• Post Traumatic Stress Disorder in the Correction Officer’s Life
    Updated On: Apr 14, 2016


     

    Post Traumatic Stress Disorder in the Correction Officer’s Life

    Donald W. Steele, Ph.D.
    Traumatic reaction can come as a single awful event like a stabbing, a hanging, a rape, an assault
    on your life. Or it may be more subtle, slowly building in small doses of watching your back, being
    physically threatened, or having your family threatened, hearing of your fellow officers being hurt
    daily, weekly, monthly over a long period of time.  The first type of sudden extreme event is clear
    cut, dangerous and
    threatening to life and a brutal assault on your safety or the safety of others. It is easy to
    understand such an event’s upsetting effect. The second type of chronic slow traumatizing is more
    subtle. It is referred to as Complex Post Traumatic Stress, not always directly threatening but
    keeping you aware that danger is always present. Officers become constantly vigilant and learn that
    even in the safest environment life threatening things happen. This chronic awareness of potential
    violence, creates an attitude of vigilance for unexpected danger.
    Constant exposure to risk leaves officers hardened, hypervigilant , anxious and depressed at home
    and on the job. They are often removed from feelings and memories even though those feeling s and
    memories drive behavior. The result of both single events and the chronic exposure can change the
    officer in many unhealthy ways.
    Sometime in the course of a corrections career there is high probability of experiencing trauma and
    a risk of developing  symptoms of PTSD.  Fortunately not everyone will experience full blown PTSD.

    Trauma is an event that is “a deeply disturbing or distressing event” according to the Oxford
    English Dictionary. In a prison there are many possible such potential occurrences. Some of the
    possible events that may be encountered in a Corrections career are:
    1)   Suicides, hanging or bleeding out bodies leaving a life time of visual memories.

    2)   Fights and stabbings that have the potential of spreading and of hurting officers.

    3) Direct threats and assaults on officers, being pelted with bodily fluids, attacked with weapons,
    being sucker punched without warning or provocation, being stuck with possibly contaminated needles
    introducing the dangers of HIV or Hepatitis.

    4)    Sudden deaths of inmates while being transported or restrained.

    5) Sexual harassment or violence can be traumatic for the victim. More so, if there is humiliation
    or retaliation associated with it. Bullying by colleagues or by fellow officers, that is associated
    with threats of danger can create feelings of insecurity and danger. Isolation and feelings of
    being abandoned in dangerous situations such as jamming radios when officers call for help.

    6)   Threats to the officer and families from gang members.

    This is a brief list of possible dangers that can lead to Post Traumatic Stress in a prison. Risk
    of danger rises with the level of security classification and with the level of violence among the
    inmate population.
    There has been some refinement of the diagnosis of PTSD in the Diagnostic Manual for Mental Health
    (DSM-5) since 2013. It is no longer classified as an anxiety disorder although symptoms of anxiety
    may be a result. More emphasis is now placed on the seriousness of the event. It needs to be life
    threatening. According to the DSM-5 “trauma is defined as exposure to actual or threatened death,
    serious injury or sexual violence in one of four ways a)directly experiencing the event b)
    witnessing in person the event occurring to others, c) learning that such an event happened to a
    close family member or friend, d)experiencing repeated or extreme exposure to aversive details of
    such events…Actual or threatened death must have occurred in a violent or accidental manner and
    experiencing cannot include experiencing through electronic media …unless it is work related.”
    Initial experience of trauma and its impact on the victim is classified as acute stress. If the
    emotional and physical disruption continues beyond a month it is re classified as Post Traumatic
    Stress.
    The disabling or unsettling emotions and behaviors that result from exposure to traumatic events
    affect the health and safety of officers. Reactions can range from mild to severe and disabling.
    Officers and others can get help for this. Good treatment will prevent more severe effects.
    Symptoms fall into four categories.

    A.   Intrusion:

    Recurrent, involuntary, and intrusive memories , dreams or nightmares of the traumatic events
    Dissociative events (flashbacks), zoning out
    Intense or prolonged psychological stress at exposure to cues (triggers) that symbolize or resemble
    an aspect of the trauma, (sounds, smells, sights touches tastes)
    B.  Avoidance

    Persistent avoidance of stimuli associated with the traumatic event. The avoidance begins after the
    traumatic event occurred.

    Avoidance or efforts to avoid distressing memories or thoughts or feelings associated with the
    traumatic event
    Avoidance or efforts to avoid external reminders, people, places, conversations, activities,
    objects, situations that arouse distressing memories, thoughts, or feelings about or closely
    associated with the traumatic event.
    C. Negative change in thoughts and mood associated with the traumatic event, beginning or worsening
    after the event and evidenced by two of the following:
    Inability to remember important aspects of the trauma due to dissociative amnesia, not drugs,
    alcohol or head injury.
    Persistent or exaggerated negative beliefs or expectations about self or others or the world. ( I
    am bad, no one can be trusted, the world is completely dangerous)
    Persistent, distorted cognitions about the cause or consequences of the traumatic events that lead
    the individual to blame self or other. (I screwed up, I should have done more.)
    Persistent negative emotional state (fear, anger, horror, guilt, shame)

    Markedly diminished interest or participation in significant activities (Giving up hobbies or,
    interests.)
    Feelings of detachment or estrangement from others

    Persistent inability to experience positive emotions, (happiness, satisfaction, loving feeling,
    isolation from loved ones)

    D. Marked alterations in arousal and reactivity

    Irritable behavior and angry outburst, (with little or no provocation), verbal or physical
    aggression toward people or objects.
    Reckless or self destructive behavior Hypervigilance
    Exaggerated startle response Problems with concentration
    Sleep disturbance difficulty falling or staying asleep, restless sleep)

    E. Duration more than a month

    F.    Significant impairment in social, occupational, or other areas of functioning.

    G.    Not attributable to physiological, substance or other medical condition

    H.   Some individuals may experience depersonalization or de-realization or both.

    Depersonalization; persistent or recurrent feelings detached from or an outside observer of one’s
    mental processes or body.
    De-realization; persistent or recurrent experiences of unreality of surroundings. (dreamlike,
    distant, or distorted view of the world)

    (For full definition refer to DSM-5)

    PREVALENCE OF PTSD IN CORRECTIONS
    Different types of prisons and jails housing many different types of offenders have different
    danger levels. Personnel there will also experience different levels of exposure. But no facility
    is completely without danger.
    Personally, I can attest that there is ample PTSD in the lives of correction officers. As a
    psychologist in private practice I have seen hundreds of officers from state and county facilities
    where there are stabbings, hangings, assaults with contaminated needles, assaults with saliva,
    urine, excrement, credible threats to life and welfare of officers and families, sudden unexpected
    deaths and suicides.
    Unfortunately, also, officer betrayal of or bullying of officers by other officers or managers also
    can cause
    severe stress or PTSD. This latter can range from demeaning an officer for “being weak” to
    punishment and intimidation such as jamming radios .Most outrageous and unexpected is betrayal and
    abuse by some administrators and superior officers who abuse authority and bully officers as though
    they were inmates.
    Observations such as the above led far sighted officers in Massachusetts and other states to begin
    “Stress Programs “ to help officers. These early Stress Programs identified problems and began
    outreach at a time when studies such as the work of Dr. Frances Cheek and her associates in the
    early 1980’s correlated higher rates of burnout and stress with heart disease, divorce, alcoholism.
    Early studies also noted that officers may only live five years in retirement although hopefully
    smoking cessation, better health insurance and more attention to preventive aspects of health
    maintenance will change that statistic.
    In 1997 Stack and Tsoudis noted a 39% higher suicide rate among correction officers compared to the
    general working population.

    Many studies were done in the 1980-2000 period all pointing to higher stress rates and the outcomes
    in substance abuse, suicide, physical health and family disruption. Programs began to spread around
    the country and in the year 2000 the National Institute of Justice, printed a report by Peter Finn
    “Addressing Correctional Officer Stress Programs and Strategies”. This report was a clarion call
    and outline of successful interventions and ways to proceed. In 2008 I wrote in concert with
    officers “ Stress Management for the Professional Correction Officer”, a booklet now used as part
    of many Employee Assistance Programs in the country.
    In 2013, Denhof and Spinaris of Desert Waters released a study of 3599 corrections personnel and
    reported findings that addressed PTSD. They concluded there is a 34% PTSD rate among corrections
    personnel. They also noted a 31 % depression rate among Corrections staff. Significantly they found
    a connection between PTSD and depression with 67% of those who had a primary diagnosis of
    depression also having PTSD and 65 % of those with PTSD as a primary diagnosis also having
    depression. Tull (2016) reports that 27% of people with PTSD attempt suicide.
    These recent studies place better definitions and refine our understandings. PTSD and co morbid
    conditions such as depression are significant factors and need to be addressed for the health and
    well being of the officers and their families and frankly for the well being of the institutions.
    Treatments will not only provide relief from psychic pain but also will reduce addiction, domestic
    disturbance, suicide and many health related problems.

    WHAT HAPPENS WHEN WE EXPERIENCE TRAUMA?
    The brain has many centers and systems that perform the many tasks that our bodies and minds use to
    function. Simply there are centers and systems that detect events and judge them for safety or
    danger. Other parts of the brain react and move us to survival mode for fight or flight or
    sometimes freeze. The systems work at lightning speed and make judgments to insure survival. In
    most situations we have perceptions of events, have emotions about them and take actions consistent
    with survival. Trauma by its nature is devastating and catastrophic. Survival is threatened,
    emotions are overridden and action is attempted to save ourselves and those around us. The shock of
    the event blunts us. Often we act without recall. For the most part in trauma it is the emotional
    systems
    that take over.

    For the PTSD victim the smooth connectedness of the systems is disrupted. Some see danger when it
    isn’t there based on a tiny piece of information, a sound, a sight, a smell or touch that recalls
    the trauma and misinterprets this tiny recall as the danger once encountered.
    Such a reminder can be crippling and overwhelming.

    Others stay in mental overdrive watching for and seeing danger at every turn so that the traumatic
    event will never happen again. They may check doors and locks at home at all hours or be overly
    protective of children among other negative behaviors.
    Still others are hurt so badly they avoid and often do not even recall the event but their bodies
    continue to react and go on alert when any reminder occurs. They tense or get defensive without
    being sure why.
    Others zone out become depersonalized and walk through danger with no concern for safety because
    mentally they have shut down. They sometime get the task done but do it without emotion.

    There is often depression, anxiety, suicidal thinking, rage, and shame for survivors of trauma.

    Whether an individual shuts down or overreacts, if one could take blood pressure or do an MRI we
    would find the brain is very alert and the body is very responsive , the heart is beating rapidly,
    adrenaline is pumping. But instead of acting in concert, one system or other prevails and is out of
    tune with the others.

    In the world of prison work as in all other places, the untreated PTSD victim is at risk.

    The avoider will not be available in a fight and may have high use of sick time, the hypervigilant
    may misjudge and either overreact or avoid when they mistake actions for danger that isn’t there.
    Many with PTSD are high risk for substance abuse that either overly stimulates or blunts emotion.
    Many find other ways to blunt emotions or to stimulate deadened feelings. High risk behaviors,
    gambling, sexual compulsions, isolation from others, caffeine and energy drink stimulants can
    become coping styles.

    TREATMENT
    There is no single proven treatment for PTSD. Medications, at best, only treat symptoms and often
    do that poorly. Treatment needs to be more intensely focused on reconnecting the brain systems that
    have become incongruent with one another.
    In treatment Bessel Van derKolk of the trauma center in Brookline, Ma has noted, and I agree, that
    the “challenge is not just dealing with the past, but to learn to enhance the quality of day to day
    experience.” For the trauma victim it is difficult to feel alive right now, they are still in the
    past.
    Treatment then is a combination of learning to be in touch with bodily feelings and sensations that
    occur now. It is learning coping strategies to manage the intrusions of the past memories until
    they can be put in a safe place that does not intrude in the present. Treatment also requires
    learning that an incident today is not going to be a repeat of the past trauma. It is a journey to
    live in the moment.

    For this I recommend therapy that incorporates body work such as yoga as a way to reconnect with
    body sensations that are currently present and to learn to focus on the present.
    Mindfulness meditation allow focus on the present . We learn to bring the mind gently into the
    present and focus on what is occurring right now. We learn to avoid focus on past trauma or future
    fears and worries. We learn that we truly only have the moment we are alive in and will get the
    most out of our lives by using the moment because we have it now. Worries about the past or future
    distract from living in the moment.
    Grounding techniques such as slow deep breathing, counting breaths, recalling some pleasant memory,
    place or upcoming event, focus all five senses on something pleasant such as a beach or forest,
    enjoying important people in life.
    EMDR is a particular type of therapy that is very productive for resolving trauma. EMDR means Eye
    Movement Desensitization and Reprocessing. Theoretically it works by reintegrating the emotional
    and cognitive systems of the brain that were disrupted in the trauma. Through a series of eye
    movements and discussion of the negative thoughts from the trauma coupled with positive realistic
    thoughts trauma survivors resolve issues that create the negative behaviors that have come from the
    awfulness of trauma. Numerous studies and numerous experiences with clients I have treated have
    shown very positive results.
    There are other treatments as well. Exposure Therapy where the survivor re-experiences the trauma
    and learns to desensitize from the emotions has been helpful. Cognitive Behavior therapy is another
    modality that examines the beliefs of the patient to observe how negative beliefs lead to negative
    behaviors. The therapy then turns to refining beliefs so as to create more positive and healthy
    behaviors.
    Of course, all treatments should address substance abuse. Programs such as Alcoholics Anonymous
    (AA), Gamblers Anonymous (GA), Sex, Love, Addicts Anonymous (SLAA), Narcotics Anonymous are good
    resources .  For Correction Officers in particular an organization such as RESPOND is a resource
    for substance abuse.
    With appropriate therapy and treatment most survivors of PTSD can learn they can once again be safe
    and successfully manage thoughts, nightmares, memories and fears. There are, however, some horrific
    experiences that will keep a very small number of individuals from returning to work in the same
    environment.

    INSTITUTIONAL RESPONSE
    Traumatized officers need support and understanding. There is an unfortunate belief system among
    many that PTSD is a sign of weakness and that it can just be handled by “sucking it up”.
    If an institution cannot provide a safe environment the fears for safety associated with the trauma
    will be perpetuated. It is doubtful that without a positive institutional and collegial response an

    officer will have a safe recovery. The likelihood of returning to the same work environment is
    greatly diminished.
    Colleagues and administration need to avoid shaming or humiliating suggestions that an officer just
    suck it up or be tough. PTSD is a real disabling response to trauma.
    Further, institutions and superiors need to make reasonable accommodations and stick to them.
    Placing an officer on another post can be helpful but only if he/she will not be required in an
    emergency to return to the old post. Often too, such accommodations become forgotten and an officer
    is forced back to a bad situation setting them up for re-traumatization.

    If the institution does not support an officer by accommodation and by respecting that this is an
    illness, if it shames and humiliates, there is a higher risk that an officer will not recover. If
    fellow officers, unions and administration continue to make an officer feel unsafe while they heal
    it is highly likely they will not return to work.

    REFERENCES

    Cheek,F.,Miller,M. Prisoners of Life: A Study of Occupational Stress Among State Corrections
    Officers, AFSCME, 1982

    Denhof,M, Spinaris,C , Depression, PTSD, and Comorbidity in United States Corrections
    Professionals:  Prevalence and Impact on Health and Functioning, , 2013

    DSM-5, American Psychiatric Association, 2013, pages 143-149 Herman, Judith, Trauma and Recovery,
    Basic Books, 1997

    Stack, S, Tsoudis,O Suicide Risk among Correctional Officers:A Logistical Research Analysis,
    Archives of Suicide Research, 1997

    Steele,D.W. Stress Management for the Professional Correction Officer, Steele Publishing, 2008
    Tull, Michael  What is Complex PTSD,   About Health, 2016

    Vander Kolk, Bessel, The Body Keeps the Score, Viking Press, 2014


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