Dump the ‘D’

Speeding ambulance
Fire/Rescue StreetSense By Kate Dernocoeur

If you’re lucky, there’s someone in your life who is that person, the one who’s always fussing to keep the crew quarters neat, the rig clean, the stuff of your lives in a semblance of order. If you’re even more lucky, there’s someone like that at home, too. Or, perhaps you’re the one who does these things—in which case, good for you. The gifts that come with a bit of obsessiveness, a bit of compulsion include getting things done and keeping up with the many demands of daily life.

It can be interesting, then, to observe what is sometimes implied about these traits, as if they are bad. Almost inevitably, there is reference to (or apology for, if speaking on your own behalf) the “OCD” (obsessive-compulsive disorder) that prompts such behaviors: “You’re so OCD! Sit down and stop fussing!” or “Oh, don’t mind me, it’s just my OCD kicking in.”

The fact is that each of us has differing degrees of interest in keeping life organized and functional. We all have a bit of both compulsion and obsessiveness, ranging along a spectrum from active disinterest to the other end. Most of us are somewhere near the middle of the bell-shaped curve, which means that most of our lives are not made dysfunctional by either obsession or compulsion. We’re just getting on with the tasks we need to handle.

Understanding “Disordered”

In emergency service, we may encounter people who aren’t so lucky. As depicted by Jack Nicholson in the 1997 movie “As Good As It Gets,” true OCD can generate such behaviors as repetitively handwashing or constantly checking if the doors are locked or taking great pains to avoid stepping on cracks. According to the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5), what actually underlies such behaviors is a taxing—yes, disordered—effort to stave off anxiety and distress.

We may also encounter a separate but similar situation called obsessive-compulsive personality disorder (OCPD). As described by the DSM-5, this is “a pervasive pattern of preoccupation with orderliness, perfectionism, and mental and interpersonal control at the expense of flexibility, openness, and efficiency.” In these cases, a person may exhibit unhealthy—again, disordered—efforts to achieve perfection or an inability to develop close personal relationships by being excessively devoted to work and other manifestations that can include hoarding.

Such disabilities can be confounding and confusing. They aren’t behaviors of choice for the people trapped in them. These people are not trying to be weird. We may encounter them having medical or traumatic situations unrelated to their psychological disorders. We may meet them when their home is burning or when a friend or relative is the patient. Whatever the case, it’s not our role to judge them. They deserve the same professional, compassionate care as every other person we assist, as surely you already know and do. Think about the disservice we do them by casually tossing around the term “OCD” when it isn’t true.

Post-Traumatic Disorder and Post-Traumatic Growth

Closer to home is the specter of another “D” that is taught nowadays at the outset of a modern emergency care career. “Critical incident stress” is the term coined in the 1980s by Jeff Mitchell, a Ph.D and a former EMT, to describe the physical, cognitive, emotional, and behavioral symptoms that can arise when our already unusual workplace generates events that are unusual even for us. Social vocabulary also refers to this as post-traumatic stress. We typically learn that those symptoms can linger and begin to interfere with a normal life, resulting in the worst-case outcome: post-traumatic stress disorder (PTSD). Indeed, for some, the incidents we handle do result in such disability—an important fact that we must not forget. Those affected need and deserve our compassionate support and help.

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Happily, though, we aren’t all destined to fall off that cliff. In fact, many of us benefit from our unusual experiences. The term coined to capture this phenomenon by researchers Richard Tedeschi and Lawrence Calhoun is “post-traumatic growth.” When highly challenging circumstances (e.g., our work) happen, positive psychological changes can result. Many emergency care veterans know this intuitively, but now the research supports it. According to a 2020 article in Scientific American, “Studies show that the majority of trauma survivors do not develop PTSD, and a large number even report growth from their experience.1 What a relief to confirm, after years of assuming this business will eventually take most people down, that this work we love has something to give us even out of its most fearsome moments.

Surely, the preference would be not to have to endure the traumas that can affect us, but that’s not realistic. According to writer Barry Kaufman, “Most people who experience post-traumatic growth are often surprised by the growth that does occur, which often comes unexpectedly, as the result of an attempt at making sense of an unfathomable event.” Outcomes found to arise from adversity may manifest, he says, in, “a greater appreciation of life, a greater appreciation and strengthening of close relationships, increased compassion and altruism, identification of new possibilities or a purpose in life, a greater awareness and utilization of personal strengths, and enhanced spiritual development.”

Four Take-Home Thoughts

The next time someone is putting in extra effort at your workplace (or at home), instead of chiding the person for being “OCD,” consider thanking that person and maybe even pitching in. And, dump the “D”!

Diagnosing OCD or PTSD is better left to the pros. However, if you’re concerned about someone you care about, reach out. Be neutral and supportive, but ask something like, “It seems like you haven’t been quite yourself lately. Is there something going on that you want to talk about?”

When you’re hit by too much of something, use the many wellness measures that can help (and avoid the maladaptive ones!) such as turning to supportive friends and family, identifying pulled personal triggers, physical exercise, a healthy diet and adequate rest, practicing mindfulness or meditating, and using relaxation strategies such as deep breathing and guided imagery.

Celebrate the personal growth that may follow on the heels of adversities you witness or encounter.

Reference

1. Scott Barry Kaufman, “Post-Traumatic Growth: Finding Meaning and Creativity in Adversity,” online at Scientific American, posted 20 April 2020 at https://blogs.scientificamerican.com/beautiful-minds/post-traumatic-growth-finding-meaning-and-creativity-in-adversity/, accessed July 14, 2020].


KATE DERNOCOEUR, retired firefighter/NREMT, still serves as a medical examiner investigator as well as a SARTECH-II with Kent County’s SAR K9 unit in western Michigan. She retired from the Ada (MI) Fire Department in 2019 and was a paramedic for the Denver (CO) Paramedic Division (1979-1986). Her emergency services career began in 1974 with the Vail (CO) Mountain Rescue Group. Educated as a journalist who also earned an MFA in creative writing, she has written extensively for EMS publications, including JEMS, since 1979, and was a frequent speaker at EMS conferences from 1984-2004. Her book, Streetsense: Communication, Safety and Control, was released in its 4th edition in 2020. She also coauthored Principles of Emergency Medical Dispatch with Dr. Jeff Clawson, MD (first edition, 1988), among other books. Her blog, “Generally Write,” is at www.katedernocoeur.com.

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