A Cop Doc's Guide to Public Safety Complex Trauma Syndrome

Using Five Police Personality Styles

Daniel Rudofossi, Dale Lund, Dale A Lund

• Publisher: Routledge
• Year: 2017
• eBook ISBN: 9781351846004
• Topic: Psychology
• Subtopic: Mental Health in Psychology
• Index: Psychology

"Cop Doc's Guide to Public Safety Complex Trauma Syndrome" is written in response to the need for an advanced, specialized guide for clinicians to operationally define, understand, and responsibly treat complex post-traumatic stress and grief syndromes in the context of the unique varieties of police personality styles. The book continues where Rudofossi's first book, "Working with Traumatized Police Officer Patients", left off. Theory is wed to practice and practice to effective interventions with police officer-patients. The 'how' and 'why' of a clinician's approach is made highly effective by understanding the distinct personality styles of officer-patients. Rudofossi's theoretical approach segues into difficult examples that highlight each officer-patient's eco-ethological field experience of loss in trauma, with a focus on enhancing resilience and motivation to - otherwise left disenfranchised. Thus, this original work expands the ecological-ethological existential analysis of complex PTSD into the context of personality styles, with an emphasis on resilience - without ignoring the pathological aspects of loss that often envelop officer-patient trauma syndromes.

I
Foundations: Theory of Police and Public-Safety Complex PTSD

1
Police and Public-Safety Complex PTSD (PPS-CPTSD): Toward an Integration of the Five Hubs of Loss

Complex trauma and grief symptoms are as disturbing, unexpressed, and denied in multiple ways as are the diverse populations experiencing them. Three different researchers examining different public-safety and military personnel groups have come up with similar findings:

It is frequently remarked by nonmilitary psychiatrists that the military service or a state of war produces no new types of psychiatric reactions. However, there occur in military service certain florid schizophrenic like states with sudden onset and rapid recovery which are seldom seen under other circumstances except perhaps in penal institutions. (Solomon & Yakovlev, 1945, p. 535)

The quote above is a field observation during World War II. The clinicians observed schizophrenic-like symptoms in combat-stress conditions. Moving on, 40 years later, Tanay suggests another broad facet of this syndrome.

We eliminate the victims we are guilty of creating on a symbolic level by denying the existence of the condition from which they suffer. The endless debates over whether there is shellshock, combat neurosis, or concentration camp survivor syndrome fulfill our manifestations of denial. (Emanuel Tanay, MD, Kelly, 1985, p. 38)

This description generalizes to what I observed time and again in public-service officers. In a publication specific to public safety, titled The Dissonance of Trauma and Grief is my reflection:

Without the skills or support to reintegrate the impact of events of trauma and loss many police officers endure, on a frequent and intense level, an almost schizophrenic disintegration of a sense of self likely engendered through physiologic and psychic processes of oppositional conflict. (Rudofossi, 1997, p. 109)

Our first move toward identifying trauma as evidenced in public-safety and police officer-patients is our choice of an appropriate term. That term must underscore the complexity of trauma and loss. Fortunately, such a phrase as well as a concept exists and has support from a wide range of research and clinical experience: Complex Post Traumatic Stress Disorder (C-PTSD). In this chapter, the conceptual basis for understanding what I have termed, Police and Public-Safety Complex PTSD (PPSC-PTSD) is presented.

My conceptualization is achieved through clarifying four branches connected by loss, which are expressed in the presentation of PPSC-PTSD. My presentation of that hub is made comprehensible by connecting multiple losses as one of the major motive forces that drive traumatic-stress syndromes. The four branches are: complex trauma and dissociative identity disorders (Chu, 1998; Cohen, Berzoff, & Elin, 1995; Gottlieb, 1997; Herman, 1992; Marmer, 1980; Putnam, 1989; Terr, 1990); complicated and disenfranchised loss and grief (Bowlby, 1975; Doka, 1985, 1989, 2002; Doka & Martin, 2001; Ellis, 1992, 1994; Rudofossi & Ellis, 1999; Rando, 1984; Worden, 2001); the noogenic neurosis and the triad of existential despair and psyche ache (Barnes, 2007; Frankl, 1978, 1988, 2000; Graber, 2003; Schneidman, 1996; Southwick, 2007) and the stress and strain of attempts toward adaptation to losses within an ethologicalecological and neurological perspective (Giller, 1991; Gibson, 1966, 1986; Gibson & Gibson, 1955; Gould, 2002; Hartmann, H., 1958; Hartmann, E., 1984; Helson, 1964; Lorenz, 1971, 1972, 1973; Lorenz & Leyhausen, 1973; Morris, 1967, 1969a, 1969b, 1971, 1977; Morris & Morris, 1966; Myers, 1940; Pavlov, 1941; Rappaport, 1971; Rudofossi, 1994a, 1997, Rudofossi & Ellis, 1999; Schiff, 1979; Southwick, 2007; Tinbergen, 1948, 1969; Van Der Kolk, Greenberg, Boyd, & Krystal, 1985; Van Der Kolk & Saporta, 1991; Vaillant, 1977; Wolpe, 1952; Yehudi, Resnick, Kahana, & Giller, 1993). A complementary approach to loss binds all four branches into a dynamic view that capture’s the patient’s presentation. That complementary conceptual approach combines theory with its extension into treatment. It gives you an applied frame-work that furthers your effectiveness in working through the real loss you are likely to encounter with officer-patients. That insight provides explanatory power that ultimately will increase your effectiveness with officer-patients. The presentation of my eco-ethological approach to trauma projects from a structure that reflects a prism of insight from evidence as articulated in an earlier publication (Rudofossi, 1997, 2007).

We will go forward in this chapter with the strength of a comprehensive theoretical basis that offers an integration of police and public safety Complex PTSD, as my theory moves from the vantage point of a conceptual to an applied clinical method. That synergistic goal is achieved via a number of composite clinical examples that elucidate different areas of complex trauma and loss. My focus will bring us closer to a conceptualization that flows into an existential insight-oriented treatment approach. That orientation toward insight may offer an intervention model that addresses whatever “gestalt” is pressing in the officer-patient’s presentation.

Gestalt used appropriately does not mean all encompassing, something my work hardly can accomplish. Rather, it means the problem the officer-patient freely associates about is attended to in “our work” session by session. That gestalt may help us develop an understanding of what the patient presents both on a conscious level and symbolically on an unconscious level from an ecologically relevant niche and within the drives that are ethologically motivated.

Your awareness of this understanding will likely help you develop your own sense of how to approach each officer-patient individually. The same applies to your development of cultural competence. Your insight may help you reach the difficult task of repeatedly unraveling the officer-patient’s conflicts and maladaptive beliefs in a way that yields meaningful change. Unraveling is hard work, ripe with resistance on a conscious, unconscious, existential, ethological, and socially constructed level.

Complex Trauma and Dissociative Identity Disorders

Some clinicians present compelling evidence that specific groups of individuals are more at risk to develop Complex PTSD (Herman, 1992). To understand that vulnerability in its appropriate context is to realize it is not by personal defect. That vulnerability includes being subject to experiences we have defined as critical incidents. That is, these individuals form groups identified by shared experiences of trauma and loss. The groups may gain their cultural identity, defenses, and shared responses anthropologically, in addition to some endogenous vulnerability. I suggest to split “nature or nurture” in conversation is to speak ideologically, not logically, empirically, or scientifically. Therefore, I choose to present examples of vulnerable patients identified as anthropologically vulnerable groups such as children of incest, severely repeated physical abuse, victims of repeated sexual assaults and rape, combat veterans, and victims of political torture, assaults, and terrorism (Chu, 1998; Figley, 1985; Freud, Ferenczi, Abraham, Simmel, & Jones, 1921; Fromm, 1973; Herman, 1992; Kardiner & Spiegal, 1947; Kelly, 1985; Krystal, 1968; Krystal, Kosten, Perry, Southwick, Mason, & Giller, 1989; Meek, 1992; Myers, 1940; Terr, 1990; Solomon & Yakovlev, 1945). The rich foundation for Complex PTSD and the relationship to complicated grief are defined and confronted in the works of Terr, Herman, and Chu respectively.

In a far-reaching review of the literature, Judith Herman presents a new argument for looking at Borderline Personality Disorder (BPD) and Multiple Personality Disorder/Dissociative Identity Disorder (MPD/DID) on a continuum of disorders that are all related to the etiology and influences of repetitive trauma. Dr. Herman suggests that repetitive trauma needs to be viewed in the historical perspective of the participant. Hysteria and the histrionic personality have roots in the history of medicine that are associated with an exaggeration on the part of the victim or survivor. Hysteria may still carry some of the archaic remnants of that epoch.

Some colleagues present a different view, in which distinctions are clearly and diagnostically important. They focus on separating the borderline character and narcissistic disorders from trauma syndromes as extant, evident, and important (Kernberg, 1984, 1995; Masterson, 1976, 1988). Evidence suggests their points are well supported.

Others have argued against the dissociative disorders/syndromes, especially DID as not diagnostically correct (Mersky, 1992). These same authors also argue that acute stress disorder, somatic disorders, and PTSD all add to needless complex taxonomies, and at worst, iatrogenic classifications that support fictitious disorders and malingering (McNally, 2003; Merskey, 1992). We will not settle these disagreements here. However, regardless of differentiation of diagnosis between disorders, what may be more relevant is an extensive category that defines an approach. That category can handle the many variations or branches that have evolved in our combined searches for what constitutes trauma and loss. Again, that is searching for commonality as well as difference under one concept. What is clear is that despite theoretical differences among colleagues, the character disorders and clinical syndromes we have highlighted are arched by a syndrome that revolves around loss and trauma. Arguably, that arch brings us back to Complex-PTSD, which can hold its weight in research, clinical support, logic, and science.

Mardi Horowitz, a leading theorist and clinician in trauma, supports Herman’s argument for the establishment of Complex PTSD as an umbrella diagnosis. Since the 1970s Dr. Horowitz has been at the leading edge of work in trauma and loss integration within a conceptual framework of a stress-response syndrome. He has presented an evolving framework of cognitive-psychodynamics (Horowitz, 1974, 1976, 1998, 1999, 2003), to his present configurational analysis and may be viewed as one of the leaders in complex-trauma formulations (Horowitz, 2003). Although Dr. Horowitz does not use the direct C-PTSD differentiation, that may be more of a lexicon emphasis, but etymologically not a real semantic differentiation.

Leonore Terr, Md: Too Scared to Cry—Complex Trauma

Of many contributions Terr makes, one that stands out is the one between what she labels Type I Trauma and Type II Trauma. The victim of a Type I Trauma endures a single traumatic experience, whereas in the latter the victim suffers a series of traumatic experiences.

One commonality among members of all these groups is that they disavow their experiences of trauma. The repetition of these events alters one’s perception of trauma as “just routine” in culturally acceptable terms. Violence becomes part of the regular landscape of experience as “par for the course.” However, nothing could be further away from the reality of the survivor’s intrapsycho-logical experience. Accompanying the survivor to the beginning of his therapy may be an intrapsychic trauma lying deeply buried. If that is so, then you may intelligently ask, “Why shouldn’t these survivors protest and release a ceaseless flow of tears?”

Please notice that first I used the word “victim” and then “survivor.” Why did I not use “survivor” or “thriver”? Allow me to clarify my conceptualization of all three terms. Although the words survivor, and thriver, enjoy prolific use, they may have evolved into almost meaningless terms. This meaninglessness may fail to distinguish victim from survivor, and certainly from thriver. Perhaps today too many people, including some clinicians, use these terms interchange-ably, as if one can simply become a survivor and thriver when these terms are applied. That application may be a move toward minimizing the gains patients make during or outside therapy. I suggest stop and pause! I suggest we explicitly define and correspond each term to the different phases that an officer-patient moves through in the experience of trauma. That is, we can say that the patient is in the “victim-stage” when the shells of terror, numbness, denial, and the symptoms of withdrawal are replete. When the patient moves into therapy, trauma is brought into awareness. The officer-patient participates in the “participant-survivor stage” through gaining understanding and working through emotional, behavioral, mental, and existential strain from a prior level of impoverished insight. That is, the patient moves into the “survivor stage” by establishing self-care and having an interest in healing. Having reached this point, the officer-patient can reclaim the meaning of his world and pursue life within the perspective of repositioning the traumatic event in his personal history as a thriver-participant.

In her milestone classic opus, Too Scared to Cry (1990), Lenore Terr spelled out why silence around trauma is so prolific. In her promise of making us all more aware, she includes her description and insight into trauma syndromes.

She relates her rich clinical experience through the voices of children and adult victims in Chowchilla, California, who were buried alive, felt death, and escaped to breathe life again. Chowchilla is a quaint, unsuspecting town which was the site of one of the major kidnappings of the twentieth century. Terr interviewed the victims. Her experience and research into the evolution of victims into survivors and thrivers suggest that consequent scars of psychic trauma remain in adults, although altered. She provides insight into adults who have been subject to traumas similar to those her Chowchilla “heroes” had experienced. In her book, the depth of loss is ever-present. In the following section, we will start with why silence is so prolific, in spite of commonsense wishes for the contrary, that is, the wish to wail forth in pain and terror.

Massive Denial and Numbing

Massive denial helps keep away the pain for a while, but it returns, as do most repressed conflicts and wishes to make it go away. For example, consider the amazing success of the rescue efforts of the police officers of Madera County’s Sheriff’s Department to liberate the child survivors of Chowchilla’s kidnapping. Dr. Terr describes the massive denial through the blind spot of emotional omission.

No old pictures of law enforcement men bringing in the Chowchilla Victims graced the wall of booths (during Chowchilla’s Frontier Days of street and historical days), nor was there a shot of the three kidnappers being escorted to their arraignment. One might have thought that the Madera county sheriff’s department would have been proud of its most famous case. From the law enforcement point of view, the outcome was highly successful. But no. No one attending the frontier days on the day I attended would have known that a bus kidnapping had ever happened in Madera County, unless, that is, the person already knew. The Chowchilla kidnapping was to be denied. . . . The need to forget the disaster and to put it out of mind far outweighed any civic pride in its “successful” outcome. What was left was a blank spot, a blank spot in group memory and a blank spot in feeling. (Terr, 1990, p. 77)

Terr taps out more than one key note in her perceptive pick-up of what illustrates denial through omission. When it comes to loss, silence may indicate a special resistance through massive denial, which is not borne of ignorance; the spots where “civic pride” in one’s wishes and actions are fulfilled are intentionally left blank. Those blank spots are often the missing acknowledgment of the law-enforcement officers expectation. That blank spot on an unconscious level may be the denial of what is meaningful in one’s approach as a police officer. The officer-patient may be “shooting blanks into the space” of what he has invested so much into making meaningful—expectations, ideals, and real good work, all in the saddle of public service.

The silence of emptiness where meaning may be expected to fill the void is left alone. Time, the officer-patient and others suspect, ought to fill the void, which is even more surreal without the context of what is lost.

That emotional loss may be associated with unprocessed and unrealized trauma. At times the experience of trauma appears to be frozen under the surface of intellectual facades. While trauma is denied, the culture of silence does not forget. It may socialize officer-patients in ways similar to how other communities of victims become socialized to trauma: through pretending as if it does not and never has existed as a painful experience.

Traumatic Anxiety and Amnesia

Dr. Terr (1990) found that children who experienced Type II trauma had an amnesia for memories of the fear, pain, and violence after traumatic experiences. Amnesia is a forgetting, altho...

Table of contents

• Cover Page
• Title Page
• Copyright
• Contents
• Foreword
• Preface
• Acknowledgments
• Introduction
• Part I Foundations: Theory of Police and Public-Safety Complex PTSD
• Part II Emerging from PPS-CPTSD: Unmasking Five Police Personalities
• Part III Eco-Ethological Existential Analytic Therapy on the Front Line
• In Praise
• Index