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.

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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.

 

The common man who left no foot prints

“I’m looking for people to stop fights before they happen and I want people to be more aware of the common man”. Juston Root, 41 – from posted video just one day before his death
Hospital video of BPD officer initial encounter with Juston Root on February 7, 2020
On February 6, 2020 Juston Root posted a few minutes of video in which he espoused a disjointed series of thoughts espousing the importance of being aware of the common man and using friends for support. Was Root speaking about himself, perhaps in need of someone? He died one day later in a frightening series of events that lasted seven chaotic minutes leaving this common man dead. Juston Root had a long history of mental illness. On the day of his death, he was seen at a local hospital in Boston displaying what appeared to be a firearm. Interestingly, his parents reported he liked to carry replica handguns sometimes using a should holster. This bespeaks an attraction to firearms and yet he did not own a real weapon. It is not clear why he chose the hospital district on Longwood to make his initial foray. He was said to have made threatening statements to law enforcement officers who he first encountered. What was said? Did Mr. Root threaten the first BPD officer seen in the video? Did the officer get a look at the weapon shown and could he have been expected to recognize it as a replica? Our training and experience set the stage for this level of acumen. Video of the scene showed Root parked in the middle of traffic wandering in and out of the frame. 4 -way hazard lights activated. Was Root so rule bound that even on his last hurrah he had the provision of thought to set his hazard lights? This seems unlikely for someone in a terminal state of homicidal or suicidal rage. What was his state of mind once shot? At some point shortly after this initial encounter a parking lot valet was shot in the head and critically injured. Mr Root did not shoot the parking attendant but this was not clear amid the next moments of radio traffic. The fact that the attendant was injured by friendly fire simply was not reported and likely, was not clear at this point in the investigation. This set the stage for manhunt that quickly came together looking for someone who had shot a parking lot attendant and pointed a weapon at the police officer. It is at this point that Root made a run for it setting into action an all hands on deck police gauntlet that he had little chance of evading.
“There will always times when police officers encounter those with mental health needs especially in times of crisis. 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
What happened next triggered a chaotic police response that led to his death just minutes after he displayed a handgun aiming it toward a Boston Police Officer. It may have ended right there had the first responding officer rightfully met force with force. The physical reaction of the first officer almost looked as though he was expecting Root’s replica to go “boom”. But he held fire. An officer 20-30 feet further away saw this and fired upon Mr. Root wounding him and hitting someone down range of the incident. Officers are responsible for where the rounds go once they leave their weapon so it is always best they hit an intended target on the range or in the street. It is likely that area police agencies were put on tactical alert. When this happens, adjacent cities and towns clear their call screens and have available units staged at intersections watching for the suspect vehicle. In the end, the weapon he carried was determined to be a replica or toy. In his preamble on February 6, he suggested that people should not call police because they often are not aware of what was happening and 911 calls often result in police “storming in” in an effort to eliminate a threat to the public. Root seemed aware that “a lot of bad things can happen in the name of justice” when people call police in what he says are “fabricated phone calls”. This presentiment may be his experience living with mental illness for decades of his life. Juston Root was known to stop taking prescribed medication aimed at keeping hallucinations and delusions at bay and regulating his mood. The body worn video is chaotic and has been edited. Multiple officers can be heard shouting instructions at Root, a 41-year-old with a long history of mental illness who had brandished a fake gun at an officer earlier in the day. When situations like this occur the adrenaline often drives officers into elevated state of arousal that requires keen environmental awareness to assure actions taken are lawful. The county D.A. in the case has determined that, given the totality of the circumstances, the degree of lethal force directed at Juston Root was lawful. In the moments before he was killed by police gunfire an off duty paramedic made an effort to care for root but was ordered to back away by police. The crash was caught on video tape from the traffic light camera on Route 9 in Brookline. It was sensational and Mr. Root was obviously traveling at a high rate of speed when he crashed. He was attempting to flee. “Moments later, he walks onto the mulched area where Root was shot, approaching an officer standing over an object that appears to be a gun.” Video that is released reveals police officers warning each other about talking openly on tape. Some say there was bravado and even laughter after the threat was gone. ”Is it fake?” the first officer asks. Yes, was the answer and officers at the scene began to understand that Root may have died as a result of officer-assisted suicide. Something no officer ever wants to encounter. Someone so distraught that they put themselves into the line of fire by acting as if they are holding a firearm or other weapon forcing police to use deadly force. It is not clear that this was his intention given the remarks he recorded one day earlier. Mr. Root had grown up with mental illness that was first diagnosed when he was 19-years old. This is quite typical of the major mental illnesses like schizophrenia or bipolar depression that present themselves in late adolescence. The National Alliance on Mental Illness described Schizoaffective disorder as having clinical features of both schizophrenia and major depression. They can be unpredictable and often exhibit signs of hallucinations, delusions, poor impulse control, and suicidal behavior. Among these patients, officer-facilitated suicide would not be unheard of. But Root’s father said he had been stable over the preceding five years although he had a history of carrying fake guns. He was quick to point out that his son often stopped taking his prescribed medication. But in his taped preamble he was not angry and made no threats toward law enforcement. In fact, he indicated that he had friends on the police force although it is likely the friends of whom he speaks were officers he encountered over the years but I am being conjectural. If Mr. Root intended to die by police officer gunfire he may not have activated his hazard lights which can be seen blinking as he staggered away from the wreckage of his Chevrolet Volt. In his video statement he started by saying he had friends on the police force. There was no obvious animosity toward law enforcement. If he had had a genuine firearm and intended to go out in a blaze of glory, he may have made a final stand either at the wreckage of his vehicle or somewhere nearby like behind a tree. That was not the case. Root was trying to get away. No final stand. No “fuck you” to the world. He was down when he was shot and there was a person there to help him who was ordered away. An officer can be heard saying “he is still moving” after the barrage of rounds over 30 in all. Juston Root was mentally cogent enough to activate his 4-way hazard lights after the high speed crash and in video that could be seen when he first entered the Longwood hospital district. Why? A formal psychological autopsy that is transparently guided might find an answer to that question. Hospital Police were on guard and had been victim of a homicide that took place inside the hospital itself in January 2015. Juston Root was here for 41 years living in what he perceived was a dangerous world. He came and grew to have an affinity for law enforcement he left without leaving any foot prints or last words.

Harlem domestic violence homicide calls for transparent psychological autopsy

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

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

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

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

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

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

Police officials said the transit worker, Ubaldo Gomez, shot his sister-in-law and stabbed her in the head with a knife, while his wife reached out for help. When Gomez refused to drop a 12-inch kitchen knife and tried again to stab the man, a police sergeant opened fire, killing him. In the end, there is always at least a single person who knows what is about to happen and often does nothing to stop it. A family member of Gomez suggested “he had some mental issue, something happened. He was always working day and night. He barely slept. He worked.” as quoted in the NY Post. Whether this duplicity and denial stems from cultural beliefs about the supposed “privacy” of DV, society must change the way in which law enforcement manages these cases. The buy-in from police, legislators, judges, probation, and the public-at large needs to be fully endorsed for real change to happen and for safety plans to work. Many states across America are planning to enact “red flag” rules that will remove weapons from individuals with a known history of domestic violence e.g. choking spouse during fight (Sefton, 2019).

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

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

Allanach, RA, Gagan, BF, Loughlin, J, Sefton, MS, (2011). The Psychological Autopsy of the Dexter, Maine Domestic Violence Homicide and Suicide. Presented to the Domestic Violence Review Board, November 11, 2011

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

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

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

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

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

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

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

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

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

Lorna Breen, M.D.

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

NBC News profile of Dr Breen

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

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

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

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

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

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

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

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.

The Field Training Officer: Important things they may not know

Most departments has active field training protocols that recruits must pass after leaving the academy.  This means they ride along with the FTO until they are ready to function independently as LEO’s.  The specific time line for this depends on FTO daily observation reports during the phases of field training.  These begin with close supervision where the trainee does little of the daily work. In the latter phase of training the FTO may pull back and provide intervention only if needed by allowing the trainee to be the lead on all calls.

Officer resilience depends upon solid field training with adequate preparation for tactical encounters, legal and moral dilemmas, and mentoring for long-term physical and mental health.  Michael Sefton, Ph.D. 2018

Law enforcement officers begin their careers with all the piss and vinegar of a first round draft pick.  This needs to be shaped by supervised field training and inevitably will be effected by the calls for service each officer takes during his nightly tour of duty. Much like competitive athletes, law enforcement officers at all levels exhibit “raw” talents, including leadership abilities and the cognitive skills to go along with them.  Moreover, like competitive athletes, these raw abilities have to be honed, refined and advanced through a combination of modeling, coaching and experience in order for the officer to develop the skills needed to improve performance, as well as prepare them for career advancement according to Mike Walker.  This important task falls upon the field training officer (FTO) and is a critical phase in probationary police officer’s development.  “The FTO is a powerful figure in the learning process of behavior among newly minted police officers and it is likely that this process has consequences not only for the trainee but for future generations of police officers” according to Caldero and Crank (2011).  In 1931 the Wickersham Commission found over 80 percent of law enforcement agencies had no formal field training protocols for new officers entering the field of police work described by McCampbell (1987). In 1972, formalized field training protocols were introduced by the San Jose, CA police department that became a national model for post academy probationary field training.

Just before I was promoted to sergeant while working for a law enforcement agency, USCG Vice Admiral John Currier, a friend of mine said to me: “Michael, move up or move out”.  I wasn’t sure what he meant by that but given my 9 years as a patrolman, I started to lobby for a promotion to sergeant.  The agency at which I worked had little turnover in the middle ranks so I was never sure I would get a chance for promotion.

All law enforcement officers should have a career path when they graduate the academy that lays out a career path based on officer interest, career improvement goals, on-going training interests, and agency needs.  Training opportunities offer new officers the chance to gain experience in anything from specialized investigations i.e. sexual assault and child abuse, firearms instructor, domestic violence risk assessment to bike patrol and search and rescue.  Our chief believed strongly in incident command, active shooter response, and emergency medical technician training.  I went on to take the paramedic technician course at a local college in 2011-2012. In many ways my former agency was well ahead of the curve in training opportunities and tactics including use of body worn video cameras, taser training, stop sticks, and individually deployed patrol rifles.  I was encouraged by my chief to participate in a research opportunity I was offered in domestic violence homicide from a case in northern Maine, a community much like the one I served. From this research we introduced a risk assessment instrument developed by  Jacquelyn Campbell.

The chrysalis for me came in August, 2012 when I was appointed by the Select Board to sergeant at the recommendation of my chief.  Before this could occur, I had put in a significant amount of time developing a field training program, domestic violence awareness and lethality assessment protocols, and police-mental health encounter training. I learned the hard way that most police officers do not like working with citizens with mental illness and hate attending training classes on mental health awareness and crisis intervention training. I realized that I needed to become a leader and in order to do so I needed to become better in communicating with the troops and with those up the chain of command. In order to develop leadership I was sent to sergeants school but what I learned was the importance of being a role model for those in training and to teach by doing, teach by example. I also learned that field training is demanding, exhausting work if done with the precision needed to fully socialize the trainee and provide needed modeling while gradually offering greater independence for the trainee.

cropped-images.jpgField training involves months of practicing ‘what if‘ scenarios, learning the ropes of the police service, use of force, and writing reports. Early in the phase of training the tough discretionary decisions faced by a probationary officer are made by the senior training officer based on prior judgement, experience and what is most prudent for the specific incident and conditions on the ground.  “Agencies should thus maintain a greater degree of FTO supervision, not just trainee supervision. Such an effort would go a long way toward improving FTO programming and better informing the needed research base” Getty et al. (2014, pg. 16). Field training is often time limited with special consideration for officers who need additional training in specific skills or personal areas of concern. Some officers are put on career improvement plans and extended field training, when needed, and some probationers are discharged from the agency because of skills or behavior that are not compatible with police work. Law enforcement agencies want active police officers who represent the core beliefs of the agency and individual community needs.

Field training has perhaps the most potential to influence officer behavior because of its proximity to the “real” job according to Getty, Worrall, and Morris (2014).

Probationary officers can be taught the how and when of effecting an arrest but the intangible discretionary education comes from FTO guidance and socialization that takes place during the FTO training period.  Research has revealed that officers’ occupational outlooks and working styles are affected more by their FTOs than formal “book” training, Fielding, 1988.  The selection of who becomes an FTO is not well defined.  In a study at Dallas PD probationary trainees were exposed to multiple FTOs over 4 phases (Getty et al. 2014).  The study revealed a correlation between new officer behavior – in the 24 months after supervision, as measured by citizen complaints and the FTO group to whom they were assigned. It is conceivable that the results in the study may be due to the relative brevity of training at each phase may have stopped short of instilling good habits or extinguishing bad habits in many new police officers. I have worked in agencies where only the sergeants were the FTO’s by virtue of rank and supervisory acumen long before systematic field training programs were introduced.  In Dallas, results showing officer misconduct via high citizen complaints may too have been associated with unprepared FTO’s who were drafted to supervise the trainee and who were not prepared for that role.

“Bad apple” and/or poorly trained FTOs may thus have a harmful influence on their trainees. Getty et al. (2014)

Choosing successful FTO’s is of critical importance for new officer development and for future generations of law enforcement officers. The values espoused by the FTO have enormous impact on the behavior, habits, and professionalism of new police officers. It has been shown that the quality of this training belies post-supervision job behavior and success.  Haberfeld (2013) has offered a supportive assessment of the assessment center approach to FTO selection suggesting there are qualities that may be quantified in the selection process. This may be helpful in the selection of FTO’s who are professionally resilient and emotionally hardy as they lead the new probationary officer into his career. If officers are randomly assigned to provide field training without forewarning or preparation this may staunch career growth in the probationary LEO.  If this becomes the norm then FTO’s may have provide more of what probationary officers need such as correct values, discretionary wisdom, and perhaps less negative socialization that can lead to embitterment, misconduct, and citizen complaints.

At times of high officer stress when high lethality/high acuity calls are taken the probationary LEO is apt to require greater support and guidance from the FTO. It is during these critical incidents that post hoc peer support and defusing may take place.  Training LEO’s should be permitted to openly discuss and express the impressions they experience to calls that may be more violent, and outside of the daily norm for what he or she has been doing.  In doing so, the impact of these high stress exposures may be mitigated and emotional resilience may germinate. The responsibility of FTO’s to reassure and invigorate trainee coping skill and mindful processing of critical incidents cannot be under emphasized.  FTO’s understand that healthy police officers must be permitted to express horror when something is horrible and feel sadness when something leaves a mark. They will become better equipped in the long run if allowed to fully appreciate the emotional impact that calls for service will elicit in them.  The stigma of high reactive emotions from high stress incidents, i.e. homicide or suicide, is reduced when officer share the call narrative and its allow for its normal human response.

Michael Sefton, Ph.D.
2019

REFERENCES
Caldero, M. A., & Crank, J. P. (2011). Police ethics: The corruption of noble cause (3rd ed.). Burlington, MA: Anderson.
Fielding, N. G. (1988). Competence and culture in the police. Sociology, 22, 45-64.
Getty, R, Worrall, J, Morris, R. (2014) How Far From the Tree Does the Apple Fall? Field Training Officers, Their Trainees, and Allegations of Misconduct. Crime and Delinquency, DOI: 10.1177/0011128714545829, 1-19.
Haberfeld, M. R. (2013). Critical issues in police training (3rd ed.). Upper Saddle River, NJ: Pearson.
McCambell, M. Field Training for Police Officers: The State of the Art (1987). DOJ: NIJ, April.

Police officer vulnerability previously ignored, hidden from plain site

What is currently understood as repeated exposure to trauma and its emotional impact was once thought to be a testament to toughness invoking the specter of a wall of silence. Law enforcement and first responder suicide has increased over the past several years and now exceeds the number of LEO’s killed in the line of duty. Why are cops choosing to take their lives? This is especially felt in Chicago where seven officers have taken their own lives in the last 8 months. In more than one case an officer committed suicide in the police vehicle or in the police department parking lot.

My colleague Dr. Leo Polizoti, Police Consulting Psychologist at the Direct Decision Institute, Inc. has been active in law enforcement training, fitness, and prescreening for over 40 years. He served over 30 agencies across New England and provides supportive psychotherapy as needed.

Dr Polizoti and I were recently involved in a symposium on Police Suicide in Chicago sponsored by Daninger Solutions from Daytona Beach, Florida. Among the presenters were Dr Thomas Joiner from the University of Miami, recognized expert in suicide, police sergeant Mark Debona from Orlando, Florida and Dr Daniel Hollar, Chairman in department of Behavior Science at Berthune-Cookman University in Tallahassee, Florida and CEO at Daninger Solutions.

There are many reasons why police officers have an increased levels of depression and stress.  Most are associated with repeated exposure to traumatic events like exposure to dead bodies, violence, childhood injury or death, terrorism, fatal car crashes, and more.  Most officers are able to remain professionally hearty when provided the opportunity to defuse the exposure soon after an incident. Career performance should include reducing officer depression and embitterment by building resilience starting in the academy and lasting throughout an LEO’s career.

The Mind-Body connection is well established and the role of stress in LEO career well-being is becoming a agency focus beginning in the academy.

“Not only must we as negotiators learn to take care of ourselves emotionally and physically – we must also be prepared to intervene with an actively suicidal officer. “

Dave DeMarco FOX News Kansas City

Is it any wonder officers lose hope and resilience.  There are inherent risks that LEO’s assume when they sign on like forced overtime, changing shifts, off-duty court appearances, the chance they may become injured, disabled or killed while serving the community.  There are also systemic stressors like supervisory bullying, professional jealousy, lack of opportunity to have an impact on policy, career stagnation, and paramilitary chain of command that often devalues education and innovation.  Agencies are beginning to track exposure to trauma and its correlated change police officer resilience in real time.

In Worcester, Massachusetts, LEO’s are required to attend defusing sessions following high lethality/high acuity exposure.  These sessions are kept private from members of the command staff and records are saved by the police consulting psychologist. The department has nearly 500 officers who are paid for their participation when they attend. It has been proposed that officers undergo annual “wellness checks” as a routine in some agencies such as KCMO. I have proposed a system of tracking officer call acuity and invoking mandated behavioral health assessment after a specified number of high acuity/high lethality calls for service. This is one way of reducing the stigma that officers face when they are sent for “fitness” evaluation or any sort of behavioral health care. The stigma associated with mental health may be reduced by having specified referrals following identified high profile incidents. Officers may be considered to be getting peak performance training at these defusing sessions as they are designed for enhancing officer awareness and reducing the human stress response.

Now, the KCMO department has mandated yearly wellness exams for officers in certain units like homicide and those dealing with child abuse. This was initiated to decrease the impact of traumatic events on police officer well-being. Officers at KCMO can also get up to six free anonymous visits to a mental health clinician each year, and the department has a peer support team.  Mental health clinicians must have experience working with law enforcement officers for best results.  Training for clinicians should be provided to best work with LEO’s and first responders. This is especially true for officers who self-refer.  Clinical hours should be supervised by the police consulting psychologist.

Police Stress Intervention Continuum: An introduction for LEO’s and command staff to reduce officer suicide

Scope of the Problem: Police Suicide and the goal to eliminate it
Police job-related stress is well-identified and reported in the media daily and the rates of suicide nationwide are being debated by Aamodt and Stalnaker. They are actually less than one is led to believe but even one law enforcement officer suicide is too much.
Stress is defined as any situation that negatively impacts an officer’s well-being. The rate of suicide and divorce among law enforcement is approximately the same or lower than the general public according to a meta- analysis conducted by Professor Michael Aamodt.  But there are areas in the country and agencies that have higher rates of self-inflicted death.
When the suicide rate of police officers (18.1) is compared with the 21.89 rate for a comparable demographic population, it appears that police officers have a lower rate of suicide than the population according to Aamodt, 2008.
Incidence of suicide tend to be elevated in cities like Chicago, where chronic gun violence and a murder rate in the hundreds per year means cops see a staggering amount of trauma and may gradually become numb to the exposure of pain and suffering (Joyner, 2009). A Department of Justice report found that the suicide rate in the Chicago Police Department is 60 percent higher than the national average.  According to the Chicago Sun Times, in a note to department members Wednesday, CPD Supt. Eddie Johnson said, “Death by suicide is clearly a problem in Law Enforcement and in the Chicago Police Department. We all have our breaking points, a time of weakness where we feel as if there is no way out, no alternative. But it does not have to end that way. You are NOT alone. Death by suicide is a problem that we can eliminate together” CST September 12, 2018.  Chicago PD is not alone with the problem of suicide among its men and women in blue.
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.
According to Hartley, et.al., 2007, “repeated exposures to acute work stressors (e.g., violent criminal acts, sad and disturbing situations, and physically demanding responses), in addition to contending with negative life events (e.g., divorce, serious family or personal illness, and financial difficulties), can affect both the psychological and physiological well-being of the LEO population.” When these officers are identified there needs to be a planned response using a peer support infrastructure that provides for a continuum of service depending upon the individual needs of the LEO and the supports available. In many agencies, especially smaller departments lacking resources, officers’ languish and sometimes spiral downward without support and without somewhere to turn.  Police officers must have support available to them long before they are expressing suicidal urges.
As programs are identified and service continuum grows the risk of peer conflict over perceived betrayal of trust must be addressed. This must be addressed in the peer support training with emphasis on preservation of life over maintenance of confidentiality or the status quo of abject silence. “In itself, it’s a product of centuries of police culture in which perceived weakness is stigmatized. Cops know their brothers have their back, no matter what, but they still don’t want to be seen as the one who’s vulnerable.” according to a recent Men’s Health article written by Jack Crosbie in a report about suicide in the NYPD published during Mental Health Awareness month in May 2018.
The argument is made that the recurring uncertainty of police calls for service often leave LEO’s with low-level exposure to trauma of varying degrees. It is common that LEO’s move from one violent call to the next without time to decompress and process what they have seen.  The repeated exposure to trauma can slowly whittle away LEO resilience – defined as the capacity to bounce back from adversity. In a national media study published by Aamodt and Stalnaker, legal problems were a major reason for the law enforcement suicides yet no other study separately cited legal problems. In another study, relationship problems accounted for the highest percentage of suicides at 26.6% (relationship problems plus murder/suicide), followed by legal problems at 14.8%. In nearly a third of the suicides, no reason was known for LEO suicide.
Police suicide has been on the radar of advocates of LEO peer support for months or years.  The incidence of suicide has remained stable across the country but some agencies have higher rates of suicide.  Smaller departments – those with less than 50 officers in general have the highest rates of suicide.  This may be linked to the lack of availability of peer support programs and a paucity of local practitioners to provide professional service with knowledge in police psychology. “While police officers may adapt to the negative effects of chronic stress, acute traumatic incidents necessitate specialized mental health treatment for police officers (Patterson, 2001)”.  A referral to the department EAP often falls flat and makes it more difficult to make the hand-off when peer support is not enough.
Real-time model of change
The use of force continuum is well described in the LEO literature and ongoing criminal justice narrative. What does that have to do with stress intervention in police officers? It sets the tone for officer behavior whenever they meet potential resistance and or increased aggression during citizen encounters. It may also be used for initiating peer support needs whenever an incident use of force has occurred.  LEO’s change the force response based on the situation they encounter in real-time in a flexible and fluid manner. In this same way, peer support programs can flexibly shift to the needs of a presenting LEO and intervene early on – rather than when an officer is at a breaking point. “This continuum (use of force) has many levels, and officers are instructed to respond with a level of force appropriate to the situation at hand, acknowledging that the officer may move from one point on the continuum to another in a matter of seconds.” NIJ publication.  Peer support too, must accommodate a law enforcement officer in real-time to begin the process of building a healthy, resilient response to sometimes horrific exposures and provide a continuum of unbiased employee assistance and when necessary professional consultation.
Protective Factors begin in Academy training
What topics should addressed while LEO recruits are in training?  Ostensibly, the resilience of LEO’s depends upon the opportunity for in-service training in topics of mindfulness, stress management, physical health maintenance, nutrition, and trust.
“Emotional resilience is defined as the capacity to integrate the breadth of police training and experience with healthy, adaptive coping, optimism, mental flexibility and healthy resolution of the traumatic events. In general, resilient people are self-reliant and have positive role models from whom they have learned to handle the stressful events all police officers encounter” according to Leo Polizotti, Ph.D. a police consulting psychologist (Sefton 2018).
Police programs for health maintenance
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The Police Stress Intervention Continuum or P-SIC, involves a system of police support that varies in its intensity depending upon the continuum of individual needs of the LEO including physical debility or other significant components impacting career success and satisfaction. The intervention protocol is flexible and fluid as well. The entry point into the peer support continuum initiates from supervisory observations of LEO history and behavior, peer recommendations, and exposure to a range of traumatic events.

 

Generally speaking, a police officer’s behavior change is a function of the resilience they develop throughout their careers. Greater attention to physical health and emotional well-being are now being espoused in police academies across the country.   Greater awareness of the correlation with the recent trauma and frequency of exposure to trauma such as the death of a child, exposure to dead bodies, suicide of a colleague, etc. have negative impact on officer well-being.  Perceived support from supervisors and the organization hierarchy builds resilience.

Career success requires that officers learn stress tolerance and healthy habits to manage the daily challenges of police service. Physical exercise and healthy routines often afford the stressed officer an outlet for reduced risk of stress-related physical afflictions in addition to the emotional and health effects of repeated exposure to unpredictable violence.

The cumulative stress associated with a career in law enforcement cannot be understated.  In the setting of police stress and stress support there is an intervention protocol that relates to the peer-support program continuum.  Depending on where officers enter the peer support network will impact the level of intervention they may require in the P-SIC program.  Peer support is not psychotherapy but officers occasionally must hand off the officer in trouble to a  higher level of care.  These hand-offs are key to linking at-risk LEO’s with range of professional support needed to keep them on the job. Yet fear of reprisal for acknowledging the cumulative impact of stress and its impact often derails the hand-off to the professional. The highest risk for suicide to a LEO is when he is denuded of badge and gun because he may be a threat to himself.
The career success they have may be directly related to the application of resiliency training to build and maintain physical and emotional hardiness that lasts a lifetime according to Leo Polizoti, 2018. Before this can happen the stigma associated with reaching out must be reduced.

Points of entry to Peer Support – Stress Intervention Continuum
copyright Michael Sefton
  • Exposure to highly stressful events in close sequence
  • Change in work assignment, district/station, deployment undercover or return from deployment
  • Increased absenteeism – over use of sick leave
  • Increased use/abuse of substances – impacting job functioning, on-the-job injury
  • Community – citizen complaint(s) for verbal abuse, dereliction of duty, vehicle crash
  • Citizen complaints of excessive force during arrest, supervisory or peer conflict, or direct insubordination.
  • Abuse of power using baton, taser or firearm, recurrent officer involved use of force. Officers are sometimes strongly embittered and angry at this point in their career due to perceived lack of support and powerful feelings career disappointment and alienation.

NIJ Publication (2009). Use of Force Continuum. https://www.nij.gov/topics/law-enforcement/officer-safety/use-of-force/Pages/continuum.aspx. Taken November 17, 2018
Aamodt, M. G., & Stalnaker, N. A. (2001). Police officer suicide: Frequency and officer profiles. In Shehan, D. C, & Warren, J. I. (Eds.) Suicide and Law Enforcement. Washington, D.C.: Federal Bureau of Investigation.
Aamodt, M. (2008). Reducing Misconceptions and False Beliefs in Police and Criminal Psychology. Criminal Justice and Behavior 2008; 35; 1231 DOI: 10.1177/0093854808321527.
Patterson, G T. (200l). Reconceptualizing traumatic incidents experienced by law enforcement personnel. The Australian Journal of Disaster and Trauma Studies, 2.
Joyner, T. (2009) The Interpersonal-Psychological Theory of Suicidal Behavior: Current Empirical Status. Science Briefs, American Psychological Association, June.
Sefton, M. (2018). Police Training: Revisiting Resilience Blog post: https://msefton.wordpress.com/2018/07/27/police-training-revisiting-resilience/. Taken November 18, 2018
Hartley, T., et.al.(2007). Associations Between Major Life Events, Traumatic Incidents, and Depression Among Buffalo Police Officers. International Journal of Emergency Mental Health, Vol. 9, No. 1, pp.
John M. Violanti, Anna Mnatsakanova, Tara A. Hartley, Michael E. Andrew, Cecil M. Burchfiel. (2012). Police Suicide in Small Departments: A comparative analysis. Int J Emerg Ment Health. Published in final edited form as: Int J Emerg Ment Health. 2012; 14(3): 157–162.

Being Alone and feeling well: Say goodbye to loneliness

There is much to be said about all the good that comes from being alone. Aloneness and loneliness are completely different. Aloneness is a feeling of aliveness and emotional freedom. It is a positive and emotionally energizing place.  It’s not the mere concept of being by oneself that defines being alone more the understanding that being alone requires both self-reliance and emotional sustainability.  People who enjoy being alone have higher self-esteem and emotional maturity.  There is a significant difference between being alone and being lonely.

Loneliness refers to feelings of being incomplete and sometimes empty.  You can be surrounded by people and still experience feelings of loneliness and the range of emotions associated with insecurity, dependence and unmet needs. Some people feeling that without another person or companion that there is something wrong and missing in their lives. Loneliness is a negative emotion that quietly robs self-esteem and can errode one’s capacity to feel complete and connected to others. Lawrence Wilson suggests that loneliness may actually be a driving force that helps people look for connection in others to fulfill emotional need (2011). Wilson asserts that loneliness may be seen as a state of suffering over loss of connection or long felt abandonment. The difference between the two feeling states is important. Aloneness is a pleasant feeling whereas loneliness is unpleasant and can lead to chronic isolation and sadness. Aloneness can bring about creative energy while loneliness brings about brooding rumination.

Think about what that means. The two concepts are almost opposing emotions yet most of us are them as synonymous. Too many people either fear being alone or depend on others to complete them by making the whole. There was an old adage that we come into this world alone and so we go out.  Emotional grown and emotional development require being alone and not total dependence on another person to feel complete or whole.

The Elevated Stress Response: Selling when Nobody’s Buying

I am preparing for an upcoming presentation at the annual Society of Police and Criminal Psychologists in Sarasota, Florida held in early October each year.  So far I have offered several police departments an opportunity for free in-service training in the area of risk assessment and domestic violence.  No interest.  I can even say that one of the chiefs I approached is a friend of mine and still there was no interest in hearing about updated issues in domestic violence and the risk associated with intimate partner abuse. This has been both a surprise – given my passion about the topic and self-ascribed expertise, but also because it brings up great anxiety when I think about the expectation for my presentation at a national conference consisting of my peers.  This post is all about how to deal with the flood of anxiety associated with presenting one’s ideas to an audience that may not be interested in what I am selling.
“If we perceive our available resources to be insufficient, along comes the ‘threat’ mindset. When threatened, stress has a catastrophic effect on our ability to perform. We receive an enormous sympathetic surge (adrenaline/noradrenaline dump), and our HPA axis pumps out cortisol. High cortisol levels have a very detrimental effect on higher cognitive processes – decision-making and prioritization” or triage as described in a blog written by Robert Lloyd and physician in the U.K.
Lloyd goes on to say “that breathing is the only autonomic process that we can consciously control (other than blinking – less useful). By doing so, we access the ‘steering wheel’ of our sympathetic nervous system, and can regain a feeling of self-control in a moment of extreme stress. Heart rate and blood pressure come down when practiced. The process of deliberately controlling ones breath in the midst of a stressful moment that is key to lowered autonomic overdrive and greater physiologic homeostasis.  Mindfulness and reslience training converts a ‘threat’ to a ‘challenge’ mindset by building resilience to a controlled stressful stimulus.” It arms you with prophylaxis against condition black when the organism is fighting for its life.
   Stress has undeniable impact on all human functioning and public health. Not enough is being done to infuse knowledge and understanding into the emotional maelstrom created by chronic stress (Sefton, 2014).  Healthy coping and productivity breaks down when uncontrolled stress occurs over and over. According to Leo Polizoti, Ph.D., the primary author of the Police Chief’s Guide to Mental Illness and Mental Health Emergencies stress can lead to a breakdown in adaptive coping. “Learned resilience can be taught and leads to reduced stress and psychological hardiness rather than psychological weariness. Psychological weariness is a drain on LEO coping and adaptation to job-related stress and the efficiency for handling everyday calls for service. As the demand for police service becomes more complex, officers must adapt their physical and emotional preparation for service or risk premature career burnout” according to Polizoti. Resilience and career satisfaction are important components of law enforcement and individual officer training, behavior and longevity. Positive resilience will reduce officer burnout.
In its absence police officers and their agencies are at greater risk for conflict both internally and with the general public in the form of civilian complaints of police officer misconduct.
So in anticipation of my own decrease in internal homeostasis and elevated production of stress hormones, I will breath and adjust my thinking for a positive outcome and not be hurt by the buyer beware myth my topic may evoke. I will take a few moments to relax and breath slowly in anticipation of the quiescence it will bring and my belief in learned resilience.