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Dr. Katherine Ramsland: Cops and Cumulative PTSD

 

“Officers who deal with human trauma might not recognize its toll till too late.”

 

KEY POINTS

  • Repeated exposure to trauma can weaken the ability to cope, resulting in cumulative PTSD (CPTSD).
  • Since it’s not linked to a specific incident, CPTSD can go undiagnosed.
  • Educating police officers about CPTSD can inspire preventative treatment that benefits the whole organization.

In the Boston Globe recently, Nicholas DiRobbio described a disabling condition that forced him out of his job as a cop. One day, something just seemed to come over him. Common noises like kids shouting jarred him. He grew scared to leave his house. Some days he sat in his cruiser and screamed. He didn’t recognize himself.

“As a cop, you struggle with your identity,” he told the Globe. “You can’t reform, and you’re broken—you’re not that person and that hero you used to be.” Finally, he quit the force and sought counseling. He knew something was wrong, but he didn’t know what.

DiRobbio learned that he suffered from cumulative post-traumatic stress disorder (CPTSD), or the sum reaction to a build-up of trauma over time. It’s like piling one too many bricks on a scaffold that finally collapses.

The Effects of Cumulative Post-Traumatic Stress Disorder (CPTSD)

“I never anticipated that it feels physical,” he said. “It feels like a weight. You get pressure on the chest area, you feel this heavy burden like a pain, and you feel physically uncomfortable in your own body… I was shaking a lot, uncontrollably… Someone who is a police officer and faced all kinds of stuff, I’m not afraid, but my body wouldn’t physically let me leave the house.”

He describes his experience in Invisible Wounds, insisting it’s not a weakness of character as it’s often portrayed but a process beyond one’s control. Dr. Michelle Beshears, in the Criminal Justice Department at American Military University, agrees. “Cumulative PTSD can be even more dangerous than PTSD caused from a single traumatic event,” she states, “largely because cumulative PTSD is more likely to go unnoticed and untreated. If untreated, officers can become a danger to themselves and others.”

We hear a lot about PTSD but not much about this more nebulous condition. Yet, those on active duty who routinely deal with human trauma are vulnerable to it. Law enforcement is one of the occupations at greatest risk, given how much they’re exposed to conflict, trauma, and death.

“I went to 30 incidents of dead people,” DiRobbio recalled. “I remember every single one of them…. There [are] sights and smells and people crying; that sticks with you.”

Cerel et al. (2018) examined the results from 800 officers who’d completed a survey about their exposure to suicide incidents. Almost all participants (95 percent) had responded to at least one such scene, with an average of 31 over a career. One in five reported a scene that had triggered nightmares, and close to half reported seeing things that had stayed with them. The researchers found a significant association between frequent exposure to suicide and behavioral health consequences, mostly depression, anxiety, and sleep disorders—all signals of potential CPTSD.

Supporting First Responders With CPTSD

This mental health injury appears to be a growing issue for first responders. Valazquez and Herandez (2019) reviewed research on police mental health. “Working as a first responder,” they write, “has been identified as one of the few occupations where individuals are repeatedly placed in high stress and high-risk situations.” Typical coping strategies show a failure within organizations to recognize a developing issue like CPTSD. One of the most persistent barriers to seeking help is the stigma attached.

“It is evident that officers unknowingly advocate negative attitudes about seeking mental health support based on the organizational stigma. Organizational stigma manifests in the way the agency prioritizes officer wellness and provides supportive services.” They argue that for the greater good, organizations must address the stigma directly, diminish its impact, and encourage the use of services.

Among the types of experiences that can negatively affect cops are officer-involved shootings, vehicle pursuits, volatile domestic situations, and witnessing the aftermath of rapes, accidents, suicides, and homicides. Symptoms of CPTSD include intrusive thoughts, sleep or eating disorders, adverse mood shifts, withdrawal from friends and family, agitation, physical deterioration, and disorientation.

However, few departments have effective support in place. It’s no secret that the police culture has traditionally dodged the topic of mental health, an approach that has only added to the rise in depression, CPTSD, and suicidalthoughts among officers. They feel guilty, embarrassed, and ashamed about asking. They think their peers will now view them differently. So, instead of expressing their feelings to relieve the pressure, they withdraw. Although some departments now include critical incident debriefing for this purpose, many do not.

Trauma Risk Management (TRiM) is a peer-support process that aims to erase stigma and encourage seeking help. Watson and Andrews (2018) found that in military populations, this instrument has shown beneficial effects. Studies with TRiM in police departments in the UK are ongoing, but early reports indicate a positive reception.

Ignoring mental health problems in cops won’t erase them. Education, training, and support are needed to ensure the welfare of those who keep us safe.

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References

Beshears, M. (2017, April 3). Police officers face cumulative PTSD. Police 1.https://www.police1.com/health-wellness/articles/police-officers-face-c…

Carlson-Johnson, O., Grant, H., & Lavery, C. (2020). Caring for the guardians—Exploring needed directions and best Practices for police resilience practice and research. Frontiers in Psychology. https://doi.org/10.3389/fpsyg.2020.01874

Cerel, J., Jones, B., Brown, M., Weisenhorn, D. A., & Patel, K. (2018). Suicide exposure in law enforcement officers. Suicide and Life-Threatening Behavior.doi.org/10.1111/sltb.12516

Velazquez, E., & Hernandez, M. (2019). Effects of police officer exposure to traumatic experiences and recognizing the stigma associated with police officer mental health: A state-of-the-art review. Policing: An International Journal,42(4), 711-724.

Watson, L., & Andrews, L. (2018). The effect of a Trauma Risk Management (TRiM) program on stigma and barriers to help-seeking in the police. International Journal of Stress Management,25(4), 348–356. https://doi.org/10.1037/str0000071

Velazquez, E., & Hernandez, M. (2019). Effects of police officer exposure to traumatic experiences and recognizing the stigma associated with police officer mental health: A state-of-the-art review. Policing: An International Journal, 42(4), 711-724.

Watson, L., & Andrews, L. (2018). The effect of a Trauma Risk Management (TRiM) program on stigma and barriers to help-seeking in the police. International Journal of Stress Management, 25(4), 348–356. https://doi.org/10.1037/str0000071

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This article originally appeared in the October 18, 2021 of “Psychology Today.” It is published here with the permission of the author, Katherine Ramsland Ph.D.

Cover photo by Katherine Ramsland.

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Katherine Ramsland teaches forensic psychology at DeSales University, where she is the Assistant Provost. She has appeared on more than 200 crime documentaries and magazine shows, is an executive producer of Murder House Flip, and has consulted for CSI, Bones, and The Alienist. The author of more than 1,000 articles and 68 books, including How to Catch a Killer, The Psychology of Death Investigations, and The Mind of a Murderer, she spent five years working with Dennis Rader on his autobiography, Confession of a Serial Killer: The Untold Story of Dennis Rader, The BTK Killer. Dr. Ramsland currently pens the “Shadow-boxing” blog at Psychology Today and teaches seminars to law enforcement.

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Qualified Immunity: A Get Out of Jail Free Card for Police?

“Qualified immunity balances two important interests—the need to hold public officials accountable when they exercise power irresponsibly and the need to shield officials from harassment, distraction, and liability when they perform their duties reasonably.” Pearson v. Callahan 

Qualified immunity protects government officials, including police officers, from lawsuits alleging that the official violated someone’s clearly established statutory or constitutional rights. More about “clearly established” in a moment.

In the case of Harlow v. Fitzgerald, the U.S. Supreme Court recognized the need for a qualified immunity defense to protect government officials, including police officers, from frivolous lawsuits that often stem from their official actions. However, the Court also made it perfectly clear that the vast majority of government officials, again, including police officers, are not entitled to absolute immunity. That privilege is solely reserved for a select few officials at the top of the food chain.

Qualified immunity lawsuits may proceed only when an individual’s “clearly established” statutory or constitutional rights have been violated.

When examining cases of qualified immunity, courts consider if a reasonable government official or police officer knew that their actions violated the rights of the plaintiff. Another factor considered by the court is if the law in question was in effect at the time of the alleged violation of a right(s). Of course, if the law is the same at both times, then that is the law that’s considered when determining an outcome.

The “reasonableness” of a particular use of force must be judged from the perspective of a reasonable officer on the scene, not in hindsight.

Qualified immunity applies only to lawsuits against individual government officials, again, including police officers, and not those against the overall government itself. Damages caused by a government official may be covered under qualified immunity, yes, but a government may still be held responsible. This is why we sometimes see damages paid by cities to individuals, or their families, as a result of, for example, a police action.

Police officers can act without fear of being sued as long as their conduct does not violate the victim’s constitutional rights. However, those rights must be so clearly established and apparent that a reasonable person would have known them. This is the intended purpose of Qualified Immunity.

An example of qualified immunity is when an officer reasonably but mistakenly concludes that probable cause exists, or when they reasonably believe that their action was constitutional.

Officer Real Lee Honest passed by a liquor store while walking his beat. He saw a man behind the counter holding the store clerk in a chokehold. The two men stood near the cash register. Officer Honest, believing the man was robbing the clerk, immediately called for back and then entered the store with his pistol in hand, aimed at the “robber.” The officer shouted for the robber to release the clerk and to lie flat on the floor. The man complied while loudly proclaiming innocence but allowed the officer to apply handcuffs to his wrists.

Lots of shouting between the officer and the suspect. The store clerk was also shouting something, but the officer whose adrenaline was in “Danger/Robber-in-Progress” mode was unable to process the words of the clerk due to auditory exclusion. His attention was on the “robber” and, of course a safe outcome of the situation.

As it turned out, the “robber” was a MMA fighter called “Snake” who trained with his best friend, the store clerk, and he was merely demonstrating a technique to his pal.

Snake felt his rights had been violated and he hired an attorney to sue the officer. The court, though, ruled that the officer acted in good faith and that no reasonable person would have thought the officer’s action were unconstitutional. An honest and reasonable mistake. Qualified immunity applies.

In the case of Derek Chauvin, the former police officer charged with the killing of George Floyd, the victim’s family may have a difficult time proving their civil case against the officer due to qualified immunity. To prevail, they must cite precedents in which past defendants were found to have violated the law in exactly the same manner as the violations committed by Chauvin.

It’s important to know that qualified immunity applies only in civil cases, NOT in criminal trials. So no, qualified immunity is NOT a get out of jail free card for police. Qualified immunity helps officers to not second guess their actions when mere seconds count when in life or death situations.

The split second decision of protecting their lives or the lives of others should not hinge on the worry of losing everything they own in a civil lawsuit. Instead, their sole worry when in a life or death situation, should be on living to see another day. Still, the decision must be one that’s reasonable and does not violate constitutional rights.

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