Tag Archives: Toronto Star

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.”

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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 truth about pants (dedicated to a disgruntled Toronto Star reader)

4 Oct

People tell me I’ve hit the big time when I receive hate mail.

I write as the men’s entrepreneurial image expert in the  Toronto Star‘s Small Business section, and one day, I got a 4 am  email from an intelligent but angry reader who couldn’t believe that I would waste his time talking about something as unimportant as socks.

He got personal, saying that I was the best journalist this side of Fox news, and expressed an interest in reading future posts he envisioned such as, “Belts vs Suspenders, which one makes you more money?” and “The Truth About Pants”.

I thought the latter would make a fine blog topic, so in honour of  this disgruntled reader, I’m pleased to tell you the truth about pants!

History

Costume is divided into five major types of clothing: draped (a wrapped cloth – e.g. togas), slip-on (over-the-head – e.g. poncho), closed sewn (e.g. tunic, shirt), open sewn costume (long cloth closed, stitched, worn over other garments – e.g. coats, caftan, Russian tulup), and sheath (sewn and tubular, fitted closely to the body – e.g. breeches, skirts).

There is evidence in Bronze Age paintings found in the Spanish Levant that men wore some kind of leather trouser that was adorned with fringe and sometimes garters, and there is mention of  “linen breeches” for all “the sons of Aaron” in Exodus XXVIII, but it wasn’t until people started riding horses that these leg tubes caught on.

Before this, men wore the types of clothing women wore – robes, mantles, and tunics. When horses became the prime mode of transportation, riding with two free legs was preferable, so the garment  was adopted by individual riders and mounted armies who, over time, made them part of military uniforms.

Heavily pleated Japanese hakama

Civilizations in Asia and Europe had some form of pants. In Japan, the Samurai wore a kind of pleated split skirt called the hakama, Turks had harem pants, and the Gauls and Celts wore breeches (brit-chez) and trousers. European breeches morphed into hose or chausses, which looked like hip-waders made of wool that tied to the braies, short drawers tied around the waist.

Chausses tied to braies

Bracae, Latin for breeches took a while to catch on in Rome, though Italy was surrounded with cultures that wore some kind of leg covering. Ancient Roman men generally avoided wearing trousers or pants of any kind, considering them barbaric, and worn by “uncivilized” people who lived outside areas controlled by Rome, like the Gauls who lived in present-day France, or the Celts in the north. But during the Roman conquests of cooler northern Europe, the chilly Roman army adopted the local dress of short, tight leg coverings for warmth and protection, which were eventually brought to Rome.

These breeches they would have worn looked like pajama bottoms, tied to the waist and held to the legs by criss-crossed bands of linen or other material. Feminalia were snugly fitting knee-length pants that covered the length of the thighbone, or femur (hence the name). Augustus Caesar (63 B.C.E. –14 C.E. ), the famous Roman emperor wore feminalia through the winter “to protect his sometimes fragile health”. (Source)

Evolution

Parti-coloured hose in Medieval Spain

In the 14th century, the cut and construction of men’s hose improved, and parti-coloured hose, hose with different coloured legs, were popular in Europe. These hose were made of knitted wool, sometimes lined with linen, and often coloured red, black, or brown – popular colours of the period made so with dyes of iron ore.

During Henry VI’s reign, men’s hose got a little more structured and laced to the doublet which, I assume, gave an increased feeling of security to the wearer. The 15th century saw the inclusion of the infamous codpiece that began as a triangle of fabric laced to the crotch to cover a gentleman’s tackle.

Early codpiece

By the time of Henry VIII, codpieces were the order of the day, padded and exaggerated in size, sometimes used as pouches for coins and such. Codpieces peeked out from the divide of a Tudor gent’s waistcoat skirts, not to be ignored!

Hose separated into two parts in the middle of the 16th century, becoming upper and lower hosen. The lower hose were more like a stocking and the upper hose looked like puffed shorts, made of brocades if the wearer could afford it. This upper piece was known as trunk hose.

16th century trunk hose

From this point in time, the trunk hose grew in length, becoming nether hosen during the Elizabethan reign, then into huge pleated knee-length slops in 1600, and heavily pleated bag breeches later in the century. For the next few hundred years, the lower garments grew longer and slimmer, becoming pantaloons by the 19th century.

Long pants as we know them today appeared during the early 1800s and have kept on since, varying in widths and rise lengths (the distance from waistband to crotch) during different eras. Front openings have evolved from tie-on crotch covers (codpieces) to button front flaps (fall-front) to a modern zippered fly.

Lots of changes, lots of forms. That is the true story of pants, an interesting and complex evolution of leg tubes developed for equine travel.

Further reading: article on pant origins in The Atlantic.