CopShock, Surviving Posttraumatic Stress Disorder (PTSD)

Question and Answer With Allen R. Kates,
The Author

**Reviewers**
Reviewers may quote the author from the following material.
For more information, call (520) 616-7643 or toll-free in US (888) 436-1402

Why did you write CopShock?
I was asked to. I was interviewing Los Angeles police officers for a possible newspaper story about cops with Posttraumatic Stress Disorder when the head of the LAPD's counseling unit invited me into his office and shut the door. He told me I had to write a book because he was seeing too many cops suffering from nightmares, flashbacks, insomnia, anxiety and overwhelming fear. I told him I didn't write books. But after calling other police departments, I discovered there was a great need that wasn't being filled. Cops had few places to turn to after experiencing trauma. And as many as one in three cops were developing Posttraumatic Stress Disorder -- perhaps the worst reaction to being traumatized. Cops need to know how to prevent or manage PTSD symptoms that can destroy their careers and family life. And their families need to know what is happening to their loved ones so they can offer support.

What is the book about?
The book describes how police officers cope with trauma. Most people seem to think that cops handle trauma well because they are trained to deal with disgusting or horrific scenes. But that's not the case. Cops are trained to control the situation, get help for those who need it and to keep their personal feelings hidden. They are not usually trained in coping with feelings. In this respect, they are just like you and me. What do you do after you have just witnessed a dead baby in a sink with its head bashed in by its father? Do you go home and tell your spouse how great your day was? How do cops after witnessing a crime scene like that stop a car for a broken taillight and act pleasant? They can't. They're in shock.

How is the book structured?
The first half of the book tells true stories of cops -- both men and women -- who have experienced devastating trauma and the solutions they choose to help themselves. The other half of the book describes how to manage the aftermath of trauma, describing over 200 support sources.

Nine officers tell their stories in the book, each story representing larger issues to which many cops are exposed. The book reveals the everyday events that accumulate and severely affect police officers' lives, the lives of their families and the people they serve and protect.

Do all the cops in the book have PTSD?
All but one of the cops depicted in the book developed PTSD, what I call CopShock. For instance, transit officer Christine McIntyre tells about being attacked in the subway and hiding her feelings for a year. Her silence led to severe PTSD. Narcotics officer John Jenks describes how the symptoms of PTSD were so hard to control that he tries to drown his sorrows in alcohol, anabolic steroids and cocaine. After shooting armed robbery suspects as part of his job in a stakeout unit, detective Ian Shaw develops panic attacks and tries to bury his feelings in excessive drinking. Ian did not develop PTSD, but his story is included because as important as knowing what PTSD is, it is essential to know what it is not.

Who in the law enforcement community will the book help?
The book will benefit active duty police officers and their families. It describes what officers must contend with and offers solutions. It explains to family members what is happening to their loved ones so family can become a strong avenue of support.

For retired cops, the book is indispensable. Retirees are very much at risk for developing PTSD because they have time on their hands and are reflecting on the incidents in their careers that disturbed them. This is what is happening to World War II veterans as well. Now that many of them are retired, they are calling up feelings they have never dealt with before. Counselors are seeing a huge increase in veterans with PTSD. In the book, I refer to combat soldiers and warfare so often that I devote an entire chapter to soldiers who become police officers. Soldiers bring a lot of problems into the job -- like alcoholism and poor coping techniques -- and what they see on the job intensifies their anxieties.

Police recruits need this book. Whether they will pay attention to it is another story. Many feel indestructible. They believe the situations in the book can't possibly happen to them. I hear this often from counselors. But then the inevitable happens and recruits become cynical and jaded. They suppress their feelings, drink heavily and practice poor coping techniques. The book makes recruits aware that bad things happen to good people, even to the rescuers in our society. The book prepares them for the worst and shows them there is no shame in seeking help.

Corrections officers, paramedics, firefighters, nurses, doctors, security guards, crime victims -- anybody who suffers from trauma -- will get a lot from the book. They often do little about their fears and sorrow until they have already developed PTSD symptoms. The book will show them how to prevent PTSD or to manage its symptoms.

So people other than police officers will benefit from the book?
Interestingly, half the people who are ordering the book are not police officers or in the emergency services professions. They are civilians, survivors of some horrible ordeal. I've asked them why they want the book. Many say that if the book can help cops with extreme trauma, then it will certainly help non-cops too. Others say that the book helps them understand the stress cops are under and their daily working environment.

Although the book focuses on cops, it will benefit anybody who undergoes a terrible shock. PTSD shows up in people who are victims of rape, muggings, assaults, natural disasters or who have witnessed crimes or loss of life. PTSD is appearing in people diagnosed with breast cancer, patients who wake up during surgery and those who have lost loved ones suddenly. For example, in a Detroit area study of people with PTSD, one third of them had lost loved ones unexpectedly.

The book is a resource and reference tool as well. Students in law enforcement courses who are thinking about police work as a profession will find the book valuable. The stories will open the eyes of anyone with an unrealistic view of what cops encounter and must cope with.

How did you choose the officers to include in your book?
Mostly, I chose officers who had been diagnosed with PTSD and had received therapy. Through therapy, they developed the ability to reflect on their condition. Of the more than 100 officers I interviewed, I chose nine whose stories represented not only their own condition but broad issues typical to most police officers.

How cooperative were the officers you interviewed?
I was amazed at how truthful, open and trusting they were. They wanted to tell their stories to benefit other cops, their families, as well as non-cops too. And I interviewed the main subjects many times. Not ever did they become impatient or uncooperative, even when discussing such embarrassing experiences as drug taking, alcohol use, promiscuity and suicide attempts.

What kinds of issues are portrayed in the book?
The book covers a lot of ground. The police officers reveal why they take drugs, overuse alcohol and anabolic steroids. They discuss eating disorders, sexual problems, suicidal thoughts and proclivity toward using violence. They show the influence of religious backgrounds, abusive childhoods and rape. One officer discusses his ostracism by other cops for not shooting someone during a confrontation and another cop describes the aftermath of being blown up by a terrorist bomb.

Officers who are assaulted, shot or who shoot suspects tell the effects these incidents had on them. Cops who were in the military describe how their combat experiences influenced how they reacted on the job. All of them describe their PTSD reactions. What becomes apparent in every case is their inherent decency and willingness to do good during their careers.

The book also focuses on the insensitivity and downright treacherousness of some police administrations. I read study after study that document how cops are less stressed out by the perps on the street than by uncaring administrators. Obviously not all administrators are like that. But the evidence is overwhelming that police bosses need to treat officers like human beings instead of pawns to move around on a chess board.

This insensitivity affects police families too. Too often they are forgotten in the turmoil of whatever happens to the police officer in their lives. After initial support, very often police administrations treat the families as if they were never part of the law enforcement community. In the case of death in-the-line-of-duty, I've heard horror stories of families totally forgotten, who must try to heal and survive on their own.

The book also delves into numerous other issues such as the roles of psychologists hired by the police administration, the effects of the job on officers' children and the stress on adult family members. The stories explore the topics of stress pensions, second-guessing, demotion, retirement, assaults on the job, recruitment from the military, theft of drugs, medical care, peer support, post-shooting trauma, psychological services, how childhood abuse and parental alcoholism affect officers, the police code of silence, and many more issues.

What is PTSD?
It's taken the American Psychiatric Association twenty years to figure out what PTSD is, but I think I can give you a clear picture. To begin, let's be sure what PTSD is not. It is not madness or insanity. It is a normal reaction to an abnormal amount of stress. It is a normal reaction to being victimized, having your life threatened with few means of escape.

To be diagnosed with PTSD, you must meet specific criteria. First, to become a candidate for PTSD you must experience or witness a traumatic event that involves actual or threatened death or serious injury. The second key ingredient is that you must respond with intense fear, helplessness or horror. These reactions pave the way for PTSD to be set in motion.

For police officers, these criteria present a puzzle. Cops are trained not to respond with fear, helplessness or horror. They are taught to control the situation, help people and move on to the next job. Despite this contradiction, cops do develop PTSD. Sometimes it is later, when they are reflecting on the incident, that they feel fear or horror.

What is PTSD? It is a psychological condition comprised of a few groups of symptoms, like clusters of stars in the sky. In order for PTSD to be diagnosed, not all symptoms must be present from each cluster -- only a certain number. It's like going to a buffet and choosing two from this tray, three from that one and one from another and you have PTSD. I'm sure psychologists will cringe at this description, but it is accurate.

How would you sum up PTSD?
You could sum up PTSD simply by saying that it consists of three clusters of symptoms. Those clusters are called reliving, avoidance and arousal.

To relive the trauma, you may persistently reexperience the event in episodes like nightmares and flashbacks. You may feel that the traumatic event is invading your thoughts.

Avoidance means avoiding anything that reminds you of the trauma. This takes the form of suppressing your feelings so well that you become unable to remember important aspects of the trauma. You may avoid thoughts, conversations about the trauma or places that remind you of it. You may believe that you no longer have any feelings, that your emotions are dulled or numb. You become detached from everyone, even loved ones, and become uninvolved in family activities or work. You withdraw from life, having difficulty actually feeling anything for anybody.

Lastly, you may experience arousal. That means you may have problems in concentrating and falling or staying asleep. You become irritable because of minor annoyances or burst out in unexplained anger. You become easily startled, every noise seems to make you jump. You overreact to situations and find yourself super-alert or hypervigilant about people or places.

Are alcoholism and drug use symptoms of PTSD?
Alcoholism, drug use, eating disorders, depression, suicidal thoughts and a number of other reactions may be present at the same time as PTSD. They may show themselves before PTSD sets in or afterwards as a reaction to trying to subdue PTSD symptoms. But they are not considered symptoms of PTSD, only red flags that represent the disorder's progress. Conditions like alcoholism, eating disorders, suicidal thoughts and the like are serious and often life-threatening. They are just not part of the specific symptoms for a PTSD diagnosis. However, if one or more of these reactions are present, a mental health professional may investigate to see if these signs are masking or medicating PTSD.

Does everybody who experiences trauma get PTSD?
Some people seem to handle trauma well, while others react badly. Why the difference? It has to do with many elements, including upbringing, perception, reaction to previous traumas, ability to talk about the event and support sources. Some people are in fact strengthened by traumas. Somehow they have developed ways to cope with unpleasant and even life-threatening incidents. They seem to have integrated the experience into their lives and accepted the events. Where we get into trouble is when we can't accept the events that have occurred. How do you accept rape as a part of your life? How do you accept the murder of a loved one? How can you get on with your life after the death of a child?

What do you mean by perception?
The main reason why some people seem to cope better than others has to do with perception. Hans Selye, the scientist who coined the word stress, said "It's not what happens to you that matters, but how you take it." In other words, how we perceive or view a situation is everything. If you say to yourself, This is the worst thing that's ever happened to me. I will never overcome it -- chances are you won't overcome it. But if you say, This is the worst thing that's ever happened, but I will survive -- it is more likely you will eventually find a way to accept the terrible event and get on with life.

Can you diagnose PTSD in yourself?
The diagnosis of PTSD is quite complex and can take years. An accumulation of several traumatic or violent events could lead to PTSD. But one major traumatic event is sufficient to cause the disorder in some people. Sometimes PTSD can be diagnosed quite early in its development, perhaps after one month or so. Other times it can take years. Only a mental health professional should attempt a diagnosis.

Why is PTSD called a disorder?
It's called a disorder because it disrupts the normal functioning of your life. It disrupts sleep, relationships, work and physical health.

PTSD is also referred to as an anxiety disorder because some of its chief attributes are anxiety, fear and avoidance of anything -- feelings, people, places -- we feel may cause us pain.

Then what is posttraumatic stress?
Posttraumatic stress occurs moments or months after a trauma has taken place. It's a sense of being overwhelmed. You are faced with demands you cannot meet. You feel you can no longer cope. The difference between posttraumatic stress and Posttraumatic Stress Disorder is in the symptoms. Posttraumatic stress may include some PTSD symptoms such as nightmares and flashbacks, but it also features symptoms like depression, eating disorders, heavy drinking and gambling, which are not part of PTSD's roster of reactions. Posttraumatic stress symptoms are generally short-lived, unlike PTSD's symptoms. But if not looked after through counseling or some other form of support, posttraumatic stress could develop into PTSD.

How does the book help those suffering from posttraumatic stress or PTSD?
For law enforcement officers, the book shows how to prepare for trauma and what to do afterwards. For their families, it explains how trauma affects their loved ones. For the public, it describes the pressures that cops find themselves under and why on some occasions they treat us badly.

Finally, the book describes over 200 support sources for officers, their families or anybody suffering from trauma. These support sources cover such areas as alcohol and drug abuse, domestic violence, assaults, counseling services, depression, eating disorders, support groups, grief and bereavement and marriage and divorce. The support sources refer to panic attacks, peer support, police political and social groups, post-shooting trauma support, rape support, retirement, stress management, suicide support, trauma research, veterans support groups and women-only police associations.

How do you know if you've been traumatized?
Sometimes we take for granted that we've been traumatized because we've experienced something frightening. But not everybody is traumatized by even the most terrifying event. So how do you know if you've been traumatized?

There are many signs that suggest traumatization. Some emotional signs are denial, fear, depression, grief, feeling hopeless, helpless and overwhelmed. We may become angry or even suicidal. Often we dwell on details of the event.

We sometimes express our feelings through physical reactions. Physical signs of trauma include chest pain, trouble breathing, high blood pressure, stomach pain, headaches, dizziness, vomiting, muscle aches, rapid heart rate, fatigue and sleep disturbance.

Cognitive signs of trauma are confusion, trouble making decisions, memory and concentration problems, dreams, nightmares, flashbacks, slowed thinking and blaming others.

We also express trauma through our behavior. These signs may include a change in speech patterns, angry outbursts, withdrawal, increase in consuming alcohol, drugs or food, gambling, buying sprees, promiscuity and unexplained or prolonged crying spells.

If you are experiencing one or more of these symptoms, you may be traumatized and need help.

What can police officers or any trauma sufferers do about trauma or PTSD?
The most important thing is to develop a support system of family members, friends, clergy, counselors and support groups for the time you will need them. Then, create a game plan, a stress management system that you practice on a regular basis. This may include routines such as exercise and relaxation procedures like deep breathing and yoga. By setting up these two systems, you are ready for the time a trauma strikes. Inoculation training is also beneficial for rescuers who may have to enter a scene of devastation like a plane crash, for example. The training will prepare you for what you will see. This helps reduce the effects of trauma.

What should you do after a trauma occurs?
During the first day, you will go through excruciating pain. The scene will replay itself thousands of times in your head. You will deny it happened. You will get irritable and angry. You may blame everybody, including yourself.

What should you do? First off, try not to take your anger out on your family. What happened is not their fault. Don't blame yourself for the way you are reacting. You are responding normally to an abnormal situation. Don't make important decisions until you have some perspective on events. If you feel like it, rest, talk , have a hot bath, a nap, a good dinner if you can eat. Spend time with loved ones or friends. Don't isolate yourself. It may be too soon to analyze events or feelings, so take it easy on yourself.

What should you do after the first day?
After the first day or sometimes on the first day, you may wish to employ stress management techniques. As well as exercise, yoga and deep breathing, you may find biofeedback, meditation, hypnosis, humor, assertiveness training, massage and spiritual awakening beneficial.

Talk to people in your support system. Tell them what happened. Tell them over and over again until you are satisfied that you have gotten the whole story out. Then begin the process of finding out what happened according to eye-witnesses. Don't rely on newspapers. They are often wrong. Talk to witnesses, check official reports. Go to primary sources, not secondary sources or gossip mongers. Work on accepting the events as part of your life.

You may also wish to be part of a critical incident stress intervention. Created by Dr. Jeffrey Mitchell of the International Critical Incident Stress Foundation, Critical Incident Stress Management (CISM) provides a program for getting your feelings out. CISM offers one-on-one interventions, defusings and debriefings. One-on-ones usually include you and a peer supporter. A defusing may include you and members of your team who experienced the same critical or traumatic incident. Sometimes mental health professionals are employed. A debriefing is much more involved than the one-on-one or defusing. It might include everybody connected with the incident including dispatchers, and take some time.

The purpose of Critical Incident Stress Management is to talk you through the crisis and return you back to work. It helps you understand your feelings and gives you knowledge for the next time. And there will be a next time. For those who are not sure if their jobs provide CISM, check with your Employee Assistance Unit. It may offer stress-reducing programs.

If weeks or months have passed and you feel that you have not come to grips with the incident, it's probably time that you talked to a therapist.

How do you choose a therapist?
Ask yourself what you would do if you needed a good mechanic. You would shop around. You'd ask friends. Because not all therapists are equal. Therapists who are not experienced in treating traumatized people could do more damage. Don't accept the first therapist that you see. Pretend you are a casting director for a movie. Take time. Compare counselors. Become active in your own recovery.

Check the therapist's credentials. There are professional organizations that train therapists in trauma-related problems. Ask if the therapist belongs to one of these organizations. Is the therapist's office away from the department? You may not want to be seen by somebody you know. Ask the therapist to waive the first session's fee while you decide if you want to spend the next several weeks or months with this person. Ask the therapist a lot of questions. How long are the sessions? Will you set treatment goals? How much will it cost? Do you maintain confidentiality? Do you work with other police officers? What is your availability? How would you assess the problems I am having?

The most important lessons I learned in therapy are that it takes time and it is hard work. It take time to get everything out and it's hard to adopt new coping techniques when you are used to the old ones, even if they don't work very well.

What can the family do to help?
The family is the prime support source for police officers or anybody who has been traumatized. Family members are the first people to whom officers will likely turn. No matter what family members might think of the events, they should never minimize what a traumatized person has experienced. Perception is everything. If officers feel traumatized, then they are.

Traumatized people are in crisis. What should family members do? Your role is to listen. Officers need your attention. Encourage them to talk, but don't push. Do not say everything is okay because it isn't. Don't allow officers to cover up. You won't be doing anybody any favors. Instead, you'll be allowing them to suppress feelings that will one day come out in a way far worse than this day.

No matter how many times officers repeat the story, don't show impatience. It's difficult to remember everything about a traumatic event. Repeating the story helps restore missing details. Officers very often express anger, guilt, grief and other unpleasant emotions. Sometimes expressing these feelings is the only way to get the story out to speed recovery. Remember, the goal is recovery.

Family members and friends should realize that things will never be the same. The critical incident cannot be undone. Don't try to put things back to normal. By helping your loved one accept the events, you will find a new normal.

How long did it take you to write CopShock?
Six years. Initially, I thought I'd have it completed in six months. But the more I learned about the police condition and culture, the more I discovered I had to learn.

What did you do to become qualified to write the book?
I went back to college and studied physiological psychology -- about the brain and behavior -- so I could understand the psychological studies on police officers that I was reading. For the book, I applied over 200 of those studies and had to put them in easily understandable language for the layperson. I attended seminars about stress and PTSD from the International Critical Incident Stress Foundation. And attended a 52-hour course on police tactics and procedures in the Santa Barbara Police Department's Citizen Police Academy.

Then I discovered that I didn't really know how to write a book. As a professional journalist, I had previously written hundreds of current affairs and documentary programs for television as well as newspaper and magazine stories. But a book was a different creature. So I went back to school again and earned my Master of Fine Arts degree in creative writing from Goddard College.

Most of all, I talked to police officers, their spouses, peer supporters, psychologists, psychiatrists, police union representatives -- anybody who would offer perspective on the police officer's job and state of mind. I went on ridealongs. I sent my manuscript to many trauma specialists for comments and they were kind enough to offer guidance and information. Twenty-three of them wrote endorsements for the book.

Based on the input and support I received, I probably rewrote the manuscript fifteen times. And the book grew from 250 pages to its present size of 472 pages. I removed six chapters, otherwise the book would have been 700 pages long.

So you made yourself into an expert?
Yes. As a matter of fact, my hard work was rewarded when the American Academy of Experts in Traumatic Stress (AAETS) granted me board certification. The AAETS accredits individuals from over 200 professions in the health-related fields, emergency services, criminal justice, forensics, law, business and education. I am now Board Certified In Emergency Crisis Response (BCECR) and listed in the Academy’s National Registry.

How did you finance the development and writing of the book?
During the long development and writing period, I taught courses in creative writing and acted as a writing coach for a number of clients. Mostly, I drew on my savings to finance the work.

Why police officers? Do you have a background in police work?
I was never a police officer, but I've had a lot of contact with them the past twenty-five years or so both as a journalist and as a citizen. My first real exposure to police life occurred in the early 1970s. I was walking home from the bus one day when two guys with shiny shoes asked me if I lived in my house. After identifying themselves as cops, they asked if I would be willing to let them use my house as a staging area for a theft-ring bust. I said, "Are you kidding?" And invited them in.

After the bust, which was pretty exciting for me to watch, the cops would use my home on occasion to take a rest break and discuss future operations. I was soon invited to their parties and got to know them as friends as well as law enforcement officers. Two to three times a week, marked police cars were parked in front of my house. As I lived in an area known for break-ins, I became quite popular with my neighbors. They hadn't ever seen such a strong police presence anywhere before and the crime rate dropped to almost nothing.

Is this why police officers trust you? Because of the rapport you have created with them?
They trust me because I tell the truth. After having conducted an exhaustive amount of research, I present the information in an objective way. I have no vested interest in the results of the stories and studies I apply in the book. Too often police officers feel that their bosses, politicians, doctors, lawyers, the public and the press are manipulating them. The book lets officers make up their own minds without shoving something down their throats. When I started to write the book, I had no preconception about what the book would reveal. I give, as Sergeant Friday in the television series, Dragnet, says, "Just the facts, ma’am. Just the facts."

What are the specifications for the book?
The book is a 6" by 9" softcover with 472 pages. It costs $19.95. As well as stories and over 200 support sources, it includes an appendix, notes bibliography, subject index and support sources index. The ISBN number is: 0-9668501-0-6.

Does the book's cover have a special significance?
Yes. The background is fire and out of the fire comes the Medal of Valor. The fire represents the turmoil that trauma sufferers endure, and the medal represents healing and recovery.

How can people order the book?
There are several ways to order the book. For orders in the United States, they can call toll-free 888-436-1402.

Foreign orders can call 520-616-7643, fax 520-616-7519 or write: Holbrook Street Press, Box 399, Cortaro, Arizona, 85652. They can also e-mail: Copshock@Copshock.com

Readers can see sample chapters and the table of contents on the Internet at: http://CopShock.com

Press here to order CopShock