HEALTH & WELLNESS
First responders:
confronting the unimaginable
Something that is unimaginable is difficult to
comprehend because it is so awful. For most of us,
the worst occurrence we’ll have at work is that we
find out that we missed a meeting, or our comput-
er is not booting up, or we find out that we need to
cover for a colleague who has called out sick.
For law enforcement officers — the first re-
sponders who are exposed to more stress and
IRIS
PERLSTEIN, trauma while protecting us in one day than most
LCADC, LPC, people will experience in a lifetime — work can
ATRBC
mean seeing an especially gruesome or large-scale
crime scene, or a personal brush with death. Law
enforcement officers are often first on the scene, exposed to a
multitude of graphic tragedies including murder, child abuse
and suicide. For some, the serious injury or death of a partner
or a vicious crime against a child can be the breaking point.
The job continues after the shift ends
As a therapist with First Responder Treatment Services , part
of the inpatient program at Penn Medicine Princeton House
Behavioral Health, I’ve heard first responders relate work expe-
riences that they unwillingly revisit. They repeatedly remember
being shot at, almost killed, or viewing and handling a mangled
body, dealing with abused, battered and sexually molested chil-
dren. These memories are fixed in their minds despite all their
efforts to forget.
Another individual in treatment revealed, “I am only able to
show anger and less able to express warmth and affection…I
shout orders rather than make requests, especially with my
children.” He revealed that he cannot communicate to his fam-
ily that he is frightened that bad things can happen to them.
He then gets angry at himself— upset that he allows himself to
get stuck in what he terms “thoughts from hell.” Other first re-
sponders report that they can’t control the images, flashbacks,
nightmares or twitching that plague them throughout the night.
Many police officers do not sleep well — and in fact are afraid to
sleep — because they want to keep from dreaming.
Specific symptoms of PTSD
As a result of repeated traumatic stress incidents, a number
of the first responders who are in treatment at Princeton House
are diagnosed with post-traumatic stress disorder (PTSD).
PTSD is considered a trauma- and stressor-related disorder by
the 5th Edition of the Diagnostic and Statistical Manual of Men-
tal Disorders (American Psychiatric Association, 2013). PTSD
can include flashbacks, intrusive thoughts, insomnia, triggered
associations, physical symptoms, hypervigilance and impulsiv-
ity. Trauma reactions can include:
• recurrent and intrusive recollections of experiences
• flashback episodes (acting or feeling as if the experience
is happening in the present)
• emotional numbness
•
•
•
•
•
distressing dreams about experiences
extreme worry, guilt, anger or irritability
periods of sleeplessness
distrust of others
problems with alcohol, drugs or other addictive behav-
iors
Additional consequences of trauma
There is a strong relationship among trauma, mental health
symptoms and substance use issues. Clinically trained trauma
specialists are skilled in the treatment of those who are suffer-
ing from the aftereffects of trauma and stress disorders. The im-
age of the law enforcement officer as the strong hero/heroine,
always in control, can lead officers to resist acknowledging hid-
den pain that is often underneath their masks of invincibility.
The enemy of recovery is the avoidance of experiencing the full
range of emotions, as well as the lack of willingness to put feel-
ings into words.
First responders who are repeatedly exposed to trauma in-
cidents appear to be at increased risk for major depression,
panic disorders, generalized anxiety disorder, substance abuse
and suicidal acts, as compared with those who have not experi-
enced traumatic events. They may also frequently have somatic
and physical illnesses, particularly hypertension, asthma and
chronic pain syndromes.
Unresolved and untreated trauma is a primary cause of ad-
diction. Self-medicating with substances such as drugs, alcohol
and other destructive behaviors pose as a solution to pain but
carry deep consequences.
How can treatment help?
It is important to come forward to receive treatment. The aim
of treatment is to reclaim the mind and body that have been
taken over. The therapeutic work is structured to help the first
responder to feel, to be and to function in the world. The goal
of treatment is to reduce the individual’s pain and enhance
healthy functioning. Moreover, with treatment, it is possible for
the officer to discover some joy, the capacity for healing and,
hopefully, peace. d
Iris Perlstein is the director of Allied Clinical Therapies and clin-
ical specialist for First Responder Treatment Services at Penn
Medicine Princeton House Behavioral Health. First Responder
Treatment Services at Penn Medicine Princeton House Behav-
ioral Health provides enhanced/customized care for law enforce-
ment officers, firefighters, active military, EMTs and other first
responders while they are in treatment at Princeton House, an
inpatient hospital for those with mental health and substance
use disorders. Princeton House intensive outpatient and partial
hospital programs also feature trauma tracks for men and wom-
en. For information, visit princetonhouse.org/firstresponder or
contact Ken Burkert, peer support specialist, at 908-346-1691.
www.njcopsmagazine.com
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