| 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. |
