Posttraumatic Stress Disorder and Hazardous Occupations [Interview][Transcript]

Dr_David_Reiss_PTSD_Hazardous_OccupationsGuest: Dr. David Reiss
Presenter: Neal Howard
Guest Bio: Dr. Reiss began training in Sports Medicine while in medical school, working with and studying the Northwestern University football team and authoring a paper, “The Psychological Anatomy of a Losing Season.”

Segment overview: Dr. David Reiss talks about some of his work with PTSD among trauma survivors, law enforcement personnel and first responders.

Transcription

Health Professional Radio – PTSD Hazardous Occupations

Neal Howard: Hello and welcome to Health Professional Radio. I’m your host Neal
Howard, thank you so much for joining us today. Our guest in studio today is Dr. David Reiss, he is here
today to talk with us about some of his work with trauma survivors, law enforcement personnel and first
responders when it comes to PTSD, head injury, and concussions. How are you doing today Dr. Reiss?

Dr. David Reiss: Very good, hello from Vermont.

N: Thank you so much for joining us today. When it comes to PTSD, we often times
get the immediate picture of a solder returning home with PTSD. But there are all sorts of people from
all walks of like that can experience PTSD, among them people that have experience auto accidents,
people who are involved in law enforcement or our first responders who are dealing with traumatic
experiences thru the course of an 8 or 12 hour shift on a daily basis.

R: Absolutely, absolutely and it’s not only people who experience trauma but people
who witness trauma.

N: Now in your experience dealing with people who are suffering from PTSD say
trauma survivor, I’m sure that a person who’s experiencing PTSD who survived an auto accident as
opposed to a law enforcement officer, whose maybe been involved in a police shooting did the
dynamics are vastly different I would say, but PTSD is still PTSD yeah?

R: Well PTSD is actually covers a pretty wide spectrum in some places I think it’s
used too generally to refer to any kind of reaction to trauma whereas really it refers to a specific
syndrome. But the thing is even that specific syndrome is very much colored by the person who’s
experiencing it, what their life history was – whether they had any traumas in the past, how they’ve
learned to cope with things. Your first responder who’s been trained to cope with trauma is still going to
have an emotional effect but it’s gonna be very different from your person on the street who doesn’t
see it coming of that exposure.

N: You worked with both. Is one more receptive to certain type of treatment than
another or can you blanket treat PTSD to a certain extent?

R: That question is easy to answer, ‘No you can’t.’ (Laugh) You have to really do a
good evaluation of the person because regardless of what walk of life their coming from anybody who
may have had childhood trauma, who may have and that could, does have the abuse, it could be a loss,
it could be depravation, it could be psychosocial situation, going to respond differently than someone
who was well protected growing up and then there are definitely differences between in general your
first responders have been trained in vernacular to be more macho into sort of hide it. And often it then
comes out in a different form than a person who isn’t ready for it and may show it as either as a direct
PTSD or turn to drugs or alcohol or other ways to try to hide what they’re experiencing.

N: Now we’ve talked a bit about pre-existing coping skills. As a healthcare provider
when someone comes to you or you encounter someone and you realized that they need your type of
help with PTSD, can some of these coping skills be learned?

R: As to a certain extent they can definitely be learned, to a certain extent you may
have to go back to rework for all trauma’s. Now that doesn’t mean remembering every particular
incident or every specific thing that happened. But basically people who have been terrified and
whether it was realistic or even if it wasn’t real but they just experienced the terror, sometimes you
have to go back and say “What patterns that this setup in your life in terms of how you cope with fear?’
And then deal with the current acute PTSD taking into account those lifelong patterns that would
develop. If you don’t do that, you’re basically doing cookie-cutter treatment that will work for the
average person which is maybe 30% and then the 40% on either the side of that it’s not gonna work.

N: Misdiagnosis, how often have you encountered a patient who is coming to you
and says that their providers said this, that or the other, and in your evaluation find that they’ve been
totally misdiagnosed? How often do you find yourself undoing something that was done in error or
maybe just the physician didn’t understand the nature of the head injury?

R: Sure. These days it’s not so much of misdiagnosed as underdiagnosed where
someone will come in with a diagnosis of PTSD, and yes it’s there but what hasn’t been diagnose is that
there was a preexisting depression or a drug problem that was already there or someone was subject to
child abuse so it’s a domestic abuse or any number of other problems. Or like I had one person recently
where they came in with a diagnosis of this PTSD spells and when I really looked at it, it turned out they
had a severe TBI totally unrelated to the PTSD actually. It was just a separate accident and they were
probably having seizures. I sent them off to a neurologist but I think they were being treated psychiatric
for it was actually seizure due to a head injury.

N: Are there any blocks to effective treatment? We talked about sports medicine,
sports injuries, we talked about some of the mindset of the first responder of the law enforcement
officer who’s been trained to deal in stress in a certain way. Do you find that you run into barriers to
treatment among certain types of people who’ve encountered these head injuries?

R: Very generally I would say there are 3 classes where there are severe blocks. One
is denial were the person just won’t acknowledge what their experiencing or want to see themselves as
invulnerable ‘I can handle this.’ The second one is substance abuse and that maybe prescribed drugs as
well as illicit drugs but when someone is using chemicals to cover it up. So you really can’t get to what’s
going on, it may suppress the symptoms but you can’t get to it. And the third, is fear people who have
been suffered some type of trauma previously are too afraid to go there and will just try to avoid really
dealing with what’s going on or look for a quick fix that isn’t really gonna work.

N: Now one final question. When it comes to barriers do you find that one gender or
another is more susceptible to having these barriers for one reason or another?

R: Very generally and it’s probably more very much more an effect of culture than it
is actually related to what sex a person is, women tend to have more fear, men tend to be more macho,
and I think that won’t surprise anyone but it really goes across the whole spectrum. And at times you get
very surprised, I mean I’ve had some of the toughest looking men that would scared the crap out of me,
who just open up and right there and some women who seem very ready and willing to work and you
get to it and they’re tough as nails.

N: Yeah, okay. It’s been great having you here with us today Dr. Reiss.

R: Thank you very much, my pleasure.

N: Thank you. Transcript and audio of this program are available at
healthprofessionalradio.com.au and also at hpr.fm and you can subscribe to our podcast on iTunes.

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