Coronavirus, behavioral health and the lingering impact on cognitive functioning in long haul covid recovered

In November 2020 we offered a virtual meeting on the Psychological Impact of Covid-19 after 6-8 months of quarantine and having schools and colleges closed to on campus activities. Professional, college, and high school sports were cancelled and teams were dealing with being in a bubble for the remainder of their seasons. Games were often postponed due to coronavirus exposure and contact tracing. It is now known that the virus has significant potential to impact all organ systems in the body – including the heart, lungs, kidneys and brain. For this post I am talking about the impact of long haul covid recovered cases of individuals who go on to experience cognitive symptoms for weeks or months. Whittier Rehabilitation Hospital has asked that SLP Lauren Guenon and I put together a presentation bringing to light what one might expect for those who are still having symptoms weeks later and what they can do about it.

There are potential long-term problems and short term issues people can expect when they are discharged from the hospital. I hope you will join us for the upcoming presentations that joins the Speech Language Pathology service and the Neuropsychological service in a hard look at the virus and it cognitive and psychological impact. Even people who had minimal symptoms and were never hospitalized are experiencing fatigue and “brain fog” as they get ready to return to work. They may be markedly debilitated and in need of rehabilitation like physical therapy, occupational therapy and now, we are seeing a need for cognitive rehabilitation provided by speech language pathologists and neuropsychologists alike. If you are interested in this topic or experiencing lingering symptoms, I hope you will join us either in person or on a live stream zoom event on May 20, 2021 at 7:00 PM.

Coronavirus

Below is a post from my Concussion Assessment website. It pertains to all that is cognitive. We are planning both an in person learning opportunity over lunch at our hospital and a live zoom event in later May 20, 2021 at 7 PM. If interested in this important topic please contact Joanne Swiderski at her email: jswiderski@whittierhealth.com

I look forward to meeting and hearing from a lot of the readers from here in Massachsetts.

Michael Sefton, Ph.D.

Domestic violence and the importance of red flag warnings for preventing homicide

The police in Austin,Texas here in the United States are dealing with a horrific case of domestic violence homicide just this week 2021. A former Traverse County sheriff’s detective killed three members of his family while picking up his son for a monthly supervised visit. Stephen Broderick shot and killed his former wife, step-daughter and the girls boyfriend. He did this all the while he was coming to visit the 9 year old boy. Broderick fled the murder scene was captured 20 hours later. That Broderick was a police officer made this case of special circumstance. The 16-year old child, who was among the victims, begged for a more restrictive supervision from her step-father who had been released from jail on lower bail and was not required to wear an ankle bracelet after a period of 3 months. The order of protection was brought against former police detective who was now unemployed. In spite of the protection order being in place, even the teen knew that orders of protection were often violated and difficult to monitor. It is reported that when victims believe that they will one day be killed by an intimate partner then the danger is real and should be considered a red flag. Having a child unrelated to the abuser In the household is another significant red flag. 
“In the year that Amy Lake’s protection from abuse order was active against Steven, he violated that order at least five times but spent fewer than two days in jail for those violations, the report found. He also stalked her on Facebook, according to Diane Bowlby of the Bangor Daily News who was at the scene shortly after homicides.
Now nearly 10 years on, the psychological autopsy conducted in 2011, looked at the red flag warnings that are common to DVH everywhere. some I have described above. What brought my attention to the case in Maine was the purported prosecutorial impotence demonstrated by the district attorney Christopher Almy provided to local television. Almy said there was “nothing that could have been done” to protect the victim, Amy Lake and her two children, from her estranged husband Steven Lake. By saying there was nothing that could be done to protect the Lake family, the DA inadvertently undermined not only the police but the many agencies and medical professionals charged with drafting safety plans for victims of intimate partner abuse everywhere. In a similar way, newly elected county DA Jose Garza said he was “confident police did all they could to protect this family and he was incredibly proud of the officers” for the way they handled the Broderick case. More than one citizen comment in the newpaper questioned how anyone can be proud of a situation resulting in the deaths of 3 human beings? Given the outcome in both cases, and countless others, comments such as these strain credulity and fail to inspire. On June 12, 2011, Mr. Lake snuck into the Amy’s rented home in Dexter and staged a despicable murder scene ultimately killing the children he claimed to love while Amy was forced to watch. Ending with her shotgun murder and is own death by suicide – ending the Lake family timeline forever. In an article on contingencies for bail in cases of domestic violence, attorney Nicole R. Bissonnette writes in the the Maine Law Review about the importance of thoughtful conditions of bail, especially among men who are found to have violated these conditions often by texting, stalking and using social media to intimidate and contact potential victims of extended family members. Her published paper adds that failure to relinquish all firearms must be reported to the federal database. Ms.Bissonnette cited our work over 12 times as it pertained to “red flag” warnings and bail reform. Bissonnette raised questions about protection orders and the need for added tools of enforcement for men who violate the protection from abuse orders (PFA) often called restraining orders. In Maine, men who violate orders of protection are often released from custody with low bail or no bail. Steven Lake was twice released from jail on two thousand dollars that was paid by his father. We proposed increasing bail by a factor of ten on any violation of the stay away order and that a comprehensive review of possible high risk warning signs and psychological history be undertaken prior to release. Using a firearm in the commission of a domestic violence incident is defacto evidence of dangerousness and no bail shall be permitted until such time as all firearms are collected and a viable safety plan is in place for potential victims including police protection. The argument made by defense lawyers is invariably, that the lack of a criminal history defies precedent for holding men on large amounts of bail. This is illogical given the numerous red flags that were present in this case and Lake’s disregard for the law. In truth, Mr. Lake had never been arrested for his history of sexual crimes during the marriage, verbal threatening or anything until his final meltdown began. Tension boiled over on June 14, 2010, at the family home at 9 Brighton Road in Wellington when Steven allegedly brandished a gun in front of his family, threatening Amy and the man he accused her of having a relationship with, as reported in the Bangor Daily News. After that event, he was arrested and charged with criminal threatening for which he was heard to say that “he would never serve a day” in jail and that “the price of divorce is 35 cents – about the cost of one bullet.”  A comment that a court appointed psychologist might have wanted to better understand. Lake slept with a pistol and holster hanging on his bed post. He posed with a rifle in his high school year book.  Steven was a gun guy and owned over 20 firearms. The criminal threatening occurred one year before he killed them all as the trial for criminal threatening approached and as the countdown to his divorce from Amy began ticking louder in his brain. None of his weapons were inventoried by police. Had he been held on high bail for each of the PFA violations and been properly assessed for his proclivity toward violence, he would have been unable to kill them one year down the road in 2011. Yet he had time to scribble over 10 suicide notes blaming everyone but himself for the deaths including the judge and his father-in-law, whom he promised to “see in hell.”  His father told us for the final report that if the judge had only let Steven see his 2 children for the 8th grade celebration, this could have all been avoided. Like his son, the senior Mr Lake looked to redirect blame away from his son. The 2 hours we spent with Steven Lake’s parents were perhaps the most unsettling and sad of the nearly 200 hours and 60 people who agreed to be interviewed.  Fast forward 10 years. The setting is north central Texas. On Sunday morning April 18, 2021, in northwest Austin, law enforcement officials say Stephen Broderick shot and killed his step-daughter, Alyssa; her mother and his estranged wife, Amanda Broderick, 35; and Alyssa’s boyfriend, Willie Simmons III, 18. The 9 year old child was not harmed. 

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Stephen Broderick booking photo 2021
It is common for former intimate partners troll the social media accounts of family members in an effort to locate estranged spouse and her children who may be in hiding. Both Amy Lake and Amanda Broderick, the Texas mother of 3 expressed an interest in having children remain in contact with extended family, in spite of pending felony charges. Amy was keen to have her children see their grandparents (Steven’s parents) and have supervised visits with Steven. She communicated with her in-laws regularly via social media showing photos and posting life without Steven that he saw while trolling her account.  Meanwhile, Amanda Broderick was said to have been sent over 30 text messages with a variety of intimidating sentiments about the upcoming trial yet she okayed supervised visits with their son, age 9. Any contact like this is a violation of the protective order and should have landed Broderick in jail. And they were sure to open up possible access to the jealous perpetrator to clues about current living arrangements, employment, after school activities, and other potential clues that raised the risk of further domestic violence and ultimately DVH. There were messages of deep felt sorrow and remorse as well, that are common in the cycle of abuse. While awaiting adjudication of felony charges there must be no contact between children and violent perpetrator whatsoever. In Austin, the victim expressed a wish to allow her estranged husband to have contact with the little boy – his son, in spite of pending felony rape charges brought forth by the 16-year old step daughter who rightfully feared for her life. Amanda Broderick saw this as being in the “best interest of the child”. This remains a weakness in the overall safety plan and should have been denied by the family court.  It was unjustified given the fear expressed by the victims in this case, which ultimately were quite valid. Firearms are a major cause of DVH and in every state are required to be taken from men with active protection orders in place. This was the default expectation in the two cases described here but in the case of Stephen Lake his arsenal of 22 firearms were not removed from his possession in spite of court orders. Similarly, the Austin killer was left with at least one firearm used to kill his family. Lake left 9 suicide notes many of which were rambling, angry tirades toward his wife and in laws. The Austin killer did not take his own life and was captured raising the specter of possible psychological analysis of his motives making the two cases very different at this level. To what extent Texas authorities will endeavor to understand the events that preceded the murders remains unclear. However, gaining a comprehensive understanding of the red flag warnings in this case is highly recommended and will add to the body of literature on domestic violence.
A court-sanctioned visitation agreement required them to maintain some contact to allow Broderick time with his son. In the application for a protective order, Amanda wrote that Broderick called her some 30 times after she left home to intimidate. She feared he would come after her and the children, she said, “because these allegations have come out and he may lose his career.” He could be dangerous, she warned.
Why would a court require that an abused family be required to allow an accused rapist to have visits with a 9 year old child? It cannot be in anyone’s best interest to have forced visitation with a violent and angry abuser.  One could argue that the killer in Austin, Steven Broderick shared most commonalities with the Maine case ten years previously, including sexual violence, coersion, threats of death, pathological jealousy, violation of the order of protection, trolling social media and refusal to surrender his firearms. He was a cop. Broderick was a SWAT trained police officer who resigned his position after being arrested for sexual assault on his step daughter. He should not have had a firearm pending the outcome of his case. He was released from jail on partial bail because he did not have the funds for the bail that was set by the court. He should not have been permitted to visit with his biological son. The risk of violence as was easily foreseen given past behavior. In the same manner, Stephen Lake would never stand trial, and had a cheap divorce in mind early on. 

“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).

  1. Threatens to kill spouse if she leaves him – pathological jealousy
  2. Actual use of firearm or other weapon anytime during domestic violence incident
  3.  Access to firearms even if he never used them – veiled threats
  4. Attempt at strangulation ever during fight
  5. Forced sex anytime during relationship
  6. Unemployment of perpetrator
  7. Stalking via social media
  8. Presence of unrelated “step”child in home
  9. Spouse finds new relationship soon after separating
  10. Low bail release from custody – high bail holds are essential in DVH mitigation
If you or someone you know is facing domestic violence, call the National Domestic Violence hotline for help at (800) 799-SAFE (7234)

Sefton, M. (2016) Blog post: DVH in MA: 4 year old child begs his father.  https://msefton.wordpress.com/2016/10/02/dvh-in-ma-4-year-old-child-begs-father-not-to-murder-his-mother/. Taken 4-25-2021

Allanach R. et al., (2011). 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. Michael Sefton

What are we learning 12 months on?

During the pandemic, mental hygiene has become just as important as hand washing. It’s time to disinfect your thoughts and kill the ANTs. As we move into year number two of the pandemic it has become clear that some American’s may be falling victim to automatic negative thoughts or ANTs.
During the pandemic, mental hygiene is just as important as hand washing. It’s time to disinfect your thoughts and kill the ANTs to overcome anxiety, depression, trauma, and grief. ANT is an acronym for —Automatic Negative Thoughts. Daniel G Amen, MD 2020
Over one year into the pandemic while only 50 % of the US population is currently vaccinated with at least the first shot, we are seeing the importance of mental health in managing the pandemic. It is now abundantly clear, that it is because of mental health underpinnings, that the next wave of the pandemic is building. People cannot remain in isolation forever. The indefinite duration of confinement grew insurmountable to enforce and the collective civility toward social distancing and mask wearing became politically untenable for many governors.  People need to socialize, be free to worship, attend weddigs and funerals, even dance in the streets, as we have seen Americans do ever since it “reopened” when state governor’s decried the pandemic under control. And we have paid the price for this. Mental health tends to be the ugly step-child of physical illness in a society that is strongly biased against the emotionally infirm in favor of the medical model of well-being. For one thing, alcohol sales increased 200 percent among Americans coping with loneliness and frustration while in quarantine. There is no doubt that people felt the stress of being cooped up during the first weeks of the pandemic. The quarantine put a strain on sensible behavior and emotional credulity over social distancing, all the while putting ANTs in our heads. In places like India and across Europe where the vaccine roll out has been less successful the infection rate has risen, and given the propagation of variants that have been reported, those who are not yet vaccinated have much to fear. Michael Sefton