Posttraumatic Stress
By Scott Janssen, MA, MSW, LCSW
Social Work Today
Vol. 23 No. 2 P. 22

Is It Contributing to Police Violence Against Black Americans?

I knew something was wrong when a friend who runs a street program for people with mental health issues called. His voice was edged with anger and fear. He needed to talk. It was urgent. When I arrived at a local diner, he was jumpy and nervous. A few days earlier, he’d watched helplessly as an unarmed Black client was gunned down by police. Now he was having intrusive memories and acute anxiety, and he couldn’t sleep.

His client had been struggling with depression and complex PTSD, including the effects of combat in Vietnam. “He was a bighearted guy,” my friend recalled. “But he was also physically big. When he saw a bunch of cops coming toward him with their uniforms, guns, and aggressive energy he got agitated. They yelled at him to put his hands up, but he was scared and confused. I thought they were going to reassure him, calm him down, but they seemed as afraid as he was. They pulled their guns and told him if he didn’t follow orders, they’d ‘take it to another level.’ He must have been a full 20 feet from them, not a threat as far as I could see, but the next thing I knew he was on the ground and blood was gushing out of him.”

It’s well documented that Black citizens are more likely than whites to be killed by police or to be victims of police violence generally. In her book So You Want to Talk About Race, Ijeoma Oluo notes that Black drivers “are 23% more likely to be pulled over than white drivers, between 1.5 and 5 times more likely to be searched (while shown to be less likely than whites to turn up contraband in these searches), and more likely to be ticketed and arrested in those stops. This increase in stops, searches, and arrests also leads to a 3.5 to 4 times higher probability that Black people will be killed by cops.”1

To illustrate her point, Uluo cites a study by the Center for Policing Equity that found Black people “were almost four times more likely to be subject to force from police—including force by hand (such as hitting and choking), pepper spray, taser, and gun—than white people.”

Police Officers Have High Rates of Posttraumatic Stress
Many factors have been suggested to explain this disparity: personal and institutional racism, lack of training, and police cultures that foster an “us vs them” mentality, overemphasize the use of force, or condone the targeting of people of color. Some cite the fact that police often don’t live in the communities they serve. Others argue that qualified immunity, lack of transparency about the extent of police violence, and suspicious patterns of dashboard and body cameras being turned off or “malfunctioning” have undermined meaningful consequences for police who act with unnecessary violence.

Rarely, however, are high rates of PTSD in Black people and, especially in police officers, considered. Yet research suggests that as groups, Black individuals and police have higher levels of PTSD than that which is found in the general population. Though more data are needed, the estimated rates of PTSD in police officers range from 15% to 35%.2,3 In fact, the higher estimate is roughly equivalent to what the National Center for PTSD estimates as the lifetime prevalence of PTSD in combat veterans of the Vietnam War.4

It’s one thing for a Black citizen to have PTSD. It’s another entirely for an officer with a gun who is empowered, if necessary, to use violence against fellow citizens. Yet this is what’s happening every day around the country as police officers with PTSD are thrust daily into fast-moving and dangerous situations.

A police officer harboring negative stereotypes and irrational beliefs about Black people, such as that they are unpredictably aggressive and/or more likely to carry weapons, may be quicker to resort to violence when confronting a Black civilian. Imagine this officer also has PTSD, common features of which include reduced impulse control when feeling threatened as well as exaggerating or overreacting to perceived threats. When it comes to police violence against people of color, adding PTSD to negative racial bias in the pressurized context of police work is like adding gasoline to a fire.

My friend’s client was showing observable signs of PTSD—situational hyperreactivity, rapid onset of fear/anger/agitation, reduced impulse control, overfocusing on a perceived threat, and failing to read the larger context. Unfortunately, rather than recognizing these signs and using basic de-escalation strategies to resolve things nonviolently, the police officers had mistaken these for indications that they were in danger.

But the police may have been showing the same signs—situational hyperreactivity, rapid onset of fear/anger/agitation, reduced impulse control, overfocusing on a perceived threat, and failing to read the larger context—raising the possibility that one or more of them also had a nervous system that had been dysregulated by PTSD.

Several reasons have been offered as to why PTSD in Black Americans appears to be higher than in the general population.5,6 In addition to being exposed to the same potentially traumatizing events as other groups, such as car accidents, traumatic losses, or invasive medical care, they can develop PTSD by being the target of chronic racial abuse (including microaggressions and discrimination) as well as exposure to race-related threats to life (real and perceived).

Black Americans are also repeatedly exposed to things that can cause secondary or “vicarious” trauma. These include recurring images of Black citizens being beaten or killed by police or viral videos of them being threatened or verbally attacked by people engaging in racist rants or menacing displays of aggression.

As for those working in law enforcement, few jobs are more chronically stressful and dangerous. Officers respond day after day to situations fraught with potentially life-threatening crises, conflict, interpersonal violence, and heartbreaking grief. They do so in unfamiliar environments with parties they do not know who may be armed, under the influence of alcohol or drugs, or who may intend them or others harm.

PTSD in Police May Negatively Affect Performance
Police officers have to size up situations quickly and make split-second decisions based on incomplete information, where the stakes can be life and death. A study at the University of Buffalo looked at whether critical decision making by police officers could be negatively affected by underlying PTSD.2 Preliminary findings suggest that three PTSD-related factors in particular could impair rapid decision making by cops in critical situations: heightened nervous system arousal related to perceived threats, inability to effectively screen incoming information, and an inability to keep attention.

Another study in the Journal of the Society for Social Work and Research looked at whether there’s a connection between levels of PTSD and “abusive policing,” which was defined as “the excessive or undue use of lethal and nonlethal force, excessive or undue use of threats of force,” and threats of sexual assault, psychological abuse, and “discriminatory slurs.”7

Though the study did not consider the dimension of race, researchers found that incidents of police abuse were highest in those officers who reported experiencing a “greater severity of PTSD symptoms.”

To better understand why elevated levels of PTSD in police may be inflaming the spiraling epidemic of police violence against people of color, it’s useful to consider how the nervous system ramps up when someone—as is often the case in police work—encounters a threat. The autonomic nervous system goes into a pedal-to-the-floor threat response. Stress chemicals such as adrenaline and cortisol flood the system, priming the individual for action. The frontal cortex, the part of the brain that runs the show when we’re engaged in analyzing information and making rational decisions, gets bypassed, and control is momentarily handed to parts of the brain such as the hypothalamus, pituitary, and amygdala, which supercharge us with energy to fight, flee, or freeze.

This happens instantly and involuntarily and is intended to help us escape danger. It can happen to Black people when they’re approached by police, and it can happen to police regardless of an officer’s discipline, training, or experience. You cannot train away the nervous system.

Imagine that the nervous system gets stuck in high gear. That’s what it’s like to have PTSD. The sympathetic branch of the autonomic nervous system gets stuck in fight/flight/freeze. This leaves someone with PTSD constantly on guard, always ready to run or fight at the first sign of danger. In fact, one of the fundamental effects of posttraumatic stress is the ongoing experience, often unconscious, of intense fear and a generalized feeling of being unsafe.

PTSD can cause someone to exaggerate, overreact, or overly focus on perceived dangers to the exclusion of other information. It can leave one edgy and constantly on guard (hypervigilance) and make it hard to regulate emotions (hyperarousal). It can impair critical decision making, reduce impulse control, and make it hard to concentrate, especially in high-stakes situations.

It can also cause avoidance and distrust and undermine a person’s ability to engage fluidly in stressful situations. And it can lead to automatic negative judgments about others (negativity bias) and expecting worst case scenarios (catastrophizing).

Police officers with PTSD may not sleep well due to nightmares, insomnia, intrusive memories, or flashbacks. They may become easily frustrated, and some may try to ease their symptoms with alcohol or other substances.

Beneath one’s awareness, the brain of someone with PTSD constantly searches for signs that there are imminent threats to safety. These signs, called trauma reminders or triggers, can be anything even remotely associated in some way with an earlier trauma or traumas. They can be simple things such as a taste, smell, or sound. They can be physical sensations (eg, a racing heartbeat); situations (eg, strangers behaving erratically); emotions (eg, fear); images (eg, the silhouette of a head in a darkened car); thoughts or beliefs, however inaccurate or biased (eg, Black people are dangerous); or painful memories related to a traumatic event.

Trauma effects, such as an exaggerated sense of danger, inability to effectively filter information under duress, amplified fear, and/or overreacting to perceived threats (real or imagined), could make an officer more likely to use violence or lethal force in critical situations.

An officer experiencing PTSD may have a short fuse due to lack of sleep, low frustration tolerance, difficulty managing emotions, or physical symptoms such as gastrointestinal upset or pain related to posttraumatic stress. Such officers may be more likely to lose attention, overreact, personalize someone’s frustration, or fail to read cues that a citizen is frightened rather than angry.

A Perfect Storm
People with PTSD often face unfair, potentially hurtful stereotypes. It’s important to remember that someone with PTSD is no more likely to be violent than anyone else. But in the potentially life-threatening situations frequently encountered by police, underlying PTSD can amplify emotions like anger and fear and cause hyperreactivity.

There are four basic commands the nervous system gives when it perceives a life-threatening danger. Many people will flee, freeze, or collapse. Police are armed and empowered to use lethal force. And they are trained, when threatened, to respond more frequently to the other nervous system command, to fight.

Police work is intensely challenging under the best of circumstances. In fast-moving, potentially dangerous interactions with unknown individuals who may be in crisis or conflict, there are bound to be occasional unwanted, lethal outcomes. Now, imagine that three elements are added to these challenges in the context of what we know about people of color being more likely than whites to be on the receiving end of police violence.

First, place these interactions in a context where there is already historical distrust and a long history of police violence, including lethal force.

Second, cloud the minds and hearts of a significant number of police officers with negative racial beliefs, biases, and stereotypes that dehumanize Black people and make them seem like greater threats more likely to require the use of force.

Third, traumatize police at much higher levels than those found in the general population, making it more likely that in crisis situations, judgment and attention will be impaired, threats exaggerated, impulse control reduced, and emotions amplified, and where officers under duress will be more likely to fear the other and expect the worst.

In recent years there’s been increasing recognition of another epidemic related to PTSD in police officers, that of police who die by suicide. This has increased sensitivity to some of the factors that often drive police suicide, such as PTSD, depression, moral injury, or complicated or cumulative grief.

For better or worse, police culture tends to prize stoicism, suppression of emotions, preparedness to respond quickly to threats, and, in some cases, the kind of black-and-white thinking that distills the world into good guys vs bad guys. Unfortunately, all of these can actually reinforce PTSD symptoms.

Officers with PTSD may be reluctant to ask for help due to fear of appearing weak, being stigmatized, or being pressured to take psychotropic medications. Others may fear that a psychiatric diagnosis will flush their careers down the toilet or get them permanently assigned to desk duty. This has to change.

When working to eliminate police violence against people of color, it is imperative to focus on the pernicious impact of racist beliefs and racially biased policies, precinct cultures, and training. But it’s also necessary to address the epidemic of elevated levels of posttraumatic stress and undiagnosed or otherwise untreated PTSD among those working in law enforcement.

Until we do, citizens, especially those who are Black, will continue to be punched, body slammed, choked, tasered, and shot. And police will continue, in moments of isolation and psychological pain, to point their guns at their own heads and hearts and pull the triggers.

— Scott Janssen, MA, MSW, LCSW, is a hospice social worker. He frequently writes about issues related to PTSD and is a member of the National Hospice and Palliative Care Organization’s Trauma-Informed Care Work Group.

References
1. Oluo I. So You Want to Talk About Race. New York: Seal Press; 2018.

2. Violanti J. PTSD among police officers: impact on critical decision making. Dispatch. 2018;11(5).

3. Weaver C. Documenting the traumas of first responders. National Alliance on Mental Illness website. https://www.nami.org/Blogs/NAMI-Frontline-Wellness/2021/Documenting-the-Traumas-of-First-Responders#:~:text=It's%20estimated%20that%2018%2D24,police%20officers%20suffer
%20from%20PTSD. Published March 12, 2021.

4. How common is PTSD in veterans? National Center for PTSD website. https://www.ptsd.va.gov/understand/common/common_veterans.asp
#:~:text=It%20is%20estimated%20that%20about,had%20PTSD%20in%20their%20lifetime

5. Payne J. Out of the Fire: Healing Black Trauma Caused by Systemic Racism Using Acceptance and Commitment Therapy. CA: New Harbinger Publications; 2022.

6. Roberts A, Gilman S, Breslau J, Breslau N, Koenen K. Race/ethnic differences in exposure to traumatic events, development of post-traumatic stress disorder, and treatment-seeking for post-traumatic stress disorder in the United States. Psychol Med. 2011;41(1):71-83.

7. DeVylder J, Lalane M, Fedina L. The association between abusive policing and PTSD symptoms among U.S. police officers. J Soc Soc Work Res. 2019;10(2):261-273.