Saskatchewan Federation of Police Officers 33 follow exposure to a traumatic event, such as hysteria for women or men of lower socioeconomic status or neurasthenia for men who were wealthy or heroic (Shephard, 2000). Both diagnoses were stigmatized, though neurasthenia less so. Advances in medicines and health technologies through World War I allowed many soldiers to survive despite many having seen substantial traumas. Unprecedented numbers of returning soldiers were reporting symptoms that overlapped, somewhat, with hysteria and neurasthenia; however, the officers referred to the cluster of symptoms as Shell Shock. The phrase became a diagnostic label further distinguished by a “W”, which was considered a “real” injury or “S”, which was functionally considered malingering. There were no empiricallysupport treatments and the notion of Shell Shock as a viable diagnosis outside of a small number of extraordinary military experiences was decried by the health care practitioners of the day. Combat Stress Reaction eventually replaced Shell Shock as a diagnosis, but the stigma continued well into World War II. During World War II the health care practitioners rapidly relearned the mental health lessons fromWorld War I and found that prevalence rates of Combat Stress Reaction ranged from 10 to 100%, depending on the level of exposure (DiMauro et al., 2014); specifically, after 240 of combat exposure 100% of soldiers became symptomatic (Dyer, 2005), making it increasingly cult to claim the symptoms were the result of weak character. After World War II the first edition of the Diagnostic and Statistical Manual of Mental Disorders was published (APA, 1952) and Gross Stress Reaction was included as a viable and independent diagnosis; however, the diagnosis was removed before the second edition (APA, 1968) due to political pressures and only re-added to the third edition under a new name – Posttraumatic Stress Disorder (PTSD; APA, 1980) – because of stunning grassroots advocacy efforts (Scott, 1990). This means that the current diagnosis is less than 40 years old, which also means there has been relatively little time for research, stigma reduction, and implementation of evidence-based policy. The contemporary PTSD diagnosis recognizes four key clusters of symptoms (APA, 2013): 1) intrusive, recurrent, involuntary, and distressing memories of the trauma; 2) persistent efforts to avoid memories of the trauma; 3) negatively altered thoughts and mood beginning or worsening after the trauma; and 4) significant increases in arousal and reactivity beginning or worsening after the trauma. There are other symptoms that can co-occur, but the four key clusters are required for a diagnosis of PTSD. Notionally, the diagnosis expects that traumatic exposure is relatively rare and until fairly recently, the diagnosis was reserved for people exposed to events outside the realm of normal human experience; however, this is complicated when considering that some members of our population, such as police, are exposed to such events far more regularly than other members of our population. There is a further complication in that, despite the importance of PTSD, it is only one of several possible sets of problematic symptoms that can occur after exposure to one or more traumatic events. Other diagnoses include, but are not limited to, Adjustment Disorder, Panic Disorder, Major Depressive Disorder, and Substance Use Disorders (2013). Since at least the early 2000s there has been increasing interest in re-casting post-traumatic diagnoses as injuries rather than disorders; specifically, as Operational Stress Injuries. The recast appears readily defensible in that the person reporting symptoms may well be describing a reasonable set of responses to an unreasonable set of experiences. An argument can readily be made that fear, anxiety, and depression might be reasonable responses to traumatic exposure, whereas no response might just as readily be described as problematic. There is an important caveat to note here and that is, despite even the high rates of trauma exposure experienced by many public safety personnel, the substantial majority do not go on to report problematic symptoms. There are likely a myriad of reasons for why some people would develop symptoms while others would not, but the best current evidence suggests that everyone has the potential to develop symptoms given the appropriate set of circumstances and that risk and Potentially Injured, We must now presume: ...continued
RkJQdWJsaXNoZXIy MTM0NTk1OA==