Book Review
Operator Syndrome (26/3/2024)
ISBN-13 978-1962202077
Chris Frueh, Ballast Books
This book is primarily intended for the Special Operations Forces Community, the operators and their families, so not intended as a specific therapy tool, but it does provide a unique and holistic perspective for psychologists working with military, firefighters and police working in Special Tactics or Armed Offenders roles, especially when the landscape of Aotearoa/New Zealand operational training is considered.
In another life, Dr Frueh writes crime novels under the pseudonym Christopher Bartley, and his skill with language is woven into explanations of pathophysiology in such a way as to make it widely accessible and digestible.
The initial part of the book describes Operator Syndrome. This constellation of presenting symptoms “may be understood as the natural consequences of an extraordinarily high allostatic load: the accumulation of physiological, neural, and neuroendocrine responses resulting from the prolonged chronic stress: and physical demands of a career with military special forces.” P7.
Frueh argues that personnel selected to Special Operations Forces (SOF) are an elite, physically and mentally tough, highly intelligent and creative problem solvers. As a smaller more general force with less specialist roles, personnel serving in the NZDF are exposed to a greater intensity of weapons use and blast exposure than countries with larger services. Therefore the information contained within “Operator Syndrome” is applicable to a larger proportion of NZ personnel, as supported by emerging research from our Australian neighbours for example.
Part Two undertakes to provide a more detailed description of the psychosocial and physiological impact of working within the Operator Environment. Initial sections focus on the pathophysiology – discussing the differences between repeated direct head injuries and the impact of repetitive blast exposures.
Chapters then discuss the psychopathology associated with Operator Syndrome, including mood and affect changes, and the perceptual processing difficulties emerging as a consequence of living under a high allostatic load. Frueh distinguishes between the presenting difficulties of this population and the reliance of agencies such as Veterans Affairs on the PTSD diagnosis, which he convincingly argues does not accurately reflect the unique constellations of symptoms for those affected, which has relevance for treating psychologists in formulation and planning.
Finally discussion leans toward the impact on the social world of the operator – the impact on family, transition to life outside of the military, and the existential concerns arising from duties more closely associated with moral injury than trauma.
The final section – which is much appreciated following the preceding descriptions of wide-ranging difficulties- offers direction through approaches which combine external biomedical treatments and personal strengths and positive habits. This approach celebrates the unique skills developed in previous roles and converts them to clear attributes for potential progress. What is most appreciated is the collaborative treatment approach recommended. Personal experience of working with defence personnel (and their similarly skilled occupational cousins such as AOS/STG police and firefighters) share attributes of an internal locus of control, and a motivation for engaging with strategies which enable a swift return to service. Frueh’s recommendations draw on academic research for treatment recommendations, but also place responsibility for health on the affected individual and their family making sensible and sustainable recommendations for positive change.
There is increasing research into the impact of Repetitive Blast Exposure injury and the differences between this interface astroglial scarring damage as opposed to injuries associated with CTE from impact trauma. Clinicians practising under the neuropsychology scope will no doubt continue to make significant contributions to this understanding, but it is argued that New Zealand providers working with populations who are exposed to RBE would benefit from understanding of the effects given the problems which are vulnerable to misdiagnoses of depression or PTSD. Frueh’s book provides a useful context for understanding the potential presentation for support couched in language which facilitates communication between across the potential cultural divide of clinic and military and it is also relevant for service provision to other first responders. It is an enjoyable and accessible read with useful application to practice.
Dr F Brinn
DClinPsych
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