Understanding How Compounded Work Stressors can contribute to PTSD

Most of us have concrete images of what military, police, fire, paramedic, corrections and emergency dispatchers do. We see them in the news, on TV and when we’re driving we pull over to let them pass. So, when we see them we naturally think we know exactly what they do and what their job is. And yes, we do have some sense of what their jobs entail. However, over the years working with them and their families I have learned that few of us ever see just how much of their energy is devoted to managing stress.

I remember speaking with a senior First Responder who had been diagnosed with Post Traumatic Stress Disorder (PTSD). He told me that he couldn’t stop thinking he was letting down his peers, his colleagues, his family and the community. He had always wanted to do more for others, so he joined a First Responder service.

As a young First Responder he learned quickly that some civilians had expectations. Expectations like why didn’t you come immediately, you shouldn’t do this or that or you should do your job better! Most people were always glad he had arrived, but some became very angry. He stated people would get angry just seeing his uniform. He and his colleagues all figured this is part of the job and what they signed up for.

I remember distinctly when he told me that the traumatic events he witnessed, and there were many, was not what bothered him the most (I will not provide any detail as this is not necessary or helpful). What was interesting to me was that he said that the big events were not the main reason for his diagnoses of Post Traumatic Stress Disorder.

He said it was all the little stresses that just kept adding up and compounding over the years. He had two children, a family, and this changed how he saw accidents or other events. He noted that when attending chemical road spills, he worried about the increased risks of cancer. His training informed him that he had an elevated risk of developing cancer due to environmental events. He started to worry allot about the risks to his physical and emotional health as he got older.

Often he worked 16 hour shifts for weeks at a time. Scheduled time off didn’t happen as they were always short staffed. For those who know shift work it means all night for many nights in a row for years at a time. Over years of work he acquired what public service personnel call “sleep debt.” Sleep debt is when you haven’t had a proper sleep usually for years. Our bodies require the recommended sleep of 7 to 9 hours and our best sleep is between the hours of 9pm and 8am. Without proper sleep this creates additional stress on our bodies. You can actually get used to, and function on, minimal sleep with enough practice but there is a price.

This gentleman also had to move his family many times over his 25 year career. He said they moved because of the lack of staff in remote communities. When remote locations and their staff were in dire need he would think all part of the job and move his family to support other colleagues he knew were struggling. The stress on his family added allot of stress on him. The stress of staff shortages compounded this as well. Remember he did this for 25 years and always managed, never complained and was promoted to a senior position.

When he finally decided to come forward, he was ashamed to tell anyone that he couldn’t manage. He couldn’t stop thinking his greatest failure was saying “I” need help. His stress had now become debilitating as he felt this had ended his career. He knew others who had come forward and were criticized by colleagues and leadership.

PTSD is classified as a stress disorder. Yes, PTSD occurs from exposure to traumatic events. Of course, exposure, repeated exposure, and exposure over time increases the risks of developing PTSD. However, stress is stress. Additional stressors such as, sleep debt, moving family multiple times, feeling isolated or yelled at due to our professional role only adds to the stress. The fear of reprisal from our superiors and colleagues is so common it has its own term “Moral Injury.”

Worrying about health-related risks begs the question should I keep doing what I am doing. If I quit my job, then what?

When understanding all the stressors which contribute to a First Responders job consider the following:

Physiological: If the body is ill, tired, hungry or other physiological issues occur we don’t function well.

Neurological: Consistent stress over time causes neurological changes in the brain. Our neural pathways change to allow us to adapt to the extreme stresses in the environment. The adaption can allow us to manage extremely stressful events but there can be a cost. We can develop depression, anxiety and our ability to process information critically can become impaired.

Psychological: Our perception of ourselves and the world changes. It is very difficult when we know we are not ourselves and that we have changed.

Emotional: We cannot seem to feel good about anything. We cannot seem to regulate our emotions. We avoid people, places and things and become isolated. We feel like we cannot trust ourselves.

PTSD is not a life sentence. People can and do recover. Think of PTSD more akin to a physical injury. Like a broken arm, assessment is needed (doctor and x-rays); Physiotherapy restores functionality (work is required) and time is necessary to allow the body to do its work. In time full functionality is recovered. As I often note a broken arm eventually becomes physically stronger than before the break. Our bodies have a way of protecting us.  I have worked with many people (and their families) who have become stronger following a diagnosis of PTSD. So much that I now refer to Post Traumatic Stress Disorder as Post Traumatic Growth.

Please click here to see the Diagnostic and Statistical Manuals definition and criteria for PTSD

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