A significant fraction of EI victims are professional electricians. In terms of cultural psychology, electricians as an occupational group have been less studied than members of other occupations that involve a significant risk of personal injury, such as firemen, military, police, or professional rescuers. Electrical accidents, with the exception of those resulting in major explosions, fire, and multiple injuries, tend to be spatially isolated, often not witnessed, and generally believed to result from the victims' own incompetence. The shame that electricians often feel following an accidental electrical contact, as well as the fear of being judged incompetent and losing their job may prevent them from reporting not witnessed "minor" accidents. Therefore, the actual levels of lifetime accidental physical exposure to electrical current among professional electrical workers are not precisely known.
The survey study of electricians performed by the authors was published several years ago. It was designed to reveal essential group attitudes and cultural norms of electricians related to their occupational risks and electrical injury that may influence patients' post-traumatic clinical presentation and long-term outcome. Out of the four hundred eighty-one (481) anonymous surveys, 96.7% of electricians reported having experienced an electrical shock at some point of their career; 13.1% reported having contacted an electrical source and been thrown away; 9.6% had experienced a "no-let-go" (i.e., involuntary muscle contraction that prevents the victim from breaking away and may cause a prolonged consciously experienced current conductance); 2.5% reported having had a loss of consciousness due to electrical contact; 25.6% reported having witnessed an electrical accident ranging from a "minor" contact to a fatality. Despite the significant reported exposure rates, only 10.8% of respondents described their shock as an injury that required medical help. Medical help was most likely sought in case of loss of consciousness (92%), while only 32% of people went to a hospital out of everybody who reported having been thrown away after an electrical contact, as did 52% of everybody who experienced a "no-let-go." As can be seen, the question of when it is necessary to seek a medical evaluation is not an obvious one in the eyes of electricians.
ELECTRICIANS' UNDERSTANDING OF ELECTRICAL INJURY SEQUELAE
An open-ended question in the survey-"what effects of electrical injury concern you the most"-was intended to address the electricians' awareness of various electrical injury sequelae as revealed through their first associations. Also, by making a collective statement on most feared changes in their physical, emotional, and social well-being, it was hoped that the survey subjects would indirectly describe their most significant values, and critical elements of their self-image. The subjects were asked to specifically indicate their concerns in terms of (a) body injury, (b) emotional consequences, and (c) overall impact on their life.
However, 11.9% of electricians chose not to respond to the whole group of questions regarding the specific sequelae of electrical injury. 17.3% provided a nonspecific reply, such as circling one of the suggested structural subgroups rather than giving a worded answer or declaring their concern with "any," "all," and "every" possible effect. The category of emotional consequences received the largest share of absent or nonspecific responses: 48.4% and 15%, respectively. Body injury was understood best and was described in specific terms by 65.7% of subjects, with 21.6% giving no answer and 12.7% nonspecific replies. The question on overall impact on life was left blank by 34.9% of respondents and received a nonspecific reply in 15.2% of cases.
The ability to understand both trauma and recovery as process experiences that include movement through stages and gradations is essential for adequate psychological functioning post injury. Thinking in terms of extremes (such as "healthy" versus "dead") may become an impediment to psychological adjustment. More research, however, will be needed to make a positive statement regarding possible connections between premorbid "black or white" thinking pattern and development of emotional sequelae following a nonfatal injury. In this study, the expressed fear of death was related to the frequency of thinking about electrical injury, with those thinking of injury more often being more likely to mention death as their major concern.
Among other electrical injury sequelae, the subjects mostly expressed concern with possible physical injury, including fear of burns (22.2%), losing a limb (21.6%), eye injury (11%), disfigurement and scarring (9.4%), heart stoppage (8.7%), and nervous system injury, such as paralysis or peripheral nerve problems (5.4%). Only 1.9% of respondents mentioned head or brain injury among possible worrisome sequelae and 8.7% of electricians were concerned with loss of mobility, physically active lifestyle, and physical independence. 6.9% of subjects focused their worries on the possibility of permanent injury consequences, no matter what kind.
A strong body seems to be the pivotal aspect of the electricians' self-awareness. The body appears to be understood more in terms of a mechanical ensemble by younger men (hence the dominant fears of losing a limb) and more in terms of soft tissue by older men (dominant fears of burns). The dominance of visible body in the electricians' self-awareness is expressed in a clear emphasis of concerns with external injuries: 39.9% of respondents mentioned only external injuries versus 6.9% who mentioned only internal (mainly, heart) and 9.8% who included both types. Therefore, electricians' self-awareness does not provide the context for them to consider and understand "nonvisible" injuries. This may result in a significant identity crisis once such injuries have occurred and further complicate the recovery.
Among emotional consequences of electrical injury, fear of electricity was stated as a possible concern by 11% of respondents. Other effects, sparingly mentioned, include memories, nightmares, reliving the traumatic experience, stress, depression, guilt and responsibility, feeling stupid, loss of reputation, being unsure of oneself, being paranoid and losing trust in coworkers, feeling like a freak, personality changes, "ego" injury, and pain and suffering. Those respondents, who were able to speak of the possible emotional effects of injury in specific terms tended to be younger, less experienced at work, and better educated, compared to both those who gave a nonspecific answer and those who didn't give any answer. The relatively younger age of those who were able to speak of emotional experience in specific terms once again may reflect the general recent shift in American culture towards more emotional openness. The higher educational level may reflect both better developed language skills and insight.
32% of all respondents mentioned disability and losing job as their major concern in case of injury. In demographic terms, this group shows higher educational level and less work experience, compared to those who did not present an immediate awareness of such sequelae. Here, again, we can see that higher educational level is related to the ability of understanding experience stage wise, which implies an appreciation that major life adjustments may be necessary following an injury, while you continue to live and support your family and be part of society. The fact that younger people show more concern with losing their job after an injury could also be related to changes in the job market, along with a perceived decline in the union strength. A number of respondents have stated that a "proud trade" with security and union protection has evolved over their lifetime into a "rat race" vulnerable to market fluctuations and increasing demands of customers who seem to value speed over safety. One could argue that the concept of "proud trade" most likely reflects their young idealism some years back and may be a variation of "the golden age" mythology. However, the extent to which competitive market demands may indeed hamper the efforts in safety education needs to be explored.
A personal history of electrical injury or the type of experienced injury (e.g., burns, "no-let-go," fall, etc.) did not show any association with expressing fear of death. The type of witnessed injury was also not significant, with the exception that those electricians who witnessed an accident and personally knew the injured person were more likely to mention death as their primary concern. It is also remarkable and deserves further exploration that none of 6 people who had witnessed a fatal accident volunteered death among their fears, while in other cases responses were split.
OCCUPATIONAL DANGERS AND SAFETY BELIEFS
In designing this survey, a skewed distribution of answers to the question, "Do you agree that if workers are well trained and follow safety rules, they can avoid injuries?," was expected. However, even so, the actual results that have shown an overwhelming belief among the electricians in the possibility of being in control and the most massive denial of any other possibility are quite impressive.
Furthermore, their statistical analysis did not reveal any significant difference in reply between those electricians who had witnessed an electrical injury or had been personally injured (including those who reported having had a "no-let-go" experience and having been thrown away after electrical contact) and those subjects who did not report any of such experiences. This finding seems to reflect the general belief among the electrical workers that any accident can indeed be explained as a result of the victim's personal professional failure and the trade as a whole must not identify with a failure. As commercial electricity appears to belong to the man-made world, it is expected to be controllable given adequate skills and behavior. In view of the fact that 96.7% of the survey subjects have reported having experienced an electrical shock at some point of their career, this overwhelming belief in control and the possibility to avoid electrical contact seems to reveal electricians' primary cultural mentality that overrides any personal history.
There seems to be an interesting cultural duality and clash of paradigms in the electrical trade. On a daily basis, electricians are dealing with energy that is highly dangerous and potentially lethal. Historically, taming the superhuman energy has always been believed to be an action of the Hero rather than that of the Master. While industrial electrical work seems to combine both aspects, electricians are mostly perceived and see themselves as skilled tradesmen, as craftsmen. They identify their trade as part of "construction." Compared to firemen or emergency workers, electricians are summoned to start and create rather than to stop or prevent. They are expected to wire things, to fix, to make things work, and eventually to craft perfect masterpieces for transmitting exclusively useful energy. They go through rigorous training and apprenticeship in order to become masters, to reach the level of technical perfection that somehow equals safety.
If a fireman puts out the fire in time to save people in danger, he is a hero. If he's too late, well it has still been a heroic effort, but there are limits to human power. If the fireman is injured, no shame attached. On the other hand, if an electrician doesn't succeed, it is because of his incompetence. When he is shocked, it is his own fault. No safety means no perfection and no craftsmanship. Injury is a professional failure.
Successful rehabilitation and return to work following electrical injury depends on both recovery from tissue damage and adequate post-traumatic psychological adjustment and reintegration into society. The electrical injury clinical presentation is highly variable and ranges from major burns and catastrophic multisystem injuries to subjectively experienced somatic malaise, fatigue, emotional and neuropsychological symptoms, and admitted personality changes in the context of virtually no visible signs of sustained electric exposure. Although psychiatric, neuropsychological, and psychosocial sequelae have been repeatedly observed following electrical injury, no correlation has been found between the extent of physical injury and development of specific neuropsychiatric symptoms. It is reasonable to expect that the essential premorbid beliefs and attitudes as well as unique characteristics of an occupational and family subculture to which a patient belongs can be instrumental in the process of recovery as the authors suggest that they define the context for the patients' understanding of their injuries.