What Cops Should Know about Posttraumatic Stress Disorder

Posttraumatic Stress Disorder (PTSD) is a formal psychiatric diagnosis. At the risk of stating the obvious, a key component to PTSD is exposure to traumatic stress. I bring this up because virtually all police officers are exposed to traumatic stress but not all develop PTSD. Traumatic stress is an occupational inevitability for cops. PTSD on the other hand is an occupational risk. Some research suggests police officers have an increased risk for developing PTSD at some point during their career.

There are a number of complicated variables that affect how we respond to traumatic incidents, some of which are dimly understood. For example, if an officer experienced childhood abuse which he or she successfully suppressed from memory, those memories may re-emerge upon exposure to a traumatic incident later in life. I’ve had clients painfully describe how previous traumatic memories have resurfaced after the incident that brought them in, like candy spilling out of a piñata.

Some of us are more vulnerable to post traumatic symptoms than others. Importantly, our increased vulnerability is not the result of mental weakness. They include constructs such as temperament, early childhood experience, social learning and coping styles.

Don’t try and diagnose yourself with PTSD. Leave that to the professionals. When is it time to seek professional help? If you’ve been exposed to a traumatic stressor and after several weeks,

1. You continue to have sleep problems (e.g., difficulty falling or staying asleep, sleeping too much).

2. You over eat or have difficulty keeping food down.

3. You continue having trouble with your mood (e.g., irritability/anger, sadness/crying,

panic response like your heart’s going to jump out of your skin).

4. Co-workers, friends or family members are expressing concern about you.

I shudder to think of how many police officers who know something is wrong with them try to white knuckle their way through PTSD. A recent study by the San Francisco Veterans Affairs Medical Center found veterans with PTSD were twenty five percent more likely to die within a year after surgery than non-PTSD veterans. This, despite the fact that the veterans were younger in age at the time of surgery and even after they had long separated from military service. The point? It ain’t goin’ away.

PTSD has an impact on entire families. It’s been described as ‘the gift that keeps giving’.

PTSD isn’t like the West Nile Virus or Yellow Fever. It’s a treatable condition. You cannot be treated for PTSD (or any other serious medical problem for that matter) unless you seek help.

As cops we pride ourselves in having common sense. We use reason instead of blind emotion, voodoo or tea leaves to arrive at the best ‘thing to do’ in any given situation. The greek philosopher Epicurus wrote,

Chance seldom interferes with the wise man; his greatest and highest interests have been, are, and will be, directed by reason throughout his whole life.

If you think you may have PTSD what do you think the wise thing to do is?

Next week I’ll end “The Body Keeps the Score” series with a discussion of how to strengthen our emotional kevlar for future exposure to traumatic stress.

"The Body Keeps the Score:" An introduction to psychological trauma for cops. Part Two

Stress and Traumatic Stress

Imagine your neighbor knocking on your front door. He’s irritated. The neighbor says your son, who’s been playing football with his friends in the street, hit his car with the ball. In this case you would likely experience stress.

Now, imagine your neighbor pounding on your door. He’s panicked. The neighbor says your son has been hit by a car and is badly injured. In this case you would likely experience traumatic stress.

It’s the experience of helplessness and horror that define traumatic stress. Exposure to traumatic stress is an occupational inevitability for police officers. Think of a horrifying event. Any event. Now, ask yourself, “would there be cops there?” Probably, right? We’re always at the horror shows, and all too frequently we experience as sense of helplessness about our ability to make it right.

The fact that police officers aren’t allowed a normal human reaction to traumatic stressors makes things worse. Let me tell you about an experiment done by Robert Sapolsky, a stress physiology professor at Stanford University.

He showed two groups of people a gruesome video (a leg amputation) and then measured their stress response after seeing it. He showed the video to the first group and measured them. As expected, their bodies were pretty jacked up. Then he showed it to the second group. However, before they saw it, the researchers instructed the group that they were to have no reaction whatsoever while watching the video. The stress reaction in this second group was significantly higher. Makes sense.

Chronic exposure to traumatic stress, if not actively managed can very bad for us. It resides in the body and will stay there if not worked through in some way. Trauma guru Bessel van der Kolk writes, “the body keeps the score.”

Some of us believe getting good and drunk after “one of those days” will help us deal with traumatic incidents. This is a dangerous and wrong path. I’d recommend participating in a Critical Incident Stress Debriefing or other means of emotional/social support. Talking it out usually doesn’t, as some suggest, make people worse or symptomatic. The vast majority of cops need to talk more, not less, about the emotional piece of this job.

Next week we’ll cover the best known and least desirable outcome of traumatic exposure: Posttraumatic Stress Disorder.

New Facebook Page

The good news: Police Mental Health now has a Facebook page. I'd like to encourage you - yeah YOU - to share what works and what doesn't work to improve police officers' lot in this world. So don't be a frickin' lurker.

The bad news: At present, the URL for the page is ridiculous: http://www.facebook.com/pages/PoliceMentalHealth/138185609550421?ref=ts

Apparently, if x number of people go to the page and hit "like" I can

abbreviate the web address to something more normal. So, can you

go there and, even if you think it's the dumbest thing you've seen in

awhile, hit "like."

Thanks.

“The Body Keeps the Score”: An introduction to psychological trauma for cops.

Can you imagine being a police officer and having no real knowledge of or interest in how to use a hand gun? Can you imagine a colleague saying, ‘I’ll figure out how to deploy my firearm if or when the time comes’?

Either can I.

We better know how to use our firearms because our life or the life of another may depend on it. Now, let’s introduce a talking point from Lt. Col. Dave Grossman. In On Combat he writes,

The stress of combat debilitates far more warriors than are killed in direct hostile action.

Hmm. By ‘stress’ Grossman here refers to cumulative stress, posttraumatic stress and critical incident stress, all of which I’ll define momentarily. For now let me ask, what do you know about these? If you’re like most cops the answer is ‘not much’. Either you’ve never given them much thought or you figured you’d learn about them if you got bit. Or, you’ve already been bit and you’ve learned all about one or more of these the hard way.

Traumatic stress is an occupational hazard for cops. You really need to get this. Moreover, traumatic stress in its various forms can be deadly. You wouldn’t wish the bad shit associated with trauma (co-morbidities) on your worst enemy.

Because trauma is located in the shadowy realm of human psychology, law enforcement has kept away from it. While this may sound unfairly harsh, police officers (who later become police executives) know about stuff we can put our teeth into, like how to clear a hard corner in a room search or how to safely approach the occupants of a vehicle during a car stop. We know all about the hazards associated with these because,

1. We talk with each other about them.
2. We consult tactical experts and utilize our own in-house experts.
3. We regularly pose scenarios to ourselves and our partners...‘what if...?’
4. We mentally attend to these potential hazards which gives us two extremely powerful tools for managing risk: prediction and control.

When we begin talking about psychological risk, cops start fidgeting in their seats. Why? Most police officers don’t know a ton about psychology so we feel vulnerable; never a good thing for cops. We want to avoid feeling vulnerable so we avoid the topic.

By avoiding (minimizing, de-valuing, ignoring) the impact psychological trauma has on individual officers, their families, the police agency and the community, we have unwittingly allowed our brothers and sisters in blue to suffer in silence. We need to stop doing this.

Okay, you don’t know much about trauma. You don’t feel comfortable talking about it. I don’t feel comfortable talking to my pre-teen son about safe sex and drugs, but I do it anyway. I balance the discomfort I feel on the one hand, against the potential destruction that may happen on the other. Fuck it, I guess I’m gonna feel a little awkward.

In this series of posts, I will attempt to get you to appreciate how important an understanding of police trauma is to you.

Some mental health problems are easy to diagnose and treat. Trauma isn’t one of them. In order to give you the best, most up-to-date and accurate information available on police trauma I’m going to break this down into bite sized morsels. Don’t ask me how many bite sized morsels there’s gonna be because I haven’t written them yet.

I hope to answer the following questions (among others):

Why does one person need to drink himself to sleep every night after a critical incident, while another sleeps like a baby?

What’s Posttraumatic Stress Disorder and how can I avoid getting it?

How does traumatic stress manifest in the body?

What does it do to the brain?

How does a traumatized cop impact the family?

What are the co-morbid conditions associated with untreated trauma?

How do you fix or treat traumatic stress?

Stand by.

Watch me

Schadenfreude and Encouragement (part two of a two part series)

Nice job

Good stop

Wow, you did a great investigation

Great arrest...good work

Not much rocket surgery in there.

It’s a curious phenomenon, this idea that we could probably dramatically improve officer’s wellness by the simplest of habits, like verbal encouragement. But when we consider the fact that the ‘work environment’ (especially ‘the administration’) usually tops officer’s Gripe List, it’s clear we’re not doing such a good job.

We blast our supervisors and administrators for their lack of support, but those lower on the food chain aren’t exempt from their roles as encouragers. So what’s the significance of ‘encouragement’ for police officers?

This is not an area I need to reference research studies or my clinical experience. I want to talk about providing encouragement here because it’s very easy to do, it makes you (the encourager) feel good, and it improves the morale and overall wellness of those you encourage.

In child rearing, a basic principle is that you should seize any opportunity to encourage your child. “Wow, Tommy, your such a good [fill in the blank]!” As parents, we offer these words not randomly or disingenuously, but in response to a job well done. Encouragement is like watering a plant, or emotionally feeding a child.

In the same way, encouragement just plain makes people feel good about themselves. Cops have enough nitpickers, paper shufflers and ass kissers to deal with. By providing encouragement to others you neutralize the toxic air that seems to pervade police buildings.

You don’t need to be a supervisor to tell a fellow officer “good job!” And when you tell them “good job” tell them what about it was so good. Be specific. Management 101 tells us that folks are way more likely to continue doing a good job or even want to do a better job, after being complimented. Conversely, negative feedback, while intended to change behavior, doesn’t seem to work so well. Weird that so many supervisors and administrators haven’t figured this one out.

Since you’ve read this week’s blog you now know you have the power to think globally and act locally. Go ahead and tell someone they did a kick ass job, it won’t kill you.

Schadenfreude and Encouragement

Schadenfreude and Encouragement

(part one of a two part series)

I walk around my department like an undercover social scientist, taking mental notes about what works to improve wellness and what...well, doesn’t. Having grown up in an alcoholic family, I’m pretty good at reading people. For example, when my dad came home I knew there were three options: 1) sober and morose, 2) drunk and violent or 3) drunk and maudlin. Back then, I had to read him real quick and take immediate action, otherwise bad things could happen. So, I’ve learned to trust my observations.

I’ve noticed cops (including myself) have an almost insatiable appetite for hearing and talking about our co-workers’ fuck ups. We love it.

Cop 1: You heard about Joe Blow, right?

Cop 2: No! What?

Cop 1: He got three days at the beach for a negligent discharge in the locker room.

Cop 2: That Joe is such an idiot, ha ha ha!

I love the word for this phenomenon: schadenfreude. It means taking pleasure from the misfortune of others. And don’t we do that? I always feel a twinge of guilt after I get done thrashing one of my colleagues. Somehow my personal wellness quotient dips just a touch.

When I worked narcotics we had a ‘team approach’. Our unit of about ten meat eaters conducted dope operations, each one offering multiple chances to fuck it up. The first thing that went through my mind after blowing something would be, “Oh shit, here it comes.” My Nextel would start blowing up. “Shannon, did you get the dope?” No, he got it down. “You’re a fuckin’ IDIOT...have you ever got dope off anyone? Ha ha ha ha!”

When an NFL QB throws a particularly poorly timed interception, have you noticed what happens? The guy trots off the field with his tail between his legs, finds an private spot on the pine and sits....alone. People leave him alone ‘cause they know he just pooched one.

Not so in law enforcement. When we screw up we get creative cartoons on the white board, new nicknames and a full round of “good job!” dripping with sarcasm. It’s a rough crowd.

An old family therapist and hero of mine, Murray Bowen, described schadenfreude as a way to reduce anxiety in groups. He calls it ‘triangulation’. For Bowen, any time two or more people are in the same place a certain amount of intimacy is floating in the space. This creates anxiety. Even if you don’t feel it, it’s there.

A very common method, albeit unconscious, people use to decrease the anxiety is to focus attention on someone not in the room. That should sound familiar. Inexplicably, when the group begins talking about the poor bastard that’s not there to defend himself, the tone is almost always critical. It seems to put everyone more at ease to join together in beating the shit out of Joe Blow.

To get a sense of how pervasive triangulation is, try an experiment. For one day, see if you can avoid disparaging a co-worker who isn’t in the room. Yeah, that includes administrators. If you’re Buddha Jr. and are able to do this without a problem, then notice it in others. Oh yeah, and share with me how you’re able to do it. I could use some help.

Next week we’ll discuss schadenfreudes’ opposite: encouragement.

Officer Fatigue

The following is an excerpt from the book on police mental health I've been working on for what feels like a frickin' decade.

Fatigue

Early on in my police career I figured there was something going on with this fatigue thing. I'd worked my whole life, knew what it was like to put in a full day and come home tired. I'd also been married seven years by the time I went into the police academy and fatigue in and of itself was never a marital issue. But the fatigue I experienced as a cop felt like a whole different beast. As an officer, being tired wasn't so much a mood as a complete mental, and physical breakdown. In fact, I call it "fatigue" but this word doesn't do it justice. That vegetable-like, completely psychically checked-out state cops fall into after getting home warrants it's own word. Another label for this dulled state of consciousness comes to us by Dr. Kevin Gilmartin in his excellent book, Emotional Survival for Law Enforcement. He calls it the "hypervigilance biological roller coaster.” Gilmartin offers a detailed, biologically-based explanation for officer fatigue.

How, you may ask, can officer fatigue become so serious that it creates marital problems? It wasn't until I came across Gilmartin's work that I began to really understand officer fatigue. Gilmartin describes the physiology of officer fatigue as an inevitable product of hypervigilance. Anderson (1998) refers to the constant state of readiness necessary for an officer’s survival as “cop-face,” another descriptive and accurate term. Let's try and understand how officer fatigue is produced, what makes it different and how to minimize it's deleterious impact on marriage.

Officers are trained to use some version of the Cooper Color Code, in which different states of mental awareness are assigned colors. White, for example, is the condition we're in while daydreaming, or taking a relaxing walk in the woods. Officers are trained never to step inside a police station while in code white. In fact, some trainers believe cops should never be totally relaxed. But let's not get into the details of the Cooper Color Code. Suffice it to say, cops are always supposed to be vigilant while at work. To be in any way relaxed while on patrol increases the chance that you will be injured or killed. Of course, one problem officers face, frequently without being consciously aware of it, is guilt about the fact that they aren't in this vigilant state at all times at work. That's because our bodies register the "vigilant all day" thing as an absurd request and rejects it. Our bodies can't maintain this elevated state of awareness without a rebound affect. The rebound for prolonged vigilance (a.k.a. hypervigilance) is extreme lethargy.

And isn't it a kind of lethargy officers fall into at home? After working and especially on weekends, we simply want to sit and engage in meaningless activities, such as video games (preferably the "first person shooter" type), internet, and sleeping. Gilmartin calls it sitting in the "magic chair." We all have that familiar place in our homes where we gravitate after work. We occupy this place (sometimes a chair) and decompress. What's happening is that our brains are on overload. These so-called meaningless activities actually serve the very important function of releasing steam from our heads. We can, if left to our own devices, do these post-work activities for many, many hours. We feel the tension in our heads begin to dissipate. Then we go to sleep.

On our weekends our bodies are bouncing back from the hypervigilant state they were in all week. The net result is that we are exhausted, both mentally and physically. We don't want to make any decisions, don't want to engage in idle chat or plan activities. We just want to recover. Importantly, this recovering isn't laziness, nor is it meant to convey the message, "I don't care" to our spouses and children. Consider a natural disaster or family emergency which required you not only to be awake for many hours, but necessitated your being extra alert. After the emergency ended your body and mind would need to recover. It's not your attitude, it's your body.

Yet, for the non-police partner this checking out business doesn't really work. Our partners have been without us all day or week. Perhaps, they've been single-parenting all day or week as well. After work and on the weekends they need our attention (not to mention our help), as do our children. That's the problem. This is the classic clash of needs. One partner really craves, and physiologically needs X and the other equally craves Y. There are things you can do to minimize the impact of this phenomenon on your marriage.

By our own awareness that fatigue can be a real issue in police families we reduce the harm associated with it. Law enforcement couples need to talk about officer fatigue. Partners of officers should understand that, while it can be extremely inconvenient, it's not a personal rejection. Moreover, there are specific activities which help our bodies rebound more quickly from fatigue.

"Poor diets, high stress, pollution, and toxic work environments all take their toll, as does our consumption of stimulants such as coffee, tea, and colas. The use of these largely caffeine-based products disrupts eating cycles, creating rebound fatigue effects and contributing to low-blood sugar and adrenal exhaustion. Sometimes a solution to fatigue is as simple as taking a good multivitamin, more protein in the diet, or regular exercise." (Butler)

You already knew that though, didn’t you? The difference between surviving your law enforcement career and thriving in it requires putting our awareness into action.

Anderson, B.A. (1998). Trauma response profile. http://www.aaets.org/article59.htm

Butler, Graham. The New Energy Crisis. http://www.alive.com/1561a4a2.php?subject_bread_cramb=83.