Police Psychology | PTSD Part 1:  What You Hear is What You Get

Gary S. Aumiller, Ph.D. ABPP

I have seven PTSD cases in my office right now at different stages.  Being hit by a car while working highway, a car accident with the leg shattered, a car accident during a chase, a guy stabbed in the eye by an Person with Mental Illness (PMI), a female punched squarely in the face losing teeth by an PMI, a guy who went through open heart surgery, a guy who went through a shooting and explosion, I am a lucky guy to see so much of one kind of case at one time, I guess.  All have been depressed, questioning the meaning of life, think life is unfair, all have anxiety, and all have balance problems.  You might literally say my patients are bouncing off the walls, as sometimes they are walking like they are on a ship in a rolling sea down my narrow hallways.

The depression and anxiety are all expected, but the amount of balance and vestibular problems is a little bit devastating.  I have a thing in my office where I do a brief neurologic test when someone comes in with PTSD.  I make them stand on one foot and count to ten which most can do.  Then I have them close their eyes and stand on one foot.  Everyone loses their balance a little, but most people can recover.  When a person has PTSD, they can try and try and there is no recovery.  It’s scary, and by the way I was the person who had open-heart surgery mentioned above and it has taken me a year to correct my balance from my mild case of PTSD.  So, let’s spend this article taking a closer look at vestibular effect of PTSD.

The Ears Have It

Endolymphatic Hydrops is the medical term for the type of vestibular problems I find in PTSD.  Now that sounds like a mouthful, but really it is not.  Hydrops means an excess of fluid.  Lymphatic means it is in the fluid other than blood in the body.  And the prefix endo means inside or within.  Medical words are just combinations of easier words.  So it is the fluid in the ear that we are talking about and it is in excess, so it built up a lot of pressure.  Vertigo, dizziness, spatial disorientation, and vision disturbance are all symptoms of vestibular dysfunction.  PTSD has been linked to dysfunction in the vestibular system, located in the inner ears, which processes information about motion, equilibrium and spatial orientation. In other words, it is the system that allows you to stand and balance on one foot with your eyes closed.

Damage or dysfunction in the vestibular system inhibits a person’s ability to rebalance the body during something as simple as walking or standing on one foot. Some of our PTSD patients appear to be walking on ice or on a moving ship while making the trip down the hallway to my office.  And the florescent lights seem to bother them a lot more.

Now let’s take it further.  Vestibular dysfunction and its symptoms like vertigo and such, tend to lead toward not feeling normal, “brain fog,” headaches, eye strain, and even psychological disorders like depression and anxiety, even without PTSD.  If we add to that a little impact trauma as in head impact or impact on the ears like shooting a gun or an explosion that is a lot to survive for a tiny little canal in the ear.  So even without PTSD, the ear mess-ups can create problems, but when you add the PTSD, it can be devastating.  Remember stress on the body is cumulative, so the stress on the body of the incident, plus the psychological stress may be tough on an ear canal that is less that 1/3 of an inch in diameter.

It is of great concern to police leaders to assess whether their officers are physically fit for duty after a diagnosis of PTSD. Police officers must be well coordinated and balanced during routine and non-routine acts of duty. Wrestling with a suspect, handcuffing, utilizing pepper spray, firing a gun and pursuing a suspect on foot or in a car all require use of the vestibular system. These situations trigger the brain to produce natural stress in order to push the body to optimal performance until the event comes to a conclusion. The stress and anxiety of these situations may trigger the symptoms of PTSD and therefore confound vestibular dysfunction. Imagine an officer suffering from vertigo linked to PTSD when his or her gun is drawn. The sensation of spinning or dizzy spells associated with vertigo greatly diminishes the officer’s ability to defend him or herself and increases the risk of casualties.

Be Aware

Police officers involved in traumatic experience are often sent back to work too soon or when inappropriate.  Many of them should never work again and go on disability.  Imagine an officer defending oneself with brain fog and a vestibular problems on the witness stand.  That is bad news and a major civil lawsuit waiting to happen.  Even working light duty and being exposed to constant florescent lights can put an officer over the edge.  The good news is vestibular function can come back.  The bad news is it doesn’t always occur right away, and the effects may never go away.  How do you diagnose Endolymphatic Hydrops?  Well there are not a lot of tests for it.  The report of symptoms is important, the observations of the doctor or psychologists are very important, but the most important thing is to know to look for it.  All the officer may report is he is a little dizzy occasionally and has trouble with light or gets a headache now and then.  Believe that or not, the average person, friend or boss may be the best person to say let’s get your vestibular functions checked out.

It is time to take a new look at PTSD’s disabling effects related to vestibular dysfunction.   Vestibular dysfunction has been reported in as many as 30% of people after suffering a mild traumatic brain injury according to vestibular.org.  You should always exercise strong caution when putting an officer back to work after PTSD or vestibular problems.

Dancing has always been one of my favorite activities.  I mean I was a drummer so I had a sense of rhythm, and I could move my feet with a beat.  I didn’t always look good, because I am just not a look good kind of guy, but I was in rhythm.  After my heart surgery I found myself with two left feet, actually it was more like trying to move on stilts that were two different sizes.  Heart surgery was a very traumatic experience in my life.  (My parents both died very young of heart problems, Dad was only 45).  Everyone I talked to who went through open heart seems to have had some PTSD symptoms, in fact there is some good research showing some people get PTSD after just a heart attack, many after surgery.  I realized I was suffering from PTSD, but not until I saw the imbalance during my physical activity. My own battle with PTSD and vestibular dysfunction on top of my experience with officers suffering as patients has inspired me to speak out on the subject.  It leads to the old expression “white men (with PTSD) can’t dance.”  I think that’s the expression, or something like that!

Gary S. Aumiller, Ph.D. ABPP

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