One Firefighter’s Dilemma with the PTSD Diagnosis

Have you heard of this little thing called, PTSD? If you’ve been anywhere near a TV, newspaper, or the internet, then it is likely that you’ve come across it. In the fire halls, it’s an unavoidable topic. For good reason. PTSD is destructive and permeates into an individual’s life, not leaving when we have walked through the doors of the fire hall. It creeps, and not quietly or softly, into the home life of our brothers and sisters. Wielding the power to push someone to the furthest brinks.

And sometimes past that.

With something so destructive, so painful, and so – they tell us – probable, what do you know about it specifically? Let’s test it out, which disorder stems from directly experiencing a traumatic event and is accompanied by the following symptoms:

1. Experiencing intrusive memories regarding the event
2. Having flashbacks
3. Sleep disturbance
4. Hypervigilance

So, what did you say?

If you said Acute Stress Disorder (ASD), you are right. These are the symptoms involved in this trauma-related disorder according to the DSM-5, the bible of psychiatry used in North America. And, unlike PTSD, the symptoms don’t need to persist for 30 days, like PTSD does. That’s right, technically speaking, if you are experiencing the symptoms of PTSD for more than 3 days but not more than 30 – you are not experiencing PTSD. You are experiencing ASD.

Yet, we neither talk of that nor have prevention plans or provincially covered programs for it.

Ok, one more quick trivia – If you take all the above symptoms and remove number 2 and, to some extent perhaps, 4 what are you experiencing?

A normal reaction to a stressful event.

We have a tendency to be too quick to pathologize every negative symptom. Resulting, inevitably, in a more vigilant and over cautious self-appraisal. Indeed, I’ve received phone calls directly from firefighters questioning their own sanity because they were struggling with a particular call immediately after it happened. Because the symptoms of PTSD are pasted everywhere, the everyday firefighter is quick to believe that they MUST be suffering PTSD. The stranglehold that this singular disorder has on our conversation about mental health is one that suffocates the ability to truly look at, and treat, mental health from a wider lens.

The message that we have inadvertently sent is this, “don’t bother talking to us until it’s serious.” As if anxiety can’t be as debilitating in some senses. Or, that depression can’t bring us to the brink of the suicidal ledge. These are not small matters in the lives of those who are navigating it, and yet we are worried that they will not be taken as seriously as one who receives a PTSD diagnosis. This is an operational problem at its very core.

On an individual level – I don’t care what you call what you are experiencing as long as it helps, and you seek help once you have a name you are comfortable with.

As educators, however, this is neither sufficient nor helpful. Indeed, firefighters are not clinicians and they shouldn’t have to be to understand the lingo that we provide them. But, “sanctuary trauma”, “Post traumatic Stress Injury”, “OSI”, “Complex PTSD” are all non-clinical terms that have little clinical relevance. There is no competition within trauma! Trauma is already debilitating, and yet we waste so much of our time arguing over who has it worse. It’s the equivalent of having people with broken arms argue about who’s more broken.

Why not spend more time actually addressing the issue of stigma? Or having the conversation that mental health is as fluid as physical health? And the fact that the mind can also be built, in a sense, to protect against ailments and injury as the built body may.

So, PTSD has become the staple of mental health within the fire service and it is not making room for any of the other issues that someone can develop following calls and stress. Moreover, what if it isn’t a call-related issue at all? What about the stress of pandemics or the organizational pressures (management seen as incompetent by front line staff, bullying, and/or coercive)? Names of other types of “traumas” arise from this – like “sanctuary trauma.” That is a reality in and of itself, is it not? But, it’s difficult to have those conversations as the moment you challenge someone’s “trauma” experience you are said to be denying them that truth. I’ve heard directly from the mouth of fellow clinicians that “trauma is whatever the client says is traumatic.” Therefore, we have an expansion from specific and clinically relevant criteria to a diagnostic lens that would allow anything from a jump scare to rolling up on a multiple motor vehicle crash with mass casualties to be viewed under the same lens.

Conversations about this from both within and without the firehall are pigeonholing us from the start. And, while well-meant and in an effort to effect helpful change, we are creating larger issues than need to be present.

The moment that we are able to break free from the manacles that bind us to this singular mental illness wall the better. Our brothers and sisters will be freer for it. The idea that because we now can name PTSD as mental enemy number one shows that we have much in the way of mental health literacy to learn. When we are able to speak openly about the panic attacks that we have, without feeling the shame of not “having the right diagnosis”, we then truly open the door to crushing stigma from the fire hall. And, what I wager that we will find is that when we do this, we may actually have the unintentional side-effect of preventing PTSD in some of our members. Having an open and inclusive social network being a major buffer, after all. And, not feeling like I have to live in secret around my colleagues if I do experience this is one less stress I need to navigate in an already confusing and difficult time.

Once upon a time, I remember that the best way to prevent house fires was a preventative program. If I recall correctly, that meant proactively engaging our communities in preventative education and events to instill the right level of fire literacy, in an effort to prevent the fires from starting in the first place. And, we didn’t settle on just the prevention of one type of fire – because that would have only taken us to so much success. We have to focus on Christmas trees and kitchen fires, how to have a campfire, and instill burn bans and permit programs. We focused on “FIRE”, no matter the source with immense success.

Why not try that with our mental health?

About the Author 

Nick Halmasy

Registered Psychotherapist and Previously Served as a Firefighter/ Fire Instructor