5 Things to do during COVID

1.     Check in

Make sure you check in, perhaps more often than usual, with yourself or others. Identify and acknowledge any stress responses that you may be experiencing and move to navigate those effectively. These are unknown times, but certainly as First Responders we are at a heightened risk of getting sick. This should be a concern for us, but check to ensure that this doesn’t slowly become a something more. Often, though, these changes aren’t something we readily acknowledge as mental health related responses. Check for those red flags.

2.     Maintain a care plan

This doesn’t mean beer binges or whiskey with cereal… sorry. Engaging in effective, non-avoidant styles of coping with our stress is more adaptive and helpful (both short term and long term). Eating well, moving your body (outside your work expectations) and connecting with loved ones or friends is important in times when isolation is not only easy, but recommended. Many therapists and programs offer phone/skype style approaches to care and you can utilize that during these times. Routines can be important to cope. Try to identify if you notice any changes in how you care for yourself or others – if routines are disrupted and self-care begins to slide, these could be red flags of more problems if they are not addressed.

3.     Stay connected

Isolation outside of work is recommended. Therefore, the need for social interaction is going to be heightened, and we may all feel the cabin fever creeping in. Luckily, we are in times when we can stay connected virtually. This, of course, is not as good or effective in value as face to face interactions – but, where possible these virtual connections can play as a surrogate. Engaging with friends, forums, or other online platforms can be ways to gaining some semblance of social interactions. These are also great times to connect like the “good ole days” with family and maybe even engage with them face to face. Though, if you really like, facetime family members who are in the same room…. They hate that :)

4.     Expect Stress

Unlike the times we are used to, where the calls are the unknown, we now have a very real risk of COVID. For most of us this will be the flu. But, obviously this is a large danger for certain population groups and therefore will also be devastating. There is little challenging in the way of cognitive restructuring (fancy terms for challenging our thoughts) because the worry we have for this threat is real, and perhaps imminent. But, this doesn’t mean we can’t do anything about it. Try not to get too lost in the sheer work volume during these times. Pay attention to how you are responding and take advantage of personal tools, partners, and any options organizationally you have to take breaks to gain some mental currency back. Keeping stress at bay is difficult – and certainly impossible to remove all or sometimes most, of it. This doesn’t translate into that we should stop trying. Follow the other 3 strategies as well as utilizing your own tried and true, or trying something new.

5.     Be Proactive

Don’t wait until things are really bad to seek help or support. Seek it soon. Right now if you have too. The cost of waiting is always greater in the long run. It is much easier to navigate the start of stress related concerns when they are fresh and new, than it is to repair and heal from stresses that have not only already cut, but scarred and calloused as well. These are new times – so we can approach this problem in a new way. Proactively seek out those things that you know will help you navigate the stress, healthily, sooner than later. MAKE TIME. There is always a sacrifice that is made here, but that doesn’t need to be a negative. Sacrificing 30 minutes of T.V. for a 30 minute run is not a net negative and the benefits of stalling the one compounded with adding the other can do wonders for our brains. Helping us decompress after a hard day can, paradoxically, require doing something hard. Sometimes every atom and molecule and synapse will tell you otherwise. Fighting against that urge is a pursuit worth engaging. In Psychobabble, this is “acting opposite” and It could be the very tool that keeps you from falling prey to stresses negative impacts. Exercise isn’t the only tool here – hobbies, skills, other activities that bring joy and passion together are helpful to overcome those daily stresses.

Explorer

The explorer

I’m enthralled with the ultra-athletes of the world. Climbers, runners, and explorers, of old and of new, I find myself immersed within their stories. Perhaps, it’s the allure of having an altogether inability to engage in such epics, even fractionally. After all, that is what a good story does; a good story puts you in the shoes of the protagonist, without fear of falling or failure. More and more I yearn for unbearable cold, unreachable height, unmentionable pressure, and their unbreakable minds.

It’s the latter I grapple with daily. Time after time, tear after tear, the unquestionable strength of the people in front of me is shaken and rattled. Not by the evidence of their true, raw, and utter courage, no. But, by the rigidity of their cognitive expectations, of which only a negative mental filter could produce! This is the true apex of psychological exploration. Walking, climbing, and digging with the person to uncover the true soul and spirit of their hearts. The one that calls out from within its closed off walls, screaming to be unleashed. The heart is screaming to be unchained.

The wanderer in front of me is utterly lost and not simply so. Our mutinous brains, in only the backstabbing way our own minds could work, diligently constructs a world in which the negative evidence is the one that catches the eye most easily. Our brains, in their sweet, simple approach, are trying to protect us in the only way they know how, through the recognition of threat.

In these later chapters it’s the world that has become the threat, however.

Of no small feat, I’m welcomed into the chapters of their lives. It’s an incredibly humbling project. To be welcomed into the wary and worried village of someone’s mind. One in which the language is familiar, but the tongue is peculiar. Like stumbling into a long lost village of pain and suffering. It’s tough, sometimes to not be eaten yourself in these dangerous places.

There is the wanderer, there, in the centre of the village. They know of a world of sense and order and long for the recovery of the compass that will guide them there. Unwillingly, they reach out to the explorer. They have reason for concern and no reason to trust. As the explorer, it is this very trust that needs to be earned.

From slow, almost insignificant steps the wanderer explains their path they’ve taken. The map is now nothing more than the crisscrossing of well beaten paths circling into ever shrinking lines. They look at their map with you with disdain and resentment; this person has turned on them, that person has left. This event went wrong, that event was avoided. This thought was planted, watered, nurtured, and cultivated. Time worked as a glue to slowly piece this world together. One that is familiar to those within it and more foreign than anything for those who never will see it.

 It’s an honor to be an explorer. One uncovering, with the wanderer’s guide, this new unpredictable and yet still utterly predictable land. Not knowing where it will lead, but the child-like yearning of curiosity of the explorer is driving the wanderer to rethink and look at their own path. Nothing the explorer suggests or advises will stick with the wanderer, though, and nor should it.  Their protective skepticism is pre-programed for their safety, and an idea that is not born of their own neuronal process is not to be trusted. The explorer, instead, shows them a section of a new map. The map fits over theirs, but highlights paths that the wanderer didn’t see, knew about, or thought otherwise unreachable. They shrug at times, because they believe that they don’t have the equipment.

The explorer is ready to land, at a moment’s notice, upon an unwelcomed ground alongside the wanderer to wade the waters with them. From the frigidity to the inferno, the explorer supports the wanderer to allow for new movements to be discovered. In an epic effort, the wanderer breaks that rigidity to find an unknown flexibility. They experience flexibility of grey area and of balance, of guidelines and not rules, of questions and curiosity, of a preparation of failure. They, too, become explorers. Masters of their own minds, experts of the seas of worry and dismay, they become avid nighttime navigators. They become firm in their ability to sail into the wind.

They learn to read the stars, for no matter what the mind’s map and landscape present as a barrier, they guide this new explorer into the right, next step. Even in the dark these small lights remind a path not yet taken and act as a guide of unshaken confidence. By day, they disappear to allow the explorer to fail and fall and, yet, sometimes even fly. At night, they warm and remind, even when they are unneeded.

The role of the explorer, in these psychological adventures, is to create a new league of explorers.  They will wonder at the things in front of them. Not in some un-phased, uncritical way. No, the wanderer’s mind still fires within. But, with the explorer’s heart now pumping in our wanderer, these are engaged and overcame. They re-write their own maps. And, as quick as the explorer came, they launch off. As this new wanderer-turn-explorer, now navigates on their own.

What’s your story, wanderer? Become an explorer.

On Death

Experience and perspective are two things that will forever change your view of the world. Here’s a silly example – when in high school, I liked to dabble with skateboarding. Was never any good, but the point is I looked at stairs differently after that. No longer were they a monotonous geometric means of access, but a brilliant and beautiful transition. That view, despite next to never actually doing anything on them, still comes to me at times. Like spontaneous recovery of a skill-set long put away. Experience and perspective have that effect on us, doesn’t it?

As a former first responder, death has certainly made this transition. We don’t often speak about death, except for when we hear other’s stories of struggles; inevitably these calls are the apex. We don’t, however, often talk about our perspective and experience in the realm of death. While I certainly believe this to be more broadly true, I’ll speak for myself. No death I’ve been at was traumatic for me. And that’s the catch, about this fickle way we are looking at the impact of the role. Death, for me, was not so often as a large metropolis. But, it still visited me often enough.

I’ve been on the chest of someone at death’s door. Most responders have, at some point. The pinnacle between life and death is the rhythmic manual pumping of their heart by hand. I felt the bones, protective as they were designed to be, move and shake under the conscious pressure giving way to the reason someone would exert that much force on another human. People talk of flow. When I reflect on those times that I worked someone, I can say that I’ve experience that. Death often “happens” to others – first responders are in the career of fighting against that.

I see death through perspective and experience, its finality, its devastation, and its relief. Through the memories flooded with adrenaline, I’ve watch loved ones say good bye – moved from bed to stretcher. This transition is never “clean”. There’s something unclinical about it. Something about this necessary service to try and beat nature, often pushes against our views or hopes for how something would go. These calls were disturbing in some way or another. We’re working with a population that few do – the dying- and yet, never really received any training for it. Our training wasn’t in dealing with the dying it was in preventing the death to begin with. But, work a cold chest and you, certainly, are now in the business of death.

I’ve also seen the moment when death is declared. This is a haunting experience, more so than any of the accidents and major biological trauma I’ve seen suffered onto someone. I remember vividly the smells, the way the room looked, the position and placement. Shifting on and off the chest with another firefighter, I constantly remember looking at the medic’s EKG with every compression, trying to ensure a sufficient enough spike. I remember one medic on the phone with the hospital the other calmly correcting and instructing and guiding us, while the wife, surrounded by first responders, paced in utter horror and desperation.

And then it stopped.

I can’t explain to you the oddness in this transition. There was something wrong, morally or ethically or something else I can’t explain, about getting up and leaving. And, yet, leaving is what we do. We too step into death, but only for a moment; a single, fleeting, fraction of a moment. Then we walk back into life, outside, and back into our trucks.

This reflection was sparked by a clinical conversation. The acknowledgement that despite dealing with folks who have experienced more than most do in a lifetime, that we, as therapists, may shy from talks of death. And this, due maybe to our uncomfortability of death, automatically prescribe its overwhelming and far-reaching impact on first responders we may see come sit in our chair. They may want to focus on a call that, for them in their own individual and meaningful way, has been hurting them. And, we could wrongly and incorrectly prescribe all the other deaths they have seen as problems in themselves to face.

A gentle reminder to simply meet them where they are hurt, while some calls the death will be the issue at others it will be the compounding factor, because it simply elicits emotions connected to the problem at hand. Fear will come to them, quickly, that they too may have something like PTSD. Of course, that’s a risk, but not the only factor. Calmly guiding them to explore other options helps squash stigma and re-align their focus. So often I’ve diffused panic and confusion, by simple explaining how utterly normal their initial experiences are.

But, our fear of talking freely about the death hinders another conversation. How we want to live. How can we speak with any conviction about the life we want to live if we haven’t a stitch of courage to talk about how we want to die? Life is about the opposites – we need to experience hate to love, grieve to be happy, rage to be content. Without the opposite, we live mere shells of the other. Those experiences are hints or shadows. They feel real enough, but because we don’t know any other experience.

We haven’t yet felt the shaping force of experience and perspective.

The Farm House

I drive by this place every day. What strikes me is that it’s still standing. Half a roof missing, door almost always open, sometimes shut (probably a ghost). Windows smashed and boards are missing. It’s a bit of a mess. 

Then I thought about it in its heyday - probably literally, given it was a farm house. There are always two stories, no? Was it love and kindness within the walls, the warmth of which made this a home and not just a house. Or, was it hate and violence. The shuddered and avoided reality of being apes first, and only later developing the rest of our brain. 

It’s a bit like us, in that way. Having felt love and warmth or hate and violence. Being. capable of love and warmth or brutal, terminal violence. Or both. Having pieces of our skin, or our hearts, shaved by the environment we find ourselves built in. Having good days and bad days. Feeling the weather, but then also protected at times. Or, maybe you’ve always worn the weather.

Regardless, boards can be changed, windows replaced, roof reinforced. Walls can be built or torn down, the fire can be lit. Love can be welcomed in, hate pushed out.
I guess we can all be a little bit like this. The difference only in being our autonomy to make these changes. We can choose to do nothing, stay the same. Or choose to throw up scaffold and fix the damn thing.

Despite all these changes, you are still very much you. No one can take away essence, being, soul. No-fucking-body. So don’t let them tell you otherwise. Stand strong on the ground, regardless of the weather. You’ll let the rain and wind in sometimes, but can decide to fix that when you’re ready.

And wherever you find yourself, practice standing tall and proud. 

#thinkdifferent

The Fickle Art of Time Travel

Anxiety. It often sits in front of me. Shaking, vibrating, and pulsating in the chair; ruminating, thinking (narrowly) hyper-focused on the negative, catastrophic, fringe excesses of potential endings to the event they have in their mind. It’s the hook into the past, dragging along those unmentionable memories. It’s a snag point in your cognitive fabric that is easily hooked by any pattern that reminds you of it in the present. You begrudgingly leave it to germinate, without recourse. Like a good friend; that you hate. It’s a warm and knowing response. Hell, it’s a protective strategy that has likely bailed you out of a situation or two. And, it’s a bit of a bitch to deal with.

It’s also a chain, carefully placed and wrapped delicately around the future. Grinding to halt the plans of the now, and placing over your eyes a lens of indescribable lies, but that seem truthful enough. The mind, you see, has shielding its clear view a mental filter. And, it is through this mental filter, tinted for negative evidence, which the mind plays gatekeeper. And, it is relentless and ruthless, in its objective: prevent, at all costs, any evidence that what you think may happen in the future--this catastrophic, infinitesimally improbable outcome--may not happen.  

Sounds like a treat.

But, that’s the fickle art of time travel. With the need to balance constant barrages of evidence that you are, in fact, fine in this moment with the immediate and equally as heavy pseudo-evidence that the world is collapsing underneath a feather’s weight. I can see it. I can sense it.

I can feel it. And, I’m 2 feet in actual distance away from you.

We approach this wrong, though. Time travel has always been about going back and exploring, with the ultimate goal of returning enlightened. We want the feeling as if we made a difference. We dream, in unison, of stopping horrific and tragic world events. We dream, individually, of stopping horrific and tragic personal events. But, as far as I can tell, no one wishes to pitch the tent and squat a while there. Time travel is, ironically, a time sensitive project.

Take the issue of spending too much time “back there”. If we have learned anything from the fiasco of those astute researchers Doc Brown and Marty McFly, it’s that consequences abound when you mess with the past. Therapy, certainly, is not messing with the past. But, instead, it’s changing our relationship to it. Less McFly becomes “jock-slayer cum cool kid” more “McFly learns to place his story in a way that makes sense and he grows from it”. And, if it weren’t for that meddling kid and his genius sidekick – he might have had a chance to experience that cognitive growth.

When time travelling – pick a destination and a reason. Lacking this, you are apt to check in to the dystopic and destructive resort of “You” for a stay indefinitely. No need for armbands here. But, you are less ready to recall your most recent stay, how miserable that was, and how ruminating on that uncomfortable past is much more unhelpful than taking some deserved nugget of knowledge as a souvenir. Making sense of our pain neither means reliving it both from regret of what we did, or didn’t do, nor does it mean that I should melt from the fear of what consequence may result in the future. Making sense of our pain means we must move through that experience, placing it on the proper, realistic, non-judgmental, and honest bookshelf of “your life”. Think like a millennial in this sense – collect experiences, not negative, overwhelming things. But, maybe leave all the other millennial traits right where you found them.

But, that’s the fickle art of time travel, the feeling that we are simultaneously doing everything that we possibly can and not doing enough. Anxiety probes us incessantly with “why” questions. In our newly adulted minds, this seems like such a mature meditation. Why does the Earth spin, it must have an answer. Why do plants reach for the sun, it must have an answer. Why me… it, too, must have an answer?

This is the trick of anxiety. Why me? There will never be an answer that you can conjure that satisfies and quenches the thirst for this quest. It’s such a noble attempt and yet, misguided and uninformed. This is exactly what anxiety wants. And, it never wants to you to understand and believe that asking a different question is not only more helpful, it’s your stainless steel, Delorean going at 88mph. It’s your path back to the present.

Instead of that inner child curiously positing why’s to the occurrences in your life, ask yourself “how do I move from here?” or “what next step is right?”, or “where do I want to go?” Recovery, you see, isn’t a return back to the “good old days” free from anxiety, though you might wish that. It’s a new normal altogether. It’s a cognitive revision based on the typos you find when you thumb the journal of your lives. The new edit, the final draft, are based on the soul of you still (after all, you are still you), and yet the words or font can be wholly different that those in the first draft.

And the best part is you’re the writer.

Anxiety. It’s the fickle art of time travel. One, with the proper mindset and a few tools, you can master and navigate toward growth, towards progress and towards the present, truly and fully. Because anxiety works to keep you stuck – but, growth works to get you moving. What are you going to do, when you next travel time?

What is your Relationship Status?

In an effort to revitalize, I took a break from the most time consuming medium for me, my presence on social media. I felt that with my slow and begrudging return, I would have an honest look at the things I uncovered for myself in an effort for you, too, to explore your relationship with this newish phenomenon. My goal here, as I will try to do with all my goals moving forward, to be as clear and laser accurate as I can. I hope not to come off as self-centered (inasmuch as an article about my personal experience can devoid me that charge) and that you may find you are able to locate some lost island of understanding for yourself.

Or, maybe you are good where you’re at and want to follow along in a process of meditation and examination and can adapt it for your purposes. Whatever your flavor, here it goes:

So, I’ve been gone for longer than I said I would. I completely disengaged from Facebook, Twitter, and LinkedIn. It was a case of burn out. As a helper, as many of you readers are, you might relate to this – the idea that you are both doing 20 percent more than you are capable of while simultaneously believing it wasn’t enough.

This was an interesting exercise for me, though not my first foray into social media disappearances. But, given my education and experience, I felt better equipped to perform and introspective examination of what it means to be connected in the way I was.

First – the guilt. This sweet, little, nugget of emotion was the most persistent throughout this process. My sense of responsibility toward each and every reader that I had amassed over the few years, washed over my “helper” lobe in my brain. This, I knew, was a sign of the immense enmeshment that social media and I had. Like an out of balance relationship. I continuously felt the need to reach out – make sure everyone was good. In the therapy world, we would label this as “my shit” to deal with. I had become a rescuer – embodying the very traits I used for good in my fire career and, now, therapy one… except these were hell bent on ensuring that I put everything else as second. The impact was not unnoticed – each time I was distracted when those around me would try to talk, or grew irritable when trying desperately to write for multiple publications at once, or frustrated when some would reach out and I was unable to connect at the level and time commitment they wanted. The pile kept growing, and I was actively avoiding solving any of it.

Second – Exhaustion. This is an interesting experience, because most of the time I know when I am tired. A week into it, I realized (on top of how I would check my phone INCESSANTLY, despite knowing there would be no notification waiting for me) that I had grown exhausted of living a very narrow and often emotionally drying world. When I waded the waters of mental wellness in the cultures where open discussion often teeters only on the worst cases, it becomes hard to extricate oneself without a sense of the abovementioned guilt. I continuously had folks I felt connected to as they had reached out in moments of vulnerability, of loss, of confusion, of absolute frustration. And, I had severed that tie. The ego that becomes wrapped in a bow with my actual ability to effect change with the real world impact I may or may not have had, played a major role in this. I felt like I was constantly trying to keep up, to a race that only I knew I was in; as if, in some magical way, my sense of purpose would wash with the waves of 100 percent success within the field. Even in the wars waged within mental wellness on the civilian side, ones that continue to rage strong, haven’t winked at such a success rate. This idea was wholly fabricated by me, one that I played to my detriment.

Third – Reliance. Knowing that I signaled to myself that with each article, quip, shot at the status quo, like, rebuttal, straight forward challenge, I grew reliant on the vehicle itself. It’s a wonder how I never before saw that the shake of the phone was clearly the same anticipatory response with what used to happen with my Minitor. I, as we do, waited in excited anxiety for that random time when the pager would go off and something “big” would be on the other end. And, just as when I was in service, I always responded as if it was the real thing. I created a sense in which this was active service. Of course, in my cognitive distorted process ignored that there was always down time, or time the pager was off. But, not here. Not while people hurt. Not when I felt true to my message. As often as it was uncomfortable, I never shot an arrow I didn’t 100 percent believe in. But, this heavy reliance on needing that connection was a telling sign that for as much as I felt this need, there was an equal and opposing realism that what I really needed was to break this relationship.

Fourth – I forgot my own message. In almost every talk I give to departments, therapy for individuals or groups, etc. I explain the mechanism for which stress impacts on the individual. I frame this in a (very broad) explanation that seems to be on many folks minds – why do some develop struggles and others don’t? But, I was ignoring the tenant that I preach upon my small pulpit. Not checking in with self to recognize the emotional impact that involvement in this was having. Indeed, I often felt the clear signs, but I told myself a different tale. This tale was one of ignorance, of ego, of self-aggrandizing. And, I told this tale to myself at my own peril. It was an honest two or three weeks, before the initial impact of breaking free really hit. And, only then did I recognize that I had failed to check in with myself. To see where I had slipped into full rescuer mode and to recognize where such a process and outlook, is never sustainable.

Fifth – the fear. At coming back! Who would have thought? And, this isn’t some earthshattering keep you up at night fear. Nonetheless, I began to understand the true time commitment that I was unfairly giving to this online presence and not to those things that actually matter – namely, almost categorically, everything in my personal life. I found clarity and relaxation for god sakes. And, therefore I had a healthy, balanced and informed concern for where this slippery slope may lead if unchecked. So, my ascent back onto the horse has been a slower, calculated, and precise an exercise. In some cases, my leg lay lame behind me dragging, a sign that a large portion of my brain was accepting and inviting the downtime. But, and as I said on my way out, I believe that the messages that I send are wholly different and often in complete contrast to the messages en masse. And, there needs to be this challenge to the status. As I have said elsewhere our intentions are true, but our aim is not.

My new rules for engagement –

I think one of my biggest takeaways, and this is likely more aimed at those that are helpers for the services, is creating rules for engagement. Without these, without a clearly defined boundary, we can flounder into feelings of guilt for not doing enough, or exhaustion or resentment for constantly giving everything we have without rest. Create a list of rules that are reasonable within the cause you are putting forth and stick to it. Hell or high water. I tell people ad nauseam and yet forgot myself – boundaries are essential in the way that they are as equally difficult to stick to. Break them for no reason, or suffer the ailments that follow.  

Create a standard you can reasonably reach.
Get comfortable with “good enough”.
Distract, but don’t avoid (your situations or positions).
Engage what you love, let little take away from that.
Create office hours – outside of that, put that shit down.
Recharge, at all costs.
 Disengage.
Challenge yourself to move through the things that pain you.
Disconnect and meditate on your relationships.
Have fun – even when the thing in front of you is supposed to be serious.
Stretch yourself, but in short, measured ways.
Get a dog (ok, this may not be sound advice for everyone).

My philosophy remains the same. I’m happy to be back at it, pushing and proding (sometimes kicking and screaming).

Let’s put our boots on, we got work to do.

TWO TOOLS FOR DEPRESSION

It is a time of year where the lag seems to be breaking. The sullen aura of winter’s grip is supposed to come off – if only one finger at a time. This is more the experience for those of you who happen to be more sensitive to seasonal variations. Longer darkness, less light, less travel, cold, etc. all work towards ensuring that you’re feelings of isolation and loneliness increase.

And if you feel aversively to any reason to get out, like for snowshoeing or snowboarding for instance, you can be sure to feel that grip even more tightly. But, what if it isn’t weather dependent? What if this happens in the middle of July at the height of the warmth, and the sun, and reasons for congregating with others? What if it happens only infrequently, or all the time? What if you’ve been riding the emotional rollercoaster into despair and numbness on and off for years?

There is no simple answer, to be sure. There are endless life events that, if arranged effectively, can ensure the lasting hold of depressive feelings. Hell, it might even evolve into a full-blown depressive disorder. To note: there is certainly a difference between feeling “depressive symptoms” and experiencing bona fide depression. And that difference isn’t small.

With so many people telling you to “shake it off” or to “get over it”, or worse even you tell yourselves that, what are you to do? Is it a problem with you? And, should you only adhere to the wise wisdom of old friends that you shall, indeed, snap right out of it. As if it was some psychological phase akin to Pogs or frosted tips (both of which, I know intimately). The failure of your friends in such seemingly useful, but in reality useless, advice is not wholly their own. In fact, it is likely that your experiences of feeling down makes them so uncomfortable that they feel compelled to rhyme you a list of “tried and true” remedies to ensure the cure arrives post haste.

And, for them, it does. You agree, out of desperation, and scuttle down to whatever suggestion they have made. In effect, you have left and they no longer feel uncomfortable. The cure has worked! It has worked for them, but not for you.

In working alongside those afflicted with depressive symptoms there are, at least generally speaking, two areas that are involved. Both are what are formally called “cognitive distortions” which is just psychobabble for “trouble thinking clearly”. Don’t get confused though, the problem is necessarily with thinking too little. Indeed, often it’s thinking too much about the wrong things and in the wrong way. But, here’s a little secret.

We all do it.

The following are two of the more common gears that continue driving the distortion cogs into maintaining folk’s struggles. By no means is this exhaustive or all-inclusive. There are, as identified, too many variables to include a cure-all. And, if such a thing existed, I wouldn’t be writing this and you wouldn’t be reading it! As a quick aside: if someone is trying to provide you with one approach to solve all your problems, with no negative side-effects. Run far. Run wide.

Have you ever seen those pictures online that appear to show one thing, but when informed that there is another image that can be seen you immediately and permanently see it too?

Or, have you ever purchased a car only to be frustrated in seeing that almost everyone else has also purchased that car? I mean, what other explanation could there be for the sudden explosion of drivers with Ford Festiva’s littering the highway?

Well, perhaps there is a third thing happening instead of a large, community wide conspiracy to purchase the cars that you love.

We in the mind-field may refer to this phenomenon as a “mental filter”. Essentially, we take the information in from the world, push it through our computers and spit out an interpretation. Is the glass half empty, or half full? Is the problem in front of you a barrier or an opportunity for growth? Is that spilled coffee a mistake or proof that you’re an unfixable, aloof, screw up?

How the mental filter can keep us in a depressive state is that the information that we are filing through that filter is spitting out interpretations bent on ensuring you’re right in thinking that way. This, though counterproductive, also makes perfectly good sense. How often are you comfortable with being wrong for instance? You look for evidence to ensure that your beliefs in the world are correct, because they give some semblance of control.

They also create shortcuts or habits. And, as we all have experienced, bad habits are as hard to be rid of as good habits are to form! You’ve been practicing this way of thinking for a very long time, and although it has never created any issues for you in the past, this approach to the world is flawed in that it is failing you in this moment. This is your, perhaps first, clue to this mental filter at work.

Countering it starts with identifying that it is occurring. Once you know that it is occurring and you are growing more skilled at recognizing it, you can identify it more readily. And that’s when this step comes into play: Challenge it.

That’s right – don’t let that negative thought bounce around in the arena of your mind playing all characters against themselves! Grab that long hook, put on the “your speech is over music” and tow that bastard out.

It takes some time to master this and you may need some initial support from someone trained to help challenge you into recognizing that “just because you THINK it is true, doesn’t make it ACTUALLY true. But, as long as it isn’t so far ingrained that you are unable to see the filter, you can largely do this on your own.

Identifying that your thinking pattern may be the vehicle for depression to ride in on is an important step to ensuring constant, un-traversable road lay before it. You may not be able to choose when it comes knocking, but you can definitely choose to give it a cold shoulder. Identify what depression needs from you(to lay in bed all day, to talk down to yourself, to sleep too much, to ignore your friends, to stop doing what you enjoy, etc.) and work hard towards doing the opposite. Be careful, though, there are more than one challenge we face and you’re decision towards this route may be hindered by another issue with thinking –

It either is, or isn’t.

Let’s start with a philosophical paradox surrounding “truth”.

You believe that being honest is the highest virtue. Something perhaps that most of us could agree with, experiencing only little reservations about its truth. Honesty is the best policy, after all, and is golden as a rule only narrowly coming second to treating others as you wish to be treated.

They’re quick and they sound great!

So, honesty as a high virtue must mean never lying. There could never be a reason to, after all, because lying only begets lying and digs us a hole that will quickly bury at least our reputation, if not our lives.

So, here is the thought experiment:

You think you should never lie. An axe murder comes to your house and wants to know where your family lives.

What do you do?

It’s a difficult experiment in and of itself, but for now we’ll ignore any interesting philosophical questions that this brings up (and, perhaps, ignoring the slight nod I seem to be doing toward lying, which isn’t my intent).

Things aren’t always so “black and white” even with something like honesty, as shown above. And they certainly are not black and white in the world. But, like the mental filter, this strategy does do something for you in that it gives a framework to see the world in. They are either good or bad, wrong or right, yin or yang. But, there are grey areas in between.

When we engage in this ridged thinking pattern, any movement outside that framework is perceived as bad and ignored. We are convinced that there is definitely no response or explanation except for the one we hold. We don’t deserve happiness – because we are inherently bad. We’ll never escape this – so there’s no point in trying. I’ll never be cured – so, what’s the point of going on.

These are all flawed though patterns that fill the black and white thinking approach.

We do deserve happiness – and our core beliefs may be what is keeping us down. We can escape this – though that may mean accepting reality as it is and making changes from there. You may never be cured – but, you can always choose to live life fully within your current means.

Luckily for us, the approaches to identifying this issue are much the same as above! It is great when we can recycle skills in order to improve our life, isn’t it?

These are certainly not the only barriers to thinking clearly – many are listed here. But, when it comes to depression these two seem to be embedded within most the people that I’ve met. Once these are identified they begin to be able to grab at these thoughts as they occur and can start to counter them. Through this, they take away the power from the thoughts and step closer towards managing their experiences.

Challenging the Paradigm

We have spent so much time talking about mental wellness issues with First Responders. Politicians, activists, writers, therapists and anyone else with a stake in this conversation has leapt up and screamed that we need support for PTSD.  

And, we do.

But, there is a dilemma. We are focused on the wrong area to invoke real, long lasting change. With our unfortunate, myopic viewpoint, we are tackling a problem at its most difficult state. By the time ‘PTSD’ is on the table for discussion much of the damage to the person’s family, career, and personal life has already been done. We are effectively stating, “No. No. You don’t get any help until you have the worst case scenario for your mental wellbeing”.

It seems even in our mental wellness struggles we continue to demand to be treated from a macho heavy, hero state: as in, wait for the toughest folks to be in the toughest position. But, for all of our attempts, for all our training programs and awareness discussions, here we still sit, in continued despair.

The reason is because we continue to ignore all other aspects of mental wellness. It has done wonders for the First Responder field to have growing public awareness of the potential impact of viewing car accidents, the deceased and dismembered, and the destruction of people’s homes and lives. Make no mistake, a First Responder does work in a field of trauma. But, a little support can go a long way. Educating them effectively on how to take care of themselves will actually become the preventative interventions we dream of.  Hopefully, we can avoid making this career in trauma, a “traumatic career”.

Moreover, this raises an entire diagnosing issue. First Responders will soon recognize that in order to get any support from the government, their organizations, and recognition from their peers they will have to have a PTSD diagnosis. Nothing other than that will be accepted. First Responders, then, need to seek out those that might be able to offer them this diagnosis, so that they can receive support, and, may push back against those who offer a different diagnosis in the face of their symptoms. In essence, denying the support they have received because it isn’t the “right” support they need or assume they should have.

Languishing while still working - Waiting to get the "right" disorder to receive help.

The overwhelming irony is that by following the timeline necessary for a PTSD diagnosis, people need to remain unwell. A claim is difficult to make if, at the time of it being honoured, the person has been able to effectively manage through their own means. Unfortunately, many have been forced to manage through their own means, because wait times for mental health treatment remain an insult to those who reach out for help. When people finally do reach out, the response they hear is "Hurry up and wait."

Real conversations do need to happen. More importantly, however, there needs to be a commitment to real change within our organizations. In order to do this, we need to recognize that the rigid, one-size fits all mental health training we are currently proctoring as the savior to our mental anguish, is going to fail. It will help some, and the argument could be won there. But, “some” is not enough. We need to remove the veil of heroism to understand that First Responders are exercising an immense amount of mental currency to remain focused on the job. First Responders often wish to identify themselves as “burying” these emotions, however, for anyone who has experienced the unfortunate events of having their emotions explode out of them, you realize that emotions can't be buried. They are compressed, shelved and constrained, and compression only works for so long.

When we continue to deny our friends and family in the First Responder field the proactive approach of programs and support allowing for the decompression of those emotions, we encourage them to spiral into mental illness; not mental wellness. For some, this results in the development of PTSD.

In order to overcome this, there needs to be a change of approach. We need to challenge the paradigm that reactive services are going to best support First Responders. There has been a lot of talk and not a lot of change. We are feeding our First Responders bread and water; enough to sustain a few, and to ensure our budgetary requirements for other “operation based demands” remain intact. We continue to ignore the very fact that anxiety, depression, and other issues will quickly boil over and while an individual case is vastly complex, a more global viewpoint is quite linear. If organizations don’t provide the opportunity for support and proactive wellness, the costs will be greater with sick leave and long term disability. With folks engaged in extensive psychological interventions in order to garner some semblance of normality back in their lives.

We need to head in the "right direction" - a focus away from "diagnosis-only" to Mental Wellness approaches.

The loss of time, then, is placed on those still at work. But, overtime in this field can often mean overexposure of negative events. Therefore, the failure to provide effective mental wellness across the board doesn’t just affect one individual, it carries on to affect those still working.

If we wait until First Responders develop one of the most difficult and life changing disorders to get support, we are effectively leaving them to languish in utter mental hell and chaos. The most acutely problematic irony here is that they continue to work and suffer in the midst of this mental hell and chaos, and that we ask them to do so.

And, in their time of desperate need, we ask them to continue suffering until they meet the right “check box” for support.

What is "Fire Culture" Anyways?

I have had a tonne of discussions with various people in the fire service. From firefighters to chiefs, across the entire spectrum and something strikes me as odd. We discuss the “culture” of the first service, and, I think, we always know what the other means. But, take the idea just a step further. Describe fire culture.

Gets tough, doesn’t it?

Well, in regard to mental wellness we seem to want to promote fire culture as maintaining a type of invisible barrier toward making progress. Fire Culture, we say, needs to “catch up”, or “well it’s the culture of the fire service that makes implementing these things difficult”. And then I go on to speak with the chief who is forward-thinking and supportive, and then the deputy, and the firefighters on the ground seem to support it as well, and I start to become confused with where this cultural barrier even lies.

Culture seems to always be considered the barrier.
*Retrieved August 10th, 2017 from https://pixabay.com/p-2309816/?no_redirect

But, the issue may lie more in our wish to both accept that mental wellness is a concern but also distance ourselves from it. Obviously, it becomes very difficult to make any blanket statements that would stick, and each department will invariably have its nuances and issues, but as far as I can tell from speaking with people, this is where I land.

We want to be supportive from a distance. Or, as a friend has said to me, we want “awareness” because that means the work is someone else’s problem. Just like being hazmat awareness level means we know just enough to think that the chemical is both scary and that we are ill-equipped to handle it.

And then, we call someone else.

Now, I have never endeavored to create firefighting therapists. And, I will never suggest that this is what we need. Indeed, creating partnerships with local mental health agencies and getting those folks familiar with each other is a likely way toward moving to a more accepting attitude toward mental wellness. With continuing to suggest, however, that simply having access to an EAP is enough, management may inadvertently promote the idea that they do not take seriously the issue at hand. From those that I have engaged with, however, I hear that they wish they knew more. That they understood more. That they were given a clear understanding of the issues that can affect them and what they can do to support each other.

This is the key to overcoming “fire cultural” barriers.

By allowing and supporting those on the front line to engage in mental wellness training just enough to ensure that they are effective for their peers. After all, the research is showing that peer-to-peer work is often the most accepted and most effective at overcoming mental wellness adversity. The culture, again we are told, has an issue with “outsiders”.

This is likely the most obvious barrier towards accepting help. And yet, this we consider part of the fire culture but is more likely an issue with human beings more generally. We don’t wish to accept that we might have a mental wellness concern. We continue to propagate the idea that having a mental health issue is somehow a weakness of character. This is exaggerated within the fire service because on the baseline we have this idea of the “hero”. Now, individually we may have issues with this, but simply google firefighter in the images and you can get an idea of the baseline cultural view. With flames, explosions, and armed with axes, the hero image is difficult to deny as solidified. And, what runs counter to this image is the opposing cultural view that mental wellness is a weakness.

Screenshot of a google search images for "firefighter" - A instance of the "culture" ?

We can hear this echoed by those from older generations. And of course, we still have these hardened ideas sprouting from newer members. This idea of mental wellness as a weakness could be considered the resulting cultural view of an entire organization when no overt messaging for the opposing view is available. Therefore, staying silent, in effect, supports the idea. We know, or at least ought to know, that mental wellness issues within a career of trauma are inevitable. Note, however, that I am not suggesting that we will develop mental health issues.

Indeed, by taking the issues of mental wellness seriously, we can mitigate many of the contributing factors that later lead to the very mental wellness issues we wish to avoid. This is an unfortunate irony.

Well, we now have a bit of a better grasp on what fire culture might be. The development of a cultural idea is both external (the beliefs and ideas that the public gives to us) and internal (the ideas and beliefs that the organization holds). And, when we discuss fire culture as being a barrier, we can at least look to see if what we mean is that we—yes, we—wish to avoid having the responsibility of helping others based on the injury.

So, then what can we do about it?

Well, provide a check-in organizationally. What is the messaging that you may be sending unconsciously? When asked or offered to go above and beyond simply having “bread and water” mental wellness interventions, do you suggest that operational costs are too high to consider it? Or, perhaps the most egregious, do you believe that this isn’t an issue for your department? We have a natural propensity towards blaming and wishing to pass the onerous onto others. We wish to label it a result of stigma, or of management, or of whatever other issues there are. But, we fail to recognize that we can create a powerful subculture.

Are you serving up "Bread and Water" interventions in your organizations?

This subculture is one of mental wellness acceptance and an understanding of the seriousness. One that takes the mental wellbeing of our brothers and sisters the same as those of physical wellbeing. When someone falls, we offer almost reflexively to pick them up. We can create a subculture of being able to respond similarly to mental wellness falls as well. After all, it is more likely that we will experience a mental wellness issue in our lives, so why not help now and develop the network of those who can help us later when we may need it.

Creating, if needed, a grassroots subculture allows the conversations around mental wellness to be had. And talking about them is the number one best thing we can do to trying to eliminate the stigma around it. Once it becomes everyday parlance, then it becomes an excruciatingly simple process to begin to spill the subcultural effects into the larger fire culture.

The hard part? Being the one who wishes to be more than just Mental Wellness Aware. Instead, being a proponent for mental wellness. Being one who will suggest first that a call has bothered you. But, remembering that you are most certainly not alone in this and that by stepping up. Others will certainly follow.

With a bit of hesitation...

One of the worst things I have had to do within my educational career was to record sessions and have them critiqued by my clinical supervisor... seriously, the worst.

Well, despite the negative impact this has had on me (and I exaggerated said impact) I'm stepping out of the comfort zone and posting this!

It was filmed at the Badge of Life conference in London on June 8th, 2017.

Happy watching

https://www.youtube.com/watch?v=tH7CuDbPdlc

Gracious Donation!

The battle for First Responder mental health can feel like a daunting one... That is, until you get into a room with both Badge of Life and Ivegotyourback... then it can feel like there is nothing left to do!

But, the reality is that there is A LOT left to do. And, there some are backing us in the battle to become stigma-crushing, change ninjas!

I need to send a massive thank you to, Don King, Bill Sparfel, and the rest of the SafeDesign Apparel team in Etobicoke! They have generously donated a Globe Bunker Jacket for me to represent Fire; the service that kicked off this mental wellness journey for me.

It's an honor to have received this. And, I dare say that it fits damn well too :)

http://www.safedesign.com/

Stay safe,

Nick Halmasy

5 Things to Stop IMMEDIATELY

The smoke and debris has settled. Hot spots are extinguished. The trucks are clean and back in service. The constant hum of the engines and the roar of the flames is just wearing off and your shoulders still ache from your pack. The call is done. But your mind races with what you should have done quicker; how the tanker was delayed; how the pump lost its prime. Thoughts about who to blame, and certainly thoughts about blaming yourself, start a chaotic tornado in your mind. But, you don’t have a briefcase to leave the work of the day behind. Inevitably, you take some of this with you when you’re done. 

But, before you reach for that extra beer know that there are things you can do to help with the impact of those tough calls. Here are 5 things that you are doing that you should immediately stop

1. You judge yourself

I start with this one because the nature of the field is one of competitiveness. Indeed, in Ontario, thousands vie for single digit jobs constantly. One of the ways that we try to sharpen our edge is through self-criticism. Calling ourselves out on our mistakes in an effort to prevent them from happening again. Unfortunately, this cognitive habit may create an unrealistic, and impossible standard for us to keep. Following this, when we make mistakes we will build these to be bigger, worse, and more important than we rate if someone else had made that mistake. We “catastrophize” the smallest errors in our pursuit of god-like skill.

These judgements chip away at our resilience. Indeed, the weight of these judgements can be enough for ourselves to implode and do worse at the very things we are so critical of ourselves for. Judgements can also accelerate problem emotions for us, such as anger. And, with it a growing sense of irritability and inability to “shake” the problem. This happens to all of us, but it helps to know that by trying to overcome our judgements of ourselves, we can also help mitigate issues that may come from a hard call.

2. You minimize the impact of those hard calls

“Ok, truth time. Despite the media coverage, not every “headliner” call is going to rattle you.”

We see a lot, and with that comes a certain level of normality. Therefore, what a person who has no experience in our field views as traumatic, might be something we see every day. But, we need to be doing a realistic, honest check. Why? Because, the calls that shake us can also be those that are innocuous. These are the medical calls that have folks that remind us of family members or friends and that can hits us harder than the accident with fatalities.

But, we often minimize the impact. When we sit around the table at the end of a call, we all take turns denying that anything happened to rub us the wrong way. “I’m fine” is the most common sentiment. And, this is also a great litmus test for stigmatic beliefs within your halls. It does grant us a certain easy escape from having to tell those around you that the call shook you. What strikes me as particularly odd is the fact that you will run into a burning building, trusting your life with those behind or in front of you, and yet you can’t trust them to take seriously an admission of mental struggle. Let’s use the brother and sisterhood to benefit us, not to harm us.

“Going it alone has been romanticized as being ‘heroic’. This battle requires a strong social network - reach out!”

Retrieved from Upsplash, May 16th, 2017 - licensed for reuse

3. You won’t talk to anyone

This has echoes above, however in a more broad sense you won’t discuss these struggles with anyone. Just as we break the old habits of collecting debris on our helmets as a show of grit, we also collect these struggles. And, like a spring, the more we cram and repress, the harder they jump at us when we finally are unable to ignore the issues. And, we all hit a point where this becomes true. Peers, friends, and especially family, are there to support us. After all, our partners are with us on every call and worry about you when we run out the door. It becomes confusing if we return home distant, irritable, and still won’t talk to them.

What should you talk about? Not the gory details. That won’t help. Talk about how that call made you feel. I know, it’s a scary word. Reflecting to your partner or peers that you felt “hopeless” or “helpless” helps them understand your struggle. Your partners will thank you as it helps them understand what it is that you’re experiencing. This goes a long way to relieve some of those compressed emotions that you have and to build stronger relationships where open discussion is important. As I often tell folks, you might not be able to change what happens at your Departments, but you can change what happens at your home.

4. You think it’s showing weakness.

 What a backwards time that we must live when we believe that continuing to push through despite mental illness is a “weakness”. Another truth time. The impact of this job didn’t magically happen to appear. It’s been here for a long time. And, many people continued in this career despite these struggles. Now, they might not have been able to cope in the appropriate manner (drinking too much, for instance, seems to align with research in the field), but they used what little resources they had. We know a lot more and we know of the impact of unhealthy coping skills. But, we also have an “untapped” resilience within our services. We should begin to use the function of the brotherhood and sisterhood to ensure that weakness is no longer being too afraid to speak up about these issues. That a weakness is actually allowing stigma to grow by allowing it to control our ability to speak out.

Isn’t it a confusing world that we live, when an Olympian wins gold despite injury and we congratulate them but, if we are struggling with an occupational injury then that is something to be hid and ashamed of? The true strength, comes from our ability to identify that we are struggling and recover in spite of it. Weakness doesn’t seem to equal the constant battle of just trying to get out of bed, let alone get dressed and work a 8, 12, or 24 hour shift and with such pressures that are expected of us to work through. And this is the way that we can finally work on that lingering, nagging stigma that continues to shade our services.

Retrieved May 16th, 2017 from Upsplash, licensed for reuse.

5. Stop believing that everyone has PTSD

This is the consequence of the light-speed propulsion of PTSD into the media limelight. A common misconception is that this role will cause you to have PTSD and this is not true. It certainly increases the risk due to the trauma exposure, but it is in no way a guarantee that you will be destined for this disorder. This is perhaps the biggest understatement of the whole movement, and is frustrating that it isn’t spoken of more. However, there are some people who wish you to believe that just engaging in this job means that you will have developed PTSD.

PTSD is a complicated disorder to diagnose and has specific criteria. And, there are also other disorders that have similar symptoms that you could be experiencing (Acute Stress Disorder is one – check out “Jargon” for a bigger list of things that can affect us! ). When we blanket everyone with a disorder it also dilutes the devastation that it has on those who do develop the disorder. Remember the last time you heard someone reflect on their OCD because their desk is so clean? Yeah, we hear it all the time. Unfortunately, being neat and tidy does not quiet capture the world shattering obsessive nature of needing to complete entire routines that interfere with every aspect of your life. When a disorder becomes so widespread and so common place, it begins to get diminished in its severity because its nuances get absorbed into our language.

Take care of yourself. It might not be as “bad ass” as learning the new fire techniques but, it’s likely because these are all things that are much harder to complete than that! Being able to identify and address mental health concerns in a culture that is shy to new ideas takes grit. We need to give credit to those that are struggling. We can do that by standing with them, supporting them, and taking care of ourselves to prevent future harms.

Stigma

STIGMA

If depression was a “black dog”, I wonder what could be made of anxiety, addiction, or PTSD? And, that is still ignoring the larger issues that first responders can suffer from. This includes, as is usually excluded, our friends in dispatch and corrections. I feel that if labelling just one of the disorders in this haunting image of shadows and teeth, I can only think to try and capture all the disorders would take some mythological knowledge. That, I do not have and leave it to smarter people to identify. But, if we are going to have any control at all, then we would need a leash.

That leash is the abolishment of stigma.

Removing the very “scary” notion that these disorders are the result of us being “wired wrong” or “different” from others is a mandatory step. We fear what we don’t know; but, we might be more fearful of what we think we know. And if we get our ideas of mental health from movies, surely we have a right to be afraid. After all, we tend to characterize violent criminals as “insane” and quickly label them as “having a screw loose”. We do this to distance ourselves from the very real idea that someone “normal” could produce such horrific, violent actions. But, if we were to learn anything from Milgrim or Zimbardo, we know that given the right circumstances, we, too could commit horrific acts.

Stigma allows us to create that distance. A psychological fence for which the Black dog, or beast, or whatever we want to identify it as metaphorically, is separated from us. I see this almost every day. Those who finally reach out for help sit quietly, head down, waiting for their appointment. They wear shame and guilt upon their face as if they deserve whatever punishment that they are experiencing. They might be 6 feet tall, but many of them, when they sit in the chair, occupy less space than small children. The stigma of their experience has pounded and gnashed their very spirits into nothingness. They sit a pool of emotional confusion and utter psychological torture. They embody the dog behind the fence. And they see all the “normal people” as outside and think to themselves that the grass seems always greener. Why can’t I be like them? Why can’t I be like I was?

Part of my role, and any therapist’s role, is to re-establish emotional connectivity and normalize their experiences. Indeed, this may seem very odd given that they struggle to get out of bed, they cut, they have actively attempted to die by suicide, and maybe often ushered to the hospital in a flurry of overdoses and other psychological and physiological concerns. How, I see in their eyes, can you call this normal? The stigma weighs them down.

It is a therapist job to create a leash. Because we need to walk this dog a while before we learn to let it go and move on. But, what of the ground for which the dog occupies? Well, that is the environment that they are in. Having spent 10 years in the fire service, I’ve felt this “us versus them” within the first responder environment.

Too many times have I read that “if you can’t cut it, cut out”. This damning and damaging adage does nothing but exaggerate the emotional confusion of their companions. And, of course, it is completely and utterly untrue. It is absurd. So, the argument can be extended, if an electrician develops anxiety then she is no good for the job? If the secretary develops depression, he is then doomed to seek other employment? The absurdity of the idea is seen clearly, when that argument is applied to its fullest.

And, the above jobs are thought to experience traumatic events rather rarely; however, the argument then suggests that even though the traumatic exposure is increased for first responders, one is held to an ever-higher standard of mental resiliency. This does nothing but continue the idea that first responders are more than human. This is the crackpot elitism that needs to be swiftly removed from the service’s philosophy. With this idea gone, we can more easily operate on the removing of stigma from the services.

There is an check for whether stigma is present in the workplace. After returning from a call, pay attention during the standard round table. Listen for if people talk about how they might have felt helpless, or hopeless, or perhaps that this call “bugged” them a bit. It is safe to say that this is on the way to developing a stigma-free workplace. Clearly, they remain comfortable and feel supported in that environment. But, as is too often the case, if “I’m fine” works its way around the table, there is work to be done. This is the most common response. Of course, that means that the facilitator of the debrief needs to change the questions; but, be cautious. If the administration remains philosophically unchanged, no amount of diverse questioning will make the crew feel safe enough to step up.

Stigma is crushing the services.

This may seem counter-intuitive to what we have been witnessing in the media with the flurry of news uncovering PTSD in First Responders. But, this is just an iceberg. What means while it is finally being admitted that there are real mental health injuries that can be the result of work within the field, we are ignoring all the mental health concerns that also affect us. We are only looking at the small piece sticking out of the water. Soon, we will realize that a more holistic outlook is needed. Mental Health is as important as physical health. We need to recognize it as such. Let’s leash the beast and take it for a walk.

The Calls That Stick

** Potential Trigger Warning**

Anyone in the service for longer a year has a story to share. These are usually quick to come to mind. There are the ones where we all laugh, usually at the expense of fellow First Responders. Or, there are the calls where the scene was a mess and yet no one was hurt. We happily relive, retell, and may even embellish these events.

But, those are not the only calls that stick.

freeimages.com

Why we were there was anyone’s guess. But, there we were. And so too were our friends in Police and EMS. The train conductor was also there. I remember reaching for the handle on the small ladder at the side of one of the rail cars, and lifting myself up and over to the other side. Preparing, as best as I knew how (which was not at all), for the scene that I was about to see. Looking down at the ground, as if to prolong the time before I needed to shift my attention to the body; then, I remember stepping over the foot.

The rest of the call was relatively uneventful, as far as scenes are concerned. We spent most of the time doing our best to find humour to take the weight of the scene off each other’s backs. What a weight to lift. We’d laugh, if not from the pressure, than at least by proxy. We were all trying our best. It was early morning, so for many of us the day had just begun. We would be expected to continue to attend to other scenes, calls and duties.

freeimages.com

What came next were the sleepless nights. Nightmares, restlessness and some insomnia were secondary to the disturbing thoughts that seemed to come from nowhere. Even as I write this I am seeing the scenes and remembering the feelings. The understanding is there now, but I had no idea what was happening to me during that period. The body and mind were working hard to understand, to make sense, of what I had seen.

The funny thing about the calls that shake us is that they also shape us. At least, it shaped me. There isn’t a day that I cross the railway, or open the door to a frozen world, where I am not reminded of that call. I never cross a railway without that “feeling” coming back, at least in some small way. As I cross the tracks, I look down at the rails almost expecting to see what I saw that day. That “feeling” that we get is not unnoticed by the researchers in the field. There are some well-known psychologists and psychiatrists who now argue that it is not just the mind that remembers, but also the body. This makes the process that more complex and a little more difficult to understand how to overcome it.

There was another person with us that day, too. The conductor. What got me the most was not his calm composition, though it was impressive. What impressed me the most was the process in place following that incident for him. The train would remain where it was until a relief conductor had arrived. Then our friend would be taken home and was given a period of time, paid, off work. Following that, and checking in with a mental health specialist, he would then be able to return to work.

Certainly, these events were not as rare as we would like to think. In the decade I spent serving my community, I had only attended one scene where someone died by train. But, for the conductor, he had already experienced multiple incidents like that.

But, as I reflect I am appalled.

A train company, a company used for hauling and moving product, had a better response plan than the first responders. First Responders who would see more horrific, more emotionally charged, and more intense scenes were left, largely, to themselves to deal with their struggle.

While the winds are certainly changing, it is difficult to feel that change on the working end. The pioneers of Critical Incident response, Mitchell and Everly, have had articles and papers out since the 80s. Their manual, which was the breakthrough text for First Responders and Critical Incident Stress, was released in the 90s! And yet, in 2016, we are still scratching our heads as to why folks are quitting, taking sick leave, and retiring early.

I fought fires the same way in 2006 as I did in 2016. Only during the later years of that short career did we begin to hear of change. Research had been out for years, but something finally had clicked. Understanding that the nature of fires had changed, did little for administrations to commit to a new approach. This resistance that seems to remain in the firefighting world, I think, plays a large part into the integration of appropriate mental health concerns.

I didn’t know what was happening to me back on that cold day. I didn’t know what was happening to me during the following weeks. I was lucky, however, as I was able to talk with someone who understood. But, I now understand how that scene really impacted me and how I took many things with me that will stay with me. That scene stuck. I certainly wasn’t alone there either, but as the “super hero” mentality is still strong in this field, no one said anything.

This is exactly where change can occur. We can continue to stand, chin-up, look around the room and echo, “I’m fine”, like our brothers and sisters before us. You can bury the problem underneath the fear and stigma that a mental health problem is something to be ashamed of, something that shows that you’re flawed. Or, you can stand, chin-up, and do the real “heroic” thing. When a scene is “stuck with you”, name it. It will be to the relief of the few who, like you, are just trying to understand something that they have never experienced before.

Over the years, my experiences have warped and torn my memory, reducing them to postcard-like snapshots. Some of the details are hard to trust, while others have forever etched themselves onto my brain when I recall them. What is important is to try and remember what you are able to learn from each of the calls, not simply remember what you saw. Each incident is a chance to grow not just skilfully, but also psychologically. We are able, and research shows, to experience Post-Traumatic Growth.

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Stress and Disease

Stress. Something we often think about, deal with, then move on. While there can be a lot said about "Eustress" aka. "good stress", when it comes to first responders we rarely mean "good" stress. The overwhelming amount of negative stress that First Responders experience has lead to the national recognition that Post Traumatic Stress Disorder as a "workplace hazard". We have heard about PTSD often in the media (and it has been spoken to on this site, and many others). What we hear about are the immediate impacts of this disorder; however, if those effects weren't horrific enough, there is some shocking research suggesting the impacts might be much further reaching!

As research progresses, we are growing to find that the mind and body are connected. This may seem intuitive, but this has been debated for years between psychologists and philosophers alike. It is a psychological paradigm shift to have therapists now paying attention to how the body is reacting to different issues from depression, to anxiety, to trauma. What is more, is that this is rarely something that First Responders are oriented to pay attention to, let alone spend any time considering.

In a discussion with Dr. Andy Brown, he asked me to reflect on a moderately stressful call. "Focus on an event, not one that was very traumatic, but one that was a little bit stressful". Once I had one in mind, Dr. Brown led me through a "Body-Scan", identifying areas that were strained, sore, or otherwise abnormal. While this experience was void of the typical clinical approach or atmosphere (you can only get so much of that via phone), I was still able to find areas in my body that seem to be triggered when I recalled the event. This is not to say that I, or you, have PTSD, but rather that the traumatic calls and stress from them can be "remembered" by our bodies. Dr. Brown hypothesized that trauma gets "stuck" in the body. If this is left long enough without intervention, the body may turn these experiences into pain.

This is the basis behind a lot of the newer research, especially that of psychiatrist Bessel van der Kolk. His book, "The Body Keeps Score" culminates his journey in psychiatry that had led him to uncover the importance of the body in understanding trauma. " Not the emotions such as anger, anxiety or fear", Bessel writes, "but the physical sensations beneath the emotions: pressure, heat, muscular tension, tingling, caving in, feeling hollow and so on".

The research is becoming quite clear on the impact that this disconnection between mind and body can have. From the relatively basic and somewhat harmless concern or attempt to supress a thought, which ironically increases the desire and obsession of the very thoughts we want to avoid (Baird, Smallwood, Fishman, Mrazek, & Schooler, 2013), to the severe and significant impact of “Alcohol dependency… considered a dissociative reaction of individuals with difficulties in identifying, expressing, and regulating emotions” (Craparo, Ardino, Gori, & Caretti, 2014).

But, studies are beginning to link a connection between the effects of on-going stress and the development of dementia. Quershi and colleagues made this link when looking at Veterans with PTSD (2010). Alarming was the finding that those with a PTSD diagnosis were twice as likely to develop dementia. This was a similar conclusion of researchers Maziab and colleagues whom found comparable results with their work with Veterans and POWs (2014).

And, while all these studies are not specifically looking at First Responders, I assume it is only a matter of time before the link is made within the ranks. While the severity and frequency of those events experienced by our military friends is significant, the accumulated experiences by First Responders can add up as well. And, of course, in some extreme cases the experiences can be almost identical. This is made ever more true by the increase in terrorist attacks on civilian targets.

Unfortunately, there is also a growing body of research finding connections between stress and fibromyalgia (a chronic pain disorder).  In one study, for example, of the participants with PTSD, 45 percent had fibromaylgia and 65 percent had chronic pain (Hauser et al., 2013). Though it's too soon to make any solid conclusions, one could certainly argue the connection between stress and disease.

It is easy to see, therefore, why EMDR (Eye Movement Desensitization and Reprocessing) therapy found such great success so quickly. While the modality (type) of therapy matters little, a therapeutic focus on integrating the mind and the body is going to yield the best results.

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Keeping in touch with how you are responding both psychologically as well as physiologically will go a long way in ensuring your flourishing mental health. There are many different ways to reconnect with your body. The body scan is one simple, but effective way. There are many sites that can outline these processes. Just choose the one that works for you.

In the meantime, a friendly challenge: Try to notice the first thing that happens when you grow upset. Where do you first feel frustration?

Resilience

RESILIENCE

In recent weeks, the term “resilience” has come to light. A quick “Google” of “first responder, resilience” for instance will produce Simon Fraser University’s online First Responder’s Trauma and Recovery certificate and Langara College’s Strategic Resilience for First Responders.

 

Resilence:

1.     the ability of a substance or object to spring back into shape; elasticity
2.    the capacity to recover quickly from difficulties; toughness

In an article released by the U.S. Department of Veterans Affairs, National Center for PTSD, titled “Resilience: An Update” the authors (Southwick, Pietraz, Tsia, and Krystal, 2015) explain that there is no universal definition for resilience. They go on to list a wide range of viable definitions that have been put forward. These include: “a stable trajectory of healthy functioning after a highly adverse event; the process to harness resources to sustain well being; enhanced psychobiological capacity to modulate the stress response” and the list continues.

Those are some of the many definitions given for resilience. There is research that speaks to the “elasticity” of the brain. Notably, this has been found in the developing brain where form and function returns to some, after a devastating events (like hydocephalus). The term “bounce back” denotes this type of response.

There are many questions left to ask and the definition of resilience does little to help clarify this for us. What is “mental toughness” or “emotionally elasticity”? When we speak about the resilience of a first responder, undoubtedly we must discuss and try to answer these questions. They are at the foundation of what makes some first responders struggle during situations and others not.

Dr. Ruth Lamb, Coordinator for the Strategic Resilience for First Responders, offered by Langara College, stated that teaching resiliency requires “the whole person, not just the mind”. Dr. Lamb has outlined that their program teaches people to be able to become attuned with both their body and their minds in an effort to reconnect the person.

In this way, resilience is not so much about “toughness”, but of elasticity. The ability to overcome the adversity at hand, not to simply endure it.

The variations in definitions are telling in and of itself. Resilience clearly looks different depending on the person. This may, partially, explain why we see a wide array of response to a trauma from both within and between groups of first responders. We are used to hearing that, “there are numerous ways that one can succumb to traumatic experiences”, but the untold side of this is that there are numerous ways of being resilient. While we are looking at those affected closely, as they need our support, those who have walked away mentally healthy should be of interest as well.

“We need to focus on prevention,” Dr. Lamb lamented.

This is an idea that is not widely spread, or at least it doesn’t come across that way in Ontario. We seem to be trying to catch up with our response to PTSD and trauma. It was only in February 2016 did a bill finally pass that allowed first responders to access services without being hounded for “proof” that it occurred on the job.

Preventative Resilience?

I asked Dr. Lamb if resilience was like learning a language, whereas if one doesn’t continue to use it they can slowly lose it over time. Or, was it more akin to learning to ride a bike and hoping on one year later seems to remain automatic. “Well, you have to use the bike a lot to learn it in the first place”. She was hinting that the various tools and strategies that you learn to build on your resiliency first require direct attention and practice.

But, with some basic research skills, interest, and the Internet, you can quickly become overwhelmed with the amount of different skills that there are for coping. So, like trying to remember answers for a test there are only so many you can cram in at one time. Dr. Lamb had some advice.

“I say pick your top 3”, Dr. Ruth said mirroring the advice she gives during the course, “and use those until they are grooved in”.

Dr. Lamb is clear that she believes resilience is much like the bike, where learning and practicing the skill, allows you to come back to it when they are needed. “The ‘strategic’ in the course title was chosen carefully”, Dr. Ruth continued, “once you have learned the skills, you know that you have a certain amount of time you need to use them within following an incident”.

Therefore, not only are the tools for resiliency important but being strategic in when and how they are used is also a large piece of the puzzle.

Do I have it?

This question is more problematic than it may first seem. For instance, are we talking about resiliency within your job or within your life, or do we mean both. Are these the same “types” of resiliency? Many factors are present and influence both. Southwick and his co-authors identify the vastly encompassing factors that predict or reflect one’s resilience. These include biopsychosocial factors; in a glimpse they suggest that biological and psychological and social/environmental factors all contribute (or diminish) one’s level of resiliency. As well, they offer that how you were raised also can affect this.

Developmental factors were found to play a significant role, according to Southwick and his colleagues. How you were raised and the environment in which you were raised also contributes to the development of resiliency skills. Therefore, resiliency skills are something that does not come “naturally” in the sense that we have a skill-set when we are born. Rather, much like the courses aim to do, we are taught them in various ways as we age.

Through a traumatic experience, you can either learn healthy coping strategies or falter onto unhealthy methods of coping. Obviously, choosing maladaptive coping approaches is going to lead you to. And, as new research has started to find, experiencing trauma and overcoming trauma also builds in resilience.. This is a much easier process when you have help.

Forward Thinking – Think Different

Moving forward, Dr. Ruth believes that we must focus on preventative factors. Establishing solid strategies prior to any issue arising will benefit the individual, their families, their departments, and the system. Therefore, establishing a preventative program benefits everyone. The largest barriers to these types of programs are our attitudes. Realizing that we need to move away from “toughness” and more towards “resiliency”. Toughness connotes a masculine, cold, unmoved type of mentality.

Unfortunately, repression of emotion and ignoring trauma experiences affects us in other ways in the long term. New research has started to shine light on how illness, cancers, fibromyalgia, and even dementia are being linked to trauma experiences and a prolonged stress response. Getting help is therefore the most important step one can have following a trauma experience.

Actually, it is "What you say"...

In my short time counseling individuals, one aspect of the process has become glaringly clear to me; people have little insight into the impact of the language they use. This small, quite small, but very impactful tool that we have available to us can at once break us and mend us. We “talk” everyday; when we order a coffee; make a call to a client; seal that big deal; make a speech or a toast; radio in updates, benchmarks and bark orders.

As a first responder, you have used language to diffuse situations. You have used language to comfort families. You have used language to negotiate terms. You have also used language to report bad news, inform of a death or someone’s rights. We use language like we walk. We use language as a means to an end that get us from point A to point B. Usually, though not always, we use language to achieve a particular result that we want. And, incidentally, this occurs almost absent of our attention. A “slip of the tongue” should be evidence enough of this.

But, while we spend a lot of time projecting our voices out towards the world, we spend much more time narrating to ourselves. As I write this, for example, I can hear myself saying the words in my head. We are talking to ourselves constantly. Incidentally, we are talking to ourselves while talking to others. Remember that last time someone asked you a question and you couldn’t remember what was just said?

Language, then, is clearly important. But, more important is how you use that language. When people arrive for counseling majority of those clients have arrived because they are faced with an immovable barrier. They have tried on their own, but to no avail. They have come seeking answers to questions. Counsellors, work hard to reframe, retrain, re-inform, and rehabilitate these clients. There are a number of new therapies that are arising that focus on the mechanisms of the body (EMDR, is one), but talk therapy is most often what people receive. “Talk therapy”, is therapy using language, or simply the process of giving people new ways to “talk” to themselves!

How often have you found yourself saying things like, “I’m an idiot, I never should have…” If we’re being honest, we all have engaged in something like this. So, let us break apart this very small sentence.

First thing is what are we trying to say? Well, clearly we have fumbled on something. We may feel like “an idiot” but is there evidence to suggest that we are an idiot? What is an idiot? Is the term idiot a placeholder for an emotion that we are experiencing? Likely disappointment, embarrassment, shame, maybe regret or anger?  

So what….

The argument here is simply that if we spend a considerable amount of time berating ourselves, part of us bears that. This is usually our self-esteem and confidence. When this is depleted, what stores can we take from that will help us take risks and be comfortable making mistakes? If we are paying close attention, there is a hint of a growing anxiety that can take place as well. This is part of the seed that could grow into a larger issue.  

Instead, trying to identify what we are experiencing and confront that head on is a much more effective approach. Human behaviour is can largely be separated in two groups: the pursuit of pleasure and the avoidance of pain. From this point of view, obviously sitting with emotions is asking you to sit with pain. Yet, confronting these is the fastest, most efficient way to overcome them.

Be careful of the language that you use to yourself. This becomes more imperative when we begin to address mental health issues. It is counter productive to degrade ourselves when we need to take a close look at particularly difficult aspects of ourselves. Just reflect on whether you would hurl the same comments at a friend… and mean it.

On Killing and the Unintentional relationship with First Responders

Lt. Col. Dave Grossman wrote on the psychological effects killing had on soldiers. He
has spent an entire 300 plus pages dissecting with precision the reasons that soldiers did
not kill; the difference between killing at close range versus killing at a distance; the impact of each of the scenarios on the soldier’s psyche; and the ways to mitigate psychological stress on the solider following war.

There were several interesting overlaps between the experience of the solider and the
experience of the first responder.

Of interest, was Grossman’s (who is also a psychologist) explanation between distance of
the soldier and the intensity of trauma as a result. What Grossman found was that distance, both physically and psychologically, made a huge difference between whether a solider would shoot to kill, as well as whether they would be traumatized by the killing. 

Grossman went on to explore the various implementations that have gone into making the
soldier more detached, such as through adding mechanical means (scopes, night vision,thermal) as well as training differences.

As a first responder, our physical distance is very intimate. Police, Ems, and Fire all
grapple with people in a very intimate and vulnerable way. Though performing CPR may
be a “firefighter’s job” (as one paramedic friend once told me), it never did get easier for
me. There was something intimate about the process that makes one uncomfortable. Indeed, it also increases the feeling (at least for me) of some responsibility for this person. Were my compressions deep enough? Were they fast enough? Did the chest rise on the last two breaths? I’d pay particularly close attention to the EKG to measure compressions and keep a keen eye locked on whatever paramedic seemed to be closest.

As EMS is clearly tied into the above role, their role is obviously more involved. As well, the medical responsibility of their role ensures the necessity to cross this barrier into personal space. And police grapple with humans at their most violent and in their upmost crisis. They are much more likely to be the targets of violence and yet are still required to enter these private, close quarter spaces.

To illustrate these space-to-space dimensions that I mean, next time you are in line for a
coffee, pay attention to whether someone is standing too close to you. How close is “too close?” Where does your space begin? Or, if you’re brave, begin to invade on the person’s space in front of you. Do they shuffle forward? Do they say something? How many times have you pulled up behind someone in your car, only for them to inch forward just a bit?

After a lifetime of military services, Grossman was showing the resistance to killing on a continuum. But, much of what he discussed seemed quite parallel to the impact of this “issue of proximity” to the role of the first responder and the ensuing trauma or stress following a call. The DSM, the criteria for PTSD require the majority of events to have happened close to, or directly to the person (though they leave room, appropriately, for vicarious trauma). Proximity plays a key role.

This may seem obvious at first glance. Of course, the trauma statistics are much higher due to the exposure rates and the intensity of these exposures for the first responder. But, often it is believed that simply being a first responder is cause of a stress disorder. It is not simply the fact that if one is a Firefighter that they will succumb to a disorder. The stress comes from the fact that we lay actual hands upon the dying heart, pumping at a fast rate to trying to literally squeeze life back into a complete stranger. That connection can lead to emotional reactions that one neither plans nor wishes for. Of course, this is not Fire specific. The gravity of this role does not easily slide from the hands of paramedics or police either.

All of these recollections are fine, but what do we do with them. Perhaps another lesson can be learned from Grossman, who identified that one of the most beneficial processes was a “ritual cleansing”. These came in a lot of different forms, from parades to mandatory down time. Ultimately, the soldiers returning from war were receiving validation for what they did and saw.

To make this relative, Grossman identified that the vets from Vietnam did not have these ritualistic returns to civilian life; in fact, they were ostracized, belittled, and in some instances even assaulted. Grossman reflected that it was the vets from Vietnam that had the most psychological injuries (although, he conceded, that even more likely buried their problems and never came forward).

One potential ritual that departments can use is the informal “round table”. This is not structured like a diffusing or debriefing, however it allows the crew to talk about what happened and to gain support from their crewmates. Who ever leads these groups needs to ensure that blame and judgment never make it into these rituals. Lessons learned can come at a later date (especially if this call was a higher stress call). Create that safe place for reflection and validation. Let’s face it, not every call ends with a survivor. But, if a few people are starting to carry a bit of that weight, we owe it to them to remind them that they are not god. They can’t always save or bring someone back.

Creating your own rituals, whatever they may be, could be a great way to instill resilience
into your crew. As they grow to understand that following a call what ever they have decided comes next. Perhaps it’s a return to the hall, round table, and then washing of gear and placing it back in service. Whatever your ritual becomes make sure that it is acceptable by most and helps to validate and consolidate the experiences the crew just had.

In Defense of Families

In Defense of Families

When you are in desperate need of money and someone hands some to you, you would not exclaim, “That’s not enough”. But, for the purpose of this plea, that is what I am doing.

Today’s movement toward mental health in the lives of First Responders is amicable. We need something. And, furthering this push for aid the Ontario Association of Fire Chiefs has adopted a “fire” tailored program, the Road 2Mental Readiness (R2MR) from military fame, to fit the needs of the individuals in the fire service. Police have already had the program and are suggesting some success. It is rumored that EMS will, soon, also have their own program. Let’s hope that they continue this so we can include our bleeding friends in Corrections, Dispatch, and Emergency departments.  

These are all good things.

So, perhaps in light of this I sound a bit crass or callused, but hear (or rather, read) me out. These movements are good things; but, they are not enough. Not only are they insignificant given the level of mire we find ourselves in, they ignore possibly the single greatest preventative aspect of any First Responder; the family.

Why are we continuously suggesting that these issues and concerns are individualistic? At first, it was status quo to write off the few who spoke out around mental health issues as few “bad apples”, though this attitude certainly isn’t extinct. Fast forward to now, and we are acting to “… ensure that the most appropriate training is provided when required to ensure CAF personnel are prepared mentally for the challenges they may encounter.” (Taken from the Canadian Forces site: http://www.forces.gc.ca/en/caf-community-health-services-r2mr/index.page).

To be fair, there is a section dedicated to information for families. But the training is, essentially, for those entrenched. Our attitude has changed, but only for the individual.

Am I being nit-picky? Perhaps. But, when disaster strikes, a community corrals and comes together in a way that was unprecedented prior to the incident. So, we should adopt the same approach when disaster strikes an individual. A community is much better suited to deal with the multiplicity of issues that arise in a mental health crisis. Luckily, for many of us, we were born into a small community already; our family and friends.

Mental health is a Team approach. Walk into a mental health clinic today and you, more often than not (unless it is private), you will hear that “we are a team here at, so-and-so”. You’ll likely have signed consents that allow some of your information to be shared throughout the team to ensure continuity in services. From there, with your permission, you’re set-up with people from different organizations that specialize in the help you need.

But, in the mental health field it is recognized that marital issues, addictions, stress concerns,(or “enter other disorder here”) are not isolated issues. We do not live in a bubble. Mental health struggles are, more often than not, married to a co-occurring disorder (“concurrent”, in mental health babble). So, when you see an counsellor you are likely to be, or have already been, connected with a psychiatrist, or have a family doctor or registered nurse on board. Whatever the configuration, you have a team. Like-minded individuals all bolstering ethics that, though written differently, have ascribed to doing no harm and increasing good. Research has shown that this approach, sometimes falling under the name “biopsychosocial approach”, is garnering the greatest results.

Individuals in these new training developments are given all the tools that they need to help themselves from developing an issue, the tools to recognize the beginning of a problem, and perhaps a few resources to connect with if an issue finally does arise. And, there are training programs that help with the aftermath of “headliner” calls. Great! For a lot of people, that is going to save a lot of time, resources, heart-ache, self-doubt, self-harm, and even attempts at dying by suicide.

When they get home, however, we have not developed a “language” that can be shared between them and family members. They cannot talk about their experiences or the level of stress they are under. Moreover, First Responders are not very keen on talking about the gruesome details to their loved ones for fear of traumatizing them. Very valid and great reasoning for avoiding to explain said details; however, that is a very weak argument for not talking of the emotions felt around the situation.

We need to remember that we are not alone in these issues. PTSD is, arguably, one of the worst disorders that can strike a First Responder. Yet, PTSD is often occurring alongside addiction issues, marital issues, other mental health issues. If left unchecked, self-harm can become the only answer to the pain felt.

I have consoled family members, watched families say good-bye to loved ones, seen the concern of a parent when they have heard their child was in an accident. So have a lot of those reading this right now. I have watched families stand strong together as they stand idly, helplessly, as all their belongings perish in a fire. The shaking, the tears, the fear, the exasperation of people, are all images that anyone in this field has or will have eventually. Not all will stick with you, but some will. But, the more people corralled around during these times the better the outcome for that person.

Let us begin, then, to speak about the family members. They are also injured, hurting, and needing help. But, as we move forward, they seem to be only an echo behind the individual. Can we let them stand beside us, instead of behind us?

Nick.