addressing the psychological burden of professionals exposed to trauma therefore appears necessary not only for their own well-being but also for relational and professional ethics.

Health professionals working in forensic medicine and trauma-related fields look directly at realities that society often prefers not to see. Yet if the traumatic burden of those who witness trauma remains invisible, that burden may gradually erode both professional judgment and the capacity for genuine, living contact.

Perhaps the most fundamental question for this field is therefore:

Who cares for the trauma of those who witness trauma?

Kaynakça

• Levin, A. P., Putney, H., Crimmins, D., & McGrath, J. G. (2021). Secondary traumatic stress, burnout, compassion satisfaction, and perceived organizational trauma readiness in forensic science professionals. Journal of Forensic Sciences, 66(5), 1758–1769. https://doi.org/10.1111/1556-4029.14747 PubMed
• McCann, I. L., & Pearlman, L. A. (1990). Vicarious traumatization: A framework for understanding the psychological effects of working with victims. Journal of Traumatic Stress, 3(1), 131–149. https://doi.org/10.1002/jts.2490030110 Wiley Online Library