DR. CHERYLYNN LEE
If you have been in law enforcement for more than a few years, you are likely all too familiar with the “effects” of the job. I’m not talking about the sweet abs after the academy or the gray tinge of your skin after three months on nights. I’m talking about “I don’t care what we have for dinner” (apathy); “I have nothing to talk about with my non-cop friends” (social withdrawal); “Eff this effing bullshit, effing eff” (anger); “I think I need to clean the garage again” (anxiety); “Is it worth it?” (depression); “Why do I always cry during deodorant commercials?” (emotional lability); nightmares; problems with concentration; substance abuse …
What if I were to tell you that if I had a window into your brain, I could show you where the problems are, similar to when you fracture your foot, and an X-ray highlights the exact location of the injury? I would tell you the reason you’re overly emotional is because you have a hyperactive amygdala. Your increased substance abuse is related to your frontal lobe not firing and wiring properly. And you’re having problems concentrating because your hippocampus is smaller than it used to be. I would venture to guess your first question might be, “Doc, am I crazy?” followed by “Will I ever be OK?”
In response to the first question, the answer is no, you’re not crazy (well, you might be, but not because of this). You cannot do this job and not be changed by it. Another way to say that is, “The expectation that we can be immersed in suffering and loss daily and not be touched by it is as unrealistic as expecting to be able to walk through water without getting wet.” Changing the culture starts by giving yourself (and others) permission to not be OK.
Secondly, in response to the question, “Will I ever be OK?” that depends. It always depends. Coming back from post-traumatic stress injury (PTSI) takes work — and if you don’t put in the work, you won’t get better. At least, you won’t recover as well as you could if you sought professional help.
When someone goes out IOD because the fight was on and they broke their wrist, there is typically minimal humming (“he’s not that hurt”), hawing (*insert eye rolling here*) and rumors (“he’s never coming back”). When someone goes out IOD because of post-traumatic stress (PTS), there is often quite a bit of humming, hawing, rumors and speculation about the legitimacy of the injury. We can be pretty terrible to one another in this profession. Why is that? Why is a brain injury less believable than a wrist injury? Why is a bodily injury after a critical incident award worthy but a brain injury after a critical incident is almost shameful? The answer is that it’s not. It shouldn’t be.
If a tree falls in the forest and no one is there to hear it, does it make a sound? If you’re handling your 15th coroner’s kid case in six months and no one knows you aren’t sleeping at night, are you really having nightmares?
As part of your job, you need to be skeptical, analytical and detail-oriented. These skills help you put away child molesters, assess active scenes for officer safety and get your reports in on time(ish). When your colleague is in a cast, you have visible evidence of the injury, and it’s no secret the injury is being treated by a professional, and your buddy is healing. When it comes to the amygdala, frontal lobe and hippocampus, however, well, there is no cast for the brain. Thus, it becomes suspect. If you can’t see it with your own eyes, how do you know it’s true?
Most often, symptoms of PTS and PTSI come from cumulative trauma, meaning it’s not necessarily one event that changes the brain but a series of events that add up over time. Everyone in this profession has symptoms of PTS at some point in their career (remember, if you’re touched by water, you’re going to get wet). PTSI is an accumulation of those symptoms over a specified period of time. For example, what was mentioned earlier (apathy, social withdrawal, anger, anxiety, depression, emotional lability, nightmares, problems concentrating, substance abuse) are normal reactions to seeing and experiencing horrible things. If a certain number of those symptoms persist beyond a month at a particular intensity, you might have PTSI.
Pain is inevitable, suffering is optional. What would be different about you, about your career, about your family life, if you were told in the academy, “Your brain is going to get injured doing this job. The injury is not because of weakness but because of strength. Because you do your job with honor, resolve, bravery and sacrifice, here is a road map for how to get help for your brain when you need it.”
Pain — “I had to Narcan a 12-year-old today.” Suffering — “I had to Narcan a 12-year-old today. If I had only gotten there sooner … If I had written a better report, CWS would have taken the kid two weeks ago. I missed the first exit and had to turn around. Did I … Could I … Should I?” Pain is what we signed up for. Suffering is what we do to ourselves.
Earlier, I stated everyone in this profession has symptoms of PTS at some point, but not everyone in this profession gets diagnosed with PTSI. There are life, genetic and resilience factors that account for the difference. You may have to go hands-on with a kid with autism — whether or not you have your own kid with an autism diagnosis will affect how you digest and process that call. If you are genetically pre-disposed to alcoholism, it’s easier for you to become addicted to alcohol. If you work out every day, eat healthily, have a good intimate relationship with your partner and have hobbies outside of work, you may be less affected by department politics. In a nutshell …
- Everyone in this profession will have some symptoms of PTS.
- Symptoms of PTS and PTSI are normal responses the brain has to seeing, hearing and experiencing horrible things (aka trauma).
- Seeking help for PTSI is the only way to recover to your full potential.
In my practice, I specialize in working with cops who have acute symptoms of PTS. Most people who walk through my door are engaging in some level of suffering (I mentioned we could be terrible to one another, but when it comes to our own self, we can be in a full-blown DV relationship filled with emotional abuse).
Part of PTS work is learning how to navigate suffering, relearning how to take care of ourselves, engaging in activities that build resilience and letting go of activities that increase stress. Do you really need to remodel the bathroom again with a hammer and toothbrush, or are you avoiding sitting still? By the way, the images and memories of trauma tend to surface when we’re trying to relax. That’s why it’s hard to sit still, be at home and sometimes easier to be at work.
Then there’s the trauma work. We are going to talk about it. All of it. You may have heard of eye movement desensitization and reprocessing (EMDR) or narrative therapy. Both are evidence-based tactics to help you process trauma. Processing trauma is all about leaning into the incident, reducing avoidance and gaining control back over the experience. Not forgetting about it. Not pretending it didn’t happen. But rather, acknowledging it happened, letting yourself feel and then letting it go.
Post-traumatic stress is not a life sentence. It’s intel. It’s information your body and brain are giving you, indicating something is hard, something is hurting you, and maybe it’s that normal response to seeing terrible things, or maybe it’s time to get help. If the fight was on and your wrist got hurt, you would use the pain as intel that something isn’t right, and you would probably go to the doctor and get checked out. Maybe not right away, but if it kept hurting or was getting worse, absolutely. Emotional pain should be no different.
If my family needs you, if I need to call 9-1-1 for help, I know without a shadow of a doubt you will show up. You will protect and serve my family and handle business. We need to get to a place in our culture where the same could be said when you or your family need a culturally competent clinician. You call, we show up. Protect, serve, handle business.
Pain is inevitable, suffering is optional. Don’t forget that. But if you do forget because of life (or that darn hippocampus), that’s what we’re here for. That’s what I’m here for. To remind you that it’s OK to not be OK. It’s just not acceptable you stay that way.
About the Author
Dr. Cherylynn Lee is a police psychologist and works full-time for the Santa Barbara Sheriff ’s Office as the Behavioral Sciences manager, overseeing the mental health co-response teams, CIT training and Wellness Unit, including Peer Support. As part of her duties, Dr. Lee is a member of the county’s threat management team and serves on the crisis negotiation response teams for both the Santa Barbara Sheriff ’s Office and the Santa Barbara Police Department. Dr. Lee has a private practice in the Santa Ynez Valley where she sees first responders exclusively, specializing in trauma, post-traumatic stress, mindfulness and job performance improvement. She is contracted with both 911 At Ease International and Counseling Team International to offer counseling and emergency response services across the state of California. Dr. Lee has led many critical incident stress debriefings for OIS, LODD, natural disasters and as requested by both local and state fire and law agencies. Dr. Lee is also a subject-matter expert with CA POST on both officer and dispatcher wellness and has participated in several training videos and initiatives aimed at supporting and encouraging wellness for departments and their personnel. She can be reached at firstname.lastname@example.org.