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following letter is from an officer who wrote
it in the Guestbook and kindly gave me permission
to use it in an article in the hope that his
experience will help others. He describes many
of the classic symptoms of police PTSD, or post
traumatic stress disorder. In fact, every distressing
thought, feeling and behavior he relates below
is a symptom of PTSD.
I am a (10 plus)-- year police
veteran and (30 plus)-- years of age. I have
become seriously concerned with some of the
events that have been taking place in my life
for the past two years. I have started having
nightmares frequently and have great difficulty
going to sleep at night. There is always a
feeling of uneasiness at night and I have
started to develop some unnatural habits associated
with these uneasy feelings. At the slightest
sound, I have to get out of the bed and check
every room in the house.
I have two children who live
with me and my wife and I have gotten to the
point that I almost always make them come
into my room at night because of the feelings
I have. If I am the first one in the house
to go to sleep, I am ok, but otherwise, the
feelings surface about 0:00 pm. I usually
end up passing out somewhere between 3 and
5 AM. I get up for work at 7 am and this has
started causing me a great deal of problems
in my job. I often find myself in a trance
thinking about traumatic events that have
taken place in my career and always find myself
in a very disheartened state afterwards. During
the recollection of these events, I often
experience a shortness of breath and fear.
I feel sad often and one specific event makes
me feel very guilty. I know that I could have
stopped a murder if I had taken other steps
at the time of this incident. I often think
about things while driving and end up going
in the wrong direction before I realize where
I am at.
Certain events that I have
experienced cause me a great deal of emotion
l distress when I think or communicate about
them. My hands are shaking here at 1:06 AM
as I write this letter. I have recently found
myself to be very irritable, and my wife and
I often argue because I don't want to go to
social gatherings with her. I am not being
anti-social, I just don't like to be around
people. I just like being with my kids and
taking care of them. I feel bad about some
things that are happening to me. My daughter
came into my room four nights ago and kissed
me on the cheek while I was sleeping. I jumped
and scared her to death. My wife came to bed
one night and when she walked up to the bed,
I drew my fist back to hit her. I get up all
hours of the night and check the house over
and over. I don't even know what I am looking
for. I was asleep about a month ago, and I
just knew that someone had fired a gun in
my living room. I hear people pound on my
door in the middle of the night, when in fact
there was never anyone there to my knowledge.
One night I got up out of the bed and got
my gun. I was about half-asleep. I don't know
what I was looking for, but on my way through
the house, I cocked my weapon. On the way
through the house, the .357 discharged and
shot a hole through my floor. Some of the
incidents that I remember the most seem vague.
I remember every aspect of a shooting where
I held the victim as he died. I can't remember
what he looked like. We do not have counselors
to speak to about these things and I feel
that the average doctor would not be able
to understand what I am talking about. I Know
I need help, but I have dealt with it for
the past two years. It is getting harder to
deal with.
An officer may develop PTSD
after experiencing an critical incident, or
being exposed over a period of time to stress
that he was unable to alleviate. These are two
basic causes of PTSD with police officers:
The first is what the public
envisions when police PTSD is brought up, especially
after 9-11. These are the single event traumas.
Perhaps someone shot him (or, throughout him
= and/or her), or maybe he had to kill someone
himself. Or perhaps both. The critical incident
stress management team might have made every
effort possible to debrief the officer. They
could have been skilled, they could have been
novices. Everyone paid attention at the time,
but their lives are like everyone else's lives,
and after a while they go about their business
and while they still cared, the officer and
his family are their own. Hopefully everything
worked out and there were no lingering effects.
Post traumatic stress disorder can sometimes
be avoided even when an individual has the most
traumatic, life threatening and life changing
experience. Sometimes officers don't get any
treatment at all and never develop it. Other
times they get what seems like the best treatment
and they do.
But sometimes intervention isn't
as good as it should be. And other times even
the best intervention doesn't work. As far as
CISM and CISD*, look at it like a vaccine that
is effective a certain percentage of the time.
You don't not want to be inoculated, but you
have to realize the preventative measure isn't
100%. So it is with critical incident stress
management and debriefing. It doesn't always
prevent PTSD. Nobody really knows why, except
that knowing this there's no excuse for law
enforcement administrators not to making sure
officers are followed closely for at least two
years after an incident. I would recommend at
least a monthly half hour session with a good
therapist and every other month a meeting which
includes the spouse if there is one. Sometimes
the individual doesn't see his own symptoms.
Either he is denying them or really doesn't
recognize how he's changed. Or maybe he kind
of sees how he's different but it's too painful
to think about it for very long.
The second kind of trauma is
addressed, in part, in some of the article list
in the "Politics" section of Police
Stressline, where the stress is caused by an
aspect of the job over a long period of time
that undermines the officers self-esteem, confidence
and trust in his superiors and/or coworkers.
This may occur where there is racial or sexual
discrimination. It may occur with an honest
officer in a less than honest department. It
may occur in an officer that believes in proactive
policing in a caretaker reactive department.
It can occur in a department where decisions
are made on the basis of favoritism, politics
and ego. The term "hostile work environment"
is generally used to describe this kind of internal
police department atmosphere. Of course prolonged
trauma that builds up and leads to PTSD can
be caused by having to work day after day with
an unappreciative or hostile public and being
exposed to the worst aspects of the human condition.
Mild PTSD can disrupt a life,
but moderate to severe PTSD is a nasty condition.
For one thing, it involves a combination of
psychological and physiological changes in a
person. On the psychological side, it can shake
a person's very belief system to the core. It
can produce overwhelming, if illogical, guilt
feelings. It can lead to an "I don't give
a crap" attitude. It can make a police
officer question whether the job has any meaning
or value. It can make someone so vigilant he
becomes paranoid, unable to trust or let his
guard down even when he's completely safe. It
can lead to suicidal thoughts and in rare instance
actual suicides. On the physiological side,
as noted in other articles here, it can produce
anxiety, irritability, depression, insomnia
and a host of physical problems from headaches
to digestive problems.
But in the interpersonal realm,
there's where the family is really effected.
PTSD can cause the sufferer to become emotionally
withdrawn and distant from family members. The
sex drive can go out the window. He can become
overly needy and dependent, or on the other
hand outrageously demanding and impatient. He
can revert back to old habits like smoking or
drinking, or become a newly hatched adolescent
and engage in reckless, sometimes life threatening,
hobbies. Sometimes hobbies like motorcycling
can border on suicidal when officers test the
limits of speed and good sense. I hate to say
it, but PTSD can contribute to an officer thinking,
"what the hell, I might as well have an
affair." He may not do it, but thinking
it can be very distressing, and the spouse may
pick up signs her mate is thinking of straying.
Needless to say, if an officer
has turned into a devil-may-care adolescent
or become sullen and melancholy, and his personality
is different, he might as well be a different
person than he was before the critical incident
and the onset of PTSD. The family becomes the
secondary victim. Loyalty is tested in the extreme.
So spouses and kids ask themselves, "if
husband or Dad isn't the person he used to be,
if sometimes it seems I hardly know him, what
am I doing sticking with him?" Of course
the families know when the changes occurred
and why, and Dad was probably a hero, made the
newspaper, got a distinguished officer award.
So they stand by him, but the unhappiness is
incredible.
What can the family do? First
of all, make sure that nothing was missed as
far as treatment goes. Especially whether or
not there ever was or still is a need for medication.
Sometimes law enforcement officers, especially
men, are loathe to take meds. But they need
to understand that PTSD may actually irrevocably
alter the way their brain functions. Research
into this is fairly new, but this is what the
evidence suggests. Most people reluctantly accept
when they've had a serious injury, say to their
back, that they may never quite be the same
again. But to think that the stress of a critical
incident can essentially injure the brain so
it will never return to optimal functioning
is a horrendous thought. And it may be true.
We know that the efficacy of
serotonin in the brain is drastically effected
by stress, and by PTSD, which alters the receptor
nerve cells. Medications like Prozac, Zoloft,
Paxil, Wellbutrin, Celexa, and more recently
Lexapro are often recommended and used very
effectively to help people through rough times.
They help the brain return to normal by making
the neurotransmitters work the way they're supposed
to. If the officer was on them after the incident
and they seemed to help, but he stopped using
them in the hopes he wouldn't need them anymore,
and the symptoms returned, he should probably
start using them again. And if he never was
on them, family members should urge him to see
his doctor to discuss a trial of at least two
months.
The treatment of choice for
PTSD is generally a combination of psychotherapy
and medication. Officers should be advised that
PTSD does not mean post traumatic stress distress.
The "D" stands for disorder, and this
indicates that one is having a serious reaction
to a single incident or to a prolonged trauma.
In addition to finding a sympathetic
and knowledgeable physician or psychiatrist,
the officer will need to seek out a therapist
who works well with police (or correction) officers.
Any law enforcement therapist has seen officers
who have developed PTSD after a critical incident
or after exposure to prolonged trauma.
I wouldn't recommend any drastic
life or career changes for an officer until
he (and again, it could be a female officer
too) has had some therapy, and when appropriate
some couple sessions with the spouse. Some officers
do quite well when they move out of law enforcement
into something completely different following
a critical incident that resulted in PTSD, but
because law enforcement is as much of a "calling"
as medicine or the clergy (or therapy), it is
not a decision to be taken lightly. And it is
never too late to start.
In closing, the good news for
those who suffer directly from it, and those
family members who suffer indirectly, is that
PTSD is very treatable like most police stress.
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