By Adeline Teoh
Depictions of post-traumatic stress disorder (PTSD) often centre on the deterioration of veterans in the aftermath of war. Films such as The Deer Hunter and Born on the Fourth of July, the latter based on the autobiography of Ron Kovic, follow returned soldiers as they try to reintegrate into society—with mixed results.
Even superheroes are not immune. Batman’s predilection for dressing in a bat suit as a crime-fighting vigilante is portrayed as his coping mechanism after witnessing the murder of his parents when he was a child. In Iron Man 3, the battleworn Tony Stark deals with two villainous forces: an evil scientist and the PTSD he acquired after helping to save the world in The Avengers, symptoms of which include insomnia, panic attacks and identity loss.
You don’t have to be a war veteran or a superhero to experience PTSD, however. Anyone who experiences or witnesses a trauma-inducing incident—from being caned as a child to being in, or seeing, a car crash—is susceptible. Due to the nature of their work, security professionals, alongside emergency services personnel, are more likely to witness such incidents whether they are physically present as a guard or behind a camera in surveillance.
Because the risk of exposure to traumatic experiences in these roles is necessarily high, or even unavoidable, circumvention is not a solution. Unfortunately the treatment program for PTSD patients has, until recently, largely been about diagnosis and providing a medical response. Today, the focus is shifting to building resilience in personnel and developing post-traumatic growth.
For BeTr Foundation director Dr John Durkin, a firefighter turned psychologist, the biggest issue is the divide between the top-down approach of medical professionals and the positive effects of bottom-up peer support. Durkin decided to study psychology after the death of three colleagues—one a suicide attributed to survivor guilt following an earlier death—and his own experience being injured in the line of duty and the subsequent unsuccessful rehabilitation.
“None of the psychologists I saw made me feel better. I realised it was the guys in the job that actually made me feel better, at least in part because they could tolerate the stories I was telling,” he explains. “I took a psychology degree convinced I could teach the bottom-up people what the top-down people know so there was a better chance of seeing a whole human being in the uniform.”
The concept of ‘being understood’ is a key one for Durkin. He recounts one visit to a psychologist, which changed the way he engaged with her. “I hadn’t even gotten to the incident yet and she was sitting in an armchair and I saw her knuckles getting whiter as she gripped the end of the arms. I realised, ‘if I say it, this could really hurt someone’. The rescuer goes into rescue mode and saves someone from distress—I hold back.”
By contrast, colleagues don’t flinch and “will probably come up with something worse,” he says. “So now I have the value of the peer who knows what it’s like at the sharp end, not the top-down academic who thinks that they’re looking for a formula that has to be fulfilled and who’d get upset on the way to doing it.”
Peer support also has no time limits, he adds. While a psychologist will stop the clock at an hour, talking to peers allows someone to get to the heart of the issue in their own time. “You might be on the verge of saying what has to be said, or worse still you say it and there’s no time to put the thing back, and you end up driving home because it’s somebody else’s turn. The idea is to produce a peer support system so that within the organisation you have permission to spend as long as you wish.”
Growth not management
Durkin studied psychology and also trained in Traumatic Incident Reduction (TIR), a process he says could turn the medical model on its head. “If you take the medical model, where a decision can be made by an expert about whether you function or whether you don’t, you can lead yourself to the logical diagnosis of PTSD,” he says. A process that aims for post-traumatic growth is different because it’s about taking it as it comes and using traumatic experiences to progress. “It fits far better with humanistic psychology than the medical model. The hallmark of post-traumatic growth is a sense of a stronger self, of having survived something you wouldn’t have known you could have survived if you hadn’t found yourself in the situation that created the problem.”
TIR examines and questions the ‘script’, which Durkin says everyone develops soon after a traumatic incident. There’s a script for employers and lawyers and a script for family and friends. “It keeps getting retold and it doesn’t burrow down, it’s only an account that will do for now,” he notes. “What traumatic incident reduction does is confront. We talk about a ‘facilitator’ and ‘viewer’—we don’t have an ‘expert’ and a ‘patient’. Our relationship is a lot more equal. What we do is identify what the viewer’s interest is.”
Very simply, the TIR facilitator asks the viewer to “go to the start of the incident, go through slowly to the end, tell me what happened” as many times as it takes for the viewer to feel they’ve dealt with the issue. Facilitators are trained not to give any emotional reaction beyond conveying interest, and they do not judge or offer advice. It’s like watching a movie for the fourth or fifth time, Durkin says. “Different characters and different stories emerge that don’t resemble the script we start off with.”
As a result, “spontaneously, the viewer can come up with their own conclusions about what the truth of the matter is,” he says. “It allows us to learn more and more from increasingly difficult material but actually get through it a bite at a time.” Sometimes the issue is not what others see as the inciting incident but perhaps an earlier experience, even stretching back to childhood.
The best candidates for TIR facilitators are people that viewers will see as peers or equals who offer no judgement, no advice and no interpretation—in other words, not clinical psychologists. To be certified, facilitators must undergo TIR sessions as viewers to clear potential triggers. “Anyone who is willing to confront their own history can do it,” says Durkin.
The other thing is to expect outrageous and sometimes incredible accounts. “Just let people go with their own material, making no assessment whether it could be true or not. They will do the viewing and they will do it to their own conclusion. They might conclude ‘that can’t possibly have happened’ and they’re happy, or ‘I reckon it did’.”
Does it work? Durkin believes it is one of the few techniques that actually promotes post-traumatic growth instead of keeping PTSD patients in a holding pattern. He refers to one former PTSD patient, Andy Pike, a military reservist and former firefighter, who undertook TIR and not only signed up to be deployed to Afghanistan last year but has since trained as a TIR facilitator. Treating PTSD is one area where being ‘all talk’ could be a good thing.
Interested in accessing TIR or becoming a facilitator? See the Traumatic Incident Reduction Association website at tir.org