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Allen R. Kates is Board Certified in Emergency Crisis Response (BCECR) and author of the internationally acclaimed book, CopShock, Surviving Posttraumatic Stress Disorder (PTSD). The A&E Television Network produced a documentary called “Cop Counselors” based on the book.
Editorial Note: Mr. Kates will present a workshop called “Surviving Stress, Trauma, and Posttraumatic Stress Disorder” at the CALEA Conference in Birmingham, Alabama on March 16, 2005.
“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
Over a 33-year career, Detective Martin experienced thousands of shootings, homicides, suicides, and natural deaths. Often he felt fear, helplessness, and despair. Thinking his feelings were abnormal, he repressed them, pushing them down, not realizing that his feelings were normal. He did not realize that the situations he found himself in were abnormal. As a result of ignoring his emotions, he developed Posttraumatic Stress Disorder, which is often considered the most severe form of traumatic stress reaction.
Bill Martin told me he had attended too many funerals of police officers that had killed themselves because they couldn’t cope with their feelings after experiencing trauma. He said that he was getting calls in the middle of the night from cops who were drinking heavily or taking drugs to try to subdue horrible nightmares and flashbacks. He told me that as many as one in three cops may suffer from Posttraumatic Stress Disorder—that thousands of dedicated officers with PTSD are impaired.
I didn’t believe him. When I set out to write CopShock, Surviving Posttraumatic Stress Disorder (PTSD), I had no preconceived idea about what I would find out. I had no axe to grind and nobody to please. As a journalist, I planned to investigate police PTSD like any other subject, approaching it in an objective way, allowing the truth to emerge. During six years of research, I analyzed more than 200 psychological studies on police stress and trauma, and interviewed hundreds of police officers, their family members, therapists, peer supporters, treatment center counselors, and police administrators.
I learned that Bill Martin was right. Studies support his belief that one-third of the police force suffers from PTSD symptoms. PTSD is not voodoo. It is a real and devastating condition that can ruin officers’ careers and family life. Sometimes the intense symptoms, from which there seems to be no escape, can cause police officers to commit suicide.
The book took me six years to research because once I delved into the material, I discovered that PTSD was a difficult concept to grasp and explain clearly. I also discovered there were no easy solutions for combating trauma. What works for one person will not necessarily work for another. In addition, two cops can experience the same horrific crime scene - one will react emotionally while the other will not. In fact, some cops seem to thrive on trauma.
Their ability to cope has to do with a lot of factors such as upbringing, exposure to other trauma and how they handled it, how they manage stress, and whether they talk about their feelings at an appropriate time, with appropriate people.
With some officers, it depends on whether their “stress bucket” is full, a phrase coined by Dr. Stephen L. Carson to refer to repressed feelings. Each drop of “water” contributes to the sense of being overwhelmed until the bucket overflows, and the officer can no longer cope. The goal for survival and healing is to empty the bucket of repressed emotions, and keep emptying it.
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 signsSome 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 signsTraumatized 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 signsCognitive signs of trauma are confusion, trouble making decisions, memory and concentration problems, dreams, nightmares, flashbacks, slowed thinking, and blaming others.
Behavioral signsSurvivors 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?
TraumaFew 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.”
StressNext 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 stressPTSD 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 NotNow, 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 IsTo 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.
RelivingTo 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.
AvoidanceAvoidance 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.
ArousalLastly, 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 PTSDSometimes 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.
[For sample chapters, go to www.copshock.com Phone: (520) 616-7643. Toll-free in the US: 888-436-1402. Fax: (520) 616-7643. Email: copshock@copshock.com.]
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