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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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