Health Psychology

Asperger’s Disorder: Not linked to violence

Michael Sefton, Ph.D. Active shooter, Health Psychology, Human Behavior, Relationships
Dr. Sefton discussing psychological autopsy of Steven Lake
Dr. Sefton discussing psychological autopsy of Steven Lake in 2012                  BDN PHOTO

WESTBOROUGH, MA – May 25, 2014 The weekend when most people are celebrating Memorial Day was marred by another mass murder involving a young man who may be linked to Asperger’s Disorder – a developmental condition in the same family as autism – but one that is thought to be higher functioning.  It is unclear that the man exhibited the syndrome of Asperger’s although it may be true.  Initial reports suggest the assailant who is now dead began having psychiatric trouble in the 4th grade – about age 10.  If this is true then it is unlikely he was suffering with Asperger’s – because this disorder is usually first observed before the age of 10.  True, Asperger’s is a social interaction disorder and like Adam Lanza, we are learning that Rodger was socially awkward.  It may eventually be clarified by history provided by those who knew him best like his parents, friends, teachers, and physician’s who were treating him for mental health issues. If current reports are accurate Elliot Rodger was a 22-year old college student in Santa Barbara, California who killed 6 people after writing a chilling 137 page manifesto espousing his anger and powerful resentment at women over his experience of being rejected.  He later was involved in a gunfight with Santa Barbara County Sheriff’s officers and was killed or took his own life.  In his wake there were 6 people killed and 13 injured either by gunfire or being struck by Rodger’s BMW during the frenetic melee.  No official word as yet on the cause of his death. Rodger’s experience was also published on You Tube entitled “Elliot Rodger’s Retribution” and came to the attention of his parents, the police, and others well before the onslaught.  His psychotherapist received an email telegraphing the event signaling the terminal onset of Rodger’s emotional dehiscence.  “Have you gotten Elliot’s email? I think you should see it,” the suspect’s therapist said to his mother just 13 minutes before authorities say he opened fire outside a sorority house, according to the L.A. Times story (May 25, 2014).

Frenetic Anger – Accelerating Risk

The events of Friday May 23 reflect the rage of an alienated, inadequate young man who lacked the basic relational capacity to form meaningful bonds.  Mental health experts see a series of “red flags” in retrospect.  The Washington Post cited Philip Shaenman who believed that authorities should have noticed “the acceleration of red flags” (May 26, 2014).  A similar acceleration [of red flags] was reported in the Psychological Autopsy of Steven Lake – Dexter, Maine Domestic Violence Homicide (Allanach, et al. 2011) and just as importantly people knew was was going to happen. The alienation Rodger experienced stemmed from loneliness and repeated humiliation eventually leading to explosive anger and blame. The specific trigger may remain a mystery.  In the written pages left behind, Rodger cited “wasting last 8 years of my life” apparently making a vague reference to the duration of time spent trying to establish a meaningful relationship without success.  Sadly, Elliot Rodger was not equipped to form the intimate bond he sought although high functioning autism seems like an unlikely cause.  More likely, Rodger was an entitled young man with deep-seated resentment and fear of women that contributed to feelings of shame.  He may have believed that his social status set him ahead of other men who were looking for the same things as he.  He may have had significant conflict over having so much status, e.g. being on the “red carpet” but having nothing of what he really wanted in the form of intimacy.

Analysis of behavioral indicators suggest high risk

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Shooting scene                                ibTimes photo

His writing revealed the preoccupation with physical attributes of both the women he sought and the men he blamed for taking them away rather than exposing the extreme pain and loneliness with which he struggled.  In spite of living in a family with financial means and outward success, Rodger saw power and success as coming from a sexual relationship with an adoring blond.  The anger he projected was indicative of delusional jealousy and humiliation during his frenetic final days.  The process of compiling behavioral data that were “red flags” in the form of a psychological autopsy may one day reveal the complex layers of Elliot Rodger’s personality, primitive coping skill, unmet needs, and perhaps the true motive for the maelstrom in Santa Barbara.  In the case of domestic violence, family members who are in the crosshair of these dangerous events often see but lack the knowledge to stop the emotional and behavioral kinetics once they start. Arguably, a continuum of interagency cooperation is needed to effectively measure risk and understand the red flags that are common underpinnings of abuse.  The psychological autopsy offers a final analysis of the behavioral data and the compilation of pre-incident red flags that may be applied to the current understanding of explosive violence as in the tragic cases in Santa Barbara, CA, the Washington, DC Naval Base shooting, and the horrific school shooting in Newtown, CT.

The frequency and intensity of red flag aggression may forecast terminal violence.  As these red flags come into focus it becomes incumbent upon each of us to take action on behalf of those most at risk.  Each of us has a duty to warn potential victims.  Given the final outcome of the Elliot Rodger timeline, one might push for this type of posthoc analysis of the tragic events and hope that in coming forth – some degree of healing may once again take place.

REFERENCES

Ronald Allanach et al., Psychological Autopsy of June 13, 2011, Dexter, Maine Domestic Violence Homicides and Suicide: Final Report 39 (Nov. 28, 2011), http://pinetreewatchdog.org/files/2011/12/Dexter-DVH-Psychological-Autopsy-Final-Report-112811-111.pdf.

Sefton, M. (2011) The Psychological Autopsy: Provides a host of pre-incident indicators. Blog:  http://www.enddvh.blogspot.com/2011/11/psychological-autopsy.htm, taken May 26, 2014.

Decisions on Bail for Domestic Violence

Michael Sefton, Ph.D. Dangerousness assessment, Health Psychology, Human Behavior, Relationships , , , , ,

THERE IS MOVEMENT TOWARD VICTIM SAFETY IN CASES OF DV

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Michael Sefton (right) BDN photo

WESTBOROUGH, MA   Is there any coincidence that Democratic House Speaker Robert DeLeo has joined forces with Attorney General Martha Coakley to bring forth a new bill that will provide for stiffer bail conditions and tougher sanctions for repeat DV offenders?  This bill was brought forth just 2 weeks after the Massachusetts SJC ruled on the case of one abuser against whom a permanent restraining order has been in place for over 10 years.  In that ruling, a man against whom a protective order was written is seeking its dismissal under the broad assumption that he is no longer  a threat to the former girlfriend because he now lives 3000 miles away.  Not so fast said the Massachusetts SJC.

The Commonwealth’s highest court reviewed the historic data in the case record and made its decision based on the documented threat of violence the abuser posed and convictions for DV against more than one partner dating back to the 1990’s.  They voted against dismissing the permanent restraining order writing that victim safety is more important than the purported rights of abusive men.  In the SJC decision the limitations placed on the abuser based on having a “protective order” against him were the collateral consequence of the behavior they exhibited early on.  The abuser believed he was unfairly being prevented from owning a firearm and had limited opportunity to work with children because of the unfair restrictions placed on him by the permanent order of protection.  Furthermore, the SJC also acknowledged that the abuser must show “convincing evidence” that they have made substantive emotional and personality changes that render him no longer a threat to the estranged spouse.

The bill proposed by Speaker Rober DeLeo asks for tougher bail conditions most notably a 6 hour delay before an alleged abuser may be released from custody.  The highly publicized case of Jared Remy who was released from custody hours before be allegedly killed his live-in girlfriend served as a stimulus to the proposed change in the law.  An important consideration not mentioned in the proposed bill is that to do with subjects with known violence in their history and how best to protect victims from revenge abuse once the abuser is released from custody.  Presumably, the new bill affords potential victims the opportunity to put in place a safety plan and affords those making decisions about bail added training about the cycle of abuse, red flag predictors, and greater access to the history of violence of the person in custody.

Unfortunately, the bill does not go far enough in its current raw form to assure that victims of violence receive the needed protection once they decide to break away from dangerous and dysfunctional entanglements.  It is this time when abuse victims are at greatest risk of death due to domestic violence as in the case of Amy Lake, a victim of domestic violence homicide whose case was carefully studied in the Psychological Autopsy of the Dexter, Maine Domestic Violence Homicide (Allanach, 2011) that occurred in June 2011.  Maine has been reviewing bail conditions since this unique study made over 50 recommendations for reducing the incidence of domestic violence homicide in that state.   This report was presented to the Governor’s Domestic Violence Homicide Review Panel in November 2011.  Only recently was a domestic violence suspect held without bail for his history of felony assault and battery on his spouse and a prior domestic partner for over 20 years.  In that case, the abuser was arrested three times in one month for violating an active order of protection during which time he threatened to kill his estranged wife.

Red Flags and Bail Conditions

In Massachusetts, Speaker Robert DeLeo warns that red flags often foreshadow an abuser’s behavior giving clues as to the intentions and the proclivity toward violence.  These are facts that are well described in the literature on DVH.  It is suspected that perpetrators ostensibly inform others about their intentions and all to often, these individuals do nothing to stop the violence.   In a prior paper, I have argued that a domestic violence registry may be useful for keeping track of those who repeatedly abuse or batter their domestic partners.  This would be similar to the sex abuse registry that requires those adjudicated for sexual abuse of children must register whenever they move from place to place.  I have also written extensively on the need for containment of those at highest risk to offend including a pertinent history of physical violence e.g. choking coupled with threats of death, access to firearms, prior violation of an order of protection, the presence of more than one simultaneous protection order (multiple victims), and other forms of coercive control such as destroying personal mementos like favored Christmas ornaments and personal photographs.   A pattern of substance abuse further elevates the risk for domestic violence and DVH.

There are changes taking place in the way in which domestic violence is handled in many states here in the U.S.  Bail conditions are being reviewed with more stringent constraints being placed upon abusers including no bail containment of the most egregious and violent cases.  Further options like GPS monitoring and a domestic abuse registry are being considered in some jurisdictions.  Some experts are calling for added training for judges and greater access to DV history before making decisions about bail conditions.  Arguably, these examples will all add to greater victims security but do very little when emergency protection orders are issued by judges during the night.  Police are frequently asked to present information to an on-call judge in an effort to provide immediate protection following a suspected incident of DV.  This information is critical in conveying what risk exists to the victim or potential victims.  Many police agencies are using dangerous assessment tools to compile and enumerate the red flags that may be the harbinger of terminal rage and the end of one’s timeline somewhere.

Ronald Allanach et al., Psychological Autopsy of June 13, 2011, Dexter, Maine Domestic Violence Homicides and Suicide: Final Report 39 (Nov. 28, 2011), http://pinetreewatchdog.org/files/2011/12/Dexter-DVH-Psychological-Autopsy-Final-Report-112811-111.pdf.

“Whether or not…

Quote Michael Sefton, Ph.D. Health Psychology, Human Behavior , , , , ,

“Whether or not a student receives support on an education plan has no bearing on the kind of support they might need when they return to school after a concussion” Michael Sefton, Ph.D. Director of Neuropsychology – Whittier Rehabilitation Hospital

Students who return to school following a cerbral concussion often require specialized scheduling, rest breaks, reduced work load, and other individualized support.

Uploading the Rhythms of Life

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

Cardiac monitoring may be an ‘event’ unto itself

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Listening to the fountain in Washington DC

The debate over life and death often focuses on the heart and the brain.  Some believe life ends when the brain ceases all activity – a term called brain death.  Others believe death results when the heart ceases to beat.  In a blog published in January 2014, the mind-body dialogue was discussed by Michael Sefton.  He described the rudimentary force of life as the heart’s beating “which begins and ends with the inimitable squeeze of the cardiac muscle.”  For patients who are being monitored the experience is highly stressful and often evokes fear and dread.

The link between what happens to our body and its effect on our mood and feeling state is well documented.  Just as we must adjust to the early developmental changes of our children so must we adapt our own thinking and lifestyle to the changes brought about by the empty nest.  Events such as having children leave home and head off to college and other events associated with empty nesting require flexibility and adaptation of roles for success.  These important transitions signal an advancing age that sometimes accompanies physical decline in health and body.  With that said it is important to note that many American’s are living healthier lifestyles and thus preserving physical health well into the eighth and ninth decades of life.

“Don’t ever get old”

Retirement was once described as a period of “golden years” and was thought to represent the final stage of one’s life during which the experience of freedom and contentment proffered a whimsical enjoyment of lazy, carefree days.  It meant taking time to share one’s wisdom with those who are younger and pass on the stories of family, culture, and life itself.  This is often not the case and I have had patients suggest that I should never get old.  Retirement is frequently a time of unbearabe loss and despair.

One factor affecting quality of life is the sense of physical well-being.  Retirement sometimes triggers an erosion of physical health and cognitive stamina choking all remaining time with recurring, monotonous doctor’s visits and tests.  In truth, what may be a glorious time is now marred by fear and trepidation about one’s health, financial stability and declining physical longevity.

Poor cardiovascular health is an underlying cause of many chronic disease processes like stroke, diabetes, and auto immune disease.  Heart attack remains among the leading precursors to early death and researchers are racing to uncover treatment options including early identification of those most at risk and life saving surgery to open clogged arteries.  Meanwhile, people should take greater responsibility for their own health by eating better and building exercise into their changing lifestyle.  Things like moderating use of alcohol, 7-9 hours of nightly sleep, and eating plenty of fruits and vegetables become the specter of truth and failure to an ever-growing problem with obesity.  This is an important lesson for young adults to discover but is easier said than done.

The mind-body dialogue is one that matches wits with any great debate.  What are the best methods for identifying ‘problem’ hearts before they reach a penultimate, fibrillating finale?  Some doctors ask their patients to wear special monitoring devices – little boxes attached to the skin that permit the ongoing monitoring of life threatening changes in rhythm.  Patients sometimes wear the monitor for a month or more.  These monitors have the potential to catch irregular heart beats and allow physician’s to see a patient’s electrocardiogram on a minute to minute basis.  The monitor requires that the person wearing the device to upload his data via a telephone line each day sometimes with little to no training.  Each recording represents a cardiac event that the person wearing it is asked to chronicle in terms of action and feeling state when the device is active.  The events are uploaded via telephone land lines in real-time that seems almost tortuous to those bearing the burden of wearing the device.  The rhythms are quickly edited, analyzed and more often than not result in nothing more than a friendly vote of confidence – “you’re all set”.

Event Monitoring

Greater thought and training should be afforded to patient’s wearing event monitors.  As time goes on most patients become accostomed to the vagaries of the heart and the sound it makes – lub dub, lub dub.  The event recordings come in one after another and become part of the month-long survey of heart activity.  Some people call two and three times daily worried that they are having a serious cardiac event.  After 30 days the monitor is turned in for analysis by the cardiologist.  These daily rhythms go on to become the underpinnings of a cardiac care regimen that may offer treatment alternatives that can save a life.  The clinicians go on to new patients and new rhythms and new reports.  But each person who wears a monitor is brought to bear the feelings of their own life force beating in his or her chest sometimes wildly out of control. For those with irregular heart beats it can be 30 days of fear, impending doom, and personal paroxysm that seems to go on forever as skipping beats and palpating rhythms.  And even those with a normal EKG, the fear and worry of not feeling well can be just as agonizing as the beats are uploaded one at a time with not so much as a “job well done” and encouragement to call again tomorrow.

The fundamental appetence for living is shaped by the relationships made during life.  Those relationships that nurture and sustain may extend ones years of viability.  Some believe the force of life is the beating heart.  For without a healthy heart the quality of life may become desultory and life itself may become nothing more than a daily upload of irregular beats on the telephone, in real time.

To read the former blog click on the link below.

https://msefton.wordpress.com/2014/01/17/the-force-of-life-and-the-fears-that-go-along/

“The underpinnings…

Quote Michael Sefton, Ph.D. Active shooter, Dangerousness assessment, Health Psychology, Human Behavior , , ,

“The underpinnings of violence are often present in some form or another and may be represented by marginalized demeanor and extremist views and often ignored by those in the cross hairs” according to Michael Sefton, Director of Psychological Services at Whittier Rehabilitation Hospital in Westborough, MA.

This quote represents a recurring belief about the evolving coping skill of an active shooter until the very end according to M Sefton.  The terminal event is often preceeded by growing fury and red flag signs of anger.  It suggests that greater awareness by outside observers of sudden changes in mental status should be recognized along with the utilization of stopping and containment protocols and coordination of care in or out of the state correctional system.