Post-traumatic stress disorder (PTSD) is often referred to as a self-inflicted malady, and this is true to some extent. But it is inflicted out of ignorance. Once individuals have knowledge of what can occur under stress and how to ‘release it’ through breathing and debriefing, they are no longer ignorant. Part one of this two-part article discusses the emotional reactions officers may experience after experiencing or witnessing a traumatic event.
Officers may have little control over when confrontations occur, but they do have control over how they respond to these events before, during and after. This is critical, because if there is no sense of intense fear, helplessness or horror, there is no post trauma. There is no fear because tactical breathing keeps the heart rate down. There is no helplessness because the training was appropriate and taught officers what to do. There is no horror because officers were inoculated against trauma. Officers have undergone a critical incident debriefing and worked their way through the event to make peace with the memory. They knew what to expect and, even though it may have been ‘different’ to what they expected, they were forewarned, and therefore forearmed, to survive.
Listed below are the diagnostic criteria for PTSD (Diagnostic & Statistical Manual of the American Psychiatric Association):
A. Exposure to a traumatic event in which both of the following were present:
- experienced, witnessed or was confronted by events involving actual or threatened death or serious injury… of self or others
- response involved intense fear, helplessness or horror (the disorder may be especially severe or longer lasting when the stressor is of human design, for example, torture, rape)
B. Traumatic event is persistently re-experienced in one or more of the following ways:
- recurrent, intrusive, distressing recollections of the event
- acting or feeling as if the event were recurring including: ‘sense of reliving’ the experience, illusions, hallucinations and flashbacks, including while awakening or intoxicated
- intense psychological distress at exposure to internal or external cues that symbolise or resemble an aspect of the traumatic event
- psychological reactivity on exposure to internal or external cues that symbolise or resemble an aspect of the traumatic event
C. Persistent avoidance of stimuli associated with the trauma, or numbing of general responsiveness, as indicated by at least three of the following:
- efforts to avoid thoughts, feelings or conversations associated with the trauma
- efforts to avoid activities, places or people that arouse recollections of the trauma
- inability to recall an important aspect of the trauma
- markedly diminished interest or participation in significant activities
- feelings of detachment or estrangement from others
- restricted range of affect (for example, unable to have loving feelings)
D. Persistent symptoms of increased arousal (not present before the trauma), as indicated from two or more of the following:
- difficulty falling or staying asleep
- irritability or outbursts of anger
- difficulty concentrating
- exaggerated startle response
E. Duration of the disturbance (symptoms in B, C, D) of at least one month
F. The disturbance causes clinically significant distress or impairment in social, occupational or other important areas of functioning
Acute: if duration of symptoms is less than three months
Chronic: if duration of symptoms is greater than three months
With delayed onset: if symptoms were at least six months after the trauma
Relief: The first response of most people upon seeing sudden, violent death is relief; they are relieved it did not happen to them. The midbrain, that part concerned about survival, sends out a message saying ‘hey, that could have been me’. This is not selfish, or inhuman, or cold; it is a normal survival reaction. If officers know in advance that it is normal upon seeing trauma and death to think, ‘thank goodness it was not me’, then that thought will not have the power to hurt them later.
Guilt: Witnessing a person suffer trauma causes the normal response of ‘I am glad that was not me’. Later, on reflection, the person feels guilty because no one ever said that the normal response of most people upon seeing a traumatic event is to focus on themselves and feel relief. In the stress of a violent encounter, the tendency to accept responsibility for what happened can be a powerful one. The midbrain can hit the person with an ‘it is all my fault’ response. Proper debriefing is important for officers to understand their role in the overall event.
Doubt: There are many burdens that weigh upon an officer, and one of the greatest is uncertainty. The constant anticipation of being involved in violent encounters can have a profoundly toxic effect, especially when this stress continues over months or years. For officers, there is a constant possibility that just around the next corner there might be an individual who will dedicate all his energies to causing them harm. When they are warned that something might happen, they can more easily control the amount of stress experienced. However, if they spend their life in denial and then something happens, it can hurt officers seriously. Uncertainty will dissipate when officers are mentally prepared and accept the fact that their job role has the potential to place them in harm’s way.
Fear: If a stressful trauma is severe enough, it can create an associated fear response that lingers well after the event. This is where situations of a similar nature, or stressors related to the event, set off arousal mechanisms under actual circumstances that are not threatening to an officer at all. It is also common for officers to relive the event, or parts of the event. This type of response is related to PTSD and, once recognised by the officer or others, it should be examined and dealt with.
Anger: Officers may feel anger after a traumatic event has passed, commonly anger at the fact that the event happened in the first place. No one has the right to harm officers, and they are likely to feel very indignant if they are put in danger by the very people they are working to protect. There is no use trying to rationalise the irrational, but officers will attempt to do it anyway. This is where professional counselling can be of use to provide an officer with a framework to hang the event on and tools for making sense of it. Officers may also experience anger from their loved ones, surprising as it may seem. If someone has tried to harm them, it is common for officers to experience anger from their spouses. Rather than react to this, officers should keep in mind that they are not actually angry at them, but rather the person who caused the trauma and the irrationality of such events, but since these factors are not readily available to remonstrate with directly and they are, then they will receive this deferred anger. Understanding and emotional openness are important to work through this, not shutting off and distancing themselves from loved ones.
Denial: Some officers, after experiencing a traumatic event, enter a state of denial. This may take several forms, such as denying the event ever occurred, or denying specific parts of the event, to even trying not to think about the event at all. None of these reactions are positive or healthy, and they will not help the officer deal with the event. It is important to make peace with the memory of the event, and the first step in this process is to delink the memory with the emotions. This means eliminating the associated stress-related arousal symptoms that may occur when recalling or reliving the event. The aim is to reach a stage where the officer can remember the event without creating arousal. Proper debriefing, support and counselling are important in this process.
Part two of this article discusses the debriefing process and post-event protocols that help officers heal.