By Dr. Derrick Edwards
Don’t think about a white bear. Whatever you do, do not think about a white bear.
If you’re like everyone else on earth, you’re now suddenly thinking about white bears.
This interesting phenomenon is known as an Ironic Process and was identified by a social psychologist named Dr. Daniel Wegner. Stated simply, “You can’t think about not thinking about something.”
Good intent, flawed logic
So, what does this have to do with emergency response? When I first became an emergency responder, 20 years ago, it was common to hear the advice to never ask another person about their worst call. In fact, it is still common to hear that advice at departments nationwide.
While I’m sure it was shared with positive intent, the advice does suffer a fatal flaw at its core. Most notably, there is an assumption that so long as I don’t ask a responder about their worst call, they never have to remember and/or relive that day. At its most basic level, this seems naive at best and harmful at worst. Whether we ask someone about their worst call or not, it still occurred. It doesn’t magically go away into the ether of a career and disappear from existence.
Unfortunately, the “don’t ask” logic has dramatically shaped the way many responders attempt to cope with difficult events they’ve experienced. We somehow try to convince ourselves that if we could simply not think about that day (that patient, that sound, that outcome), then we would feel better. We, in essence, spend a great deal of time attempting to think about not thinking about something – an Ironic Process.
Your Rolodex of calls – aka your mental media library
As both an emergency responder and a professional counselor, I have spent a large part of my career traveling the country speaking about the mental health implications of emergency response. I’ve spent countless hours working with individuals who have been directly impacted by the things they’ve experienced on the job, and I’ve developed some thoughts about what leads us to either mental wellness or mental struggle.
Our career in emergency response can be compared to a Rolodex. (Many of you now need a moment to look up the word Rolodex, so go ahead and use your favorite search engine and we’ll be here when you get back.) Every call we run adds to our collection of Rolodex cards – aka our mental media library. (For our even younger readers, think of this like your incident reel or your experience vault.) From the most benign non-emergent calls to that call you can’t help but remember right now in this moment, every call leaves some type of lasting impression that gets filed away in our Rolodex, mental media library, vault or whatever you prefer to call it.
We do a great job processing the vast majority of these calls. We might talk about the use of a skill we haven’t used in a while or how ridiculous the patient was acting or how we can’t even believe what our eyes have seen. We talk about these calls around the kitchen table, in the bay and when we’re around other responders. The point is, we talk about it. Talking about these calls equates to reading the Rolodex card or scrolling through your mental media library. It allows us to fully process the information so that, in time, our brain can process.
Bear in mind, these openly discussed calls tend to not be the ones that cause us problems down the road. Sure, we can easily come up with hundreds and hundreds of cards throughout our careers, but so long as we’re openly discussing them, they tend to stay in their place. Unfortunately, there’s another type of Rolodex card that gets punched from time to time. This card is not one that we want to discuss, so we do our best to avoid it.
“Avoid avoidance at all costs”
Anyone who has ever heard me present has heard me use the phrase “avoid avoidance at all costs,” and I believe it’s the most vital component of effective coping. As we attempt to avoid reading our newly printed Rolodex card, our brain realizes the omission. Our brain desperately wants to file every card in its appropriate place within the Rolodex. What happens next is among the earliest and most frustrating parts of psychological trauma. Seemingly out of nowhere, this unfiled card finds its way in front of your mind’s eye. Suddenly, you find yourself hyper-focused on the very thing you have attempted to not think about. In mental health terms, we call this an intrusive thought, and it typically results in more attempts at avoidance. Eventually, in a desperate attempt to find the right file, your brain will give you potential suggestions of files – including similar calls. Now the responder isn’t faced with an intrusive thought about a singular event, but rather they’re seeing a veritable greatest hits of the worst calls they’ve ever experienced. Unfortunately, this rapid-firing traumatic memory parade also tends to increase our desire for avoidance.
Here are three truths about avoidance:
- You don’t get better.
- You don’t stay the same.
- You will get worse.
Avoidance, and any attempt to engage in an Ironic Process, leads us down a path of Diminishing Wellness. As it gets harder and harder to avoid processing what we’ve experienced, we often turn to things like substances, increased workloads or other sensation-seeking behaviors to make the intrusive thoughts quieter.
The opposite of avoidance is processing. During processing, we’re able to read our Rolodex card and be reminded of three different truths:
- It is real, and what I experienced matters.
- It is over and is part of my past.
- In time, my brain will process it.
These three truths are the basic tenets of any trauma therapeutic treatment program because they rely on avoiding avoidance.
Open to talk
Every responder is building their own Rolodex or mental media library that will remain with them for the rest of their life. The good news: Our experiences in emergency response are not destined to negatively impact our lives. In fact, it’s quite the opposite. Emergency response gives us the opportunity to see real life and has a way of molding us for the better – it’s called post-traumatic growth. Some of the most well-adjusted people I know carry with them a Rolodex filled with memories that matter, are in the past, and have been processed.
I would never ask you to want to recall the most difficult times of your life, but if we are to prevent the white bear from intruding on our lives, we must be willing to talk about it.
ABOUT THE AUTHOR
Dr. Derrick Edwards is a Tennessee licensed professional counselor and a mental health service provider. Edwards serves as an assistant professor of psychology at Tennessee Tech University, where he operates the TTU Responder Health Lab. His research focus centers on the psychological effects of being an emergency responder. Edwards joined the fire service in 2004 and is a licensed AEMT. He is also a member of the Tennessee Federation of Fire Chaplains.
