CJ 720 Trauma & Crisis Intervention Blog

The Stress of Law Enforcement

As a law enforcement officer myself, I have become all too aware of the realities of chronic stress and PTSD that come from the profession. Unfortunately, it's not just myself, but rather every person in law enforcement that has to deal with extreme stress and likewise, the repercussions it may have on our ability to perform our duties. In many cases these repercussions might extend far beyond having  a mental freeze at a crime scene. Officers who suffer PTSD and/or chronic stress may be deemed unfit for duty resulting in a reassignment of post (likely to a desk job), inability to carry a firearm, or even result in a termination of their job. Many report, the biggest fear they have with seeking professional advice is that there job will be informed of their meeting. It still remains that many agencies require you to disclose any counseling you have had and if you fail to omit that information, if at any point during a background investigation it becomes known you could be eligible for termination. 

As a result of the severe repercussions that come along with displaying signs of stress or PTSD, a stigma had been created where law enforcement officers are reluctant to speak up about their stress, much less seek professional advise. The profession has for decades been known as a "tough" machismo like field where having mental stress only makes you weaker. As a result it, if you were an officer suffering and came forward you would be quickly ousted by your peers and superiors, in due time would result in less job duties.

Another underlying issue that comes along with not being able to, or fearful of, discussing the stress one endeavors, is that it only gets worse and continues to build up. This build up of stress overtime will likely turn into PTSD and will continue to impact your life outside of work and your overall health as well. As we learned in the module 3 reading, the physiological effects stress has on our brain can be severe and ever lasting. According to The Badge of Life (2018), the average life expectancy of a cop is a 66 years, or 10 years post retirement. According to Corrections Today (1982), the average life expectancy of a correction officer is 59 years old, or 3 years post retirement. These statistics are clear indicators that the role of stress, and furthermore the lack of combating stress, has on the life of law enforcement officers. 

According to Basińska & Wiciak (2012), there is a slew of other health risk that come from chronic mental fatigue including:

• Difficulty managing personal relationships
• Excessive use of sick time
• Extreme weight gain/loss
• Increased mood swings
• Substance/Alcohol Abuse
• Increased gastrointestinal problems
• Increased risk for cardiovascular disease

While the daily stress itself may inherently result in a shorter life span, if we are able to seek and receive help we can surely make these statistics change for the better. That said, the first thing that has to be done to combat the problem is to allow officers to seek help. This includes promoting and providing opportunities, within agencies, departments, and as fellow officers, for others to engage with psychologists, counselors, and each other. The structure needs to be changed from the top down starting with addressing the stigma. Instead of being seen as a flaw, seeking help must become a word of encouragement. It is also crucial that nobody feels that there job is being threatened because of the hardship that job itself has put on them.

Moving to a more personalized approach, there are things we can address or do daily to help minimize the effects that the jobs has on us. Basińska & Wiciak  (2012) stress the importance of leaving work at work and focusing on personal relationships and civilian life. By avoiding to "talk shop" while outside of work you refute the notion that work is all that you have. Overtime, keeping work out of your personal life will allow you to distinguish each from the other, and thus lead a happier personal life. Other ways one can assure to live happy and healthy person life include:

• Planning vacation and downtime
• Seeing a therapist, counselor, or psychologists
• Seeing your doctor regularly
• Living within your means (not relying on overtime)
• Creating a buddy system to check in on each other
• Planning meals
• Exercising

Solitary Confinement, Incarceration and the Impact on Offenders

I found the topic of solitary confinement disheartening because of the impact it has on the offender’s mental health. Solitary confinement is the “state of being kept alone in a prison cell away from other prisoners” (Merriam Webster, 2018). Solitary confinement began in the 1970’s and conditions vary from state to state and facility to facility. It is a punishment that is used to isolate and control men and women for breaking infractions while incarcerated. It could be due to fighting with other inmates, getting caught with contraband, a way of managing gang members among other “justified” reasons. Although solitary confinement may solve the issue and serve as a deterrent for other inmates, it comes with cons. If a person isn’t mentally ill when entering an isolation unit, by the time they are released, their mental health has been severely compromised (American Friends Service Committee, 2018). There are more than 80,000 men, women, and children in solitary confinement in prisons across the United States, according to the Bureau of Justice Statistic (American Friends Service Committee, 2018).

In a prison account I came across, written by John Jay Powers, he was arrested in 1989 for unarmed bank robbery, possession of a stolen motor vehicle and illegal firearms that were found in a closet in his home. He received a lengthy sentence and was sent to prison for the crimes. While incarcerated, he witnessed a gang murder and testified against the attackers. He was promised protecting for doing this but he did not receive anything. Due to being scared for his life, he attempted an escape, was caught and sent to another prison where he spent 12 years in extreme solitary confinement but all together, Mr. Powers stated that he spent 25 years in solitary confinement for various reasons. Mr. Powers had no mental illness prior to being incarcerated but suggested that during his time in solitary confinement, he developed sever psychological problems which includes Post Traumatic Stress Disorder, suffered from suicidal attempts and compulsions towards self-harm which forced him to slice his finger, genitals and drill a hole in his skull. He stated that the self-injurious actions were caused by being locked down for more than a decade.

What I find disheartening is that this individual lived a fairly “normal” life and had no mental issues until he was incarcerated. The system is set up to punish offenders, to rehabilitate but to also serve as a deterrent to others. However, there was a serious injustice in Mr. Powers’ case based on the promise that was made to protect his life. He attempted to do the right thing by testifying against murders but then was forced to protect his life based on the fact that the prison officials did not protect his rights. So, he felt he needed to step in and protect his own life which only caused more trauma. My question here is, does being incarcerated do more harm than good? Does being in solitary confinement and incarceration create mental illness and trauma?

According to DeVeaux  (2013), “a body of literature concludes that the psychological effect of incarceration is substantial, even among those experiencing relatively short-term confinement in a jail or refugee and detention incarceration” (p.258). There is literature that suggests that people in prison experience mental deterioration and apathy, endures personality changes, and become uncertain about their identities (DeVeaux, 2013, p.258).  Researchers also believe that “people in prison may be diagnosed with posttraumatic stress disorders, as well as other psychiatric disorders, such as panic attacks, depression, and paranoia; subsequently, these prisoners find social adjustment and social integration difficult upon release (DeVeaux , 2013, p.258).   DeVeaux (2013) argues that psychological suffering is compounded by the knowledge of violence, the witnessing of violence, or the experience of violence, all too common during incarceration and that psychological effect of incarceration, developed during confinement, are likely to endure for some time following release (Retrieved from my original discussion post). Mr. Powers is still incarcerated currently and I wonder how his life will be upon release, if he is even eligible for release. He has been away from society for countless years and will he be able to be acclimated to society and his community? With the amount of men and women currently incarcerated and being placed in solitary confinement, wouldn’t  having mental illnesses exacerbate risky behaviors which will make them statistic for recidivism upon release? These are questions that the criminal justice system really needs to keep in mind when solitary confinement is utilized to “punish” offenders again for sometimes minor infractions.

Reference

American Friends Service Committee Retrieved from https://www.afsc.org/resource/solitary-confinement-facts

DeVeaux, M. (2013). The Trauma of the Incarceration Experience. Harvard Civil Rights-Civil Liberties Law Review. Volume, 48.2013

Solitary Confinement. (n.d.) In Merriam-Webster’s collegiate dictionary. Retrieved from https://www.merriam-webster.com/dictionary/solitary%20confinement

The Trauma of Sepsis

I can remember it like it was yesterday. Monday, October 8, 2012. 2:32 AM. My eyes opened right as the lights in my hallway turned on. I knew something was wrong. I heard my mother yelling at my sister to call 911. She bursts into my room, “Put some clothes on, your father can’t breathe.” I hurried and grabbed a sweatshirt and pulled sweatpants on over my shorts and ran downstairs. I looked into my parent’s bedroom. There my dad was, slumped over in his reclining chair, struggling to catch his breath. Moments later, paramedics showed up. My dad was a paraplegic, he was paralyzed during routine back surgery 8 years prior. There were wheelchairs in the dining room and the bedroom, my sister also informed the 911 operator of this. The paramedic, a young female, put the stretcher in the dining room and went in to look at my dad. She took his vitals and noticed that his skin was yellowing, put on oxygen mask on him then asked if my dad could walk out to the stretcher – THREE TIMES. And THREE TIMES we had to tell her NO – he can’t walk. My mom and I pulled my dad up and got him on to the stretcher, with no help from the paramedic. At this time, another paramedic showed up and helped her get my dad out to the ambulance. They drove away, no lights, no sirens. My mom and I left the house 10 minutes after they did. We wanted to give them time to get to the hospital before we got there. Even leaving 10 minutes after them, we still got there first and it’s nearly a 15-20-minute drive.

A little after 5 AM, a doctor finally came out and talked to us. He informed us that by the time the ambulance got to the hospital, my dad’s blood pressure dropped so low that he lost consciousness and he had started to aspirate. They said they had pumped liters of blood and waste from his stomach and lungs, which did not make any sense to anyone – why was he not throwing up at home? They had pinpointed the problem. A gallbladder infection had made its way into his blood and caused him to go septic. They wanted to remove his gallbladder, but he was still too unstable. So, we waited. Around 9 AM, he was transferred up to the MICU. I was not prepared for what I was going to see. I remember sitting in the waiting room of the MICU and waiting for them to bring him up. I heard the elevator doors open and looked out the doors of the waiting room and there he was, being pushed down the hall on a ventilator. We sat and waited while they got him situated in his room and then went back. When I walked into the room, my dad, who was 260 pounds, looked so small in his hospital bed. He was hooked up to a ventilator, an oxygen saturation machine, and the most I think I counted, somewhere around 10-15 IVs, maybe more. Basically, he was on life support.

That night, he was stable enough to have his gallbladder removed. After the surgery, it was about 10:30 PM, we went home. I had just stepped out of the shower when my mom got a phone call – he was in cardiac arrest. We rushed down to the hospital. They were able to get him stable. My brother, who was in Pittsburgh at the time for school, had his friends drive him up. When he got there, around 2 AM, we all just sat there at stared at each other. We didn’t know what was going to happen next. We stayed at the hospital that night, sleeping on the floor of the waiting room. I can still feel out cold and hard that floor was, using my jacket as a blanket and my purse as a pillow. Around 6:30 AM, we were woken up by code blue calls over the intercom. My mom looked at me and said go look, I got up and ran to the doors leading into his hall and saw a group of 10-15 doctors and nurses hovering outside his door. I ran back yelling it’s him and run back to his room. From Monday night, to Tuesday morning he had coded five times. The last two codes were the calls we heard. After this, they had placed him on constant dialysis in hopes to flush the infection out of his blood. The rest of Tuesday went smoothly, no codes, just sitting and praying.

Wednesday morning, we had a visit from our family doctor who told us we should start thinking about palliative care. The hospital staff was furious that came in and told us that. They said he had no right coming in and talking to us because he had no idea what was going on yet. Again, Wednesday went by smoothly, no codes. His sister had flown up from Florida to be with him and help take care of my grandma. By the time Thursday got around, our hopes were increasing. We were told the first 48 hours are crucial and we had made it through them. He had started to take breathes on his own, his oxygen levels were staying up, they put him on a feeding tube, and they took him off the paralytic and sedatives to allow him to wake up – if he could. Then, before we had to leave, they did a corneal reflex test where they took a cotton swab and pulled some off, so it was wispy and ran it across his eye – and he blinked! That was a good sign because it showed that oxygen was never cut off to his brain while he coded. We went home happy – finally, good news and progress!

Then, not even 12 hours later my mom gets a phone call. Something happened. We needed to get down there. By the time we had gotten to the hospital, they had been performing chest compressions for 45 minutes. It was like a scene from Grey’s Anatomy. There had to have been 30 people in his room. Doctors yelling and demanding answers for what happened because when they left the night before he was making progress. As soon as they got him stable, he would crash again. The doctor looked at my mom and told her that it could be minutes, hours, days, weeks, or even months, but he would crash again. Right after he said that, machines went off. My dad stopped breathing again. At that time, we as a family decided to let the doctors try one more time. They took us to a small room down the hall. Not even 10 minutes later, a nun walked in and informed us that my dad had passed away.

After his passing, I spent a lot of my time researching sepsis. I had never heard of it before and it turned out, not a lot of people had – roughly 55% of American adults have heard of sepsis. According to Sepsis Alliance (2018) sepsis is the body’s overwhelming and life-threatening response to infection that can lead to tissue damage, organ failure, and death. Our immune systems work to fight off germs and prevent infections. In the cases where you do get an infection, your immune system tries to fight it off – either alone or with the assistance of medication. But, there are times where your body essentially turns on itself, for reasons unknown, and this is the start of sepsis. When your blood pressure drops to dangerously low levels, you go into septic shock – the most severe level of sepsis.

In 2014, sepsis was named the most expensive in-patient cost in American hospitals – costing nearly $27 billion each year (Sepsis Awareness, 2018). Any kind of infection, whether it be pneumonia, a UTI, strep throat, or influenza, can lead to sepsis and septic shock. Even a simple cut can lead to sepsis. Rory Staunton was 12 years old when dove for a ball during gym class and cut his arm. Instead of being sent to the school nurse, the gym teacher put band aids on the cut without washing it. The following day, Rory woke up with a pain in his leg and a fever of 104. He was taken to his pediatrician, where she examined the scrape on his elbow and took his vitals – noting mottled skin, the pain in his leg, and stomach tenderness. She, the pediatrician, advised Rory’s parents to take him to the hospital for re-hydration and fluids. Doctors at the hospital claimed his discomfort was the result of a sick stomach and dehydration, they gave him two bags of intravenous fluids, took three vials of blood and gave him a prescription for Zofran (anti-nausea). The pediatrician at the hospital said it was a stomach virus and that he would be better in a week. Rory continued to complain of pain, wasn’t eating and his temperature was uncontrollable. He was admitted to the ICU. Through the cut on his arm, bacteria had entered his blood. He was in septic shock. Rory was brought back to the hospital on Friday night, the day after being seen by ER doctors who said he just had a stomach bug and by Sunday evening, Rory had passed away.

Sepsis is the leading cause of death in U.S. hospitals. Reports show that roughly 40% of individuals diagnosed with severe sepsis do not survive. Around 50% of those who do survive suffer from post-sepsis syndrome (PSS) and 62% of people hospitalized with sepsis will be rehospitalized within 30 days. Along with PSS, survivors can suffer from PTSD, chronic pain and fatigue, organ dysfunction, and/or amputation(s). Survivors have a shortened life expectancy, are more likely to suffer from a diminished quality of life and are 42% more likely to commit suicide.

Post-sepsis syndrome is a condition where survivors are left with physical and/or psychological long-term effects, such as insomnia, nightmares, vivid hallucinations, panic attacks, disabling muscle and joint pain, extreme fatigue, poor concentration, decreased mental functioning, and loss of self-esteem and self-belief (Sepsis Alliance, 2018). Those who are older and survive severe sepsis are at a higher risk for long-term cognitive damage and physical problems. Problems they face range from not being able to walk, despite having that ability before their illness and loss of ability for everyday tasks (i.e., bathing, cooking). Doctors and other healthcare professionals, who care for these survivors, need to recognize PSS and help their patients get any necessary treatment by referring them to physical, emotional, and psychological support professionals (physical therapy, counseling, CBT, or neuropsychiatric assessment).

Along with reporting symptoms of PSS, many sepsis survivors report symptoms of PTSD. There are several long-term effects, both mental and physical, that make this group vulnerable to PTSD, such as nightmares, difficulty sleeping, organ failure and loss of limb(s). Once released from the hospital, it is not unusual for a sepsis survivor to want to be alone, avoid family and friends, experience flashbacks, feel anxious, depressed, frustrated, confusing reality, poor concentration, and not caring about one’s appearance. When treating sepsis, you are placed in ICU. Johns Hopkins Medicine released a report in 2013 that linked PTSD symptoms with ICU survivors. With these ICU survivors, researchers found that those who were suffering from depression before their hospitalization were twice as likely to develop PTSD and those who had sepsis during their ICU, and those who received high doses of opiates, were more likely to develop PTSD (Desmon, 2013).

In 2008, Boer, van Ruler, van Emmerik, Sprangers, Rooij, Vroom, de Borgie, Boermeester, Reistsma, & the Dutch Peritonitis Study Group conducted a study to determine to what extent patients who have survived abdominal sepsis suffer from the symptoms of PTSD and depression and tried to identify any potential risk factors for PTSD symptoms. There was a total of 135 patients who were eligible for the study, 107 completed the questionnaire. The combination of long ICU stays, and multiple surgical and non-surgical interventions make this group vulnerable for developing PTSD. To assess the level of PTSD symptoms, Boer et al. (2003), used the Post-Traumatic Stress Scale 10 (consists of 10 items, each ranges from 1 point, none, to 7 points, always – higher scores indicate more symptoms) and the Impact of Event Scale – Revised (consists of 22 items, ranging from 0, no problem, to 4, frequent problems – scores above 24 (possible 66 total) generally considered indicative of PTSD). Potential risk factors that were looked at were general patient characteristics, disease characteristics and postoperative course, and traumatic memories of ICU/hospital stay. Results showed that 28% of patients scored moderately for PTSD, while 10% were high scoring – making a total of 38% of patients reporting elevated levels of PTSD symptoms on at least one of the questionnaires (Boer et al., 2008).

Sepsis doesn’t just affect the patient, yet everyone around them as well. In a study conducted by Davydow, Hough, Langa, & Iwashyna (2012) it was discovered that the prevalence of substantial depressive symptoms in wives of patients with severe sepsis increased by 14% at the time of the diagnosis (3-4 times more than average) and husbands had an 8% increase. It was stated that older women may be at a greater risk for depression if their spouse is hospitalized for severe sepsis and that spouses of patients with severe sepsis may benefit from greater support and depression screening, both when their love ones passes or survives (Davydow et al., 2012). Due to seeing a loved one so ill, and possibly passing from sepsis, relatives may experience feelings of guilt, anger, develop anxiety or even symptoms of PTSD due to the fear and intensity of living through the experience.

Speaking personally, I can attest to those feelings of guilt, anger, and anxiety. We all thought my dad had the flu because I was sick the week before. We just assumed that he got what I had. It’s hard not to blame yourself. You think because you spend so much time with a person, you should have been able to notice that something was wrong. That’s where the feelings of guilt kick in. Then you get angry. Not just at yourself, but the individual. My dad didn’t want to go to the hospital, we tried to get him to go earlier that morning. If we would’ve just forced him to go, maybe it wouldn’t have ended the way it did. Then you think about the doctors and the nurses. You think about what went wrong in those 12 hours you weren’t there. What happened to the positive progress he was making? Then anxiety kicks in. What if we did make him go, and he knew what was going on and he was scared. Because he was unconscious, he didn’t know what was happening, how bad things really were. Maybe that was a good thing. Just thinking about the idea of him lying there knowing what was going on and not being able to say anything causes my chest to close up.

I chose this topic, sepsis and septic shock, because I think that it’s something not a lot of people know about and it is the root of my own personal trauma. There is no cure for sepsis. By the time it is detected, it may be too late -- every hour treatment is delayed, the mortality rate increases 8%.

There is a helpful way to remember the symptoms (Sepsis Alliance, 2018):

S – Shivering, fever, or very cold
E – Extreme pain or general discomfort (worst ever)
P – Pale or discolored skin
S – Sleepy, difficult to rouse, confused
I – “I feel like I might die”
S – Shortness of breath

** Watch for a combination of these symptoms, if you suspect sepsis, call your doctor or 911 immediately or go to the hospital and say, “I am concerned about sepsis.”

References

Boer, K. R., van Ruler, O., van Emmerik, A. A. P., Sprangers, M. A., de Rooij, S. E., Vroom, M. B., & The Dutch Peritonitis Study Group. (2008). Factors associated with posttraumatic stress symptoms in a prospective cohort of patients after abdominal sepsis: a nomogram. Intensive Care Medicine, 34(4), 664–674. http://doi.org/10.1007/s00134-007-0941-3

Davydow, D. S., Hough, C. L., Langa, K. M., & Iwashyna, T. J. (2012). Depressive symptoms in spouses of older patients with severe sepsis. Critical care medicine, 40(8), 2335.
Desmon, S. (2013). PTSD symptoms common among icu survivors. Retrieved from https://www.hopkinsmedicine.org/news/media/releases/ptsd_symptoms_common_among_icu_survivors

Sepsis Alliance. (2018). Definition of sepsis. Retrieved from https://www.sepsis.org/sepsis/definition/#

Sepsis Alliance. (2018) Symptoms. Retrieved from https://www.sepsis.org/sepsis/symptoms/

Generational and Historical Trauma in African Americans and Police Interaction

One of the hottest and most controversial topics today in law enforcement, media, trauma, and race relations is that of the black American experience and, in particular, how it relates to modern policing. This has permeated not only our news, it has seeped into our popular culture. And while police violence against blacks is the peak of this story, it would lack much greater emotional power and context for victims without looking at the effects (including systemic) of intergenerational trauma. As stated in a study by Bryant-Davis, Adams, Alejandre, and Gray “There is a history of violence against racial and ethnic minorities that contextualizes the traumatic experience of police violence” (2017, pg. 1). “Finally, survivors of police violence targeting racial and ethnic minorities are often persons who have been exposed to multiple traumas resulting in a cumulative effect” (Bryant-Davis, Adams, Alejandre, and Gray, 2017, pg. pg. 1).. Historical trauma is defined as a form of intergenerational trauma “… caused by events that target a group of people. Thus, even family members who have not directly experienced the trauma can feel the effects of the event generations later” (Jones, 2012, pg. 16). This trauma runs deep and, additionally, it is both “…cumulative and collective. …[and] manifests itself, emotionally and psychologically, in members of different cultural groups” (Ross, 2011, pg. 3)

The question of post-traumatic stress induced via racism is a hot one. Center for Mental Health Disparities director Monica Williams states that black Americans may experience “race-based trauma” (Corley, 2015, para. 2) and that instances such as publicized instances of police brutality, accidental killings, and so on trigger not only recent events but the long-time institutionalized suffering undergone by black and African Americans, many of which are still alive and able to recall the days of segregation, lynchings, and even conversations with those who have endured slavery. Williams goes on to state that while an individual may not have experienced a shooting by a law enforcement officer for instance “...maybe we've had uncles or aunts who have experienced things like this, or we know people in our community [who have], and their stories have been passed down. So we have this whole cultural knowledge of these sorts of events happening, which then sort of primes us for this type of traumatization" (Corley, 2015, para. 5). This, in addition with persistent instances of micro-aggressions and acts of bias real and imagined, and the sense of helplessness to change or the feeling of being oppressed or not being heard in spite of virulent action, can indeed cause trauma which may result in anger, stress, and so on. So as we can see, this legacy of trauma, racism, violence, and institutionalized oppression have led to current negative social problems today which influence and inform modern day interactions and responses to police and instances of reported police brutality.

Bryant-Davis, T., Adams, T., Alejandre, A., & Gray, A. A. (2017). The Trauma Lens of Police Violence against Racial and Ethnic Minorities. Journal of Social Issues,73(4), 852-871. doi:10.1111/josi.12251

Corley, C. (2015, July 02). Coping While Black: A Season Of Traumatic News Takes A Psychological Toll. Retrieved April 11, 2018, from https://www.npr.org/sections/codeswitch/2015/07/02/419462959/coping-while-black-a-season-of-traumatic-news-takes-a-psychological-toll

Jones, B. (2012). Legacy of Trauma: Context of the African American Existence. Retrieved April 10, 2018, from http://www.health.state.mn.us/divs/che/projects/infantmortality/session2.2.pdf

Ross, K., PhD. (2011). Impacts of Historical Trauma on African Americans and Its Effects on Help-seeking Behaviour. Retrieved April 10, 2018, from http://www.umsl.edu/services/cps/files/ross-presentation.pdf

Police Work Environment and Stress

Within law enforcement there are many stressors that are placed on our minds and bodies. These stressors affect each officer in different ways and how we cope with them differ as well. I briefly touched on this subject in our module six in-depth question, but I would like to elaborate further about the effects of the internal work environment and PTSD symptoms that come from it.

It is a known fact that police officers experience traumatic events daily. Whether these events are physically experienced by the officer or they are witnessing the aftermath, each critical incident can have a lasting effect. Going into this job you expect and possess some understanding that this is what comes with the territory. What you do not expect is how the internal workings of a police department can become even worse to your physical and mental health. Many items within a police agency can place undue stress on an officer; issues with equipment, problems with other officers or civilian staff, quality of supervision, shift work, and your identity within the department (Maguen et al., 2009). These factors are key as more research is being conducted on PTSD within law enforcement and the findings are showing that “routine work environment” plays an important part in the growth of mental health distress (Maguen et al., 2009). This issue of work environment, according to Maguen et al’s study, highlights that fact that the reasons stated above have a “direct impact on PTSD symptoms” (Maguen et al., 2009). As a recruit entering my first law enforcement job, this finding would have staggered me.

In my own experience, what affects officers the most is the lack of quality supervision. I have seen good supervisors and very poor ones. It is that absence of leadership that causes the most stress. You feel on your own with the other members of your squad or unit. There is no leader to turn to unless a de facto leader emerges from within the ranks, but this creates another problem. When a police department’s administration feels the need to place an unqualified individual in a supervisory role, then added stress is placed on the officers that must deal with that lack of leadership. For example, I have seen supervisors throw their officers “under the bus” to protect themselves from a poor decision they made. The stress of the incident was enough yet now the officer must worry about potential discipline as an internal investigation takes place. All because a poor leader failed to take responsibility for their actions. This example also would place an added burden on the other officers under this command. Seeing what just occurred can affect them in future incidents leading to unnecessary stress concerning events that have not occurred.

But work environment can also be a positive and not a stress magnet for officers. Morale is a big part of police work. Having a positive, effective work environment can fuel morale and work ethic. When strong leadership is present, it can create a barrier against the effects of stress which leads to better morale and overall production as a professional officer (Maguen et al., 2009).  It has also been shown that when a positive work environment is established within a law enforcement agency it can help with negative events contained in an officer’s home life (Maguen et al., 2009). If an officer brings the effects of stress and PTSD symptoms home, it is logical that those effects will be placed upon the officer’s loved ones. This creates added stress in both worlds were the officer spends much of their time. When one of these worlds becomes out of balance, meaning high levels of stress as compared to low, it creates a chaotic atmosphere in both because the problems in one lead to problems in the other. One study by Mikkelsen and Burke (2004) sustains this very idea within police officers; when events outside of work that are negative, “such as work-family conflict,” they are identifiers to poor mental health (Maguen et al., 2009).

For the law enforcement profession, it is essential that we explore ways to foster positive work environments. This is key to protecting and retaining officers who can add to the success of the profession. If our vocation lacks the foresight in understanding the effects of work environment on our officers it will have devastating effects, for example suicides. Suicides within the police world are the number one killer of cops (Rousseau, 2018). This needs to be recognized as a real threat. When an officer is killed in the line of duty, the media reports on it for days if not weeks. If an officer takes their own life in may gain attention for a day. Law enforcement needs to pay attention each day on the effects of stress and trauma to gain the advantage against its repercussions such as suicide.

There is not one police department that can control what critical events occur within their jurisdictions (Maguen et al., 2009). But we can control is preparing for the worst and hoping for the best. With that mindset, we can control what occurs within our own work environments. Fostering positive surroundings and providing strong leadership can minimize the effects of stress and PTSD symptoms. This will lead to successful and professional departments which creates positive outcomes in the communities we serve.

References:

Maguen, S., Metzler, T., McCaslin, S., Inslicht, S., Henn-Haase, C., Neylan, T. and Marmar, C. (2009). “Routine Work Environment Stress and PTSD Symptoms in Police Officers” National Institute of Health Public Access. October 2009 197(10) pages 754-760.

Rousseau, D. (2018). Trauma and Crisis Intervention. Module Six-Trauma and the Criminal Justice System lecture. Boston University; Metropolitan College

Trauma of Success

The Trauma of Success

On April 5, 1994, Kurt Cobain, rock legend and lead-singer for famous band, Nirvana, committed suicide in his Seattle home. In the final years of Cobain’s life, he was greeted with tons of success. So many do not understand what drove him to end his own life so soon. It seemed like every time he reached a great achievement, he would actually end up suffering. Cobain’s band, Nirvana, finally signed a deal with a major label, Geffen Records, in 1991. Soon after this time, he began using heroin (Biography.com, 2015). In 1993, Nirvana released the highly celebrated album, In Utero, which jumped to the top of the music charts immediately. Less than a year later, Cobain put shotgun in his mouth and fired the weapon. Prior to his death, Cobain wrote a lengthy suicide note expressing his significant mental and emotional troubles. A prime excerpt from his suicide note was him saying, “sometimes I feel as if I should have a punch-in time clock before I walk out on stage. I’ve tried everything within my power to appreciate it (and I do, God, believe me I do), but it’s not enough” (Guise, 2015). Why did success have such an adverse effect on Cobain’s psychological state?

Success can be traumatizing. As stated in Module 1 of this class, “trauma is an inescapably stressful event that overwhelms people’s existing coping mechanisms” (Rousseau, 2018). Once people finally achieve success, everything that comes with it can be tremendously overwhelming for their psyche. The problem resides not in the actual success itself, but from the perception that comes with success. Continuing the module quote from above, “trauma represents exposure to a threat or perceived threat of some kind” (Rousseau, 2018). Once you finally make it to the top, the fear (threat) of losing it all and returning to the bottom becomes unfathomable.

This fact is evident in a number of real-life cases of child-stars. This is why a lot of them end up getting into drugs and spiraling out of control after they finally taste success. Not only do they face the incredible pressure of having all eyes on them all the time, but they are also constantly dealing with the possibility that all of the money and fame could be gone very soon. They develop this overwhelmingly stressful perception that everything they produce from now on needs to maintain that same level of magic.  The best example of this situation is the famous former child-star, Macaulay Culkin. Throughout the 1990s, Culkin was on-top of the world! He was undoubtedly the most well-known child-star on the big screen. He cranked out box-office-bangers such as Home Alone, Home Alone 2, and Richie Rich. But as he transitioned into adulthood, he began regularly using heroin, and eventually became addicted. He fell out of the spotlight and has recently been jumping in and out of rehab for his drug addiction. This is essentially the same story for a number of other child-stars, as well, including Orlando Brown, Lindsey Lohan, Jaimee Foxworth, and more. The fame and the pressures that come along with success traumatizes individuals and corrupts their mental and emotional sanity.

Macaulay Culkin photo. Retrieved from https://net-worths.com/wp-content/uploads/2013/08/Macaulay-Culkin-Actor-Wallpaper-Image.jpg

Now obviously, success is not an evil, unmanageable entity. It can be effectively dealt-with, even at an early age, such as described above. A lot of people of all ages have been able to accept everything that success comes with, and resist succumbing to its adverse effects. These individuals range from late stars such as Morgan Freeman, and Taraji P. Henson, to child-stars such as Zac Efron and Demi Lovato. But, as we learned in this class, what makes a huge difference in these situations is the foundation and support system that these individuals have at the time of the arrival of success. The level of the person’s resistance to trauma and having positive people around them to help them through the process plays a huge role on the impact of the trauma (Rousseau, 2018).

One of the readings for class, read that “trauma leaves traces on our minds and emotions, and on our capacity for joy and intimacy…” (Van der Kolk, 2015). Once success, fame, and fortune arrive, it is sometimes difficult to continue to feel the same joy for it, as initially. It comes with all of the pressure to maintain it, which can be devastating on an individual’s psyche, especially for that of a child. However, provided the person has a solid foundation and supporting cast surrounding them, as for any type of trauma, they can get through it.

References

Daily Mail Reporter. Macaulay Culkin looks back to his healthy best at NYC comic con after ‘battling drug addiction. Daily Mail. Retrieved from http://www.dailymail.co.uk/tvshowbiz/article-2455568/Macaulay-Culkin-looks-healthy-battling-drug-addiction.html

Editors. (2015). Kurt Cobain Biography. Biorgaphy.com. Retrieved from https://www.biography.com/people/kurt-cobain-9542179

Guise, Stephen. (2015). How to be an Imperfectionist. Selective Entertainment, LLC. Charlotte, NC.

Rousseau, Danielle. (2018). Trauma. Module 1. Retrieved from https://learn.bu.edu/webapps/blackboard/execute/displayLearningUnit?course_id=_44854_1&content_id=_5544529_1&framesetWrapped=true

Van der Kolk, Bessel. (2015). The Body Keeps the Score: Brain, Mind, and Body in the Healing of Trauma. Penguin Books. New York, NY.

Active Duty Military, Veterans, First Responders & their Families, & Yoga Warriors Int’l

For my final project I am a writing a proposal to present to the Providence Police Department, in conjunction with the International Critical Incident Stress Foundation used by the PPD Peer Support Unit, to collaborate with Yoga Warriors International, for the treatment of First Responder depression, anxiety, PTSD, psychological stress, and the stigma of mental illness, all of which are normal reactions to the abnormal situation of routinely being exposed to threats, actual or perceived, and the prolonged and/or chronic stress associated with a career in Law Enforcement.  Just as YWI successfully helps Veterans get 'unstuck' from the moments in the past which are preventing them from living in the present, and planning for the future, through active Yoga Warriors methodology, where classes integrate concepts of traditional hatha yoga with modern knowledge of the mind/body connection, First Responders are taught that moments in their careers do not define them, their present, or their futures.  The JOB can become the thing that used to take precedence; a facet of their complexity, and not their entire persona.  The JOB is filled with chronic routine work environment stress, and the very nature of police work includes regular and ongoing exposure to confrontation, violence, and potential harm.  Evidence based hatha yoga and mindfulness are used to prevent or alleviate symptoms of Post Traumatic Stress Disorder PTSD or combat stress (COSR),  by actively taking the collaborative 'first breath'.

https://youtu.be/swni1cAhjM4

Evaluation of Someone Else’s Work in the Field

About a year ago, I worked as a Therapeutic Mentor/Therapeutic Training and Support in which I worked with kids and teens on a 1:1 basis. With my Therapeutic Training and Support (TT&S) role, I worked alongside a master’s level clinician during family sessions. There is a specific case that had a strong impact on me that I still frequently go back to when thinking about trauma. For a year I worked with a 6 year old little girl who had endured severe trauma from her biological mother before being adopted into a loving more stable environment. I had the opportunity to work with two different clinicians on this case and was able to get a glimpse into how different clinicians work when it comes to handling trauma cases and to see just how educated they are when teaching and helping families who are going through it.

When the case first opened in November 2015, it was myself as the Therapeutic Training and Support (TT&S), and the master’s level clinician. This clinician stayed on for only a few months. Throughout those months, I observed the way she took approaches to the child and the family and began to notice that the family and child were unresponsive, the approaches were not well thought out, there were some things in regards to trauma that she herself was unsure of but never took the time to learn and figure it out so that she could inform the family. Every week, I had supervision with my supervisor in which we would discuss all of my cases, how I’m dealing with my caseload, and if there was any cases they were beginning to take an effect on me. More often than not this one specific case would come up. I explained to my supervisor that I would go to the sessions an hour early to work with my client 1:1 and it seemed to go okay, but the family sessions were very messy, the client’s behaviors were escalating, and there was only so much I could do on my part. As a TT&S you are to work directly under the clinician and follow their lead, but there was no lead to follow. The family began to look at me as the sole clinical provider in the sessions due to the fact that I was doing more work than the clinician. I was fairly new to being trauma informed in was in the middle of a training class the company offered. It eventually got to the point where the family decided they no longer wanted this clinician working with their family, but wanted to keep me. The clinician was taken off the case, and my supervisor had begun to take over. I watched and observed very carefully how attentive my supervisor was to the family needs and admired and respected the approach that she took to first educate the family on exactly what trauma is, how they need to help their daughter through it, and how they can help themselves through it.

As previously mentioned, myself, as well as my supervisor was apart of an ARC training in which it taught us about kids with trauma and how to approach it with both the child and the family. The clinician taught mainly out of the book that we used from the training, Treating Traumatic Stress in Children and Adolescents: How to Foster Resilience through Attachment, Self-Regulation, and Competency by Margaret E Blaustein and Kristine M. Kinniburgh. There was a section in the book that was reflected on for reference when approaching topics that needed to be taught to the parents during parent sessions:

• Trauma Experience Integration
• Executive Functions
• Self Development and Identity
• Affect Identification Modulation
• Affect Expression
• Caregiver Affect Management
• Attunement
• Consistent Response
• Routine and Rituals

Each of these topics were discussed first with the parent, and then again during family sessions in which the clinician used a more age appropriate approach so that the 6 year old would be able to understand.

Some of what was taught during the training was mentioned throughout this course, and was used during our family sessions. Module 4 of the course reminded me a lot of what was taught during the ARC training as well as what was used during both family sessions with the clinician and during my 1:1 sessions with the client. In module 4, we learned about Reactive Attachment Disorder (RAD), which is something that my client was diagnosed with.

“When children are raised in an environment with grossly negligent or abusive care, especially in the first five years of their life, they may develop RAD. The development of attachment is a normal process in infancy, and dictates a person’s ability to love, trust, develop awareness and empathy for others feelings, to regulate their own emotions, to develop healthy relationships as well as a positive self-image. Healthy attachment can only occur when an infant is consistently attuned to, comforted, and when their needs are repeatedly met. The lack of these factors in the first few years of their life can negatively impact their entire future” (Rousseau, 2017).

For about 8 months I was able to watch and observe first hand my supervisor/clinician walk the parents of my client through exactly what RAD is, the impact that it has on children, the importance of consistency, why our client acted the way she did, and the required steps moving forward. It was expressed that one of the most important things to do as a parent with a child with RAD and a trauma history is to come to a complete understanding of what trauma does to a child on every aspect. She began parenting sessions with a teaching guide and incorporated fun learning activities for when it came time to include our client and it was then that the family and client began to thrive.

Working with two different clinicians on this case I was able to fully evaluate each of their work and how it impacted the family. It became a learning experience of what works for a family and what does not. The most important thing that I took away from my supervisor was to understand the many types of trauma that a child can endure and more importantly how to approach it with clients so that they can learn to understand what a trigger is, what it does to their body, and understanding age appropriate tactics. In our case, with a 6 year old little girl, we used music, dance, art, basically any kind of play therapy to work with her and it turned out to be affective.

PTSD, Post-Traumatic Growth, and PFA

A Post-Traumatic Stress Disorder (PTSD) diagnosis and post-traumatic growth are not mutually exclusive events.  Nor is the opportunity for post-traumatic growth null in the event of a PTSD diagnosis.  The fundamental difference between these two events is the reaction of the individual and their support system, or lack thereof, after the trauma has occurred.  Society has been conditioned to believe that trauma is a rare occurrence and not that the “trauma response is a normal response to an abnormal situation” (Rousseau, 2017).  Due to this conditioning, many individuals who experience trauma are overwhelmed with a sense of shame due to their actions or inactions in the face of a traumatic event (Van der Kolk, 2014).

One of the hardest aspects of recovery for trauma survivors is the fact that “people can never get better without knowing what they know and feeling what they feel” (Van der Kolk, 2014, p. 27).  It takes a tremendous amount of trust and courage for a survivor to allow themselves to remember (Van der Kolk, 2014), but that can be the key difference between suffering with PTSD and engaging post-traumatic growth.  With the proper social connections, a survivor can develop the necessary physical, mental, emotional, and social resilience to positively impact their sense of self, social interactions, and philosophy of life (Rousseau, 2017).

A key transition point in determining whether post-traumatic growth would be successful could be directly, or shortly, after the event itself.  Psychological First Aid (PFA) could provide the necessary support and encouragement that makes the difference between a lone-PTSD diagnosis that someone struggles with and their ability for post-traumatic growth.  PFA is a strength-based model of support and intervention designed for immediate use after a traumatic experience.  PFA can be implemented by almost anyone in the presence of someone who has experienced trauma or distress:  mental health workers, disaster responders, emergency workers, law enforcement officers, crisis counselors, or even a parent with their child.  PFA should occur in a natural setting where the survivor will be most comfortable and least influenced by stressors (2011a).  Two of the most important things to remember when implementing PFA is to ensure that “what [providers] do does no harm” (2011a), and that disaster and other trauma survivors are having a “normal reaction to an abnormal situation” (2011a; 2011b).

The goals of PFA include establishing a calm environment, human connection, and trust, providing practical assistance, safety and comfort, and promoting adaptive coping while ensuring the survivor’s immediate needs are being met and that they are being linked with necessary services (2011a).  To achieve these goals, providers are encouraged to observe the survivor without intruding, model healthy responses, maintain confidentiality, and acknowledge the survivor’s successes to encourage strengths-based healing (2011a).  It’s important that providers working with survivors are direct, do not speculate, and are willing to admit that they don’t have the answers to some of the questions that may be posed by the survivor (2011b).

The immediate moments after a trauma has occurred can become extremely sensitive for the survivors.  Van der Kolk (2014) asserts that “after trauma the world becomes sharply divided between those who know and those who don’t.  People who have not shared the traumatic experience cannot be trusted, because they can’t understand it” (p. 18).  This is parallel to the assertion of the presenters in Psychological First Aid (2011a) that providing PFA to survivors is a careful balancing act to establish trust, largely due to this assertion that those who have not survived trauma cannot understand what their clients are going through.  It can be extremely triggering for a survivor to receive support from a provider who claims to understand how they are feeling; one of the presenters in Psychological First Aid (2011b) expressly warns the audience to avoiding using such terms as “understand” when supporting individuals because of this risk.

I strongly believe that training in PFA for individuals who are at the forefront of trauma- and first-response would be the best practice for trauma survivors.  It is the responsibility of the community and the organizations who are trusted to care for these individuals to provide the best options for treatment and growth after a traumatic event has occurred.  The social mindset surrounding trauma and the regularity of appropriate treatments have much room for growth, however with the appropriate education and advocacy, we as growing professionals can ensure this best practice is achieved.

References:

Cavalcade Productions (Producer). (2011a).  Psychological first aid I:  Goals and guidelines [Documentary].  Available from http://bu.kanopystreaming.com.ezproxy.bu.edu/video/psychological-first-aid-i-goals-and-guidelines

Cavalcade Productions (Producer). (2011b). Psychological first aid II:  Caring and coping strategies [Documentary].  Available from http://bu.kanopystreaming.com.ezproxy.bu.edu/video/psychological-first-aid-ii-caring-and-coping-strategies

Rousseau, D. (2017).  MET CJ 720 Trauma and Crisis Intervention - Module 1:  Introduction to Trauma

Van der Kolk, B. A. (2014). The body keeps the score : Brain, mind, and body in the healing of trauma. New York: Viking.