Posttraumatic Stress Disorder (PTSD) has been a large part of my professional life in the past year, with both corrections officers and inmates. Many of our officers survived a highly publicized traumatic day with fatalities a little over a year ago, and I recently encountered one of those persons who has not yet been able to return to work. Before I get into our conversation, I have listened to many misperceptions and assumptions since the event that changed all of us to a large degree. The trauma affected each of us differently, some much more than others, whether or not a person was on that shift that day, came in later that day, or did not work until the following day. What I have observed since last year is that whether or not one was there should not be a factor in judging if they were or were not affected.

 

PTSD has been extensively researched in recent years, particularly in the early years following the Gulf War in veterans. Psychologists learned even more after veterans returned from Iraq and Iran, and as such, the Diagnostic and Statistical Manual of Mental Disorders Fifth Edition (DSM-5, 2013) has greatly expanded its definition to include minute details of this disorder. Most importantly for the purposes of this article, these specific criteria have been greatly misunderstood. First and foremost, “Exposure to actual or threatened death, serious injury, or sexual violence in one (or more) of the following ways:” To simplify what follows, these ways include direct experience in person, learning about the incident to close family members or friends particularly when the event is violent, and experiencing repeated or extreme exposure to the details, even if that exposure is via media and is work-related. As you can see, direct exposure is not required to experience PTSD.

 

PTSD looks different from person to person depending on a plethora of variables, the most serious of which is the extent to one’s involvement in the traumatic event. Some of these variables include past experiences, temperament, age, emotional sensitivity, coping skills, and plenty of others that I could continue to list. Visual symptoms may look like a person’s inability to move as they relive a memory or experience a flashback, avoiding where an incident occurred, panic attacks associated with random and intrusive memories, or physiological responses such as increased breathing, sweating, or spontaneous tears or anger. They may refuse to discuss it, or may be unable to recall parts of the event, blaming themselves or inappropriately accept responsibility, significant mood changes towards negativity. Those mood changes may take the form of argumentativeness, sadness, inability to smile or experience enjoyment, irritability, even explosiveness without an identifiable trigger, and avoiding others or socialization events. A person may be very easily startled, unable to concentrate, may exhibit hypervigilance, and may appear fatigued subsequent to sleep problems.

 

Part of my job over the past year has simply been peer support, or advising officers that they need help outside of the building. Sometimes they just needed 5 minutes to vent or gather themselves. Sometimes they needed to be directed to seek more help. I watched for a long time, took extra time to listen, closed the door to let them shed some tears. Two officers in particular who worked on that fateful day responded in completely opposite ways. Both of them saw most of everything. One officer had no exposure to that extreme trauma and continued to experience PTSD symptoms nearly every day, some days worse than others. It affected every aspect of daily living. The other officer grew up in an area where crime was high and shots were fired daily while he observed deaths. The latter officer has shown no symptoms in the past year. The former officer has been able to put the event behind after our facility provided staff with a beautiful memorial and tribute. For the officers that attended who had been affected, they were able to move on. That day was a very positive turning point.

 

Back to that officer and our conversation, it was a chance meeting. The officer was so glad to see me and did not avoid conversation about ongoing severe symptoms. The officer saw all fatalities on that day as well as the locations where they occurred, and had worked with these people for years. The officer was unable to control emotions and discussed nearly being debilitated since that day. Unable to leave the home, unable to get onto elevators without a son coaching the officer, unable to be outside in the dark, constant fear and anxiety with panic attacks, dreams, even losing concentration while driving. S/he stated that his/her son often said, “There’s a red light!” The son is literally coaching this officer through life, down to habitual activities of driving. S/he included that lists do not help with severe memory and attention problems. The officer stated repeatedly how badly s/he wanted to return to work and felt great guilt and shame for letting down coworkers, sergeants, work family, and team, by not returning. Through tears s/he repeatedly stated, “I want to be better! I can’t get there! I’m trying so hard, but it’s not working.” Continuous therapy and unwanted medication, although taken as directed, are ineffective in this case. Classic PTSD symptoms, hitting on every single criterion listed in the DSM-5. This person’s career in this field is over. My best advice to this officer was to make a choice to leave and plan a different future. Talk to the therapist about simply making the decision.

 

Others’ perspectives have been critical of persons affected to this degree. Make no mistake; there are officers who are or have taken advantage of that tragedy for their own selfish purposes and without regard to the institution or their colleagues. I hold no respect for those officers, and they know who they are. However, for the truly traumatized officers, alleged social media posts showing times of happiness are perceived as potential abuse of time off. My thought was that it was a moment of attempting to feel pleasure, or enjoying something other than what they feel on a daily basis. Other criticism has been that “they just need to make the decision”. My personal observation is that the “decision” is exacerbating the symptoms because it’s pressure to relive the trauma, or fear of losing a career, or being unable to envision a future outside of the identity they had assumed as a corrections officer. They don’t want to disappoint, they don’t want to be mentally ill, they don’t want the medication, they were consistently good workers and now feel helpless, and are consumed with sadness, fear, guilt, and shame. Interestingly, when I mentioned this article to a coworker after I wrote it, this veteran staff member asked how I knew from “just one conversation” that the officer’s symptoms were real as opposed to fabricated or malingered. It was easy. The details the officer provided of symptoms were not those that could be found in a book. The majority of the officer’s responses fit into all of the categories of PTSD and then some, not detailed in a book. The officer’s behavioral responses were spontaneous, unprovoked, uncontrolled, with embarrassment and shame. Verbally and behaviorally, the responses were not practiced, but were uncontrolled, raw, and genuine.

 

Thankfully, Administration has been highly considerate of my recommendations on how to memorialize our lost staff members. They listened when I said that the affected people were not talking to them, but they were talking to me. I felt heard when I said, take down the poster. Our institution was presented with beautiful plaques for each lost officer or staff member and they were professionally humble. No faces to see every day, a simple name burned into wood and covered with glass, beautiful memorials. Administration listened when I said, these are perfect. Officers are not reminded with pictures. In looking at the plaques, the names do not stand out but can be found if searched. They are smaller, not glaring or consuming of their wall space. Officers are satisfied with that simple, humble reminder. Symptoms of PTSD are truly beginning to reside and be resolved.

 

With all that said, allow me to acknowledge and inform that officers are traumatized so often that the public is largely unaware. They are underpaid officers who are verbally abused and occasionally assaulted, and I’m not certain which is worse for them. In comparison to the events of last year, it appears possible that these brief encounters are not nearly as traumatic because officers are desensitized to a degree and can manage the “mini-traumas”. However, in our work, PTSD is largely misunderstood, particularly in the wake of this particular event, one that had not been seen in the history of this corrections system. It was different in so many ways and expectations revolved around how better equipped staff were able to manage by returning to work, many of whom were also “not okay”… Regardless, a “bad day” can happen anywhere and PTSD needs to be better understood and informed.

 

American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. Arlington, VA, American Psychiatric Association, 2013.