One of the few benefits to come out of the Vietnam War was the acknowledgment that tough guys do cry, and that it's good for them.

Unfortunately it took ten years for the Veterans Administration to recognize this and begin to set up programs to help Vietnam vets whose lives were in a shambles because of post traumatic stress disorder (PTSD). I started one of the first and few programs funded by, but independent from, the VA and one thing became tragically clear in the course of a few years after we lost several vets to suicide and saw a number of marriages end due to the symptoms of PTSD. That is how so much of this would have been avoided if the vets had received some counseling immediately after horrific incidents. Even war has critical incidents beyond the usual day to day carnage. Some you've heard about, or maybe experienced. Others seem unbelievable: like the medic I counseled who told me about having to deal with a friend, still conscious, who had a mortar round halfway embedded in his head and who would, who had to, die the death you can imagine since the round could not be touched, let alone removed safely without going off.

The military learned a lesson, witness the programs set up for the Gulf War, so soldiers would have stress counseling when it would do the most good. Many people didn't realize that psychologists, social workers and psychiatrists in the reserves were also mobilized for Desert Storm. But in some respects while the field of critical incident stress debriefing (or critical incident stress management, CISM, as it is now often called) for the military, and even for civilians (for example, school children after a shooting) is well accepted, CISD for law enforcement and emergency personnel while well established and beautifully run, has not been as readily accepted in some departments and areas of the country as it should be.

I still hear credible reports that a few chiefs and command officers in corrections privately suggest that officers who need help handling their emotions after a critical incident are "crybabies". I'm not saying these so-called leaders are in the majority. In fact, I tink they are a dwindling minority. But until they either die out or are enlightened, one is too many.

If critical incident stress debriefing is to be effective in preventing later problems, it should be done soon after the incident. But most CISD teams won't come in if they aren't asked to, and even if they do intervene without "being invited" in an incident they learn about second hand (in the news or because someone outside the chain of command calls them), there are times when incidents go unnoticed. The ultimate responsibility for calling in the CISD team or counselor rests with the leadership. There's a window of opportunity where intervention does the most good, which is why I titled this "Use it, or loose it."

The most common after effect of not dealing promptly and appropriately with the emotions aroused by a critical incident is "repression of affect", more commonly called "stuffing your feelings". And in time the most prevalent symptom isn't the nightmares and flashbacks that are so dramatic and disturbing. Those symptoms often lead officers to finally seek the counseling they need. The typical symptom is emotional numbing and shutting off feelings, distancing oneself from family and friends, and often using alcohol to further detach oneself.

Even at this late date, counseling and psychotherapy are very effective. Officers should not shy away from this with the idea that the therapist is going to want them to break down and sob like a baby (I've heard this notion too). Sometimes this happens, sometimes it doesn't. If the feelings need to be expressed that way, so be it. It is trite to say this, but sometimes a good cry is what is needed and you do feel better afterwards. But if an officer is one of those "real men don't cry" kind of guys, there's a good chance he's been numbing himself with alcohol (the great emotional anesthesia), so I'd suggest a healthier motto, "real men don't drink themselves into oblivion".

Remember, a "critical incident" is what gets to you, not what you think should or shouldn't get to you. An emergency room nurse or an EMT in a big city will handle hundreds of trauma cases, including children, for years, until one day she (or he) looses one too many children to a drive-by shooting. Nobody can predict which one it will be or when it will happen, so colleagues and supervisors need to be sensitive to this. It is always better to inquire and be wrong than assume the individual is handling it as routine. Asking "are you okay with this?" is better than saying nothing. The same thing goes for spouses. If your mate comes home covered with blood and shrugs off the incident as routine, maybe it was and maybe it wasn't. But asking shouldn't get a hostile response, and it's a bad sign if you do. You are right to ask. Sometimes you know your partner better than they know themselves.

Humor, gallows humor to be specific, is one way officers, fire fighters and emergency personnel sometimes deal with critical incidents where lives are lost. Folks, burn victims are not "crispie critters"! They are people who had lives and families and futures and hopes just like you, who probably died a horribly painful death. Humor has it's place, an important one in fact, in coping with high stres jobs. It is probably the one thing that keeps us going at times. But it is unhealthy when it is used as a way to escape your own humanity.