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My Experiences with Self-Care

Many jobs are stressful.  That being said, I think that criminal justice jobs are especially stressful given how many hours of work are involved (quite often significantly more than 40) and given the types of things that cops have to witness and encounter in the course of their duties.  The police are rarely called in when everything is going perfectly, usually people only call the cops when something is going terribly wrong.  These types of incidents include serious car accidents, suicides, murders, rapes, and many more highly traumatic incidents.  Not only do police officers frequently have to function effectively in very stressful and adrenaline-inducing incidents, but they also have to deal with the emotions of the general public who are less-accustomed to dealing with traumatic incidents.  Most people know that there is a risk of PTSD when one experiences severe trauma first-hand. What many people do not realize is that it is also possible to get PTSD second-hand, from dealing with people who have experienced trauma first-hand.  “‘Vicarious trauma is the transformation that occurs within the therapist (or other trauma worker) as a result of empathic engagement with the clients’ trauma experiences’ (Perlman and Mac Ian, 1995)” (Rousseau D., 2019. Module 1.)  While this quote is referring primarily to therapists, police officers also experience vicarious trauma because of their interactions with severely traumatized individuals or through looking at media, such as photos or videos, of traumatic incidents including rape, murder, suicide, and other violent deaths.  All of this means that law enforcement personnel are usually under a tremendous amount of stress, and not surprisingly the rates of PTSD in Law Enforcement are between 7% and 15% (U.S. Department of Veterans Affairs, 2018), which is significantly higher than the national average, and suicides rates among law enforcement are roughly four times the national average (National Alliance on Mental Illness, 2019).   In order for law enforcement to stay sane and continue to do their jobs they need to have effective methods for coping with stress. Self-care techniques are almost never sufficient to address issues such as PTSD, but these techniques can help alleviate daily stress, and can help prevent a buildup of stress that could cause more serious health issues.  These techniques can also help those who are suffering from PTSD, as long as they are combined with visits to a specialist who can help with the aspects of PTSD that cannot be effectively self-treated.

Over the years both in school and in various jobs I have had to learn to deal with being in stressful and sometimes frustrating situations. Throughout this time, I have found three specific things that help alleviate my stress and help me relax. The first one is dogs, well really any type of animal, but I prefer dogs.  Growing up I had dogs and I found that when I would get stressed out, if I just played with the dogs, I would feel better.  When I went away to college, I was not able to take my dog with me and he had to live 7 hours away with my parents.  While I was away, I met professors who had animals and I would go over to their houses and play with their pets.  Now that I have a house with my wife, we have a two-year-old Siberian husky and I find her very helpful in reducing stress.  Over the years I have found that taking a dog for a walk is particularly effective at reducing stress.  And this brings me to my second strategy – exercise.  I enjoy walking and hiking, but I do not particularly enjoy running. That being said, I have found that any form of outdoor exercise, including running, is effective at reducing stress and frustration.  This is particularly true if I combine it with dogs and go for a walk or hike with my dog.  The third strategy that I use is music.  I have studied classical violin my whole life and for the past ten years I have also played Scottish fiddle music.  I generally do not find that playing music is as effective as outdoor exercise, but it certainly helps.  I am sure that these strategies will not work for everyone, but in my experience, exercise helps most people, and animals help those whom are not allergic to them or afraid of them.

References

Rousseau D. (2019). Module 1. Introduction to Trauma. Lecture, BU Blackboard Learn

Rousseau D. (2019). Module 6. Trauma and the Criminal Justice System. Lecture, BU Blackboard Learn

U.S. Department of Veterans Affairs. (2018, September 25). National Center for PTSD. Retrieved April 29, 2019, from https://www.ptsd.va.gov/professional/treat/care/toolkits/police/managingStrategiesPolice.asp

National Alliance on Mental Illness. (2019). NAMI. Retrieved April 29, 2019, from https://www.nami.org/find-support/law-enforcement-officers

Trauma and Stress in the Field of Law Enforcement

Stress and traumatic events in life are things that can affect anyone at any given point in time. The level of severity may differ, but we all are equally susceptible to such events. With the varying level of severity, individual’s ability to react to such incidents vary as well. People work through stress or traumatic events they have experienced, to retain the normal/positive life they lived before. Sometimes this does not occur. As a member of law enforcement, this topic is very real and important in the law enforcement community. Working as a law enforcement officer, I as well as others, chose to get into the field understanding the stress that comes with the job and assume that we will not fall a victim of traumatic situations from our work experiences. This class has developed my understanding around things such as trauma, stress, and PTSD. I used to believe individuals that suffered from these things were not mentally determined enough to overcome their experiences or simply could not separate incidents from their personal life. I quickly discovered with this course, we can all feel the effects of traumatic and stressful situations. If symptoms go untreated, it can lead to many life changing struggles to include PTSD. Other symptoms include “increased absenteeism, turnover, declines in performance,  slower reaction time, poorer decision-making ability,  increases in complaints, policy violations, and misconduct allegations. (RTI, 2018)”

Law enforcement officers respond to calls when almost every time, people are experiencing their worst days. With responding to negative situations frequently, officers are exposed to traumatic events that can affect an individual differently both physically or mentally.  In addition to stresses brought on by responding to a situation, the negative social views on law enforcement can increase the stress felt from by an individual when handling a situation as many individuals do not support police. When responding to calls, officers are required to make split second decisions that could be life or death endings and are required to possess the cognitive ability to think as a counselor as well as an enforcer of the law. “Managing officer stress facilitates better decision-making, fairer treatment and improved relationships between officers and the community members they serve. (RTI, 2018)”

In order to combat the effects of stress/trauma, individuals must recognize the work-related as well as individual factors that create stress and fatigue in the officer. Examples of work-related factors are excessive overtime, shift rotations, change of job duties, etc. Examples of individual factors are family problems, financial problems, health concerns, etc. (Beshears 2017). An officer’s ability to recognize which factors are relevant to them will assist in developing a customized plan to strategically attack the negative factors affecting their mental state. As we have seen in class, this becomes effective once an agenda is absorbed and supported by a police department as a whole to include superior officers. Breaking the barriers to seek treatment is a big obstacle to overcome as the negative stigma surround mental care is still relevant in today's time. I believe that once this challenge has been overcome, individual’s likelihood to seek treatment or help will exponentially increase with them not having a fear of being targeted negatively. Individuals have many options when it comes to treatment but it requires publicity on its availability as well as it having no negative consequences to participating in it.

Police One wrote an article highlighting the ways officers can manage and reduce stress they encounter at work and at home. The article focused on healthy eating, leveraging vacation, exercise programs, and focusing on friendship relationships with individuals outside work that will assist in encouraging non-work conversations (Beshears, 2017).  This will help to reduce but not eliminate the threat officers faces of trauma/stress symptoms. One way that our organization has developed a process to check the well-being of its officers is through re-enlistment.   Our organization requires individuals to be medically screened both physically and mentally every three years to ensure that nothing is going unnoticed. This does not only benefit the organization but also prevents officers from hiding their internal struggles as this is a mandatory program.  One thing that I would recommend is for them to increase the frequency of how often the tests are completed rather than only every three years. It would better provide an explanation to whether or not an individual’s mental state is declining or getting better. By our organization participating in this, we have seen officers benefit tremendously as well as folks of the community. Officers are able to maintain the readiness to adequately respond to calls for service and properly serve their people without any threats from internal struggles they may face.

Beshears, M. (2017, March 30). How police can reduce and manage stress. Retrieved April 28, 2019, from https://www.policeone.com/stress/articles/322749006-How-police-can-reduce-and-manage-stress/

Stress Reduction Programs for Police Officers: What Needs to Change. (2019, February 01). Retrieved April 28, 2019, from https://www.rti.org/insights/stress-reduction-programs-police-officers-what-needs-change

Seeking the Appropriate Care for Mental Illness

Medication is a common approach used to treat many forms of mental illnesses, including depression, anxiety and PTSD.  It is estimated that approximately 242 million adults in the United States, roughly one in six Americans, take prescription psychiatric drugs (Fox, 2016).  Many people who experience mental health issues seek care from their primary care physician, rather than a mental health expert, which can lead to several issues. 

Psychiatric medication is not a bad thing, as long as prescribed by a mental health professional and it is not abused.  In fact, medication can be very useful in treating symptoms of mental illness.  However, research conducted by the Center for Disease Control and Prevention, has shown that going directly to a primary care physician without consulting a mental health professional, could result in the patient being prescribed the wrong medications (Smith, 2012).  This research also revealed that many people who go directly to their primary care physician for help with mental illness may not be made aware of other evidence-based therapies that could help them (Smith, 2012).  According to Dr.Rousseau,“most literature regarding pharmacotherapy stresses that it works more effectively in tandem with other treatments rather than individually” (Rousseau, 2019, p.12).  Some forms of therapy have been found to be more effective then medication alone, for example, a study using EMDR to treat PTSD, showed that EMDR was more effective than Prozac (Van der Kolk, 2015).      

Medications alone do not cure mental illness, they reduce symptoms by manipulating neurons and neurotransmitters (Rousseau, 2019).  Without curing the underlying issue, the patient will never recover and will need to stay on the medication(Van der Kolk, 2015). This could result in medications being used long-term, which could make them habit forming (Holmes, 2016).  A study conducted by the Agency for Healthcare Research and Quality, found that 84% of participants in the study who reported taking psychiatric pills, reported they had been taking medication for two years or more (Holmes, 2016).  Another factor is that all medications have side effects, so long term use could cause other health issues. 

Although it may be comforting to go to a primary care physician because a relationship has already been established or because medication seems like a quick fix, the best option is to see a mental health professional for mental health issues.  Mental health professional have been specially trained to give proper diagnoses and are able to offer more treatment options then medication alone.   

Work Cited:

Fox, M. (2016, December 12). One in 6 Americans take antidepressants, other psychiatric drugs. Retrieved April 28, 2019, from https://www.nbcnews.com/health/health-news/one-6-americans-take-antidepressants-other-psychiatric-drugs-n695141 

Holmes, L. (2016, December 15). Study Shows Taking Mental Health Medication Is Incredibly Common. Retrieved April 28, 2019, from https://www.huffpost.com/entry/psychiatric-medication-use_n_58515e35e4b0e411bfd49171

RousseauD. (2019). Module 4. Pathway to Recovery: Understanding Approaches to Trauma Treatment. Lecture, BU Blackboard Learn

Smith, B. (2012, June). Inappropriate prescribing. Retrieved April 28, 2019, from https://www.apa.org/monitor/2012/06/prescribing

Van der Kolk, B. (2015). The body keeps the score: Brain, mind, and body in the healing of trauma. Penguin Books.

Model Mugging and the Impact of Trauma Aware Self-Defense

While many self-defense organizations teach important moves that could protect someone during an attack, those moves are useless if they cannot be recalled in a moment of panic. Bessel Van der Kolk (2014) explains how, in situations of danger or panic, “...the old brain takes over, it partially shuts down the higher brain, our conscious mind, and propels the body to run, hide, or fight, or, on occasion, freeze. By the time we are fully aware of our situation, our body may already be on the move” (p. 54). Because during such a moment of reaction to danger our rational minds are not driving our behavior, recalling complex self-defense moves may be near impossible. Van der Kolk (2014) shares a story of a woman with a fifth-degree black belt in karate, and yet who froze and could not fight back when she was being sexually assaulted. Though this woman had all of the knowledge she may have needed to defeat her attacker, “her executive functions- her frontal lobes- went off-line, and she froze” (p. 220). This demonstrates that her high-level training was not enough to protect her from this situation, and the brain’s reaction to such a highly adrenalized situation played an important role in her inability to protect herself from this attack.

In part due to this experience, the model mugging program was developed to teach people how to react when they find themselves exhibiting a freeze response. Van der Kolk (2014) explains that this works, “through many repetitions of being placed in the “zero hour” (a military term for the precise moment of an attack) and learning to transform fear into positive fighting energy” (p. 220).  Thus, placing participants in a real-feeling situation where their emotional brain is activated allows them to notice what their reaction might be and develop self-defense techniques that account for this reaction in a safe environment. This program was developed in California, but iterations of it can be found throughout the country.

In Boston, the IMPACT:Ability training offered for people who are disabled as well as able-bodied people utilizes some of the same techniques described by model mugging. One important insight that these self-defense programs utilize is the resource that adrenaline can be during moments of high stress or panic. The production of adrenaline gets our bodies moving, but it can also shut our bodies down, as it did for the woman in Van der Kolk’s example. By simulating adrenaline-inducing situations, these self-defense programs are teaching participants how to react when their bodies are under high stress, thus hoping to make it more likely that in a real-life situation of danger when fight-flight-freeze hormones are coursing through a person’s body, they will be more able to react in self-defense. Van der Kolk’s example of the young woman who had suffered ongoing childhood abuse, but who was able to fight off three attackers late one night outside her college library, indicates that this training can indeed have an impact on a person’s reaction to adrenalized situations (Van der Kolk, 2014).

As a participant in IMPACT:Ability, I found the program to be invaluable in helping me to remember to breathe in scary situations. Remembering to take a breath is one of the main teachings of the course, and I have noticed that during intense moments at work I am able to think more clearly and respond more calmly when I have reacted to a situation first by intentionally taking a deep breath. For more information about Impact:Ability, or to register for a training, please visit: https://triangle-inc.org/impactability/

Sources cited:

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

Breaking the Cycle – Intergenerational Trauma

Intergenerational trauma is “transmitted through attachment relationships where the parent has experienced relational trauma and have significant impacts upon individuals across the lifespan, including predisposition to further trauma” (Isobel, S., Goodyear, M., Furness, T., & Foster, K., 2019). Fortunately, the understanding of this method of the transmission of trauma is now becoming more widespread and given a more serious focus than in the past. It is described by Van der Kolk that the ability to feel safe with others is “probably the most important aspect of mental health” (2015, p.81). But what if those who you are supposed to feel safe with, your own family, are the ones causing said source of suffering and are inhibiting your capability of feeling safe with and trusting in others? In a film created by The International Society for the Study of Trauma and Dissociation, the contributors comment that within society, it is very common to come across children who are victims of abuse, who’s parents were also victims of abuse, who had parents that were victims of abuse, and so on. They mention that usually shoulders are shrugged, and the topic of conversations moves on but that “is what keeps the cycle going” (The international society for the study of trauma and dissociation, 2007).

In addition to PTSD, other forms of adverse childhood experiences, that come from a variety of other mental health disorders, can be considered intergenerational trauma. For example, if a parent is more preoccupied with trauma they’ve faced or are suffering from, they may not be emotionally stable or consistent in providing the proper upbringing of a child. Our emotional development starts from the day that we are born and our ability to form attachments to others is also key to feeling safe and therefore being attuned to other people. Disorganized attachment is understood as “not knowing who is safe or whom they belong to, they may be intensely affectionate with strangers or may trust nobody” (Van der Kolk, 2015, p.119). Through research, it becomes more and more apparent that there is “an intergenerational component, and the more we can work on it and stop it at its root and prevent it, the better it is for all who are suffering and also for society” (The international society for the study of trauma and dissociation, 2007).

Treatment for breaking this cycle can be as simple as educating the public to understand the way that their trauma, past or present, effects their families but also ranging from the training being available to front line professionals to help them whilst dealing with traumatized members of the community. If a Child Protective worker understands that when dealing with a distressed mother that has a more severely stressed baby, research shows it is more efficient to calm the distressed mother first to have a more soothing effect on the baby, they can therefore have a more active role in stopping the trauma from continuing (The international society for the study of trauma and dissociation, 2007).

More formally, it is purposed to utilize the family systems approach to dealing with and preventing intergenerational trauma. In Module 4, Professor Danielle Rousseau explains a form of family systems therapy – Internal Family Systems Therapy (IFS). In this form of therapy, the focus is on the Self. IFS was developed by Dr. Richard Schwartz when he realized that there were significant connections that his clients made between external family systems and internal self-talk. He “began to identify specific “parts” of the self, and determined that they all had value, and could learn to work together rather than against each other” (Rousseau, 2019). Additionally, within the family systems approach therapists are able to redirect and help heal pain from intergenerational trauma by utilizing 4 strategies: use of culture informed treatment, interruption of unhealthy family communication patterns, giving trauma a voice within the family, and helping parents offer children the permission to dissociate (Sells, 2018). When the combination of knowledge, education, training, and various forms of treatment are used, it feels as though the progression towards breaking the cycle of intergenerational trauma is well underway.

References:
Isobel, S., Goodyear, M., Furness, T., & Foster, K. (2019, January 1). Preventing intergenerational trauma transmission: A critical interpretive synthesis. Journal of Clinical Nursing. https://doi.org/10.1111/jocn.14735

Rousseau, D. (2019). Module 4 – Pathways to recovery: Understanding approaches to trauma treatment – Lesson 8.

Sells, S. (2018, October 12). A family systems approach to treating intergenerational trauma. Retrieved from https://familytrauma.com/a-family-systems-approach-to-treating-intergenerational-trauma/

The international society for the study of trauma and dissociation (Producer). Fran Waters (Executive Producer). (2007). Trauma & Dissociation in Children I: Behavioral Impacts [Video file].: Cavalcade Productions. Retrieved April 8, 2019, from Kanopy.

Van der Kolk, B. (2015). The body keeps the score: brain, mind, and body in the healing of trauma. New York, NY: Penguin.

The Erasure of Women of Color in the Me Too Movement: Impact of the Sexual Abuse to Prison Pipeline

The Me Too movement has stirred the pot in Hollywood and has helped bring transparency to sexual harassment and assault that happens within the workplace and everyday life. While the Me Too movement has swelled after Alyssa Milano's involvement, it began with Tarana Burke, a woman of color (Onwuachi-Willig, 2018). Women of color have seemingly been left out of the mainstream Me Too movement, which is especially problematic considering that women of color are more vulnerable to sexual harassment than white women and are less likely to be believed when they report harassment, assault, and rape (Onwuachi-Willig, 2018).

The abuse and harassment the Me Too movement calls out is not only in the workplace, and does not only happen to adults. Childhood sexual abuse is appallingly prevalent in our society. Van Der Kolk asserts that child abuse is the nation's largest public health problem (2014). The Adverse Childhood Experiences (ACE) study importantly found that negative experiences in childhood are common (Van Der Kolk, 2014). For girls with an ACE score of 0 (little to no negative experiences), the prevalence of rape in adulthood was 5%, but for girls with an ACE score of four or more, the prevalence of rape in adulthood was up to 33% (Van Der Kolk, 2014). Therefore, it is likely that those affected by the Me Too movement have long term histories of sexual abuse, but the conversation focuses on elite workplaces.

One potential reason for the exclusion of these voices is that they are simply not around to be included. Perhaps even more troubling than the prevalence of childhood sexual abuse and adult rape and harassment, is our punitive response to survivors. Sexual abuse is one of the primary predictors of involvement in the juvenile justice system (Saar, Epstein, Rosenthal, & Vafa. 2015). A study conducted in Oregon in 2006, found that 93% of girls in the juvenile justice system had experienced sexual or physical abuse, and 76% had experienced at least one incident of sexual abuse by the age of 13 (Saar et al., 2015). Girls of color are much more likely to be involved in the juvenile justice system, Black girls are 20% more likely to be detained, and three times as likely to be referred to court; Native American/Alaska Native girls are 50% more likely to be detained and 1.4 times more likely to be referred to court than white girls (Myers, 2016). The charges that call for these actions are minor, girls account for 35% of arrests for disorderly conduct, 37% for simple assault, 38% for domestic battery, 40% of liquor violations, 29% of curfew violations, and 76% of arrests for prostitution (Myers, 2016). The charges of these arrests are closely linked to sexual abuse, curfew violations for running away from abuse, prostitution to survive away from the home, substance use to cope with the trauma, and assault as self-defense against sexual abuse. These statistics highlight the disturbing trend called the sexual abuse to prison pipeline. Young women, especially those of color, are being punished for their abuse, and retraumatized, rather than treated.

Van Der Kolk discusses many effective treatment methods for persons who have experienced childhood sexual abuse including, yoga, EMDR, and IFS. Unfortunately, our systematic response ignores these options in favor of incarceration, despite what is known about development. Van Der Kolk explains that girls who have experienced sexual abuse have an entirely different developmental pathway, their biology is up against them, leading them to overreact or numb out (pg. 165, 2014). While incarcerated, girls are further traumatized through invasive search procedures and restraints, and are subject to potential abuse from correctional officers. A study of incarcerated girls found that 46 percent of participants reported that the staff, programs, and treatment in county juvenile justice facilities did not help them deal with past trauma in their lives; 4 percent said their time in county facilities did more harm than good in dealing with past trauma (Saar et al., 2015). The National Child Traumatic Stress Network (NCTSN) holds that, “[m]any characteristics of the detention environment (seclusion, staff insensitivity, loss of privacy) can exacerbate negative feelings and feelings of loss of control among girls, resulting in suicide attempts and self-mutilation" (Saar et al., 2015).

The NCTSN has found that 70% of girls with juvenile justice involvement had been exposed to some form of trauma, and over 65% had experienced symptoms of PTSD (Saar et al., 2015). Further, 80% of justice involved girls have mental health diagnoses, but mental health screenings are rarely administered, and there is a severe lack of services, only half of youth are in facilities that even offer services (Saar et al., 2015). Trauma based interventions have been effective post release at decreasing recidivism (37% less likely), and reducing teen pregnancy (only 26.9% of those who received the intervention became pregnant at a young age, compared to 46.9% of those who did not) (Saar et al., 2015). The justice system does not meet health needs for expecting girls, or any gynecological or obstetric care (Saar et al., 2015).

The Me Too movement cannot be effective if it continues to exclude the voices of girls and women of color, and those in the sexual abuse to prison pipeline. The great successes the Me Too movement has had in creating transparency should be shared with those experiencing the sexual abuse to prison pipeline. The moralistic, punitive approach we hold towards these girls and women must be changed to stop the re-triggering and further traumatization of these girls.

Myers, A. (2016, June 22). What You Need to Know About the Sexual Abuse to Prison Pipeline.   Retrieved from https://now.org/blog/what-you-need-to-know-about-the-sexual-abuse-        to-prison-pipeline/

Onwuachi-Willig, A. (2018). What About #UsToo?: The Invisibility of Race in the #MeToo Movement. The Yale Journal Law Forum. Retrieved from             https://www.yalelawjournal.org/pdf/Onwuachi-Willig_h1vexk3y.pdf.

Saar, M. S., Epstein, R., Rosenthal, L., & Vafa, Y. (2015). The Sexual Abuse to Prison Pipeline:        The Girls' Story (Rep. No. 031215). Retrieved https://nicic.gov/sexual-abuse-prison-          pipeline-girls-story

Van Der Kolk, B. (2014). The body keeps the score: Brain, mind, and body in the healing of          trauma. Penguin