Month: November 2014

Things of importance

Michael Sefton, Ph.D. aging and memory, Human Behavior, psychological relevence, retirement , , ,

WESTBOROUGH, MA November 30, 2014 A patient once said Dr. Sefton “don’t ever grow old”.  At the time I wondered what he meant.  The man was alert, physically fit and had a great support system. We have heard for years that today’s baby boomers are growing older. No kidding, I am one of them.  “People believe human touch and the relationships we forge along the way sustain us into our old age with a sense of well-being”  according to Michael Sefton, Ph.D., who provides neuropsychological testing for older patients.  Along the way the connections we make open our experience and our hearts. As people age, time begins to have greater significance – especially at the end of life. Some people say time moves quicker with age – especially when memory fades. Greater attention to things of importance must include keeping memory and history alive. Ask yourself “what do I value most?”  If the answer in your head is money, job promotion, or things like material objects then priorities may be outright misguided. Next, ask yourself how much dignity you might feel if you suddenly were made to feel irrelevant?  That is how may older Americans feel as they age and enter the “golden years”. Depression and loneliness are highest among people who are older and have become marginalized. This contributes to the inability to participate in their communities adding to feelings of loneliness and increased risk of functional decline and even early death (Singh, A. and Misra, N., 2009).

Cultures everywhere include senior citizens among the things that are valued and respected although this is not universal. Some believe that with age comes wisdom. Here in America, the population of older citizens will grow by a factor of 2 in the next decade or two. No society should discredit those who are older and may be stepping aside to a younger generation.  “Senior citizens, especially those who may be blind, deaf, immobile or senile, contribute less and require more care, which is likely unavailable” according to Discovery Health. The growth of older Americans has far exceed the growth of programs geared to help those in need. Why?

Retirement and aging

For those who are entering the last years of employment a sense of trepidation may confound their decision to retire. The age of retirement has edged upward largely due to financial need. People are constantly speaking out about the need to plan ahead for the retirement years. In a blog I wrote about police officer retirement the success a person feels in retirement depends upon how valued they feel in society (2014).  Many believe that older workers are more reliable and bring a higher level of maturity that benefits employers everywhere.  Others see the older worker as the greeter at the local box store – someone now irrelevant. The impact of this prejudice adds to a high incidence of depression among people over 65. The rate of poverty among older Americans is greater than 15-20 percent, according to Intergenerational Learning Service based in Illinois.  And the rate of grandparent’s who take care of their grandchildren has never been higher.  How is this scenario apt to impact human development for years to come?

A fundamental change in attitude must take place toward people who are aging here in America.  At the same time, a belief in lifelong learning and personal responsibility for health and well-being will give an older person an equal advantage for those who are aged and wish to continue being relevant.

Michael Sefton

REFERENCES

Singh, A. and Misra, N., (2009). Loneliness, depression and sociability in old age. Industrial Psychiatry Journal, Jan-Jun; 18(1): 51–55.

Sefton, M. (2014) https://msefton.wordpress.com/police-service/the-working-chief-a-job-greater-than-the-sum-of-its-parts/. Blog post, taken November 30, 2014.

Watch for the flying of the flags

Michael Sefton, Ph.D. Dangerousness assessment, Human Behavior, Relationships , ,

Terminal rage dissembled by increased red flag threats and violence

WESTBOROUGH, MA  November 2, 2014 A group of my colleagues and I were drawn into the chilling events of June 13, 2011 after Stephen Lake killed his family and then himself.  During the final moments of his life Lake laid out the death scene ostensibly to torture his spouse from whom he was estranged and ordered to stay away.  While police closed in, Lake killed and attempted to burn his victims in an act of emotional mayhem.

Arguably, the murderer in this case became blinded by anger and resentment at perceived disrespect and exclusion from the lives of his children. This anger had grown over the year since a protective order was issued following a violent episode in the family home. The perpetrator grew marginalized during the coming months becoming resentful and humiliated at missing key events like Christmas and an 8th grade commencement.  All the while he posted on social media sites his love for his family he grew depressed and disorganized.  12 hours before the violent ending he tearfully described feeling depressed to a family member and was advised to seek help.  Lake wrote 9 suicide notes that were found in the days after his death.

Renewed interest in retrospective study

The psychological autopsy revealed an increasing pattern of red flags in the weeks before the murder-suicide in Dexter, Maine. Greater awareness of these red flags may serve as a stopping and containment point for perpetrators of intimate partner violence.  In a sad retrospective, the Maine state Chief Medical Examiner cited that “in spite of some mental health treatment the extent of (the perpetrator’s) anger was not fully appreciated”. The research led to a call for no bail holds for some violent abusers and GPS monitoring for others.  After 3 years, these recommendations are finally beginning to emerge in the protection of victims of domestic violence in Maine. Mr. Lake was alleged to have violated the protective order more than twice.  His reported view of the “cost of divorce was the price of one bullet”.

Who can be expected to bear witness to red flags?

It is well documented that domestic violence is a secret happenstance that effects far too many families across the country.  Victims are expected to remain loyal servants of their spouses under the dissembling guise of love and devotion.  The findings published in the Dexter, Maine study reveal that people knew what to expect from Mr. Lake.  His unwinding was clear to some of his closest family members.  A paternal aunt was quoted as saying “I never thought he would take the kids” suggesting an awareness that Lake might kill his spouse and then himself – sparing the children.  Others believed Lake might commit suicide in front of his wife and children leaving them with the emotional specter of his violent death.  Instead, as the chief medical examiner cited the full extent of Lake’s anger was not appreciated.  In this case, as in many other retrospective studies of DVH red flags were not appreciated. Many believe that an order of protection is not effective in protecting victims from violent spouses who seem to ignore “stay away” orders seemingly at will and without consequence.  These are the red flags that require containment of the abuser and must serve as the frank evidence of elevated risk for domestic violence homicide.

The team of people helping 22-year old Elliot Rodger, a young man who went on a shooting rampage at the University of California at Santa Barbara in May 2014, all reached out to police and the media when they could not reach the estranged and overwrought man.  But they were too late as he had made his mark on history by then.  The the Virginia Tech shooting some red flags were missed.  Had the subtle clues the Rodger’s underlying mood been recognized the shooting may have been averted.  To read the blog from the UCSB shooting click here.

Mandated reporting for domestic violence 

As a civilized society there should be mandated reporting for those most at risk for domestic violence and the penultimate DVH as it becomes apparent.  Just as practitioners are mandated to report cases of suspected child abuse and elder abuse so too must we begin to take heed of the signs of domestic or intimate partner abuse and take action.  By doing this we may save the lives of those most effected by DV and arguably break the recurring cycle of domestic violence.  Some people wrongly believe there is nothing that can be done about domestic violence homicide. Others remark that “what happens behind the closed doors in a dysfunctional and violent household is no business of anyone else”.  To the extent that this draconian belief system prevails in the public understanding of DVH there is little chance of preventing this scourge.  As a result states are slowly changing their response protocols for DV and the police response to signs of abuse with mandated arrest for suspected perpetrators.

Risk assessment of those arrested for domestic violence is often overlooked.  However, police departments are teaming up with agencies serving the population of abuse victims like never before and are adopting tools to assess the likelihood of future violence when determining bail amounts. Bail commissioners must be educated about the cycle of abuse and domestic violence when assessing bail amounts.  The average abuse victim experiences 5-7 episodes of DV prior to calling the police. Police response to DV has slowly started to include a careful analysis of the history of aggressive events including the number and type of physical assaults that have taken place.  Some events are clearly more foreboding like choking to a point of unconsciousness, sexual aggression, threats of suicide, and the use of veiled threats of death if the spouse ever tries to leave. Other behaviors such as unrealistic jealousy may be the underpinning of current or domestic violence.  One victim told me that the abuse started as soon as she said “I do” 16 years earlier.

REFERENCES

Ronald Allanach et al., Psychological Autopsy of June 13, 2011, Dexter, Maine Domestic Violence Homicides and Suicide: Final Report 39 (Nov. 28, 2011), http://pinetreewatchdog.org/files/2011/12/Dexter-DVH-Psychological-Autopsy-Final-Report-112811-111.pdf.

Sefton, M. (2011) The Psychological Autopsy: Provides a host of pre-incident indicators. Blog:  http://www.enddvh.blogspot.com/2011/11/psychological-autopsy.htm, taken May 26, 2014.