Hazmat Suit for the Soul—Part 1 of 3
A prior version of this article was printed on Corrections.com January 03, 2011. It has been updated and reprinted with permission from Correctional Oasis: Volume 12, Issue 9.
The other day I heard someone state that, as firefighters expect to see charred bodies on the job, correctional workers should expect to encounter violence, injury or death at work. Consequently, that person proceeded to say, they should be prepared to deal with such incidents, and not be negatively affected by them.
The speaker made two points here about corrections personnel: (1) that staff should be prepared to deal with workplace traumatic incidents; and (2) that they should not be adversely affected by such exposure—that they should be practically immune to its effects, even when these keep happening over and over.
These are two separate issues that need to be addressed separately.
(Before proceeding with this subject, however, I would like to add that there is an underlying assumption in the above statement about firefighters that does not hold true when scrutinized further. That assumption is that firefighters are not psychologically harmed by their exposure to trauma on the job. The fact is that in several studies firefighters have been found to suffer from high rates of PTSD, depression, and alcohol abuse disorder [1,2]. This indicates that regardless of their degree of preparation, on the average, firefighters may not be getting through traumatic exposure unscathed.)
Let us now go back to the two issues of corrections staff’s preparation for what they may encounter on the job, and the degree to which they may be affected by traumatic exposure.
Corrections agencies diligently train their staff to respond to incidents of violence, injury or death. They train them to intervene and take charge of situations to minimize harm to both offenders and staff. Staff are trained to save lives in the case of offender self-injury or suicidal behaviors, offender medical events or accidents. They are trained to deescalate conflict, to quell disturbances of various sizes as safely as possible, and to respond to arson. Staff are also trained to prevent such incidents through wise use of intelligence, their own observations, and their communication skills. Corrections personnel are usually very well trained to take control of their external environment.
However, how well are they trained to manage their internal environments—that is, themselves, their thoughts, emo-tions, and physical reactions right before, during and after such events?
Historically, the psychological effects of corrections staff’s routine exposure to traumatic incidents has not received a lot of attention. The traditional perspective has been that there is no need to address this issue because corrections staff (officers, in particular) on the whole are unaffected, due to their “toughness.” But how valid or realistic is that perspective, particularly after staff’s repeated and often intense exposure to such events?
The fact is that exposure to trauma, especially when it happens intensely and repeatedly, can have a multitude of ad-verse consequences, regardless of preparation. The military has recognized that during the last few decades.
(Let us now introduce a new term here. Repeated exposure to traumatic incidents is also called “complex trauma.” We shall use this term in the rest of this article, as corrections professionals are rarely if ever exposed to only one traumatic event in the course of their careers.) [3,4]
Complex trauma can result in psychological symptoms and even diagnosable psychiatric disorders, with their associat-ed functioning impairments in one’s personal and professional life. Conditions such as PTSD (full-blown or partial), different types of depression, various anxiety disorders, and substance use disorders, such as Alcohol Use Disorder, frequently follow complex trauma. Moreover, these disorders may be comorbid—that is, a person may suffer from more than one of these disorders at the same time. One common such combination in the corrections workforce (as well as in military personnel and veterans) is the comorbidity of PTSD and depression, which can have devastating outcomes, such as suicide. [5]
As if that was not enough suffering, complex trauma can also result in physical illnesses, such as cardiovascular disease, gastro-intestinal diseases, and sleep disorders, also with their associated functioning impairments. The Adverse Childhood Experiences (ACE) study [6] showed that clearly in the general population. According to Bessel van der Kolk, “(a)s the ACE study has shown, child abuse and neglect is the single most preventable cause of mental illness, the single most common cause of drug and alcohol abuse, and a significant contributor to leading causes of death such as diabetes, heart disease, cancer, stroke, and suicide.” (p. 351) [7]
Both the psychological and physical consequences of complex trauma affect the workplace adversely. Job performance is hampered by, for example: (a) absenteeism—“calling in sick” and necessitating that other staff work doubles (increasing overtime costs) or posts remain vacant (increasing the risk of something dangerous happening, or of something important remaining undone); (b) policy violations (due to errors of omission, such as due to forgetfulness or fatigue, or errors of commission, such as due to staff irritability or anger outbursts), or even (c) “presenteeism”—staff reporting to work while ill, injured, depressed or anxious, thus saving on overtime for their agencies but performing at levels lower than their usual productivity.
This could include substantial errors of omission (one of the most frequent causes of security violations), while masking and failing to deal with any potentially relevant underlying issues, thereby perhaps prolonging them, and possibly, as a result, spreading negativity to co-workers.
The cost of these consequences to administrators is enormous. For example, a recent study reports that the economic burden of individuals with Major Depressive Disorder in 2010 in the U.S. was $210.5 billion dollars, of which 48% were attributable to workplace costs of absenteeism and presenteeism. [8]
And, perhaps most ominously, complex trauma can result in biochemical and even structural neurobiological changes. These brain changes then manifest in a variety of physical, psychological, and spiritual symptoms. (For a fascinating, though technical read of the neurobiology of psychological trauma, read “Healing the Traumatized Self: Consciousness, Neuroscience, Treatment” by Paul Frewen and Ruth Lanius. Another excellent and less technical book is “The Body Keeps the Score: Brain, Mind, and Body in the Healing of Trauma” by Bessel van der Kolk.)
What do we know about corrections personnel? What happens to those exposed to traumatic incidents on the job? In a nutshell, malfunctioning—be it underperforming at work, absenteeism, physical illnesses, psychological distress symptoms, and even full-blown psychiatric disorders. Data exist on the prevalence of PTSD, depression, anxiety, and the most toxic combination of co-occurring PTSD and depression in corrections staff. Data exists on the relationship between such disorders and consequences on physical health, sick leave, and dissatisfaction with life. Data exist on the prevalence of Corrections Fatigue and the low implementation of resilience-promoting behaviors among corrections staff. Data also exist on the extremely high suicide risk of corrections officers. And HR departments have the data on staff policy violations on the job, and malfunctioning off the job—including DWAIs, DUIs, family violence, and other types of violent incidents in the community.
So, repeated exposure to traumatic incidents—complex trauma—wields a formidable weapon against staff’s psychological and physical well-being. To use another metaphor, complex trauma is toxic, hazardous to staff’s health. But if traumatic toxicity is an expected part of the profession, how are the staff being prepared to protect themselves?
Professionals trained to clean up toxic materials don their hazmat suits before going to clean up a liquid chlorine spill on the highway. Workers in nuclear settings wear contamination suits as well. And soldiers carry equipment to counter different types of environmental eventualities. Yet correctional workers are oftentimes thrust into situations that make war zones pale by comparison in terms of unspeakable gruesomeness, mayhem, and danger that can follow them home. How are they being psychologically prepared beforehand to handle such “hazardous materials,” and how do they “decontaminate” themselves afterwards? What kind of hazmat suit are they given to wear while exposed to such incidents and conditions? They—YOU—train themselves/yourselves physically to respond, but do they—you—train to de-contaminate emotionally ? Is it even realized or acknowledged that an incident may have had hazmat-type consequences? And how frequently is that realization a part of correctional training and preparation?
To be continued in the October 2015 issue of the Correctional Oasis.
REFERENCES
[1] Perrin, M.A., DiGrande, L., Wheeler, K., Thorpe, L., Farfel, M. & Brackbill, R. (2007). Differences in PTSD prevalence and associat-ed risk factors among World Trade Center disaster rescue and recovery workers. American Journal of Psychiatry, 164, 1385-1394.
[2] Wagner, D., Heinrichs, M., & Ehlert, U. (1998). Prevalence of Symptoms of Posttraumatic Stress Disorder in German Professional Firefighters. American Journal of Psychiatry, 155, 1727-1732.
[3] Herman J.L. (1992). Complex PTSD: A syndrome in survivors of prolonged and repeated trauma. Journal of Traumatic Stress.;5(3):377-391.
[4] International Society for Traumatic Stress Studies. The ISTSS Expert Consensus Treatment Guidelines for Complex PTSD in Adults. Available at http://www.istss.org/ISTSS_Main/media/Documents/ComplexPTSD.pdf.
[5] Connera, K.R., Bossartea, R.M., Hea, H., Aroraa, J., Lua, N., Tua, X.M., Katz, I.R. (2014). Posttraumatic stress disorder and suicide in 5.9 million individuals receiving care in the veterans health administration health system. Journal of Affective Disor-ders, 166-1-5.
[6] The ACE Study. http://acestudy.org/
[7] van der Kolk, B. A. (2014). The Body Keeps the Score: Brain, Mind, and Body in the Healing of Trauma. New York: VIKING, Pen-guin Group
[8] Greenberg, P.E., Fournier, A.-A., Sisitsky, T., Pike, C.T., and Kessler, R.C. (2015). Journal of Clinical Psychiatry, 76, 155-162.