The mental scars of battle
FOR police psychologists, it is a familiar story. The incident on the street is over, but for the officer concerned in a live-or-death situation, the drama is far from finished.
Recurring nightmares, chronic insomnia and acute paranoia are just some of the reactions experienced by police officers who survive such critical incidents as this week's shootout in Mongkok.
The Lan Kwai Fong tragedy, the Vietnamese camp fire last Lunar New Year's Eve, the mudslide in May and the ever-increasing number of armed robberies, are all crises that have a personal cost for the men and women who must deal with them on our behalf. The mental strain has never been greater.
''It is the police who have to take the fingerprint, in a pool of blood, of someone who has jumped off a building,'' said senior force clinical psychologist, Mr Eddie Li Kam-wah.
According to the psychological services group of the Hongkong police force, the number of officers receiving professional counselling has increased steadily over the last three years.
The total number of new cases dealt with by the division jumped from 137 in 1991 to 196 last year.
Of those who sought counselling many were officers who had family or financial problems (or both) as well as those who suffered stress-related disorders long after a particular critical incident.
The number of consultation sessions, run for one or more officers, has also increased from 627 in 1991 to 728 in 1992.
''More officers now come to us and also there are more [critical] incidents happening,'' explained Mr Li who joined the group in 1987.
''Certainly there is a stigma in seeing psychologists, so we have to rely on our welfare officers, who are professional social workers, to be fully alert.'' The psychological services group, a sub-division of the police welfare branch, was established in 1984 in recognition of the potential high stress level faced in the day-to-day work of police officers.
At present, two psychologists work within it.
Officers involved in a shoot-out must attend mandatory meetings with them.
''According to what other modern forces have experienced, in the United States and United Kingdom, involvement in a shoot-out can be extremely stressful . . . and they are not even near to the situation in Hongkong where grenades are used,'' said Mr Li.
''The extent to which the officer will suffer from the incident would depend on the circumstances of the case, his experience and personality.'' Clinical psychologist Miss Gillian Marcoolyn, who is in private practice, said that police officers, ambulancemen, and firemen have to come to terms with the fact that their lives could be threatened in the course of their work.
''Because of the nature of their jobs, police officers are to some extent more prepared psychologically for crises than the average citizen,'' she said.
''However, given the ongoing stressful nature of their job and the accumulating stress that would result from it, and their greater sense of responsibility to deal with an emergency rather than flee to safety, the stress that they too experience may be considerable.'' Miss Marcoolyn said many officers would also feel a sense of guilt because there was always something else they could have done. They have to fight the natural response of thinking about their own safety first.
An officer could also feel guilty if a colleague was injured or killed in the incident, because he would think that man was braver than him, she added.
Most officers at first refuse to admit they are under stress, because of their macho image. But in fact many of them need professional guidance.
Mr Li said there is a cluster of symptoms or syndromes involved, such as the inability to shake off some of the images of a shootout.
There can also be a momentary inability to feel happy or sad and some may have ''startled responses''.
''For example, seeing a boy playing with a toy gun can be a reminder of the incident, or a bang on the street, or even the sound of a braking vehicle, all this could lead to certain responses. One of which is to take shelter [immediately],'' Mr Li said.
There can be a physical effect too, said Miss Marcoolyn.
''The accumulation of stress definitely has a physical effect and [those with a prolonged trauma] don't recover very well.'' She labelled these symptoms as post-traumatic stress order, a term invented after the Vietnam War to describe an intense, and usually prolonged, reaction to the intense stress caused by a natural catastrophe or man made disaster.
''There is also stress on the family. It's frightening to know your husband was in the incident. The policemen themselves also have the worry about their family welfare,'' Miss Marcoolyn said.
During counselling, psychologists try to teach officers certain stress control exercises such as relaxation or to help them to build up a mental framework to prevent the symptoms from recurring.
They introduce officers to stress management, but most important is to share their feelings with other officers who have the same experience.
''Usually, a session lasting one to 11/2 hours would suffice. Sometimes officers do [the counselling] in a group form, knowing that they are not alone and they do get support from their fellow officers,'' said Mr Li.
''Maybe 20 per cent of them need further follow up and they may be referred to hospitals for medical advice. We do have cases which need to be followed up for more than a year.
''Recently there was a death in one of the police prison cells. The suspect had committed suicide, and some officers in the aftermath felt very bad. Then the information commander contacted me and asked me to go down to talk to the group,'' said Mr Li, who also extended his service after the Vietnamese camp fire incident.
''Certainly I'm doing something for the Lan Kwai Fong group but everything is not finalised. I don't want to talk too much on that. But this is a kind of out-reach work that we do.'' Unlike the police force, there is no in-house counselling for officers working in the Fire Services Department. Those who need help are normally referred to their doctor then, if necessary, to a hospital.
However the Fire Services have invited professional psychologists to counsel those involved in the Lan Kwai Fong tragedy.
''This is a special circumstance because so many of our officers were involved in the rescue operation,'' said service welfare officer Mr Lai Chi-kwan.
The police psychological services group is now feeling the strain and hopes to have more manpower to cope with the increase in the number of officers now seeking its services.
''One senior official had fired a shot in an incident 25 years ago and a culprit was killed with justification, but he is still haunted by the incident,'' Mr Li said.
''But he told me now, as a friend, that if there had been a psychologist at that time, he would have probably forgotten about it.''