After the Last Bullet: Dealing with PTSD

Editor’s Note: The following is a syndicated article by author Steve Albrecht that first appeared in USCCA’s Concealed Carry Magazine Volume 13, Issue 7 October 2016 under the title, “After The Last Bullet: Dealing with PTSD.” 

In his 2003 song “Beer For My Horses,” country artist Toby Keith said it so well. After taking care of bad guys, “When the gun smoke settles, we’ll sing a victory tune and we’ll all meet back at the local saloon.” Except it ain’t always that easy. Your intuition for survival, hours of range training and constant dry-fire practice can get you through the physical part of having to shoot someone. But are you ready for the mental part?

In the aftermath of your shooting event, your emotions will range from doubt, sadness and guilt (even if you did the exact right and legal thing) to shame, fear, anxiety and anger, as in, “Why did that attacker put me into the position where I had to pull the trigger?” You might experience mood disorders and hyper-vigilance, where you can’t seem to turn off your need to protect yourself or your family. You might experience sleep problems and nightmares, intrusive thoughts, loss of appetite or digestive problems, no or low sex drive, headaches, low energy, and just a general body ache and fatigue that doesn’t seem to go away. You might feel the need to cope with alcohol and sleep medications, which are harmful separately and potentially fatal when taken together. Don’t suppress your mind and your body’s natural reactions to trauma with chemicals. You can expect to feel horrible, then much better, then horrible again, all in the span of a day or a week or a month. Know this now and when it might happen: These are all normal responses to an abnormal situation. You’ve just experienced life-threatening, life-altering stress. How you will react to it is the question.

KNOW WHAT TO EXPECT

You can expect to experience triggers now and anchors later. Triggers happen when you experience a related or even unrelated part of the event. Something you see, hear, smell, taste or touch can be a trigger. Examples include driving by the scene of the shooting and feeling tremendous anxiety, hearing gunshots on a TV show or loud noises around you that activate your startle reflex, or even smelling your gun oil in your range bag. These can become anchors, when their presence triggers the same negative mind-body response over and over again. You might be triggered by print or TV news stories about the shooting or while walking into a courtroom and seeing the criminal who attacked you. Even the one-year anniversary of the event can become a trigger for you to re-experience your actions in a stressful way all over again.

A veteran child abuse detective, who handled a number of homicide cases where babies were left in trash dumpsters to die, told me he thought he was fine until one day he was eating sugary breakfast cereal and burst into tears. He couldn’t figure out why, but then he realized it: Little kids eat cereal. That was his trigger, and it took him back to the anchor he had created at the homicide scenes for those dead children.

PROTECT YOURSELF

Getting skilled therapeutic help is now just a given after a shooting event. We’ve proved its value over many decades for the survivors of wars and horrific national violence or local disasters. The therapy process has evolved and improved because of the important post-trauma support work that has helped our soldiers, police officers and firefighters lead normal, thriving lives, even after multiple exposures to unthinkably bad things. Besides just psychotherapy (or “talk therapy”) and cognitive behavioral therapy, trained counselors are using EMDR (eye movement desensitization and reprocessing) to interrupt the path to PTSD with excellent results.

Even tough people need help, and it should be no sin or sign of weakness to get help for your internal wounds, just like you would certainly do if you had external wounds. Referral sources for help with PTSD symptoms are closer than you might think. Just like you should carry your USCCA membership card and your lawyer’s business card, you should already have a list of mental health resources ready too. If you have a good friend who has worked as a police officer or firefighter, or a pal who has survived combat, he or she might be able to make a referral to a skilled clinician with experience in PTSD avoidance.

Check to see if your employer has an Employee Assistance Program (EAP) provider. Despite what some of your uninformed co-workers might say, EAP services are free, confidential and can put you into immediate contact with therapists who can handle a variety of personal and professional stressors that might arise as part of your involvement in a shooting.

Your primary care doctor can also give you a referral to a psychologist for therapy and a psychiatrist for anti-anxiety or anti-depression medication. The key here is to select a therapist who has experience working with people who have PTSD, not just general life problems. In a perfect world, you should work with a therapist who has been trained in police psychology, military PTSD or similar support for first-responders.

If you’re a spiritual person, besides the power of prayer, you might be able to get help from an experienced pastoral counselor at your church. There are pastors who understand that sometimes you need to take a life to save a life as shepherds are supposed to do. It’s not a sin to protect yourself.

There is a lot of mistaken information about confidentiality and the therapy process. It is not the function of the therapist to get you committed, take away your guns or ruin your life. They don’t create secret reports. They are your advocates and want to help. The only exception is if clients say they want to kill themselves or someone else and refuse to get crisis care. For those rare situations, they are duty-bound, based on the ethical and license requirements for their states, to either get their clients emergency mental health care and/or notify the targets of those threats.

Life-changing trauma is best addressed by a combination of three critically connected support areas: talking with people who care about you, including trusted family members or close friends who can keep things confidential; meeting regularly with a therapist who specializes in critical incidents and helping to prevent PTSD; and, lastly, and just as important, the passage of time. What seems painful soon after — and might create intrusive thoughts and terrifying dreams — will soon start to blur. These disturbing images pass in number and intensity over the weeks and months after your shooting, but only if you allow for the two T’s: time and talking.

But there should be a limit to what you say and to whom. Your good friend who was a cop or a combat soldier is probably a better person for the details of what happened than your spouse, partner or children. You might feel the need to tell your friends and family everything to unburden yourself of the horribly difficult situation you faced, but be careful of what mental health clinicians call “secondary victimization.” We learned this the hard way after so many debriefings after the 9/11 attacks. Therapists who held these group debriefings learned valuable lessons about the expanding effects of trauma.

Group discussions with people who were at Ground Zero and saw the towers fall actually made the event worse for people who were not at the scene and only saw what happened on TV or responded later to the scene. Telling the details of your shooting to someone who is not ready to hear the story and who can’t process it successfully might create a second PTSD victim. It’s best to only tell what happened in an overview version to the people who care for and love you, so as not to have them share the intensity if they aren’t ready for it. Even if they ask, consider your audience and don’t overshare. And stay away from friends or family members who are toxic or who will say stupid things to you, like: “He needed killin’” or, “Why couldn’t you just aim for his leg?” Some of these people might mean well, but they can’t and won’t ever know what it’s like to share your burden.

LET IT OUT

One important step is to document the event on paper as soon as you can. Keep in mind your recollection of the shooting might change over time. In an effort to protect your mind, your brain can play tricks on you, eliminating or changing certain details it doesn’t want to cope with until much later. It’s not uncommon to have tunnel vision and/or tunnel hearing in these events, where you can‘t remember how many rounds you fired or even hearing the sound of the gunfire around you. You might only recall new details many days, weeks or months after the shooting.

Writing down what happened serves several purposes: It helps you vent about what took place; you can fine-tune the accuracy and depth of the event as the days and weeks pass and your memory improves; and it captures your version to support your testimony in a civil or criminal trial. This document should be given only to your lawyer, so it is not subject to a subpoena.

Many police officers and soldiers who have been in shooting events have found much help with this stress management acronym: BREADS, which stands for Breathing (focusing on slowing it down, especially as a way to manage pending anxiety); Relaxation (meditating at least once per day for 10 minutes); Exercise (to burn excess energy and help you sleep and eat better); Attitude (relentlessly positive — “I will come out on the other side of this experience as a better person”); Diet (careful eating and staying away from too many feel-good foods, liquor or caffeine); and Sleep (using good, restful sleep as a way to “reboot” your brain and recharge your body).

TAKE NO CHANCES

Clint Eastwood as Harry Callahan said it best: “A man’s got to know his limitations.” If you ever get into a state where you are so depressed or you have so much survivor’s guilt about what you have done that you contemplate suicide, you have to get immediate help. You need to have the courage — with a capital C — to ask your family to lock up your guns and take you straight to your family doctor, local emergency room or your county’s mental health hospital. Nothing that you experienced in a shooting event is ever worth taking your life in return. No one in your family or group of friends will ever agree that your suicide was the right thing to do. Get help. Save your life and your family’s future pain.

Experts who study these events talk about the power of resiliency, the ability to bounce back, cope, be hardy, see a better future beyond the traumatic event and not let it consume the rest of your life. Being forced to shoot someone is rare and life-changing, but it should be an event in your life, not the event of your life. Lots of people have survived life-threatening, life-saving incidents involving the proper and legal use of their firearms. With professional legal and mental health help, support from family and friends and the passage of time, you will too.

Discover how you can join nearly 300,000 responsibly armed Americans who already rely on the USCCA to protect their families, futures and freedoms: USCCA.com/gunsamerica.

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