Tag Archives: PTSD

PTSD and gendered mental health

30 Oct

Throughout this post-traumatic stress disorder series, we have seen massive misunderstandings about the illness and mental health in general, lack of funding yin yangfor proper support and care for those suffering, and alternative methods of treatment. But no matter what angle I look at PTSD and the way it affects men, it seems to boil down to a concept that is, as far as I’m concerned, the root of many social problems: disregard of the feminine and the reluctance of men to ask for help when they need it.

When I interviewed Kent Laidlaw, 25-year police force veteran, we had a fascinating discussion about PTSD, and he came out with a bomb. He said that while he was on the force during the 1990s, the popular and accepted view of PTSD was understood to be a “man’s” disorder, while women suffered from depression.

This is of course as ridiculous as it is untrue. Anyone can have PTSD and anyone can suffer from depression. I’m not sure if there is such a thing as a gender-related mental illness, but there are certainly gender-related beliefs around mental health.

“We assign a gender to human traits like emotional intelligence, and then “feminize” the act of asking for help, stigmatizing men who express they are hurting and need support,” says Jeff Perera, Community Engagement Manager for White Ribbon Campaign.

With associations like this, is it any wonder that men are terrified to show anything remotely suggesting that they are anything less than what is expected?

Socialized masculine stereotypes dictate that men are expected to know, to be in control of any situation, and to be self-reliant. With all of that real or imagined expectation, there is little room for their true selves. Constructed gender beliefs rob men of their authenticity and their naturalness, and this is alarming to me. I think it’s clear that men aren’t women, so it seems very strange to me that men insist on fighting tooth and nail to prove to the world that they aren’t women, even if it means sacrificing their quality of life and their health.

Bullsh*t gender expectations

Logic says that when we experience physical trouble, we seek medical help. Researchers now see PTSD as brain damage and this should warrant medical attention. Between the heart and the brain, the human body cannot function, so why wouldn’t someone seek medical help for a damaged brain, and how is it different from say, a broken leg or a malignant tumour?

In Why Men Won’t Ask For Help, Peter Griffiths says that “men can fall too easily into the “willpower” trap, and ignore available help at their peril. The wards and hospitals are full of men who refuse to go to the doctor when they have physical symptoms and who seem to prefer to pay the price rather than go for help.” How many of you can come up with an example of a man putting himself at risk because of this masculine code? I know a man who waited until he peed blood before going to a doctor after an excruciatingly painful sports injury.

As a society, we’re not going to get very far if we frown upon men going for help when they need it. It’s ridiculous and I believe, abusive towards men.

Masculine emotion and why men have trouble asking for help

Socially, we look through masculine eyes and make masculine judgements about the world around us. This distorted view not only disregards the feminine but promotes anxiety and violence in men who constantly try to prove themselves as men, and not women. Humans have dual nature and the feminine, like the masculine, exists within us all, but many men insist on fighting the impossible fight against this part of themselves.

While girls are socialized to be emotional and nurturing, it’s fine when they ask for help when it’s needed. However, boys are taught that emotions aren’t becoming to their gender to the degree that they may not even be able to recognize their feelings and thus, they cannot identify or understand them, let alone express them in a healthy manner. But whether or not the emotions are understood, they still exist, and attempting to deny them and take on the world can be devastating to a man and other people in his life.

“In many men’s minds,” Griffiths says, “if a man can’t handle everything, then he must be a failure. And if that’s the case, he feels embarrassed and afraid about others, especially other men, finding out he is “not a man”.”

The “grave” admittance of vulnerability and of relinquishing control is, for some men, an uncomfortable, if not, terrifying idea. Take the innocuous act of  asking for directions, for example. In Nick Collins’ Telegraph article, Men refuse to ask for directions out of “blind panic”,  he says that “while women are more happy to use all available resources to help them reach a goal, men will rigidly stick to their original “system”… even though it has clearly led them astray.”

He says that when confronting the idea that their system doesn’t work, it makes men flustered and causes them to do sometimes reckless things to avoid the reality of the situation/failure. Griffiths agrees, and says that men don’t like to admit or even recognize when they feel helpless, and can feel lessened at the thought of going to someone else who is better equipped to help solve their problem.

The social negativity around PTSD and mental illness in general keeps men away from getting help, an this is can be painful, devastating, and extremely damaging. Emma Watson, during her United Nations address this fall, drew attention to this idea as she summarized social problems that stem from society’s treatment of men: “We don’t often talk about men and gender stereotypes… but I’ve seen young men suffering from mental illness, unable to ask for help for fear it would make them less of a man. In fact, in the UK, suicide is the biggest killer of men between the ages of 20 and 49… I’ve seen men made fragile and insecure by a distorted sense of what constitutes male success.”

Permission to be vulnerable

Why has the gender that gave us the Sistine Chapel brought us to the edge of cosmocide? Why have the best and the brightest exercised their intelligence, imagination, and energy and managed only to create a world where starvation and warfare are more common than they were in Neolithic times? Why has the history of what we dare to call “progress” been marked by an increase in human suffering?

-Sam Keene, Fire In the Belly

Emma Watson says “When [men are] are free, things will change for women out of natural consequence. If men don’t have to be aggressive in order to be accepted, women won’t feel compelled to be submissive. Both men and women should feel free to be sensitive…[and] strong.

“It is time when we all perceive gender as a spectrum, instead of two sets of opposing ideals. If we stop defining ourselves by what we are not, and start defining ourselves by who we are, we can all be freer… Men should have permission to be vulnerable and human, to reclaim those parts of themselves they’ve abandoned, and in doing so, be a more true and complete version of themselves.”

We must do a collective about-face around our beliefs of men and allow them to ask for help when they need it, receive it, and heal. Women are not outside of social conditioning and are just as much a part of this equation as men are. Women have to give men the space and the respect to reach out for help, support men as they strive to be better people, and allow them to be vulnerable. I for one, feel a great privilege when a man cries in front of me because this is the man at his most honest.

When we stop propagating a violent and angry culture and let go of  masculine expectations, when we stop expecting men to be something they are naturally not, when we get over the idea of believing that anything feminine is weak, then change will occur. If we change our perspective about asking for help and consider it a strength and a strategy to utilize everything at our disposal to reach our goal, change will occur. We do this every day in business, so why not for ourselves?

To be concerned with what other people think is one thing, but to sacrifice our health for someone else’s sake is quite another. The traditional masculine stereotype exists simply because we let it, but the stereotype doesn’t serve anyone; it is an idea that we allow to exist in our minds, perhaps because we are afraid of change, or that we don’t have the imagination to think outside of the traditional box.

To make things different around mental illness and general life, all we have to do is simply change our minds.

Alternative PTSD treatments, self-healing, and self-empowerment

16 Oct

self-empowermentMore than a mental health issue, more than a first responder issue, post-traumatic stress disorder is a human issue. Post-traumatic stress disorder is a serious anxiety disorder often associated with the military, first responders, and sexual assault victims, but anyone who experiences trauma can be affected by it. As a one-time or accumulative anxiety disorder, PTSD can be a terribly haunting, unrelenting reality for many people.

People who are most prone to the illness are first responders because they see more trauma more often. Though there is effort on the part of first responder organizations to deal with trauma-stricken employees with early psychological support, peer support, medical attention, and hot lines, first responders continue to take their own lives. It seems that every week, we hear of another first responder suicide. Why is this happening? PTSD is a disorder in which therapies fall into a political game of what is acceptable and what is taboo, complicated by a negative social regard for mental illness, and a society that expects traumatized men to “suck it up” and get on with the job ( this topic to be further discussed in the next and final installment of this PTSD series).

PTSD is as complex as it is terrible.

Treatment of PTSD should be thought of as an investment. Until quite recently, the outlook for PTSD sufferers didn’t look so good unless years of therapy and pill-popping seemed appealing. New alternative therapies have emerged for PTSD, and the options give promise of better things to come, provided that we’re open to acknowledging that we have a problem that affects our normal function, and that we’re willing to reach out and ask for help.

The physical origins of PTSDbrain neurons

University of Toronto psychology PhD candidate, Lauren Drvaric, says “good mental health means good physical health and well-being. Poor mental health influences physical health, and we should be investing in the entire self, mind and body.”

Many professionals in psychiatric fields keep the mind and the body separate; their focus is on the mind, behaviour, and cognitive operations, with no attention paid to the body. This is curious, since the brain commands the body and the body responds to the brain; they cannot be separated.

Toronto psychotherapist, Matt Cahill, says when his clients do not verbally discuss their trauma, he picks up on the non-verbal cues. “Tears, blushing, or tremors, to name just a few,” he explains. “Sometimes a client will comment on how a part of their body feels numb or, alternately, feels constricted during a session where we are covering traumatic experience, rather than openly discuss their feelings. The body tells its own story, so I try to pay attention to everything.”

Dr. Bessel van der Kolk, has been involved with PTSD research for over 30 years and believes that trauma lies in our bodies; PTSD has a physical-basis that prompts “a cascade of physiological catastrophes that affects almost every major system in the body”.

Van der Kolk believes that trauma victims are alienated from their bodies by a response from a brain structure called the amygdala, the brain’s emotional processing and feeling centre. The amygdala responds to threats and traumas with a flood of hormones that set off the “fight-or-flight” response. The physical response subsides when the threat does, but when it doesn’t, as is the case with people with PTSD, the traumatic memories play out in the patient’s mind, and the amygdala continues to produce stress hormones that sustains a heightened state of anxiety.

Dr. Frank Ochberg, MD, psychiatrist, and founder of trauma science, believes that there are possibly two types of PTSD. One type makes PTSD-affected people more prone to flashbacks, and the other causes a numb, dream-like state that cushions people from feeling the anxiety associated with PTSD. Some people experience both types. Ochberg notes a measurable change in the electrical discharge of brain cells in the grey matter of the right temporal lobe in PTSD patients, and believes that this part of the brain is responsible for traumatic flashbacks.

Traumatic brain damage causes other problems in the brain. Dr. Ochberg notes a reduction in the number of pathway cells between the limbic system (of which the amygdala is a part of) and the grey matter (the thinking part of the brain). The hippocampus, another part of the limbic system, is part of the mid-brain that looks like a long wishbone; it organizes and saves memories and associates them with feelings and actions. Studies on combat soldiers exposed to trauma show a correlation between a smaller their hippocampal volume and the tendency to develop PTSD.

Trauma is literally “all in our mind” and also of our brain; it manifests physically as damage to our brains, and brain damage, as Dr. Ochberg sees PTSD, should be considered an injury, an injury that can be healed.

PTSD therapy: the body and mind connectionyoga

In her article, A Revolutionary Approach to Treating PTSD, Jeneen Interlandi says “If there’s one thing van der Kolk is certain about, it’s that standard treatments are not working. Patients are still suffering, and so are their families. We need to do better.”

Van der Kolk says psychological trauma should be treated through the body, not the mind. He says trauma has nothing to do with cognition, but the body interpreting the world as a dangerous place. In many cases, the PTSD patient’s body was violated, and they need to find a sense of security in their own bodies. “Unfortunately,” van der Kolk says, “most psychiatrists pay no attention whatsoever to sensate experiences. They simply do not agree that it matters.”

There are no cures in the world of psychiatry; there are no physical tests for mental health disorders, and there are no drugs that can cure brain injuries. However, it turns out that there are a number of promising, albeit unconventional therapies that eclipse traditional psychotherapy, and questionable, side effect-laden psychomeds for treatment of PTSD. Some of these therapies will sound odd, even outrageous, but there are no side effects, no secret ingredients, and best of all, many of them are free that people can do themselves.

Eye Movement Desensitization and Reprocessing (EMDR)

EMDR, or Eye Movement Desensitization and Reprocessing looks bizarre but it has an excellent track record for relieving mental and emotional anguish. During the treatment, the patient holds their trauma in their mind while their eyes follow the therapist’s fingers that move back and forth before them. It sounds crazy, but according to EMDR.com, the therapy works “for reasons believed by a Harvard researcher to be connected with the biological mechanisms involved in Rapid Eye Movement (REM) sleep, internal associations arise and the clients begin to process the memory and disturbing feelings. In successful EMDR therapy, the meaning of painful events is transformed on an emotional level.”

Over 10,000 therapists worldwide use EMDR therapy and millions of people have been successfully treated since its inception in 1989. In fact, EMDR is now recognized as an effective treatment for trauma by the American Psychiatric Association, the World Health Organization, and the U.S. Department of Defence. This unusual therapy may still have its controversies, but van der Kolk, who uses this technique himself, knows what he sees in his own patients and places his faith in the treatment. EMDR is especially useful to people with acute PTSD from isolated traumatic memories like single episode assaults and car accidents.

Yoga and massage

Yoga and massage are complimentary therapies for people with PTSD. A U.S. yoga group specifically for PTSD-affected combat veterans, Yoga Warriors,  says that yoga helps veterans “retrain” their fight-or-flight response.

“When vets confront a situation that triggers their memories,” the Yoga Warriors site says, “instead of resorting to aggression or drowning in fear, they have other options: deep breathing, for example, as a means to self-calm.”

Yoga, like dance, focuses on breath and movement and helps with body and emotional awareness, relaxation, and mental clarity. Yoga Warriors says it “allows one to safely express stored emotions such as guilt, shame, anger, sadness and grief so those feelings can be understood and integrated.”

Massage, the laying on of the hands, can help people with PTSD relax and feel safe in their bodies; massage can release toxins, and reduce scar tissue and muscle pain. According to the Canadian College of Massage, the practice may make the PTSD-affected feel more mentally balanced, and can “help to reduce mental anguish, anxiety and trauma by regulating stress hormones. Regular massage therapy reduces cortisol [the stress hormone produced by the amygdala] and stimulates the release of endorphins like serotonin and dopamine”, the hormones that make us feel good.

Acupuncture

Acupuncture, the ancient Chinese treatment, is finally being taken seriously. Through the use of small needles, heat, or pressure on points of the body’s energy meridians, pathways that carry blood, body fluids, and Qi, or life force energy, this very effective therapy provides relief of many physical ailments, improves sleep, relieves stress, and balances the emotions. The theory is that when the body’s flow of energy is disrupted due to an injury, trauma, or an emotional disturbance, acupuncture can help to free the energy blockage and release the patient back into health. There is evidence that acupuncture can regulate brain function and modify the activity in the limbic system, where PTSD is thought to originate.

Energy psychology and Emotional Freedom Techniqueenergy

The energy meridians acupuncture is based on is the root of energy psychology, or energy medicine for the emotions, a method that helps change the way the brain processes thoughts, feelings, and behaviours. Clinical psychologist and pioneer in energy medicine, David Feinstein, says tapping on accupressure points changes the neuropathways to bring about changes in the energies that underlie psychological problems, including PTSD.

Multidisciplinary doctor and healer, Dr. Adonis Makris, says that modern medicine focuses on chemistry, but energy healing has to do with the body’s electricity. Energy work is based on the body’s undeniable electrical nature. Most of us don’t often consider the body electric, but if you’ve ever been to a hospital for tests, you may have experience with the EEG, or electroencephalograph, the system that monitors your brain’s electrical activity, or the EKG, or electrocardiograph that reads the heart’s electricity.

Both energy psychology and Emotional Freedom Technique (EFT) use the energy meridian system to initiate healing. Carol Look, EFT master, explains energy work affecting the entire body: “Our feelings, states, moods, and levels of stress are formed by emotional responses and subsequent chemical reactions to specific events in our lives. These events and chemical reactions are stored in our cellular, physical, and emotional memories.” Her explanation explains how memories, thoughts, sights, smells, and sounds can trigger a PTSD-related flashback or sustain the anxiety related to it.

By tapping on various energy points on the skin and focusing the mind on specific problems (i.e. trauma), the brain’s electrochemistry can be shifted and the body’s energy system brought into balance, which allows the mind and body to resume their natural healing abilities. Studies show that accupoint stimulation (tapping) can reduce production of cortisol, the stress hormone, normalize brain wave patterns, and like massage, increases hormones associated with pleasure.

Gary Craig, EFT founder, says that trauma is a result of a disruption in the body’s energy system, and tapping works to neutralize the emotional charge. “I have helped hundreds of people with traumatic memories,” he says. “After using EFT, not one person – ever – has shown any interest in exploring the issue further or “getting to the bottom of it”. For them, it is completely resolved and they are gratefully relieved of its burden. People’s attitudes about the memory change almost instantly. They talk about it differently. Their words shift from fear to understanding. Their demeanour and posture evidence a dramatic shift.”

“It’s difficult for us to compute EFT because it’s so foreign to us, so unconventional,” Craig explains, “but at the same time, we’ve been conditioned to believe that medicine is the answer and doctors should not be questioned, but second opinions are always a good option.”

This energy work sounds so simple, so amazing, but this seems too easy, I hear you say. Even the pioneers of the treatment and experts in Traumatology agree.

Dr. Charles Figley is a psychologist and expert in Traumatology at the Tulane University in Florida. He says that sometimes the simplest things bring on the strongest results: taking deep breaths can calm anyone down, getting into a warm bath to relieve stress seems to be “a miracle” he says, and EFT is just as miraculous. “We don’t understand it, and it doesn’t make sense, but it works.”

Dr. Figley believes in EFT and the tapping method for trauma. He sees tapping as an alternative to the hierarchy of fear method that many PTSD treatments employ — therapies that begin at the lower level and build up to the terror, like exposure therapy which forces the client to relive their trauma over and over again in an effort to desensitize the patient. “These simple treatments reverse 50 years of psychological research and are turning the scientific community on its head in many ways.”

Gary Craig explains that there is no long, drawn out, tell-me-your-life-story feature to EFT. “There are no pills. There is no painful reliving of past traumatic events. It takes a fraction of the time typically required in conventional psychotherapy, it is often done in minutes. People simply get beyond their emotional luggage, usually permanently, and go about their lives more effectively.”

Compared to EFT, Craig says, “in general, conventional psychotherapy is among the slowest, most ineffective sciences on Earth.”

Positive Psychotherapy

When we think of psychotherapy, we may envision people who languish on couches, discussing nighttime dreams with cold, our-of-touch Freudians  who write prescriptions for mostly useless drugs for years on end. But a new and progressive psychotherapy that you’ve probably not heard of is making headway.

Positive Psychotherapy, born in the late 1960s, focuses on a client’s perception to realize the positive influences in their life instead of focusing on the negative – an all-too-common modern psychological state. This type of therapy directs a client’s attention to such things as positive character strengths, optimistic emotions, and their happiness in the present moment. Positive psychotherapy is much happier and more dynamic than conventional psychotherapies and the treatment typically lasts for weeks, not years.

Tayyab Rashid, licensed psychologist at the University of Toronto and a practitioner of Positive Psychotherapy, explains that the treatment acknowledges the client’s negative emotions, but instead of picking them apart and dwelling on them, the therapy “aims to validate these experiences, whilst gently encouraging clients to explore their effects and seek out potential positives from their difficult and traumatic experiences.”

Positive Psychotherapy has made significant gains in trauma prevention, to the point that it has made its way into a U.S. army program, Comprehensive Solider Fitness. The therapy is used in resilience training to “build mental toughness and identify signature strengths, meaning, purpose, and positive relationships, in addition to preventing pathology.”

Alternative drug therapy: MDMApills

“There’s not a single pharmacological treatment out there that has been developed specifically for PTSD,” says Dr. Alexander Neumeister, MD and psychiatrist at the New York University. “There’s a consensus among clinicians that existing pharmaceutical treatments such as an antidepressant simply do not work.”

Long-term medication places a band-aid on the wound at the core of the problem: trauma; its emotions, its energy, and its connection to mind and body. An alternative to pharmaceuticals is psychedelics. These drugs are pure and powerful, and administered under controlled conditions. MDMA, methylenedioxymethamphetamine, also known as ecstasy, is one of these drugs and it has long-term potential for PTSD.

MDMA increases feelings of trust, affection, and compassion for others, could make an excellent combination with psychotherapy for PTSD. Unlike most mental illness medications that are taken daily for years, pure MDMA only needs to be used a few times or less, and there is no threat of addiction to the drug.

Early studies are promising. Dr. Michael Mithoefer is the investigator in MDMA studies through MAPS, the Multidisciplinary Association of Psychedelic Studies. Dr. Mithoefer has seen 90 percent of rape victim’s symptoms vanish after just one intense 8-hour session with MDMA. In another study, combat veterans, fire fighters, and police officers took MDMA and 14 out of 19 patients reported dramatic improvements to PTSD-related issues.

MAPS is the only organization in the world that funds clinical trials for MDMA-based psychotherapy, according to its website. The goal is to make MDMA into an FDA-approved prescription medicine by 2021.

Medical marijuanamarijuana

The drugs that they were giving them … they couldn’t get up in the mornings,” said Army first sergeant Gregory Westbrook. “Most of the guys weren’t the type of soldiers who had issues before Iraq or even in Iraq, but they bring them back and put them on these drugs, and they’re falling asleep in the chair. There was no way they could function, especially in a civilian job. So maybe marijuana is an alternative. (Source)

THC, tetrohydrocannibanol, the active chemical in marijuana, binds with cannabinoid receptors in the brain that affect appetite, memory, and pain. Marijuana is associated with forgetting and this is the link to PTSD that researchers are most interested in. “Forgetting well is almost as important as remembering,” says Michael Pollen, American author, journalist, activist, and professor of journalism, and author of Botany of Desire, an investigation of the nature of plants. “Forgetting is about editing, it’s about taking the flood of sense information coming at you, and forgetting everything but what is important.”

Pollen says that life is not about accumulating memory because memory can cripple us, and uses combat experiences in his argument. “Soldiers return from war zones traumatized by experiences that they can’t unlearn. So if you could help them unlearn that, essentially a productive kind of forgetting, with a drug or another kind of regime, it would be incredibly useful.”

Marijuana calms the mind, relieves anxiety, and promotes new thought patterns and behavioural responses. A recent Globe and Mail article reports that marijuana users may be more likely to survive a serious head injury. For people affected by PTSD, cannabis brings users into the present instead of watching the reel of never-ending traumatic scenes that keep them in their mental prison.

Medical marijuana for PTSD looks promising, but unfortunately, marijuana carries a stigma with it, even though it is legal for medical use. Sadly, the social stigma around cannabis is associated with the suicide of another first responder’s life. Just last week, RCMP Corporal Ron Francis, a PTSD sufferer and medical marijuana user, committed suicide.

Cpl. Francis was videotaped smoking pot while wearing his formal red serge, to protest the RCMP’s PTSD policy last year. “I’m trying to draw attention to the fact that the RCMP fails to have a program in place for proper [PTSD] screening for their members and proper information for their families,” he said. The National Post reported Justice Minister Peter MacKay’s condemnation of the stunt, saying it “sets a poor example for Canadians.” Francis was forced to hand over his RCMP uniform, and a year later, was dead.

If we as a society are serious in our support of people who suffer from PTSD, we must let go of old rules and laws that keep relief from those who need it most. Drug stigma is politically based and we have been conditioned to believe that illegal drugs – natural and synthetic substances associated with counter-culture — are harmful and should not be a therapy alternative. What is legal are dodgy, psychotropic medications with sometimes horrendous side-effects that may not do much to help people in dire need of effective therapies.

Through brain scan technologies, early neurological markers have emerged for PTSD. This is exciting because now that PTSD can be “seen”, it gives validation; a visual change in the brain makes it more factual, and this will move us toward a social acceptance of mental illness as something real.

Relief for PTSD sufferers may lie in unconventional therapies that don’t line the pockets of the pharmaceutical companies and are rooted in self-empowerment. We are more powerful than we think. As Dr. Makris says, “We have an incredible capacity to heal themselves in so many ways.”  

PTSD and first responders

2 Oct

“I think I’m too broken to ever be fixed.”
Text from Ken Barker, retired RCMP officer to his sister during a traumatic flashback

Barker was one of the first responders to arrive at the scene of the ambulancehorrific Manitoba Greyhound bus beheading in 2008. This summer, he ended his life. Since April 2014, Barker was one of an unprecedented number of first responders in Canada whose suicides have been linked to PTSD.

Post-traumatic stress disorder, considered an treatable anxiety disorder is a mental illness that can result from a traumatic one-time experience or accumulative trauma and stress on a personal or large scale. PTSD can bring the horrors of past traumas to life and wreak havoc in the minds and the lives of all it touches. PTSD can happen to anyone; the most vulnerable  people are rape victims.

PTSD has its roots and associations in modern warfare, and its incidence rate is highest among people who experience trauma every day – military and emergency services personnel. Symptoms include flashbacks to the traumatic event, nightmares, sleep disorders, and uncontrollable thoughts; anger, fear, distrust, personality changes, and extreme anxiety. PTSD can manifest physically as chronic pain and hypertension, and can induce self-destructive behaviour like drug and alcohol abuse, long-term addiction, and suicide. The collateral damage of PTSD is its effect on relationships, families, finances, and work and social status. It can be devastating on many levels.

PTSD in emergency services

The men and women of Canada’s public safety, military and correctional organizations witness human suffering up close and it sometimes becomes very difficult to cope with the aftermath. There is light at the end of that dark tunnel. There is help available, and we want to make sure these men and women – and their families — know where to find it.
Heroes Are Human

Vince Savoia is the founder of Heroes Are Human and a former paramedic. His organization focuses on PTSD research, education, and training, and acts as a peer and psychological support resource for Canada’s public safety organizations personnel.

Savoia says 16 – 24 percent of emergency personnel suffer from PTSD, but he believes this is a modest number. Paramedics are faced with more trauma more often, and run a risk of PTSD two to three times higher than in any other emergency service. Kim McKinnon, Superintendent at Toronto Emergency Medical Services (EMS), says PTSD predictors for paramedics include their “involvement in a critical incident like a mass casualty event, or an organizational or environmental event such as the death of a service member in the line of duty.”

EMS personnel tend to victims of horrific scenes large and small, they resuscitate the sick, and witness death. At the same time, they form a bond with sick and injured people as they spend time talking and giving hands-on treatment. This one of the reasons why Mr. Savoia believes paramedics are the hardest hit of any emergency service.

PTSD does not discriminate. While it affects paramedics more often, PTSD afflicts 10 – 12 percent of police officers and 6 – 8 percent of fire fighters. According to a recent StatsCan report quoted in the Globe & Mail, PTSD rates among members of the Canadian Forces have nearly doubled since 2002; 1 in 6 Canadian soldiers have mental health problems after ten years in Afghanistan. And the numbers keep growing.

First responder organizations must create programs and supports for their employees, but this takes funding and resources that may or may not be available. Some emergency services have excellent support systems in place for their employees like Toronto EMS’ comprehensive suite of services for employees to proactively manage their health. With a focus on prevention, their resources include early psychological support with a staff psychologist, a peer support team, employee assistance plans, and other community resources.

Canada’s RCMP has nation-wide systems in place that utilize peer support, RCMP doctors, and chaplains. A Regina RCMP sergeant explained that the RCMP wants to make sure it’s there to listen to their officers who respond to major incidents like car crashes, deaths of children, multiple fatality incidents, shootings, and violence.

We’re fortunate that we’re finally acknowledging PTSD as a real illness with real consequences, but despite the good intentions of emergency services to their employees, the question is, are the support systems being utilized, and if not, why not?

Stigma, discrimination, penalization, and the John Wayne Syndromesuffering in silence

In the emergency services culture, there is stigma and perhaps a shame attached to being affected by trauma and asking for help. It is considered a “weakness” and it is the largest problem that first responders face because it is a deterrent to getting help.

Though more women are joining military and emergency services, men still form the majority of employees, and because they’re men, they are expected to adhere to the traditional masculine code that demands they use the “suck it up” method of dealing with harrowing trauma and stress.

Vince Savoia says that first reponders work with respect for the public who needs them, but the same respect is not offered to colleagues. “First responders who look for support are bullied by their peers and colleagues,” he says, “they are ridiculed and harassed. Mental health is viewed as a weakness, not an illness, and the expectation is that we should be able to stop it and move on.”

The mental illness stigma exists in all branches of emergency services and the armed forces. David Whitley, a paramedic who suffered his own PTSD from a terrible ambulance accident, now volunteers for a local emergency services support group that checks in with first responders who experience potentially traumatic events like shootings, suicides, crashes, and situations that involve children.

“We give [members of the group] an opportunity to talk because there is a stigma,” he told the Toronto Star. “First responders need to lower the trauma mask, and that’s scary because there are feelings of vulnerability and anxiety. But if you don’t do that it’s a precursor to mental illness, including PTSD.”

Kent Laidlaw, a retired police veteran in Burlington, Ontario, and principal of Canuckcare, a consulting service for people who deal with workplace stress and trauma, says that the systemic corruption that exists in police ranks ensures that officers who ask for help are considered “less than” and therefore a weak link in the chain. They are penalized rather than punished, a subtle difference that speaks just as loud.

New York State police veteran and police trauma and suicide researcher, Dr. John Violanti, observed in the Ontario Ombudsman’s 2012 report that the nature of the policing environment often goes against the goal of improving health: “The police culture doesn’t look favorably on people who have problems… Not only are you supposed to be superhuman if you’re an officer, but you fear asking for help… you may not be considered for promotions and you may be shamed by your peers and superiors. In some cases, your gun can be taken away, so there is a real fear of going for help.”

 ***

Emergency service workers are very well trained but cannot be prepared for every possible situation, so perhaps masking the emotional response to what they experience is the way to cope, but unfortunately, first responders are human, and part of being human is to be emotional. To expect that anyone could not be affected by horrific and traumatic events is ridiculous, and then to believe that there is no emotional aftermath is absurd, even abusive.

The code of masculinity that demands men to be stoic, brave, and in control, subscribing to what Vince Savoia calls the “John Wayne Syndrome”: the tall, rugged, macho cowboy who can deal with any situation and stand up for justice. Savoia believes that first responders have to be this way in order to do their job, but what happens after the mission is accomplished and reality sets in?

On his very first call, a house fire, Vince Savoia lost his first patient, a two-year old child. He wanted to talk to his paramedic crew about it, but when he tried to, “the crew was very stoic –just walls.” If this code prevents men from being able to get support from the experiences of trauma in their jobs, what purpose does it serve? A culture of hyper masculinity is a hindrance more than a help; it creates broken men who can’t do the job as well as healthy men.

Saskatchewan counsellor, Peter Griffith, says that men don’t like to admit, or even recognize when they need help, to the degree that they will ignore their own health problems sometimes until it’s too late. Hospital wards, he says, “are full of men who refuse to go to the doctor when they have physical symptoms and who seem to prefer to pay the price rather than to go for help.”

Anna Baranowsky, a clinical psychologist who works with police officers in private practice, explained to the Toronto Star in 2012 that “people can recover[from PTSD], but if we see ourselves as being strong and we won’t tolerate any kind of weakness, then what we might end up doing is pushing (ourselves) until we are past the point of recovery, and that is really dangerous.”

Experts say that the stigma attached to mental health needs to change for us to get anywhere. It could be as simple as changing our perception of what it is to ask for help and equate it with responsible prevention, with the power to keep oneself healthy, capable, and strong. Putting a positive spin on the consequences of responding to a traumatic situation is much more agreeable than demeaning someone who can’t control their mental health response.

The PTSD misunderstandingshattered glass

There is a very interesting argument happening right now around PTSD. Some, like Vince Savoia, believe that PTSD is responsible for taking the lives of more than 20 first responders since the spring, but some mental health professionals like psychologist, Dr. Paulette Laidlaw, believes that PTSD has become something of a blanket diagnosis for many other problems.

While it’s true that in some cases, PTSD symptoms can worsen after an emergency service employee retires, Dr. Laidlaw wonders why is it when we hear “police suicide”, we make the automatic assumption that it is related to PTSD.

Dr. Paulette and Kent Laidlaw do not believe that first responder suicides are exclusively job-related, but are more likely a combination of many stresses including work, finances, and relationships. They say the individual’s long-term mental health should be examined and more questions asked about a first responder’s life before we slap the PTSD label on them, just because that individual happened to work in the armed forces or emergency services.

Dr. Laidlaw explains that PTSD is not as commonplace as we are led to believe. “PTSD affects only 8 percent of the population,” she says, “whereas depression affects 30 percent and anxiety touches 20 percent. We’re in murky water trying to distinguish PTSD from burnout, acute stress, trauma, grief, or clinical depression”.

We see PTSD in the news a lot and it has become something of a “trendy” disorder. Media reminders of the illness can cause people to self-diagnose via the Internet, and all hell can break loose. Dr. Laidlaw suggests that PTSD is the “sexy” disorder of the day, and with any popular disorder, like we saw with childhood ADHD, suddenly there are specialized medications and “PTSD therapists” come out of the woodwork. PTSD can only be diagnosed by registered psychologists and medical doctors.

How will change happen?fireman

“I wish I had cancer because then people would understand.”
-Veteran paramedic Ken Barker communicated to his sister shortly before taking his life

Mental illness is not something tangible, something that hurts, something that can be fixed with a cast or a bandage. It affects the brain and though it may not show on the outside, it can torment the mind from the inside.

Regard for mental health is changing, albeit slowly, but Vince Savoia believes that cultural change in PTSD acknowledgement has to come from the top down, and says that “we must respect mental wellness as an issue and stop the harassment and bullying from the bottom up. It has to be a grass-roots movement to encourage people to take responsibility about how they treat themselves and their colleagues.”

Dr. Violanti agrees:  “If I tell you that the first time you see a dead body or an abused child that it is normal to have feelings of stress, you will be better able to deal with them; exposure to this type of training inoculates you so that when it does happen, you will be better prepared. At the same time, middle and upper management in police departments need to be trained in how to accept officers who ask for help and how to make sure that officers are not afraid to ask for that help.”

This means changing the culture from one that ridicules people who need support to one that supports and embraces human vulnerability.

Dr. Jeff Morley, former RCMP officer and psychologist for Canadian Forces and Veterans Affairs says “Canada needs a national mental health strategy for first responders, but the political will does not exist right now.”  He says that to change the system, we need a high-profile person to promote the cause, like Romeo Dallaire who played a big role in the beginning but retired from senate this year.

“That, or if the government clues in that the high financial cost of not doing anything (i.e. disability costs, sick time, leaves of medical absence) exceeds the cost of early intervention, education, and prevention.” He says that the RCMP spends tens of millions of dollars per year on PTSD disability claims, but asks how much they’re willing to come up with to prevent it.

The Globe & Mail reports that global estimates for antiviral drugs have run close to $10-billion since the SARS outbreak of 2002.  The authors of the original report in the British Medical Journal acknowledged that the “important benefits have been overestimated and harms under-reported”. Imagine if the Canadian government spent the same amount on long-term mental health as it spends on stockpiling useless drugs for unlikely flu epidemics. Imagine if people shrugged off the toxic masculine codes that keep men from flourishing and actually paid attention to what they need. And can you imagine the tremendous benefits of supporting the mental health of the people we depend on to take care of us?

 

The evolution of PTSD

18 Sep

Some psychiatric casualties have always been associated with war, but it was only in the twentieth century that our physical and capability to sustain combat outstripped our psychological capacity to endure it. – Lt. Col. David GrossmanPTSD

The media frenzy around post-traumatic stress disorder (PTSD) may make us think that it is a new disorder, but PTSD reaches back to the early part of the last century where it began to manifest during the first major European war of the 20th century.

PTSD reared its ugly head during World War 1 when it was known as “shell shock”, a disorder of psychological origin. Soldiers on both sides of this conflict suffered immeasurably from new types of weapons in trench warfare: tanks, heavy machine guns, mortars, and poison gas including mustard, nerve, and chlorine gasses which caused horrific damage to the human body. Casualties were immense but for those who survived, a curious condition began to emerge. Shell shock was the first mental health disorder associated with war and the military wasn’t sure what to make of it.

BBC’s excellent documentary on shell shock explains the confusion around the sometimes bizarre behaviour found in military troops at the time: “Soldier’s unconscious minds, so distressed by war, crippled their bodies and took them out of fighting. The military found it hard to accept such a radical theory; it undermined the theory that men could and should control their fears and emotions.”

Soldiers stricken by war trauma displayed strange behaviours never seen before. Men in the ranks suffered from body tremors, paralysis, temporary blindness or loss of speech, and the inability to walk. As a misunderstood condition, shell shock was considered contagious and the men who suffered from it were thought to threaten to their platoons. Six months into the war, 15 percent of the British army suffered from the condition. Dr. Charles Myers, a consulting neurologist to the army with an interest in the growing condition, coined the term “shell shock” in 1915, and decided that the roots of the problem were psychological. By 1916, the British War Office officially recognized shell shock as a genuine war wound.

When officers began to display their own shell shock symptoms — stammering, irritability, and loss of memory — the military realized that this psychological response to warfare was taking an enormous toll. Something had to be done.

Military hospitals were set up and experiments with various treatments began; from Freudian dream analysis to hypnotism to electric shock, some shell shock therapies were successful, others not. The biggest obstacle to dealing with shell shock was the stigma attached to it; men affected by the condition were thought of as “incurable lunatics” or cowards, and a shame was carried with the condition, a shame divided up like a class system.

The condition did not discriminate, but the military did. Men in the ranks were shell-shocked but for an affected officer, to have shell shock in his medical records was an embarrassment so instead, officers suffered from “neurasthemia”, prolonged and exhaustive exposure to war. Officers, you see, were not meant to break down; they were strong, masculine leaders who could, or were expected to control their emotions and behaviour.

Shell shock was an uncontrollable external event that affected the military men internally, but it wasn’t interpreted that way. Sadly, many men who suffered from shell shock or neurasthemia were court martialed, shot, or committed suicide.

Battle exhaustion of World War IIWW2 military man

When World War II began, the military did not learn any lessons from the First World War, and shell shock took on a new identity: “battle exhaustion” or “battle fatigue”. Soldiers in this war suffered paralysis, amnesia, trembling, sleep disorders, memory loss, fear, isolation, and hopelessness. For a sense of the vastness of psychiatric casualties during this war, 20 percent of U.S. war casualties were neuropsychiatric-based, and 25 percent of all British D-Day casualties were psychiatric.

With numbers this high, the military was forced to look for more effective treatments, and young doctors wanted more dynamic cures for their battle fatigued patients. A number of new therapies emerged: talking therapy, individual and group psychoanalysis, electric shock therapy, hypnosis, sports therapy, and art therapy.

Battle exhaustion was considered a temporary condition and military psychiatrists believed that if the soldiers simply rested, they could recover and carry on fighting. An unconventional “sleeping therapy” or “narco-analysis” consisted of psychologically affected soldiers given sodium amytal (also known as “truth serum”), a sedative that induced sleep for weeks at a time to settle anxiety and exhaustion. Drugs administered during the sleep brought soldiers around so they could briefly recall and describe their battle experiences; this was considered a “cleansing” experience without any anxiety upon waking and completing the therapy.

Psychiatrists acknowledged by 1945 that every man had his breaking point and that shock and breakdowns were inevitable, yet the stigma of psychological damage from war remained. Battle fatigue was still considered contagious and men touched by the condition were treated like criminals at army hospitals. Being afraid and showing it was something of a military suicide because the consequence was the humiliation of being labelled “LMF” — lacking in moral fibre, or otherwise cowardly, and having your rank stripped from you. The only saving grace to battle fatigue this time around was that a frightened and battle exhausted man would not be shot.

It should come as no surprise that military men were psychologically impaired because of their wartime experiences. As one World War II solider put it, “I can’t stand seeing people killed.”

 Modern warmodern soldier

Technologies and the methods of modern war have changed enormously since wars after World War II, but the psychological effects of war have not. What was once known as shell shock, battle exhaustion, and post-Vietnam syndrome has become post-traumatic stress disorder, and it is just as devastating as it has always been.

PTSD seems to be an accepted part of military life in the modern era; the tragedy of the loss of human life and the psychological effects of death and destruction is part and parcel of serving one’s country. Indeed, one in three American service people suffer or will suffer from PTSD according to an Al Jazeera report, The War Within. The news agency describes PTSD as “a ticking time bomb with a decades-long fuse — a problem whose true magnitude is difficult to determine.”

Press TV documentary, Invisible Wounds-Break Down, investigates the effects of PTSD on Afghan war vets and reports that more than 30 percent of U.S. Afghanistan veterans are psychologically damaged.  Suicide is one of PTSD’s effects and according the U.S. Department of Veteran Affairs, about 18 veterans take their own lives every day.

The true tragedy of modern war is that the response for service people who reach out for help is ridicule, bullying, humiliation, and hazing; affected personnel are expected to “suck up” their psychological trauma. It’s some kind of unwritten code of valour and it reaps a heavy toll. Cynthia Thomas, a U.S. army wife interviewed by Al Jazeera said that her husband was punished for asking for help and in the end, did not receive any. His suffering continues.

“Unless these officers are held accountable,” she says, “nothing is going to change.”

Conclusion

War as an industry, an industry we’ve been conditioned to accept as a part of our modern life. But war isn’t natural. In fact, according to U.S. military psychologist, Lt. Col. David Grossman, humans very much go against the grain of nature when they kill their own, affirming the idea that war is an act of political will.

In a TVO interview about his book, On Killing, Grossman explains that the first time someone kills another person, it at first feels exhilarating because the target has been hit and the job done, but most people will feel empathy and profound remorse and nausea when they realize what they’ve done; killing is repulsive to us.

There is a lifelong process of rationalization and acceptance [to killing], and if an individual fails at this process, the result is post-traumatic stress disorder, or some type of trauma that will stay with them for the rest of their lives.

Grossman says that through conditioning and desensitization, we now associate violence with pleasure and by doing this we are overcoming a powerful resistance to killing in our minds and in society. He says that combat is more about posturing more than it is about killing, and maintains that combat troops during WWII actually fired their weapons at their enemy only 15 percent of the time (he says that the vast majority of death during that war came from the fighter planes that dropped bombs), to 55 percent in Korea, to a stunning 95 percent in Vietnam. Aiming a weapon at another human being and pulling the trigger became a conditioned reaction.

By now, war, violence, and killing as seen through TV, film, and video games, takes away the horror of human suffering and turns it into entertainment. This completely counter-intuitive perception has enormous implications, and people don’t really know what is at stake.

History has seen leaders use political means to carry out their aggressive and violent motives, leaving the agents of their intentions dead, maimed, or psychologically injured. Assuming a false presumption that men, at least according to the patriarchal construct of men, could ignore their natural emotional state and freely kill other human beings without psychological consequence has proven throughout modern history to be profoundly flawed and deeply tragic. Men are emotional human beings no matter what our patriarchal-based society imposes and expects. One cannot just walk away from taking the life of another human being and remain unaffected. It isn’t natural.

PTSD is an enormous and multi-faceted topic that I will continue to discuss in posts to follow. Thank you for reading.