Why firefighter mental health's top enemy is stigma
Firefighters will needlessly suffer until we break down the fence separating mental health fact from fiction
By Nick Halmasy
If depression is a black dog, I wonder what could be made of anxiety, addiction or PTSD?
To try to capture all the disorders confronting first responders, including our oft-overlooked friends in dispatch and corrections, would take mythological knowledge. That, I will leave to smarter people. But, if we are going to have any control over this issue at all, then we would need a leash.
That leash is the abolishment of stigma.
Removing the very scary notion that these disorders are the result of us being wired wrong or different from others is a mandatory step. We fear what we don’t know. But, we might be more fearful of what we think we know.
And if we get our ideas of mental health from movies, surely we have a right to be afraid. After all, we tend to characterize violent criminals as insane and quickly label them as “having a screw loose.”
We do this to distance ourselves from the very real idea that someone normal could produce such horrific, violent actions. But, if we were to learn anything from Milgrim or Zimbardo, we know that given the right circumstances, we, too, could commit horrific acts.
Dog behind the fence
Stigma allows us to create that distance. It’s a psychological fence to keep the black dog, the beast or whatever we want to call it separated from us.
I see this almost every day. Those who finally reach out for help sit quietly, head down, waiting for their appointment.
They wear shame and guilt upon their face as if they deserve whatever punishment they are experiencing. They might be 6 feet tall, but many of them, when they sit in the chair, occupy less space than small children.
The stigma of their experience has pounded and gnashed their very spirits into nothingness. They sit a in pool of emotional confusion and utter psychological torture.
They embody the dog behind the fence. And they see all the normal people outside and think to themselves that the grass always seems greener. “Why can’t I be like them? Why can’t I be like I was?”
Part of my role, and that of any therapist, is to re-establish emotionally connectivity and normalize their experiences. Indeed, this may seem very odd given that they struggle to get out of bed, they cut, they have attempted to die by suicide, and maybe often ushered to the hospital in a flurry of overdoses and other psychological and physiological concerns.
It is a therapist's job to create a leash. Because we need to walk this dog a while before we learn to let it go and move on.
But, what of the ground for which the dog occupies? Well, that is the environment that firefighters are in. Having spent 10 years in the fire service, I’ve felt this “us versus them” within the first responder environment.
Too many times have I read that “if you can’t cut it, cut out.” This damning and damaging adage does nothing but exaggerate the emotional confusion of their companions.
Faulty stigma logic
And, of course, it is completely and utterly untrue. It is absurd.
So, if an electrician develops anxiety then she is no good for the job? If the secretary develops depression, he is then doomed to seek other employment?
The absurdity of the idea is seen clearly when applied to other professions.
And, the above jobs are thought to rarely experience traumatic events. The logic would then hold that because first responders are exposed to more trauma, they are held to an even higher standard of mental resiliency.
This does nothing but continue the fallacy that first responders are more than human. This is the crackpot elitism that needs to be swiftly removed from the service’s philosophy. With this idea gone, we can more easily begin removing stigma from the services.
There is another check for whether stigma is present in the workplace. After returning from a call, pay attention during the standard roundtable talk.
Listen for people who talk about how they might have felt helpless, hopeless or perhaps that this call bugged them a bit. When this happens, the department is on its way to developing a stigma-free workplace. These firefighters are comfortable and feel supported in that environment.
Tip of the iceberg
But, as is too often the case, if “I’m fine” works its way around the table, there is work to be done. This is the most common response.
Of course, that means that the facilitator of the debrief needs to change the questions. But, be cautious. If the administration remains philosophically unchanged, no amount of diverse questioning will make the crew feel safe enough to step up.
Stigma is crushing the services. This may seem counter-intuitive to what we have witnessed in the media with the flurry of news uncovering PTSD in first responders.
But, that is just the tip of an iceberg. While we are finally admitting that there are real mental health injuries that result from work within the field, we are ignoring all the other mental health concerns that affect us.
We are only looking at the small piece sticking out of the water. Soon, we will realize that a more holistic outlook is needed. Mental health is as important as physical health. We need to recognize it as such.
Let’s leash the beast and take it for a walk.
About the author
Nick Halmasy is a registered psychotherapist and recently retired from a decade in the fire services. He is the founder of afterthecall.org, a free, mental health resource for first responders and their families. He is also the clinical director for After The Call CISM team in Ontario. He can be reached at firstname.lastname@example.org.