First responders suffer mental fatigue, isolation

LOS ANGELES — Some workers pull a muscle or get carpal tunnel syndrome from their jobs. Cheryl Valentino’s work induced a tumor.

Valentino was a social worker in child and family services for 19 years in both Hawaii and California. While the 53-year-old spent nearly two decades helping others – about 3,000 families, she estimated – the work began running her down, causing fatigue, and, eventually, a tumor formed.

“I was so stressed work-wise,” Valentino said. “It was taking a toll on my body, and I was in dis-ease, and I got this disease.”

Valentino is one of the millions of first responders in the U.S.: people serving on the front lines in the military or as police officers, paramedics, fire fighters and social workers.

Like the leading bird in a V-shaped flock, these first responders find a way to protect themselves from the wear and tear of cutting through harsh winds and weathering turbulence.

Because of this, first responders are susceptible to stress-related and anxiety disorders, such as acute stress disorder, post-traumatic stress disorder and depression.

Society tends to hold first responders to a higher standard than everyone else – after all, they willfully choose their path. The responders often hold themselves against a tougher measure, too.

“You begin to identify yourself as the strong one,” said Randall Hagar, director of government relations for the California Psychiatric Association.

When first responders get pigeonholed in this role, any lapse of this strength often becomes unacceptable and unspeakable. And excuses emerge.

It’s part of the job.

I signed up for this.

I can handle this.

I’m OK.

“Well, you go through life and you say, ‘I’m OK, I’m OK,’” said Rick Miglia, captain of Monrovia Police Department in LA County. “And it builds up and after a while it’s not OK.”

Responders’ desire to help people can become their own downfall. The constant giving and one-sidedness of the job is naturally draining, some said.

“Sometimes you just get tired of dealing with other people’s problems,” Miglia said. “You have to raise their kids, you have to separate them with their fights, you have to be all that kind of stuff and sometimes that wears on you. You get tired of it.”

Coping with crisis

In a sweep of budget cuts and downsizing, Valentino was one of the more than 60 CFS social workers Contra Costa County laid off in late 2008. Optimistic and somewhat relieved to be out of the exhausting work, she has been visiting career centers and exploring new paths. Valentino took a vocational survey – like an aptitude test – to guide her search.

The results: The “Helping” bar on her personality chart spiked to 96 percent, with “Social” and “Communicative” close behind.

It’s perhaps not surprising that a first responder’s personality would score this way when her job is to help people.

“All these people, with their family dynamics, with all sorts of issues, and you’re over there trying to help all of them – and you’re required to,” Valentino said. “This (job) is where you go to bust your balls, if you have any.”

But even more detrimental is responders’ self-negligence: Their habit of helping everyone else leads them to sometimes ignore their own needs.

While drive and passion for their work may carry first responders through a few years or even decades of work, many develop an unhealthy balance of give and take in their off hours. Valentino called the type of work “a bad addiction.”

“Addictive personalities – it doesn’t have to be substance abuse – tend to be attracted to this work. (They’re) addicted to adrenaline (or) addicted to being abused,” she said. “You’re in crisis mode every time you walk in (to work).”

Instead of asking for help, many first responders find alternative coping methods. Some are positive, such as Miglia channeling his anger at a criminal into dedication to make a better case for court. A healthy lifestyle and ability to leave work at the office are also recommended to protect their bodies and minds.

Other self-help habits, on the other hand, only worsen the symptoms they’re supposed to alleviate.

“(First responders) are very good at taking care of other people, and they’re really crappy at taking care of themselves,” Miglia said. “(Police) are here to go to a scene that’s out of control and put it under control.

“When my job is out of control, how can I reach out for help?” he asked, adding, “What I can do is I can go home and drink, or I can go home and isolate from my family.”

“They can never understand”

Family is an integral part of the equation. Whether responders withdraw from or lash out at their family, their job and their families are never discrete.

But some first responders try to keep the two from intersecting. In line with the theme of self-negligence, some responders keep mum about what happens at work, whether to spare their family the burden or to avoid reliving an already unpleasant event.

For others, this silence is not by choice, but rather out of their family’s unwillingness to listen.

“Imagine being in a relationship where a significant part of the relationship cannot be talked about,” said Joel Fay, the president of the West Coast Post-Trauma Retreat in Marin County, Calif.

“If you have something you need to talk about ... you’ll find someone else you can talk about it with, and that can lead to divorce and other problems,” he said.

Fay’s center not only has retreats for first responders but for their spouses, too. The center aims to teach spouses to be a helpful part of that conversation, he said.

Being able to vent to their spouses and families about a hard day at the office allows first responders to cope by providing catharsis.

However, families are not fool-proof therapists, and relationships can be strained.

“One of the things that does happen is your partners and your families get the brunt of your mood swings and anxiety,” Valentino said. “They suffer. Your family suffers ... because you’re coming home to them and that’s the safest place you can talk.

“I’ve often heard myself say to each partner (that) they can never understand.”

Understanding is a big issue for first responders, especially because most people have no comparable experiences or way to empathize.

For example, whereas others might find comfort in a group therapy session, the gap is often too wide between first responders and other members of the group.

“(Responders are) sitting, talking to somebody who’s a housewife and gets anxious going to the grocery store. (And for you) every time you hear a siren, you start thinking about the baby whose head got cut off,” Fay said. “It’s very difficult to talk about this stuff to people who are not responders.”

Even many clinicians, Fay said, are unfit for dealing with and helping first responders.

“These clinicians say stupid things,” he said, “or they get overwhelmed with what the responders are talking about so the responders end up taking care of the clinicians.”

That might as well be another shift at work.

Instead, many people in these professions get close with their coworkers, who are some of the only people who can relate.

Soldiers, for example, can only turn to other soldiers to share stories about their first day at the base or commiserate about the heat where they were stationed.

“There is a tremendous sense of comfort and ease which the veterans have when they are in the company of each other,” said Ahsan Naseem, the director of the PTSD clinic at the Veteran’s Affairs center in Lincoln, Neb.

“I would accept, hands down, that that (camaraderie) is an integral force that plays into how they manage their issues once they’re back.”

Years ago, while Miglia and his partner were driving through the city, they were stopped at an intersection and watched as a car hit and ran over a man in a wheelchair.

This memory is one of the strongest in Miglia’s career, and he and his former partner still talk about the event and the effect it had on them.

Reluctant to reveal

But sometimes first responders are wary of sharing, even with each other, because it might seem weak. In many police stations, chaplains are a less threatening resource and alternative for venting.

“It’s not your peer, who you may be competing with. We all compete – compete for promotions or compete in life or have that competitive nature – so you may not open up to your peer for that reason,” Miglia said.

On the other hand, officers may not feel comfortable enough with professional psychologists – who are virtually strangers – to reveal private feelings, Miglia said.

“So the chaplain fills that void that’s somewhere in the middle,” he said.

Yet, many first responders do seek out professional help, especially with resources such as Naseem’s PTSD clinic.

These resources have become more prevalent and accessible as first responders and their employers realize the importance of having help available and the potential consequences if it’s not.

In Nebraska, the VA is working to develop clinics in places such as Norfolk, Bellevue, Shenandoah and North Platte to make the resources more accessible to people in rural communities. Other first responders’ employers have increasingly bulked up their employee assistance programs, as well.

Miglia said his department has developed a stronger employee assistance program since he began working there. And not only that, but the officers are now more apt to use it.

“I think (in) the generation of police officers that are coming up, we got rid of that macho cop stigma where you’re weak if you admit that something bothers you,” he said. “Now it’s like, no, you’re smart if you admit that something bothers you.”

andreavasquez@dailynebraskan.com