Resilence and management of high stress situations

 The likelihood of becoming involved in an on-the-job shooting in one’s career is generally quite low across law enforcement officers in the US and Canada. However, there is a high degree of likelihood of almost daily encounters with high stress calls involving intimate partner violence, substance abuse, children at risk, unbearable human suffering and death.  I recall being involved in a search for a middle age male who did not return home after a night of drinking.  His route typically brought him across an abandoned rail road bridge.  As you might guess he did not make it across the bridge on that cold night instead falling off and drowning. He was found partially submerged and caught on some tree branches visible only by his L.L. Bean jacket which he had bought for those cold walks back from the neighborhood watering hole.  He was known to most of the police officers – two of whom were charged with going out into the river and retrieving his remains.  The body had been in the water about 48 hours.  It was not something I had seen before. I stood by for the retrieval and was involved in the notification.  My first of many.
These kinds of calls stay with you.  Especially early in one’s career.  The response of the family to losing their 50-year old father was especially difficult as he had young children from his second wife.  But I know officers and EMS first responders who have had one
images 2
Boston Police Officers react to Marathon bombing  ABC TV – photo credit
experience after another just like this and worse. A colleague described rolling up a driveway to an open garage and bearing witness to the home owner hanging from a ceiling joist. Suicide. Imagine the psychic imprinting officers experienced responding to recent mass shootings in Las Vegas or to a small church in rural Texas where so many people are killed or maimed and to be unable to stop the bad guy before it all happened. It happens every day it seems.
Here in Boston, 3 people were killed over 300 people were badly injured after two homemade bombs were set off during the Boston Marathon setting the stage for a complete shutdown of the city while area police officers searched for the suspects.  MIT University Police Officer Sean Collier was killed by the bombers while seated in his patrol vehicle on duty 3 days after the bombing.  Within hours a firefight ensued in Watertown, MA as the bombers were found in a hijacked SUV.  The brave officers from Watertown, MA, Boston Police, MBTA Transit Police, and Harvard University PD fought it out for 8 minutes with Dzhokhar Tsarnaev and his brother Tamerlan who was killed in the gun battle and run over by his brother. MBTA officer Richard Donohue was shot during the gunfight nearly losing his life. After a year of rehabilitation he returned to duty and was promoted to sergeant but ultimately could not recover from his wounds and retired in the line of duty. It took extra days and over 1000 police officers to locate the second bomber cowering in the covered boat of a Watertown resident. His image was published in the Boston Herald depicted with the snipers red dot on his forehead.  Citizens applauded law enforcement as they left Watertown on that night.
To survive these incidents one needs to have resilience also known as the psychological resources to process the experience with all of its ugliness and to know that you did what was needed with the training and experience you bring to the job every day.
By using alcohol to cope instead of resilient thinking one often develops other problems and this can lead ultimately to suicide. Alcohol is often related to suicidal behavior.” according to Leo Polizoti, Ph.D at the Direct Decision Institute in Massachusetts.  
After a stressful event, your body and mind must return to its baseline calm and ready state so that the officer may again activate and serve in whatever capacity is required without the baggage of the calls gone by.  As this “baggage” builds unfettered the likelihood of a decline in officer job performance grows sometimes exponentially.  There should be opportunity and on-going training to process the images in order to put them away and restore emotional equilibrium.  In some department realistic training includes use of simuntions where officers actually shoot their weapons at active shooters during training exercises.  The weapons are full sized handguns fitted with special projectiles that do not cause lethal injuries.  All training is conducted with head and face protection.  Many departments are building resilience training into their recruit academies – no only building physical strength but emotional wellness too.  “Current training teaches officers about biological awareness (bio-awareness) since psychological and physical reactions in the body arise from biological responses to the environment. Mental and physical states don’t happen independently and both must be addressed in reality-based training” Anderson, et. al., 2017.
“When a person encounters a threatening situation, they experience a surge of natural chemicals, such as adrenaline and cortisol. These chemicals allow the body to respond quickly. When this biological threat response is moderate, it enhances performance through more accurate vision, hearing, motor control, and response time. However, when the threat response is severe, the response can negatively affect performance by creating distortions in thinking, vision and hearing, and by increasing motor control problems, which can result in slower reaction times.” Anderson, et. al., 2017
Police in Massachusetts and throughout America are faced with the worst of all human experience.  Arguably, everything from unattended death, domestic violence, child abuse, and a fatal motor vehicle crash may show up on the call board of any dispatcher on any day or night as I posted in May, 2015. In the case of traumatic events – officer safety demands CISD and in the long run physical health and well-being are the underpinnings of a resilient professional who will be there over and again –  when called upon for those once in a lifetime calls that most of us will never have to answer (Sefton, 2015). “Psychological benefits include reducing distress, enhancing confidence in abilities and recognizing psychological responses that need the attention of a mental health professional” Anderson, et. al., 2017.  When necessary police officers undergo critical incident debriefing and peer support. Some benefit has been demonstrated using biofeedback to reduce the trending autonomic arousal through a paced breathing protocol to ameliorate the sympathetic-parasympathetic mismatch that has well described negative impact on physical health, emotional embitterment, and job satisfaction (Sefton, 2017).
“The primary goal of all modalities of biofeedback including physiologic modalities and neurofeedback is to restore the body to its “normal” state of homeostasis.  The process promotes mindfulness and paced breathing to gradually lower respiratory drive, reduce heart rate and blood pressure, and enhance other abnormal physiological readings such as skin conductance, abnormal finger temperature, and elevated electromyography.  It takes practice and understanding of its value.” Sefton Blog post 2017
Ultimately law enforcement and all first responders must be afforded support along with training to adapt to situations most human beings would never choose to confront and do so in a manner that instills personal dignity,  integrity, and continued professionalism.

Polizoti, L. (2017) Psychological Resilience: From Surviving to Thriving in a Law
Enforcement Career. Direct Decision Institute presentation.
Judith Andersen, Ph.D., Harri Gustafsberg, M.A., Peter Collins, M.D., Senior Cst. Steve Poplawski, Bsc., Emma King, M.A., Performing under stress: Evidence-based training for police resilience. RCMP Gazette Magazine Vol. 79, No. 1.
Sefton, M. (2015) Critical Incident Debriefing: The cumulative effects of stress. Blog post: https://msefton.wordpress.com/topics/dv-and-trauma/police-service/critical-incident-debriefing-the-cumulative-effects-of-stress/ Taken 12-30-17.
Sefton, M (2017) Biofeedback: Teaching the body to return to a proper homeostasis. Blog post: concussionmanagement.wordpress.com https://wordpress.com/post/concussionassessment.wordpress.com/3682, taken 12-30-2017

The Myth of Mental Illness and School Violence

WESTBOROUGH, MA January 13, 2018 The true incidence of violence among people diagnosed with a nervous and mental disorder is quite low. It is a common misconception that whenever something hideous occurs it must be “mental illness” that is the driving force behind its fury. Occasionally this is true but much less than one may anticipate.  I have written on those with both mental illness and co-occurring substance abuse in prior posts (Sefton, 2017a, Sefton, 2017b).  In most cases mental illness alonebigstock-Mental-illness-in-word-collage-072313 is neither the reality nor the underlying cause of terminal rage. In light of the information being uncovered about the Newtown, CT mass murderer, the specter of mental illness insures a convenient scapegoat. Updated information from Newtown recently confirmed that Adam Lanza had studied the media stories of prior mass killings as he planned for his despicable finale. In retrospect, I wonder what “red flags” have been uncovered that offer insight into his substantive motivation. People will speculate about random causes of Lanza’s behavior unless it can be studied scientifically.  Was Adam Lanza mentally ill?
There are some instances when mental illness may be associated with serial homicide such as the Son of Sam killer who plied his murderous delusions in NYC during the 1970’s using a Charter Arm’s Bulldog .44 caliber revolver. David Berkowitz used that weapon to kill 6 and wound 7 during his spree. He claimed to have been commanded to kill random couples he saw in cars by a dog he believed possessed by the demon. After spending time in a mental institution following his conviction he was transferred to the state prison at Sing Sing and finally Attica to serve 6 life sentences. When he was on trial Berkowitz plead not guilty by reason of insanity – the delusions he had about communicating with demons. In the end, it was determined that Berkowitz was not mentally ill. The Columbine, CO high school killers, Klebold and Harris were methodical in their planning of the attacks on the school and its students. They built explosive devices and practiced their attack in the weeks before the assault on the school. By outward appearances these two were from middle class families with involved parents.
columbine-investigation-video
Kliebold and Harris were identified as Columbine. CO H.S. mass shooters
Many believe Klebold and Harris were the victim of bullies. Psychological experts believe mentally ill persons lack the higher order planning to execute the complex steps necessary for these types of crimes. Neither Dan Klebold nor Eric Harris was mentally ill. The Virginia Tech killer Seung-Hui Cho murdered 31 students and faculty in 2007 after a period of decompensating rage. He wrote a profanity laden manifesto blaming everyone for their maltreatment of him that sounded paranoid and vindictive yet was able to send the videotaped diatribe to a news agency. Yet Cho was able to plan his killing spree methodically even to the extent that he chained the entry doors into the building in which he made his final assault. This delayed entry by the active shooter team by minutes. Cho had been held in a psychiatric hospital 2 years prior to his rampage after becoming marginalized. He should not have had access to firearms under current statutes.  Was he mentally ill?
      The Psychological Autopsy is a clinical assessment of the time line and antemortem emotional comportment of the perpetrator of sometimes despicible terminal events.  These types of case studies explore changes in cognitive and behavioral functioning immediately before a terminal event of homicide. An extensive review of a case from 2010 that was published in 2011 generated over 50 recommendations about DV and factors to consider when victims are at greatest risk.  The cost of these interviews and substantive case review is the primary reason they are not regularly conducted.  It is also less compelling when the perpetrator has killed himself and survivors want to turn the page.
Recently, shooters have survived mass killings in Aurora, CO and Tuscon, AZ. They are the face of mass murder today and as they moved through the criminal justice system – both ultimately found guilty.  It is hoped that important information may be gleaned from studying their motives, personal history, and triggers to their rage.

Ronald Allanach et al., Psychological Autopsy of June 13, 2011, Dexter, Maine Domestic
Violence Homicides and Suicide: Final Report 39 (Nov. 28, 2011), http://31xf6v26wmo03e4ujj27kr80-wpengine.netdna-ssl.com/wp-content/uploads/2011/12/Dexter-DVH-Psychological-Autopsy-Final-Report-112811-111.pdf
Read more at: http://www.msefton.wordpress.com
First posted by Michael Sefton, Ph.D. at Friday, March 13, 2013

Analysis of Facts helps Reduce Harm to victims of DV

DOMESTIC VIOLENCE REVIEW BOARDS
WESTBOROUGH, MA  January 5, 2018 As we begin to make program recommendations for reducing intimate partner violence it is worth noting that change comes very slowly in protecting those who are most at risk. There is still a paucity of protective measures in place to assess and contain those who are most violent in our society. Retired New Braintree Police Sergeant Michael Sefton was in Augusta, Maine in October 2011 providing testimony about the results of the psychological autopsy conducted by Michael Sefton, Ph.D. Brian Gagan of Scottsdale, AZ, and Ron Allanach, Ed.D. of Conquitlam, BC, Canada and former Chief of Police Joseph Laughlin of Portland, ME.  Dr. Sefton, who holds a doctorate in psychology and is a licensed psychologist provider in Massachusetts provides neuropsychological and forensic consultation on domestic violence including domestic violence homicide and assessment of risk.  The report that was filed came up with over 50 recommendations directly related to reduced intimate partner violence. The report was cited over 12 times in a recent Maine Law Review publication on proposed Conditions of Bail. Little has changed in Maine since our first report in 2011 and there is no leadership to bring forth legislative dialogue.
PUBLIC INFORMATION
The testimony provided to the domestic violence review board offered details about a hideous case of family violence that ended with the homicide of 4 members of the same family and was culminated by an attempt to burn the bodies after the murders and the killer shooting at police officers responding to the missing victim. But they were too late. Their research was conducted over a 3 month period following the homicide deaths of Amy Lake and her children.  The team conducted interviews with over 60 persons with direct knowledge of Amy Lake, the victim, her two children, Monica and Cody, and the murderer Steven Lake.

Maine Law Review

“Although Maine’s statute lists these prohibitions, it lacks the enforcement tools to protect victims against violence associated with guns and other weapons, which is a major factor in Maine’s domestic violence deaths.” Nicole Bissonnette, 2012
HIGHEST RISK
Most researchers agree it is nearly impossible to predict when DVH will occur.  However, the psychological autopsy provides many obvious red flags that offer clues to an impending emotional conflagration or explosion of anger and blame.  The problem in the 2011 case was two-fold.  First, the requirement for bail was not seriously considered because Lake had no criminal history – and yet Mr. Lake had demonstrated an unwillingness to adhere to the legal mandates of the order of protection and violated the court order at least 4 times over the year before he killed his family. Given this unfettered lack of personal control, he should have been held for a hearing of potential dangerousness.  And secondly, the cache of firearms that Lake was known to have kept was not surrendered to police nor was an effort made to obtain the 22 weapons Lake owned by members of law enforcement. No one thought the guns would be an issue.
Many believe that when the victim indicates a strong fear belief that her spouse intends to kill her that risk of DVH is elevated exponentially and must be taken as fact. These often unspoken fears illustrate the need for supervision, assessment of potential for dangerousness and containment of PFA violators. Substantive red flag factors suggest a true risk of violence exists. The study also found that individuals with heart disease who are depressed will often have higher inflammation levels in their body. Many studies show that a combination of exercise and fatty acids, such as Omega-3 found in salmon, can reduce inflammation and consequently reduce bouts of depression and mood swings.In the sworn statement in 2010 for an order of protection, Amy Lake specifically reported that she feared that her husband might kill her. These fears of death would come to fruition one year later. And they did come true in despicable, horrific fashion.
It is not uncommon that red flags are often present early in the relationship as people reported during our research interviews during the psychological autopsy.  Many people we spoke to were aware something agregious was going to happen.  These include obsessional jealousy, threats of death, sexual aggression, unwillingness to integrate into extended family, any use of a weapon, and others.  In the course of their research Sefton and Gagan interviewed Dale Preston who was convicted of DVH in 1982 and served 18 years in Maine State Prison for the murder.  When asked what may have stopped him from killing his wife, Mr. Preston indicate “there was nothing that could have stopped me…”  In these cases, a greater awareness of risk or dangerousness is essential and in some cases a person must be contained for the safety of others.  Such containment requires NO direct contact with an abusive spouse, GPS monitoring, house arrest, or no bail imprisonment.
The case in Maine occurred in June 2011 – exactly 1 year to the day after the victim obtained a protection from abuse order from her husband.  The murders occurred 2 weeks before the divorce was to be finalized and were likely triggered by the abuser’s anger over not being permitted to attend his son’s 8th grade graduation ceremony.  The Bangor Daily News presented details of the recent psychological autopsy presented recently in Augusta, Maine.  Over 30 states across America have formal homicide review boards.  “To make this general deterrence aim successful, abusers must not have access to their victims nor to potential weapons, and the risk of punishment associated with breaking the law must outweigh the abuser’s urge to commit the conduct.” said Denaes, 2012. Bail is a judicial condition that allows a person to be released from jail with the promise to appear in court to answer to charges. Bail also provides for public safety by keeping violent offenders in jail when necessary.
I make an effort to review those published from New England states.  Vermont has an excellent annual report of domestic violence homicide and publishes all recommendations and changes in statutory requirements following individual cases of DVH.

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.
Nicole R. Bissonnette, Domestic Violence and Enforcement of Protection from Abuse Orders: Simple Fixes to Help Prevent Intra-Family Homicide, 65 Me. L. Rev. 287 (2012).
Available at: https://digitalcommons.mainelaw.maine.edu/mlr/vol65/iss1/12
Johannes N. Denaes, PUNISHMENT AND DETERRENCE 7 (1974) (“General prevention may
depend on the mere frightening or deterrent effect of punishment—the risk of discovery and punishment
outweighing the temptation to commit crime.”).
See id. at 34-35