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