Police Psychology | PTSD 3:  Car Accidents

by Gary S. Aumiller, Ph.D. ABPP

Of course, they’re driving around 24 hours a day, non-stop.  The problem is there are other people on the road.  The cops have lights on the car and fancy writing, but that just attracts people who have only partial attention to a mundane task like driving.  Two cars hit, one of them is a cop car.  From helping cop to a victim, from a person in charge to helpless man lying on the ground in pain or even unconscious.   At an accident scene, we are worried about everything from keeping the traffic moving to making sure everyone gets the help that is needed.  But the help the cop needs may not be as obvious as a broken bone, or some blood-stained clothes.  And that becomes a major problem for policing.

A New York Times article in June of last year told a story about a physician that was analyzing a soldier’s brain that had been in Iraq and Afghanistan, and had died of a drug overdose.  He was complaining of sleep problems, cognitive problems, memory loss, balance problems and suicidal depression.  The physician notices a buildup of a certain type of protein and some dust-like scarring between the gray matter and the white matter of the brain.  Many other soldiers’ brains seem to have the same scarring and complained of the same symptoms.  The physicians felt it was from blast exposure, or all the loud sounds a soldier was exposed to.  Up to 20 percent of soldiers seem to have these symptoms at different levels of severity.  Problem was soldiers didn’t want to report it for fear they would be seen as going crazy.  The article opines that in World War I, thousands of soldiers were shot for desertion or cowardice that may well of had a Traumatic Brain Injury (TBI).  In the 2015 movie “Concussion,” Will Smith play Dr. Bennett Amalu who fights against the NFL when he discovers microtears in the brains cells of football players and the NFL won’t recognize it.  Players complained of headaches, problems sleeping …(you know the rest).   The NFL and the American Military recognize it as a disorder, when will our police departments become aware of it and recognize it?

One problem is the fact that this pattern is below detection.  In both the movie and the military, we find that this problem was discovered on autopsy, after the person was dead.  See after death they can take the brain and do what is called a histology which are micro-slices of the brain.  It was in the micro-slices that the tears were discovered.  It was also where the scarring was found.  Unfortunately, the CATs and the MRIs and other tests of the living brain cannot pick them up.  They’ve called this disorder Post-Concussive Syndrome (PCS) , which is common in football players and boxers, and yes, people in car accidents.  It is the beating that the brain takes with repeated exposure to concussions.  What is also hard to know is what number of these concussions will lead to post-concussive syndrome.  It seems the younger brain is more pliable, but is it the tenth concussion, the fifth, the third that leads to post-concussive syndrome; we just don’t know.

It is also hard to know what is Post Traumatic Stress Disorder(PTSD) and what is Post-Concussive Syndrome.  In Post-Traumatic Stress Disorder, which is considered a psychological disorder, there is the same symptom group with some added stimuli specific fear and concerns.  PCS seems a little more generalized, but the symptoms are often the same.  With PTSD, generally you see some major improvement after six months of treatment, but often you don’t.  With Post-Concussive Syndrome or Traumatic Brain Injury (TBI) you may not see major improvement in the symptoms, only plateaus in the tolerance of the symptoms for amounts of time.  But it seems the symptoms come roaring back full blown at times.  All signals that we may be dealing with a brain injury cluster, not a PTSD cluster.

I have three patients on my therapy load right now who fit this diagnosis.  All have had a couple of car accidents in addition to some roll arounds where they had gotten a little shaky afterwards.  All are noticeably brain damaged.  One couldn’t drive for a year and the others all have a little trouble driving at night.  All have had vestibular therapy, sleep problems, emotional vacillation problems, a little agoraphobia, fatigue, etc.  All are affected by the florescent lighting in my office so I purchased indirect lighting and that made me feel better too.   I have to be honest, for a year and a half after my open-heart surgery, I had many of the same symptoms, but mine went away.  There’s seem to be somewhat permanent, and that is sad.  I can’t give permission to let these people go back to work, because another concussion is very likely and they would be lost, pulling out their teeth to let the bugs out of their body, like in the movie “Concussion.”  They are very susceptible to another concussion and it is not a matter of if another situation will occur with a cop, it is when will the next situation occurs.  A simple roll around could set them off.   I want these guys out and disabled.  But my opinion is as a union representative, not the department.

In Suffolk County, we have a Medical Evaluations Unit within the department with the imperative to get people back to work.  They see people who have cheated the system and they want to make sure it does not happen anymore.  They assume everyone wants to cheat the system.  Raging headaches, lack of sleep, false sensation in the body, fatigue, light sensitivity, and balance problems in addition to an emotional reactivity make them not a candidate for full time duty.  So, they put them on light duty at the front desk, which one officer described as the patrol car without the wheels, and the prestige.  Supervisors in my area tend to take one look at the cops and say, “you really are different and messed up,” and try to adapt the work environment for them.  They try to help, but the battle becomes the cops v. medical evaluation.  They are made to feel something is truly wrong with their desire to work.  They are made to feel they are lazy and trying to take advantage of the county.  It is disgusting to watch these men destroyed. 

They go home exhausted from work.  Domestic disputes are rampant in their families.  They can’t even get emotionally charged about their kids anymore.  The bureaucracy eats them up.  If the guys have enough time in, they consider retiring at this point, if not they use up their sick time to get away when they are not feeling good, and all sense of self starts to wither away.  Then when they apply for disability, they are rejected because there is no bloody shirt or broken bones.  Maybe the World War I military tradition of shooting them was more humane than putting them through the scrutiny of accusing them of not wanting to work, and being lazy.  Certainly, it has been that way for my patients.

This practice has to stop and eventually it will.  But during this period, those with Traumatic Brain Injury are lost to the system and the many cheaters who have caused the pendulum to swing in the direction of lacking empathy.  Eventually medicine will invent a scanning process that will pick up the micro-tears in the brain.  It happened in football and the military, it will happen in policing.  For now, we need to recognize this is a problem and be a little more empathetic when a person comes from a car accident where he has lost consciousness or has symptoms of a brain injury.  Look for this in your department, and try to help these men.  When a cop tells you he can’t sleep, he feels strange, his emotions are not right, or he has headaches and can’t stand the lighting, see these as signs and symptoms of an injured cop, and help him or her out.  You may save a suicide, or a drug problem from developing.  Eventually, disability and departments will recognize this problem.  The military and the NFL fought recognizing it, but they came around.  Cops have this problem too, and the numbers of car accidents in this profession will make it come to light.

Site Administrator:  Gary S. Aumiller, Ph.D. ABPP

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