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  • Matthew J. Sharps, Ph.D.

First Responder Stress: Mental Health at the Extremes

The psychology of extraordinary stress may teach us much about mental health.


KEY POINTS

- The psychological consequences of chronic high stress can prove extremely serious.

- Some of the consequences of chronic high stress may have arisen from processes that were actually adaptive in specific ancient contexts.

- A psychoeducational approach to understanding processes behind chronic high stress may prove to be productive and useful.


First Responder Stress

Law enforcement officers, firefighters, and other emergency personnel face stressors the rest of us generally do not. These extraordinary stressors influence the mind.


Long-term immersion in high levels of the adrenergic human "fight-or-flight" response can result in negative behavioral consequences. We may develop insomnia and be hypervigilant about such things as potential insults. We may be aggressive and irritable, subject to dissociation and to "tunnel vision," focusing on the core of events rather than on peripheral elements that may be of psychological and social importance. We may be impulsive to the point that we do things that are very negative for our futures; we may, under stress, resoundingly insult our bosses or explain to our spouses that their family resembles a herd of musk oxen with poor hygiene habits. We may do this without the slightest rumination or remorse—until, of course, the consequences catch up with us later. The psychological effects of stress can introduce us to the unemployment line, our spouse's divorce lawyer, or the inside of a prison cell with extraordinary alacrity. These impulsive and aggressive behaviors have essentially no place in the modern world (Sharps, 2022); yet we may engage in them anyway. Who do we think we are, Vikings?


But what if we were Vikings? Or other ancient warriors?


This question is by no means trivial; it goes directly to the heart of our conceptions of mental health.


Mental health conditions frequently grade into normal human life

The idea of mental health presupposes the concept of mental illness. There is a dichotomy: We have a mental illness, and we wish to remove it to create mental health.


In much of organic medicine, this idea generally works. A given microorganism is attacking our bronchi, so we introduce an antibiotic to kill the offending germ; illness is destroyed, and health is restored. It's a dichotomous, yes/no, bimodal situation: Either we have some level of bronchitis, or we don't.


Yet mental conditions are, symptomatically, frequently less bimodal than unimodal; we can be slightly sad, or very sad, before we reach the heights of clinical depression, on a relatively smooth, unimodal symptomatic distribution. Attention deficit hyperactive disorder (ADHD) provides an excellent example of this concept; ADHD symptoms tend to be distributed unimodally, not bimodally, in large populations (Buitelaar & Van Engeland, 1996).


In other words, with important exceptions such as tertiary neurosyphilis and traumatic brain injuries, mental conditions tend to differ from many purely medical conditions in that they frequently grade into normal human life, rather than deriving from the attacks of identifiable pathogenic influences.


This line of reasoning implies that many mental conditions, such as those frequently inherent in chronic exposure to very high stress, may not be the same as physical illnesses.


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High-stress symptoms could have been adaptive in the past

Physical illnesses are not useful in any environment; if one is vomiting, the vomiting in question will have no utility in any conceivable human social environment.


Yet, think of the symptoms involved in states of very high stress, as frequently demonstrated by first responders: Insomnia? Suppose, for a moment, that we really were Vikings. Did we really want to be firmly asleep when the enemy attacked? Light sleep, and even insomnia, may have had utility in the ancient world. Hyper-alertness and aggression? Perhaps useful, in ancient context: Did we want to ignore, or fail to recognize, a challenge from a rival? Dissociation? Did we want to make a careful analysis of our relationship to Thor and Odin, or did we want simply to believe that the Gods would protect us within our fate under the governance of the Norns? How about tunnel vision and impulsivity? Did we wish to hang back and consider the psychological provenance of an enemy's attack, or did we need to focus and stab him as quickly as possible?


Human actions typical of high-stress, fight-or-flight psychology can prove disastrous in the modern world, which contains attorneys. However, for ancient warriors such as Vikings, these crucial elements of their everyday lives, the extraordinary stressors of combat, may not have proven pathological at all; some of them may have formed a job description.


In no conceivable human social environment are fever or nausea good things; yet many psychological symptoms, including those that are characteristic of extreme stress, may have proven to be virtues rather than defects in specific environments of human history and evolutionary descent. The medical model, in which a given type of psychopathology may be dependent on disease processes, is of course useful in context; the potentially psychotic consequences of tertiary neurosyphilis provide an obvious example. Yet many psychological conditions display unimodally distributed characteristics, which may indicate a biological distribution within human evolution rather than an identifiable disease process.


It is interesting that symptoms of extraordinary stress may in fact be essentially identical with those of PTSD or incipient PTSD, simply with a much greater elevation of these symptoms in these conditions, and that we see similar symptoms in cases of traumatic brain injury afflicting the prefrontal cortex. The prefrontal cortex is clearly the home, so to speak, of these behavioral anomalies; yet their manifestation in the real world may be dependent, in terms of its relative valuation, whether we are in the world of Eric Bloodaxe and Thorfinn Skull-splitter, or whether we inhabit our modern world of divorce attorneys, industrial tribunals, and lawsuits for perceived offenses.


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Stress, first responders, and the need for psychoeducation

These concepts may be important for the modern psychologist who deals with the extraordinary stresses of first responders, as well as with the less profound stresses typically experienced by the rest of us. Are we dealing with some form of disease process in many mental conditions, or are we frequently dealing with maladaptive responses to modern conditions, seated in what may have been essentially adaptive responses to conditions of the ancient world?


If the latter situation is the case, an obvious solution lies in the realm of psychoeducation, training in the reconfiguration of essentially natural responses from their currently maladaptive ancient sources toward a more adaptive series of responses to the modern world.


Matthew Sharps, Ph.D. - website - blog


References

Buitelaar, J.K., & Van Engeland, H. (1996). Epidemiological Approaches. In S. Sandberg (Ed.), Hyperactivity Disorders of Childhood. Cambridge: Cambridge University Press.


Sharps, M.J. (2022). Processing Under Pressure: Stress, Memory, and Decision-Making in Law Enforcement (3rd ed.). Park City, Utah: Blue 360 Media.

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