Families who have one or more members suffering from PTSD are affected in a number of ways. One of the common defense mechanisms that someone with PTSD uses is to emotionally “numb themselves” so that they can avoid painful feelings. The truth is that it is impossible to numb one aspect of life and not the others. Damping down the emotions of sadness, fear, guilt and anger mean also being unavailable to experience love, joy, happiness, enthusiasm and anticipation of pleasant events. Emotional intimacy may be substituted for mechanical interactions.
This may make family members feel pushed to the side and rejected. The other reason that a sufferer may make family members feel rejected is that they often do not want to talk about the disturbing events they encountered in the line of duty. They may feel that by refusing to talk they are protecting those closest to them from bearing witness to what they see as the harsh realities of life. Regardless of the cause, pushing the family away results in both the traumatized person and their family members feeling isolated and unloved.
Feeling Isolated
Furthermore, feelings of anxiety, depression and worthlessness lead to feelings of inadequacy and guilt, and may lead to detachment and being cut off from other people. They may no longer participate in activities and friendships that used to sustain them before the trauma. When a family member with PTSD withdraws, it becomes difficult for the family to enjoy normal family activities. Childcare and other responsibilities may disproportionately fall on the unaffected spouse. If this scenario follows a long absence where the PTSD sufferer was away, for example on deployment, the resentment may be even more acute. Children who had to adjust to having one parent absent may feel a betrayal when the missing parent suddenly returns, only to disrupt the family functioning.
The majority of the family’s emotional and other resources may be consumed by focusing on the affected partner’s needs, leading to further resentments of the rest of the family, who begin to feel that their needs don’t matter.
People with PTSD usually have their sleep disrupted, so they may feel tired and irritable a good portion of the time. They may be angry and lash out in ways that seem excessive and uncalled for. They may try to dull their pain with drugs and alcohol, which leads to its own set of problems.
Anger may be one of the most prevalent emotions that a sufferer of PTSD displays. They may be angry because of injustices they have seen. They may feel that a criminal they worked hard to apprehend might not be convicted because of some technicality. They may be angry because of inhumane acts they have witnessed. Often they are angry because of the way they have been treated by their organizations or insurance companies when it has become apparent that they have had an operational stress injury. Regardless of where the anger comes from, it can be destructive to the harmony of the family.
The police officer or veteran with PTSD may become very controlling of their family members. They may want to protect them from perceived threats and dangers. They may have developed such a lowered self-esteem that they feel that it is just a matter of time before their spouse leaves them for someone else.
Over a period of time, these problems with family and friends can severely erode trust and intimacy. Eventually, it may become too much for those close to the individual. Following trauma, the likelihood of separation and divorce is considerably increased.
The answer to these problems is begins with good information. Usually it is not helpful to try to confront the suffering family member with the intention to perform an “intervention” as this may just cause an inflammatory reaction.
Gaining Insight
Firstly, it is important to understand and acknowledge what exactly is happening here. Having some insight into the experience and vantage point of each family member can be truly enlightening. A skilled therapist who specializes in PTSD family systems therapy can help guide the way through the work that needs to be done.
The afflicted family member may benefit from some individual treatment that can move them into a position of positive growth while simultaneously addressing the family dynamics.
Thankfully, there is new research leading to new effective programs for the treatment of PTSD.
So many families have come forward to our organization with questions and wishes to support their loved ones through the fallout of PTSD. Please visit the link below for a list of tools that could help you and your loved ones:
Project Trauma Support is one resource for first responders focused on “deep, personal connection,” peer group support and utilizing physicians with lived experience.
Project Trauma Support is an organization located in Perth, Ont., offering a six-day retreat for first responders, military members and veterans. Photo: Project Trauma Support
When it comes to post-traumatic stress disorder (PTSD) in Canadian first responder services, things don’t have to be the way they are.
That’s the opinion of Dr. Manuela Joannou, the medical director of Project Trauma Support, which is an organization located in Perth, Ont. Launched in 2016, it offers a six-day retreat for first responders, military members and veterans.
Many police services are working short staffed and underserviced because they have an inordinate number of officers off work or on accommodated duty due to psychological injuries such as PTSD, anxiety and depression. We hear some services are squeaking by with up to 30 per cent of their force missing from action.
“Police officers are very reluctant to put up their hand to ask for time off, for a break, or some other consideration when the demands and the stresses of being on the job are getting to be too much,” Joannou says. She goes on to note there are several reasons for this.
Stigma is the big reason. Members of society expect our emergency responders to be larger than life, somewhat like the heroes in the comic books they grew up with. Their emergency services and supervisors hold them to very high standards, but the officers also hold themselves to impossibly high standards, which very often is where the problem lies.
Project Trauma Support is working in partnership with the Mood Disorders Society of Canada and with research teams at Queen’s University and the University of Alberta to gather evidence that their model can lessen the symptoms of PTSD, and in some cases even promote post-traumatic growth. Photo: Project Trauma Support
Stigma comes in at many levels. The first level is self-stigma, where an officer will refuse to admit that they could be having some issues with the demands of the job because they equate this to being somehow weak or inadequate and the idea of this is too unacceptable to entertain. Often an officer who is finally getting to the point where he or she just cannot go on feels that they are letting their entire platoon down and this creates a sense of shame. The next level of stigma comes from the service itself.
Supervisors trying to fill the shifts are often exasperated when yet another officer is asking for time off. Other members of the team are irritated when they can’t get the holidays they want, they must work overtime, or they feel they are put in unnecessary danger when they are working short staffed because so many others are off.
Although there is currently a significant effort being made to minimize the stigma that surrounds asking for help, many officers still feel that admitting any sort of “weakness” is akin to committing career suicide. Someone who has worked very hard to gain a desirable assignment or rank, or is looking to be promoted, often feels that they can kiss their achievements goodbye if they come forth indicating that they are struggling emotionally or psychologically.
All these levels of stigma are significant barriers that keep any officer who might be noticing the first signs of stress from asking for help.
Many provinces now have presumptive legislation whereby if an officer is diagnosed with PTSD, it is presumed that the condition was caused by one or more critical incidents occurring on the job. To be formally diagnosed with PTSD, one must have borne witness to (or repeatedly examined the facts pertaining to) a critical incident or incidents involving loss of life, threatened loss of life, or severe sexual trauma. These are almost a given in the working life of a police officer.
They must also be harbouring symptoms that span four main categories1 summarized by intrusive thoughts involving reliving the event(s) and/or nightmares, avoidant behaviour where one stays away from people, places or things that could be reminders of the trauma; numbing of emotions so that one is mentally “checked out” and does not have to deal with uncomfortable feelings; and hypervigilance, where one is constantly scanning their environment for possible threats. There must be significant mental distress and/or distortions of thinking caused by these symptoms, and the symptoms must be present for one month or more.
The symptoms must be prolonged before a diagnosis can be made, because very often a person will be able to find the right way to process or make peace with an incident within a few weeks after it happens, so that they will never go on to develop PTSD. This offers a window of opportunity after a traumatic event where an officer can be helped to find and use healthy coping strategies, psychological defense mechanisms and perceptions so they remain resilient.
Most times, when an officer finally is unable to continue working because their stress injury is too great, they will have been suffering from symptoms for years and often decades. It is arguable that any officer who has spent a few years on the job is likely impacted by some degree of post-traumatic stress. It makes sense that we should be trying to identify and strengthen the coping mechanisms that can promote resilience to the job-related stress.
What is resilience? One definition is the ability to bounce back, resist, or even thrive in the face of adversity. How advantageous would it be if every time an officer faced a critical incident, instead of having adverse symptoms as a consequence, they were able to process the event in a way that could improve their coping mechanisms?
Project Trauma Support is working in partnership with the Mood Disorders Society of Canada and with research teams at Queen’s University and the University of Alberta to gather evidence that their model can lessen the symptoms of PTSD, and in some cases even promote post-traumatic growth.
Moreover, one of the main focusses of the program is addressing what is known as moral injury.
“Moral injury is just beginning to be recognized as an important component of Operational Stress Injuries (OSIs). In many cases we feel it is moral injury that causes the burden of suffering,” Joannou states. “Moral injury is an affront to the very being of a person, what one might describe as an injury to one’s heart and soul.”
Although there is not yet a consensus on a definition for moral injury, according to Joannou, they have a working definition that seems appropriate.
“A moral injury might result from having done something you wish you hadn’t, or not having done something you wish you had, and this resulted in dire consequences. Moral injury can also come from witnessing something that you feel is just plain wrong.”
The Centre for Addiction and Mental Health (CAMH) describes moral injury as “a loss injury; a disruption in our trust that occurs within our moral values and beliefs. Any events, action or inaction transgressing our moral/ethical beliefs, expectations and standards can set the stage for moral injury.”
The symptoms of moral injury include shame and guilt, or overwhelming sadness. There is also often what is known as “Sanctuary Trauma” or “Institutional Trauma.” This occurs when a person feels that the very institution for which they served with great pride, effort and personal risk does not come to their rescue when they experience hardship, but instead acts in such a way to make matters worse. Leadership failure and the feeling that one has been scapegoated, ostracized or unfairly punished all lead to feelings of anger, betrayal or a sense of injustice.
“There are some myths surrounding PTSD and moral injury that we feel need to be exposed,” Joannou says. “The idea that only weak people get these injuries is totally false. We have run our program a total of 33 times so far, with 334 participants and those who come to us are anything but weak.”
These are the “bravest members of our warrior class who have put themselves out in a way that most people could not imagine,” she continues. “It does not matter how well-trained, brave, well-intentioned or experienced someone is, there is a limit to what a human can withstand… Instead of this being a sign of weakness, this injury should be a testament to the degree of courage, critical difficulty and personal hardship they have been exposed to. If this is recognized early, there is every reason to hope that the right types of support can be put into place to help build resilience and resistance.”
The current culture in policing — with the stigma surrounding psychological trauma symptoms — poses a detrimental barrier to implementing procedures to intervene at opportune points. There needs to be more awareness on the part of supervisors and command staff so that critical incidents and emotional and psychological impact can be recognized early and dealt with in a helpful rather than inadvertently harmful way.
“We feel that specially trained peers with lived experience can act as resilience ‘life coaches’ for officers on the job,” Joannou says.
Currently, by the time an officer finally admits that they need to go off work, sees a psychiatrist or psychologist, gets a diagnosis and has an insurance claim approved for therapy, valuable time has passed where some effective interventions could have been deployed. The more time that passes without any help, the harder it is to keep a person on the job.
The Project Trauma Support model involves physicians with lived experience supervising peer mentors who drive the program. These mentors learn to identify common faulty thinking patterns that promote increased psychological distress and can point these out to those trying to process their difficult incidents.
A police officer with a municipal force in Ontario for more than 20 years, Sgt. Mike Richardson also previously served in the Canadian Forces for 14 years. He is currently off work with an OSI from a traumatic work event and was diagnosed with post-traumatic stress in 2017. He says Project Trauma Support has been a “gamechanger” for his wellness thanks to the team environment it champions and the resources it raises awareness about.
“Sure, there are days I feel lonely from symptoms of PTS but now I am never alone,” he tells Blue Line in an email. “When we have PTSD, we want to isolate ourselves… The team from Project Trauma Support, my wife and my cohort brothers continue to provide me with unending support, 24/7 — whether it’s a text, phone call or even a visit. I just can’t say enough about this Project, as it’s such an important and integral part of my support system, my tool box.”
Another common myth, according to Joannou, is that once someone is diagnosed with PTSD, they will just have to learn to live with the symptoms.
“This makes me so sad,” she says. “I think it is a terrible thing to take away someone’s hope. We have seen many come through our program who have been able to process their experiences in a new way and they feel that they come out stronger than they ever were. This often involves doing some soul searching and finding where they may have been psychologically underdefended or may have been personally affected through some link with early life experiences. We also help people find meaning in their experiences, which gives them new resolve and often reminds them of why they signed up to serve in the first place.”
Joannou states that although psychiatric medications are often prescribed for sleep difficulties and mood disturbances that accompany PTSD, medication has its limitations in treating this condition — especially when it comes to addressing moral injury. Receiving support from a peer group is invaluable.
“We find that the group processes we use help to validate our participants’ experiences and allows them to process the resulting emotions. Very often trust issues and feelings of shame and guilt will make a person with an OSI want to isolate, but that is the worst thing you can do. There is no better way to work through pain and negative emotions than to sit with someone who knows exactly what you went through and how you feel, who tells you, ‘I sure get it. It was awful, I had to do the same thing. You were just doing your job.’”
Richardson says when he attends the Project, he feels “instantly accepted and there is no judgement. The doctors, the mentors and all involved understand us and get what we are going through… They just get it.”
Joannou adds she finds it advantageous to bring military members/veterans and first responders together in the group experience.
“When you take off the uniforms, you have the opportunity to work where we all intersect as human beings, and that is where the healing happens. There is a mutual respect between the different members. The details of their stories might be a little different, but the emotional fallout is the same. Deep personal connection seems to be the ingredient that is necessary. Throughout human history, we have come together as community, as neighbours and as tribe to make us feel safe and to work through our struggles, our tragedies and natural disasters. Somehow we seem to have lost sight of how important this is and how to do it.”
The Project Trauma retreat centre is a stigma-free, judgement-free zone, she states, echoing Richardson.
“I am really hoping that we can come to look at post-traumatic stress as a normal response to the first responder experience, and that we can continue to train more clinicians and peers in effective ways to help… I tell all of the participants in our program ‘you did not go through all this for nothing, and your story is not over yet.’”
*The DSM-5symptom groups are intrusion, avoidance, negative alterations in cognition and mood, and alterations in arousal and reactivity.
Disclaimer Blue Line is providing this content for general information only. Mental health conditions are complex, people differ widely in their conditions and responses. Information provided is not a substitute for professional advice. If you feel that you may need medical advice, please consult a qualified health care professional.
My friend just sent me a poster saying “January was a tough year, but we got through it!” We know that Seasonal Affective Disorder (SAD), or the “Winter Blues” is a real thing causing feelings of depression for many people.
Shorter days and cold and inclement weather make travel or even just putting the garbage out less enjoyable. People already battling mental health issues can certainly find the winter to be something akin to a long, lonely sentence. If you are struggling with PTSD or another Operational Stress injury, we know that the worst thing you can do is to isolate. Yet the lethargy and decreased mood that comes with SAD and the cold weather can easily drive you to do just that.
For those of you who are lucky enough to be snow birds and can escape to the south for the winter, good on you! For the rest of us that have to stay here and slog out another Canadian winter, here are some things to contemplate.
Nature, working with the physics and chemistry of life, constructs the seasons. Spring is the season of new growth and expansion, summer the season of vibrancy and brilliance, fall the season of reaping and storing, and winter the season of rest and submission. There are other cycles of life as well. A mighty oak grows with oxygen, sunlight and nutrients, but when its life cycle is over, it returns to the earth
Although it may look like things are at a standstill in the winter, there is actually much going on in preparation for the new growth season, which is only (How many weeks away? What happened to the groundhog this year, anyone know?) The apparent dormancy we see over the winter in nature is much more than a period of suspended animation. Seeds in the ground are still metabolizing, but at a slower rate. After a period of time, hormones trigger initiation of new growth, which can happen if the conditions are favourable (ie enough water around). And this time of year, all the gardeners are starting to plant seeds indoors, looking forwards to spring.
As many of you have probably figured out, we are always either growing and expanding or retreating ourselves. We are never staying at a standstill. You can feel like you are getting into better physical shape or deconditioning. You can be learning new skills and keeping up in your field, or falling behind. You can be improving mentally, or isolating more and becoming more anxious and despondent. If you pay attention to your thoughts and energy levels and where you place them, you may become more aware of what is actually going on with you.
When you are expanding, you feel excited, optimistic and energized. You feel focussed and driven. Creative ideas abound. When you are in a contracting, retreating state, you feel listless and more depressed and anxious. You may sleep too much or not enough. You feel hopeless and too often you will tend to use your thoughts and the energies you have to mentally punish yourself.
But what if you use this quiet winter time like seeds underground, to build yourself up to get ready to spring? What if you put your energies into winter sports to improve physical fitness and the time you invest in your family? What if you go into hibernation to do some serious research on courses you might want to take, projects you might want to tackle, a new business you might want to look into?
And if you are seriously in a place where you are finding yourself spiralling down, gather your energy to pull yourself up. Call your doctor and ask for an extra appointment to talk about how you are feeling and what you can do about it. Or read some good books on improving your mental state.
Call a friend and go for coffee. Go to a peer support group. Maybe there are others who are also struggling and could use your support. Maybe feeling compassion and caring for others is just the distraction and boost you need.
Winter is a great time to meditate on what is truly important. It is a time to nurture yourself and your loved ones. It is a time to be optimistic about the future and to plant those spring seeds.
The definition of a warrior is someone who is willing to put themselves in harm’s way for the benefit of others.
In the lives of our first responder and military warriors, intense, dangerous and critical scenes and incidents occur regularly. The daily stress combined with one too many tragic circumstances can lead to physical and psychic injury in caring individuals. This is what we call operational stress injury or post-traumatic stress. Very often the condition involves ethical dilemma or moral injury. This can occur if one must helplessly bear witness to unjust human suffering or is left wondering if they could have or should have done more or better. With a split second to decide, a police officer may do what he has been trained to do following exact protocols, and then may face criminal charges for having done so. A soldier may have been carrying out orders when he or she caused untold suffering. The feelings of guilt and resentment may be compounded if it is believed that the war had no noble cause. Moral injury occurs when we veer off the course that is charted by our moral compass, either by choice or by order. Feelings of guilt, sadness, anger or resentment at having been put in certain situations or being treated unfairly often combine to create an emotionally messy situation. Suicides can be the outcome of suffering caused by a seemingly unsolvable moral dilemma, leading only to more tragedy for those of us left behind.
When you are caught up in an emotional tornado, it is sometimes difficult to see the possible ways out. It can be even more difficult to choose the best one.
I learned long ago that the best way to deal with an emotionally complex and messy situation is to break it down into “basic principles”. Basic principles are those dictated by our deeply held values: love, respect, freedom, loyalty, integrity, compassion, honour, humility, peace. These trump matters of preference such as personal ease and comfort, pleasure, being “right”, winning the argument and getting our own way.
As parents, we try to teach our children right from wrong. We want them to grow up to be mature, successful, law abiding citizens who function well in society, who can sustain loving relationships and be employable. Ultimately we want them to be happy and at peace. We teach our children these basic principles by instructing them not to hit or bite others.
We encourage them to share in the sandbox and not steal other’s toys. If they have been mean to others, we make them apologize. If they destroyed someone’s property, they are made to clean it, repair it or replace it. We teach them to say things like: “thank you”, “I’m sorry”, “how can I help?”, “how are you?”, “want to come over?” We instill in them the Golden Rule. Life is difficult. Life is therapy. Our life story is a movie where we are the star character. We have many supporting actors, some who play major roles throughout our movie.
Some just make cameo appearances but may be integral to very significant scenes and plots that deeply affect us. Throughout our life movie, we are given many lessons in which to apply our basic principles. Some of us show up for these and do the homework. Some of us just don’t bother.
If we learn our lessons well, we evolve into centered, mature, wise and peaceful human beings. If we don’t heed them, we stay stuck, and because our lessons seem to come with ever increasing intensity, we often end up miserable. Sometimes the lessons are brutal. Tragic events, unfortunate choices, unforeseen circumstances, crimes inflicted upon us through the use of free will by others, all are the crux of the intense plots of our life stories. To a certain extent, we can’t avoid them.
Going back to basic principles can lead us out of the quagmire of messy emotions. You will note that most of the values that make up our basic principles involve our interactions with others. This is no accident. We are hardwired for struggle, but this is mitigated because we are also hardwired for connection.
Harboring feelings of guilt, regret, anger and desire for revenge are a waste of psychic energy and often times destructive.
They arise from a feeling of separation from others, from a desire to protect or punish the ego and the self, not from an empathic place of connection. But we have the choice to stand down.
We can always choose peace.
We can let go of our drive to be always “right” and drop the argument.
We can allow ourselves to be vulnerable.
We can make amends by saying we are sorry.
We can do our best to atone for serious transgressions or soothe painful empathy by personally addressing the victims if appropriate, or by honouring them through meditative acknowledgment and mentally sending them apologies and blessings.
We can pour our energies into restitution by making sure the same things don’t happen to others in the future. We can lobby politically for awareness and change.
We can get better and “pay it forward”.
When we follow what is dictated by basic principles, we are offered a more gentle and sensible way through the emotional tornado. Because basic principles arise out of time honoured values, they are steeped in the noble choices recorded in the great stories of history and mythology. We honour the stories of our brave warriors who faced danger, loss and adversity but who ultimately did the right thing. We honour ourselves and our own stories when we also feel we are doing the right thing in the circumstance of trials and tribulations. Making good choices about one’s attitude and best course of action is difficult, especially when post-traumatic stress symptoms affect judgement and lead to isolation. Traditional societies did not let their warriors reconcile and process their experiences alone. Tribes celebrated their returning warriors and honoured their war actions with the acknowledgement that difficult choices were made for the good of the community. Ceremonies retold the stories of courage, strength, and victory but also the stories of sacrifice, loss and hardship. These are the themes of human existence, where the richness of human experience truly reside. Contemplation of the human condition in the supportive environment of a closely knit society where all members are granted unconditional positive regard leads to psychologically healthy processing of psychic and moral trauma. Sadly, our warriors do not experience this in our current social climate. The good news is that they can.
Project Trauma Support is a new Canadian initiative that promotes connection and honours the warrior story and spirit. Promoting time tested values and unconditional acceptance, the program helps participants transition from post-traumatic stress to post traumatic growth.
2024 Music Fundraiser
Come out and join in support of Project Trauma Support, Saturday August 10, 2024.
The majority of the family’s emotional and other resources may be consumed by focusing on the affected partner’s needs, leading to further resentments of the rest of the family, who begin to feel that their needs don’t matter.
Thankfully, there is new research leading to new effective programs for the treatment of PTSD.
My friend just sent me a poster saying “January was a tough year, but we got through it!” We know that Seasonal Affective Disorder (SAD), or the “Winter Blues” is a real thing causing feelings of depression for many people.
As many of you have probably figured out, we are always either growing and expanding or retreating ourselves. We are never staying at a standstill. You can feel like you are getting into better physical shape or deconditioning. You can be learning new skills and keeping up in your field, or falling behind. You can be improving mentally, or isolating more and becoming more anxious and despondent. If you pay attention to your thoughts and energy levels and where you place them, you may become more aware of what is actually going on with you.
Call a friend and go for coffee. Go to a peer support group. Maybe there are others who are also struggling and could use your support. Maybe feeling compassion and caring for others is just the distraction and boost you need.
