Stigma and the Black Dog

If depression was a “black dog”, I wonder what could be made of anxiety, addiction, or PTSD? And, that is still ignoring the larger issues that first responders can suffer from. This includes, as is usually excluded, our friends in dispatch and corrections. I feel that if labeling just one of the disorders in this haunting image of shadows and teeth, I can only think to try and capture all the disorders would take some mythological knowledge. That, I do not have and leave it to smarter people to identify. But, if we are going to have any control 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.

Stigma allows us to create that distance. A psychological fence for which the Black dog, or beast, or whatever we want to identify it as metaphorically, is 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 that 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 pool of emotional confusion and utter psychological torture. They embody the dog behind the fence. And they see all the “normal people” as outside and think to themselves that the grass seems always greener. Why can’t I be like them? Why can’t I be like I was?

Part of my role, and any therapist’s role 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 actively attempted to die by suicide, and maybe often ushered to the hospital in a flurry of overdoses and other psychological and physiological concerns. How, I see in their eyes, can you call this normal? The stigma weighs them down.

It is a therapist 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 they 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. And, of course, it is completely and utterly untrue. It is absurd. So, the argument can be extended, 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 that argument is applied to its fullest.

And, the above jobs are thought to experience traumatic events rather rarely; however, the argument then suggests that even though the traumatic exposure is increased for first responders, one is held to an ever-higher standard of mental resiliency. This does nothing but continue the idea 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 operate on the removing of stigma from the services.

There is a check for whether stigma is present in the workplace. After returning from a call, pay attention during the standard round table. Listen for if people talk about how they might have felt helpless, or hopeless, or perhaps that this call “bugged” them a bit. It is safe to say that this is on the way to developing a stigma-free workplace. Clearly, they remain comfortable and feel supported in that environment. 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 been witnessing in the media with the flurry of news uncovering PTSD in First Responders. But, this is just an iceberg. What means while it is finally being admitted that there are real mental health injuries that can be the result of work within the field, we are ignoring all the mental health concerns that also 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.

-Nick Halmasy is a registered psychotherapist (q) 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 nhalmasy@afterthecall.org.