What is Posttraumatic Stress Disorder (PTSD)?
Posttraumatic Stress Disorder (PTSD) is an anxiety disorder that can occur after you have been through a traumatic event. A traumatic event is something horrible and scary that you see or that happens to you. During this type of event, you think that your life or others' lives are in danger. You may feel afraid or feel that you have no control over what is happening.
Anyone who has gone through a life-threatening event can develop PTSD. These events can include:
• Combat or military exposure
• Child sexual or physical abuse
• Terrorist attacks
• Sexual or physical assault
• Serious accidents, such as a car wreck.
• Natural disasters, such as a fire, tornado, hurricane, flood, or earthquake.
After the event, you may feel scared, confused, or angry. If these feelings don't go away or they get worse, you may have PTSD. These symptoms may disrupt your life, making it hard to continue with your daily activities.
How does PTSD develop?
All people with PTSD have lived through a traumatic event that caused them to fear for their lives, see horrible things, and feel helpless. Strong emotions caused by the event create changes in the brain that may result in PTSD.
Most people who go through a traumatic event have some symptoms at the beginning. Yet only some will develop PTSD. It isn't clear why some people develop PTSD and others don't. How likely you are to get PTSD depends on many things. These include:
• How intense the trauma was or how long it lasted
• If you lost someone you were close to or were hurt
• How close you were to the event
• How strong your reaction was
• How much you felt in control of events
• How much help and support you got after the event
Many people who develop PTSD get better at some time. But about 1 out of 3 people with PTSD may continue to have some symptoms. Even if you continue to have symptoms, treatment can help you cope. Your symptoms don't have to interfere with your everyday activities, work, and relationships.
What are the symptoms of PTSD?
Symptoms of posttraumatic stress disorder (PTSD) can be terrifying. They may disrupt your life and make it hard to continue with your daily activities. It may be hard just to get through the day.
PTSD symptoms usually start soon after the traumatic event, but they may not happen until months or years later. They also may come and go over many years. If the symptoms last longer than 4 weeks, cause you great distress, or interfere with your work or home life, you probably have PTSD.
There are four types of symptoms: reliving the event, avoidance, numbing, and feeling keyed up.
Reliving the event (also called re-experiencing symptoms):
Bad memories of the traumatic event can come back at any time. You may feel the same fear and horror you did when the event took place. You may have nightmares. You even may feel like you're going through the event again. This is called a flashback. Sometimes there is a trigger: a sound or sight that causes you to relive the event. Triggers might include:
• Hearing a car backfire, which can bring back memories of gunfire and war for a combat veteran
• Seeing a car accident, which can remind a crash survivor of his or her own accident
• Seeing a news report of a sexual assault, which may bring back memories of assault for a woman who was raped
Avoiding situations that remind you of the event:
You may try to avoid situations or people that trigger memories of the traumatic event. You may even avoid talking or thinking about the event.
• A person who was in an earthquake may avoid watching television shows or movies in which there are earthquakes
• A person who was robbed at gunpoint while ordering at a hamburger drive-in may avoid fast-food restaurants
• Some people may keep very busy or avoid seeking help. This keeps them from having to think or talk about the event.
Feeling numb:
You may find it hard to express your feelings. This is another way to avoid memories.
• You may not have positive or loving feelings toward other people and may stay away from relationships
• You may not be interested in activities you used to enjoy
• You may forget about parts of the traumatic event or not be able to talk about them.
Feeling keyed up (also called hyperarousal):
You may be jittery, or always alert and on the lookout for danger. This is known as hyperarousal. It can cause you to:
• Suddenly become angry or irritable
• Have a hard time sleeping
• Have trouble concentrating
• Fear for your safety and always feel on guard
• Be very startled when someone surprises you
What are other common problems?
People with PTSD may also have other problems. These include:
• Drinking or drug problems
• Feelings of hopelessness, shame, or despair
• Employment problems
• Relationships problems including divorce and violence
• Physical symptoms
Can children have PTSD?
Children can have PTSD too. They may have the symptoms described above or other symptoms depending on how old they are. As children get older their symptoms are more like those of adults.
• Young children may become upset if their parents are not close by, have trouble sleeping, or suddenly have trouble with toilet training or going to the bathroom
• Children who are in the first few years of elementary school (ages 6 to 9) may act out the trauma through play, drawings, or stories. They may complain of physical problems or become more irritable or aggressive. They also may develop fears and anxiety that don't seem to be caused by the traumatic event.
What treatments are available?
When you have PTSD, dealing with the past can be hard. Instead of telling others how you feel, you may keep your feelings bottled up. But treatment can help you get better.
There are good treatments available for PTSD. Cognitive-behavioral therapy (CBT) is one type of counseling. It appears to be the most effective type of counseling for PTSD. There are different types of cognitive behavioral therapies such as cognitive therapy and exposure therapy. A similar kind of therapy called EMDR, or eye movement desensitization and reprocessing, is also used for PTSD. Medications can be effective too. A type of drug known as a selective serotonin reuptake inhibitor (SSRI), which is also used for depression, is effective for PTSD.
(This information was provided by the National Center for Posttraumatic Stress Disorder) http://ncptsd.va.gov/ncmain/ncdocs/fact_shts/fs_what_is_ptsd.html
How does this relate to Law Enforcement?
Because of the nature of their work, police officers would seem to be prime candidates for the development of posttraumatic stress disorder. What is it about some police officers that makes them more likely to develop PTSD? What treatment approaches have you found to be effective for these patients?
Environment Causing Underreporting?
Exposure to trauma is inevitable in police work. Data show that one-third of police officers exposed to various work-related traumatic events develop significant symptoms of PTSD. In my opinion, the prevalence of PTSD is more common than has been reported. Several factors that may prevent police officers from seeking help or assistance include fear of denunciation, negative consequences on job responsibilities (such as losing one's weapon and a change of assignment), and perception of failure and personal weakness.
I have diagnosed and treated several police officers for PTSD who were initially reluctant to come for help in the mental health clinic. They all presented with the chief complaint of sleep disturbance, but after psychiatric evaluation were found to have significant symptoms of PTSD. Some refused to be labeled as having PTSD because of the fear of losing their job or a promotion.
In addition to psychopharmacologic treatment, I have found that PTSD peer groups are beneficial. Participation helps patients gain insight and understand that they are not alone. This helps to decrease the stigma and guilt associated with PTSD in police officers.
S. Faiz Qadri, M.D.
Omaha, Neb.
“PTSD is a greater cop killer than all the guns ever fired at police officers.”
These are the prophetic words of Lieutenant James F. Devine (Retired) former director of the New York Police Department Counseling Services. At least 300 police officers kill themselves every year, more than are murdered by felons. Many of these suicides occur after officers have given up trying to cope with the deadly symptoms of Posttraumatic Stress Disorder (PTSD).
Nightmares, flashbacks, anger, concentration problems, emotional detachment, avoidance of people and places are some of the signs of PTSD, a condition that can lead to depression, suicidal thoughts, addictions, eating disorders, as well as job and family conflict.
Detective William H. Martin (Retired), former coordinator of the drug and alcohol rehabilitation program for the Los Angeles Police Department, knows what PTSD can do. He suffers from it.
He says:
“As police officers, we have a very real problem. We don’t recognize how what we see, hear, smell, taste, and feel affects us on a daily basis. Our responses to violence are so subtle and long-term that we do not realize what is happening to us until we begin to lose what is most important in our lives: our families, friends, health, spirituality, honor, commitment, and sense of self-worth.
For most of my police years, I was addicted to alcohol and prescription drugs. I often had suicidal thoughts and once tried to kill myself. I didn’t realize that my exposure to frequent trauma was causing Posttraumatic Stress Disorder.”
—Excerpt from CopShock
The first step in trying to cope with PTSD or in helping others with PTSD is finding out what it is and what it is not. Let’s begin by examining the major signs of trauma that might impair a police officer and lead to PTSD. Symptoms of trauma are broken down into four categories: emotional, physical, cognitive and behavioral.
Emotional signs
Some emotional signs are denial, fear, depression, grief, and feeling hopeless, helpless, and overwhelmed. People may become angry or even suicidal. Often they dwell on details of the event.
Physical signs
Traumatized people sometimes express their feelings through physical reactions. Physical signs of trauma include chest pain, trouble breathing, high blood pressure, stomach pain, headaches, dizziness, vomiting, muscle aches, rapid heart rate, fatigue, and sleep disturbance.
Cognitive signs
Cognitive signs of trauma are confusion, trouble making decisions, memory and concentration problems, dreams, nightmares, flashbacks, slowed thinking, and blaming others.
Behavioral signs
Survivors of trauma also express feelings through their behavior. These signs may include a change in speech patterns, angry outbursts, withdrawal, gambling, an increase in consuming alcohol, drugs, or food; buying sprees, promiscuity, and unexplained or prolonged crying spells.
If you observe officers experiencing one or more of these symptoms, they may be traumatized and on the way to developing PTSD if they don’t receive guidance.
When we listen to discussions about PTSD, several murky words are thrown around like so much confetti at a New Year’s Eve dance. They sure are colorful, but they mean different things to different people. They are obvious words like “trauma,” “stress,” and “posttraumatic stress.” What do they really mean?
Trauma
Few of us have not experienced trauma in our lives. It’s a shock, a sudden kick to the body or mind that sends us into a spin. Trauma is, in part, “An emotional shock that creates substantial damage to the psychological development of the individual.”
Stress
Next is stress. Stress is not a thing. You cannot hold it in your hand. You can’t carry it in your pocket. It is a process, as intangible as happiness, anger, love, fear, and pain. Stress results when we fail to adapt to a situation. Any change can lead to stress. Stress is also the feeling of being faced with demands that cannot be met. These are demands we believe are beyond our capability of fulfilling.
Posttraumatic stress
PTSD and “posttraumatic stress” are not the same thing. Posttraumatic stress occurs moments, hours, days, or months after a traumatic event has taken place. It’s a sense of being overwhelmed. Sufferers feel they can no longer cope.
The difference between posttraumatic stress and Posttraumatic Stress Disorder is in the symptoms. Posttraumatic stress may include some PTSD symptoms such as nightmares and flashbacks, but it also features symptoms like depression, eating disorders, heavy drinking, and gambling, which are not part of PTSD’s roster of reactions. Posttraumatic stress symptoms are generally short-lived, unlike PTSD’s symptoms. But if not looked after through counseling or some other form of support, posttraumatic stress could develop into PTSD.
PTSD: What It Is Not
Now, finally, on to the definition of Posttraumatic Stress Disorder. Almost. First, let’s be sure we are aware of what PTSD is not. It does not mean mental illness. It is a normal reaction to an abnormal amount of stress. Dr. Aphrodite Matsakis, author of eight books on Posttraumatic Stress Disorder, says, “…you are not crazy… PTSD is a normal reaction to being victimized, abused, or put in a life-threatening situation with few means of escape.”
PTSD: What It Is
To be diagnosed with PTSD, candidates must meet two specific criteria as defined by the American Psychiatric Association in its publication called The Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, also called the DSM-IV.
First, to become a candidate for PTSD, a person must experience or witness a traumatic event that involves actual or threatened death or serious injury. The second key ingredient is that the person must respond with intense fear, helplessness, or horror. These reactions pave the way for PTSD to be set in motion.
For police officers, these criteria present a dilemma. Cops are trained not to respond with fear, helplessness, or horror. They are taught to control the situation, help people, and move on to the next job. Despite this contradiction, cops do develop PTSD. Sometimes it is later when they are reflecting on critical incidents that they feel fear, horror, and helplessness.
What is PTSD? You could sum up PTSD simply by saying that it consists of three clusters or groupings of symptoms. Those groupings are called reliving, avoidance, and arousal.
Reliving
To relive the trauma, sufferers may persistently re-experience the event in episodes like nightmares and flashbacks. They may feel that the traumatic event is invading their thoughts.
Avoidance
Avoidance means that the victims avoid anything that reminds them of the trauma. This takes the form of suppressing feelings so well that the traumatized individuals become unable to remember important aspects of the trauma. They may avoid thoughts, conversations, or places where the trauma occurred. They may believe that they no longer have any feelings, that their emotions are dulled or numb. They become detached from everyone, even loved ones, and become uninvolved in family activities or work. They withdraw from life, having difficulty actually feeling anything for anybody.
Arousal
Lastly, survivors of trauma may experience arousal. That means they may have problems in concentrating and falling or staying asleep. They become irritable because of minor annoyances, or burst out in unexplained anger. They become easily startled; every noise seems to make them jump. They overreact to situations and find themselves super-alert or hyper-vigilant about people or places.
What I have just described is a simplified definition of PTSD. For more symptoms and qualifiers, please consult the DSM-IV.
Signs of PTSD
Sometimes we mistake other symptoms of trauma for signs of PTSD. Some of these symptoms are alcoholism, drug use, eating disorders, depression, and suicidal thoughts. They may be present at the same time as PTSD. They may show themselves before PTSD sets in or afterwards as a reaction to trying to subdue PTSD symptoms. But they are not considered symptoms of PTSD, only red flags or associated conditions that represent the disorder’s progress.
Conditions like alcoholism, eating disorders, suicidal thoughts, and the like are serious and often life-threatening. They are just not part of the specific symptoms for a PTSD diagnosis. However, if you notice that fellow officers are exhibiting one or more of these conditions, you may wish to advise them to see a counselor experienced in treating trauma victims. These symptoms may be hiding PTSD.
As you can see, with exceptions and qualifiers, PTSD is not easy to determine. You cannot diagnose yourself. Even mental health professionals find it difficult to diagnose PTSD, as the symptoms are complex, and a proper assessment can take months. So when fellow officers tell you that a professional has diagnosed them with PTSD, don’t think it’s a fraud or a joke. It’s no joke. They are experiencing days and nights teeming with nightmares, cold sweats, tears, and misery you can’t even imagine.
As a friend, partner, or manager, if you think officers are having a hard time coping with a specific critical incident or years of accumulated crime scenes, suggest they talk to a peer supporter or outside counselor. Find a way to ensure confidentiality; otherwise they might not seek help. Perhaps the officers will resent you for interfering, but it’s better to be wrong than to lose an officer to PTSD or suicide.
http://www.calea.org/online/newsletter/No87/ptsd.htm
Killer Cocktail: PTSD and Your Local Police
by Kelley B. Vlahos, April 27, 2010
The moment that Austin police officer Wayne Williamson began unloading his pistol in a filled parking lot was probably the first time he realized he hadn’t left Iraq too far behind.
Williamson never hit his target –a fleeing, "possibly armed" suspect – but only one of the bullets he discharged in the parking lot was ever found. It was lodged in the back seat of a car in which two children, a 14-year-old girl and a four-month-old baby, had been sitting (miraculously, neither was injured). There were no excuses or cover-ups, however – Williamson was subsequently terminated from his nine-year career as a police officer.
Williamson is one of thousands of veterans who have returned from Iraq and Afghanistan with post-traumatic stress disorder (PTSD), though he had not been treated for it before the aforementioned incident on March 14, 2007. A National Guardsman who left his job at the Austin Police Department (APD) to go to war in 2005, Williamson saw heavy combat in Tikrit before coming home and going back on patrol. He later told a reporter how a fleeing suspect like the one he had encountered in the parking lot would have been handled in Iraq.
“Bad guys get away over there, they come back with things strapped to their chest, and they don’t mind blowing themselves up – or you or somebody else around you,” he told writer Jordan Smith, who added, "That was a soldier’s lesson it seems that no one at APD thought to help him unlearn before he returned to patrol."
Members of the Army National Guard and Reserves have been rotating in and out of the two-front war with such regularity it’s become difficult to tell the difference between the "part timers" and the active-duty force – with one major distinction. Guardsmen and reservists go back to civilian jobs in between their multiple tours. Many are police officers. In fact, police departments across the country are actively recruiting part-time soldiers and veterans because their acquired "skill set" apparently makes them a desired fit for this line of work.
So what happens when they bring the war to work with them?
Williamson never denied the gravity of what happened in the parking lot that day. When speaking before the police disciplinary review board on the matter, he said, “That day, I posed a threat to other people … innocent civilians. If I’m a greater danger to the people than the guy that I’m chasing, then there’s … something definitely wrong there, sir.”
Experts who spoke with Antiwar.com said the relentless urban war zone through which these citizen soldiers have rotated for one, two, even three tours can warp their perspective of the policing environment back home. Their "area of operation" today may be a gritty public housing project or a sleepy middle-American burg, but it may all seem like Baghdad again in a troubled vet’s mind. Unfortunately, the acceptable military "rules of engagement" are completely incompatible with the authority and obligations of a civilian police officer.
Soldiers are trained to kill; police are trained to "keep the peace." Soldiers shoot first and ask questions later. Cops read Miranda rights. They are supposed to abide by the Constitution. In a hyper-criminalized society in which police are already criticized for being too aggressive and the gulf between cop and "civilian" is ever widening, this could be lighter fluid poured on a fire for departments and communities across the country.
Allen Kates, author of CopShock: Surviving Post-traumatic Stress Disorder, said that any cop left to go about his job with untreated PTSD is like ticking time bomb. "It can be very dangerous for military people who have not dealt with their PTSD to do their police work," he stressed, noting that departments struggle enough with how to handle officers who are traumatized by events that occur on the job. Handling vets who come back from urban combat overseas is even harder.
Plus, while 54 percent of departments across the country have some sort of counseling unit, "that does not mean a majority of cops will go – there is still a stigma," Kates said. Unless there is confidentiality promised to the officer up front, many will see counseling as a potential blot on their record, and cause for suspicion and ridicule. This is not so different from the way military people have viewed mental health care as a potential stain to be avoided.
So what are the symptoms? We know Williamson suggested he reacted like a soldier in Tikrit, not a cop, when chasing his suspect that fateful night. In addition to disorientation, experts say hyper-vigilance to the point of paranoia, a quick temper, overreaction, lack of empathy, and poor performance due to a loss of sleep and problems at home are all potential signs of a cop in need of readjustment and treatment.
The problem is that police not only carry weapons, but their badges give them special power over the civilians they are sworn to "protect and serve." That trust is put on the line when an officer is temporarily stuck in a reality thousands of miles away.
"[Cops] are trained to stuff their feelings," said Kates. "If you keep stuffing them, they’re sooner or later going to come out, in a dramatic way."
But while the vast majority of vet-cops will never shoot into a crowded parking lot or repeatedly punch a handcuffed suspect in the face, an important study released in September by the International Association of Chiefs of Police (IACP) and the Bureau of Justice Assistance indicates that a growing number of officers admit to carrying negative baggage from the war – and their superiors are noticing.
"Employing Returning Combat Veterans as Law Enforcement Officers" [.pdf] is the result of interviews with 53 Iraq/Afghanistan veterans now serving as police officers and 112 department leaders, as well as written responses from 340 additional veterans.
Of the vets who responded to the question about behavioral changes on the job after returning from war (about 19 percent of the total), 75 percent reported they were more sensitive to sudden noises and movement, and 72 percent reported changes in mood. They were also more irritable and more prone to anger post-deployment.
Of all vets surveyed, 28 percent said they "were experiencing mental health symptoms that they associate with combat." Some comments included "examples such as exaggerated survival instincts, PTSD, paranoia, and anxiety."
From the report’s summary:
"Troops must make instantaneous decisions when confronting resistance in the urban combat setting, and it is very possible that such combat experience enhances their decision-making abilities in the domestic policing environment. However, the environments in which service members work are quite different from the environments in which law enforcement officers work. Sustained operations under combat circumstances may cause returning officers to mistakenly blur the lines between military combat situations and civilian crime situations, resulting in inappropriate decisions and actions – particularly in the use of less lethal or lethal force. This similarity may cause an operational or reactive issue that could result in injury or death to an innocent civilian."
Let’s listen to the cops, as recorded in the survey, on making that "mental shift" to Main Street from Haifa Street:
"In [California], a gang city, I responded to gun fire. There was an 11-year-old gunshot victim. I get there, and chaos is breaking out, there is a crowd. They are all asking questions, pushing to get on the scene. And I thought I was back in Iraq, and I thought I was going to lose my control. … In Iraq you would fire a couple shots in the air to push the crowds back. …
"It is real hard, especially when have just come back from a tour. It is hard for your mind to transition from a military to a law mode. … I did not act on my impulse like it was Iraq, I actually physically stepped back to my patrol car and watched things for awhile and I was able to clear my mind. It wasn’t that I didn’t know where I was, it was more I felt overwhelmed by all the screaming. I was more nervous because of having to deal with crowds in Iraq."
Then there are the different rules of engagement:
"In SWAT, no one can get shot. When we enter a building or room [in the military] we yelled ‘down’ and shot anyone who didn’t, but not in SWAT. You have to make a judgment call. By military standards, I am successful if I take less than 13 percent casualties but in SWAT, you can’t take any casualties."
"Control issues" also come into play:
"The hardest thing for me during my transition was control issues. … A student told me recently that I was so intimidating. … I didn’t see myself as intimidating. I had two complaints lodged on me. Both of them dealt with people perceiving me to be very military in bearing and unbendable on the scene."
Some veterans express frustration with – and little tolerance for – the society they have come back to:
"I have no tolerance for people asking me for directions. Someone stopped me and I said, ‘Why can’t you just leave me alone?’ I had a bad attitude, and I could tell from his face that I made him mad, and rightfully so. I was disrespectful. [I have] this ‘I don’t care’ attitude. I don’t want to waste my time with disabled vehicles because I want to go catch the bad guys. I have less tolerance for the minor things, and they should be just as important."
Other responses included a learned bias against people with Middle Eastern names and features. Vets also admitted to bringing their family problems to work. Some admitted to disliking their supervisors and trusting and socializing only with fellow veterans, thus exacerbating the us-vs.-them atmosphere that can be poisonous in a department.
Good Cop, Bad Cop
Lisa Zepeda was deployed for two years with the Army, one in Kuwait at a combat hospital, the second at Abu Ghraib in Iraq. A single mother, she returned to her teenage son and her job as a Chicago police officer in 2005. She recently joined up with two Vietnam vets to form a support group for fellow cops who have done time in combat and are dealing with readjustment issues.
"I think there are a lot of people suffering in silence – these are the people I’m going to reach out to," she told Antiwar.com.
Zepeda insisted that a lot of cops actually grow and become better police officers after war, and the survey in part bears that out – but they must get the treatment and have the transition time when they get home to realize the potential positives.
"I feel more compassionate, I have more empathy. I’m going to be more patient with people. [War] has made me more understanding," she said. "I know what’s important and what’s not important."
But she admitted that when she got home she was "angry" – mostly at the government for sending soldiers into a long, confusing mission with seemingly no end. She joined Iraq Veterans Against the War. She hung out with only fellow vets during the police department’s required retraining at the police academy.
But it was the transition – including the available counseling – that made her feel like herself again. The Chicago Police Department, she said, "had the resources to retrain us and keep us off the job for a few months. They buffered us and retrained us and sent us back on the street. With smaller departments, they don’t have that luxury. They’re just sending them back on the street. I don’t think that does anyone any good."
Some 84 percent of vets surveyed agreed that a period of transition bolstered by counseling and other assistance by the department is essential before putting combat vets back on the beat.
This puts smaller departments in a Catch-22. A small force can’t afford to train and maintain new officers while its Guard members and reservists are constantly rotating in and out of the force, so it is always stretched. When veterans come home, the department has to get them back on duty ASAP to plug the gaps.
Take the tiny Milton Police Department in Vermont. Five of its 14 officers are currently deployed overseas, according to a recent write-up in the Burlington Free Press.
"It’s created a lot of overtime shifts and a lot of officers are working many many more hours," said town police chief Brett Van Noordt, who said the department has not had any problems with returning veterans so far. He normally gives vets as much time as they need to re-acclimate. "We let them come back at their own pace."
We hope that most police officers are like Zepeda, more compassionate, reflective, and grounded because of their terrible experiences overseas.
Of course, the chances of this get slimmer as the wars wear on, requiring more cops to leave to fulfill their Guard and reserve duty, risking burnout, mental and physical stress, and moral compromise. Police departments – already strained by today’s fiscal burdens – are often too stretched to provide necessary mentoring and assistance to avoid the Williamsons and others who might blow up on the job.
While we should be grateful that someone out there is aware of all these pitfalls, it sounds like the only way to keep the war out of our police departments and off our streets is to get out of the war, period. We don’t need a survey or glossy report to tell us that.
http://original.antiwar.com/vlahos/2010/04/26/killer-cocktail/
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