A Failure to thrive: Learned Resilience

Resiliency training has been shown to be a viable professional development and may better inoculate the police officer and paramedic against the range of emotional contagion faced on a regular basis.Books and papers have been written about resilience. In Dexter, Maine, at least one public service employee is at high risk for post-traumatic stress and its potential to corrupt long-term health. Containment and harm reduction should be the focus of the legal system and social service agencies alike in order to bring the importance of emotional resilience and DV orders of protection to life for those other than victims. 

The judiciary and political machinery in states throughout America must speak out about protecting victims and families by not saying “there is nothing that can be done” to stop DVH and citizen well-being.  When calls for service become solely a transaction between first responder and customer it may be a sign that professional resiliency is over taxed and career burn-out may be rising from the proverbial ashes of the calls we did before.

Michael Sefton Blog Post 2018

Containment and harm reduction should be the focus of the legal system and social service agencies alike. I have heard from many that the system of bail is broken. In some states, like Maine, the system of bail has not changed in over a century. The judiciary and political machinery in the states throughout America, must speak out about protecting victims and families and never say “there is nothing that can be done to stop DVH”. The Maine Law Review has espoused in the 2012 issue on DV and Bail conditions that there are important changes that should take place to safeguard potential victims. These include GPS tracking and no bail holds for repeat violators of orders of protection. These changes add both security for potential victims and offer law enforcement agencies some degree of deterrence against those “who prowl the world looking for the ruination of of souls”.

Death by First Responder by Michael Sefton, Ph.D.

“You can’t watch this appalling video posted by brave eyewitnesses on social media without seeing police officers’ callous disregard for a black man’s life,” ACLU of Minnesota Executive Director John Gordon said, calling the death “both needless and preventable.” ACLU of Minnesota Executive Director John Gordon
The death scene in Minneapolis, MN was horrific. I am sickened by the bull shit police work that brings forth justifiably angry people who are themselves suffocating in a society who does not regard them as human. I get that and I share the anger they espouse toward law enforcement. That is not how I was brought up and it was not how I was trained. But not all cops are murderers. First off, there was no need to kill this suspect – George Floyd. No urgent call to control his life and ultimately end it. Mr Floyd had not committed a felony nor was he trying to escape or attack the police. The African American male was suffocated to death by the officer placing his body weight upon the carotid artery of the human being who was in custody. It is well known that once someone is under control and in handcuffs the need for such restraint is reduced appreciably. 
“There will always times when police officers encounter those with mental health needs especially in times of crisis and social disorder. Training and education offer the best hope for safe and efficient handling of cases. A continuum of options for detox, dangerousness assessment and symptom management must be readily available – but here in Massachusetts they are not”  Michael Sefton, 2017
I have had previous posts about the use of force continuum. Officer’s can get off the suspect once control has been established. A law enforcement officer can let up the fight and assuredly, most do so when the fight is over. Whether or not suspect X fought the police after being identified as a suspect in a check forgery scheme or not he did not deserve to die. Even if he were the ringleader in the check forgery scheme and cashed thousands of dollars worth of bad checks, he did not deserve to die. He did not deserve to die. The police will say that the suspect fought until his death – trying to hurt or kill police. Perhaps they will say he was thrashing about and kicking – just off camera. Even if he was the use of deadly force would not be allowed. Bystander video tape will prove or disprove this theory. There is also the body worn camera footage that will surely be published into evidence. From the video released so far, it does not appear that Mr. Floyd was continuing to threaten law enforcement after he was handcuffed. It would appear that the police officer whose full weight rested upon the neck of George Floyd did not reduce his use of force to meet the resistance put forth by Mr. Floyd in kind. That is a serious abuse of power and the officer is now being held on the charge of murder in the second degree. 
“It emphasizes accountability, making amends, and — if they are interested — facilitated meetings between victims, offenders, and other persons like the police.” Center for Justice and Reconciliation
Community policing requires not only programs bringing community members together with police officers in various ways including block meetings, police athletics leagues, and “coffee with a cop” but also developing a mutual trust between law enforcement and the people they are sworn to protect. How does this happen? Police chiefs, deputy chiefs, superintendents, command staff, and patrol officers need to press some flesh out in the neighborhoods. Trust and visibility brings forth accountable and transparent policing. By doing so it opens the doors to community membership by inviting input and honest dialogue.  Restorative justice is a process that slowly repairs the harm caused by crime and malfeasance through ongoing dialogue, respect, and genuine contrition even as it pertains to police abuse of power. Community members, including police officers, and victims of abuse meet for talks aimed at transforming mistrust and anger.  Policing reforms are being introduced from coast to coast Most cities have (again) banned the choke hold that was taught but not permitted in 1982 when I first went through police training. On June 22, 2020, a NYPD officer was put on unpaid suspension for again choking out a suspect who was black. The suspect survived the arrest and was checked out at a local hospital. Meanwhile, the work of the police must continue especially now as Americans learn what to expect from the new normal and beyond. Call 911 if you have an emergency and need the police. 

Risky business: Faucci will not vote against the virus

The Corona virus has taken over 120,000 American lives since it began its tornadic viral defoliation of senior citizens and others with preexisting conditions in the Spring of 2020. The virus caught Americans unprepared. Everything has changed. The impact of the virus has been like a tsunami wave around the world whose point of origin is the giant industrial city of Wuhan, China. Only now are countries like Brazil being decimated and will soon top the United States in total cases and deaths. Countries who went into immediate lockdown were less effected like Norway, New Zealand, and Canada. The United States waited too long and the virus took hold. 

States here in North America, like Georgia, Arizona, and California, who grew weary of the economic impact of the virus and put forth ambitious reopening plans are now seeing record numbers of cases for the first time. The rate of infection is now being felt among younger citizens without pre-existing infirmity. 

Concerns about negative secondary outcomes of COVID-19 prevention efforts should not be taken to imply that these public health actions should not be taken,” wrote the CDC in one of its briefing statements. Secondary outcomes include the broad range of emotional responses to the virus including depression from loss of loved ones, sudden unemployment, increasing substance abuse, threat of homelessness, anger and existential anxiety from loss of control and loss of purpose in life. “However, implementation of supports should include a comprehensive approach that considers multiple U.S. public health priorities, including suicide prevention.” 

The Psychological toll of pandemic is beginning to show after festering for 3 months. The loss of employment, fear of foreclosure, food shortages, price gouging, addiction, and family conflict each increase the bonifide stress associated with the disease and its impact on the human family. People are becoming rattled. The President understands this and wants to exploit the opportunity by holding a campaign event. Trump brushed off concerns about the virus ahead of his highly anticipated rally in Tulsa, Oklahoma, because the number of cases there “is very miniscule”, despite the state’s surging infection of according to a report in the Boston Globe.  Instead, the rally was miniscule and embarrassed the President. 

Top physician and epidemiologist, Anthony Faucci has stated that given the unprecedented and unpredictable nature of Covid-19 that lessening of current social distancing protocols, the use of masks in public, and contact tracing are the best hope for keeping the number of new infections trending downward and to lessen the number of people who die from Covid-19. States who reopen for business without these same precautions are at risk for spikes in cases and more death. Since mid May we have heard from Dr. Faucci less and less as the White House has tried to imply that these concerns are unwarranted and there is “very little of the virus left”. 

President Trump, himself something of a germophobe, has put the needs of the campaign before public health and safety for the sake of his raucous and fervent base. In doing so, he will create a campaign spike that will be measured by new cases and deaths in the next 3-6 weeks time. That is on him and the courts who failed to put limits on the event or cancel it all together in Tulsa, Oklahoma on Saturday June 20. Since February, the president has not taken the pandemic with the kind of leadership that demonstrates his understanding of the virus and respect for those who have succumbed to the disease. 

Meanwhile states like Georgia, Texas, California, and Florida are having thousands of new cases because governor’s of those states have failed to heed the warnings of Dr. Faucci and others. The sudden conflagration of new cases is not the second wave that we have been warned about. The jump in cases correlates with opening businesses without any adherence to protocols. See Tulsa, OK. 

In Florida, the average age of new cases who are hospitalized has dropped to 37-years old. “Those thousands of new cases also signal that, in a week or two, some portion of those people will show up in the hospital, and, about a week after that, a number of them will be dead, even as clinicians have learned more about treating severe Covid-19” said the Boston Globe. For his part, albeit in a greatly reduced capacity, Dr Faucci predicts that a tidal wave of infections is coming unless we do what most medical experts agree starts with respect for social distance recommendations, sanitary hand hygiene, and mandatory quarantine for those who test positive for the virus or are feeling unwell.  

We all know this by now, and it is hard to swallow unless you are among those people who claim to have super immune functioning and refuse orders to wear a mask in public?  Sadly, many will become infected and go on to infect others, unwittingly, all the while they feel nothing and are emboldened by the President who insists the risk of getting the virus at a campaign event is miniscule. Perhaps some readers of this post or others like it do not believe the numbers and chalk it up to fake news.

The emotional impact of the virus has yet to reach its peak. But the racial unrest may be one indication that many are becoming unhinged including a small number of law enforcement officers who lack empathy and understanding of the human effects of stress on unconscious bias and veiled bigotry.  Faucci is getting on the virus. Let us leave the prognosticating to the scientists who are watching the numbers and tracking those who are carrying the virus without symptoms, and may not know it yet. 

 

Harlem domestic violence homicide calls for transparent psychological autopsy

The psychological autopsy is an individually designed case study that elicits a broad range of factual data regarding the behaviors of a decedent in the immediate day or days leading up to domestic violence homicide. The study is especially important when first responders and essential workers are involved all the while a pandemic ravages the city in which they live. Michael Sefton, Ph.D. Direct Decision Institute, Inc.

The recent domestic violence homicide in Harlem raises the specter of an essential city worker who killed his sister-in-law while his wife called for help. The police stopped the attack resulting in the death of Ubaldo Gomez but not before he shot and stabbed a women in the head with a kitchen knife. The fact is that domestic violence has increased during the pandemic as it does at other of life’s stress points. Did the fact that the alleged murderer was an MTA employee considered to be “essential personnel” have an impact on his mental health that may have been foreseen? What role, if any, did his role as an auxiliary police officer for the NYPD have in the terminal event? A psychological autopsy would answers these questions and establish a worst case scenario of frontline exposure to trauma and possibly offer insight into underlying history that may have been anticipated and stopped. Certainly the hierarchy at 1 Police Plaza will have an interest in this case. The Corona virus has added to risk of DV and DHV.

For too many women who are abused repeatedly during times of crisis there is no place to run and no one to keep them safe. Orders of protection are ineffective and without GPS monitoring and they are nearly impossible to enforce. In a 2011 domestic violence homicide in Maine, the protective order was violated 4 times by Steven Lake who killed his wife and children in Dexter before killing himself in June 2011. That alone was grounds to hold Lake without bail. No police agency removed access to his collection of over twenty firearms. The scene diagrams illustrate how Lake was armed with two firearms and a hunting knife. He murdered his children while forcing his estranged intimate partner to watch. It was thought that he planned a murder spree and he left 9 suicide notes. The final despicable act, as police arrived, was to attempt to light the bodies on fire.

In general, there is little interest in such a comprehensive post hoc psychological examination because there is no pending prosecution. Nevertheless, a psychological autopsy conducted on Lake in the Fall of 2011 revealed a clear timeline littered with red flag warnings that were missed or ignored. The research conducted in 2011 was done pro bono. It undertook over 200 hours of interviews and presented the Domestic Violence Review Board with over 50 recommendations for reducing high rates of domestic violence homicide in Maine (Allanach et al. 2011). The medical autopsy editorialized the case in its final report:

“Despite receiving some mental health counseling it is apparent, in retrospect that the degree of violence and anger possessed by the abuser was not realized.”                                                            Chief, Maine State Medical Examiner

This latest case in point involved an estranged wife, her sister, and the building manager in Harlem. The three were having dinner when someone armed with a firearm broke into the apartment. It was the estranged husband of one of the women. He was wearing his Metropolitan Transportation Authority uniform, and he had a gun according to the NY Post reports. In the meantime we have been told that the perpetrator was an auxiliary police officer and was licensed to carry a firearm. What triggered this paroxysmal violence? If it was foreseeable, then Mr Gomez should not have had access to his firearm.The psychological autopsy will address prior history of intimate partner violence, protection orders in place, work-related stress, recent health concerns related to the corona virus and Mr Gomez trauma exposure history, and his mental health in the days before the murder. 

Police officials said the transit worker, Ubaldo Gomez, shot his sister-in-law and stabbed her in the head with a knife, while his wife reached out for help. When Gomez refused to drop a 12-inch kitchen knife and tried again to stab the man, a police sergeant opened fire, killing him. 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. A family member of Gomez suggested “he had some mental issue, something happened. He was always working day and night. He barely slept. He worked.” as quoted in the NY Post. Whether this duplicity and denial stems from cultural beliefs about the supposed “privacy” of DV, society must change the way in which law enforcement manages these cases. The buy-in from police, legislators, judges, probation, and the public-at large needs to be fully endorsed for real change to happen and for safety plans to work. Many states across America are planning to enact “red flag” rules that will remove weapons from individuals with a known history of domestic violence e.g. choking spouse during fight (Sefton, 2019).

Family members who may be in the crosshairs of these insidious events often see but lack the knowledge to stop the emotional and behavioral kinetics once they start. The fear of being murdered by an intimate partner creates emotional paralysis. In a large percentage of DV occurrences, financial and self-image influences as well as outright fear of the abuser by the victim limit moves toward safety. Therefore, a continuum of interagency cooperation is needed to effectively measure risk and understand the pre-incident red flags that are common manifestations of abuse and often forecast terminal violence, all of which occurred in this case. As the totality of these red flags comes into focus it becomes incumbent upon each of us to take action to prevent domestic violence threats from becoming reality (Allanach, et al. 2011).

It would seem to be vitally important that a transparent psychological autopsy be initiated to gain an understanding of the factual behavior that was observable and measurable in the days leading up to the murder especially given the likely unintended victim. Preliminary reports described Gomez as having a pattern of pathological jealousy and victim stalking. For her part, Gomez’ wife Glorys Dominguez called for help in the weeks prior to the terminal event seeking help.

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 (2019) Violence prediction: Keeping the radar sites on those who would do us harm. Blog post https://wordpress.com/block-editor/post/msefton.wordpress.com/5012 taken May 23, 2020.

Sheehan, K, Moore, T. Woods, A. NY Post May 21, 2020 https://nypost.com/2020/05/21/man-killed-in-nyc-police-involved-shooting-was-auxiliary-cop/?

Chaos, Fear and Death from Covid-19: The loss of trust in leadership

The Coronavirus has brought to bear chaos and fear among Americans from coast to coast. I am unsure whether any of us expected the virus would grow and infect over 1 million Americans alone in 6 short weeks. The death toll at the time of this post is just under 80 thousand lives. Personally, my aunt and my mother were both infected with the virus at their living facility. Sadly, my aunt has died from the coronavirus but my mother, has been without symptoms, in spite of testing positive 2 weeks ago. Over 30 percent of Americans know someone who has died or been infected by the virus. The fallout to mental health is real. I see it in my own family as nerves become frayed 8 weeks on.

The virus’s threat to basic needs and personal security has eroded the trust in federal leadership. This is due to the lack of an integrated plan to develop a vaccination, provide testing and contact tracing, support unemployed workers, and reconcile still-rising numbers of Covid positive cases while at the same time as some states begin opening businesses. In doing so, potentially asymptomatic individuals may unknowingly carry the invisible killer into a restaurant, laundromat, or tattoo parlor – all deemed essential services as states like Georgia begin coming back on line. This is a fact, whether or not they meet federal government mandates for “opening up” including 2 weeks worth of reduced rates of infection, decreased death rates, and lowering hospital admissions due to Covid-19.  Many epidemiologists believe that opening businesses too quickly will result in a rise in cases of the virus and an increased rate of death.

Now, the White House Task Force is finding itself in the crosshairs of the invisible and lethal disease as members of the White House staff are being diagnosed with Covid-19 and self-quarantined because of exposure to the virulent disease. Members of the inner circle have been tested and some have been diagnosed with the virus including members of the White House service staff and the Vice President’s personal secretary. In the west wing, there is chaos among the staff as to what precautions should be taken while potentially being exposed to the coronavirus. Dr. Anthony Fauci, who has been the face of the response to the virus is now in a voluntary quarantine as a result of the spread of the virus in the west wing among staff members of the White House. Three physicians have gone into voluntary quarantine as a result of coming into contact with the virus as protocols recommend.

Former President Barack Obama harshly criticized President Donald Trump’s handling of the coronavirus pandemic as an “absolute chaotic disaster” during a conversation with ex-members of his administration. Yahoo News May 9, 2020

Medical personnel across the country are on the front line and they are being recognized for their tireless bravery in the hot zones in American cities like New York, Boston, and New Orleans. The law enforcement and fire service have all shown their appreciation with 7 PM shows of support. This also includes members of newly graduated physicians who have been sent to the front lines of the virus in ICU’s and Covid-19 floors in America’s best hospitals. The stress of this is often overlooked. “Since the pandemic began, newly minted residents who normally wouldn’t take care of patients with severe respiratory illnesses, such as those training to be psychiatrists, podiatrists, or orthopedic surgeons, have been asked to volunteer to work in COVID-19 wards” across the country according to a report by Deanna Pan in the Boston Globe on May 9, 2020. These are teaching moments that have brought out the best in young physicians and the old seasoned veterans who supervise. But the cost has been great with increased rates of suicide since the shutdown began in March including those on the frontlines.

On April 27, Lorna Breen, a physician specialist in emergency medicine took her own life after being witness to dozens of patient deaths during the peak of the coronavirus and contracting the virus herself and surviving it. Dr. Breen was a professional and emergency service medical director of NewYork-Presbyterian Allen Hospital and had no history of depression or mental health diagnoses. In the hours before her death her father, himself a physician could tell something was wrong.

Lorna Breen, M.D.

On the night when the nation’s top virus spokesperson physician Anthony Fauci, M.D. went into voluntary quarantine, the president of the United States had a meeting of his senior staff and none of the members at the meeting were wearing personal protection, like masks. Physicians and epidemiologists are calling for social distancing and personal protection yet the White House resists and engages in ongoing updates and meetings without the use of masks or social distancing. With two White House staffers testing positive for the virus, including Mike Pence’s secretary Katie Miller, the president is making light of the protocols set forth by the CDC and the WHO. This inconsistency and disingenuous message is not lost on anyone.

NBC News profile of Dr Breen

Delayed actions at the top have resulted in confusion about what steps the U.S. Government and the individual states must take to reduce the impact of the viral outbreak. The U.S. has the highest number of Covid-19 cases and the highest number of deaths in the world. The streets of America are empty and businesses are shut down and many will never reopen. The unemployment rate is nearly 15 percent. This is the highest rate of unemployment since the great depression. People are worried and in conflict over medical information they are hearing and what they see in the White House increases that conflict.

“It’s a terrifying, solitary, dehumanizing death that these people go through, and it’s going to leave wounds in our society for a long time,” Tara Bylsma, 30, a second-year internal medicine resident at Boston University Medical Center in Boston Globe May 9, 2020

Working on the front lines with patients who are dying is horrific. This is especially painful when there is seemingly nothing that can be done to help them. First responders and frontline hospital workers are trained to provide emergency care. When their training is not effective than feelings of helplessness will grow. These feelings can be overwhelming. At the same time, the rule of law comes into question and there is growing suspicion that the virus is man-made or an overblown scam. People are pushing for release from social distancing and using the argument that their constitutional rights are being infringed upon by forcing them to remain in their homes. Some are becoming angry and out of control.

In late January, 2020, the World Health Organization declared a pubic health emergency because of the exponential growth of the virus in China and later in Italy and Spain. Trump has since denuded the WHO as being overpriced and undervalued as only he is capable of doing. Sadly, Americans were unprepared when it’s first case arrived in February and we were told not to worry the virus would soon disappear. But it has not gone away and the United States is in lock down as a result.

Human to human transmission of the disease was thought ‘not possible’. The pandemic was first publicized and forewarned by a physician in Wuhan, China who ultimately died from the virus. He had been arrested and warned by police against speaking publicly about the risk of the virus and threatened with sanctions.

Meanwhile, President Trump was publicly yammering about his trust in Chinese President Xi Jinping and the deals he was making to benefit the American economy. His focus was not on the growing fear of American workers but the vulnerable economy that President Trump needs to get himself reelected in 6 months. In the meantime, the virus has not vanished nor faded away with warmer weather but continues to claim over 1000 lives each day across the country. Now, with the coronavirus in the White House, the presidential spin over wearing masks and maintaining social distancing takes on new meaning.

How will the political narrative shift now that Trump and his team has been directly exposed to the virus and members of the Coronavirus Infectious Disease team have become quarantined leaving the president alone in the garden for his bite of the apple?