“Have you gotten Elliot’s email? I think you should see it,” the suspect’s therapist said to his mother just 13 minutes before authorities say he opened fire outside a sorority house. LA TIMES 5-25-14
Year: 2014
The hardest thing…
The hardest thing…
“For a person working with athletes, the hardest thing to do is to keep them out of the game they love when they’ve had a concussion. Especially if they are a teammate” No player should return to the field who is still experiencing symptoms associated with concussion.
Michael Sefton
Decisions on Bail for Domestic Violence
THERE IS MOVEMENT TOWARD VICTIM SAFETY IN CASES OF DV
WESTBOROUGH, MA Is there any coincidence that Democratic House Speaker Robert DeLeo has joined forces with Attorney General Martha Coakley to bring forth a new bill that will provide for stiffer bail conditions and tougher sanctions for repeat DV offenders? This bill was brought forth just 2 weeks after the Massachusetts SJC ruled on the case of one abuser against whom a permanent restraining order has been in place for over 10 years. In that ruling, a man against whom a protective order was written is seeking its dismissal under the broad assumption that he is no longer a threat to the former girlfriend because he now lives 3000 miles away. Not so fast said the Massachusetts SJC.
The Commonwealth’s highest court reviewed the historic data in the case record and made its decision based on the documented threat of violence the abuser posed and convictions for DV against more than one partner dating back to the 1990’s. They voted against dismissing the permanent restraining order writing that victim safety is more important than the purported rights of abusive men. In the SJC decision the limitations placed on the abuser based on having a “protective order” against him were the collateral consequence of the behavior they exhibited early on. The abuser believed he was unfairly being prevented from owning a firearm and had limited opportunity to work with children because of the unfair restrictions placed on him by the permanent order of protection. Furthermore, the SJC also acknowledged that the abuser must show “convincing evidence” that they have made substantive emotional and personality changes that render him no longer a threat to the estranged spouse.
The bill proposed by Speaker Rober DeLeo asks for tougher bail conditions most notably a 6 hour delay before an alleged abuser may be released from custody. The highly publicized case of Jared Remy who was released from custody hours before be allegedly killed his live-in girlfriend served as a stimulus to the proposed change in the law. An important consideration not mentioned in the proposed bill is that to do with subjects with known violence in their history and how best to protect victims from revenge abuse once the abuser is released from custody. Presumably, the new bill affords potential victims the opportunity to put in place a safety plan and affords those making decisions about bail added training about the cycle of abuse, red flag predictors, and greater access to the history of violence of the person in custody.
Unfortunately, the bill does not go far enough in its current raw form to assure that victims of violence receive the needed protection once they decide to break away from dangerous and dysfunctional entanglements. It is this time when abuse victims are at greatest risk of death due to domestic violence as in the case of Amy Lake, a victim of domestic violence homicide whose case was carefully studied in the Psychological Autopsy of the Dexter, Maine Domestic Violence Homicide (Allanach, 2011) that occurred in June 2011. Maine has been reviewing bail conditions since this unique study made over 50 recommendations for reducing the incidence of domestic violence homicide in that state. This report was presented to the Governor’s Domestic Violence Homicide Review Panel in November 2011. Only recently was a domestic violence suspect held without bail for his history of felony assault and battery on his spouse and a prior domestic partner for over 20 years. In that case, the abuser was arrested three times in one month for violating an active order of protection during which time he threatened to kill his estranged wife.
Red Flags and Bail Conditions
In Massachusetts, Speaker Robert DeLeo warns that red flags often foreshadow an abuser’s behavior giving clues as to the intentions and the proclivity toward violence. These are facts that are well described in the literature on DVH. It is suspected that perpetrators ostensibly inform others about their intentions and all to often, these individuals do nothing to stop the violence. In a prior paper, I have argued that a domestic violence registry may be useful for keeping track of those who repeatedly abuse or batter their domestic partners. This would be similar to the sex abuse registry that requires those adjudicated for sexual abuse of children must register whenever they move from place to place. I have also written extensively on the need for containment of those at highest risk to offend including a pertinent history of physical violence e.g. choking coupled with threats of death, access to firearms, prior violation of an order of protection, the presence of more than one simultaneous protection order (multiple victims), and other forms of coercive control such as destroying personal mementos like favored Christmas ornaments and personal photographs. A pattern of substance abuse further elevates the risk for domestic violence and DVH.
There are changes taking place in the way in which domestic violence is handled in many states here in the U.S. Bail conditions are being reviewed with more stringent constraints being placed upon abusers including no bail containment of the most egregious and violent cases. Further options like GPS monitoring and a domestic abuse registry are being considered in some jurisdictions. Some experts are calling for added training for judges and greater access to DV history before making decisions about bail conditions. Arguably, these examples will all add to greater victims security but do very little when emergency protection orders are issued by judges during the night. Police are frequently asked to present information to an on-call judge in an effort to provide immediate protection following a suspected incident of DV. This information is critical in conveying what risk exists to the victim or potential victims. Many police agencies are using dangerous assessment tools to compile and enumerate the red flags that may be the harbinger of terminal rage and the end of one’s timeline somewhere.
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.
Maine man held without bail in case of DV
WESTBOROUGH, MA March 30, 2014 The Portland Press Herald reported on the case of Jason Lawrence who is being held without bail for domestic violence. He is a repeat offender whose violence against women can be traced back to 1997. Is anyone surprised that the well-being of victims in this case were not considered by the judicial system who twice released Mr. Lawrence into the community. Finally, the perpetrator’s actions convinced someone he was the real deal and is being held without bail in Maine. At what point does the well-being of victims and potential victims rise above the abuser’s right to bail? Some circumstances warrant the containment of those who exhibit abject cruelty over and over. Many states including Massachusetts are beginning to realize how emotionally dehiscent an abuser can become. The case in Maine is the first I have seen to hold a violent abuser without bail in that state.
Recently, the SJC in Massachusetts denied to remove a protective order that has been in place over 10 years. He claimed to have “moved on” and wanted to work with children and own firearms – arguably two rights surrendered when domestic violence allegations have been proven against you. The SJC called the rights of abusers to have protective orders dropped years later – as the collateral consequence for the years of documented abuse (Sefton, 2014).
In the June 2011, Dexter, Maine homicide, one police officer was heard to say he had never before been so afraid for a victim of domestic violence and in spite of those fears and having access to firearms, Steven Lake was released from custody with little bail. The subsequent Psychological Autopsy conducted in 2011 by 4 current or former law enforcement officers identified red flags – just like those exhibited by Jason Lawrence – as being highly predictive of domestic violence homicide (Allanach et al., 2011). Mr. Lake killed his family and then himself in June 2011. People knew this was his ultimate intention and said nothing until the terminal rage he concocted resulted in the deaths of 3 innocent citizens from the state of Maine. Red flags were identified in the post hoc analysis of the case and were presented to the Domestic Violence Homicide Review Panel in November, 2011 in Augusta.
Does anyone doubt what Mr. Lawrence’s ultimate intention was in the 3 weeks between arrests? His anger and marginal behavior were escalating by the day. It did not matter to Lawrence that a protective order was in place. A “no contact” order means nothing to a man who believes all control has been taken from him. Arguably, when a district attorney identifies someone as “one of the worst domestic violence individuals ever” – as in this case, those words should be key is setting the parameters for bail. Greater discretion for bail is necessary in this case just as when a police officer believes a victim is not safe from her purported abuser. Ultimately, the premonition of the deputy sheriff in northern Maine came true on the morning of June 12, 2011.
Mr. Lawrence is not afraid of the police or being sent to jail because he has no limits on what he can do. He does as he pleases and containment is the only correct solution. Red flags were apparent as far back as 1997. The valid predictor of future violence is past violence. regrettably, the secrecy of victims and those who choose remain silent are the one’s who might stop domestic violence. And as a society we must do something to bring a voice to these individuals because to do nothing is unthinkable.
Read more from the Bangor Daily News:
Citation:
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.S., Collateral Consequences, taken on 3-30-14, https://msefton.wordpress.com/2014/03/11/collateral-consequences-stay-away-orders-that-are-forever/
“Whether or not…
“Whether or not a student receives support on an education plan has no bearing on the kind of support they might need when they return to school after a concussion” Michael Sefton, Ph.D. Director of Neuropsychology – Whittier Rehabilitation Hospital
Students who return to school following a cerbral concussion often require specialized scheduling, rest breaks, reduced work load, and other individualized support.
Collateral consequences: Stay away orders that are forever
WESTBOROUGH, MA Protective orders are devised to keep victims of domestic violence safe and are valid and useful judicial tools to arrest perpetrators of DV who violate them. Some orders are vacated automatically if the facts of the case do not warrant the renewing of an order or if the victims does not wish to continue the protective order. In the extreme, protective orders are put in place that do not expire because the perpetrator has exhibited such high risk behavior and the facts of the case bear out the necessity of such an order for the safety of victims. These orders are not handed out without compelling evidence of repeated violent and coercive behavior toward victims and are subject to rigorous judicial and legal scrutiny.
Perpetrator wants 2001 order vacated
The Massachusetts Supreme Judicial Court has ruled that Kevin Caruso must submit “clear and convincing evidence” that he no longer poses a danger to former girlfriend in a case dating back to 2001. The Supreme Judicial Court in Massachusetts has required that Mr. Caruso provide proof that “he has ‘moved on’ from his history of domestic abuse and retaliation”. Merely being in a new marriage is not sufficient to prove that he is no longer a threat to the former girlfriend. In fact, it is well known that men move from one abusive relationship to another inflicting fear and terror with every passing day. In most cases, red flags litter the wake of repeated domestic violence with violent behavior including choking, threats with firearms, social media stalking, and other forms of sadistic, coercive control. In this case, Mr. Caruso has been stopped from working with children because a permanent “stay away” protective order appears in his CORI – criminal record. It has been an inconvenience because he is now prevented from owning firearms and has been subjected to searches when he pass through airports. In the written opinion, SJC Justice Ralph W. Gants states “the only relevant issue is the safety of the plaintiff – not the passage of time” as published in the Boston Globe (3-14-2014). The SJC called the frustration felt by Mr. Caruso the “collateral consequence” of the permanent restraining order put in place initially issued as a result of his threats to kill his former girlfriend. According to Justice Gants, “the impact on the life of the alleged abuser is not a critical issue for the judges” and ultimately he must show “clear and convincing evidence that it is no longer equitable for the order to continue.
The Massachusetts Supreme Judicial Court has taken an important position in this decision to help protect victims of DV with the most egregious case histories. Accordingly, distance alone and a new relationships are not conclusive documentation of “moving on” and as a result do not reduce the risk to victims. In the decision the SJC rightfully protects the safety of the most vulnerable by requiring “persuasive evidence that the conduct of the abuser has had a significant change of circumstances” that results in the reduction of risk to the victim or victims. Perhaps this is the first step toward a national data base of domestic violence offenders similar to the sexual abuse registry. Substantive decisions about bail or no bail holds will be more reliable by having access to the violent history of domestic violence offenders and the protective orders that have been issued time and time again.
Uploading the Rhythms of Life
Cardiac monitoring may be an ‘event’ unto itself
The debate over life and death often focuses on the heart and the brain. Some believe life ends when the brain ceases all activity – a term called brain death. Others believe death results when the heart ceases to beat. In a blog published in January 2014, the mind-body dialogue was discussed by Michael Sefton. He described the rudimentary force of life as the heart’s beating “which begins and ends with the inimitable squeeze of the cardiac muscle.” For patients who are being monitored the experience is highly stressful and often evokes fear and dread.
The link between what happens to our body and its effect on our mood and feeling state is well documented. Just as we must adjust to the early developmental changes of our children so must we adapt our own thinking and lifestyle to the changes brought about by the empty nest. Events such as having children leave home and head off to college and other events associated with empty nesting require flexibility and adaptation of roles for success. These important transitions signal an advancing age that sometimes accompanies physical decline in health and body. With that said it is important to note that many American’s are living healthier lifestyles and thus preserving physical health well into the eighth and ninth decades of life.
“Don’t ever get old”
Retirement was once described as a period of “golden years” and was thought to represent the final stage of one’s life during which the experience of freedom and contentment proffered a whimsical enjoyment of lazy, carefree days. It meant taking time to share one’s wisdom with those who are younger and pass on the stories of family, culture, and life itself. This is often not the case and I have had patients suggest that I should never get old. Retirement is frequently a time of unbearabe loss and despair.
One factor affecting quality of life is the sense of physical well-being. Retirement sometimes triggers an erosion of physical health and cognitive stamina choking all remaining time with recurring, monotonous doctor’s visits and tests. In truth, what may be a glorious time is now marred by fear and trepidation about one’s health, financial stability and declining physical longevity.
Poor cardiovascular health is an underlying cause of many chronic disease processes like stroke, diabetes, and auto immune disease. Heart attack remains among the leading precursors to early death and researchers are racing to uncover treatment options including early identification of those most at risk and life saving surgery to open clogged arteries. Meanwhile, people should take greater responsibility for their own health by eating better and building exercise into their changing lifestyle. Things like moderating use of alcohol, 7-9 hours of nightly sleep, and eating plenty of fruits and vegetables become the specter of truth and failure to an ever-growing problem with obesity. This is an important lesson for young adults to discover but is easier said than done.
The mind-body dialogue is one that matches wits with any great debate. What are the best methods for identifying ‘problem’ hearts before they reach a penultimate, fibrillating finale? Some doctors ask their patients to wear special monitoring devices – little boxes attached to the skin that permit the ongoing monitoring of life threatening changes in rhythm. Patients sometimes wear the monitor for a month or more. These monitors have the potential to catch irregular heart beats and allow physician’s to see a patient’s electrocardiogram on a minute to minute basis. The monitor requires that the person wearing the device to upload his data via a telephone line each day sometimes with little to no training. Each recording represents a cardiac event that the person wearing it is asked to chronicle in terms of action and feeling state when the device is active. The events are uploaded via telephone land lines in real-time that seems almost tortuous to those bearing the burden of wearing the device. The rhythms are quickly edited, analyzed and more often than not result in nothing more than a friendly vote of confidence – “you’re all set”.
Event Monitoring
Greater thought and training should be afforded to patient’s wearing event monitors. As time goes on most patients become accostomed to the vagaries of the heart and the sound it makes – lub dub, lub dub. The event recordings come in one after another and become part of the month-long survey of heart activity. Some people call two and three times daily worried that they are having a serious cardiac event. After 30 days the monitor is turned in for analysis by the cardiologist. These daily rhythms go on to become the underpinnings of a cardiac care regimen that may offer treatment alternatives that can save a life. The clinicians go on to new patients and new rhythms and new reports. But each person who wears a monitor is brought to bear the feelings of their own life force beating in his or her chest sometimes wildly out of control. For those with irregular heart beats it can be 30 days of fear, impending doom, and personal paroxysm that seems to go on forever as skipping beats and palpating rhythms. And even those with a normal EKG, the fear and worry of not feeling well can be just as agonizing as the beats are uploaded one at a time with not so much as a “job well done” and encouragement to call again tomorrow.
The fundamental appetence for living is shaped by the relationships made during life. Those relationships that nurture and sustain may extend ones years of viability. Some believe the force of life is the beating heart. For without a healthy heart the quality of life may become desultory and life itself may become nothing more than a daily upload of irregular beats on the telephone, in real time.
To read the former blog click on the link below.
https://msefton.wordpress.com/2014/01/17/the-force-of-life-and-the-fears-that-go-along/
“The underpinnings…
“The underpinnings of violence are often present in some form or another and may be represented by marginalized demeanor and extremist views and often ignored by those in the cross hairs” according to Michael Sefton, Director of Psychological Services at Whittier Rehabilitation Hospital in Westborough, MA.
This quote represents a recurring belief about the evolving coping skill of an active shooter until the very end according to M Sefton. The terminal event is often preceeded by growing fury and red flag signs of anger. It suggests that greater awareness by outside observers of sudden changes in mental status should be recognized along with the utilization of stopping and containment protocols and coordination of care in or out of the state correctional system.
The force of life and the fears that go along
Another look at the mind body dialogue. The force of life lies within our body bringing forth our human energy. Those energy traces forge the bonds that form meaningful relationships in time and space and sustain us. The force of life starts with a tiny heart’s beating and does not stop until life’s last day when the heart no longer makes its inimitable squeeze.
The meaning of what is human is derived from the social appetence inscribed into it by mentors and those who tend to its garden from early on. Human growth stems from a caref
ully crafted blend of biological gifts and environmental design shaped over time. This may be lost without the core ingredients and nurturing bond that nourish it. In their absence, the vessel becomes incapable of tolerating life’s abject aloneness and may become diseased. The heart is a muscle that does not tire and yet it must be sustained or it quickly loses it lean and supple appearance slowly requiring more energy to power its life long lub-dub, lub-dub while still perfusing the body. Arguably, the interaction between one’s heart and one’s head is undeniable. What we do and how we think has much to do with the health of the body and ultimately, our life force.
Finding balance
It takes time to establish the human contacts needed to trust another person and put yourself in the hands of another with complete emotional certitude. The fundamental appetence for living is shaped by the relationships made during life. Those relationships that nurture and sustain may extend ones years of viability. Those relationships that suppress the normal, effusive, life force are detrimental to health much like a toxin.
MSefton's Human Behavior Blog 