Yeah, right. "Suffering is a function of pain and the degree to which the pain is being resisted" (Shinzen Young).
Line of duty death.
Death or injury of a child.
Prolonged failed rescue and mass casualty events.
Victim known to responder.
Suicide of a colleague.
Administrative or colleague betrayal.
These are the main “critical incidents” that can cause a first responder, or anyone, to develop symptoms of post-traumatic stress. PTSD is real. Unfortunately, it’s become a throw-away term, and not even taken seriously. There are oftentimes extremely strong emotions attached to the event that can interfere with a person’s ability to function either at the crisis scene or away from it at home (see Critical Incident Stress Debriefing From a Traumatic Event).
PTSD is not “Oh, I couldn’t find toilet paper at the market, I get such PTSD from shopping!” PTSD is what happens when a brain keeps cycling through fight-or-flight, when the amygdala (the non-verbal part of the brain) stores emotions connected to traumatic experiences. The incident itself triggers a cascade of chemicals in the brain, over which you have no control. This is the body protecting you. The feeling is intense. Like being poisoned, in some ways.
Some traumatic memories are useful (they can protect you); some are upsetting (guilt, fear, regret, shame, abandonment); and some are triggered into activity when something reminds you of the traumatic experience, however distantly (you smell cigarette smoke and so you run and lock yourself in your room, because the scent of the smoke is the scent of the person who raped you, and so you have to run ... without knowing why).
With PTSD, your brain is telling you that the world is unsafe and dangerous. You can get hurt, and people aren’t trustworthy.
What I like about PTSD – yes, I said that – is that it reminds me that what others, or I, perceive in myself as deficiency, inability, laziness, or poor ethics (among other judgment calls) is not about me at all. It’s about what my brain is doing, caught in its rut of emergency response that may have lasted for years.
What I also like about PTSD is that it reinforces the notion that we do not go through life like little islands, insulated from the world or each other. That we affect each other, in real, tangible, biological and energetic ways. That bad things can “stick.”
And one more thing: I like the idea that you can overcome PTSD. You can even prevent it, IF action is taken shortly after the critical incident to mitigate its effects.
I’ve been to a couple of what I call “PTSD Summer Camp” sessions at a nonprofit facility for first responders. There, I have been taught to take things in small bites. Because there are many bites to be taken, and it can be overwhelming. And of course, besides the major critical incidents listed, there are also the other major challenges in life that feel very similar and can derail you and make you think you’re in a trauma situation again (and maybe you are), such as divorce, moving, loss of work, and sudden major health changes.
First responders are surprised when others look aghast at them when they recount a critical incident as if it’s commonplace. The fact is, only 4% of the population is capable of doing “first responder” kind of work.
This is something that I must often repeat to myself. To me, it was “natural” to walk into an emergency room bay and sit with a dead person and his/her family. For most people, that barely ever happens. Such experiences echo the meaning of the Latin word “absurd” in both its existential context and literal translation of “being out of tune.”
Critical incidents – trauma – are “out of tune” with normal life. They are things that should not happen – or at least, things we are not used to have happening. Planes flying into the Twin Towers. Your child being raped. An earthquake, or a pandemic.
I made a list of things I’ve been involved in not only in the past year, but in my life, and, like all good first responders, initially thought they were nothing. That’s why you have to take this stuff in small bites – because it’s heavy and intense, and painful, and the reason why some people arrive at a point where they see no other solution to their pain but to take their own life.
On my list for the past year:
- suicide of a colleague
- death of a child (five, actually)
- serious injury to a child (several)
- COVID19 (mass casualty; death of colleagues; personal safety in jeopardy; prolonged failed rescue; line of duty death)
- administrative/colleague betrayal (former couples therapist misconduct; elementary school scandal over child sex abuse)
... and moving, loss of relationship, loss of work.
On my list for my entire life:
- fired upon by mortars in Afghanistan (personal safety jeopardized - duh)
- death of a friend in Afghanistan
- worked in Haiti on three separate service trips right after the earthquake of 2010 (personal safety; mass casualty; prolonged failed rescue)
- chaplain to patients/families/staff during the bombing of the Boston Marathon (mass casualty)
- chaplain (all night long) to the police officer murdered that week (mass casualty; personal safety; failed rescue; death of a child – even though he was a young man, when I met his mother, he was a little boy again)
- death or injury to other children, including one the same night as the police officer’s death
- danger to my own children (taking youngest daughter as a baby in the middle of the night to the ER)
I’m probably leaving something out.
(painting by me)
On top of all that, two divorces, recent broken relationship, lost jobs, feeling of being “at sea,” addictive crap, prostate cancer, intractable chronic pain from nerve damage, two car crashes, several instances of sexual abuse as a kid ... Those are all pretty critical too.
And all include the component of grief, either allowed, or repressed in order to just survive.
I guess I feel chronically unsafe. That’s a PTSD symptom: head on a swivel, sitting in a room where I can see the door, making sure I know where the exits are. As well as being unable to really concentrate, nor to sleep well; unable to hear certain songs or see certain pictures or even to visit certain places because those things also impact me. Not poignancy nor nostalgia, but more like punches in the gut.
And then: the pulsing moments of what must be a kind of joy, a realization that if you can swing it, all of that happens while good things in life happen too. (That’s a moment when I can let down my guard, I suppose).
And also: that you’re not alone. Pain reminds me that we are in this together, much as we so arrogantly assume we’re not.
That list above certainly gives me pause, and may make you also wonder, what keeps him going? But everyone has their stuff, don’t they? We try to escape it, a lot.
The other choice is to dive into it, and make a temple of your pain, as a Buddhist named Shinzen Young says. The harder you fight against it, probably the worse it hurts. And for sure, to embrace and meditate on pain is not instinctual at all. I'm going to try it. Can someone be an accountability buddy for this?