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just over the past decade it has become common
knowledge that law enforcement personnel, along
with other emergency services workers, are a population
highly prone to suffering with Posttraumatic Stress
Disorder (PTSD). As a direct result of their work,
there is regular involvement with traumatic events
over the course of their entire careers. This
is especially true for those of us working in
the field of critical incident stress management.
For those individuals in law enforcement, however,
who generally entered into their careers as physically
and mentally "strong," highly idealistic,
and caring people, PTSD is often quite baffling.
Moreover, it is a concept that is hard to accept
by those who are following the mantra "to
protect and serve." Understanding the needs
of this unique population, highly prone to PTSD,
is imperative for mental health professionals
attempting to assist survivors with healing and
moving beyond this disorder.
When discussing PTSD within the law enforcement
community, one must be careful not to presume
that it only affects the men and women on the
"front lines" - those in uniform. PTSD
does not only affect police officers. Call takers
who first talk with a traumatized victim or dispatchers
who send their "men and women in blue"
into harm s way or hear the frantic voice of an
officer (who is, perhaps, also a personal friend
of theirs) calling over the radio for desperately
needed help, are also affected. Depending upon
the dispatcher s or call taker s perception, any
of these events can be just as harrowing for them
as they can be to an officer on the scene.
Those of us who work with PTSD know the importance
of education for the sufferer; however, some populations
are not so easy to teach. As a police officer
myself on the job since 1973 and, more recently,
also as a mental health professional, I know how
hard it can be to educate these "strong"
men and women. It may be a challenge to teach
them that there are forces out there that can
and do erode their defenses and their sense of
invulnerability over time, causing them to need
help and care for themselves. They avoid discussion
about job-related stress because they believe
that it should not be bothering them. They have
a concern about being seen as "mentally ill"
or "unfit," because this can mean the
loss of their job. They oftentimes may present
with an aversion to going to a psychologist or
other mental health professional, as these people
are the ones who commit the "truly"
mentally ill to institutions. Consequently, law
enforcement personnel can be the last people to
seek out qualified help.
In educating, I often teach law enforcement personnel
about the natural relationship of PTSD to their
profession. In fact, by the very definition of
and by the diagnostic criteria for PTSD, I inform
them that law enforcement is a natural "set
up" for PTSD. I educate them about their
expected responses to trauma (i.e., "normal"
reactions to "abnormal" events). From
this perspective, they begin to understand. Ultimately,
this paves the way for them to begin to truly
heal - transitioning from victim to survivor.
And, they learn to take better preventative measures
to lessen the impact of future traumatizing events
that are sure to occur during their careers.
The Diagnostic and Statistical Manual of Mental
Disorders - Fourth Edition (DSM-IV) indicates
that the essential features of PTSD include: "experiencing,
witnessing or confrontation with an event or events
that involve actual or threatened death or serious
injury, or a threat to the physical integrity
of self or others." Moreover, the person's
response involves "intense fear, helplessness,
or horror" (American Psychiatric Association,
1994). When PTSD was first recognized and named
as a disorder in 1980, the Diagnostic and Statistical
Manual of Mental Disorders - Third Edition (DSM-III)
simply indicated that the essential feature involved
exposure to a "traumatic event that is generally
outside the range of usual human experience"
(American Psychiatric Association, 1980). In either
case, this essential feature seems to be a constant,
unavoidable hallmark of the law enforcement career.
A comparison of the remaining diagnostic criteria
for PTSD to the "routine" experiences
of law enforcement paints an interesting picture.
Other DSM-IV criteria include:
(1) Persistent
re-experiencing of the traumatic event (e.g.,
dreams, flashbacks, or other intrusive recollections;
intense psychological distress and physiological
reactivity upon exposure to internal or external
cues that symbolize or resembles an aspect of
the trauma).
(2) Persistent avoidance of stimuli associated
with the trauma and numbing of general responsiveness
(e.g., avoidance of thoughts, feelings, activities,
places or people; diminished interest or participation
in significant activities; feelings of detachment
or estrangement from others; restricted range
of affect and sense of a foreshortened future).
(3) Persistent symptoms of increased arousal
(e.g., sleep disturbance, irritability or anger,
difficulty concentrating, hypervigilance, exaggerated
startle response).
(4) Duration of the disturbance is more than
one month (or onset of symptoms is delayed beyond
six months); the disturbance causes clinically
significant distress or impairment in social,
occupational, or other important areas of functioning.
Beyond the obvious, such as a shooting, what events
are "generally outside the range of usual
human experience" that might contribute to
the potential development of PTSD? Among many,
consider continually being called upon to make
split-second, sometimes "life or death"
decisions that, in many cases, have no favorable
resolution. Consider facing a weapon in the hands
of a criminal who would kill you if given a chance.
Moreover, consider involvement with fights, foot
chases, vehicle pursuits, physical injuries and/or
death of a fellow officer. Imagine having to deal
with hostage situations, undercover work, dangerous
drug busts or other raids or handling injury or
fatal accidents. How about having to manage in-progress
crime calls, shift-work, disasters (especially
those man-made), the never-ending procession of
people being injured, mutilated or killed and
having to become "accustomed" to seeing,
smelling, feeling and hearing the blood, gore,
pain and suffering associated with crime scenes
and victims including battered and abused children.
Finally, think about what it would be like to
have made an error on the job and be criticized
or worse, face investigation, disciplinary action
or criminal prosecution.
By virtue of their job, law enforcement personnel
generally experience or are exposed on a recurrent
basis to traumatic events. Consider the fact that
these individuals persistently
re-experience traumatic events by virtue of responding
to and handling similar events throughout the
duration of their careers! They need to operate
despite their personal feelings and be able to
resume action immediately beyond a traumatic event
because the public depends upon them to be available
when needed. Over time, officers get accustomed
to "numbing." They may not even realize
that, after a while, many of their daily activities
which seem so "routine" are actually
quite stressful. Seeing the devastating effects
of criminal activity, hypervigilance can become
constant on and off-duty. Any noise or disturbance
within hearing range of the hypervigilant is usually
interpreted as a pending attack so an exaggerated
startle response also appears to be a norm. Being
ever vigilant, tuned in to anything out of the
ordinary and being ready for anything are often
the difference between whether an officer survives
the job or not (Mason, 1990). This, of course,
increases anxiety.
Because a law enforcement career usually lasts
for at least twenty years, the duration criterion
is met. Clinically significant distress or impairment
in social, occupational. or other important areas
of functioning all too often show up in an officer
s life as evidenced by high divorce, alcoholism,
and suicide rates. On an intimate level, officers
who learn to keep things at work on a depersonalized
level, are usually unable to talk about the details
of brutal and horrifying experiences with anyone
other than a fellow officer. Also, along with
being accustomed to always being the "authority"
who must take control of every situation, they
may have a hard time successfully relating emotionally
with their loved ones. An officer s traumatization
does not grant immunity from its effects to his
or her loved ones! When it comes to PTSD, individuals
going into law enforcement do so with the deck
stacked against them from the start! It is a natural
"set up" for PTSD or other stress-related
diseases and maladies.
Law enforcement is a profession where the danger
level and stress potential of traumatic events
remain fairly high on any given day. To best ensure
survival, law enforcement personnel must be "combat
ready" at all times while remaining "normal"
in every other way (Williams, 1987). They learn
to remain at a high level of readiness.
There is also an unrealistic stereotype that many
officers must keep up like "Superman"
or "Wonder Woman" (Shilling, 1993) and
be immune to stress. In addition, regardless of
what the officers believe, the public often holds
officers to this stereotype. Officers may go out
of their way to portray themselves as "cool,"
"calm" and always in "full control"
of their emotions - an image that is reinforced
repeatedly on TV and in movies (Jones, 1988).
Too often in law enforcement, personnel equate
mental disorders with being "crazy"
and they feel that an emotional response to trauma
indicates "weakness." This myth must
be erased. Law enforcement personnel must come
to admit that they, too, are "normal"
human beings who react in "normal" ways
to exposure to abnormal events that make up their
job environment. It is important to consider that
this is an environment that lends itself naturally
as a "set up" for PTSD. To this end,
education becomes most imperative!
References
American Psychiatric Association. (1980). Diagnostic
and Statistical Manual of Mental Health Disorders
3rd Ed.). Washington. D C Author, pp. 236-238.
American Psychiatric Association. (1994). Diagnostic
and Statistical Manual of Mental Health Disorders
(4th Ed.). Washington. D.C.: Author, pp. 424-429.
Jones, C.E. (1988, March). Fatal feelings. The
Thin Blue Line, pp. 1-26.
Mason. P. (1990). Recovering From the War. New
York: Penguin Books, pp. 231-253.
Shilling. R. (1993, Fall). On coping. The Washington
Police Officer, pp. 4-6.
Williams, C. (1987). Peacetime combat: Treating
and preventing delayed stress reactions in police
officers. In T. Williams (Ed.), Post Traumatic
Stress Disorders: A Handbook for Clinicians.
Cincinnati: Disabled American Veterans, pp.
267-292.
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