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Trauma Response Profile:
Beverly J. Anderson, Ph.D., B.C.E.T.S.
JSV: I know that you have been very
committed to providing psychological services to law enforcement agencies
for almost 20 years. Can you tell me about the positions that you
currently hold? BJA: I am the founding Clinical Director
and Administrator of the Metropolitan Police Employee Assistance Program
and have been since 1988. This program is unique in that it is a joint
union-management approach to addressing the serious stress-related
problems that are a direct result of policing. I do not work for the
Police Department or the City. My contract is with the Fraternal Order of
Police Labor Committee. The best part about this independence is that it
ensures confidentiality. The records belong to me as a private clinician
which facilitates trust in those whom we assist. We have 3,500 officers in
the Washington Metropolitan Police Department. We are not an employee
assistance program in the true sense. We are actually a long-term services
program and provide individual therapy, family therapy, marital therapy,
play therapy, and various group therapies including Veteran officers
groups, alcoholism prevention and relapse groups, and weekly critical
incident debriefing groups. With regard to this latter point, we have an
average of two police-involved shootings per week. Subsequently, we have
ongoing debriefings. Our police department must contend with one of the
highest murder rates in the United States for a city of our size.
Moreover, we have one of the highest rates of ambushes and unprovoked
attacks on police officers in the nation. There is a lot of gang violence,
drug-related problems and the like. We have a situation here that demands
all of the emotional resources of the force. We also do a lot of training.
The foundation of our comprehensive program is based on training. We have
a critical incident program that begins with the recruits in the police
academy and involves family members. We are on call 24 hours a day. In
fact, just this morning at 1:30am, I was paged to a police-involved
shooting and had to go to the Homicide Division. I sat with the officer to
assist with what is best referred to as defusing. This involves debriefing
the officer after the shooting and then for six mandatory meetings within
three months of the shooting. We are also engaged in research. We have
done work with Dr. Frank Putnam from the National Institute of Mental
Health on Secondary Post-traumatic Stress Disorder in the children of
police officers. We are still compiling data. In working with police
families over the years, we have noted a preponderance of symptoms in the
children to include hyperactivity and attentional problems. I believe that
this is a direct result of experiencing the effects of parental exposure
to trauma. JSV: As you are aware, The American
Academy of Experts in Traumatic Stress is a multidisciplinary organization
comprised of professionals from over one hundred forty specialties. Many
of these individuals respond on the "front lines" of risk and, at times,
danger which are significant stressors. How does law enforcement stress
differ from other occupational groups such as firefighters and Emergency
Medical Technicians (EMTs)? BJA: The first thing that comes to my mind
is the public response to firefighters and EMTs. For the most part, it is
a very positive response when compared to the police. Think of being
stopped by a police officer for speeding, for example, and you think that
you are going to get a ticket. One of the first things that you may do is
try to get out of it, be nice, or lie. The public mind set toward the
police officer seems to be more negative. Although there is a clear danger
potential in all of these groups, the danger is different for police
officers. As the level of violence in this country escalates, the echos of
that violence reverberate throughout the police community. Unprovoked
attacks on police officers are at an all-time high. Just a year ago, D.C.
Master Patrol Officer Brian Gibson sat in his patrol car at a stop light
and was shot execution style by a young man who was put out of a local
night club by a police officer. Another example is Officer Wendall Smith
who was exiting his vehicle after returning home from his evening shift.
When the attackers saw that he was a police officer, they shot and killed
him. In 1995, Scot Lewis was shot in the head and killed by a passerby
while Officer Lewis and his partner were assisting a hearing-impaired
person. The assailant then turned the gun on Scot's partner, Officer Keith
Deauville who returned fire, fatally wounding the attacker. In these
situations, the danger is not obvious and you don't know who is going to
attack you. The police officer always has to be ready. That is why
officers have what I call "cop-face" (the need to be hypervigilant). They
have "cop-face" because they never know (when they have to move into
action). The unpredictability of the job of policing is an added stressor.
This means that the stress hormones need to remain elevated at some level
(recall the General Adaptation Syndrome). The police officer is always
looking for what is "wrong" in the picture. Shift work and midnight duties
are common to other professions but the unpredictability and the violence
make police work unique. You can add to this, a revolving-door justice
system, with the person you locked up today, back on the street tomorrow.
A police officer also has to contend with mixed messages from police
administration. On one hand they are told to lock-up and arrest those
involved with crime and, on the other hand, always remain professional
while doing it. There is public scrutiny of police work, and at times,
media misrepresentation of events. There is always a threat of civil law
suits. There is significant stress associated with the use of deadly force
- having to kill another human being. I have yet to meet an officer who is
emotionally ready to kill another human being. Many officers say that the
first thing that came to mind after they fired the fatal bullet was "Thou
shall not kill." All of these stressors make police work different from
other professions. Of course, the on-going, day-to-day exposure to
murders, assaults, rapes, child abuse, domestic violence and "man's
inhumanity to man" intensifies this stress-related burden. JSV: What is the most significant
stressor for police officers? BJA: If you ask a police officer about the
most significant stressor of policing, they often report "police
administration." However, the nightmares they experience are not about
administration. These nightmares are about the use of deadly force,
shooting their guns, and being shot. It becomes apparent that the most
considerable stressor is the constant exposure to trauma, especially over
prolonged periods of time. However, problems regarding "police
administration" are very real for officers and sometimes constitute the
"second wound." Officers expect that the public and the media will
mistreat them; they don't expect betrayal from the very organizations they
risk their lives for every day. JSV: This is quite consistent with
combat veterans who serve multiple tours of duty. BJA: This is absolutely correct and I think
that you bring something out that is so much a part of the police
experience. Without minimizing the trauma of combat, consider the
following. During wartime, soldiers go to a foreign land, and are likely
to remain there for six months to a year. Police officers are likely to
see twenty years of peacetime combat, in their own country where they do
not always know who the enemy is. The enemy could be anybody. JSV: What is "Police Trauma Syndrome®"
and why do you think that it has taken so long for its wrath to be
examined in the trauma literature? What are the stages leading to this
syndrome? BJA: Police Trauma Syndrome® is
a diagnostic term that I authored several years ago to depict the cluster
of symptoms many police officers suffer as a direct result of the job of
policing. It is now a registered trademark. In diagnosing trauma-related
disorders with police officers, we have found great difficulty with the
criteria set forth in both the DSM-III and DSM-IV (Diagnostic and
Statistical Manual of Mental Disorders). It has been problematic for
us to use the DSM-III or DSM-IV criteria for police officers because they
typically do not fit into the Posttraumatic Stress Disorder (PTSD)
criteria per se. A police officer can witness, inside of one week, more
trauma than most people see in a lifetime. Not only is it qualitatively
different but also, quantitatively different. They see so much trauma. If
you examine the first of the DSM-IV criterion (for PTSD), it states that
the person's response to the event must involve intense fear,
helplessness, or horror. Police officers are more often than not, the
first responders to a scene. They have been tuned to dissociate from their
emotions or suppress their emotions in order to be able to endure the
scene. Theoretically, in most cases, police officers would not fulfill
this first criterion. They are trained to respond behaviorally (not
emotionally). Also, we tend to see a biphasic response which oscillates
between anger or intrusive thoughts and numbing. We see extremes in their
responses. This does not imply that police officers get used to being
exposed to trauma, because we know that this is not the case. Chronic,
long-term and cumulative stress takes its toll on police officers. When we
talk about the issue of police brutality, it becomes clearer that the
effects of such stress will come out one way or another. Police Trauma
Syndrome® can result after a single, catastrophic event such as
when an officer witnesses his partner being killed, and then having to
defend his own life perhaps by killing the assailant. This could
precipitate full-blown PTSD or Police Trauma Syndrome® in an
officer. On the other hand, after years of traumatic exposure, Police
Trauma Syndrome® can be triggered by an incident that is not
immediately life-threatening, like the following incident. A veteran officer with young children at
home got a call to respond to an unconscious person. Well, what do you
think of when you hear "unconscious person" - a street person, a person
who is intoxicated, a stroke or heart attack victim? There is not too much
warning in these situations. The officer goes into an apartment and there
he finds an eight-month-old baby with a core body temperature of 106
degrees. He immediately begins mouth-to-mouth resuscitation because the
baby is not breathing. The baby vomits sour milk into the officer's mouth.
The ambulance finally gets there and the baby is taken to the hospital and
dies. No one tells the officer what the baby has died of. He doesn't know
if the baby is HIV positive, has meningitis, or is contagious! No one will
talk with him because there has not yet been an autopsy. He goes home. Can
he touch his children? He cannot look at his young baby without having
intrusive thoughts and overwhelming feelings about the baby who had just
died. In this case, the officer had an acute reaction and this triggered
memories of other experiences and he was in a full-blown crisis. Another
example is the veteran officer who had been on the scene of many suicides
over the years. On one particular occasion, he began to tremble and
hallucinate, and he experienced panic symptoms, etc. This was a person
with 22 years on the force! There are so many factors involved. The
important thing to convey about Police Trauma Syndrome® is that
when a clinician sees this term, consider that the individual is suffering
from events experienced primarily on the job. It is a direct result of the
occupation of policing. Our veteran officers group has identified several
stages leading to full-blown Police Trauma Syndrome®. (This
group has been meeting for four years and is comprised of officers with 17
years or more on the Department. They have all been high achievers on the
job but have paid a price emotionally). They have defined a five-stage
model. In the first stage, the "Rookie" Stage, an
officer is "shocked" by the world he sees - the violence, the neglect and
cruelty toward children. He sees a world that he didn't know existed. The
second stage is the "John Wayne" Stage and is marked by an uncertainty as
to the "balance" of the badge. The officer is filling a role as he/she
understands it. The "tough" image portrayed by the media cops is all that
officers may know. The officer may take pride in owning all of the police
gadgets. Their communicative style is primarily one of "commanding,
ordering and directing." During the third stage, the "Professional" Stage,
the officer has a good sense of his/her own identity. No matter how much
verbal abuse they encounter, they remain courteous and in control (e.g.,
responding to an angry motorist he has just ticketed, you might hear,
"Well, sir, I am sorry that you are making reference to my mother right
now; however, you did go through that stop sign and I am required by law
to cite you"). While for appearance's sake, this may seem problem-free, in
actuality what's happening is that the officer may be "numbing" his
natural emotions. "Dehumanizing" citizens as a coping mechanism will cost
the officer in his personal life. Defense mechanisms that help an officer
adapt to the job are maladaptive in his/her personal life. These stages do not necessarily follow a consecutive pattern. Our experience has been that officers can jump from one stage back to an earlier stage. For example, a veteran officer who is in the "Professional" Stage may revert to the "Rookie" Stage upon witnessing a gruesome, traumatic event. We found this in many officers who responded to the Air Florida crash in 1982. The carnage and death they were exposed to that night and during the body recovery days after changed their lives. Many of the officers experienced the "Burnout" Stage which is number four in our model. Anger and contempt for the criminal justice system, the Department, politicians, and the citizens highlight this stage. The officer begins to isolate from family and friends - believing that they do not "have a clue" as to what the world is really like. The fifth and final stage is full-blown "Police Trauma Syndrome®." The individual is no longer able to function effectively as a police officer. This state is characterized by sleep problems, anxiety and/or depression, flashbacks, intrusive thoughts, mood swings, rage attacks, social isolation, and a deterioration in relationships. The officer may consume alcohol or other drugs or experience an escalation in usage. Suicidal thoughts may arise. This condition is far more pervasive than one might think. Sadly, what usually happens, without intervention, is that the officer retires (if he/she can) and disappears into obscurity. We are working very hard to prevent Police Trauma Syndrome®. JSV: What about the use of deadly
force? For example, what do police officers go through after they are
involved in a deadly shooting? Does the use of deadly force affect police
officers more than other stressors? BJA: Involvement in a police shooting may
be the cataclysm of a police career. When I began working with officers,
it was almost unheard of for an officer to be involved in a shooting. It
was rare. Now in this city (Washington, D.C.), we average two
police-involved shootings a week. There are many factors involved in the
event that have to be examined. For example, was the officer injured? How
lasting was the injury? Was the officer's partner injured or killed? Was
the suspect killed? Who was the suspect - an adolescent, elderly person, a
mentally ill person? How grotesque was the shooting? What was the physical
proximity of the officer to the suspect? For instance, I remember one
officer who told me how the suspect looked at him before he died and asked
"why did you kill me?" That is what the officer will remember. Was the
officer taken by surprise? For example, one minute the officer was giving
directions to a citizen and the next, he has a gun pointed at him. Also,
were other people in danger of being killed or injured? Was the use of
deadly force appropriate or can the officer be potentially convicted of
homicide? There is also the potential for civil liability. What is the
officer's coping style? Is there substance abuse? Police officers
oftentimes use self-destructive coping mechanisms such as drinking,
gambling, workaholism, etc. What was the department's response to the
shooting? Were they supportive or punitive? Some departments take an
officer, remove his weapons, and place him in the back of the car. Who
else goes in the back of the car? Suspects! What is the emotional impact
on an officer when this happens? He feels that he must have done something
wrong. Another factor that affects officers in the aftermath of a shooting
is how the media handles the reporting of the shooting. So often, in their
haste to report a story, the media will distort the facts and not usually
to favor the police. Officers have a favorite phrase they use to describe
the media, "Don't let the truth get in the way of a good story."
Immediately after a police shooting, a
quick response by management and mental health personnel is crucial.
Counselor support within hours of the shooting as well as follow-up
services send a critical message: "You are important to this Department
and this community." Follow-up services should also include the family. We
have prepared a booklet for officers, officials and family members that
discusses how to best manage police critical incidents. JSV: Recently, in New York, there was a
very unfortunate encounter for some police officers involving
"Suicide-by-Cop" in which an individual, who apparently wanted to kill
himself, pointed a plastic gun at officers and was, subsequently, fatally
shot. In your experience, how often does this occur and how do you assist
officers who confront such an event? BJA: This is yet another very sad fact of
life for law enforcement officers - one that happens all too often. The
kind of individual who uses police officers for his/her own suicide will
influence the officer's reaction. Individuals who commit heinous crimes
and then precipitate an officer's use of deadly force will evoke a
different response from an officer than a depressed adolescent who just
wants to die and doesn't have the nerve to do it himself. The natural
response for the officer is often one of anger. When a person makes a
decision to point a gun at a police officer, that officer must react to
protect his life. The public doesn't seem to understand this. Citizens
will ask "couldn't you have shot him in the arm?" or "couldn't you shoot
the gun out of his hand?" Our job is to help the officer place the
responsibility on the person who caused this event. At the same time, we
validate the normal feelings that accompany such a tragedy. JSV: Police officers are often
portrayed in the media as the "cool" and "calm," Clint Eastwood-type. In
your opinion, what effect does such a stereotype have on officers, if any?
BJA: We have worked very hard to dispel
that myth and it seems to be working with our younger officers. With
officers on the job ten years or so, you see that macho-mystique portrayed
in the Lethal Weapon movies. I remember Mel Gibson taunting the police
psychologist in one particular movie after she had voiced concern for him.
That image is not helpful for the public or the police. I have yet to meet
a cop who has a "make my day" philosophy of policing. However, the rigid,
macho mentality that does exist is a barrier to debriefing after a
critical incident. In the long run, it makes the officer more vulnerable
to the cumulative effects of traumatic exposure. JSV: From time to time the media has
highlighted cases of police brutality such as the Rodney King beating in
1991 in Riverside, California. Do you think that police "brutality" is a
problem in this country? BJA: Yes, I do think it is a problem. I
also say that we have to look at this problem in context. This begins with
verbal abuse which, I believe, is a direct result of chronic exposure to
trauma such as death, suicide, rape, assault, etc. (i.e., precipitants for
Police Trauma Syndrome®). Police departments need to begin to
deal with this more appropriately and more efficiently. They need to do
more than one debriefing meeting. They need to train recruits and
supervisors in an ongoing, comprehensive fashion. Standards need to be set
high and kept high. Unless there is change, I think that we will continue
to see this problem. We need to look at stress education and training in
the same manner as we look at body armor (i.e., bulletproof vests). This
equipment prevents physical trauma to the body. Likewise, if a department
has a good stress inoculation training program that is ongoing, then this
is the kind of armor that is needed to prevent (or mitigate) some of the
psychological trauma. JSV: On that note, how is critical
incident stress debriefing in the Metropolitan Police Employee Assistance
Program conducted by you and your colleagues? BJA: Knowledge about the debriefing process
begins in the Police Academy. The recruits and their family members are
given a booklet entitled Critical Incident Stress Debriefing -
Important Information for Officers and Family Members. We begin with
that education in the Academy. The recruits go through stress training. If
and when they have an incident, they become more responsive. As soon as an
incident occurs, one of the on-call therapists responds. The protocol of
immediate intervention involves normalizing and validating feelings. We
may also educate the officer (e.g., "these are some of the reactions that
you may have and the important thing for you to remember is that this is
normal"). After that, debriefing times are offered to the officers who
will attend a total of six mandatory debriefings on department time. If
they come when they are off of their shift, they receive compensation time
for attending. Our offices are not located near a police facility. We are
in an office building away from police facilities. There is ensured
confidentiality. The meetings are held in a group setting. They are co-led
by police officers who have been through a critical incident. The officer
is not acting as a therapist, but talks about his/her own reactions.
Appropriate boundaries between the police and therapist roles are
essential for the success of the program. The debriefings involve stress
education and exploration of each police officers' event. They learn that
they all respond in a relatively consistent way and there is normalization
of their responses. They are able to hear other officer's "story" which
helps many officers to believe that they can heal from their experience.
To quote one officer, "You see things through new eyes." I refer to this
process of debriefing as a cognitive-affective-behavioral intervention.
They understand what has happened to them, learn about their feelings, and
have to go an extra step to learn how this event is going to change them.
The ultimate goal is to help officers find some meaning in the event and
take their experiences to a new level. This is what survivors need to do.
It is not just survival but prevailing and overcoming. We have to help
officers respect the enormity of what has happened to them and understand
that it is powerful. We also have to help officers realize that, in time,
they have to make the event a part of the past. It does not need to be a
constant torment even if the memory may last forever. JSV: Although there is an increasing
recognition of the psychological effects of domestic violence on victims,
considerable research still needs to be conducted. With regard to the
effects of domestic violence on children, what recommendations could you
give to officers who respond to domestic violence calls where young
children have witnessed a traumatic stressor (e.g., mother's battering,
etc.)? BJA: There are some states that have passed
laws that are much more stringent with regard to protecting people.
However, there is so little that a police officer can do. He/She can
arrest a perpetrator, which he may have to do. But, when it comes to
removing a child from the household, it becomes painful for a police
officer. I have spoken to officers who have described a desire to take the
child home with them which, as you can imagine, can cause other problems.
Officers are so powerless in many situations. This powerlessness is close
to police officers. They must live with this. The only thing we can tell
them is that they should talk about it but, they oftentimes, don't want to
talk about it. It hurts to talk about it. They say, "What good does
talking do, it doesn't change the situation." This is another stressor for
police officers. When they go home, they say they don't want to talk about
it because they "leave the job at work." The real reason they don't talk
about it is because they are trained on the job to suppress their emotion.
So, if they begin talking about it at home, they can't just tell it like a
story that happened to somebody else. They may become overwhelmed with
emotion and they don't know what to do with those feelings. We go back to
that biphasic response - numbing and dissociation. Many officers are
uncomfortable with their own emotions. JSV: As a member of the Board of
Scientific & Professional Advisors of The American Academy of Experts in
Traumatic Stress, are there any suggestions or concluding comments that
you could offer with regard to helping survivors of traumatic stress?
BJA: The big word for me is "depathologize."
We need to look at the public health problem of traumatic stress in
society. We need to look at traumatic stress not as a mental illness but
as a public health issue. I read an interesting comment recently in an
article. The author said that "PTSD is to the world of psychology what
AIDS is to the world of medicine." I think that this is true. There is a
preponderance of traumatic events (e.g., the increase in violence, natural
and man-made disasters, etc.) in society. Those who are exposed to trauma
need to receive assistance and should not have to feel that they are
"crazy" when they seek help. JSV: As you are aware, The American
Academy of Experts in Traumatic Stress recognizes that traumatic events
are an unfortunate part of the human experience that individuals from many
disciplines work with on a regular basis. What do you see as the major
advantage of an organization such as the Academy that is dedicated to
increasing awareness and ultimately, improving the treatment for survivors
of such events across such an eclectic group? BJA: The American Academy of Experts in
Traumatic Stress serves a unique and vital purpose. We have to take
traumatic stress out of the exclusive domain of psychology and psychiatry.
We have to do this! Traumatic stress and its aftermath belong to all of us
- medical doctors, lawyers, police departments, psychologists,
psychiatrists, teachers, insurance companies, legislators, etc. Education
is a crucial step and the issues must be addressed in a public forum (as
the Academy's mission statement indicates). JSV: Tell me about The American Academy
of Police Psychology. I understand that you are the President of this
organization which is the first organization of its kind to address the
concerns of the law enforcement community. BJA: The American Academy of Police Psychology is an organization dedicated to addressing the unique concerns and stressors of the law enforcement community. Some of the major goals of our organization are to establish standards for police counseling, debriefing, and stress programs and to initiate research in the area of police trauma. Moreover, we are committed to educating police departments, family members, police officers, educators, and criminal justice programs about the nature of law enforcement and the unique stressors associated with this profession. With regard to this latter point, this must be dealt with in order to have a healthy work force. This can benefit the police officer, their families and the community. As an organization, we want to focus exclusively on law enforcement. We have had other agencies approach us who want to affiliate with us and work on other issues. However, we want to remain focused on law enforcement stress and traumatic exposure of police officers. We want to advise communities and police departments on how to put programs together that can be preventative in nature. Many police officers, when they retire, suffer in silence. Twice as many police officers kill themselves each year than are killed in the line of duty. The high incidence of divorce is reflected in the fact that intimate relationships are difficult for many police officers. There is a high incidence of trauma-related problems that really demands that we take care of law enforcement officers in the way that they take care of us. We have nearly 700,000 law enforcement officers in this country. They have spouses and many have children. All of those people are affected as well. Law enforcement is an emotionally and physically dangerous job. The Academy's mission is a singular one - helping those who protect and serve. ©1998 by The American Academy of Experts in Traumatic Stress, Inc. Click here to return to The American Academy of Experts in Traumatic Stress Home Page Copyright © 1998 The American Academy of Experts in Traumatic Stress, Inc. All Rights Reserved. Reprublished on Police Stressline with permisssion.
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