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In
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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