How to identify PTSD in our Police Officers.....
One of the difficult issues germane to policing is the repetitive nature of calls for service, repeat situations that they have addressed with all manner of people. Some calls are for assistance with a problem, medical needs, personal and/or social concerns, and often those that require assistance in resolving escalating conflict. Other calls reflect the breakdown in social order, the re-occurrence of violence and criminal events, and trauma of victimization counseling. It is these instances that leave the officer feeling either a sense of accomplishment or discouraged over the detritus of humanity.
Those situations where officers return time and again, encountering negative environments, injuries, victimization, crime, disorder and death, take their toll overtime. The repetitiveness of calls for service encountering someone doing something unscrupulous, will generally result in varying degrees of officer anger and/or disbelief. Constant encounters with deviant behavior, eventually takes its toll. How many times in twenty plus years have officers encountered people under the influence, someone ranting, threatening, and acting aggressive? How many dead bodies, injuries and harm are witnessed before a realization that society is cruel sets in and alters what was once a more optimistic attitude? That accumulated anger, frustration, disgust, and other emotions do not just evaporate, they linger and they are harmful.
Immersion in problems, crime, offenders, victim needs, death and destruction, encountered for years on end, can warp optimistic beliefs that society can overcoming the negativity associated with harm to others. When most encounters with the public include events that demonstrate deviation from social norms, normality may appear a distant component of humanity.
Officers seek immunity from the onslaught of repetitive negativity, yet they frequently are engaged in providing a shield against undesirable human behaviors. An officer continuously hears the same dumb comments by drunks, smells alcohol, vomit and worse, and engages in work related activities that most people would flee from. The same threats are repeated, similar bloody results caused by out of control people, and adults and children fearful of becoming a victim, if not already so. Police see children who have been physically, mentally and sexually abused, suffering malnutrition, or who are sent off to school without boots and warm clothes in the winter, no breakfast and little hope for food when they get home to a cold and empty house. It is a difficult fact to reconcile and challenging to fix.
A drunken husband’s assault on his wife or significant other that requires her hospitalization, greets the officer with, "get the fuck out of my house" and acts defiant and aggressive. Rationalization of the situation and the outcome that will result in an arrest, perhaps requiring a physical engagement, elevates stomach acid, pumps adrenaline, increases sweating, adds tension in arms and legs, heightens reflexes, raises heart rate, breathing and evokes a severe challenge to self-control. When it is over, the officer often finds it nearly impossible to return to physical and emotional balance before dispatch to the next call. The effect of the stress and adversity on the human body in encounters as described, will, over time cause lasting physical and emotional harm.
Just writing this, I can recall places and people of the past who engaged in these events in my life in policing and suddenly I feel the need to move forward, as it triggers the same old revulsion, anger and sadness, a combination that is not emotionally healthy. Past events continue to haunt my psyche even though decades have passed.
The journey of a police officer is not without danger, stress, adversity and trauma. Over time, well-being is replaced with suspicion, unease and a growing dis-comfort with people, place and position. Self-protection becomes important, which then necessitates wearing or having a firearm nearby. Focused attention wanders from those speaking to us to a scan of the environment in which we are standing. There is a body tension, awareness, a persona that indicates, somewhat willingly, that I am a cop. The world that others observe with normalcy and a certain level of unawareness has been replaced by a reality that offers a more unsavory side. It has its own level of sadness and it requires some effort to understand that everyone is not bad. Yet, after twenty-five years of urban combat, normalcy seems illusive and the scars, both internal and external, remain as symbols of engagement in a world often never seen by most of the population.
We observe the same post traumatic stress symptoms in today’s police officers. Originally associated with combat or war experiences, it has more recently been recognized as being prevalent in any population exposed to traumatic events (Ahmed, 2007). This is represented by an accumulation of stress and adversity and exposure to trauma from engagement and witnessing accidents, murders, rapes, assaults, robberies, and other appalling events for decades. A job that engages in people’s problems often corresponds with danger, where people strike at you, use weapons, drive recklessly, and threaten you and your family. It gradually replaces optimism with pessimism and while more gradual than military combat, the results are no-less deadly in the final outcome. The exposure time is longer, but the accumulated morbidity is no less serious to the individual.
PTSD is illustrated by high morbidity, divorce, suicide that is twice the rate of average citizens. We observe officers that are physically overweight, have respiratory and heart issues, back problems and unfortunately alcohol and substance abuse. Physiological, psychological, social and emotional issues that, while mostly hidden, are eating holes in the officer’s physical and mental health, leading to an accumulating and debilitating outcome. The common "suck it up" attitude is contributory and solves nothing, yet it remains part of the culture.
If concerns have not risen to the surface yet, there are chronic issues of concern that should sound the klaxon horn. They include:
Table 1....Issues of Concern
Difficulty sleeping Digestive problems Addictive behaviors Attraction to danger Hyperactivity and restlessness Diminished emotional responses Reduced ability to deal with stress Feeling of isolation and detachment Flash back to traumatic experiences Hyper-vigilance (on-guard all the time) Abrupt mood swings (rage, crying, anger) Exaggerated or diminished sexual activity Depression and feelings of pending doom (pessimistic) Psychosomatic illness (headaches, neck and back pain)
Stress contributes to a variety of physiological and behavior related ailments. They are serious manifestations that will diminish life, moderate the quality of one’s life and reduce performance at work and with other engagements. They include the following manifestations:
Table 2.....Manifestations of Stress
Ulcers Anxiety Nausea Diarrhea Smoking Poor diet Chest pain Depression Irritable bowel Heart palpitations Sleep disturbance Breathing difficulty Poor concentration Shortness of breath Flawed decision-making Poor disposition with others Restlessness and feelings of being overwhelmed Excessive consumption of alcohol or illegal drugs Physical and emotional withdrawal from family, friends and colleagues.
If not, you should be! The days of “shrug it off” or “suck it up” are invalidated by the numerous examples of police officer self-destruction, a job incident whose occurrence results in discipline, suspension, firing or perhaps prosecution. Responsibility and accountability to address the issue initially rests with the individual, his or her supervisor, and the chief administrator of the organization. There is no room for error, no hoping that observed manifestations will cure themselves, and no excuse when some act results in discipline or other action, for with warning signs there is a corresponding increase in the mandate to act.
Strengthening Resilience and Reducing Vulnerability
Not all officers experience PTSD and many are able to manage a state of equilibrium when faced with an event of substantial stress or trauma. Ahmed (2007) attributes this to enhanced resilience and factors such as the individual’s beliefs, attitude, coping strategies, behaviors and psychosocial consistency in the face of adversity. A number of strategies can be utilized to overcome and minimize the effects of trauma on the individual. The goal is to increase optimism and feelings of well-being, while diminishing the negative pull of trauma that can suffocate unless cast off. And, resilient individuals adapt well to adversity, and are able to better cope with stress, grief, tragedy and other critical events encountered (Lumb et al, 2009).
The same level of care extended for officer physical safety (weapons, vests, safety training, etc.), must apply to psychological and emotional well-being. It is deemed a weakness to express the need for assistance, driven by the belief that it can be controlled and self-managed. Common beliefs include the need to “get a grip, snap out of it, get your head out of your rectum, or straighten your butt out,” and other euphemisms, whose utterance offers insignificant help. To quote an appropriate saying, it is a “cop out” by the supervisor and irresponsible for not drilling down to determine a sustainable resolution to the issues.
There is a strong belief that if administration is aware of an issue that it will be used against the officer. Peers, supervisors and administrators harbor similar beliefs that they must not display any weakness whatsoever, for it indicates something disdainful to someone who represents law enforcement. Yet, unwanted change occurs, and a day of reckoning will arrive if no positive intervention takes place when issues are observed or identified.
Police administration often is not sufficiently stepping up to the plate to help insure that mental and emotional health and well-being is as necessary and needed as is physical health (vest, guns, and other bodily protection devices). The newspaper headline that Officer X was relieved of duty for a violation of department policy, or an allegation of wrongdoing, is generally not the first notice, it is the switch turning on a neon sign that indicates a series of missed opportunities to manage declining mental health and resultant behaviors. .
In the policing profession minimal training in resiliency is required, but it is not in sufficient depth to allow application when issues arise. The field needs to be open and honest about the challenges and obstacles each officer faces when dealing with the multiplicity of issues they encounter. Training should include direct and vicarious trauma, using examples and stories germane to their time and era. We must discuss the effects of long term exposure to stress, adversity and trauma and what it can and will do to the individual’s well-being. What is post-traumatic stress syndrome (PTSD) and how is it illustrated in policing and more importantly, what can be done to assist officers? What are the visible signs and symptoms, the manifested behaviors, thoughts and actions that if continued will result in negative outcomes?
It is a normal human condition to be traumatized by exposure and immersion in events that are out the customary range of expected behavior or which boggles the mind in disbelief of the observed event. The challenge before us, what to do about it? Sadly, there are far too many stories of divorce, suicide, aberrant behavior, physical and psychological health issues, each of which illustrates the need for a change in policy and practice within the profession. An officer can wade through the blood, human damage, sadness, and abuse of others for only so long, and at the end of the day, it will exact a price to be paid.
Recognition, prevention and treatment of emerging problems begin with the individual. Supervisors and administrators bear no less accountability to promote and instill beliefs in mental health well-being, as the harm to the officer, if not maintained, is devastating.
Many police, public safety and first responders all too often walk in the shadow of death, either aware of the implications, or caught unaware of the danger that stalks them. Time on the job provides many with sharpened awareness, a sixth sense that danger is about and they intuitively and with corresponding automatic body functions, reactions begin to build defense and resilience, anticipation for what may come. Realized or not, the outcome on the individuals psychological and physiological system is the same, it responds and it carries the outcome of elevated stress along with past incidents. It will diminish, but over time it also accumulates and the harmful effects eventually manifest and the individual faces personal troubles, that left unattended, can be devastating.
We may require minimal resilience training, but it is not enough. We also must find ways to provide officers with periods of positive engagement and not constant exposure to calls for service where one encounters drunks, addicts, angry and abusive people, those who have harmed, killed or engaged in events that, to the normal citizen, are horrendous when witnessed or read about.
We know we can help, to build resilience and understanding that we can manage ourselves and our mental and physical health. The key lies in a willingness to do so. When we procrastinate, the path described earlier become more difficult to deviate from, time in this case is not the companion we should seek.
Ahmed, A. (2007). Post-traumatic stress disorder, resilience and vulnerability. Advances in Psychiatric Treatment, vol. 13, 369-375.
Lumb, R., Breazeale, R., Lumb, P., & Metz, G. (2009). Public Safety Officer Emotional Health: Addressing the Silent Killer. (Reprinted) American Jail Association, March/April 2010, XXIV(1), 8-20.