| Over the past decade, as I have worked with cops, | | | | Regardless of the origin of the terror, the brain |
| firfighters, abuse victims and children of addicts, I | | | | reacts to overwhelming, threatening, and |
| have learned that there are many causes for PTSD. | | | | uncontrollable experiences with conditioned emotional |
| It has also affirmed my belief that PTSD is real and | | | | responses. For example, rape victims may respond to |
| harmful, not only to those who have it, but also to | | | | conditioned stimuli, such as the approach by an |
| those around them. It impacts the way we act, | | | | unknown man, as if they were about to be raped |
| react, our motivation and our capacity to feel--well, | | | | again, and experience panic. |
| anything. | | | | Remembrance and intrusion of the trauma is |
| Terrifying experiences that shatter people's sense of | | | | expressed on many different levels, ranging from |
| predictability and invulnerability can profoundly alter | | | | flashbacks, feelings, physical sensations, nightmares, |
| their coping skills, relationships and the way they | | | | and interpersonal re-enactments. Interpersonal |
| perceive and interact with the world. The criteria for | | | | re-enactments can be especially problematic for the |
| Post Traumatic Stress Disorder (PTSD) are 1) | | | | officer leading to over-reaction in situations that |
| exposure to a traumatic event(s) in which the person | | | | remind the officer of previous experiences in which |
| witnessed or experienced or were confronted with | | | | she or he has felt helpless. For example, in the child |
| an event or events that involved actual or | | | | abuse example above, officers may be much more |
| threatened death or serious injury, or a threat to the | | | | physically and verbally aggressive toward alleged |
| physical integrity of self or others, and 2) the | | | | perpetrators and their reports tend to be much more |
| person's response involved intense fear, helplessness | | | | negative and subjective. |
| or horror DSM IV p. 427-28). Gradual Onset | | | | Hyperarousal. While people with PTSD tend to deal |
| Traumatic Stress Disorder can be caused by | | | | with their environment by reducing their range of |
| repeated exposure to "sub-critical incidents" such as | | | | emotions or numbing, their bodies continue to react |
| child abuse, traffic fatalities, rapes and personal | | | | to certain physical and emotional stimuli as if there |
| assaults. | | | | were a continuing threat. This arousal is supposed to |
| Nevertheless, not all people exposed to trauma are | | | | alert the person to potential danger, but seems to |
| "traumatized." Why? In 1998, Pynoos and Nader | | | | loose that function in traumatized people. This is sort |
| proposed a theory to assist in explaining why people | | | | of like when rookie officers start and a hot call is |
| have different reactions to the same event. They | | | | toned out, they usually have an adrenaline rush. After |
| asserted that people are at greater risk of being | | | | two or three years, the tones hardly have any |
| negatively impacted by traumatic events if any of | | | | impact on them. Since traumatized people are always |
| the following are present: 1) they have experienced | | | | "keyed up" they often do not pay any attention to |
| other traumatic events within the preceding 6 | | | | that feeling which is supposed to warn them of |
| months, 2) they were already stressed out or | | | | impending danger. |
| depressed at the time of the event, 3) the situation | | | | Numbing of responsiveness. Aware of their difficulties |
| occurred close to their home or somewhere they | | | | in controlling their emotions, traumatized people seem |
| considered safe, 4) the victims bear a similarity to a | | | | to spend their energies on avoiding distress. In |
| family member or friend and 5) they have little social | | | | addition, they lose pleasure in things that previously |
| support. | | | | gave them a sense of satisfaction. They may feel |
| It has been argued that officers, emergency service | | | | "dead to the world". This emotional numbing may be |
| personnel, children of addicts and abuse victims | | | | expressed as depression, and lack of motivation, or |
| experience traumatic events or threats to their | | | | as physical reactions. After being traumatized, many |
| safety on an almost daily basis. Being abused, not | | | | people stop feeling pleasure from involvement in |
| knowing when or if your parents will come home, | | | | activities, and they feel that they just "go through |
| repeatedly seeing children murdered, people burned in | | | | the motions" of everyday living. Emotional numbness |
| car fires and devastated victims starts to take its toll. | | | | also gets in the way of resolving the trauma in |
| People like idealistic officers who joined the force to | | | | therapy. |
| change the world and protect the innocent begin to | | | | Intense emotional reactions and sleep problems. |
| feel like nothing they do makes a difference, they | | | | Traumatized people go immediately from incident to |
| cannot even keep their zone safe (criteria 3). This is | | | | reaction without being able to first figure out what |
| especially problematic for officers who live in or near | | | | makes them so upset. They tend to experience |
| their work zone and often leads to frustration and | | | | intense fear, anxiety, anger and panic in response to |
| burnout (criteria 2). Children start to feel that the | | | | even minor stimuli. This makes them either overreact |
| whole world is uncontrollable and unsafe. | | | | and intimidate others, or to shut down and freeze. |
| It is still not totally accepted within the law | | | | Both adults and children with such hyperarousal will |
| enforcement community for officers to discuss the | | | | experience sleep problems, because they are unable |
| impact of situations on them. Anger, humor and | | | | to settle down enough to go to sleep, and because |
| sarcasm are but a brief outlet for what many | | | | they are afraid of having nightmares. Many |
| officers dream about at night. As their condition | | | | traumatized people report dream-interruption |
| worsens, many officers withdraw, because they are | | | | insomnia: they wake themselves up as soon as they |
| fearful of seeking help or support for fear it is a one | | | | start having a dream, for fear that this dream will |
| way ticket to a fitness for duty evaluation or will get | | | | turn into a trauma-related nightmare. They also are |
| out and be an obstacle for future promotions. | | | | liable to exhibit hypervigilance, exaggerated startle |
| Several studies in recent years have shown that Post | | | | response and restlessness. |
| Traumatic Stress Disorder (PTSD) is among the most | | | | Learning difficulties. Being "keyed-up" interferes with |
| common of psychiatric disorders. | | | | the capacity to concentrate and to learn from |
| Another thing that distinguishes people who develop | | | | experience. Traumatized people often have trouble |
| PTSD from those who are just temporarily | | | | remembering ordinary events. It is helpful to always |
| overwhelmed is that people who develop PTSD | | | | write things down for them. Often "keyed-up" and |
| become "stuck" on the trauma, keep re-living it in | | | | having difficulty paying attention, they may display |
| thoughts, feelings, or images. It is this intrusive | | | | symptoms of attention deficit disorder. |
| reliving, rather than the trauma itself that many | | | | After a trauma, people often regress to earlier |
| believe is responsible for what we call PTSD. For | | | | modes of coping with stress. In adults, it is |
| example, I have worked with officers who have | | | | expressed in excessive dependence and in a loss of |
| responded to child abuse calls and had a child of their | | | | capacity to make thoughtful, independent decisions. |
| own who was a similar age (criteria 4). In the course | | | | In officers, this is often noticed because they |
| of daily life children get hurt and have bad dreams. | | | | suddenly begin making a lot of poor decisions, their |
| As parents they have seen looks of pain and fright | | | | reports lose quality and detail and they are unable to |
| on their kids faces. This makes it just that much | | | | focus. In children they may begin wetting their bed, |
| easier to envision the looks of terror and agony on | | | | having fears of monsters or having temper tantrums. |
| the face of the child as their parent beat them. | | | | Aggression against self and others: Both adults and |
| Sometimes this visualization gets corrupted and | | | | children who have been traumatized are likely to turn |
| officers suddenly they start to see their child in their | | | | their aggression against others or themselves. Due to |
| mental re-enactment of the trauma, obviously a | | | | their persistent anxiety, traumatized people are |
| much more powerful memory. These officers are | | | | almost always "stressed out," so it does not take |
| much more likely to be "traumatized" by the incident | | | | much to them set off. This aggression may take |
| and potentially get "stuck." | | | | many forms ranging from fighting to excessive |
| Traumatized individuals begin organizing their lives | | | | exercise or obsession about something---anything to |
| around avoiding the trauma. Avoidance may take | | | | keep them from thinking about the trauma. |
| many different forms: keeping away from reminders, | | | | Psychosomatic reactions. Chronic anxiety and |
| calling in sick to work, or ingesting drugs or alcohol | | | | emotional numbing also get in the way of learning to |
| that numb awareness of distress. The sense of | | | | identify and discuss internal states and wishes. May |
| futility, hyperarousal, and other trauma-related | | | | traumatized people report a high frequency of |
| changes may permanently change how people deal | | | | headaches, back and neck aches, gastro-intestinal |
| with stress, alter thier self-concept and interfere with | | | | problems etceteras. Since the stress is being held |
| their view of the world as a basically safe and | | | | inside, the body begins to become distressed. |
| predictable place. In the example above, these people | | | | Summary |
| often became even more overprotective of their | | | | After a trauma, people realize the limited scope of |
| children, suspicious of others, and had difficulty | | | | their safety, power and control in the world, and life |
| sleeping, because every time they close their eyes | | | | can never be exactly the same. The traumatic |
| they see the child. | | | | experience becomes part of a person's life. Sorting |
| One of the core issues in trauma is the fact that | | | | out exactly what happened and sharing one's |
| memories of what has happened cannot be | | | | reactions with others can make a great deal of |
| integrated into one's general experience. The lack of | | | | difference a person's recovery. Putting the reactions |
| people's ability to make this "fit" into their | | | | and thoughts related to the trauma into words is |
| expectations or the way they think about the world | | | | essential in the resolution of post traumatic reactions. |
| in a way that makes sense keeps the experience | | | | This should, however, be done with a professional |
| stored in the mind on a sensory level. When people | | | | specializing in PTSD due to the wide range of |
| encounter smells, sounds or other sensory stimuli that | | | | reactions people have when they start confronting |
| remind them of the event, it may trigger a similar | | | | and integrating the memories of the trauma. |
| response to what the person originally had: physical | | | | Failure to approach trauma related material gradually |
| sensations (such as panic attacks), visual images | | | | is likely to make things worse. Often, talking about |
| (such as flashbacks and nightmares), obsessive | | | | the trauma is not enough: trauma survivors need to |
| ruminations, or behavioral reenactments of elements | | | | take some action that symbolizes triumph over |
| of the trauma. In the example above, sensory | | | | helplessness and despair. The Holocaust Memorial in |
| triggers that triggered some of the officers | | | | Jerusalem and the Vietnam Memorial in Washington, |
| memories were certain cries, hearing or seeing a | | | | DC, are good examples of symbols for survivors to |
| parent spank their child, returning to the same | | | | mourn the dead and establish the historical and |
| neighborhood for other calls and, of course, television | | | | cultural meaning of the traumatic events. There are |
| shows or news reports that involved descriptions of | | | | several events for survivors of traumas that officers |
| abuse. | | | | can also take part in. These events remind survivors |
| The goal of treatment is find a way in which people | | | | of the fact that there are others who have shared |
| can acknowledge the reality of what has happened | | | | similar experiences. Other symbolic actions may take |
| and somehow integrate it into their understanding of | | | | the form of writing a book, taking political action or |
| the world without having to re-experience the | | | | helping other victims. |
| trauma all over again. To be able to tell their story, if | | | | PTSD is real, and can be resolved with time, patience |
| you will. | | | | and compassion. |
| The Symptoms of PTSD | | | | |