Does PTSD Cause Violence? Article from Badge of Life

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Police Killings and Mental Health

By

 

Andy O’Hara, Sergeant (ret.) California Highway Patrol and Founder, Badge of Life, and

 

Richard L. Levenson, Jr., Psy.D., CTS, Vice Chairman, Badge of Life

 

 

 

Are veterans (or police officers) with Posttraumatic Stress Disorder (PTSD) a danger on the streets?  Are combat veterans with PTSD returning home as “trained killers?”

 

 

We have all read these newspaper headlines:  “PTSD made him a Murderer!”  “Psychologist:   Killer has PTSD!”  “War damaged vet kills girlfriend; PTSD to blame?”  “Officer uses PTSD defense for strangling, battering his wife.”

 

These are the kind of headlines making the rounds as thousands of military veterans return from our wars in Afghanistan and Iraq.  Not only is society fearing them, but some police departments are warning their personnel to “be on the watch” for veterans in general (as if you can tell them apart), with the implication that military service alone carries the threat of having the “PTSD germ.”   

Defense attorneys are always open for a ready-made opportunity to suggest that a suspect was conditioned by the military into responding to any stress situations with violence—and thereby commit a murder. The media, of course, sees a story guaranteed to generate both interest and controversy throughout the extended length of a trial, and the headlines, as we have seen, inflame and arouse a variety of passions.

 

The unfortunate consequence of this sensationalism, sadly, is to stigmatize not only veterans with PTSD, but all PTSD sufferers, as being potentially dangerous.

 

This is not really new. To begin with, society has always tended to view the mentally ill as “dangerous.” Mental Health America reports that characters with mental illnesses are depicted in prime time television shows as the most dangerous of all demographic groups: 60 percent were shown to be involved in crime or violence. Also, most news accounts portray people with mental illness as dangerous. The vast majority of news stories on mental illness either focus on other negative characteristics related to people with the disorder (e.g., unpredictability and unsociability) or on medical treatments.

 

The result is predictable. Most citizens believe persons with mental illnesses are dangerous. Instead of improving, attitudes are getting worse: a longitudinal study of American’s attitudes on mental health between 1950 and 1996 found the proportion of Americans who describe mental illness in terms consistent with violent or dangerous behavior has nearly doubled.  Many employers, already reluctant to hire anyone with a mental illness or provide them the accommodations they might need, disregard or find creative ways to circumvent the Americans with Disabilities Act and deny employment or other rights to PTSD victims, adding to the burden already faced by returning veterans. 

 

It is no small wonder, therefore, that we find so many police chiefs in the United States and Canada resistant to the idea that police work can lead to PTSD (and that suicide as a result is impossible).

 

Where do we begin, in order to address this question? Does a diagnosis of PTSD include the potential for violence?

 

First, we need to remember that PTSD is an injury—both emotional and physical. While it is listed as a mental illness, it is the only one listed in the DSM (Diagnostic Manual of Mental Disorders) as being caused by an external cause. Second, PTSD is caused when a person is exposed to a catastrophic event (or series of events over time) involving real or threatened death or injury to themselves or others. During exposure to that trauma, one experiences intense fear, feelings of helplessness, or horror.

 

There is likelihood that most people will experience a traumatic event at some time in their lifetime. Not all will suffer from PTSD, depending on a number of factors that include their individual backgrounds, their relationship to the type of trauma, the degree and manner of exposure, and other factors. Military combat and police work are particularly high-risk areas for PTSD, however, because of the intensity of the types of trauma, the frequency of traumatic events and, particularly in the case of law enforcement, the fact that traumatic events are accumulated over years and decades.

 

But what about the actual PTSD symptoms? What are they, and do they typically include violent behaviors, like murder?

 

Simply put, PTSD is “fear” based, not “aggression” based. The DSM-IV-R (Diagnostic Statistical Manual, Revised) is clear. In brief, the primary features of the this illness are:

 

flashbacks

withdrawal

numbing

hyperarousal

and isolation.

 

Violence is not included. In fact, not one single research study exists linking violent behavior with the diagnosis of PTSD. While, anger and agitation are common symptoms of PTSD, these feelings tend to be turned inward, contributing to making it the terribly painful disorder it is. Combined with depression, it is not unusual for the sufferer to become suicidal. But a diagnosis of PTSD, in itself, does not make a person violent towards others. Again, the concern should be more that they will be a danger to themselves, not others. There is a possibility, of course, that unintentional harm could come to others as the result of a suicide attempt, not only by gunshot, but though an intentional automobile accident, jumping from a building, or any other number of self-destructive acts. John Violanti, Ph.D., in his book, “Police Suicide: Epidemic in Blue,” points out the interesting phenomenon of “suicide by suspect,” in which an officer consciously or unconsciously wishes to die and willfully involves himself in situations of extreme danger or confrontation with a criminal, thereby increasing the risk of death. Even so, in these situations the danger to others is indirect and unintentional.

 

The unfortunate result of this misinformation is that more and more cases are erroneously using the defense that PTSD is to blame for murders by veterans when, in fact, there were other emotional disorders and problems involved, including prior anger issues, Traumatic Brain Injury (TBI), and substance abuse, that were more likely responsible for the individual’s violent behavior. Society already views the mentally ill as "dangerous"--we need to be very careful not to further stigmatize these people via this illness by suggesting that a violent/murderous potential exists or was the primary factor until everything has been examined.

 

___________________________________________________

 

There are other emotional disorders and problems involved, including prior anger issues, Traumatic Brain Injury (TBI), and substance abuse, that are often more likely responsible for the individual’s violent behavior.

 

___________________________________________________

 

A note of caution, however. On the one hand, we must be intelligent enough to understand that a diagnosis of PTSD or the suspicion that a person may have PTSD alone does not label them as violent. On the other hand, we cannot be so foolish as to ignore the fact that there may be other factors at play (in addition to the PTSD) that could make the person a threat or that may have played a role in a crime already committed. A person with PTSD may have a variety of other concomitant problems, such as other emotional disorders or substance abuse issues that could make a radical difference in their behaviors.

 

The purpose of this article is not to suggest that a person diagnosed as having PTSD can never be violent. Nothing, in the real world, is that predictable. We are, however, attempting to make it clear that the established criteria of symptoms of PTSD do not include violence.

 

We can all play an important role in the education and understanding of this very serious psychological disorder by being attentive when these cases arise and draw attention to medical facts without hasty conclusions. We owe that to those who have given so much in service to their country, whether it was in military service, as police officers or, increasingly today, both.

 

 

 


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