I recently was chatting with a colleague and was asked what injured me enough to cause PTSD. What were the signs and symptoms and how can we prevent it?
I explained PTSD can be like a death by a thousand cuts for some first responders, but we can all be just one call away from needing a time out. The cumulative effects of what we see doing our jobs slowly changes us. Each of the “Traumas” we see affect us differently. It is a twist of fate when a victim reminds you or your own child or childhood, or a particular call touches you in a personal way. PTSD is reasonably well understood, but some of the traumatic things we see on the job lead to “Moral Injuries”.
Moral Injury is an injury that affects the heart and soul of a person and shakes the very core of our being. It can erode our faith in humanity, and cause overwhelming sadness, shame and guilt.
“Sanctuary Trauma” is another type of Moral Injury. This is when the organization that you serve with great dedication and pride seems to cause you harm instead of providing support when you suddenly need it. This can come from a colleague unfairly blaming you, a sense of leadership failure, SIU investigations resulting from just doing your best on the job, lack of support from the command staff, difficulty from insurance companies.
The symptoms of Sanctuary Trauma are a sense of betrayal, injustice, anger and resentment.
With help, we can make peace with the things we see on the job. We signed up for this knowing we would experience challenging times. What we were never trained for is how to deal with the moral injury and sanctuary trauma, and these can cause the burden of suffering for Operational Stress injuries.
In 2018 The Centre for Addiction and Mental Health (CAMH) release a discussion paper on Police Mental Health stating 29% of us were in the clinical diagnostic range for PTSD.
PTSD symptoms are both mental and physical. We are exposed to so many fight or flight moments over our career. We are trained to look out for threats and our brain becomes wired to believe everything is a threat. This leads to a natural type of hyper-vigilance which gets magnified when PTSD sets in.
We also learn to numb our emotions, so we can continue to remain professional in the face of chaotic and emotionally charged situations. Widespread numbing of emotions becomes another symptom of PTSD.
However, what keeps us alive on the street doesn’t serve us very well while off duty.
The physical symptoms of PTSD are related to stress and tension and include:
-Upset stomach & irritable bowel
-Back and neck pain
-Heart palpitations, chest tightness and shortness of breath.
The psychological symptoms of PSTD include:
-Flashbacks and nightmares with sleep disturbance
-Numbing of emotions
-A secondary depression may develop.
Many people with PTSD also suffer from the shame and guilt or overwhelming sadness of moral injury.
Many also have some degree of sanctuary trauma, which causes anger and a sense of injustice.
Suicidal ideation may develop when a person feels that their situation has become hopeless.
People with PTSD, moral injury or sanctuary trauma may try to self medicate with drugs and/or alcohol, or they may try to distract themselves with risky behaviour, gambling, or sex.
Organizations must become aware of the ways in which they unwittingly inflict sanctuary trauma if the morale of the membership is going to improve. It is important that there is some mechanism where management consults with and listens to the concerns of the members. Care must be taken to not punish a member who comes forth asking for help. The stigma of identifying as having an operational stress injury is the main reason why someone struggling is reluctant to ask for help. There is the concern for loss of chance of promotion, or being removed from a position that was difficult to achieve. There must be consistent standards of behaviour for all, members and management alike. There must be a fair and just promotional process, so that promotions are offered to individuals who will work to improve the effective functioning of the organization, but also act in a way to foster and maintain a healthy workplace free of stigma.
Confidentiality must be maintained so that a person’s mental health, physical health or personal information is not divulged to other members or the media. Anyone facing a SIU investigation should feel supported by the organization. Accommodated positions that truly offer meaningful work should be identified or created, and the return to work process should be simplified and made to feel safe and seamless.
A healthy workplace would also ensure that disciplinary measures are kind, just and time limited. Supervisors should be promoted for their performance merit and emotional intelligence. They should be trained to be respectful and to sensitively respond to members displaying signs of stress injuries. They should be able to give praise for a job well done, knowing that this is appreciated from time to time.
A career in policing has numerous rewards. It comes with great privilege, but also with responsibilities and significant inherent stress. Operational stress injuries, PTSD, Moral Injury and Sanctuary trauma must be actively addressed by all emergency services, or they will become the cost of doing business. Without taking proactive steps, more and more members will suffer in silence, many will go off work, some for long times or forever, some will quietly give up their struggle and die by suicide, because they would rather this than to face the stigma that comes with admitting they are injured.
The good news is that we know that we can lighten our loads by educating ourselves about the nature of operational stress injuries and developing personal resilience philosophies. We know that coming forward for help early can make all the difference when it comes to being able to continue to enjoy a long and satisfying career, and retirement.
Management must make it safe to come forth for help with no stigma and no repercussions. We must engage our families, our care providers, leaders and coworkers, so that we all work together to ensure a healthy work and home environment.
With today’s added stresses of the COVID pandemic and the current anti- police rhetoric, the challenge to stay mentally healthy is greater than ever. Much can be done to proactively address the risk of PTSD, Moral Injury and Sanctuary trauma. It is going to take all of us to make a difference.
Knowledge is power.
Pain is inevitable; suffering is optional.
Signed, a cop with PTSD.
London Project Trauma Support Group