Today, education and discussion on mental health, suicide and PTSD are at the forefront for first responders. However, despite effort, it almost seems as though negative outcomes are on the rise.
In fact, a scroll through social media would lead many to believe that a career in public safety is causal of negative mental health outcomes, suicide and PTSD.
In fact, many first responders are renaming Post Traumatic Stress Disorder (PTSD), to a more socially acceptable term, Post Traumatic Stress Injury (PTSI) because they believe that by replacing Disorder with Injury, they are reducing stigma and blame on the individual.
This is flawed on so many levels. First and foremost, clinicians and researchers alike recognize that PTSD is different from Post-Traumatic Stress Symptoms (PTSS). The former generally arises when a traumatic event is not properly processed and can even be described as a disorder of recovery, and the latter is a natural response to trauma. Further, attributing suicide to a career in public safety, is also erroneous. This is because suicide is never the result of a single cause. Rather, it’s the result of a complex interplay of many factors, to which are varied from person to person. Attributing to a single cause is not only wrong, but also harmful. There are underlying factors that can be so deep-seated, that even the individual can’t always appreciate their significance.
For example, somebody with an Adverse Childhood Experience (ACE) score of six, is at a 5000 percent increased likelihood of suicide attempt, and a score of four can triple their risk of suffering from depression. We cannot and should not make assumptions based on profession alone. While we know that certain professions have higher rates of suicide, we also know that it’s not the profession that leads to suicide, but rather individual factors associated with persons who enter their respective professions. For example, we often attribute military and first responder careers with suicide and blindly attribute the suicide to “the traumatic calls.” However, military findings have discovered no relationship between combat and suicide. According to war journalist Sebastian Junger, there are several underlying factors that members bring to the military and additional factors created by military association.
Dr. Craig Bryan explains, “we train our warriors to use controlled violence and aggression to suppress strong emotional reactions in the face of adversity, to tolerate physical and emotional pain and to overcome the fear of injury and death.” These factors are all associated with increased risk for suicide. Dr. Brene Brown takes it one step further by explaining that “in organizations when we lead, teach, or preach from a gospel of Viking or Victim, we crush faith, innovation and adaptability to change. Take away the guns, in fact, and we find outcomes similar to those for soldiers and police in corporate America. The American Bar Association reports that suicides among lawyers are close to four times greater than the rate of the general population.”
For the previously mentioned populations, strength, resilience, courage and personal sacrifice in the face of adversity is valued. Yet, the stigma associated with illness, weakness, sadness and a desire to die by suicide is seen as weakness. Therefore, the association between being a firefighter and suicide is not causal, but instead due to a host of other variables to which they are both linked, and which explains their association. This means, we cannot generalize causal factors based on occupation, we must consider individual factors.
Moreover, there is no such thing as PTSI. While you will find PTSD in the diagnostic and statistical manual (DSM), you will not find PTSI. I understand the reasons people explain for using this term. They claim that PTSD is too harsh of a diagnosis since disorder blames the individual, and Injury is less stigmatizing. We must understand that PTSD is real, however, so is PTS. Post-Traumatic Stress is universal, and it’s normal, and all of the symptoms associated are healthy and adaptive. Most people exposed to trauma will display PTSS. And with good sleep, a good social network and good coping skills, most people will not develop long term PTSD.
Furthermore, 80 percent of people who do develop PTSD will recover! PTSD IS NOT A LIFE SENTENCE. However, we must understand that it is real, and there are things we can do to prevent its manifestation. For example, we know isolated and alienated people are at greater risk for both suicide and PTSD. Moreover, so are people who are unable to disclose their true sources of pain, and people who are unable to receive post traumatic support.
Finally, by blindly attributing suicide to trauma, PTSD, PTS, or PTSI, we are causing more damage to those who are struggling in silence from other stressors. We are conveying the message that PTSD/I is honorable and unpreventable. Through this messaging, we are further silencing those suffering from depression, anxiety, substance use disorder, relationship issues, bullying and many other common stressors.
And while the causes of the previously mentioned mental health disorders are complex and varied, the solutions are not. The solutions are all common sense, yet unfortunately not common practice. Because of this, most first responders are not well prepared to process negative events or manage stress in a healthy way.
Historically, our method to deal with the bad stuff was to bury it down by either staying busy or drinking the negative thoughts away. However, today, we know all that does is build up until the most insignificant thing makes you implode.
So, what’s the alternative.
First and foremost, supervisor support and willingness to talk to your crews about EMOTIONS and difficult feelings is critical. Research has found that supervisor support is the strongest predictor of decreased PTSD severity. If the company officer has the courage to open up and know available resources, members are more likely to utilize those resources. Company officers must take time to learn about the resources available to them and to their crews. It’s imperative that they understand how their agencies EAP works, know how to find a therapist, how therapy works and why just simply talking is helpful.
Traumatic situations can get stuck in the limbic system, and the best way to free them and move them to memory without physical response is to simply process them by talking about them. A great resource for anybody is https://www.psychologytoday.com/us. All you have to do is type in your zip code, insurance and whatever issues you may need help with. Then the screen will populate a list of clinicians with their picture and biographies. It is recommended that you select three clinicians to reach out to and meet. After talking to each of them, pick the one you feel most comfortable with. Finding the right clinician is like finding the right pair of running shoes.
However, you don’t always have to reach out to a clinician to heal. You simply must find somebody to have meaningful conversation with. This doesn’t have to be a professional or even a trained peer. It’s anyone who you can open to without fear of judgement.
I know, talking is hard. An alternative is journaling. Multiple research studies from college students, to rape survivors, combat veterans, and even prisoners have found that writing about traumatic thoughts and experiences helps to resolve them and store them as memory and not trigger. You can simply write down your thoughts, then tear them up if you don’t want the reminder. The simple practice of writing them down is sufficient.
No matter how you decide to process your trauma, if you want to improve mental health, you must sleep. Sleep is what Dr. Van Der Kolk (world renowned trauma psychologist) refers to as in-built therapy. Specifically, REM sleep. REM sleep works to process and lay traumatic memories to rest. Furthermore, sleep scientist Dr. Matthew Walker explains that insufficient sleep is tied to every single mental health disorder. Poor sleep results in an amplification of the amygdala which reduces patience and increases emotional responses.
We must work to develop good sleep habits early in our careers and lives. Because without a good sleep routine, stress and trauma can make sleep even more difficult. Small changes have profound effects on sleep. Get rid of blue light and television an hour before bed. Work to develop consistent bedtime routines and times. Stop using sedatives (Ambien/alcohol/etc.) to sleep. Because they sedate you, they also suppress the active processes that take place during sleep. They prevent you from getting to REM sleep and ergo, their use increases the risk of PTSD, depression and suicide.
Learn a mindfulness practice to calm your mind and become less reactionary to stimulus and less judgmental of your thoughts.
My favorite app is Headspace, but Calm, and Insight Timer are also great.
Allow yourself to feel what you feel. If you are angry, be angry. If you are sad, be sad. Feelings have a life cycle of 90 seconds if you allow them to roll though. Research recommends feeling them all the way through and even letting them complete their cycle vocally resolves them. YELL, CRY, SCREAM, whatever you need to do to allow the cycle of the feeling to pass. If you think I am crazy, study other mammals. No mammal suppresses their feelings, they jump and scream, and then return to baseline calm without the need to get drunk. Releasing their feelings allow them to remain calm and prepared.
Modern society has normalized the destructive habit of suppressing those feelings that should signal to your body that something is off. Sadness tells us that we need to grieve a loss, anger tells us that we need to get rid of something, and joy tells us that we need to embrace the moment. Don’t be afraid to utilize your feelings as clues. Knowing what you feel is the first step to understanding why you feel, which is a clue to taking action.
Finally, take time to practice gratitude. I know it sounds crazy with all the bad in the world. But expressions of gratitude are scientifically proven to reduce distress and increase our resilience. Take five minutes to sit and consider all that you have to be grateful for. Make this a daily habit.
I know I said finally, but now, Lastly, Laugh. Laughter is medicine. Find something or someone to laugh at.
If you need support, please reach out to a trusted confidant. If you’re in crisis, never hesitate to call the suicide prevention lifeline 1-800-273-Talk. If you just need a little support, you can Text SUPPORT To 1.833.698.7864 to reach Next Rung or if you’re in North Carolina, call North Carolina Peer Support 1-855-7NC-PEER.
There is no doubt that a first responder career is stressful. Everything from the time away from home, sleepless nights and unspeakable calls add to our stress bucket. But those buckets don’t have to overflow. By learning the positive coping skills mentioned in this article, we can grow into a stronger and more resilient version of ourselves.
Dena Ali is a captain with the Raleigh, NC Fire Department where she has worked her way up the ranks. Ali has a degree from North Carolina State University and an MPA from the University of North Carolina—Pembroke, where her research focused on firefighter suicide. She received the NC Office of State Fire Marshal Honor, Courage, and Valor award in 2018 for her steadfast effort to bring awareness to firefighter mental health through her vulnerability. She is an advocate of awareness, education, and understanding of mental health disorders and suicidality. She speaks locally and nationally on these topics and is a QPR Suicide Prevention Gatekeeper Instructor and is the founder and director of North Carolina Peer Support where she helped to develop their statewide curriculum. She is also a founding member of the Carolina Brotherhood, a group of cyclists/firefighters in North Carolina who honor the fallen and their families annually.