Long-term effects of violent encounters

[seamusTX]

In addition to the immediate and short-term psychological effects of violent encounters discussed in this thread, violent encounters frequently (in more than 50% of cases) have long-term psychological effects, including

• persistent recrimination or regret ("what could I have done differently?")
• depression
• anxiety
• flashbacks
• panic attacks
• nightmares
• insomnia

These are symptoms of Post Traumatic Stress Disorder (PTSD). Here is a good article about it: http://www.mayoclinic.com/health/post-t ... er/DS00246" onclick="window.open(this.href);return false;

For these reasons, many police agencies now recommend that officers involved in the use of deadly force and other violent incidents receive psychological counseling immediately after the event and periodic follow-up.

These concerns are not limited to shooting in self-defense. People often have similar symptoms after being on the receiving end of a violent attack, or car wrecks, fires, or other disasters.

There is probably no telling whether a particular person will suffer from PTSD after a violent incident. Some people seem to go through the most horrendous situations, such as being held in a Viet Cong prison camp, with no long-term effects. Others suffer severe effects from a single incident.

This information might fall into the "everybody knows that" category, but it's worth discussing from time to time.

- Jim

[atxgun]

Years ago my apt was robbed while I was out of town for christmas vacation. This year I wasn't able to make it home to family so I was staying w/ a friend on christmas eve. Christmas morning I had a nightmare my place was getting robbed. Ended up with one of those movie scene wakings where I jump up breathing heavily and can feel adrenaline coursing through my veins.

It left me with one of those weird after dream feelings lingering that my place *was* getting robbed. Even though I knew this was illogical I still eventually had to get up and and drive back to my place to ensure everything was okay to shake the feeling.

[seamusTX]

Years ago my apt was robbed while I was out of town for christmas vacation. This year I wasn't able to make it home to family so I was staying w/ a friend on christmas eve. Christmas morning I had a nightmare my place was getting robbed.

This "anniversary syndrome" seems to be common. Many Americans who were adults on December 7, 1941, experienced it for decades after.

Andy, how do you account for your resiliency? Do you think it is due to basic personality, or specific training or mental preparation?

- Jim

[Excaliber]

In addition to the immediate and short-term psychological effects of violent encounters discussed in this thread, violent encounters frequently (in more than 50% of cases) have long-term psychological effects, including

• persistent recrimination or regret ("what could I have done differently?")
• depression
• anxiety
• flashbacks
• panic attacks
• nightmares
• insomnia

These are symptoms of Post Traumatic Stress Disorder (PTSD). Here is a good article about it: http://www.mayoclinic.com/health/post-t ... er/DS00246" onclick="window.open(this.href);return false;

For these reasons, many police agencies now recommend that officers involved in the use of deadly force and other violent incidents receive psychological counseling immediately after the event and periodic follow-up.

These concerns are not limited to shooting in self-defense. People often have similar symptoms after being on the receiving end of a violent attack, or car wrecks, fires, or other disasters.

There is probably no telling whether a particular person will suffer from PTSD after a violent incident. Some people seem to go through the most horrendous situations, such as being held in a Viet Cong prison camp, with no long-term effects. Others suffer severe effects from a single incident.

This information might fall into the "everybody knows that" category, but it's worth discussing from time to time.

- Jim

Those who are least prepared for the possibilities and whose whole world view is "turned upside down" by the event are much more likely to suffer from PTSD. It is not an inevitable follow on to being involved in a life threatening situation.

Those who are well prepared for the type of incident they're involved in, well trained, and act with clear justification with no other good options available, tend to get through just fine, particularly when they are well supported by their close family and friends.

During my time in police service, several officers who I knew very well were involved in fatal officer involved shootings. None of them suffered anything more than a few nights of lost sleep, primarily due to the overstimulation of coming that close to death and thinking about it afterwards. They all personally regretted that they had to take a life and spent a good deal of time going over every detail to see if there was anything they could have done differently to avoid having to kill, but they understood that it was the aggressor's actions that compelled them to act, and there hadn't been any desire on their part to harm another..

Each incident was a good, clean shoot with no other reasonable options available. That being said, routine counseling after such an event is the prudent thing for any department to do. The risk is there, and it should be addressed. This is especially true when the initial circumstances are questionable, and where either the media or segments of the community demonize the officer or defending civilian for his or her actions.

Wartime military environments are much different than civilian defense, or even police work in most areas. Soldiers today often operate in theaters where it's almost impossible to sort out friend from foe until being fired on. They go through IED explosions, and see multiple instances where their close friends are seriously injured or killed, often in very compressed time periods. They have to make multiple rapid decisions on when to engage an apparent enemy, only to sometimes discover afterwards that the engaged individual was not really a threat, and they don't have the shelter of being assigned to administrative duties for weeks or months to help them sort things out. These situations carry a much higher risk of PTSD than well justified civilian defense incidents.

Police work where officers are constantly exposed to very high levels of violence also carries much higher risk than similar work in areas where violence is the exception and not the norm.

[Excaliber]

I've never experienced any of the above, apart from a lingering sadness (not regret) - wishing that / wondering if different actions could have avoided the loss-of-life.

Andy,

Your reaction is very much in line with what I've seen in other well trained, moral warriors.

Good men don't want to harm others, and will always question themselves to see if there was another way. If they find a plausible one later, they may beat themselves up over it for months or years, even though that solution wasn't available because it wasn't thought of during the time frame available during the incident, and may well only have come to light from facts from the post incident investigation, and unknown to the defender at the time. In these cases, it almost always takes the help of others who understand these issues to help the involved individual come to terms with himself and God.

[stevie_d_64]

I've never experienced any of the above, apart from a lingering sadness (not regret) - wishing that / wondering if different actions could have avoided the loss-of-life.

I believe Andy nails it here...And since I know he comes from experiencing this first hand, he has the correct attitude from the results of those encounters...

I believe most of the "counseling" out there is to make the person "feel" (I hate that term) regret, or remorse; and the effect of that counseling is designed to bring about doubt, and hesitation (second guessing) if that person want to continue in a particular line of work, (i.e.: law enforcement, military service, fire and rescue, etc etc)

Don't get me wrong, I do not believe anyone who takes up those careers is destined to be a basket case at the end of the day...

I believe it is ok to experience sadness, and I believe you need to analyze your actions to determine if you might have been able to do something different to avoid some negative aspect as to the result of your actions...I believe you can learn from that type of analysis, but it should not be to the point that you regret anything about a particular course of action...

The one cold, hard fact to our community is that we certainly do have the ability to take a life in the defense of our own, and others...But the reality is that you had better be prepared to be responsible, yet equally accountable for your actions...That is a yoke you bear every single time you strap a firearm to yourself, even when it is for all the right reasons...

[seamusTX]

[Soldiers] don't have the shelter of being assigned to administrative duties for weeks or months

That's a good point.

Also, when civilian LEOs are off-duty, they have the same low risk of violent encounters as other middle-class citizens.

Soldiers can never know that they are safe from missiles and other such sudden attacks when they are in theater.

This situation was particularly troubling for WW II personnel, because radar was not widely available, and aircraft bombers had a large tactical advantage.

- Jim

[seamusTX]

I believe it is ok to experience sadness, and I believe you need to analyze your actions to determine if you might have been able to do something different to avoid some negative aspect as to the result of your actions...I believe you can learn from that type of analysis, but it should not be to the point that you regret anything about a particular course of action...

Sadness is normal. Most people get over it with time. But when it leads to overpowering feelings of grief, guilt, or depression, it is as serious as a stroke.

The final episode of M*A*S*H contained a dramatic illustration of this condition.

- Jim

[Excaliber]

I've never experienced any of the above, apart from a lingering sadness (not regret) - wishing that / wondering if different actions could have avoided the loss-of-life.

I believe Andy nails it here...And since I know he comes from experiencing this first hand, he has the correct attitude from the results of those encounters...

I believe most of the "counseling" out there is to make the person "feel" (I hate that term) regret, or remorse; and the effect of that counseling is designed to bring about doubt, and hesitation (second guessing) if that person want to continue in a particular line of work, (i.e.: law enforcement, military service, fire and rescue, etc etc)

Don't get me wrong, I do not believe anyone who takes up those careers is destined to be a basket case at the end of the day...

I believe it is ok to experience sadness, and I believe you need to analyze your actions to determine if you might have been able to do something different to avoid some negative aspect as to the result of your actions...I believe you can learn from that type of analysis, but it should not be to the point that you regret anything about a particular course of action...

The one cold, hard fact to our community is that we certainly do have the ability to take a life in the defense of our own, and others...But the reality is that you had better be prepared to be responsible, yet equally accountable for your actions...That is a yoke you bear every single time you strap a firearm to yourself, even when it is for all the right reasons...

I would not agree that most counseling is aimed at making the involved individual feel regret or remorse. Any department that engaged a person who did this would be performing a major disservice to both the involved officer and to the department itself.

Not everyone with a degree in psychology is qualified to do this type of work competently. That's why I stressed that any such counseling should be done by a professional with strong training in this specific area of practice, which is much different from many other mental health issues.

There's also nothing wrong with acknowledging something that could have been handled better. Once it is recognized, you can't forget it anyway so it's best to deal with it head on. Involved individuals need to be reassured that they did the best they could with what they knew and had available at the time. After action reviews are great for next time, but they don't change what happened in the past.

Your last point about responsibility and accountability is very well taken. Carrying a defensive firearm is not for living out fantasies. It's a last ditch tool for managing life threatening encounters, and whatever we do with it, we'll have to live with the results, which will be microscopically examined by many others in the cold, hard light of the following day.

[Bart]

I read studies that show people who have no options and become victims suffer more psychological damage than people who fight back. In both cases I think the effects are going to depend a lot on your own mental state before the attack, your religious and moral belief system, your support group, and if the press and others try to revictimize you.

[seamusTX]

I agree on all counts.

- Jim

[Excaliber]

I read studies that show people who have no options and become victims suffer more psychological damage than people who fight back. In both cases I think the effects are going to depend a lot on your own mental state before the attack, your religious and moral belief system, your support group, and if the press and others try to revictimize you.

I agree on all points.

[ELB]

Some -- many? -- emergency services, such as police, fire, ems, recommend or even require that after certain events that everyone involved participate in Critical Incident Stress Management/Debriefing (CISM or CISD, depending on the program) in order to deal with after effects such as PTSD.

Three authors -- two psychologists and a criminal justice teacher (and FBI retiree) wrote an article on CISD/CISM, focused on law enforcement (FBI in particular), that argues basically that CISD and CISM are bunk. "Pseudoscience" in their eyes, something that looks scientific on the surface, but has no valid scientific underpinnings. When I read it I was surprised that they note that not only are there not any scientifically valid studies supporting CISD/CISM, but there are at least two (if I recall correctly -- they may cite more) studies that show CISD/CISM cause longterm harm. Their criteria is not whether people "feel good" immediately after going through a debriefing, but whether they show any ill effects in the long term.

You may read the article for yourself at this link:
http://cjb.sagepub.com/cgi/content/abstract/35/10/1337" onclick="window.open(this.href);return false;

I agree with those above that people who prepare themselves, who think through the likely consequences of various scenarios, who train themselves and have some idea of what to do, are much less likely to be traumatized by real life events. I doubt any amount of counseling can make up for not being prepared for a high stress encounter, whether it is self-defense, responding to a fire or medical emergency, or even risky sports. If you've never even thought of jumping from an airplane, and I suddenly without warning strap a chute to you and throw you out several hundred feet above the ground I doubt you will enjoy the experience or even get your ripcord pulled. If I send you to Airborne school for three weeks, you'll not only be prepared, you probably can't WAIT to get out of that airplane.

I encourage you to read the article. It was very educational for me.

[seamusTX]

I agree that certain forms of counseling can result in a mutual pity-party that makes matters worse.

I would add that certain parties have an interest in promoting the value of counseling or psychotherapy, and certain parties have an interest in dismissing it. The same is true of spiritual or religious ministry.

However, IMHO, each individual human being has different responses to stress. Some shrug off a protracted regional disaster. Some are devastated by a minor incident. Each person must seek a solution that works for him or her. There is no universal answer.

- Jim