Roanoke Times
Copyright (c) 1995, Landmark Communications, Inc.
DATE: MONDAY, January 20, 1992 TAG: 9201180265
SECTION: EXTRA PAGE: 1 EDITION: METRO
SOURCE: DANIEL GOLEMAN THE NEW YORK TIMES
DATELINE: LENGTH: Long
HELP IS AVAILABLE TO RESCUE THE HIDDEN VICTIMS OF TRAUMA
When an engine fell off American Airlines flight 191 near O'Hare International Airport in 1979, the crash resulted in a death toll of 273 people.But it took another, more subtle toll - on the emotions of those who had to deal with the emergency.
Some of the greatest suffering was among the police officers who sifted through the wreckage to gather pieces of mutilated bodies.
"Within a month or so almost every one of them had started looking for transfers to other jobs," said Christine Dunning, a professor of government at the University of Wisconsin in Milwaukee.
At the time of the crash, Dunning, herself a former police officer, was asked to meet with the upset officers and to talk with them about the emotional aftershocks they were suffering.
That was one of the first large-scale attempts to deal with a fact that had long been ignored: Rescue workers themselves can become hidden victims, psychological casualties of traumatic events.
The conventional wisdom has been that people who routinely encounter horrible events somehow learn to endure the emotional turmoil that so often afflicts the victims they rescue.
But today such suffering is recognized as an occupational hazard for police officers, firefighters, rescue workers, ambulance teams and other people whose jobs regularly put them in the midst of tragedies and traumas. As a result there are now nationwide efforts to provide psychological help for them.
In the early 1980s, the issue was "whether workers needed any help at all," said Dr. Don Hartsough, a psychologist in Indianapolis who consults with firefighters and police officers there. "The public thought, `These are professionals, they see it all the time, they're different from the rest of us.' "
Dunning, who has studied the psychological aftermath of traumatic situations, said that because these attitudes were also common in police departments, fire departments and rescue services, there was a tendency, especially among safety workers, "to suffer in silence. People were ashamed they were having these reactions."
Despite the training procedures devised for rescue workers, more than 70 percent have symptoms of post-traumatic stress in the course of their work, according to a report last month in the British Medical Journal.
Post-traumatic stress disorder is a set of symptoms that result from an unusually disturbing event. Symptoms, including nightmares, flashbacks and nervousness, can last from weeks to years.
Information about emotional vulnerability is being included in training courses, and psychological debriefing by specially trained peers is becoming routine after traumatic incidents.
One such debriefing has been devised for police officers involved in a shooting. "In Milwaukee, if an officer has someone fire at him, a specially trained officer responds immediately," Dunning said. "If an officer is shot, there's someone there in the hallway of the hospital 24 hours a day in case he wants to talk."
Once unusual, debriefings are now common in the police departments of major cities, at the Secret Service, the FBI, military units, fire departments, and for workers in emergency services and protective services who handle cases of child abuse.
Rescue workers find incidents that involve the death of a child the most traumatic, Dunning said: "There was a fire in Milwaukee in which 12 children died. Seeing the death of that many children is overpowering. The paramedics who had to bring the bodies out were psychologically overwhelmed. Some had nightmares and flashbacks."
For police officers Dunning surveyed, the second most traumatic event, after one involving the death of a child, was shooting or injuring someone, and the next was being shot or injured themselves.
The most common reaction was a heightened sense of danger and vulnerability. "One trait police are selected for is a sense of being in control, a command presence," Dunning said. "A shooting strips away that protective sense of invulnerability. It leaves you shaken."
For rescue workers, a major source of post-traumatic stress is the failure of their mission - the inability to save someone. "One of the most traumatic situations I know of was when a police officer came on a car that had slammed into a telephone pole," said Dunning.
"The husband was dead at the wheel and his pregnant wife was pinned in the front seat, yelling, `Save my baby.' Only after he got her out and the car burst into flames did the officer realize that she meant he should save her 1-year-old baby in the back seat."
One frequent reaction to such incidents is to withdraw emotionally from families and friends. Besides such emotional estrangement, "domestic violence is often a result of the anger," Dunning said. "Other common reactions include drinking and affairs. Post-traumatic stress takes its toll on families, too."
While studies show that alcoholism is one of the more common reactions to post-traumatic stress, suicide also occurs, though rarely.
One of the best antidotes is psychological preparation. "If we educate people to demystify the post-traumatic reactions - alert people to the fact that crying, nightmares and flashbacks, fears are normal, then the stigma is gone and they can talk about it when they need to," Dunning said. "It's no longer an embarrassment."
In her educational programs, Dr. Dunning emphasizes that post-traumatic stress is a normal reaction to horrific situations. "No one thinks the less of you if you break an arm in a car wreck," Dr. Dunning said. "The same is true for the emotional wounds of responding to a traumatic incident. It's a mental injury, not something to be ashamed of."
In a typical intervention, all the people who were involved in the traumatic event are gathered together within a day or two to talk about it in confidential sessions. First, each person tells their version of what happened, how they felt and what they thought at the time. Then they talk about their reactions since the event.
"As people hear their reactions are shared, they realize they can be affected and still be competent," said Hartsough. "The first 72 hours is the window of opportunity. After that people begin to seal over their raw feelings."
In the debriefing sessions, people also are told about the range of reactions that are considered normal in the weeks and months after the event. One is that "unwelcome reminders have their effects," said Hartsough. "If a crew goes back to the same neighborhood where they had a troubling time, they'll remember and have an upwelling of feelings."
The main symptoms of post-traumatic stress usually clear up in a matter of weeks. "I tell people that if they're still feeling upset about this in a month, they should come see me for more counseling."