Author: Michael Sefton, Ph.D.

Reducing Stress for Law Enforcement: Effective Strategies

Michael Sefton, Ph.D. Human Behavior , , , ,

Police departments everywhere are using tools to lower the stress response among law enforcement officers and all first responders so that they may function at maximum efficiency through resilience training, debriefing high stress incidents e.g. OIS, fatal crash, loss of a member. We have proposed an annual stress assessment using police officer emails. The test may be taken in the cruiser, at home, anywhere. Scores are check and filed in a confidential mailbox. Scores that kick back as elevated, may demonstrate some concerns, are reviewed and push up to the next step in this process. Along with the technique of regular journaling officers may take responsibility for their observations and feelings that may become available to them using this tool.

Law enforcement officers (LEO’s) encounter the worst of all experience on a routine basis. The people who call the police may be society’s best upstanding citizens but, on this occasion, it could be the worst day of their lives, and they seek help from police.  Many times, it is not the pillars of society seeking help but those people in the fringes or margins of society now victims of violent crime or abuse.

When an officer endorses high level stress response and poor coping skills that can lead to career burnout, frustration, and even moral indignation – the feeling of being wronged. To enhance LEO job satisfaction and bring about change in bias toward officers who as for help. The men and women should be covered for as long as they need.

https://msefton.wordpress.com/2018/11/19/police-stress-intervention-continuum-an-introduction-for-leos-and-command-staff-to-reduce-officer-suicide/

Love Bombing: “There is no danger to the general public” But wait.

Michael Sefton, Ph.D. Dangerousness assessment, domestic violence, DVH, Human Behavior, Massachusetts domestic violence, terminal rage , , ,

“… He stood in the doorway with a loaded gun and talked about killing himself and/or the children and myself. He was bringing up old verbal threats and I thought they were going to come true”

Amy Lake – July 2010 (from a filed restraining order)

Domestic violence is not a private issue—it’s a public health crisis. Every year, millions of people in the United States experience physical, emotional, or psychological abuse at the hands of someone they love or once trusted. This abuse often happens behind closed doors, making it invisible to the outside world until it escalates into something fatal. But let us go back to the beginning of when something begins to go wrong. Love bombing is a term that has gained traction in discussions about relationships and mental health. It refers to a period, often at the beginning of a romantic relationship, where one partner overwhelms the other with excessive affection, attention, and gifts. While this might initially feel exhilarating, it can serve as a red flag for potential emotional and physical abuse later on. Understanding the concept of love bombing is crucial for recognizing unhealthy relationship dynamics and the psychology behind domestic abuse.

Amy Lake and her two children were murdered by her husband in 2010. Steven Lake killed himself as well and tried to light his children on fire either before or after they were dead. Right after the killings, a district attorney in Maine stated, “There was nothing we could have done to prevent these deaths.” These words sparked a team of professionals, including myself, to investigate the sequence of events that led to this tragedy. In 2011, a formal psychological autopsy was conducted after the murders, resulting in more than 50 recommendations to the Maine Attorney General’s Domestic Violence Board (Allanach et al., 2011). Our group conducted 200 hours of meetings with family, friends, and co-workers of the victim and her husband. We were not paid for our work.

In June 2011, Steven Lake of Dexter, Maine, violated a protective order four times before killing his wife, children, and himself. He stalked her on-line and had sycophants writing and praising him. He posted his love for his children daily and his groupies decried his virtue as a father. Despite the violations, Lake remained free, retained his collection of over 20 firearms, and faced no meaningful restrictions on his movement. This case demonstrates systemic failures that leave victims unprotected. This happens everywhere all too frequently. One of the most chilling aspects of domestic violence is how predictable it can be. Research has identified common red flags: escalating control, threats of harm or suicide, isolation from friends and family, obsessive jealousy, and access to weapons. Despite this knowledge, systems often fail to respond adequately when victims reach out—or worse, they don’t reach out at all due to fear, stigma, or lack of resources.

“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 2010

In many cases of domestic homicide, there were signs. Friends, family, neighbors, and even professionals sometimes miss—or are unsure how to respond to—the warning behaviors. The chief medical examiner in Maine acknowledged missing the risk Steven Lake posed to his wife and family was not identified soon enough to keep him contained. That’s why education and awareness are so critical but often falls short. And this is why behavioral scientists must look into the similarities of each case. All to often when the assailant is deceased there becomes no interest in a shakedown of the specific lead-up to the tragedy. In this case, and many others like it, taking the time to assess the facts of an assailant’s attack can lead to greater concern for people living with a protection order and the risk of allowing the recipient to remain out of jail.

A father killed his partner in front of his children, and then himself. This is called an intimate partner homicide-suicide or familicide in this case. These tragedies occur daily in the United States, and the impact is immeasurable. Surviving families mourn the loss of family members, and in some cases the mass murder of a family. Children grapple with the loss of their parents while surviving family members become their new caretakers. For those who survive, they may live with lifelong wounds and emotional trauma. 

In many cases of domestic homicide, warning signs were present. Yet, friends, family, neighbors, and even professionals often miss or struggle to address these red flags. This is why education and awareness are absolutely crucial. It’s also why behavioral scientists must analyze the commonalities between cases in the form of a psychological autopsy. Too often, when the perpetrator is deceased, the investigation into the events leading up to the tragedy fades away, leaving critical opportunities for learning and prevention unexamined.

Research consistently points to key warning signs: escalating control, threats of harm or suicide, isolation from loved ones, obsessive jealousy, and access to weapons. Yet, even with this knowledge, systems too often fail to act when victims seek help—or victims remain silent out of fear, stigma, or lack of resources. That’s why, when the district attorney claimed nothing could have been done to prevent this, we found his words far too disingenuous to be the last word on domestic violence homicide.

Too many women who are abused during times of crisis have no place to run and no effective protection. Orders of protection, without GPS monitoring or strict enforcement, fail to prevent repeat violations. Domestic violence doesn’t begin with homicide—it ends there. By taking earlier signs seriously, listening without judgment, and being willing to learn from past tragedies, we can create a safer future for individuals and families. It’s not enough to mourn; we must act.

Being aware of the signs of love bombing can help individuals protect themselves from potentially dangerous relationships. Some key indicators include:

Rapid Intimacy: The relationship progresses unusually quickly, with declarations of love or commitment happening within weeks.
Excessive Attention: The partner constantly showers gifts, compliments, and affection, making it difficult to understand the true nature of their feelings.
Pressure to Commit: There may be pressure to label the relationship or to make significant life decisions early on.
Mood Swings: The partner may alternate between extreme affection and sudden withdrawal or criticism, creating emotional instability.

  1. Allanach, R., Gagan, B., Sefton, M., & Loughlin, J. (2011, November 28). Psychological autopsy of June 13, 2011, Dexter, Maine domestic-violence homicides and suicide: Final report (Report No. 39). Pine Tree Watchdog. Retrieved from http://pinetreewatchdog.org/files/2011/12/Dexter-DVH-Psychological-Autopsy-Final-Report-112811-111.pdf
  2. Campbell, J. C., Glass, N., Sharps, P. W., Laughon, K., & Bloom, T. (2007).
    Intimate partner homicide: Review and implications of research and policy.
    Trauma, Violence, & Abuse, 8(3), 246–269.
    https://doi.org/10.1177/1524838007303505 This study outlines risk factors for intimate partner homicide and emphasizes the importance of early intervention and assessment tools like danger assessments.
  1. National Coalition Against Domestic Violence (NCADV).
    Domestic Violence National Statistics.
    https://ncadv.org/STATISTICS Provides updated statistics and information on the prevalence of domestic violence in the U.S., including its impact on survivors and communities.
  2. Violence Policy Center (2023).
    When Men Murder Women: An Analysis of 2021 Homicide Data.
    https://vpc.org/publications/when-men-murder-women/ Annual report analyzing FBI data on female homicide victims killed by male offenders, most often in the context of domestic relationships.
  1. Centers for Disease Control and Prevention (CDC). (2023).
    Preventing Intimate Partner Violence.
    https://www.cdc.gov/violenceprevention/intimatepartnerviolence/fastfact.html Offers insight into prevention strategies, risk factors, and public health approaches to addressing intimate partner violence.
  2. Sefton, M. (2017, February 26). Psychological autopsy may help answer questions in domestic violence homicide. Blogspot: MSefton Blog. https://msefton.blog/2017/02/26/psychological-autopsy-may-help-answer-questions-in-domestic-violence-homicide/
  3. Sefton, M. (2016, December 16). Domestic violence homicide risk factors. Blogspot: MSefton Blog. https://msefton.blog/2016/12/16/domestic-violence-homicide-risk-factors/

When someone targets children

Michael Sefton, Ph.D. Human Behavior , , ,

The suspect in the Minneapolis church shooting followed by a manifesto against children, transgender people, Jews, and others. The mass shooting at Annunciation Catholic Church was described as an act of domestic terrorism. In this case the violence culminated in two fatalities and 18 wounded. Terrorism requires an intent to bring chaos and death to a mass society – in this case children praying at mass during a catholic school’s opening day of school. The FBI says the events was targeted against the Catholic school. The gunman fired their rifle at children and worshipers sitting in the Annunciation Catholic church during mass. Chief O’Hara at Minneapolis Police called it senseless and a deliberate act of cowardice beyond comprehension.

Only Darkness for Uvalde: Now asking tough questions of law enforcement two years on

Stress and its malignant power to impair

Michael Sefton, Ph.D. Human Behavior

Stress is a cumulative response to exposure to threatening, fearful, or chaotic scenes. It is especially important that police officers can quickly assess violent scenes to offer the best and most prompt action. Active shooter protocols need that teams of officers are not distracted in their search for the shooter sometimes stepping over victims along the way. It can become exceedingly difficult unless they are disciplined. “Officers are trained to be vigilant and alert. The job demands it. The fight/flight mechanism that keeps us on guard plays a primary role on how people feel after episodes of high stress. Police officers are no different.  Feelings of frustration, lack of focus, chronic fatigue, and even depression can result from an over reliance social media like an unfed addiction. Therein lies the malignancy that can be attributed to the human stress response. No one is immune from its impact and there is a price to pay when our brains can’t turn off images and the media.

Stress: The human cost of technology

The unforeseen consequence of traumatic exposure in some professions you might not expect

Michael Sefton, Ph.D. Human Behavior , , ,

WESTBOROUGH, MA November 30, 2024 – Stress affects all aspects of how we feel. There is no cure for human stress we must learn to modulate its impact. What affects one person may not impact another in a stressful manner. I have had a series of posts on the Human Behavior blog recently and since beginning this blog in 2014. If you are seeing this blog, you have access to my other posts and hopefully the research cited in the musings I espouse here. This post is about how some people are impacted by the work they choose and may experience serious physical and emotional problems directly associated with it. The example here is a tow truck operator who is suffering with the consequence of being exposed to motor vehicle accidents while towing for state police or other agencies who regularly call upon towing companies to haul away the wrecked cars and trucks driven by a host of young drivers who may not be on their best behavior. But I have regularly wondered how young EMT’s, funeral home operators, medical examiner recovery teams, and tow truck operators deal with the things they see. In addition to the lowest paid these personnel tend to be the youngest and most inexperienced and least trained setting up an unhealthy risk for long-term traumatic stress.

Recently, I began seeing a man who was referred because he had sustained a serious stroke. The man was only 59 years of age and needed quite a bit of help from his wife. He was referred by the speech pathologist here at Whittier who had a stong instinct the man had a psychological component to his condition. She was correct. I learned in our first visit that the man worked as a tow truck operator for over 10 years in a private towing company. Many police agencies use private companies to haul away cars involved in motor vehicle crashes or subsequent to an arrest. It is common practice here in Massachusetts. I strongly suspected that the man is experiencing the chronic symptoms of stress and it is highly likely he has full blown post-traumatic stress disorder from years as a tow truck operator. His body was so injured by the stress of his job that it created the perfect storm for both physical and emotional injury. He was at high risk for hypertension, heart disease, cardiovascular disease, obesity, and depression. Nothing is for certain, but he has the hallmark triad of PTSD (avoidance, hypervigilance, and triggering) in addition to the full blown stroke syndrome that left him disabled.

Before you say “does everybody have PTSD?” let us understand that exposure to traumatic events (beyond normal experience) can cause an acute stress reaction that in some cases evolves into PTSD over time. Human beings can adjust to traumatic stress if they have time to process what they experience. Sometimes they require professional crisis intervention or debriefing such as post incident review.

Our bodies are equipped with a built-in defense system—a complex army of infection-fighting cells and proteins that warn other cells of invaders, fight them off when they arrive, and heal any damage the resulting conflict produces. Stress is the number one cause of silent and malignant conditions like hypertension, stroke, heart disease, obesity, and autoimmune disorders like chronic fatigue, lupus, Type I diabetes, and others. Even multiple sclerosis and inflammatory bowel disease are linked to autoimmune disorders. These all have a known link to stress. The Washington Post published a story about human “weathering” a term first coined by Arline T. Geronimus, a professor and population health equity researcher at the University of Michigan. The fact of stress weathering our bodies from the “inside out” is a point not lost on many of us who previously worked in public service as police officers. And here in the United States, life expectancy levels have decreased for 2 straight years – the first time in decades. Chronic stress and its associated disease states is a likely culprit.

Blood pressure remains high. Inflammation turns chronic. In the arteries, plaque forms, causing the linings of blood vessels to thicken and stiffen. That forces the heart to work harder. It doesn’t stop there. Other organs begin to fail. Washington Post by Akilah Johnson and Charlotte Gomez in 2023. “Too much exposure to cortisol can reset the neurological system’s fight-or-flight response, essentially causing the brain’s stress switch to go haywire.” Relentless stress is associated with changes in our body’s chromosomes and shortens the life of our cells resulting in premature death to those who are vulnerable to its environmental biopsychosocial confluence.

Within the past month, Harvard Medical School has published a helpful booklet on the inflammatory response and the impact of chronic inflammation, edited by Mallika Marshall, MD (2024). The inflammatory response is regulated by the body’s immune system to promote quick healing. When this becomes chronic, like when we are under constant threat from environmental stress, the body begins to change and can not return to a state of equilibrium.

Our bodies are equipped with a built-in defense system—a complex army of infection-fighting cells and proteins that warn other cells of invaders, fight them off when they arrive, and heal any damage the resulting conflict produces.  Inflammation is the body’s response to threats that reach our insides. Inflammation is necessary whenever we are injured or infected. The only true way of heading off the impact of stress is taking direct action to lower the elevated fight-flight response involved in the stress response, lower physical tension and other signs, and minimize unrealistic expectations. The body has been accostomed to respond to threats every since our species evolved. Part of this evolution is to react quickly to threats (that saved us from being eaten) and to just as quickly return to our normal resting state. The constant elevation of the threat arousal system is not realistic nor sustainable. It is important in early adulthood to keep in mind there are specific behaviors that may be learned to mitigate the negative impact from chronic stress before it has negative impact on our health.

The other day I was so wound up with some much stress and tension, I almost cut my 12-hour day short. Things settled down but not after an 8:30 AM crisis call from a patient living on Cape Cod. All at once, my day was diverted to needing to find a hospital bed for a client with a boat load of unrealistic anger and now suicidal ideation. Not easy. I can honestly say that stress impacts me more now than it did early in my career but that said, I am mindful about managing the stress more purposefully. This post is not about me or my work habits. Although I read these posts and many others in order to make myself a better psychologist and to understand the importance of managing stress before it can cause irreparable damage to one’s mind and body. The connection has never been better understood by medical and psychological providers. So in order avoid weathering from the inside out, start taking control of things in your life that you can control and apply mindfullness strategies to your routine. You will feel better.

Active shooter: Run, hide, or fight

Michael Sefton, Ph.D. Human Behavior , , , , ,
  • Hiding and hearing the sound of gunfire

WESTBOROUGH, MA October 22, 2024 – The daily round up of active shooter incidents seems so repetitive and grim. People are learning the concept of run, hide, or fight in defense of their right to live or work, or attend concerts. Here in the United States, there are active shooter events every day or every week. These events start and end quickly averaging only 7-10 minutes before the shooter is dead.  But in that time shooters fire hundreds of high power .223 rounds from assault rifles purchased for only this reason the police arrive and usually are met by the recently deceased body of the angry and misguided shooter.

The “active shooter” refers to just that – ongoing, systematic slaughter of innocent civilians with the specific purpose of violence and murder.  These events start and end quickly averaging only 7-10 minutes before the shooter is dead. 

Michael Sefton 2013

Some argue it is the availability of firearms that creates the opportunity for mass killing. Countries that have strict gun laws rarely see recurring gun violence. Japan, Norway, Iceland, and many other countries have rates of gun violence that are flat in terms of recurring active shooter events. That means that police rarely are called upon the face an active shooter like police officers here in the United States. And the noncombatants are left to wait for reunification with parents and counseling. Prayers for all. Teddy bears and candles abound. And the ultimate answers as to why this happened will be revealed in the psychotic, rambling, manifesto of the mentally injured shooter. That will tell us all we need to know about school shooting and those who might bring us harm.

https://www.youtube.com/watch?v=5VcSwejU2D0

How Legal System Shortcomings Fail Domestic Violence Victims and what we may learn from these failings

Michael Sefton, Ph.D. Bullying, crisis intervention, Dangerousness assessment, domestic violence, domestic violence homicide, DVH, Health Psychology, Human Behavior, Massachusetts domestic violence, Police officer behavior, Relationships, terminal rage

WESTBOROUGH, MA – October 31, 2024 – I am writing in the aftermath of another murder suicide here in Massachusetts. It happened 3 months ago at the end of the school year. An adolescent girl was walking home from school and was abducted by her former step-father who is charged with raping her when she was 13. He was wearing an ankle bracelet designed to provide police with GPS coordinates when he deviated from going to and from his work place or if he deviated anywhere near the victim from whom he had a stay away order. Technically, as soon as he drove near the childs school or home the police should have been notified. But this did not happen and now the girl and the former step-father are dead. I have written to the Middlesex County district attorney here in Massachusetts about this case with ideas I have about domestic violence homicide and best practices, but so far, I have heard nothing back. I presume they have all the expertise and advice they require to help keep people safe from trolls and jealous spouses with outstanding orders of protection.

I am a former police sergeant and have looked at several cases each year that are compelling and I try to report these. I asked the local chief of police for the police reports on this case but was sent only the press release. My interest started both from my experience in law enforcement and also out of a response to the abject horror the so many of these cases, like this one. People living in fear, month after month, or in some cases years of fear. This case was delayed over and over. A common tactic used by defense attorneys to avoid going to trial at all. They are banking on the victim being too frightened to testify or better yet, the victim moves away and cannot be found. Victim witness advocates will tell you that teenaged children carry a great deal of shame with them after being victimized. Every delay or change in court dates can trigger fear and often self-doubt. Many know the protection orders have very little that prevents a stalking step-parent from wreaking terror on his victim and her family. In this case, the restraining order failed the victim in spite of the best efforts of law enforcement with things like old technology GPS monitoring.

This case flew under the radar because the criminal trial of the accused was re-scheduled 3-4 times over several years. It was finally headed toward the court room and it is a fact, that as this occurs the risk to potential victims increases as domestic violence cases plod toward a trial. Every change in court date is enough to put a frightened victim into crisis. Many if not most, victims of DV change their minds and do not prosecute. They often blame themselves for breaking up the family by coming forth with sometimes horrific accusations as in this case. In the long run, this impacts their emotional development and victims should be afforded all the support they require to be capable of going to trial. They often are too afraid to stand up and admit what was done to them. They feel shame and deeply frightened.

As I said, I am a former police officer and currently MA licensed psychologist working in here in Massachusetts. When I patrolled the town, I frequently stopped at houses known to us for domestic violence calls in the days afterward. I sometimes had one of our community policing officers with me in the aftermath of the call. When everything was settled down and the dust had cleared, I would stop and try to connect with the couple. Follow-up on recommendations I may have offered – like family or couples therapy and other local resources. And let them know help is available. I was surprised at how many families moved away soon after being involved in a family fight. Off my radar right? My understanding of domestic violence is that it cycles from guilt and shame to honeymoon and a family love fest. The cycling of coercive, violent behavior ramps up one a trial nears or some other dramatic change like divorce. These are the most dangerous times and any violations once the GPS monitor is in place should require arrest with no bail. While in containment, the psychological assessment must be initiated and presented to the court.

The double dose of the stigma of both suicide and intimate partner violence (IPV) leaves the details of many of these traumatic experiences untold. 
Everytown Research and Policy, 2024

“These tragedies often include children, family members, and friends.” Despite the devastation and immeasurable impact, these events garner little public attention and recognition as a frequent form of gun violence.” according to a story published on 8-8-2024. More needs to be done to protect child victims from known violent perpetrators such as Juliano Santana, who killed a 16-year-old girl a few weeks ago in Acton, Massachusetts. Child victims like the 13-year-old victim in this case often blame themselves for being physically assaulted or being groomed for sexual assault. They lack the developmental and emotional maturity to fully understand what has happened to them and often live in recurring fear that the rapist is going to come back and hurt them again or kill them next time. The media portrayal of these horrific events failed to ask the important question how did the perpetrator avoid being captured before he got to his one-time stepdaughter? He was attached to a GPS device, right? And where did he get the firearm used to kill the teen and turn it on himself? Well, it sounds as though the police have determined that the GPS may be partially to blame. As soon as they queried the device, they knew Santana was on the move and the victim was grave danger. And where did the deadly firearm come from?

“Access to a gun is the centerpiece of the dual tragedies of intimate partner homicide and suicide.” 

The GPS ankle monitor system did not protect the victim because it was not the type of monitor that would alert law enforcement when a suspect diverts from his programmed daily route or if he drove near the school or apartment complex where the victim lived. So, after 3 years the trial was set to begin in July 2024. That is usually a red flag and signals growing anxiety in both the victim and the suspect. Under state law, prosecutors cannot request a hearing to determine if someone is dangerous or whether he should be held in cases involving egregious cases of child rape. The rape of a child is de facto evidence of dangerousness in most circles.

As a former law enforcement officer and a now licensed psychologist here in Massachusetts and I have looked at DVH. I find it necessary to draft reports that highlight the murderer’s unpredictable violence. Certainly, the probation department looks at the perpetrator’s prior criminal history in making recommendations for bail. It is likely that Mr. Santana had no criminal history although we have not been told this fact. Juliano Santana drove to Acton with one thing in mind – to shoot and kill the 16-year-old girl whom he first violated 3 years prior when she was just 13. He should have been in a holding cell until he received a dangerousness assessment.

“Law enforcement agencies should implement a lethality risk assessment protocol in domestic violence cases that includes instructing officers to ask about the presence of firearms and other known risk factors for lethal violence.”

There is nothing more frightening than to be the person who asks for a restraining order for protection from a monster that allegedly raped her as a 13-year-old girl. She was not his biological daughter. How is it possible that someone who has demonstrated such violent and dangerous behavior cannot be held until his dangerousness can be assessed? Here in Massachusetts conditions of bail have no bearing on criminal behavior once released. Bail does not stop secondary criminality. The likelihood of terminal violence such as this, is extremely high as the court begins to move on the case.  Santana skidded through the pervious gauntlet and killed his victim and then himself. Rather than say that there were many things in place to protect the victim, there needs to be an investigation as to how the protection order failed? This case is an abject failure.

More needs to be done to protect child victims from known violent perpetrators. News reports say there were things being done to protect the victim. Not enough was done. The county court probation system failed this victim releasing Juliano Santana on three thousand dollars cash bail – thirty thousand surety bond. In all orders of protection, the perpetrator is required to forfeit all firearms. The fact that Juliano Santana had a firearm needs to be investigated. Did he have a license to carry the firearm he used in the killing? If so, this should have been taken away from him immediately upon the order by the judge on the day the victim went to police in Malden. Someone provided the gun, and someone knew that he had plans for using the weapon. The psychological autopsy can develop facts that shed light on these truths. The facts gleaned in the PA will directly help other cases like this one. The question always comes up as to how the guns were acquired or how the guns were not removed as mandated by law?

“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. In all likelihood the girl lived in fear and terror” according to Michael Sefton, Ph.D. at a police psychology program in Worcester. This after incident examination can provide a good deal of information and warning signs that extreme risk for violence exists. These studies may add to the collective understanding of DVH – especially when family annihalation results.

We conducted a psychological autopsy on a man in Maine who murdered his wife and two children. This occurred just days before his divorce was to be finalized and two weeks before he was to be tried for criminal threatening. Steven Lake was known to be violent toward his wife and daughter. He violated the order of protection over five times with impunity. His firearms were not taken from him. He had over twenty to choose from when he made his move. This is what happens in systems where defense lawyer argues about eighth amendment rights to “reasonable” bail in lieu of consideration for the traumatized victim and her family. What modern society leaves its children at considerable risk for death in crimes like these? There were most certainly red flags that the perpetrator waved in the days and hours before this kidnapping and murder.  His anger was likely extremely high as the trial date neared. He would not allow the victim to take control of his life by sending him to prison where he belonged.

Someone knew that this was going to happen and said nothing. Maybe a family member or co-worker. He may have contacted the victim wanting to apologize or threaten her against telling the truth. Or her family was threatened?  But it is quite likely the unnamed 16-year-old lived in fear that her tormentor may strike and take her again. Just as he did on Thursday in late June as she walked to her home.  It is vital to future cases of domestic violence that common red flags do not become holes in the safety plan of victims seeking safety and protection. The results of the psychological autopsy of Steven Lake were presented to the Maine Attorney General’s DV Homicide Review Board. The document is 75 pages long and offers over 50 recommendations for lowering risk and lowering deaths by DV.

Governor Charlie Baker had the right idea and proposed it to the legislature that allows the court to require a dangerousness evaluation in the case of rape and other crimes. We learned that this failed in 2022 as too expansive a mandate with too few resources to hold perpetrators accountable.  Why? The Middlesex County D.A. should bring this to life and use the event to highlight the imbalance in domestic violence prosecution and the protections it gives to perpetrators from (low bail) and the fear it drowns its victims who feel unprotected. Even having an ankle monitor did not work until it was too late and provided no “real time” monitoring. If it had, then Santana could have been tracked when he diverted from his given route and came to Acton to murder his stepdaughter.  

Everytown Research & Policy is a program of Everytown for Gun Safety Support Fund, an independent, non-partisan organization dedicated to understanding and reducing gun violence.

Career Burnout: The overwhelming impact of stress and understanding the cost to Human Capital

Michael Sefton, Ph.D. Corona virus, Health Psychology, Human Behavior, Leadership, psychological relevence, PTSD, Stress , , , , , , , , , , , ,

WESTBOROUGH, MA October 17, 2024 When we talk about career burn-out, we are looking at the impact of chronic and sometimes overwhelming stress on work efficiency and job satisfaction. As a clinical psychologist, I espouse the risk of stress and its associated malignancy to everyone I meet. Stress adds costs to workforce management because as workers become overwhelmed they start to look for better jobs. Surprisingly, it is often not the compensation that makes workers want to switch jobs – but the work ecology, those subtle factors most of us seek in the relationship between us and the company. Replacing intelligent and career oriented nurses and doctors is very expensive and disruptive to everyone. It means that supervisors are always interviewing and floor nurses are always orienting someone to the idiosyncrasies of the role.

It has been suggested that employees who are under chronic stress are at greater risk for making medical errors and other mistakes. Shortages in staff trickle down to patient care too. Hardly a day goes by when I do not hear someone say “I had to wait 30 minutes for someone to come and help me get back into bed.” When it comes to healthcare, people are not concerned with staff shortages when a loved one is hospitalized. Customer satisfaction is key to good medicine and community policing alike. And like police officers, a nurse or doctor who is on the last hours of a 12-hour shift is more likely to be ill-tempered and out of sorts. And like police officers, healthcare workers experience stress from long hours, shift work, and the nerver ending number of patients. Just ask any nurse or physician working in the emregency department and they will tell you it goes on and on round the clock. It is a mystery how some can stay in one job for any length of time given the current model of corporate medicine and the megagroup practice devouring one sole practitioner after another.

“The prolonged elevated cortisol levels that come with chronic stress and post-traumatic stress disorder (PTSD) can interfere with and damage the brain’s hippocampus” Wendy Suzuki author of Good Anxiety: Harnessing the Power of the Most Misunderstood Emotion.

The brain and body experience stress like a jolt of toxic hormones that have the power to gradually reduce the ability to relax and quiet the body. I am tasked with assessing employees following high acuity/high lethality calls for service who find themselves in an unsustainable state of physical tension and mental fatigue. I teach mindfullness and biofeedback strategies for people suffering with the effects of chronic exposure to high stress situations and the physical impact of these. When working with a group of medical providers stress may become overwhelming after a particularly stressful shift, like many hospitals experienced during the coronavirus pandemic.

I presented a conference on Stress and Healthcare providers: Caring for the Caregivers shortly after our emergence from the nationwide pandemic response in 2022. On that night, I wanted to bring some examples of current stress the frontline healthcare workers experience – especially with the pandemic now in the rear view mirror. In doing so I realized that even preparing for this 90 minute presentation was as much as I could handle with so much on my plate. I needed to remind myself, I am not a superman, I am not a warrior. I must take time for myself and cleanse my psyche of the evil spirits floating around in my unconscious mind. I am aware of the impact of stress on my thinking and my intimate life.

In the short term, our bodies need the adrenaline and cortisol to quickly activate our brains and other organs to react when a threat exists such as when a patient unexpectedly goes south. Since we were being chased my sabertooth tigers we have relied upon the “threat response” to keep us alive. In any environment our bodies need this fight-flight system to modulate and guide our behavior including when to run, fight, or freeze. It comes down to using our sensory system to be on guard for us and when we are exposed to something threatening, like a crash in our patient’s blood pressure or looking through a darkened building trying to find a burglar.

“If you exercise regularly, get good-quality sleep and take steps to reduce and/or manage your stress, “you can reduce stress activity in the brain, systemic inflammation and your risk of developing cardiovascular disease,” reported Ahmed Tawakol, a Massachusetts General Hospital physician quoted in Washington Post article on Stress published in 2022.

Chronic stress is hard on the human body. Most people who seek out a blog like this one are well aware of the toxic impact of an abnormal stress response. “The prolonged elevated cortisol levels that come with chronic stress and post-traumatic stress disorder (PTSD) can interfere with and damage the brain’s hippocampus, which is critical for long-term memory function,” Wendy Suzuki said in a Washinton Post article (2022). The hippocampus and amygdala are a constant filter for danger and threats to safety. Abnormal activation or damage to these organs leave a person struggling with constant activation of the fight-flight response that we know is unsustainable. Or even worse, we are left somewhat helpless without this cueing mechanism. When it starts to rain upon us and we do nothing to initiate staying dry or move away from the lightning. Long-term increases in cortisol can also damage the brain’s prefrontal cortex and its interconnective pathways. These are essential for focused attention and concentration, as well as the functioning of the higher order executive system needed for problem solving and other cognitive tasks we often take for granted. That is until they are corrupted by stress hormones running amock.

What are the signs of burnout? First, there are many nurses who have become numb and disinterested. Some career nurses pull the plug on their roles leaving to become a home health nurse or perhaps off to the nursing home nearest to their homes. Many experience caregiver fatigue and waning empathy from hours of high stress patient care and management. During the relentless pandemic Many want to go back to the “old way” of taking care of patients by using the primary nurse model which divides high acuity patient among the senior nurses on a shift. The primary nurse is usually repsonsible for attending team meetings designed to update physicians and consultants as to how treatment goals are being met.

Secondly, burnout can leave people exhausted, unmotivated, and cynical – the consequences of which can be catastrophic in many professions. As well as impacting professional growth, research suggests that these extreme stress levels can impair social skills, overwhelm cognitive ability, and eventually lead to changes in brain function and damaging physical disease and inflammation in vital organs leading to premature aging.

The stress of this is often overlooked. “During 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. Professionals including residents in training, who ride a high stress career need time to process the trauma they face each day. That is not always possible. As a result, the cumulative impact can abbreviate even the most stalwart among us. Supportive supervision can assist young professionals to mitigate the impact of trauma and stress. Time for resilience should not be put off because of staffing shortages.

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 (Sefton, 2020). These feelings can be overwhelming. The cost has been great with increased rates of suicide since the shutdown began in March including those on the frontlines where the decisions they made both right and wrong may have been impacted by the unending stress of patient care.

On April 27, 2020 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. 

More should be done for employees to assist them in remaining emotionally hardy and resilient for long-term career satisfaction. We know that days of stress from never ending patient flow can undermine career-oriented nurses and shorten their work life – something that no employer wants to see. The same as in law enforcement, finding replacements for nurses, doctors, and other caregivers is not easy. It is important to get ahead of career paths and lower the chances of losing the best and brightest because they are pushed too hard by a hallow system that does not care for its employees. Its human capital is the source of all business success. The loss of its human capital is the actual cost of stress and should be better addressed with thoughtful awareness, firm compassion, and kindness.