| For
nearly 20 years, Dr. Beverly Anderson has provided
psychological services to law enforcement agencies
around the nation. She has consulted on traumatic
stress to more than thirty international and national
law enforcement organizations. Dr. Anderson has
been a featured speaker on Posttraumatic Stress
Disorder (PTSD) for Good Morning America, CNN,
and dozens of television news stations. She is
featured in the Channel 4 News video"Cops
Under Fire." She has been invited to present
her research on Police Trauma Syndrome®
to several organizations and groups
including the International Society for Traumatic
Stress Studies. Dr. Anderson is the Clinical Director
and Administrator of the Metropolitan Police Employee
Assistance Program in Washington, D.C. Moreover,
she is President of The American Academy of Police
Psychology, an organization that is dedicated
to addressing the unique concerns and stressors
of the law enforcement community. Dr. Anderson
is a Diplomate of The American Academy of Experts
in Traumatic Stress and the Academy is privileged
to have her serve on the Board of Scientific &
Professional Advisors.
JSV: I know
that you have been very committed to providing
psychological services to law enforcement agencies
for almost 20 years. Can you tell me about the
positions that you currently hold?
BJA: I am the
founding Clinical Director and Administrator of
the Metropolitan Police Employee Assistance Program
and have been since 1988. This program is unique
in that it is a joint union-management approach
to addressing the serious stress-related problems
that are a direct result of policing. I do not
work for the Police Department or the City. My
contract is with the Fraternal Order of Police
Labor Committee. The best part about this independence
is that it ensures confidentiality. The records
belong to me as a private clinician which facilitates
trust in those whom we assist. We have 3,500 officers
in the Washington Metropolitan Police Department.
We are not an employee assistance program in the
true sense. We are actually a long-term services
program and provide individual therapy, family
therapy, marital therapy, play therapy, and various
group therapies including Veteran officers groups,
alcoholism prevention and relapse groups, and
weekly critical incident debriefing groups. With
regard to this latter point, we have an average
of two police-involved shootings per week. Subsequently,
we have ongoing debriefings. Our police department
must contend with one of the highest murder rates
in the United States for a city of our size. Moreover,
we have one of the highest rates of ambushes and
unprovoked attacks on police officers in the nation.
There is a lot of gang violence, drug-related
problems and the like. We have a situation here
that demands all of the emotional resources of
the force. We also do a lot of training. The foundation
of our comprehensive program is based on training.
We have a critical incident program that begins
with the recruits in the police academy and involves
family members. We are on call 24 hours a day.
In fact, just this morning at 1:30am, I was paged
to a police-involved shooting and had to go to
the Homicide Division. I sat with the officer
to assist with what is best referred to as defusing.
This involves debriefing the officer after the
shooting and then for six mandatory meetings within
three months of the shooting. We are also engaged
in research. We have done work with Dr. Frank
Putnam from the National Institute of Mental Health
on Secondary Post-traumatic Stress Disorder in
the children of police officers. We are still
compiling data. In working with police families
over the years, we have noted a preponderance
of symptoms in the children to include hyperactivity
and attentional problems. I believe that this
is a direct result of experiencing the effects
of parental exposure to trauma.
JSV: As you
are aware, The American Academy of Experts in
Traumatic Stress is a multidisciplinary organization
comprised of professionals from over one hundred
forty specialties. Many of these individuals respond
on the "front lines" of risk and, at
times, danger which are significant stressors.
How does law enforcement stress differ from other
occupational groups such as firefighters and Emergency
Medical Technicians (EMTs)?
BJA: The first
thing that comes to my mind is the public response
to firefighters and EMTs. For the most part, it
is a very positive response when compared to the
police. Think of being stopped by a police officer
for speeding, for example, and you think that
you are going to get a ticket. One of the first
things that you may do is try to get out of it,
be nice, or lie. The public mind set toward the
police officer seems to be more negative. Although
there is a clear danger potential in all of these
groups, the danger is different for police officers.
As the level of violence in this country escalates,
the echos of that violence reverberate throughout
the police community. Unprovoked attacks on police
officers are at an all-time high. Just a year
ago, D.C. Master Patrol Officer Brian Gibson sat
in his patrol car at a stop light and was shot
execution style by a young man who was put out
of a local night club by a police officer. Another
example is Officer Wendall Smith who was exiting
his vehicle after returning home from his evening
shift. When the attackers saw that he was a police
officer, they shot and killed him. In 1995, Scot
Lewis was shot in the head and killed by a passerby
while Officer Lewis and his partner were assisting
a hearing-impaired person. The assailant then
turned the gun on Scot's partner, Officer Keith
Deauville who returned fire, fatally wounding
the attacker. In these situations, the danger
is not obvious and you don't know who is going
to attack you. The police officer always has to
be ready. That is why officers have what I call
"cop-face" (the need to be hypervigilant).
They have "cop-face" because they never
know (when they have to move into action). The
unpredictability of the job of policing is an
added stressor. This means that the stress hormones
need to remain elevated at some level (recall
the General Adaptation Syndrome). The police officer
is always looking for what is "wrong"
in the picture. Shift work and midnight duties
are common to other professions but the unpredictability
and the violence make police work unique. You
can add to this, a revolving-door justice system,
with the person you locked up today, back on the
street tomorrow. A police officer also has to
contend with mixed messages from police administration.
On one hand they are told to lock-up and arrest
those involved with crime and, on the other hand,
always remain professional while doing it. There
is public scrutiny of police work, and at times,
media misrepresentation of events. There is always
a threat of civil law suits. There is significant
stress associated with the use of deadly force
- having to kill another human being. I have yet
to meet an officer who is emotionally ready to
kill another human being. Many officers say that
the first thing that came to mind after they fired
the fatal bullet was "Thou shall not kill."
All of these stressors make police work different
from other professions. Of course, the on-going,
day-to-day exposure to murders, assaults, rapes,
child abuse, domestic violence and "man's
inhumanity to man" intensifies this stress-related
burden.
JSV: What
is the most significant stressor for police officers?
BJA: If you ask
a police officer about the most significant stressor
of policing, they often report "police administration."
However, the nightmares they experience are not
about administration. These nightmares are about
the use of deadly force, shooting their guns,
and being shot. It becomes apparent that the most
considerable stressor is the constant exposure
to trauma, especially over prolonged periods of
time. However, problems regarding "police
administration" are very real for officers
and sometimes constitute the "second wound."
Officers expect that the public and the media
will mistreat them; they don't expect betrayal
from the very organizations they risk their lives
for every day.
JSV: This
is quite consistent with combat veterans who serve
multiple tours of duty.
BJA: This is absolutely
correct and I think that you bring something out
that is so much a part of the police experience.
Without minimizing the trauma of combat, consider
the following. During wartime, soldiers go to
a foreign land, and are likely to remain there
for six months to a year. Police officers are
likely to see twenty years of peacetime combat,
in their own country where they do not always
know who the enemy is. The enemy could be anybody.
JSV: What
is "Police Trauma Syndrome®"
and why do you think that it has taken so long
for its wrath to be examined in the trauma literature?
What are the stages leading to this syndrome?
BJA: Police Trauma
Syndrome® is a diagnostic term
that I authored several years ago to depict the
cluster of symptoms many police officers suffer
as a direct result of the job of policing. It
is now a registered trademark. In diagnosing trauma-related
disorders with police officers, we have found
great difficulty with the criteria set forth in
both the DSM-III and DSM-IV (Diagnostic and
Statistical Manual of Mental Disorders).
It has been problematic for us to use the DSM-III
or DSM-IV criteria for police officers because
they typically do not fit into the Posttraumatic
Stress Disorder (PTSD) criteria per se. A police
officer can witness, inside of one week, more
trauma than most people see in a lifetime. Not
only is it qualitatively different but also, quantitatively
different. They see so much trauma. If you examine
the first of the DSM-IV criterion (for PTSD),
it states that the person's response to the event
must involve intense fear, helplessness, or horror.
Police officers are more often than not, the first
responders to a scene. They have been tuned to
dissociate from their emotions or suppress their
emotions in order to be able to endure the scene.
Theoretically, in most cases, police officers
would not fulfill this first criterion. They are
trained to respond behaviorally (not emotionally).
Also, we tend to see a biphasic response which
oscillates between anger or intrusive thoughts
and numbing. We see extremes in their responses.
This does not imply that police officers get used
to being exposed to trauma, because we know that
this is not the case. Chronic, long-term and cumulative
stress takes its toll on police officers. When
we talk about the issue of police brutality, it
becomes clearer that the effects of such stress
will come out one way or another. Police Trauma
Syndrome® can result after a single,
catastrophic event such as when an officer witnesses
his partner being killed, and then having to defend
his own life perhaps by killing the assailant.
This could precipitate full-blown PTSD or Police
Trauma Syndrome® in an officer.
On the other hand, after years of traumatic exposure,
Police Trauma Syndrome® can be
triggered by an incident that is not immediately
life-threatening, like the following incident.
A veteran officer
with young children at home got a call to respond
to an unconscious person. Well, what do you think
of when you hear "unconscious person"
- a street person, a person who is intoxicated,
a stroke or heart attack victim? There is not
too much warning in these situations. The officer
goes into an apartment and there he finds an eight-month-old
baby with a core body temperature of 106 degrees.
He immediately begins mouth-to-mouth resuscitation
because the baby is not breathing. The baby vomits
sour milk into the officer's mouth. The ambulance
finally gets there and the baby is taken to the
hospital and dies. No one tells the officer what
the baby has died of. He doesn't know if the baby
is HIV positive, has meningitis, or is contagious!
No one will talk with him because there has not
yet been an autopsy. He goes home. Can he touch
his children? He cannot look at his young baby
without having intrusive thoughts and overwhelming
feelings about the baby who had just died. In
this case, the officer had an acute reaction and
this triggered memories of other experiences and
he was in a full-blown crisis. Another example
is the veteran officer who had been on the scene
of many suicides over the years. On one particular
occasion, he began to tremble and hallucinate,
and he experienced panic symptoms, etc. This was
a person with 22 years on the force! There are
so many factors involved. The important thing
to convey about Police Trauma Syndrome®
is that when a clinician sees this term, consider
that the individual is suffering from events experienced
primarily on the job. It is a direct result of
the occupation of policing. Our veteran officers
group has identified several stages leading to
full-blown Police Trauma Syndrome®.
(This group has been meeting for four years and
is comprised of officers with 17 years or more
on the Department. They have all been high achievers
on the job but have paid a price emotionally).
They have defined a five-stage model.
In the first stage,
the "Rookie" Stage, an officer is "shocked"
by the world he sees - the violence, the neglect
and cruelty toward children. He sees a world that
he didn't know existed. The second stage is the
"John Wayne" Stage and is marked by
an uncertainty as to the "balance" of
the badge. The officer is filling a role as he/she
understands it. The "tough" image portrayed
by the media cops is all that officers may know.
The officer may take pride in owning all of the
police gadgets. Their communicative style is primarily
one of "commanding, ordering and directing."
During the third stage, the "Professional"
Stage, the officer has a good sense of his/her
own identity. No matter how much verbal abuse
they encounter, they remain courteous and in control
(e.g., responding to an angry motorist he has
just ticketed, you might hear, "Well, sir,
I am sorry that you are making reference to my
mother right now; however, you did go through
that stop sign and I am required by law to cite
you"). While for appearance's sake, this
may seem problem-free, in actuality what's happening
is that the officer may be "numbing"
his natural emotions. "Dehumanizing"
citizens as a coping mechanism will cost the officer
in his personal life. Defense mechanisms that
help an officer adapt to the job are maladaptive
in his/her personal life.
These stages do
not necessarily follow a consecutive pattern.
Our experience has been that officers can jump
from one stage back to an earlier stage. For example,
a veteran officer who is in the "Professional"
Stage may revert to the "Rookie" Stage
upon witnessing a gruesome, traumatic event. We
found this in many officers who responded to the
Air Florida crash in 1982. The carnage and death
they were exposed to that night and during the
body recovery days after changed their lives.
Many of the officers experienced the "Burnout"
Stage which is number four in our model. Anger
and contempt for the criminal justice system,
the Department, politicians, and the citizens
highlight this stage. The officer begins to isolate
from family and friends - believing that they
do not "have a clue" as to what the
world is really like. The fifth and final stage
is full-blown "Police Trauma Syndrome®."
The individual is no longer able to function effectively
as a police officer. This state is characterized
by sleep problems, anxiety and/or depression,
flashbacks, intrusive thoughts, mood swings, rage
attacks, social isolation, and a deterioration
in relationships. The officer may consume alcohol
or other drugs or experience an escalation in
usage. Suicidal thoughts may arise. This condition
is far more pervasive than one might think. Sadly,
what usually happens, without intervention, is
that the officer retires (if he/she can) and disappears
into obscurity. We are working very hard to prevent
Police Trauma Syndrome®.
JSV: What
about the use of deadly force? For example, what
do police officers go through after they are involved
in a deadly shooting? Does the use of deadly force
affect police officers more than other stressors?
BJA: Involvement
in a police shooting may be the cataclysm of a
police career. When I began working with officers,
it was almost unheard of for an officer to be
involved in a shooting. It was rare. Now in this
city (Washington, D.C.), we average two police-involved
shootings a week. There are many factors involved
in the event that have to be examined. For example,
was the officer injured? How lasting was the injury?
Was the officer's partner injured or killed? Was
the suspect killed? Who was the suspect - an adolescent,
elderly person, a mentally ill person? How grotesque
was the shooting? What was the physical proximity
of the officer to the suspect? For instance, I
remember one officer who told me how the suspect
looked at him before he died and asked "why
did you kill me?" That is what the officer
will remember. Was the officer taken by surprise?
For example, one minute the officer was giving
directions to a citizen and the next, he has a
gun pointed at him. Also, were other people in
danger of being killed or injured? Was the use
of deadly force appropriate or can the officer
be potentially convicted of homicide? There is
also the potential for civil liability. What is
the officer's coping style? Is there substance
abuse? Police officers oftentimes use self-destructive
coping mechanisms such as drinking, gambling,
workaholism, etc. What was the department's response
to the shooting? Were they supportive or punitive?
Some departments take an officer, remove his weapons,
and place him in the back of the car. Who else
goes in the back of the car? Suspects! What is
the emotional impact on an officer when this happens?
He feels that he must have done something wrong.
Another factor that affects officers in the aftermath
of a shooting is how the media handles the reporting
of the shooting. So often, in their haste to report
a story, the media will distort the facts and
not usually to favor the police. Officers have
a favorite phrase they use to describe the media,
"Don't let the truth get in the way of a
good story."
Immediately after
a police shooting, a quick response by management
and mental health personnel is crucial. Counselor
support within hours of the shooting as well as
follow-up services send a critical message: "You
are important to this Department and this community."
Follow-up services should also include the family.
We have prepared a booklet for officers, officials
and family members that discusses how to best
manage police critical incidents.
JSV: Recently,
in New York, there was a very unfortunate encounter
for some police officers involving "Suicide-by-Cop"
in which an individual, who apparently wanted
to kill himself, pointed a plastic gun at officers
and was, subsequently, fatally shot. In your experience,
how often does this occur and how do you assist
officers who confront such an event?
BJA: This is yet
another very sad fact of life for law enforcement
officers - one that happens all too often. The
kind of individual who uses police officers for
his/her own suicide will influence the officer's
reaction. Individuals who commit heinous crimes
and then precipitate an officer's use of deadly
force will evoke a different response from an
officer than a depressed adolescent who just wants
to die and doesn't have the nerve to do it himself.
The natural response for the officer is often
one of anger. When a person makes a decision to
point a gun at a police officer, that officer
must react to protect his life. The public doesn't
seem to understand this. Citizens will ask "couldn't
you have shot him in the arm?" or "couldn't
you shoot the gun out of his hand?" Our job
is to help the officer place the responsibility
on the person who caused this event. At the same
time, we validate the normal feelings that accompany
such a tragedy.
JSV: Police
officers are often portrayed in the media as the
"cool" and "calm," Clint Eastwood-type.
In your opinion, what effect does such a stereotype
have on officers, if any?
BJA: We have worked
very hard to dispel that myth and it seems to
be working with our younger officers. With officers
on the job ten years or so, you see that macho-mystique
portrayed in the Lethal Weapon movies. I remember
Mel Gibson taunting the police psychologist in
one particular movie after she had voiced concern
for him. That image is not helpful for the public
or the police. I have yet to meet a cop who has
a "make my day" philosophy of policing.
However, the rigid, macho mentality that does
exist is a barrier to debriefing after a critical
incident. In the long run, it makes the officer
more vulnerable to the cumulative effects of traumatic
exposure.
JSV: From
time to time the media has highlighted cases of
police brutality such as the Rodney King beating
in 1991 in Riverside, California. Do you think
that police "brutality" is a problem
in this country?
BJA: Yes, I do
think it is a problem. I also say that we have
to look at this problem in context. This begins
with verbal abuse which, I believe, is a direct
result of chronic exposure to trauma such as death,
suicide, rape, assault, etc. (i.e., precipitants
for Police Trauma Syndrome®). Police
departments need to begin to deal with this more
appropriately and more efficiently. They need
to do more than one debriefing meeting. They need
to train recruits and supervisors in an ongoing,
comprehensive fashion. Standards need to be set
high and kept high. Unless there is change, I
think that we will continue to see this problem.
We need to look at stress education and training
in the same manner as we look at body armor (i.e.,
bulletproof vests). This equipment prevents physical
trauma to the body. Likewise, if a department
has a good stress inoculation training program
that is ongoing, then this is the kind of armor
that is needed to prevent (or mitigate) some of
the psychological trauma.
JSV: On that
note, how is critical incident stress debriefing
in the Metropolitan Police Employee Assistance
Program conducted by you and your colleagues?
BJA: Knowledge
about the debriefing process begins in the Police
Academy. The recruits and their family members
are given a booklet entitled Critical Incident
Stress Debriefing - Important Information for
Officers and Family Members. We begin with
that education in the Academy. The recruits go
through stress training. If and when they have
an incident, they become more responsive. As soon
as an incident occurs, one of the on-call therapists
responds. The protocol of immediate intervention
involves normalizing and validating feelings.
We may also educate the officer (e.g., "these
are some of the reactions that you may have and
the important thing for you to remember is that
this is normal"). After that, debriefing
times are offered to the officers who will attend
a total of six mandatory debriefings on department
time. If they come when they are off of their
shift, they receive compensation time for attending.
Our offices are not located near a police facility.
We are in an office building away from police
facilities. There is ensured confidentiality.
The meetings are held in a group setting. They
are co-led by police officers who have been through
a critical incident. The officer is not acting
as a therapist, but talks about his/her own reactions.
Appropriate boundaries between the police and
therapist roles are essential for the success
of the program. The debriefings involve stress
education and exploration of each police officers'
event. They learn that they all respond in a relatively
consistent way and there is normalization of their
responses. They are able to hear other officer's
"story" which helps many officers to
believe that they can heal from their experience.
To quote one officer, "You see things through
new eyes." I refer to this process of debriefing
as a cognitive-affective-behavioral intervention.
They understand what has happened to them, learn
about their feelings, and have to go an extra
step to learn how this event is going to change
them. The ultimate goal is to help officers find
some meaning in the event and take their experiences
to a new level. This is what survivors need to
do. It is not just survival but prevailing and
overcoming. We have to help officers respect the
enormity of what has happened to them and understand
that it is powerful. We also have to help officers
realize that, in time, they have to make the event
a part of the past. It does not need to be a constant
torment even if the memory may last forever.
JSV: Although
there is an increasing recognition of the psychological
effects of domestic violence on victims, considerable
research still needs to be conducted. With regard
to the effects of domestic violence on children,
what recommendations could you give to officers
who respond to domestic violence calls where young
children have witnessed a traumatic stressor (e.g.,
mother's battering, etc.)?
BJA: There are
some states that have passed laws that are much
more stringent with regard to protecting people.
However, there is so little that a police officer
can do. He/She can arrest a perpetrator, which
he may have to do. But, when it comes to removing
a child from the household, it becomes painful
for a police officer. I have spoken to officers
who have described a desire to take the child
home with them which, as you can imagine, can
cause other problems. Officers are so powerless
in many situations. This powerlessness is close
to police officers. They must live with this.
The only thing we can tell them is that they should
talk about it but, they oftentimes, don't want
to talk about it. It hurts to talk about it. They
say, "What good does talking do, it doesn't
change the situation." This is another stressor
for police officers. When they go home, they say
they don't want to talk about it because they
"leave the job at work." The real reason
they don't talk about it is because they are trained
on the job to suppress their emotion. So, if they
begin talking about it at home, they can't just
tell it like a story that happened to somebody
else. They may become overwhelmed with emotion
and they don't know what to do with those feelings.
We go back to that biphasic response - numbing
and dissociation. Many officers are uncomfortable
with their own emotions.
JSV: As a
member of the Board of Scientific & Professional
Advisors of The American Academy of Experts in
Traumatic Stress, are there any suggestions or
concluding comments that you could offer with
regard to helping survivors of traumatic stress?
BJA: The big word
for me is "depathologize." We need to
look at the public health problem of traumatic
stress in society. We need to look at traumatic
stress not as a mental illness but as a public
health issue. I read an interesting comment recently
in an article. The author said that "PTSD
is to the world of psychology what AIDS is to
the world of medicine." I think that this
is true. There is a preponderance of traumatic
events (e.g., the increase in violence, natural
and man-made disasters, etc.) in society. Those
who are exposed to trauma need to receive assistance
and should not have to feel that they are "crazy"
when they seek help.
JSV: As you
are aware, The American Academy of Experts in
Traumatic Stress recognizes that traumatic events
are an unfortunate part of the human experience
that individuals from many disciplines work with
on a regular basis. What do you see as the major
advantage of an organization such as the Academy
that is dedicated to increasing awareness and
ultimately, improving the treatment for survivors
of such events across such an eclectic group?
BJA: The American
Academy of Experts in Traumatic Stress serves
a unique and vital purpose. We have to take traumatic
stress out of the exclusive domain of psychology
and psychiatry. We have to do this! Traumatic
stress and its aftermath belong to all of us -
medical doctors, lawyers, police departments,
psychologists, psychiatrists, teachers, insurance
companies, legislators, etc. Education is a crucial
step and the issues must be addressed in a public
forum (as the Academy's mission statement
indicates).
JSV: Tell
me about The American Academy of Police Psychology.
I understand that you are the President of this
organization which is the first organization of
its kind to address the concerns of the law enforcement
community.
BJA: The American
Academy of Police Psychology is an organization
dedicated to addressing the unique concerns and
stressors of the law enforcement community.
Some of the major goals of our organization are
to establish standards for police counseling,
debriefing, and stress programs and to initiate
research in the area of police trauma. Moreover,
we are committed to educating police departments,
family members, police officers, educators, and
criminal justice programs about the nature of
law enforcement and the unique stressors associated
with this profession. With regard to this latter
point, this must be dealt with in order to have
a healthy work force. This can benefit the police
officer, their families and the community. As
an organization, we want to focus exclusively
on law enforcement. We have had other agencies
approach us who want to affiliate with us and
work on other issues. However, we want to remain
focused on law enforcement stress and traumatic
exposure of police officers. We want to advise
communities and police departments on how to put
programs together that can be preventative in
nature. Many police officers, when they retire,
suffer in silence. Twice as many police officers
kill themselves each year than are killed in the
line of duty. The high incidence of divorce is
reflected in the fact that intimate relationships
are difficult for many police officers. There
is a high incidence of trauma-related problems
that really demands that we take care of law enforcement
officers in the way that they take care of us.
We have nearly 700,000 law enforcement officers
in this country. They have spouses and many have
children. All of those people are affected as
well. Law enforcement is an emotionally and physically
dangerous job. The Academy's mission is a singular
one - helping those who protect and serve.
©1998
by The American Academy of Experts in Traumatic
Stress, Inc. |
