PTSD. This acronym, slight and neat, has wreaked havoc upon those it afflicts. “I thought I was stronger than this”. This small, world-destroying statement is not something that is uncommon to hear. Due to the strong “hero” image within the fire service, we have a hard time accepting the idea that we could suffer a mental illness. We spend much of our waking time separating “us from them”. What we really need to come to terms with is that the “them” we run from is within our realm of experiencing. We just need the right mixture of environment, biology, and psychosocial factors.
Drill down into firefighter mental health and we see that the bullet does not stop at the person with the label; it drives a wedge deep within the family. The irritability, depression, and anxiety that accompanies someone with PTSD is a difficult minefield of unknowns for both the person, and their loved ones. Across the board, these small 4-letters dash destruction on much of what it touches. And this illness transcends. It tears through the entire breadth of people from poor to wealthy. I’ve met with folks from the lowest possible places. A real Hell, not the mythological one. One of perpetual, consistent, and tortuous being. And, I have met with others who are well-to-do, comfortable in the pay grid, and possess coveted jobs.
And yet, they both end up in the same chair. My chair.
And, there is also a lot of misinformation around the genesis of PTSD. While the media is busy diagnosing some in days, psychiatry is telling a different story. The symptoms that are now infamous need to be present for at least 30 days (according to the Diagnostic Statistical Manual (DSM)). That means living with nightmares, anxiety, thoughts of death or suicide, flashbacks, and three more pages of symptomology, for a month prior to diagnosis. While this may shock some, it also explains why blanketing all First Responders with the diagnosis is wrong. Clinically and ethically. Credit needs to be given to those who lived this hell; both to those who have lost the battle and those who have won.
The role of therapy is usually two-fold: the identification of problem thoughts and behaviours and the re-establishing of an identity. We refer to this as a “new normal”. But, this is not a passive engagement. Therapy is not easy. The trials and triumphs one needs to experience in the dismantling of an old way of living to create a new one, full of conscious distress tolerance and emotion regulation practices, takes grit. One should not fear the process, but instead trust it. Too often, people reach out to therapy at a point of desperation. Because, nothing else has worked. Not the pills, or the booze, or the other drugs. Not the short-term or the long-term sick leave. When your entire worldview has been shattered by the proof that this world can be horrible, it’s difficult to figure out exactly what might help.
But, we continue to subscribe to the approach of mental health with the emphasis on getting “help” only when we have reached a point of crisis. We ignore the prospective view of thriving mental wellbeing – which takes the idea that mental well-being is on a continuum. It isn’t black and white.
Firefighter mental health is important. And, yet we still have old guard adages and unhelpful philosophies. I remember as a probie I was once asked to conduct the age-old “sniff test”. For those unfamiliar, this was to take the newest member and have them stick their head into the structure following the fire. If their eyes water, ventilation needed to continue. If not, overhaul can begin. These ideas die hard and it takes a lot of resilience to overcome them. The idea of strength in the fire service, that safety is weakness and that health is secondary to image, remains strong.
If we struggle to promote positive physical health still in the Fire service, it is really clear the uphill battle left to overcome mental health. Thereby, stigma remains strong.
As a firefighter, I found the most commonly uttered words around the hall are “I’m fine”. More importantly, it matters who says it. If it is management who are reflecting that there was no problem and that they are “fine” after a tough call, it seems almost a guarantee that the firefighters will follow suit. This can serve as a great litmus test for stigma in your halls. Listen for it. If you hear it regularly, question whether you’ve an organizational set-up that is supportive of firefighter mental wellness.
Where should we go from here?
Education is the first step. Mental wellness of firefighters isn’t “you’re either made for it, or you’re not”. We need to remove this idea from our ranks. You want to know why some individuals have a tough time at certain calls and others do not, think of this:
Imagine a pitcher of water as your ability to withstand stress. Quickly filling glasses of stressors will lead to an empty pitcher. No “water” leaves us with no ability to handle stress. No ability to handle stress and we develop mental health concerns. And, we need to worry about much more than PTSD. The good news is PTSD is the worst-case scenario for us, meaning that there are things we can do to help protect us from it; the bad news is there are many other mental health concerns that can take hold of us prior to this, so we should be building in resiliency programming wherever possible.
So, what is resiliency? It’s what we do to re-fill our pitchers. There are many different definitions, but let’s use a simple and general one for our purpose here. Resiliency is our ability to withstand stressors without falling prey to them and to develop the necessary skills to have thriving mental health. Seems simple. What does that mean, though?
Resiliency is not something that we learn passively. We need to engage in it. Work at it. Develop it.
While there is much to do when you have been given the diagnosis of PTSD, a preventative intervention can be found in exercise. Exercise is backed by research to show its ability to melt stress. Stress is an energy. A very old energy. And we are no longer on the Serengeti, where we run for our lives or fight off the danger in front of us. We are now locked in careers, stuck on trucks, with no obvious outlet for this energy. So, we swallow hard and look proud. We’re heroes after all. And, after years of engaging in this, we experience dissipating mental wellness and develop issues. We need to rid ourselves of that energy. Exercise is one aspect that we can include to help us tamper stress and thereby fill some of our pitcher again.
Resiliency is also found in our ability to talk about the stress. Therapy looks to normalize your experiences. To suggest to you that having the reaction you are having is not “crazy” and you are not alone. Therapy is the process where you slowly open up to that stranger in the opposing chair and through this, you learn to talk. But, you can engage in this practice in advance with your crewmates, partners, and family. Spare them the gory details, that won’t help them anyways. But, talk to them about how that call made you feel. We all have times where we feels hopeless, helpless, useless, frustrated, enraged, depressed, and shocked. So, own it. Talk about it.
For those who have experienced trauma and may even carry the diagnosis of PTSD, there is good news for you as well. Post Traumatic Growth is a field in its infancy, but is showing promise. The premise is simple: by engaging in recovery practices for PTSD, you are learning new coping mechanisms to handle different stressors. And, through this practice, you become stronger and more resilient to future stressors and experiences. Through your struggle, you are able to grow. This is not an invitation to accept trauma experiences as trophies and to not engage in support. Some research, for instance, has found that children of parents with PTSD can exhibit the same symptoms. PTSD, but with no trauma exposure! So, ensuring you are getting treatment becomes paramount for your family’s health.
We need to be ensuring that we are as every bit mentally fit as physically fit. Think “State of mind AND body”. They aren’t separate after all, we need to stop treating them as such. Beginning to develop personal, if not professional and organizational, programming for resiliency is imperative.
We can’t wait for the Fire Service to overhaul itself and build this programming in for us. We need to be proactive and not reactive. If you develop your own resiliency practices, as you move through the ranks, you take that philosophy with you. Soon (and this is sooner than you think) you’ll be in a position to make those changes. Mental health is not something that is leaving. It is something that we need to learn to protect from, educate ourselves on, and destigmatize.
For more information, go to www.afterthecall.org
About the Author
Nick Halmasy is a registered psychotherapist (qualifying) in Ontario Canada. He also served for 10 years as a firefighter and Fire Instructor for both municipal and industrial firefighting.
