| The 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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