June 26 is National PTSD Awareness Day. We live in traumatic times. Political upheaval and the ever-present threat of foreign and domestic terrorism hover over all our lives, most especially those of first responders and their families. Post Traumatic Stress Disorder (PTSD)—or the term my colleagues and I prefer, Post Traumatic Stress Injuries (PTSI)—is a serious, disabling condition affecting police officers, but it’s an injury, not a life sentence. People struggle with disorders, they recover from injuries.

These are hard times to be a cop. There are days when it seems like the actions of a few have tainted the entire law enforcement profession. Policing is a complex profession, far more complex than most people understand. What other job requires you to be combat ready at the same time you are called upon to be a counselor, a priest, a lawyer, and a social worker? What other profession authorizes you to use deadly force and then mandates that you attempt to save the person you just tried to kill?

There are approximately 900,000 sworn officers in the United States. According to some studies –19% of them may have PTSD. Other studies suggest that approximately 34% suffer symptoms associated with PTSD but do not meet the standards for the full diagnosi. This is pretty alarming. An officer with PTSD cannot think clearly. Is probably hyper vigilant, has a short fuse, may not be sleeping well because of nightmares, might be policing in a reckless manner, constantly triggered by reminders of the event, self-medicating, or making such great efforts to avoid a similar situation that he isn’t doing the job properly.

What causes PTSD in cops? The list is long and topped by injuries or death to children, serious line-of-duty injury, and officer involved shootings. Shootings are remarkable and infrequent events. Most officers will never shoot their guns in the line of duty except on the firing range. Most law enforcement officers gain cooperation from the people they are trying to arrest using only verbal commands.

When an officer is involved in a shooting, he will temporarily experience physical, cognitive, and behavioral symptoms. Time slows down or speeds up. Hands or weapons appear larger than life. Gunshots don’t sound the way they do on the firing range. And afterwards? Memory degrades. So does patience. Isolation increases. It’s hard to sleep, to stop thinking about the shooting or to engage in normal family activities. The officer is “dieseling at the curb,” her body responding to triggers as though the cop was still in fight for her survival. None of us get to vote on these reactions. They are involuntary, generated by a storm of stress hormones and neuro-chemicals activated by the human response to threats against survival. Normal or not, post-traumatic stress can make an officer feel as though she’s going crazy.

Why do some cops get PTSD when others don’t? That depends on a lot of factors, internal and external to the officer. How well or poorly the officer copes with stress, what else is happening in her life, how many other unprocessed traumas he has, does she have a concurrent condition like depression or substance abuse? And then there are the external factors, often involving betrayal, slanted media reporting, rejection by the community and lack of support from the officer’s agency.

There are many evidence-based treatments for PTSI; residential treatment, eye-movement desensitization and reprocessing (known also as EMDR or bilateral stimulation), prolonged exposure therapy, cognitive behavioral therapy, and peer support. Cops are often reluctant to seek help, fearing it will jeopardize their jobs and/or make them look weak. I think getting help makes them look human.

Behind every officer who is involved in a critical incident, there is an almost invisible family left to pick up the pieces or to watch helplessly as a once familiar and loving individual changes into a stranger. Police families are at risk for secondary trauma, also known as vicarious trauma or compassion fatigue, an emotional response with symptoms that mimic PTSD. It results from indirect exposure to a traumatic event through repeatedly listening to vivid firsthand accounts of the event. In some families, an officer’s reluctance to talk about what happened can damage the intimacy needed to form and maintain a relationship.

Take a moment on June 26 to smile at a cop. They see so much negativity in their work lives that something as simple as a smile, an expression of thanks or saying “Be safe” can make their day.