Post-Traumatic Stress Disorder – an acceptable diagnosis?

As a retired fire captain, licensed counselor and founder of Firefighter Behavioral Health Alliance (2010) I have been around the fire service for 30 years. It has been my deepest honor to serve my communities, as well as my brothers and sisters, across the US and Canada. At FBHA, we have been tracking/validating firefighter, EMS and dispatcher suicides since 2010. I have personally travelled over 750,000 miles presenting educational workshops for FFs, EMS, Dispatchers, Counselors and Chaplains on our culture and the effects from it. Discussion has taken place on such issues as addictions, depression, relationships, PTSD, anger, suicide and other behavioral issues. Our data we have collected is truly an eye opener about these issues, in particular, the numerous brothers and sisters who have died by suicide.

So when I was asked to write an article I gave it some deep thought on what my subject would be. In fact, when I selected this topic I felt it might meet plenty of resistance, but I base my subject on the data FBHA has collected from over 1,630 FF/EMS and dispatcher suicides. I base it on the thousands of people I have met and spoken to over these past years.

I will always recall my first four workshops back in 2011. FBHA presented to the Philadelphia FD. It was one full of excitement and anxiety as I presented the subject matter of PTSD and suicide awareness. This was new territory for the fire service world and 11 years later we are still out here educating on some difficult subject issues. One of the biggest movements on behavioral health has been on Post-Traumatic Stress (PTS). There is a term many use, which I support, called Post-Traumatic Stress Injury (PTSI). This term is preferred over Post-Traumatic Stress Disorder (PTSD), but for this article I will be using the PTSD because PTSI is not recognized in the Diagnostic Statistics Manual V, which is used by the counseling world, for diagnosing and treatment of clients. Hopefully, in the DSM VI, PTSI will be inserted when dealing with first responders and the military.

The question I pose to others, as well as myself is simply this. Because PTSD is recognized as a true threat to firefighters’ behavioral health, does it become easier for us to accept a diagnosis of PTSD then a diagnosis of depression or addictions? Is it more acceptable for others to understand PTSD than a brother or sister having suicidal thoughts due to a relationship falling apart?

My question comes from the numerous articles and stories of our courageous firefighters, who struggle with PTS/PTSD, who stand up and talk about their stories to help others. They should be commended for their strength! There are numerous states in America who now recognize PTSD as Workman’s Compensation cases (it should be in all 50 states).

Yet, there are fewer stories of those who struggle with depression or addictions and fewer discussions about being suicidal from relationship issues. I ask this question because when I look at the FBHA data the number-one known reason for firefighters killing themselves is not PTSD but marital/family relationships followed by depression. Yet, there are not a lot of conversations about these two behaviors that are affecting the fire service.

So once again the question: ‘Does having a diagnosis of PTSD become more acceptable than depression or losing a relationship?’ I cannot answer this question as each case is challenging and different because we are human beings. All I can do is look at the proof of how there is so much talk and action regarding PTSD in the fire service yet neglect on the top two reasons why we are killing ourselves. Yes, PTSD can affect our behaviors, which can cause relationship issues and depression, but in the FBHA data the top two reasons stand alone and did not have a cause and effect related to PTSD.

The point of this article is to get our culture to continue to talk about our behaviors from the challenges we see both as career and volunteer firefighters. But we, the fire service, need to talk about all the behavioral health issues like relationships, depression, anger, addictions, sleep deprivation, etc. that have us killing ourselves and not just focus on PTSD.

In the end, we are not dealing with numbers in our data, because these aren’t numbers. They are the faces and names of our brothers and sisters and the families they left behind. This is not just a US problem but a global one! So let’s talk about all the behavioral health issues because FBHA wants you to have a great career but a better retirement.