“One of the major findings in this study is that there is a dramatic difference in brain activity in the amygdala and hippocampus during inhalation compared with exhalation,” said lead author Christina Zelano, assistant professor of neurology at Northwestern University Feinberg School of Medicine. “When you breathe in, we discovered you are stimulating neurons in the olfactory cortex, amygdala and hippocampus, all across the limbic system.”
There are places in the world where intimate partner violence is pervasive. so pervasive that it Places the opposite gender in peril for 50% of the poor Places like Russia, Saudi Arabia, France, Egypt, and the United States have excessive rates of domestic violence and domestic violence homicide. This week in Russia, three sisters await trial for the murder of their physically and sexually abusive father. He was murdered while he slept. In spite of having first-hand audio of his abuse the three young women face over 10 years in prison for the crime
While France has a progressive reputation and pushes for women’s rights around the world, it has among the highest rates in Europe of domestic violence, in part because of poor police response to reports of abuse. Many of the women killed this year had previously sought help from police.
Violence against women is a costly and pervasive public health problem and a violation of human rights according to a 2010 paper by the Population Research Bureau. “In Egypt, a third of women are physically abused by their husbands,” according to the 2005 Egypt Demographic and Health Survey (DHS). “Most victims suffer silently and don’t seek help to prevent or stop the violence because they think it is part of life or they are embarrassed by the abuse.”
It is like that here in the U.S. as well. Victims undergo unbearable pressure to anticipate what triggers the violence they experience. Substance abuse adds to the unpredictable nature of the perpetrators. In some rural communities in Egypt and elsewhere, honor killings remain taboo and are often minimized as a “family matter”. When a woman falls in love with a man of a different religion she may face honor killing by her father or oldest brother who feels duty bound to revenge the dishonor brought by such behaviors. This is a significant problem here in the United Stages as well. In a recent article, a man in his taxi cab ran over his wife because he had a dream she was being unfaithful to him. There are over 25 honor killings estimated annually here in the U.S.
These are not isolated incident from third world countries. While I was working in law enforcement, one victim said to me that “she was beaten by her jealous husband for taking too long in the voting booth.” It was unacceptable to him that she visit with friends and neighbors she encountered while in line to cast her vote. He called her on the cell phone three times in 30 minutes which illustrates the coercive behavior and control seeking put upon victims of intimate partner abuse.
In the French Republic, French film and TV stars joined abuse victims and activists calling for an end to “femicide.” Many held banners reading “Sick of Rape.” Like many developed countries there is an engrained denial and secrecy about spousal abuse including rape. In parts of Africa, including Kenya, Tazania, and South Africa, domestic violence may reach 50 percent of girls over age 15. These figure illustrate the problem of gender inequality in the developing countries alike.
The protest in the French capital came on the U.N.’s International Day for the Elimination of Violence Against Women and is aimed at pressuring the French government before it unveils new measures Monday to tackle the problem. A shift in egalitarian gender roles will take generations to take hold. Meanwhile, protection of girls and women should include safety planning, early intervention in public education, greater police response to physical violence, and a zero tolerance policy for violating an order of protection.
Domestic violence is a major cause of disability and death among women worldwide, and puts women at a higher risk for unintended pregnancies and sexually transmitted infections, including HIV/AIDS. An undeniable double standard exists across the world when it comes to sexual violence and male infidelity. The incidence of honor killing remains a despicable happenstance in India, Pakistan, Turkey and Egypt and 5000 innocent girls annually.
The proposed intervention measures are expected to include seizing firearms from people suspected of domestic violence and prioritizing police training so they won’t brush off women’s complaints as a private affair. In late November, Time Magazine’s Angela Charleton featured a profile of intimate partner violence that is worth the read . However, countries like France, Saudia Arabia, and Egypt have a low rate of gun ownership so further study must but undertaken to understand the secret narrative that threatens an entire gender.
“…Such are the places where every man, woman, and child seeks equal justice, equal opportunity, equal dignity without discrimination. Unless these rights have meaning there, they have little meaning anywhere. Without concerted citizen action to uphold them close to home, we shall look in vain for progress in the larger world,” said Eleanor Roosevelt.
More than ever women around the globe are now shouting out in private and public spaces, regardless of the possible backlash, “I am equal!”
“The term femicide was first coined in the 1970s to refer to gender-related killings. Femicide is not recognized in the French criminal code, but Marlène Schiappa, the junior minister for gender equality, said the recognition would be discussed in the coming weeks” described Laura Fourquet in a September 2019 NY Times article on the topic
PRB. (2010). Domestic Violence High in Egypt, Affecting Women’s Reproductive Health taken November 25,2019.
In the 1970’s there was a bill that allowed police officers who earned their college degree to be paid extra money called the Quinn Bill. The Police Career Incentive Pay Program was enacted by the Massachusetts Legislature to encourage police officers to earn degrees in law enforcement and criminal justice according to the Massachusetts Department of Higher Education website. The funding for this ended in 2012 when the Commonwealth of Massachusetts stopped paying its share to cities and towns across the state. Officers hired after 2009 were not eligible for this program. In many cases, officers earned thousands of dollars on top of their base salary to continue their education. Many officers went on to earn advanced degrees and came to depend on this funding.
“Public safety is a priority, and it is essential that we have a highly trained and educated police force to keep our community safe.’’Hon. Setti Warren, Mayor of Newton, MA
In Newton alone, the money to pay its police officers with earned an earned college degree amounts to an annual budget amount of 1.3 million dollars according to Mayor Setti Warren who believes it is worth it. Newton and many other communities in Massachusetts have continued payments to officers even after the state subsidies were no longer available. It is the right thing to do. In a similar way, reimbursing cops for “wellness training” should include subsidies for mindfulness and voluntary critical incident defusing sessions with peers following high lethality-high acuity events such as an active shooter incident.
Officer wellness is a vital component to resilient community policing. Officers who are resilient and mentally healthy provide better response to citizens in crisis. Just as it is important for law enforcement officers to be rewarded for continuing their education legislation may be enacted that provides funding for officers who undergo behavioral health and fitness training when it is associated with job-related trauma and mental illness. Peer support and crisis intervention training (CIT) teach LEO’s the skills needed to support fellow officers in need and deescalate people in the field who are in mental health crisis. By doing so, they avoid use of force and potential civil action against the police from use of physical force or incidents of officer involved shooting (OIS).
Officers are urged to sign up once they are released from formal field training and agree to be open to behavioral health follow-up moving forward. They do so after seeing the department psychologist to review incidents they have experienced in their early careers. Once cleared they agree to participate in regular defusing sessions in the aftermath of high profile incidents. At the same time, they may keep an electronic behavioral health profile with dates of traumatic cases and their role and response to each. If the LEO wishes to share these self-reports the department psychologist may have access to the case files and individual behavioral health responses. Family members would have access to the department psychologist if deemed necessary. There would be mandatory meetings with the department psychologist following OIS incidents and at other times depending upon department regulations and protocols.
Once a police officer opts to join the Career Behavioral Health Resiliency program he or she would receive a stipend that would be commensurate with the total time allotted to their participation wellness and resiliency programming. They can go all in and receive an annual incentive for both the resilience they achieve and for being part of the peer support network that might include mentoring another officer who is struggling with career embitterment or from the effects of repeated trauma. In some cases, an officer may choose not to mentor a fellow officer but agree to personal growth and mindfulness activities along with participation in educational offerings. The program would be a win-win all around by raising the behavioral health and emotional stamina of the troops in the field and the chain of command.
I suggest proposing a law enforcement version of “no man left behind” ethos espoused in the U.S. Military. There should be a path to recovery for most police officers who are willing to receive this current “best practice” standard of care leaving no man or woman behind. Dr. John Violante, a University of Buffalo research scientist and former N.Y. State Trooper believes “police officers have a moral duty to care for members of law enforcement who are in crisis”. This will put an annulment on the stigma associated with the human response to trauma that often leaves officers feeling alone and ostracized by the men and women with whom they serve. By using a robust peer support network and collateral police psychology model officers may develop a sense of normalcy for intervention following high acuity calls.
The International Association of Chief’s of Police (IACP) has a broad-based Mental Wellness program it is reporting on its website that highlights the importance of this kind of support. “The IACP, in partnership with the University of Pennsylvania (Penn) and the Bureau of Justice Assistance (BJA)’s VALOR Initiative, is customizing a program specifically designed to help officers and agencies by enhancing resilience skills. The cost of such a program will reap rewards in the form of career longevity, officer well-being, officer morale, quality of community policing, and greater faith and trust in law enforcement in general.
copyright 2019 Direct Decision Institute
Domestic violence homicide results when victims decide to move on with their lives and inform a jealous, insecure spouse that they no longer want a relationship. October is Domestic Violence Awareness month. The risk is greatest when victims decide to leave. At first glance one might say “Lots of people break up and do not murder their spouse and family” according to Michael Sefton shown in the photo on the left. That is a fair statement but it happens enough in the United States and elsewhere that it must be considered. Last week in Massachusetts a family was murdered because one spouse asked to be let go and people were stunned that they saw nothing to warn them of what was brewing.
“Domestic violence is not random and unpredictable. There are red flags that trigger an emotional undulation that bears energy like the movement of tectonic plates beneath the sea.” according to Michael Sefton (2016).
At what point does a potential begin to wonder whether she and her children are safe? We are lead to believe that abusive intimate partners cannot be held in jail unless they are in violation of an order of protection, AKA: restraining order. Time and again, violent and abusive partners stalk and ignore orders of protection – especially using social media tracking software and trolling social media sites like Facebook, Instagram, and What’sAp. It is all about control and instilling fear.
Restraining order’s are authorized by a district court judge who is on call night and day. They are not authorized unless substantial threat to the victim exists. These orders are carefully crafted by investigating police officers whose reports highlight the exact nature of the violence and the reason the victim needs protection. “Protection orders are offered to the victim after the first sign of physical violence. It has been espoused that the police are not called until after the 6th or 7th episode of domestic violence” according to Sefton, 2016. DV is a secret affair between members of a family who are often ashamed or embarrassed to come forward for help often until things gradually get worse – sometimes years into a pattern of violent dysfunction.
Research is clear that separating spouses for the night does not positively impact the level aggression and risk in the household as much as the formal arrest of the aggressor. What usually happens is the police break up the fighting couple by sending the aggressor off to the home of a friend or family member – less often to jail unless there are obvious signs of abuse. Arrest is mandated by law when physical signs of abuse are apparent. It has become all too often the case that hindsight – taken seriously – may have saved a life. It is when they are attempting to leave that 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, et. al. 2011) that occurred in June 2011. Lake’s husband and murderer was heard to state that “if you ever try to leave me I will kill you”.
In research conducted by this author and colleagues we learned that as soon as police leave the scene the risk for violence is increased. We interviewed a man who served 18 years for the murder of his wife and he described in vivid detail how he used nonverbal coercion to manipulate his wife while being interviewed by sheriff’s deputies in Maine. He admitted that as soon as the police were out of the driveway he strangled and drowned his wife for calling them.
In the end, there is always at least a single person who knows what is about to happen and often does nothing to stop it. Whether this unwitting duplicity stems from the cultural belief that what happens behind closed doors is “nobody’s business” or the conscious result of intimidation should not change the law enforcement intervention in these cases. Early incarceration provides access to a viable safety plan for potential victims and in some cases, will instill a desire for change in the violent partner. In the meantime, substantive buy-in from police, legislators, judges, probation, and society needs to be fully endorsed for real change to happen and for safety plans to work and violent partners to be contained.
Allanach, RA, Gagan, BF, Loughlin, J, Sefton, MS, (2011). The Psychological Autopsy of the Dexter, Maine Domestic Violence Homicide and Suicide. Presented to the Domestic Violence Review Board, November 11, 2011
Sefton, M (2016). https://msefton.wordpress.com/2016/07/20/the-psychology-of-bail-and-alternatives-to-incarceration/ Blog post: Taken October 9, 2019
Today, as we read about another family destroyed in domestic conflict here in the Boston area, I can imagine the images seared into the eyes of those who responded to the call finding 3 children dead along with their parents. The Abington, MA police chief described the death scene in the Boston Globe as “something unimaginable”. Some people are better equipped to handle horrific cases where death is on public display – perhaps even today’s horrific domestic terror attack here in Massachusetts. Others become impacted by the recurring images and how they are all the same after a while. Too many calls resonate with the officer’s personal well-being and safety leaving him or her constantly on guard. But over time – even the neurosurgeon – will become harmed by embitterment when his learned craft can do nothing to fix a leaking brain and his patient dies. Perhaps he feels that with updated equipment and training he may have been able to save the life?
This is what LEO’s face. A loss of purpose in life and the unmitigated stench of a decomposing society over which they have no control and, too often, a internal command structure who does not know what it is like to be in a lonely barn at 2 AM and see the hanged remains of someone who, after 5 hours, would leave even the most hardened of us on our knees and wanting out.
October is Domestic Violence Awareness month. Cases such as today’s Abington murders often leave emotional tracers that can grow a database which LEO’s can utilize when investigating calls for service. Lives will be saved when society takes a closer look at red flag violence – these are the pre-incident indicators that violence and domestic violence homicide are at highest risk (Sefton 2018). Some behaviors are secretly guarded among intimate partners – as “nobody’s business”. Police officers must inquire and listen carefully to the victim who firmly believes her spouse intends to kill her. The underpinnings of her fear are generally spot on as in the case I that investigated in Maine using the psychological autopsy in 2012. For the cases with high likelihood of domestic violence homicide, greater care for victims must be initiated from the beginning before it is too late. It can be a hard sell, I know, but the reports we write must also be “spot on” when it comes to dangerousness, risk, and containment.
Sefton, M (2018) Violence prediction: Keeping the radar sites on those who would do us harm. Blog post: https://msefton.wordpress.com/2018/05/20/violence-prediction-keeping-the-radar-sites-on-those-who-would-do-us-harm/ Taken October 8, 2019
This is a photograph produced by Dave Betz who lost his son (pictured) in 2019 to suicide.
Officer Dave Betz lost his son David to suicide in 2019
The code of silence. It surrounds the culture of police work and always has. I was once told there are two kinds of people: police officers and ass holes. If you were not a police officer then you were an asshole. It was a brotherhood with a formidable blue line that defined the police service as a singular force against all that is bad. Some have said that law enforcement offers a front seat to the greatest show on earth. Until what is viewed in the front row cannot be unseen and slowly chips away the veneer of solidarity by threatening the existing culture. For police officers to have long term career success the organization must come to grips with its membership and relieve them of the stigma they feel that prevents them from coming forward. Who would go for that?
If the organization devalues its rank and file for experiencing the natural, neurobiological reaction to repeated, high lethality exposure to violence and death, then who would join such an organization? Fewer and fewer applicants are signing on in 2019. If a police officer is emotionally denuded by the job why would he or she step up and break the code of silence and be labeled a “nut case” only to lose his badge, firearm, and police authority? No one will sign on for that kind of treatment.
Each time a member of the law enforcement community takes his or her own life the unspoken silence becomes a lancing wound to the festering emotional infection that is from repeated exposure to traumatic events. The reappearing wolf in sheep’s clothing cuts his teeth on the souls of unwavering academy graduates now paired with senior field trainers who promise to teach the tricks of the trade. Academy graduates come forth like professional athletes with all the confidence and enthusiasm of an elite athlete. They need experience and mentoring so they know what they are up against. I was asked to speak at the annual Society of Police and Criminal Psychology meeting in Scottsdale, AZ in late September, 2019 on the importance of the field training program on long-term officer wellness and career satisfaction.
Country music blared from the car radio as Dave, dressed in pajama pants and a t-shirt, stood over his son and realized he was dead.
Father of 24-year old police officer David Betz, 2019
The psychological autopsy may provide insight into the manner of death and must include prior exposure to trauma. How many first-in homicide calls had the decedent handled? How many unattended SIDS deaths? How many death notifications? How many cases of domestic violence where the victim was too frightened to speak about the nightly horrors in the marital home? How many times did he witness the remnants of a violent motor vehicle crash with ejection? Each time he bears witness to this inhumanity he risks never coming back. Some spouses will say they remember when they lost a husband or wife. “It was after the 4-alarm fire – sifting through the rooms for possible causes and finding the old woman who rented the place in an upstairs bathtub” or “the time the addict threw his newborn son off the 14th floor balcony because his baby mama did not return from work when she was expected.” Many espouse the use of the psychological autopsy as a way of honoring an officer who died by suicide as a means of linking the suicide to their tour of duty.
High lethality calls must be tracked allowing for paid psychological defusing time in the aftermath of these calls. Defusing and psycho- education can be provided for the entire group who handled the high lethality call rather than identify a single officer. Aftermath check-ins and peer support should follow. An officer who begins to exhibit changes in his normal work routine, e.g. increased tardiness, citizen complaints, or substance abuse should be referred for psychological follow-up that is linked to annual performance reviews and recommendations for corrective action.
In truth, the reader may wish to put himself into the position of the first arriving police officers at Sandy Hook Elementary School in a place called Newtown. In December, 2012, twenty seven people were violently murdered – most were first grade students. I have read the Connecticut State Police report of the Sandy Hook shooting and was left feeling numb and physically sickened. It is over 1000 pages of grueling detail. Now, when I see TV images of LEO’s running on campus toward the sound of gunshots, I know they must step over the desperate victims, some of whom take their last breath reaching for a pant leg or a blue stripe or a black boot covered in blood all the while begging to live.
Recruits enter the police service with high hopes of making a difference but quickly learn that their purpose in life is being sucked out of them like embalming fluid moving though the lifeless remains of a brother or sister officer who could endure no more. Coming forth and asking for help is not a sign of weakness but a sign of strength, resilience, and heroism. There should be no penalty or secondary administrative sanction when an officer comes forth. They must be provided behavioral health treatment and a pathway to return to the job.
Police officer suicide impacts police agencies everywhere in America and across the globe. Many officers feel abandoned by their agencies and become marginalized because they struggle with depression, substance abuse, and PTSD after years of seeing the worst life has to offer. It is time to lessen the expectation of shame among the troops who serve communities large and small. No father should be first in at the suicide death of his own son and be expected to stand with a photo and share his story at the same time he remains stoic and brave.
Neurobiology, PTSD, and Hope
SGB. I just saw the 60 minutes story on SGB as a possible treatment for PTSD. SGB stands for Stellate Ganglion Block. Ganglion simply means a bundle of nerve fibers. We have numerous ganglia in our bodies. The Stellate ganglion is different and offers a potentially serendipitous treatment option for posttraumatic stress disorder (PTSD) that heretofore has been refractory to conventional psychiatric therapy. If so, these 3 letters may offer hope to thousands of law enforcement officers and even more returning military veterans who experience the symptoms of PTSD. The availability of the SGB procedure for law enforcement is unknown – I have seen no studies involving members of law enforcement. My hope is to bring the protocol to the fore front by starting the dialogue in these pages. By now, thousands of interested clinicians, physicians, and patients who are diagnosed with PTSD and those who should be diagnosed with PTSD have seen the compelling case for SGB. According to the Diagnostic and Statistical Manual of Mental Disorders Fifth Edition (DSM-5), PTSD is defined by 4 clusters of symptoms: (1) intrusive re-experiencing of a traumatic event, (2) avoidance of trauma-related stimuli, (3) negative changes in mood and cognition, and (4) persistent physiological arousal and reactivity. Diagnosis of PTSD requires that the symptoms significantly impair functioning and last for at least one month (taken from Peterson, et al (2017). Symptoms emerge in response to exposure to events that are outside what is considered to be “normal” human experience like seeing dead bodies, witnessing the death or a friend or fellow officer, child victims of war or domestic violence, death and dismemberment from motor vehicle crash, and other. These are the worst of all cases of human behavior, depravity, and emotional poverty. “Chronic exposure to traumatic scenes and a host of other factors gradually elevate the hypothalamus-pituitary-adrenal (HPA) axis in the brain and body of typical career LEO’s.” There are neurological changes that evolve from repeated exposure to trauma (Sefton, 2019). It is this automatic response that the SGB protocol is designed to mitigate reducing or eliminating symptoms as a result.
“These nerves help control the brain’s fight or flight reactions, signals that go haywire with PTSD.” 60 Minutes June 17, 2019The use of a small amount of anesthesia provides a risk free blockade of the autonomic nervous system overflow that contributes to the toxic levels of anxiety and stress among people with PTSD. This elevated arousal puts them on high alert. All the time on high alert. It is hard to function when the body signals the brain that a threat exists around every corner – whether on duty or off. This is the enduring problem when LEO’s are exposed to threat after threat without chance to defuse. Currently only 12 of the 172 V.A. hospitals offer this treatment but it has gone into clinical trials to determine its true efficacy versus placebo according to the 60 Minutes story broadcast 6-17-19. The sympathetic system activates the bodies internal survival mechanism by raising the threat level needed to fight or to flee. It is almost instantaneous. The fight/flight mechanism exists in all animals having an evolutionary value needed for survival and defense against potential prey. “Stellate ganglion has been demonstrated to have second and third order neurons connections with the central nervous system nuclei that modulate body temperature, neuropathic pain, the manifestations of PTSD, and many other areas.” Lipov, et al. (2009). I am no expert but a risk-free protocol to break the neurobiologic underpinning of PTSD is something I would try if I needed to. It has been used for conditions such as chronic pain, migraine headaches, upper extremity pain, and symptoms of menopause in women. Only recently has it been shown to relieve the suffering of people with this debilitating and chronic condition. However, a study by Hanling et al (2016) was equivocal in its report that the SGB was no more effective than a Sham injection. This seems like a set back for this hopeful treatment. Other studies have emerged that support the utility of SGB for PTSD including the Peterson et al. paper published in 2017. Findings from a case series of 30 active-duty military service members with combat-related PTSD suggest that people with predominantly hyperarousal and avoidance types of symptoms may be more likely to benefit from SGB according to Lynch et al. in 2016. Does anyone still believe that PTSD is merely a psychological problem? It is not. In fact it is more a biological response by primitive structures in the brain that are activated when the human being is exposed to highly traumatic events such a those occurring during times of extreme violence like war. “A 2016 longitudinal study comparing functional MRIs and symptom scores of 72 Veterans with and without PTSD during which PTSD patients received trauma-focused therapy suggested that higher baseline dorsal anterior cingulate cortex (dACC), insula, and amygdala activation may predict poor response to PTSD treatment.” van Rooij, 2016. This has been demonstrated in subjects over and over. These brain regions activate as a protection against the threat of extinction or death triggering our instinctive drive to survive. https://www.cbsnews.com/news/sgb-a-possible-breakthrough-treatment-for-ptsd-60-minutes-2019-06-16/
REFERENCESAmerican Psychiatric Association. Diagnostic and statistical manual of mental disorders (DSM-5®). American Psychiatric Pub; 2013. Hanling SR, Hickey A, Lesnik I, et al (2016) Stellate Ganglion Block for the Treatment of Posttraumatic Stress Disorder: A Randomized, Double-Blind, Controlled Trial Regional Anesthesia & Pain Medicine; 41:494-500. Peterson, K, Bourne, D, Anderson, J, Mackey, K, and Helfand, M. (2016) Evidence Brief: Effectiveness of Stellate Ganglion Block for Treatment of Posttraumatic Stress Disorder (PTSD). https://www.ncbi.nlm.nih.gov/books/NBK442253/#vaganglionblock.s25 Taken June 17, 2019 Lynch JH, Mulvaney SW, Kim EH, de Leeuw JB, Schroeder MJ, Kane SF. (2016) Effect of Stellate Ganglion Block on Specific Symptom Clusters for Treatment of Post-Traumatic Stress Disorder. Military Medicine. Sep; 181(9):1135–1141.Evidence Brief: Effectiveness of Stellate Ganglion Block for Treatment of Posttraumatic Stress Disorder (PTSD) Lipov, E, Joshi, J, Sanders, S, Slavin, K. (2009) A unifying theory linking the prolonged efficacy of the stellate ganglion block for the treatment of chronic regional pain syndrome (CRPS), hot flashes, and posttraumatic stress disorder (PTSD). Medical Hypothesis. Volume 72, Issue 6, June 2009, Pages 657-661 https://www.sciencedirect.com/science/article/abs/pii/S0306987709000413?via%3Dihub American Psychiatric Association. Diagnostic and statistical manual of mental disorders (DSM-5®). American Psychiatric Pub; 2013. Sefton, M. (2019) The Neurobiology of police work. Linkedin publication: https://www.linkedin.com/pulse/neurobiology-police-work-michael-sefton-ph-d-/ Taken June 17, 2019 Hanling SR, Hickey A, Lesnik I, et al (2016) Stellate Ganglion Block for the Treatment of Posttraumatic Stress Disorder: A Randomized, Double-Blind, Controlled Trial Regional Anesthesia & Pain Medicine; 41:494-500. Peterson, K, Bourne, D, Anderson, J, Mackey, K, and Helfand, M. (2016) Lynch JH, Mulvaney SW, Kim EH, de Leeuw JB, Schroeder MJ, Kane SF. (2016) Effect of Stellate Ganglion Block on Specific Symptom Clusters for Treatment of Post-Traumatic Stress Disorder. Military Medicine. Sep; 181(9):1135–1141. van Rooij SJ, Kennis M, Vink M, Geuze E. Predicting Treatment Outcome in PTSD: A Longitudinal Functional MRI Study on Trauma-Unrelated Emotional Processing. Neuropsychopharmacology: official publication of the American College of Neuropsychopharmacology. Mar 2016;41(4):1156–1165.
Stereotype threat and topics in general are quite important when we consider the incidence of violence against unarmed men of color. There is a circular, transactional exchange between two people where the action of one triggers a reaction in the other. In turn, this creates an elevated risk to both as each perceives a high degree of personal “threat”. This is what adds to the elevated risk to both members of the transaction. It is a complex interplay of wills, awareness, and stereotype.
This may, in fact, have no bearing on the context of the interaction as it unfolds. Neither person in the transaction is actively aware of this in real time. Yet it may have immeasurable bearing on the future conduct and well-being of both. The proper way to avoid this is to slow the pace of the encounter and interpretation of the actual circumstances that are occurring without the underpinnings of stereotyped expectations. The resulting behavioral action/reaction that must occur should allow for normal human apprehension and fear in the person who is stopped by police as well as the assumed, plausible threat to law enforcement given the time of day, neighborhood area crime, and specific circumstances of the evolving encounter.
“The important part of crisis intervention training comes in the interdisciplinary relationships that are forged by this methodology. Trust and respect between the police and its citizens builds slowly one person at a time. “Michael Sefton, 2017
Police officers have historically been ill prepared to deal with people exhibiting signs of mental illness or severe emotional disturbance. Many were thought to be unpredictable and therefore resistant to the typical verbal judo officer’s are trained to use. The CIT programs provided training to police officers in an attempt to bridge the gap between myths about mental illness passed down from one generation of LEO’s to the next and actual training and experience in talking with citizens experiencing a crisis in their life, learning about techniques to manage a chaotic scene, strategies for enhanced listening, understanding the most commonly encountered disorders and role playing. For one thing some person’s afflicted with mental illness have difficulty following directions such as those suspected of hearing voices, paranoia or command hallucinations but this is not always the case. Many individuals CIT trained officers will encounter are normal human beings who are experiencing a high stress, crisis such as the death of a loved one, financial loss, failed marriage or relationship, or major medical illness. This adds a layer of complexity to the CIT model that officers soon experience.
Acuity increases with encounters of mentally ill who are both substance dependent and have some co-occurring psychiatric condition. The alcohol or drugs are often veiled in the underlying “mental illness” but in truth they are not mutually exclusive. The importance of treatment for substance dependence and mental illness cannot be understated as violent encounters between law enforcement and the mentally ill have been regularly sensationalized. The general public is looking for greater public safety while at the same time M.H. advocates insist that with the proper treatment violent police encounters may be reduced and jail diversion may be achieved.
5 Stages of Police Crisis Intervention
- Scene safety – Assess for presence of firearms – obtain history of address from dispatch – have back-up ready
- Make contact with complainant & subject – express a desire to help; listen to explanation of the problem – ascertain what is precipitating factor?
- Establish direct communication with subject – attempt to establish trust; support for taking steps toward change; “why now?”; identify any immediate threats – sobriety, weapons
- Pros and Cons for change – ascertain how willing is subject to begin change process, i.e. sobriety, counseling, detoxification
- Positive expectations for change = direct movement toward change – hospital program; rewards that will come with positive change
“A crisis event can provide an opportunity, a challenge to life goals, a rapid deterioration of functioning, or a positive turning point in the quality of one’s life”(Roberts & Dziegielewski, 1995)
There is a high degree of stress in any call involving a person in crisis. Repeated exposure to trauma is known to change the fight/flight balance we seek for emotional stability. Excessive autonomic arousal poses a threat to cardiac functioning and damaging hypertension. After high intensity/high lethality calls I suggest a defusing session take place immediately after the shift or as soon as possible. Excess adrenaline from an abnormal stress response can have significant health effects on LEO’s. Defusing or debriefing sessions can help reduce the impact of these types of calls. Full critical incident debriefing should wait until the normal effects of such calls wear off.
Sefton, M. (2017) Human Behavior Blogpost: https://msefton.wordpress.com/2017/03/30/police-are-building-bridges-and-throwing-life-savers/ taken December 10, 2017
Are there evil people living among us here in Boston? I learned much about the criminal personality while attending graduate school. I was fascinated when reading about psychopathy and its prototypic charm, lack of remorse, and proclivities toward violence. I read Norman Mailer’s The Executioner’s Song, first published in 1979 about serial killer Gary Gilmore. Gilmore was the last death row inmate to die by means of the firing squad here in the United States. It was his request to be put to death in this manner. The book was an encyclopedia of the underpinnings of psychopathy or sociopathy, used here interchangeably. I also studied David Berkowitz, the Son of Sam killer in New York City. Berkowitz used a Charter Arms Bulldog, a .44 caliber pistol, to kill 6 and wound 7 in 8 separate shootings in 1976. At his trial, he claimed that a neighbor’s dog instructed him to kill young lovers whom he caught and killed while parking on lover’s lane. He later retracted these claims and was sentenced to 6 consecutive 25 year-to-life sentences. It is largely impossible to truly “know” someone but if you are picking up subtle signals in your brain about something someone said or did during your time together, Gavin deBecker might say that your unconscious “gut instinct” appraisal center in the amygdala and hypothalamus is giving you a warning to stay away. His book Gift of Fear was published in 1997.
“Beware of false prophets who come to you in sheep’s clothing, but underneath are ravenous wolves”. Mt 7 15-20
While these publications are not specifically about criminal personality or the neurobiology of antisocial behavior, it struck me during the Spring semester class that a neurobiology of rage, and a neurobiology of moral development, and the neurobiology of emotions are very real. Professor Sabena Berretta, M.D., a physician studying brain disease at McLean Hospital in Belmont, Massachusetts carefully laid out the ground work for this. It is written, in the same way a good tree cannot bear bad fruit nor can a bad tree bear good fruit.
Dr. Berretta described the case of Theodore Bundy who may have killed and mutilated over 30 female college students – even females as young as 12 year of age. Mr. Bundy was intelligent and charming and disarmed his victims slowly. He earned the trust of many of his victims only to use his cunning to undue that trust by sexual torturing and mutilating his captives often while still alive. These members of society have callousness, lack of remorse, egocentricity, manipulativeness, superficial charm and shallow affect (Berretta, 2019). They are able to act witty and charming in a callously, predatory manner. Ostensibly, predation is a biological phenomena over which one might argue Bundy had no control.
This is a hard sell for me. I was always of the belief that psychopathy represented something of an anomaly in human behavior and it was for them that death row was made. I began to see for myself when I heard the predator analogy – see Great White shark, Alaska Brown bear, and the pride of lions – all hunter killers.
After some degree of give and take Dr. Berretta made a compelling case for mental illness as the cause of these horrific events committed by people I believe to be fully culpable for their crimes. The mutual understanding Dr. Berretta and I came to accept was based on our knowledge of the center for emotional regulation in the brain – the amygdala and hypothalamus and prefrontal brain coupled with a lack of social and moral development and disinhibited sexual drive and unregulated anger were the multifactorial underpinnings of his serial killing. These are all functions regulated by circuits in the brain. Ted Bundy did not affiliate with others and had no interest in anyone but himself and meeting his primal drives highlighting the hypothalamic and pituitary absence of oxytocin – a hormone that when present at normal levels produces affiliative, pro-social behavior AKA “the love hormone”.
Bundy was, by definition, a career criminal and was put to death in 1989 – a bonafide wolf in sheep’s clothing. No one should lose sleep over his departure from this world.
It can be unsettling when career criminals go free. In another case in point, in July 2018, Albert Flick was released from prison in Maine after serving 30 years for the violent murder of his wife. This was committed in front of her two children and was by all accounts a gruesome murder. The crime occurred in Westbrook, ME in a city police agency where I served as a patrolman. Soon after Mr. Flick was released he began stalking a woman and her two children near Auburn, Maine. Within a few months his fixation grew and he started to follow her. She knew he was around. Always around. Something in her brain triggered an early warning of danger. Shortly after this the victim told friends that he worried her although he was 72-years old and appeared somewhat frail. She should have listened to that primitive signal. Gavin deBecker described the fear instinct as a gift to be recognized when in the presence of evil. Dr. Berretta linked this early warning to a primitive survival instinct seen in all animals. It drives the fight-flight response in the autonomic nervous system and keeps us on guard. Long before there is conscious awareness of danger the amygdala signals that a threat exists.
Within a few days of disclosing this she was dead. She had a strange feeling about Albert Flick that she shared with her friends. She was stabbed to death, again in front of her two small children. Flick stabbed both women, his wife – 30 years earlier, and a relative stranger with whom he had an infatuation, both occasions in the presence of small children.
Flick is once again in prison where he belongs.
At the same time I am studying the underpinnings of psychopathy. Psychopathy is a term ostensibly used interchangeably with sociopathy and refers to a pattern of criminality. The neurobiological underpinnings of which come from a lack of empathy, sensation seeking, and superficial exploitation of others. These features are derived from a primitive drive state of predation, stalking, and killing or injuring without conscience. In animals these are survival instincts and as human beings, we sometimes naively believe in a higher order sense of right and wrong.
There are people who are drawn to committing violence and would like nothing more than to steal our lives if we let them. But these citizens lack the internal moral development needed to affiliate with others and are often transient. Some families seem to contain far more than their share of criminal family members across several generations. This familial concentration of crime has been confirmed as a characteristic of the general population.
As a society we need to identify these sociopaths before they become active. They seek out violence and are rewarded by the release of brain chemicals when locked in or on the chase. That brings excitement and often erotic pleasure. They are predators and they live among us. Their brains are wired differently than most of us and they live without moral contemplation or regard for the feelings of others. These members of society have callousness, lack of remorse, egocentricity, manipulativeness, superficial charm and shallow affect (Berretta, 2019). They are able to act witty and charming in a callously, predatory manner all the while planning the snare looking very wolfish and bearing their teeth.