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

Law enforcement suicide: Using the psychological autopsy for questions of line of duty deaths

Two Capitol police officers have taken their own lives since the insurrection at the U.S. Capitol on January 6, 2021. This information came after the two officers spent 5 hours fighting the insurrectionists sometimes in hand to hand combat. Jeffrey Smith, a D.C. Police officer, and Capitol Police Officer Howard Liebengood both “took their own lives in the aftermath of that battle” according to an article in Politico on January 27, 2021. A third officer, Brian Sicknick died during the insurrection and his manner of death has not yet been officially determined. Some reported seeing Officer Sicknick being struck in the head with a fire extinguisher during the riot.

First responder suicide is generally not considered a line of duty death and as such, fails to yield the honor given to officers who die in shoot outs or other direct line of duty incidents. And deaths by suicide do not bring family members the death benefits they deserve. Two police officers have died by suicide after confronting rioters at the Capitol that were sent by Commander in Chief Donald Trump. This fact was brought forth by House Impeachment Managers during Trump’s second impeachment trial recently completed.These men must be afforded the honor and benefits provided to any surviving spouse of a line of duty death because that is why these men died. 

The juxtaposition of these facts cannot be ignored. Every one of the hundreds of police officers put their lives on the line as a result of the former president’s truculent narcissism. It would be a dishonor to the men who gave their lives by denying this causal underpinning of their deaths. Suicide by law enforcement officers exceeds the number of officers who die in in gun fights, car accidents, on-duty heart attacks, attacks by citizens, calls for domestic violence, and other police calls for service. “This fact thrust these most private of acts into the national spotlight and made clear that the pain of Jan. 6 continued long after the day’s events had concluded, its impact reverberating through the lives removed from the Capitol grounds” as written in a recent Washington Post report. 

There are things that must be done when law enforcement officers die as a direct result of the the calls they take and the trauma they experience that directly results in their death. Neither of these officers would have died if they had not jumped into the crisis taking place at the U.S. Capitol. Both men were solid members of the Capitol and Metropolitan Police Departments and had no history of behavioral health claims. A transparent psychological autopsy would show the factors that triggered the terminal events leading to each man’s death. For their part, members of Congress spoke highly about the three police officers who died as a result of the riot.

In the days that followed, Erin said, her husband, Capitol officer Jeffery Smith seemed in constant pain, unable to turn his head. He did not leave the house, even to walk their dog. He refused to talk to other people or watch television. She sometimes woke during the night to find him sitting up in bed or pacing. Her husband was found in his crashed Ford Mustang with a self-inflicted gun shot wound that occurred on his way to the job.

Peter Hermann Washington Post 2-12-2021

Rioters swarmed, battering the officers with metal pipes peeled from scaffolding and a pole with an American flag attached, police said. Officers were struck with stun guns. Many officers were heard screaming into their radios “code-33” the signal for “officer needs help” and usually a signal bringing an “all hands” response to the scene of the emergency. Situations like this send chills down the spine of officers responding to calls for help – some are injured in car crashes racing to back-up officers in danger. It is always hoped that when the call for help goes out that there will be enough manpower to push back on the crowd, however large. In this case, the crowd far exceeded the number of LEO’s available for duty. 

 The psychological autopsy is a single case study of a death event that serves to uncover the psychological causes of death. This study would answer these questions and establish an understanding of worst case scenario of frontline exposure to trauma and possibly offer insight into underlying history that may have been anticipated and stopped. When law enforcement officers take their own lives this careful analysis of the hours and days preceding their time of death is essential. “From this information an assessment is made of the suicide victim’s mental and physical health, personality, experience of social adversity and social integration. The aim is to produce as full and accurate a picture of the deceased as possible with a view to understanding why they killed themselves.This would answer the question as to whether or not the deaths may be considered to be line of duty, as they must. Psychological autopsy is probably the most direct technique currently available for determining the relationship between particular risk factors and suicide” Hawton et al. 1998

I have proposed a Behavioral Health initiative in conjunction with changes in police policy and transparency that has been the central posit of social clamor since the death of George Floyd this summer. 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.

This investigation is an individually designed case study that elicits a broad range of factual data regarding the antemortem behavior of a decedent in the immediate day or days leading up to the suicide. In this case, what are the events that transpired in the days before the two Capitol police officers took their own lives? The fact is that both men were exposed to incidents and participated in protecting the Capitol on January 6, 2021. Both men were engaged in hand to hand combat.  It is known that the insurrection resulted in the death of a fellow officer and the deaths of 4 other people engaged in violent mayhem in which these men and hundreds others may have been killed. Both men believed the insurgency was potentially deadly to them or their fellow officers. The psychological autopsy is especially important when first responders and essential workers are involved and die soon after. When LEO’s and first responders are put in fear of death or see other officers being placed in the direct line of fire, are vastly outmanned, and have no way in which to stop an attack, they are at high risk for the “hook” that comes from an acute stress reaction and over time, becomes a monkey on the backs of so many fine men and women.  Michael Sefton, Ph.D. 2018 Direct Decision Institute, Inc.


Hawton, K., Appleby, L., Platt, S., Foster, T., Cooper, J., Malmberg, A. & Simkin, S. (1998). The psychological autopsy approach to studying suicide: a review of methodological issues. Journal of Affective Disorders 50, 269–276.

IACP (2021) Officer Resilience Training Conference https://www.theiacp.org/projects/law-enforcement-agency-and-officer-resilience-training-program, Blog post taken February 13, 2021

The fine art of being present: A Chaplain’s call for the spiritual connection with front line cops

Sometimes being present in the moment is enough to allow feelings of vulnerability to emerge and for healing to begin. Cops, and I dare say fire fighters, are not used to being vulnerable. Often less is more when is comes to shared space, personal pain and having a connection with one or more people who understand. A quiet moment of reflection after a difficult call may be enough to diffuse the experience of trauma and provide damage control going forward. Career hardiness and satisfaction requires that some moments be recognized with a circle of shared vulnerability and authentic empathy that can be just a few seconds to minutes.

Police Chaplaincy since 1800’s

During the coronavirus after a particularly deadly shift, members of ICU teams took a moment to share the names of those who had died in their care. These were somber events that acknowledged the losses and a measure of desolation shared among team members. People undergoing enormously stressful events can unburden themselves only if they acknowledge their inner feeling state. “We’ve seen chaplains accompany COVID patients in their last moments when loved ones could not be present. The year 2020 inflicted deep wounds on many in our communities and chaplains were there offering support,” said Wendy Cadge, the project’s principal investigator and Senior Associate Dean of Strategic Initiatives at Brandeis University

“When we can feel and acknowledge our deepest fear – it can be liberating and reduce the perceived stigma of being vulnerable and in pain.”

Elissa Epel, Ph.D., UCSF, as quoted in NY Times

Police, fire, and first responder agencies across America have called upon the chaplaincy when their membership has experienced an out-of-the ordinary exposure to trauma like fatal car crash, death by suicide, death of a member, school or mass shooting, and more. Some of these are more routine like a notification of the sudden death of a family member. Meanwhile, other incidents leave a searing imprint of the entire event like the shooting of over 20 Sandy Hook elementary school students in Newtown, CT. It has been frequently mentioned that exposure to death and uncivilized brutality has an impact on wellness and personal resilience. Not a surprise. In the case of Sandy Hook how can any member of law enforcement or EMS ever forget that day? But what can be done?

Police chaplains is one part of the solution. The Chaplaincy Innovation Lab received two grants totaling $750,000 from the Henry Luce Foundation in the second half of 2020 to continue building and supporting resilience in chaplains and other spiritual care providers across the country. Chaplains often find themselves on the front line and frequently encounter operational chaos when they are called upon to minister to the troops. Yet that rarely stops them. They were there at Sandy Hook in 2012. The new program at Brandeis University in Boston aims to train chaplains to be better equipped for things like Sandy Hook or any community event that impacts large groups of people.

In Boston, the call went out that a firefighter was down. This during a 2-alarm fire in Watertown, MA. The department chaplain Father Matthew Conley was needed “now” at the Mount Auburn Hospital in Cambridge, MA for the Anointing of the Sick – known to many as “the last rites.” Fr. Matt had not been on scene during the incident as it appeared to be a routine call. But like so many calls it went south in a hurry.

Firefighter Joseph Toscano was near death from a medical emergency suffered while on duty fighting the fire. It was a hot summer day. He was 54-years old and had a large family of a wife and 5 children. The family were all members of the Catholic faith at a parish a short distance from Watertown. For many Catholics, the anointing of the sick is something to bring about reconciliation for someone who may wish to ease their suffering on the journey toward death.

Firefighter Toscano died that day while doing the job he was trained to do. The Last Rites involve prayers and the final Holy Communion known as the Viaticum. These were something Fr. Conley had done many times before. But when he arrived at the Mt. Auburn Hospital that morning he was met by a phalanx of Watertown police and fire fighters. As he walked into the emergency department of the large Cambridge, MA hospital he knew right away by the look in their eyes that this was no ordinary blessing. He was called to minister, first, to the dying public servant, his wife and children who had been brought to his bedside at the trauma center. But what’s more, he was tasked with consoling the entire brotherhood who looked to him for comfort and hope when no amount of prayer could bring back their fallen brother. But he listened, and he heard their pain, and validated their experience.

“You are here for all of them”, he would say, “and I am here for you.” Fr. Matt Conley sharing the words of former Parish Administrator Fr. Kevin Sepe at Watertown Collaborative.

The story is told that as Fr. Conley dealt with the enormity of the pain felt by all who felt the sudden loss of the career firefighter, when in-walked Fr. Kevin Sepe, the Watertown Collaborative priest administrator. The presence of Father Conley brought a strong empathic presence to the family who had lost their husband and father and to the first line firefighters who felt the loss deeply. Fr. Matt listened and he offered prayers.

From his years as a priest and police chaplain, Fr. Sepe understood what Fr. Conley was facing in the call to the hospital crisis as the department chaplain. His support was largely nonverbal that day. “You are here for them,” he would say, “and I am here for you,” bringing his presence, peer support, and understanding of the enormity the ministry at hand.

“Police chaplains aren’t there to push a religion on police officers; their role is primarily to listen and offer emotional and spiritual support” from an article in Police One, 2015. The chaplain program has been around for over 200 years and often works in the background subliminally. The military has utilized multi-denominational chaplains to minister the troops as well. These men and women are on the front lines and 3 members of the clergy have paid the ultimate price for their calling during recent wars.

Chicago Police Chaplain Father Dan Brandt

Not everyone is religious and you might believe that a goal of a department chaplain is to advocate one denomination over another. Not the case at all. The chaplain may be a Catholic priest as in the illustrated case or he or she may be an ordained Protestant minister, Muslim Imam, or a Jewish rabbi or some other ordained member of the clergy. As a police officer, I worked with a female protestant chaplain who was very helpful with members of our community. I would not have hesitated speaking with her in confidence if I were in need. The role of the chaplain is to provide support and to listen. She was good at it too. Being present with someone who is in crisis or dying can be among the most gut wrenching of all human experience. Fr. Conley once told me he never goes anywhere without the Sacramental oils for the blessing of the sick. This allows him to be ready to offer the Sacrament should he be called to do so. He felt deeply that this anointing was his duty and one of seven sacraments priests are prepared to offer.

I have given death notifications before and have witnessed the soul wrenching-anguish experienced by those receiving these notifications. It is a horrible experience and I remember most all of these events and am still bothered by several.

For line of duty deaths, chaplain’s ask if prayer might be helpful. The sacrament of the sick is one “of strengthening, peace, and courage to overcome the difficulties that go with the condition of serious illness or the frailty of old age provided by the Catholic Priest. This grace is a gift of the Holy Spirit, who renews trust and faith in God against the temptation of discouragement and anguish in the face of death” according to Michelle Arnold published in Catholic Answers in 2017.

The key to a successful departmental chaplaincy is contact — if you have enough chaplains strategically placed who are artful in “reaching out and touching someone,” two things will happen. Successful interactions will take place and the word will get around. Once calls for a chaplain begin to come directly to a chaplain from the on-scene sergeant or deputy, the chaplaincy has made its mark.  Chaplains can best serve when their role is defined and the confidentiality of their relationship to law enforcement is understood. Police One, 2015

The chaplaincy has been around for centuries in public service. It is making entry into many law enforcement agencies in earnest. Many have had chaplains riding in cruisers for decades like Fr. Dan Brandt in Chicago and his fine crew of law enforcement trained chaplains of all denominations. At some times, this has raised the issue of mixing government with religion. But there are guidelines in place. “In Lemon v. Kurtzman, the justices established the three-pronged “Lemon Test,” which, as it translates to the chaplain’s position, says he must have a secular purpose, must not excessively entangle the government with religion, and neither proselytize nor inhibit religion” said reporter Jon O’Connell in a 2017 report. The police and fire department chaplain is there for support of first responders, not as an evangelist, but as moral reminder of the “sacred nature” of their work, according to Fr. Dan Brandt, the director of the Chicago Police Ministry. In Watertown and now Scituate, Massachusetts, Fr. Matthew Conley brings forth his presence with kindness, reverence, and often good humor making the human connection with those in his purview.

Brandeis Now. Chaplaincy Innovation Lab at Brandeis University receives $750,000 from Henry Luce Foundation. January 23, 2021

O’Connell, J. (2017) Police chaplains take a stronger role in community policing. Scranton Times-Tribune. News article.

McDermott, M and  Cowan, J. Combating Pandemic Fatigue. Quoted in NY Times. October 2020.

The Psychological Impact of Pandemic: The best and worst of human behavior

On November 11, 2020, I presented a program on the Psychological Impact of Pandemic sponsored by Whittier Rehabilitation Hospital.  It was well attended with a mix of nurses, midlevel practitioners, social workers, and nonclinical participants. The program was presented on the zoom platform. I am now going to put to paper my perspective narrative espoused in my 90 minute presentation.  I had also invited members of law enforcement with whom I have regular contact as the information was drawn from the growing literature on mental resilience and its positive impact on coping with exposure to trauma.

ca-times.brightspotcdn

According to the PEW Research Group, 4 in 10 Americans know someone who has either been afflicted with Coronavirus or someone who has died from the virus. My mother was infected with the Coronavirus in mid April in the same nursing facility where I lost my 93-year old aunt in the first wave of the virus in May, 2020. My mother survived the virus but it has taken a significant toll on her physical and cognitive well-being. We were not permitted to see my mother during her illness and my aunt was alone on May 1 when she succumbed to the virus. Both living on a nursing unit that was doing its best to render compassionate care under extraordinary conditions, in some cases with nurses, aides, and therapists working round the clock. Both of these loved ones received extraordinary care. Nursing units across the country suffered unimaginable loss of life including over 70 elderly veterans at the Soldier’s Home in Holyoke, Massachusetts.  We all saw the images of refrigerated trucks holding victims in expiated purgatory hidden behind hospitals. It may bring horror to those who lost loved ones and never saw them again.

I saw my mother on November 12. She looked frail and disheveled.  The nurse practitioner had ordered a blood draw out of concern for her physical well-being. She is 92 and may have a blood disorder. They had three staff people hold her in place to obtain the small sample of blood which took over and hour.  She has always had difficulty having her blood drawn and this has gotten worse as she has gotten older. She fought and screamed from pain, and fear, I was told. It was torture for all those involved, including me.

Little did anyone realize the extent of disease, contagion, and trauma this pandemic would bring to the United States and the world. We waited in February and March with curiosity and vague forewarning from our leadership. We were led to believe the virus would dissipate once the weather became warm and it would essentially vanish in the heat of summer. This did not happen and public health officials at CDC and WHO were spot-on in terms of the contagious spread of covid-19 and the deaths it would bring.  Now with the approach of winter our fear borders on panic.

This virus poses significant stress and emotional challenges to us all. It raises the specter of both an overwhelmed medical system as well as increasing co-occurring emotional crisis and a collapse in adaptive coping, for many. Sales of alcohol went up 55 percent in the week of March 21 and were up over 400 percent for alcohol delivery services. Americans were in lock-down and many made poor choices. The link between stress and physical health and well-being is well documented and will be a factor as American’s find their way free from the grip of Covid-19. 

“The human mind is automatically attracted to the worst possible case, often very inaccurately in what is called learned helplessness”

Martin Seligman

Whenever human beings are under stress they are going to utilize skills they have learned from other times when they felt under threat. Chronic stress has been shown to have negative effects on health including autoimmune functions, hypertension, inflammatory conditions like IBS, and pain syndromes. Many find it impossible to think about anything but the worst case scenario. Marty Seligman described the concept of “catastrophizing” that is an evolutionarily adaptive frame of mind, but it is usually unrealistically negative.” This leads to a condition known as learned helplessness. In another book, Dr. Seligman writes about learned optimism published in 1990. His cognitive strategies hold true today.

So many use the same coping mechanisms over and over, whether they are effective or not like drinking or gambling to let off steam. These things may help in the short term but can cause further health and social problems later on. They are not adaptive strategies. Stress is unavoidable and the best thing we can do is to understand its physical impact on us and adapt to it in healthy, adaptive ways. Stress raises the amount of cortisol and adrenaline in the body activating the fight-flight response. For many, that meant an uptick in the procurement of spirits in late March to help bring it down. Others think differently. Many began a routine of walking or running or cycling. Regular exercise contributes to reducing stress and when kept in perspective, is an adaptive response to the threat of coronavirus.

Many people in our hospital were afflicted with the virus or some other health concern and became immersed in loneliness and isolation that can lead to disconsolate sadness. It is hard not to be affected by this suffering. Most reviewed studies reported negative psychological effects including depression, anxiety, post-traumatic stress symptoms, confusion, and anger, according to Brooks, et.al. Lancet 2020. At Whittier, we had many cases of ICU delirium where patients became confused and frightened by healthcare providers wearing PPE including face shields, masks, and oxygen hoods. Many thought they were being kidnapped or that the staff were actually posing as astronauts. This made it hard to help them feel safe and to trust the core staff including doctors, nurses, and rehabilitation therapists.

Michael Sefton

We have had some very difficult cases including a man who found his wife on the floor without signs of life. He fell trying to get to her and both lay there for over 2 days. He was unable to attend her funeral because of his broken hip. We had another man who pushed us to be released from the hospital. He worried about his wife who needed him to assist in her care at home. She has Parkinson’s disease. He was discharged and died shortly after going home. His wife fell while getting ready for his funeral and is now in our hospital undergoing physical rehabilitation and receiving support from our psychology service. The table below is a list of observations from recent admissions:

  • Anxiety – what will my family do while I am here?
  • Deep felt sense of loneliness
  • Depression – loss of support; loss of control 
  • Exacerbation of pre-existing conditions i.e. sleep disturbance, asthma, uncontrolled diabetes, hypertension
  • Slower trajectory toward discharge
  • Debility greater than one might anticipate to diagnosis
  • Subtle triggers to prior trauma – changes in coping, regression, agitation, sleep and mood

What is left for us to do? Have a discussion about what it means to be vulnerable – talk about family members who have been sick with non-covid conditions like pneumonia or chronic heart disease, COPD, etc. It is important to be ready to work from home again such as when schools switched to remote learning this spring and when governors’ call for closing things down. Consider the return of college kids as campus dorms everywhere are likely to close this winter.

The 1918 Spanish Flu pandemic killed 50 million people worldwide. 500 million people were infected with the virus that lasted 2 years. The virus was said to have been spread by the movement of troops in WW I. The website Live Science reported that there may have been a Chinese link to the Spanish flu as well due to the use of migrant workers and their transportation in crowded containers leading to what we now call a super spread event. We know a lot more about this virus than we did in March 2020 when it first took hold but we need to understand the eradication will be a herculean task driven by science.

“The coronavirus has profound impact on the emotional stability of people around the world because of its unpredictability and lethality. It evokes fear, and uncertainty as it spreads unchecked. Later, the virus can serve to trigger long hidden memories in a way that can sabotage healthy human development leading to vague anxiety, physical symptoms, loss, and deep despair” said Michael Sefton, Ph.D. during a recent Veteran’s Day presentation. People must have resilient behaviors that foster “purpose in life, to help them survive and thrive” through the dark times now and ahead, according to police consulting psychologist Leo Polizoti, Ph.D. at Direct Decision Institute in Worcester, MA.

 

Covid-19 pandemic: No more important time for resilience

It has been frequently mentioned that exposure to death and uncivilized brutality has an impact on wellness and personal resilience. Not a surprise. Especially in these pages, I make an effort to point out that the cumulative impact of traumatic exposure slowly whittles away one’s capacity for mental health, empathy and emotional efficacy. “There is a relationship between the severity, frequency and range of adverse experiences, and the subsequent impact on mental health.” (Dillon, Johnstone, & Longden, 2012). The conundrum has always come down to just what constitutes a “traumatic” event in childhood? Sometimes there is no single identifiable event that a child brings forth that may later become a trigger of serious emotional instability later in adulthood.

The Covid-19 virus has the potential for creating traumatic events depending upon the degree of exposure and a child’s understanding of the narrative brought forth by parents and other trusted adults during the pandemic. “Over 30 percent of Americans know someone who has died or been infected by the virus. The fallout to mental health from the coronavirus is real. I see it in my own family as nerves become frayed 8 weeks on.” according to the blog post from May, 2020. Trauma informed therapy supports the model of early traumatic experience being the underpinning of many mental health outcomes we see later in life. The biopsychosocoial model identifies physical abuse, sexual abuse, exposure to violence, chronic substance abuse as the substantive reasons for many mental and physical illnesses years later. When we look in the rear view mirror at this virus we will see the litter of emotional wreckage that may leave its hooks in many people around the globe.

Coronavirus. Ise.ac.uk

There is a relationship between the severity, frequency and range of adverse experiences, and the subsequent impact on mental health.

(Dillon, Johnstone, & Longden, 2012).

“The more adverse events a person is exposed to in childhood, the greater the impact on physical and mental health and well-being, with poor outcomes including early death” (Anda, Butchart, Felitti, & Brown, 2010; Anda et al., 2006; Felitti et al., 1998). There was a time in my training that I collected data on childhood fire setting and the psychodynamics of pyromania. I saw 50 children in my fellowship year who came because of fire setting. Without a doubt, there was marked early instability in the childhood homes in these kids that likely germinated into fascination with fire play and perhaps more directly, physically aggressive behavior. Many of the children I assessed were suffering from early onset trauma.

Depending upon the age of onset using fire as an expression of internalized conflict suggests a serious emotional disorder in need of expert assessment and treatment. The interest in fire may appear normal but slowly interest foments in homes where a prevailing emotional vacuum permits – decreased emotional warmth, access to fire starting materials, an absent parent, and frequent domestic violence.  

The inconsistent and unpredictable exposure to violence contributes to excessive and unpredictable behavior as children become adults. Often without direct knowledge of a specific trigger, trauma activates brain circuits that drive fear and emotional behavior including substance abuse, domestic violence, and assault. What is more, these absorb community resources as psychological needs grow.

The coronavirus has profound impact on the emotional stability of people around the world because of its unpredictability and lethality. It evokes fear, and uncertainty as it spreads unchecked. Later, the virus can serve to trigger long hidden memories in a way that can sabotage healthy human development leading to vague anxiety, physical symptoms, loss, and deep despair.

Scott D. Jones of Arlington, MA was a decorated paramedic who responded to a mass homicide in 2000 in which 7 people were shot in an episode of workplace violence. He would go on to kill his second wife and 2 children 14 years after repeated episodes of severe depression and suicidal behavior and domestic violence toward his first wife.  These behaviors were the first red flags of an impending emotional breakdown and terminal rage. Paramedic Jones certainly had problems but the repeated exposure to trauma – especially the mass shooting, activated his fight-flight response intolerably and may have been one of the demons he faced in the end.

Michael Sefton, Ph.D.

Trauma can be triggered by loss due to Coronavirus in two ways. First, by direct contact with a family member who is hospitalized and may have died. Nearly every person who contracted the virus had someone left behind that was worried about their health and eventual recovery. Many had family members who communicated with patient via text messaging and FaceTime – until the loved one could no longer do so. Families relied on the updating calls of first responder nurses, chaplains, social workers, and physicians.

Next, through secondary exposure to similar cases and media coverage that assails efforts at closure and engrains the narrative of fear, guilt and shame by reporting ever increasing case numbers, hospitalizations and deaths survivors are left feeling numb and unable to mourn. Funerals were deferred or could not be held at all as some jurisdictions required the cremation of the remains of coronavirus victims. This has a negative impact on survivor health and well-being often evoking a religious and moral crisis of faith. Survivors have enormous guilt and sadness not being with a loved one who died from the virus or waiting to go for medical at the onset of symptoms. They mourn to mourn and are left feeling numb at the lack of closure.

So whether it is early trauma associated with domestic violence or trauma from repeated exposure to work-related experiences, there is a resilience that resides within most people that guides the rise from being overwhelmed again and again to move forward with courage and hope and feelings of hardiness. These are learned responses to high stress events like a pandemic, but people who are positive thinkers, optimistic, physically fit and emotionally insightful rise up, controlling the lives they lead.

We are offering a zoom platform event entitled The Psychological Impact of the Cornavirus Pandemic: Common sense answers on November 11, 2020 at 5:30 EDT and again in December 10, 2020 at 7 PM. It is free and to be sent the zoom link contact: jswiderski@whittierhealth.com or call the Whittier Rehabiltation Hospital at 508-870-2222 in the U.S. If you plan on attending the 12/10/2020 session please drop me an email at: msefton@whittierhealth.com

Michael Sefton, Ph.D.

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. 

 

Positive Policing and Purpose in Life

Purpose in life has been introduced as benefiting people, including law enforcement officers, to find a positive sense of purpose and personal satisfaction in their work product and in their lives. It was originally espoused by Viktor Frankl in 1946. Frankl, a physician, survived the German concentration camps and the deliberate extermination of 6 million Jews during WW-II. His wife and entire family were killed at Auschwitz and Dachau. How could he possible find purpose and meaning in life after this horrific experience. In the book Man’s Search for Meaning, first published in 1946, Victor Frankl shares the experience of seeing hundreds of people herded off to their extermination. People and members of his immediate family were horrifically gassed and sent to mass graves. Frankl’s theory holds that “there are three primary human capabilities, or, in his words, noological possibilities: self-detachment, self-transcendence, and the ability to “spiritually be in touch” with something or someone independent of spatio-temporal dimensions” according to McGann (2016) who reviewed Frankl’s book Man’s Search for Meaning.
Officer well-being is essential for career longevity. It becomes apparent that police officers grow and remain productive in an environment of support: both within the organization and within the community in which they serve. These attributes build a sense of personal meaning and career purpose. Leo Polizoti, Ph.D.
In Man’s Search for Meaning, Frankl described the daily demoralizing prisoners underwent both physically and psychologically. Survivors of the horrific images at concentration camp Auschwitz began to find meaning in their forced labor – even humor along with camaraderie. Many of us glean a significant sense of well-being from what we do personally and professionally. Most cops derive great personal meaning and purpose from the job of police officer at least for the first 3-5 years. Law enforcement officers’ derive much of their identity from the work they do on a daily basis and can experience wide ranging stress from call to call. As such, it has become well-known that police work requires special understanding of one’s community and a positive sense of personal responsibility, well-being and resilience for career success and hardiness (Polizoti, 2018).
Our tour guide at the West Bank in Israel in 2019 – Rami Nazzali found great purpose in teaching visitors about the plight of Palestinians on the West Bank and Gaza Strip – He strongly believes the plight of Palestinians in the Gaza Strip and West Bank are fighting for purpose and meaning in their lives. Rami Nazzali writes for The NY Times.
Purpose in life refers to an underlying belief that what you do for work has importance and purpose on a larger scale. Moreover, to diminish oneself as a result of career embitterment runs a risk of the erosion of purpose and loss of group membership. That is when one becomes marginalized and loses his purpose and the “why” for living. Viktor Frankl believed that once gone the purpose of life and the will to live cannot be restored. Mark Dibona previously was a patrol sergeant for the Seminole County Sheriff’s office in Florida, where he supervised nine officers, but the memory of the June morning where he was called upon to resuscitate and dying infant still haunts him. “Other stressful situations include, but are not limited to: long hours; handling people’s attitudes; waiting for the next call and not knowing what the situation will be; and even politics within the department. Then, on top of it all, officers are frequently criticized, scrutinized, and investigated for decisions they make” said Michelle Beshears on the faculty at American Military University. Among police officers between seven percent and 19 percent of police officers experience symptoms of Post-Traumatic Stress Disorder, compared to 3.5 percent of the general population. A colleague and friend, Sergeant Mark DiBona retired from law enforcement in 2019 has had some difficult times on the job in Florida that effect him in a profound way. He is an strong advocate for law enforcement mental health and suicide prevention. “Until this day,” said Dibona, who admits to having contemplated suicide several times before he began counseling, “I can feel the warmth of that baby on my arm.” A child Mark believed he could save.

Thailand: Royal Thai police face daunting job to reform national agency

“Police suicides and police apathy are two of many issues highlighting a dire need for constructive police reforms within the Royal Thai Police for some time.” Bangkok Post October 14, 2019 The Thai National Police (TNP) are mired in politics and age-old tradition which has contributed to significant tension within the TNP ranks.

As recently as early February, 2020, an embittered Thai police officer went on a rampage in the northern province in Thailand. Over 20 persons were killed in an extremely rare display of public rage and terminal violence. The perpetrator ultimately took his own like as members of the Thai Special Forces moved in.

Dr Ronald Allanach and Dr Michael Sefton are pictured with the Northern Police District Administrator during a meeting 2 weeks before the rampage. There was no sense among the officers we met that tension and despair underlie this outwardly professional police agency. The officers we interviewed were all happy and content with their assignments. There was no sign of the frustration and vulnerability identified in the Bangkok Post report.

Dr. Ronald Allanach (left) pictured with Northern Sector Thai National police administrator and Dr. Michael Sefton in January 2020

Police reform is a problem across America and the world. In Thailand, a centralized police force is overseen by the country’s prime minister who is responsible for naming the chief general who leads the Thai National Police. This is no easy task. Some believe there are complex issues that contribute to the distress felt by police across Thailand. The investigation into the February 2020 rampage is in its early stages but links to conflict between the officer and a higher ranking administrator are being floated. A psychological autopsy would provide added facts to the “red flags” that may have lead up to the terminal event and offer substantive interventions that can reduce the growing problem in The TNP.

These include officers who are sent to distant police assignments leaving them without the normal emotional and agency supports they need. The pay is low and the trust felt by the TNP from its citizenry is inauspicious at best.

In a 2018 published paper in the Journal of Humanities and Social Sciences by Police Major Thitiwat Yachaima, similar factors affect the levels of stress in Thai police officers as that impacting cops in the United States. This includes work environment, relationship to superior officers and peers, specific work and hours of weekly service, support from family

“Today police morale and emotional health have hit rock bottom, he said, because of a number of factors, including botched policy-making when it comes to their career path that doesn’t take into consideration the officer’s needs and desires.”

Bangkok Post December, 2019

The Bangkok Post published an article about police suicide in Thailand. According to the Bangkok Post, “four police officers – based in Chumphon, Chiang Mai, Sing Buri and Kamphaeng Phet – were overwhelmed by stress and took their own lives after being transferred from their home provinces to investigation units in the other provinces.” 

More recently, police officers in Thailand have been able to request transfer to their home provinces in an effort to reduce the stress experienced by newly deployed officers and other specialists. There are over five thousand unfilled positions in the investigation units for the Thai National Police. As a result of this shortage, it requires that officers be shared among divisions across the country adding to the stress officers’ experience.

Overall, Thai police are defensive about the underpinnings of officer suicide citing “physical health and personal problems” as a primary source of the problem – not simply job assignment. National police chief Pol Gen Chakthip Chaijinda has recently come under attack from subordinates for making what appeared to be abrupt, politically motivated transfers for those who challenged his authority as he nears retirement age.

What factors need to be examined when looking to reduce police stress in general and to understand factors that are shared among law enforcement officers across societies? A study conducted in 2011 in the Journal of Nursing Science suggested that officers who have self-efficacy and respect from the communities they serve as among the factors that yield the greatest health-related behaviors and personal hardiness.