For most of us, about the worst thing that happens on the job is our boss gets angry, or we lose a client, or we discover our lunch has gone missing from the company refrigerator. For first responders—the firefighters, police officers, military personnel, emergency dispatchers, EMTs and others who keep us safe—work can mean close encounters with danger, chaos and tragedy, sometimes on a daily basis.
Over time, exposure to such stress can take a toll on first responders’ mental and physical health. In some cases, post-traumatic stress disorder (PTSD) results, with symptoms such as:

• Flashbacks, nightmares, and recurring thoughts
• Emotional numbness
• Extreme worry, guilt, anger or hopelessness
• Avoidance of people, places or things that are reminders of the trauma
• A loss of interest in things that once gave pleasure
• Feeling anxious, on edge or jumpy, and startling easily
• Sleep issues
• Problems with alcohol, drugs or food

The Challenges of Seeking Help

Professionals trained to treat trauma can help those who are suffering reclaim their emotional footing. But that requires acknowledging the problem, and first responders don’t always find that easy.
There are many reasons why.
For one thing, first responders generally operate in a culture that seeks to uphold an image of invincibility. It’s a way of dealing with all they must encounter. Admitting that there are cracks in the armor can seem not only counterproductive but dangerous—a way of undermining the confidence necessary to do the job effectively and safely.

Unfortunately, that’s an attitude that can rise all the way up to management ranks, with those who open up about what they are feeling to their superiors sometimes being told to simply “deal with it” or “toughen up.”
There’s also the fear that any admission they’re struggling will be seen by others as proof that they’re just not up to the job. That can be terrifying to contemplate for first responders, who tend to see their work as not simply an occupation but as their identity. If I’m not a cop, what am I? 


Then there’s the stigma surrounding mental health issues, which stereotypes those with mental health problems as somehow defective or weaker, sometimes leading to prejudice and discrimination. That stigma can turn inward as well, leading the person to buy into all the negative things they’ve heard about mental illness and to hide their distress rather than take steps to overcome it.
Encouragingly, there are signs that stigma is slowly beginning to lessen as research helps us better understand mental illness and how to address it, and as more people in the public eye openly share their struggles and anti-stigma campaigns proliferate. And that openness is beginning to filter through to the first responder community, which more and more is realizing its responsibility to be proactive about the mental health of its members.
But stigma is far from vanquished, and it can be especially strong in team environments such as first responders have, where the actions of one directly affect the well-being of the others. A chain is only as strong as its weakest link, the saying goes. A first responder dealing with trauma can sometimes feel like that weak link.

What Treatment Teaches

If you are a first responder affected by trauma, it can seem difficult to come forward. But trying to ignore what you’re going through only increases your stress and allows the problem to become more entrenched and tougher to treat. It can also lead you to try to self-medicate the distressing feelings with food or drugs or alcohol—and that can lead to a whole other set of problems, including addiction.

Specialized, confidential treatment for first responders does exist, and this is what it can help you understand:

• You aren’t alone. About one in five people experiences a mental health issue in any given year, research shows. And the extraordinary stressors that first responders face boost that risk. 
• Trauma is a normal human response to an abnormal situation. It would be strange, after all, if you had no negative reaction to putting your life at risk each day or seeing terrible things happen to people and being powerless at times to help. Understanding this allows you to move from a mindset of “what’s wrong with me?” to a more empowering “this is what’s going on with me.”
• Trauma is better understood as an injury to the brain than an illness. In fact, some groups prefer the term post-traumatic stress injury to post-traumatic stress disorder. Left unaddressed, however, that injury can lead to illnesses such as depression and anxiety.
• We are all wired differently in terms of how trauma affects us, but each of us can build resilience to it. That’s achieved primarily by working on your connections with others. The more supportive, caring, trustworthy people you have in your life, the more able you are to cope with the experiences that can lead to trauma. Also important is learning how to manage feelings, improve communication skills, and develop more realistic and positive ways of viewing yourself and your experiences.

Another bonus to getting help for trauma is this: It’s not just you who benefits. You family, your friends—all the people who are closest to you and are often the first to notice your struggles—will gain much from the improved relationship you’ve built with yourself. It also helps your fellow first responders, who may be suffering silently in exactly the same way. When you allow yourself to be helped, you make it OK for them to get help too.
David Sack, M.D., is board certified in psychiatry, addiction psychiatry and addiction medicine. As C.M.O. of Elements Behavioral Health, he oversees a network of trauma treatment centers that includes Journey Healing Centers in Utah and The Ranch rehab center in Tennessee.