**The following article comes from my conversation with Harold Hoover about his views on first responder mental health. The ideas expressed in this article are his own which he has developed over many years of PTSD recovery, and which he would like to share. Please note that this article describes his own battle with suicidal thoughts, and everything written herein is written and published with his approval. **
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Fear is something that Harold Hoover, a 62-year-old retired EMT from New York City, has had a lot of experience with. A good conversationalist and a quiet, unassuming kind of guy, Hoover (as his friends call him) can have a meaningful chat with most anyone no matter the topic. He is the kind of guy listens to someone rather than planning what to say next as they’re talking, and who takes the time to think through what he’s going to say before he says it.
One topic that he can speak at length about (and a subject he’s clearly spent a lot of time developing his thoughts on) is PTSD and its relation to repressed fears. Like many of his colleagues, Hoover has undergone years of therapy to help him cope with what he has endured on the job. To name every experience that sticks in his memory would take up several pages, so just to name a few examples:
Repeated trips to extricate injured people from the collapsing towers on 9/11,
Exposure to children so malnourished that he feared finding them dead in the next call (that memory sticks with him…),
Working to save lives in under-equipped ambulances,
And more distressing situations.
Over his career, this daily dose of trauma had its effect on Hoover so that as time went on and his (as yet undiagnosed) symptoms of PTSD progressed, he became less receptive to people and experiences, reacting to everyday events as he would react to a stressful and frightening situation at work. These outward personality changes were accompanied by chronic fatigue from night-long nightmares that would wake him up and resume again once he fell back asleep. One day Hoover blacked out on his way home from work only to “come-to” again in his driveway; operating on autopilot, he had no recollection of driving home. His symptoms then became physical, manifesting themselves as headaches, blurred vision and memory loss.
His every waking moment became a 24/7 cacophony of pain, stress, fear, and sleepless nights, and as he grew ever more tired of the relentless assault on his mind, his thoughts edged closer to suicide. Having spent a career working in an ambulance he had seen plenty of examples of just how he could end his life. He decided that the quickest, easiest and most certain way to end things was to get in the fast lane on a highway and pull the steering wheel towards the concrete barrier. As he described it to me, it would have taken nothing more than a momentary decision, a turn of his hand, to finalize his decision.
Clearly, since he was alive to tell me his story, he didn’t pull the steering wheel but rather sought help. Why, I wondered, did he let it get to this point? Why not seek help the moment he felt like something was off? Why not reach out to someone when he started seeing changes in his personality?
The answer is the stigma around mental health.
Hoover avoided seeing a professional early in his career because he didn’t want to look crazy and/or be ostracized because of it (a feeling not uncommon among first responders). Nobody wants to look weak. Nobody wants to look like they “can’t handle it”. Though eventually he realized that something needed to be done, it’s not hard to have Hoover’s perception about mental health when (at the time) the subject was seldom addressed, never taught, and avoided like the plague.
The first time he went to see a therapist it was only because he had by chance heard of one in Manhattan. He was nervous about going; not knowing that his PTSD was rather common, he was afraid that if he opened up about it, he might be thrown into an insane asylum. Instead, after opening up, he felt a sense of safety that he’d not felt in a long time and the thoughts and feelings that then came pouring out did not stop. The lack of judgement and the relief having his feelings validated washed over him and he continued his therapy… for only 6 months. At the time, the insurance companies determined that 6 months was enough to recover from a mental injury and the salary of EMS professionals then (as now) was woefully too little to comfortably afford it.
Instead, those 6 months were just enough time to feel safe and to start healing before having his recovery progress all ripped away and he remembers being a total wreck because of how it felt to have 6 months of mental health progress erased. Despair and a sense of helplessness were soon to follow as he understood that another half-year of therapy would do nothing to help.
It was only after thinking of suicide that Hoover started therapy again, no matter the financial burden, and he spent the next 15 years working through his trauma.
Over those 15 years, he concluded that at the root of his trauma is his fear. In his line of work, he would experience fearful situation after fearful situation, from 9/11 to fearing for the malnourished child, and everything in between. Working through his pain, he realized that for years he never quite felt safe at work nor at home where his experiences would follow him. When he wasn’t fearful of something specific, there was a sense of general anxiety that soon there would be something to be fearful about, or otherwise there was something going on currently that he should be fearful of so that even a lack of fear was to be feared.
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Fear is a survival mechanism. Defined as “an unpleasant emotion caused by the belief that someone or something is dangerous, likely to cause pain, or a threat”, it is neither good nor bad; like joy, anger, or disgust, it’s simply a mechanism designed into the human body to help it react to and survive in its surroundings. Our capacity to experience fear (and react accordingly) has developed throughout our species’ history, enabling us to detect dangerous situations and react to ensure our survival.
Such a strong emotion can get out of hand, though, and mental pathways like the ones that control fear can be reinforced through repetition, thus becoming dominant. When someone is in complete lack of safety in their life, fear steps in to make them safe, and when fear is compounded upon fear, trauma follows not too far behind. The result is that someone subjected to constant fear is primed to use those pathways when interacting with the world.
Not until Hoover went to a therapist for the first time did he realize that he felt safe and was able to roll the fear back did he learn that the key to a healthy mental space is to deal with fear in a healthy way. Having a space or an interpersonal dynamic where one can talk without fear of judgement is an effective way of dealing with and recovering from fear; it is not somehow virtuous to stoically repress and never show any feeling, let alone fear. More broadly, Hoover says that fear that "life-controlling fear" doesn’t have to come only from what a first responder is subjected to. Fear in everyday life, such as fear of failure or rejection, can come to control someone in similar ways.
The message that Hoover wants to convey to everyone in the first responder field and indeed, everyone in the border public, is that taking the time to address one’s fears and thoughts is not something to run away from. Rather, it is something to be encouraged. To operate healthily and to view everyday events with a balanced mindset, it is of paramount importance to have a judgement-free and fear-free zone where feelings can be expressed and dealt with.
