I have no doubt this piece will be misunderstood, it will be polarizing and it will make people angry.
PTSD is not something to be proud of, it is not something to brag about, it is not an excuse to act like an asshole and it is not a thing to rally around and sell paracord bracelets or challenge coins about.
With frequent pictures of ghost surrounded, sobbing angel-winged EMS providers and numerous gofundme sites for nonsense* like horse therapy for EMS providers with PTSD…Are we trivializing those who are really injured?
PTSD is no more glamorous than a work related back injury. It should be treated like any other work place injury, not some sacred cow that is above reproach. It is a very real thing, that is not up for debate. People are exposed to things working in EMS that may cause a mental or physical injury. I am asking all of us to really take a look at how we view these injuries and examine how we are portraying them.
Have we created a culture where it is now taboo to ask questions about PTSD, where it is frowned upon to examine what is and what is not legitimate? Where do we draw the line? First hand exposure to trauma seems reasonable, how about being a dispatcher and just hearing the calls? Is there claim to PTSD legitimate? How about a QA officer who has to read countless reports of these calls and imagine what it looks like? Would their claim to PTSD be legitimate?
Have we turned this in to a money making complex or worse a cult of damaged hero worship?
Some EMS providers have gotten confused and made assumptions that if you are in EMS long enough you will acquire PTSD at some point in your career because of all the things we see. Mistakenly, a portion of EMS providers have taken PTSD and turned it in to some materialistic badge of merit, like a scar from a war wound it adds a sense of legitimacy to them, a red badge of courage for distinguishing the real EMS veterans.
Today a well-known EMS artist published a photo of a female EMS provider with what appears to be a life threatening gunshot wound and a police officer holding pressure on the wound while returning fire. 14 hours after being posted on Facebook over 1200 people clicked on the “love this” button. What the fuck is wrong with people? A female EMT just died this week in NYC and the artist knows that because he made a picture of her as well. I don’t understand the position of advocating for treating EMS acquired mental health issues at the same time as posting photos of dying EMS workers as art.
I have no doubts the artist could make a picture of a depressed EMT putting a pistol in their mouth or slitting their wrists in a dirty EMS station bathroom and that thousands of people would love that picture.
Can I blame the artist for giving the audience what it wants? I don’t know.
The unpopular truth is many of us have been in EMS for years and have no mental health ills from it. Sadly, this needs to be said because there are people taking the position that all of us in EMS are damaged, that we are all considering killing ourselves and are all suffering from wok acquired mental health illness.
This is not a slight on those that have suffered a mental health injury. We should support those that are dealing with a work acquired mental health injury, but at the same time we need to not paint a picture that we are all one more bad call away from suicide, that we are all struggling with addiction or other mental health woes.
I love my job and if anything, the things I see at work make me appreciate other things in my life more. I would go as far to say that my career in EMS has improved my mental health. Just as we should not dismiss work place mental health injuries we should not propagate the notion that everyone in EMS is suffering from them, or will be at some point.
The notion that we are all ticking time bombs is bullshit.
Why do I care? First there is the propensity for EMS workers to self-diagnose. Secondly there exists a very real possibility where a lazy or incompetent mental health provider will fall prey to a confirmation bias and say “oh you’re in EMS and having mental health issues? It is PTSD.” It seems that many EMS provider suicides are automatically assumed to be from work acquired PTSD when we have no idea why they killed themselves. What ever happened to garden variety depression? People kill themselves all the time from depression. How about substance abuse? Perhaps burnout? Or even compassion fatigue? Are all of these treated the same?
We need to be honest with ourselves and others. Being completely honest is not easy, it is not popular, it gets you in trouble and it alienates you from those who wish to be shielded from reality.
In the spirit of honesty I am angry. I am tired of seeing people making memes about how damaged we are as an industry. I struggle with this because I do not want to ostracize those with legitimate work acquired mental health injuries but at the same time I won’t stand by idly while people make all of the industry out to be unable to provide the service we promised we would provide.
I have grown weary reading about all the people with mental health issues from EMS who blame the toxic culture and refuse to bear personal accountability for their own wellness.
There are toxic cultures, I don’t want to downplay that, but I would argue that it is not exclusive to EMS and it is likely just an unpleasant part of human nature. Sometimes the world is a terrible place and we have to work with people that are frankly, assholes. We toss around terms like resiliency at the same time blaming the toxic culture and making people in to victims. Somewhere there has to be a more balanced approach, a middle path to be taken.
We are not special because of all the things we have seen. Thinking we are somehow different than others because of all the things we see is nonsense. Life is full of terrible painful things. Much of human history is full of disease, suffering, loss and violence. Perhaps it is only in recent times that we have become shielded from that reality and when the curtain is removed we are faced with having to reconcile our beliefs about how the world is.
We need to be honest and up front with those coming in to EMS. They deserve the truth. We owe it to them to let them know they are not going to be heroes, they will save very few lives, there will be no thank yous or gratitude, most of what they do will not matter and they will bear witness to countless terrible things. They will have a front row seat to the human experience. They need to care, but not too much.
Day one in EMT class should start with “You are going to see dead babies, you are going to try and save people and you will fail. This is what you are signing up for. You will probably see images of things you wish you did not see over and over in your head, how you deal with them is important. How you help others deal with them is important.”
Here is the truth as I see it. If a call fucks you up, then be fucked up. Unless the macho front you manufactured can’t handle that crushing blow. Are you really trapped in a prison of your own making? Be a genuine person, maybe for the first time in your life. Drop the façade. Make no mistake, it is not always an easy thing to do, to be genuine; some people would rather kill themselves than do this. If the dead person you saw doesn’t bother you in the least that is also fine. If a call screws with your head and you can’t stop seeing images of that scene that is okay too, be honest about it. Be strong enough to ask for help.
No one who matters is going to think less of you because of it.
If you need help now: http://suicidepreventionlifeline.org/
*There is no evidence of efficacy in using equine therapy for the treatment of PTSD.