The day started normally enough with a ceremony for children who had made the honor roll. The parents of these children had no idea that the ceremony would be the last bright moments of their young child’s life. Shortly after the end of the honor roll ceremony the proud 4th graders went back to their classrooms. When a few minutes later, the school was breached by a former student of a different variety. At 11:28 AM, Salvador Ramos entered the Robb elementary school through an open door. The 911 system had been activated. Law enforcement was in the building and took fire. Only months earlier, they had trained for this and learned they must quickly engage the shooter.For his part, Salvador Ramos would receive no awards on this day. He was no longer a student; he was a hunter. By all rights his rampage may have been cut short by an hour or so, had law enforcement brought the tip of the spear to him as shots first rang out. We know this from Columbine. His day would end in blackness, just like the front page of the Uvalde Leader-News.
The tactical training instructs officers to move to contact and bring the fight to the sound of the guns even when you must step around or over victims. In the Pulse Nightclub massacre in Orlando, FL, Sergeant Mark DeBona led a team of officers after a power outage darkened the club. He told us that had to ignore victims pleading for their lives as this small group of sheriff’s deputies chased the shooter in pitch darkness into a men’s room and neutralized the threat. We were taught that as few as three officers could bring an end to an active shooter incident by quickly entering a building and moving to the sound of the shooting and neutralizing the threat.
We knew from Columbine, that the longer we waited the more children, teachers, and staff would be lost. There was no way a swat team could deploy in the time needed to move into the school and find the bad guy and put an end to the killing. We trained in neighboring schools too, so we might be familiar with the maze of corridors common in most school buildings for a time when we may become the tip of the spear. Our chief in New Braintree, MA vowed that he would drive his cruiser through the front doors of the school if needed, to gain immediate access in order to save lives. He believed this would cause a significant distraction to the gunman allowing the assault team to catch up. The New Braintree elementary school was much like the school in Uvalde with many doors and easy access to classrooms.
Much of the aftermath scrutiny will catalog social media red flags that may have informed law enforcement of his embittered beliefs. The psychological autopsy will chronicle the facts of Ramos’ final weeks. Information about his state of mind will slowly emerge and the roadmap of his disaffected early beginning. No one knows how long Ramos may have been emotionally percolating when he purchased 2 high powered rifles after turning 18 in March. His mother, Adriana Martinez said he was angry for failing to graduate high school with his fellow classmates Friday, adding that “he was not a monster.” In an NBC News interview, Adriana Martinez’ boyfriend, Juan Alvarez, said that Ramos went to live with his grandmother after a fight with his mom over Wi-Fi. He said the relationship between Ramos and his mother was tumultuous and that the two often fought.” Since the pandemic quarantine Ramos’ mother described him as mean and police had been to the home more than once. His closest friend said that Ramos was bullied in middle school because of a stutter years later after posting a photo of himself wearing black eye liner. He grew distant from friends and sometimes used a BB gun to shoot people while driving around with friends. He had an online presence where his beliefs were broadcast and played violent video games with friends like Tour of Duty. These psychological underpinnings will be studied for years to come.
May 24, 2022 will forever be remembered as among the darkest in Texas history. It was an abject failure among contemporary law enforcement tactics and protocols for active school shooting. On this day, the wolf was camouflaged in sheep’s clothing, lurked on the periphery until he spoke, moving in, telling children “you are going to die”. The wolf gained access without so much as a growl from any sheep dog guarding the flock. And then he took 21 for his last supper, leaving the flock depleted of its young. Then Uvalde went into the darkness trying to understand what had happened “.
Above is the front page from the 5-26-22 Uvalde Leader-News that shows all that was left. Or perhaps, the sheep are forever in hiding in the darkness.
ADDENDUM on 7-17-2022: According to the report released 7-17-2002, 376 law enforcement officers massed at the school. The overwhelming majority of those who responded were federal and state law enforcement. That included nearly 150 U.S. Border Patrol agents and 91 state police officials.
The neurobiology of burnout starts with high levels of stress hormones coupled with perceived lack of efficacy and fatigue
Stress is well-known to the medical community and is treated with lifestyle adaptation and management of symptoms and disease. Once stress becomes too intense, it has a measurable impact on one’s own health. I have posted blogs about a variety of stressful circumstances, some are associated with personal behavior and lifestyle choice; others are more in line with exposure to traumatic, stressful events experienced by first responders like members of law enforcement or front line healthcare providers.
As well as impacting professional growth, research suggests that extreme stress levels can impair social skills, overwhelm cognitive ability, and eventually lead to changes in brain functioning. People who under constant stress pay a price in being unable to fully relax. They report feeling under constant threat from forces beyond their control and being stuck running in place. “In a recent study, job satisfaction, overall there were little differences between groups in ratings after a mindfulness program. The study looked at the impact on job satisfaction among members of a university faculty using weekly mindfulness meetings. Among those who participated, there was a significant link between feeling calm and relaxed, and greater workplace wellbeing, with those reporting less stress and anxiety also noting higher levels of job satisfaction according to Dr. B. Grace Bullock reporting on an Australian study in efficacy of mindfulness training.
Burnout can leave people exhausted, unmotivated, anxious and cynical – the consequences of which can be catastrophic to business and front line workers across all sectors of society. This is especially true among healthcare workers, where the stigma associated with mental illness still enables silence among those most in need. It is the real deal and probably underlies the recent exodus of nurses, doctors, police officers, and other front line professionals who have had enough and are moving on from their jobs. At our rehabilitation hospital more and more staff nurses are opting for a shorter commute by changing jobs. Some are leaving to become stay-at-home mothers after 18 months of fighting the fight with the virus, all the while their children were home in quarantine – going to school on their laptop computers.
“In a recent study, job satisfaction, overall there were little differences between groups in ratings after a mindfulness program but there was a significant link between feeling calm and relaxed, and greater workplace wellbeing, with those reporting less stress and anxiety also noting higher levels of job satisfaction.
B. Grace Bullock 2017
Stress tends to create significant reactivity within the body. This brings forth rampant chemical flooding by the adrenal cortex and other stress hormones. These chemicals can add to a decline in physical well-being. These over active hormones are lethal for the medically infirm and physically vulnerable. Yet, for some people, stress is like a drug and creates a circular pattern of sensation seeking as described in the prototypic type A personality.
The neurobiology of stress and PTSD is being studied and may be linked to primitive brain circuits involved in the fear conditioning response and its eventual, sometimes refractory extinction or habituation of on-going perceived threat (Do Monte, Quirk, Li, and Penzo 2016). As an example, Police work carries with it a neurobiological underpinning that is well documented in terms of the impact of repeated stress and exposure to traumatic events. Chronic exposure to traumatic scenes and a host of other factors gradually elevate the hypothalamus-pituitary-adrenal (HPA) axis in the brain and body of typical career LEO’s. “The human brain, having evolved to seek safety in numbers, registers loneliness as a threat” as reported in a recent NY Times piece.
Stress effects all aspects of how we feel. Most physicians know that mindfulness techniques lower subjective levels of stress. However, even though paced breathing puts the brakes on sympathetic overdrive, people do not use it long enough to create habits. “Meditating”, according to Dr. Woolery-Lloyd, initiates “the relaxation response,” which activates the body’s parasympathetic nervous system and decreases cortisol and inflammation.” Yet even our primary care physicians and physicians in emergency rooms across the country are at risk from frontline stress, burnout and area at higher risk of suicide. This taken from a story written by Jessica Defino about the impact of stress on human skin in NY Times on 12/08/2020. The point being that the stress response is pervasive in human functioning and can wreak havoc on physical health including the integumentary system – our largest organ – our skin.
“Why don’t we come up with a program before bad things happen?” asked Dr. Englert. “Bad things are going to happen. When they do, the person, the individual, and their family will be more resilient, more able to recover quickly from that event.” said Alexa Liacko, ABC News interview. It is in being vulnerable that we are able to stretch our emotional experience that brings forth growth and reduces stigma. You cannot expect frontline healthcare and first responders to walk through water and not get wet.
Lloyd, C et al. (2002) Journal of Mental Health 11, 3, 255–265
This video is about an introduction to a post that will be forthcoming in a short while it is reference to law enforcement officers and the suicide death of officers who carry trauma.
The NYPD is making use of psychological autopsies, a research-based approach that attempts to better understand why someone took his or her life.
The fight/flight mechanism that keeps us on guard plays a primary role on how people feel after episodes of high stress. Feelings of frustration, lack of focus, chronic fatigue, and even depression can result from an over reliance social media stimuli like an unfed addiction.
Officers often walk alone when exposure to trauma whittles away their resilience
Two Capitol police officers have taken their own lives since the insurrection at the U.S. Capitol on January 6, 2021. This information came after the two officers spent 5 hours fighting the insurrectionists sometimes in hand to hand combat often being humiliated and threatened. Jeffrey Smith, a Metropolitan D.C. Police officer, and Capitol Police Officer Howard Liebengood both “took their own lives in the aftermath of that battle” of January 6, according to an article in Politico on January 27, 2021. A third officer, Brian Sicknick, age 42 collapsed while on duty the day of the attack. He died in the aftermath of the insurrection a day or two later.
The manner of his death has been determined to be natural causes. Officer Sicknick died from multiple strokes according to the medical autopsy. Some reported seeing Officer Sicknick being struck in the head with a fire extinguisher during the riot. The official cause of death was stroke – or cerebral vascular attack and it is well-known that high stress situations can lead to stroke such as an insurrection or even shoveling one’s drive following a snow. Sicknick was only 42 years old and in good health prior to the Capitol attack. Officer Sicknick was afforded the honor of laying in honor in the Capitol Rotunda after death. Antoon Leenaars, past president of the American Association of Suicidology, described the patterns of thinking among depressed or suicidal persons, and explained how the use of “psychological autopsies” can uncover the key elements that are present in many suicides. This is an important first step in the battle to change officer suicide to become more attributed to line of duty death. This determination is owed to many of these brave men and women who died as a result of the recurring emotional trauma to which they were exposed.
“Jeffrey Smith was still fighting to defend the building when a metal pole thrown by rioters struck his helmet and face shield. After working into the night, he visited the police medical clinic, was put on sick leave and, according to his wife, was sent home with pain medication. Smith returned to the police clinic for a follow-up appointment Jan. 14 and was ordered back to work, a decision his wife now questions. After a sleepless night, he set off the next afternoon for an overnight shift, taking the ham-and-turkey sandwiches, trail mix and cookies Erin had packed. On his way to the District, Smith shot himself in the head.
Smith’s wife Erin reported after her husband took his own life
“On April 2, 2019, PERF and the New York City Police Department took an important step to elevate the national conversation on police suicide and to identify concrete actions that agencies can take to address this public health and public safety crisis. Our two organizations hosted a one-day conference at NYPD headquarters that brought together more than 300 law enforcement professionals, police labor leaders, researchers, mental health care and other service providers, policymakers, and others—including three brave officers who themselves have dealt with depression, PTSD, and suicidal thoughts in the past and who were willing to tell us their stories” according to published executory summary 2019. “The NYPD is making use of psychological autopsies, a research-based approach that attempts to better understand why someone took his or her life. Following an officer suicide, personnel try to reconstruct what was going on in the person’s mind by systematically asking a set of questions, in a consistent format, to the people with the greatest insights into the person’s life and mind—family, co-workers, and friends.” The psychological autopsies contribute to the existing database of information about law enforcement suicide in general, and they help guide individual prevention programs and establish in the line of duty rewards for those whose death’s may be directly associated with their recent tours of duty as in the example of the Capitol officers who died immediately following the trauma of the insurrection where each of them was prepared to die.
The multiple deaths by suicide have renewed attention on another troubling and often hidden issue: Police officers die by their own hands at rates greater than people in other occupations, according to a report compiled by the Police Executive Research Forum (PERF) in 2019, after at least nine New York City police officers died by suicide that year. I was involved in the April 2019 presentation at 1 Police Plaza on the impact of LEO suicide as it related to the high incidence of police officer death by suicide. Police Commissioner James O’Neill gave an impassioned presentation imploring officers to get help and promising to “listen and eliminate stigma” of having trauma-related illness.
Regrettably, first responder suicide is generally not considered a line of duty death and as such, fails to yield the honor given to officers who die in car crashes, shoot outs, or other direct line of duty incidents. “Now, the surviving families of the courageous defenders of democracy, Jeffrey Smith and Howard Liebengood — who were buried in private ceremonies, want the deaths of their loved ones recognized as “line of duty” deaths”. These deaths lack the honor and pageantry that accompanied Sicknick’s memorial service in the Capitol Rotunda — Why is the distinction made between the many ways LEO’s die?
The denial of this recognition diminishes the honor of one man’s service and by doing so, fails every man or woman who puts on a uniform by saying “your experience is yours alone”. And even worse, it amplifies the stigma attached to law enforcement deaths at a time when all else has failed them.
Michael Sefton, Ph.D. 2022
The careful analysis of antimortem exposure and actionable behavior that follows and event like January 6 or September 11 draw the clear, indisputable facts that link officer suicide to line of duty traumatic exposure. The denial of this recognition diminishes the honor of one man’s service and by doing so, fails every man or woman who puts on a uniform by saying “your experience is yours alone”. And even worse, it amplifies the stigma attached to law enforcement deaths at a time when all else has failed them. I cannot stand by this exception to what may be obvious line of duty exposure and police officer death especially after 9-11 and after the Capitol insurrection. But it should in no way minimize the loss of life attributed to suicide when years of exposure have gone unnoticed and even unreported by a law enforcement officer.
After the September 11, 2001 attack on the World Trade Towers there was an increase in LEO suicide. Men and women who witnessed the enormity of the attack coupled with the deaths of hundreds of police officers and fire fighters lost the will to grudge onward by no fault of failure character of their own. They swam in the muck and got wet and could not recover from darkness that engulfed them. The psychological autopsy would quantify these wounds just as the pathologist counts entry and exit wounds from an ambush.
The juxtaposition of these facts cannot be ignored. Every one of the hundreds of police officers put their lives on the line as a result of the former president’s truculent narcissism. It would be a dishonor to the men who gave their lives by denying the causal underpinning of their deaths. Suicide by law enforcement officers exceeds the number of officers who die in in gun fights, car accidents, on-duty heart attacks, attacks by citizens, calls for domestic violence, and other police calls for service. “This fact thrust these most private of acts into the national spotlight and made clear that the pain of the insurrection of January 6 continued long after the day’s events had concluded, its impact reverberating through the lives removed from the Capitol grounds” as written in a recent Washington Post report. “It is time the District recognized that some of the greatest risks police officers face lead to silent injuries,” Weber said. “Why do we say that one person is honored and another person is forgotten? They all faced the exact same circumstances.” according to a report in the Washington Post by Peter Hermann in February 2021.
There are things that must be done when law enforcement officers die as a direct result of the the calls they take and the trauma they experience that directly results in their death. Neither of these officers would have died if they had not jumped into the crisis taking place at the U.S. Capitol. Both men were solid members of the Capitol and Metropolitan Police Departments and had no history of behavioral health claims. Neither officer was in trouble with finances, gambling or substance abuse, internal affair investigation, or marital trouble. In the days that followed, Erin said, her husband, Capitol officer Jeffery Smith seemed in constant pain, unable to turn his head. He did not leave the house, even to walk their dog. He refused to talk to other people or watch television. She sometimes woke during the night to find him sitting up in bed or pacing. Her husband was found in his crashed Ford Mustang with a self-inflicted gun shot wound that occurred on his way to the job.
Peter Hermann Washington Post 2-12-2021
Rioters swarmed, battering the officers with metal pipes peeled from scaffolding and a pole with an American flag attached, police said. Officers were struck with stun guns. Many officers were heard screaming into their radios “code-33” the signal for “officer needs help”. This usually is a signal bringing an “all hands” response to the scene of the emergency – in Metro DC, that would mean hundreds of officers would roll. Situations like this send chills down the spine of officers responding to calls for help – some are injured in car crashes racing to back-up officers in danger. It is always hoped that when the call for help goes out as it did that day that enough manpower will respond with enough force to push back on the crowd, however large. In this case, the crowd far exceeded the number of LEO’s available for duty and many officers expected to be killed by the mob.
The psychological autopsy is a single case study of a death event that serves to uncover the psychological causes of death. This study would answer these questions and establish an understanding of worst case scenario of frontline exposure to trauma and possibly offer insight into underlying history that may have been anticipated and stopped. Without its use men and women die alone and often flooded with shame and loss of dignity. When law enforcement officers take their own lives this careful analysis of the hours and days preceding their time of death is essential to understand. “From this information an assessment is made of the suicide victim’s mental and physical health, personality, experience of social adversity and social integration. The aim is to produce as full and accurate a picture of the deceased as possible with a view to understanding why they killed themselves.This would answer the question as to whether or not the deaths may be considered to be line of duty, as they must. Psychological autopsy is probably the most direct technique currently available for determining the relationship between particular risk factors and suicide” Hawton et al. 1998
The evidence on Crisis Intervention Team (CIT) programs is thin, in part because these programs vary widely, with some representing basic officer awareness training and others composed of full-fledged and well-funded co-responder programs. However, the evidence on the impact of de-escalation training, which includes instructing police in how to identify and respond to people in crisis, is relatively strong.
I have proposed a Behavioral Health initiative in conjunction with changes in police policy and transparency that has been the central posit of social clamor since the death of George Floyd this summer. The International Association of Chief’s of Police (IACP) has a broad-based Mental Wellness program it is reporting on its website that highlights the importance of this kind of support. “The IACP, in partnership with the University of Pennsylvania (Penn) and the Bureau of Justice Assistance (BJA)’s VALOR Initiative, is customizing a program specifically designed to help officers and agencies by enhancing resilience skills. The cost of such a program will reap rewards in the form of career longevity, officer well-being, officer morale, quality of community policing, and greater faith and trust in law enforcement in general. Without psychological autopsy systemic failures in training and support often go unnoticed leaving men and women without a life saver to hold on to.
This investigation is an individually designed case study that elicits a broad range of factual data regarding the antemortem behavior of a decedent in the immediate day or days leading up to the suicide. In this case, what are the events that transpired in the days before the two Capitol police officers took their own lives? The fact is that both men were exposed to incidents and participated in protecting the Capitol on January 6, 2021. Both men were engaged in hand to hand combat. It is known that the insurrection resulted in the death of a fellow officer and the deaths of 4 other people engaged in violent mayhem in which these men and hundreds others may have been killed. Both men believed the insurgency was potentially deadly to them or their fellow officers. The psychological autopsy is especially important when first responders and essential workers are involved and die soon after. When LEO’s and first responders are put in fear of death or see other officers being placed in the direct line of fire, are vastly outmanned, and have no way in which to stop an attack, they are at high risk for the “hook” that comes from an acute stress reaction and over time and soon becomes a monkey on the backs of so many fine men and women.
Some agencies, such as the Fairfax County, VA Police Department, are beginning to implement periodic mental health check-ups for their officers and other employees. The goal is twofold: 1) to “normalize” the act of visiting a mental health professional, thus reducing the stigma against seeking mental health care, and 2) to identify and address potential issues early on. (PERF 2019)
“This heroic sequence of behaviors is besmirched by the bias against mental health responses to events that would bring any one of us to our knees. Men and women of law enforcement walk in the darkness, always in death’s shadow. It is time to recognize these officers and help them and their families to know they do not walk alone.”
Michael Sefton, Ph.D. 2018 Direct Decision Institute, Inc.
Departments should consider flexible job assignments or adding exercise to work schedules as a way to release stress. Mental health should be regularly addressed at roll calls, and departments generally have to reduce the stigma — in part by acknowledging the deaths. According to Dr. Leo Polizoti at the Direct Decision Institute, Inc. in Worcester, MA, an annual stress inventory should be conducted as part of the official officer evaluation program. This may be easily done by tracking high lethality calls that may be followed by mandatory defusing/debriefing as close to high stress incidents as feasible. Officers in Worcester, MA are given paid time for these aftermath behavioral health sessions.
Hawton, K., Appleby, L., Platt, S., Foster, T., Cooper, J., Malmberg, A. & Simkin, S. (1998). The psychological autopsy approach to studying suicide: a review of methodological issues. Journal of Affective Disorders 50, 269–276.
The expectation that we can be immersed in suffering and loss daily and not be touched by it is as unrealistic as expecting to be able to walk through water without getting wet.
Rachel Naomi Remen, MD
“You are going to get wet in this business, it is what you do with it and how you process the “wetness” that impacts how your brain is going to react over time, according to Jamie Brower, Psy.D. a Colorado Police Psychologist. Brower explains this concept to the LEO’s and first responder’s treats following years of exposure to critical incidents. Many officers believe they are handling things well but gradually experience the loss of purpose in life often seen in cases of trauma. The key to treating repeated trauma is to intervene routinely following traumatic high lethality events, such as death of a member, multi-casualty critical incidents, and others with routine defusing immediately following the incident. I believe this should include all members who were on the call including supervisors. I once conducted a critical incident review following a fatal automobile crash with multiple fatalities and injuries. All members who responded to the incident were present except the on-duty sergeant and the fire chief. When necessary, peer support, debriefing, and direct psychological intervention are a must for career well-being and resilience.
“Your resiliency is like an immunization or protective factors against what life will throw at you” according to Mike Grill, M.S., a counselor in Colorado. Resiliency refers not to survival of the fittest but to the species that adapts quickest to changes in the environment. So the resilient person who is exposed to a horrific event like a school shooting or the death of a child is going to say: “Hey this bothered me and I need to do something about it” not “I should be able to handle this on my own” according to John Nicoletti, Ph.D. How do you get balance back in your life because, if all you see is death than you are going to have a pretty weird perspective going forward in life said Dr Nicoletti, in a short, Lifelines documentary in association with Stories Without Borders shot to inform on PTSD and law enforcement, fire service, and first responders.
Post traumatic stress is an injury that occurs during the course of an event like a mass shooting, or cumulatively over the years of exposure during the career in law enforcement or other first responder service like fire or EMS. It is not a mental disorder. Children in the family can be the first responder’s lifeline back. You will still have a scar but the injury will heal said Dr. Daniel Crampton, a retired Ute Pass Regional paramedic and trauma specialist in Colorado. Dr Crampton is available for peer support and has been very responsive and ethical at times I’ve reached out to him. In previous blog posts I have suggested that building resilience may be forged by having annual behavioral health “check-ups” and that in doing so, officers may earn extra payments for adhering to a behavioral health protocol each year that includes attending defusing and debriefing sessions following critical incidents. Just like the Quinn Bill in the 1970’s here in Massachusetts, where officers earned extra salary for attending college and earning their degrees, a similar incentive may be added for officers who attend annual behavioral health screenings and regular stress reduction trainings. The obvious benefit is a healthier mind and body among front line police officers with enhanced job satisfaction and career resilience.
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.
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.
It has been frequently mentioned that exposure to death and uncivilized brutality has an impact on wellness and personal resilience. Not a surprise. Especially in these pages, I make an effort to point out that the cumulative impact of traumatic exposure slowly whittles away one’s capacity for mental health, empathy and emotional efficacy. “There is a relationship between the severity, frequency and range of adverse experiences, and the subsequent impact on mental health.” (Dillon, Johnstone, & Longden, 2012). The conundrum has always come down to just what constitutes a “traumatic” event in childhood? Sometimes there is no single identifiable event that a child brings forth that may later become a trigger of serious emotional instability later in adulthood.
The Covid-19 virus has the potential for creating traumatic events depending upon the degree of exposure and a child’s understanding of the narrative brought forth by parents and other trusted adults during the pandemic. “Over 30 percent of Americans know someone who has died or been infected by the virus. The fallout to mental health from the coronavirus is real. I see it in my own family as nerves become frayed 8 weeks on.” according to the blog post from May, 2020. Trauma informed therapy supports the model of early traumatic experience being the underpinning of many mental health outcomes we see later in life. The biopsychosocoial model identifies physical abuse, sexual abuse, exposure to violence, chronic substance abuse as the substantive reasons for many mental and physical illnesses years later. When we look in the rear view mirror at this virus we will see the litter of emotional wreckage that may leave its hooks in many people around the globe.
Coronavirus. Ise.ac.uk
There is a relationship between the severity, frequency and range of adverse experiences, and the subsequent impact on mental health.
“The more adverse events a person is exposed to in childhood, the greater the impact on physical and mental health and well-being, with poor outcomes including early death” (Anda, Butchart, Felitti, & Brown, 2010; Anda et al., 2006; Felitti et al., 1998). There was a time in my training that I collected data on childhood fire setting and the psychodynamics of pyromania. I saw 50 children in my fellowship year who came because of fire setting. Without a doubt, there was marked early instability in the childhood homes in these kids that likely germinated into fascination with fire play and perhaps more directly, physically aggressive behavior. Many of the children I assessed were suffering from early onset trauma.
Depending upon the age of onset using fire as an expression of internalized conflict suggests a serious emotional disorder in need of expert assessment and treatment. The interest in fire may appear normal but slowly interest foments in homes where a prevailing emotional vacuum permits – decreased emotional warmth, access to fire starting materials, an absent parent, and frequent domestic violence.
The inconsistent and unpredictable exposure to violence contributes to excessive and unpredictable behavior as children become adults. Often without direct knowledge of a specific trigger, trauma activates brain circuits that drive fear and emotional behavior including substance abuse, domestic violence, and assault. What is more, these absorb community resources as psychological needs grow.
The coronavirus has profound impact on the emotional stability of people around the world because of its unpredictability and lethality. It evokes fear, and uncertainty as it spreads unchecked. Later, the virus can serve to trigger long hidden memories in a way that can sabotage healthy human development leading to vague anxiety, physical symptoms, loss, and deep despair.
Scott D. Jones of Arlington, MA was a decorated paramedic who responded to a mass homicide in 2000 in which 7 people were shot in an episode of workplace violence. He would go on to kill his second wife and 2 children 14 years after repeated episodes of severe depression and suicidal behavior and domestic violence toward his first wife. These behaviors were the first red flags of an impending emotional breakdown and terminal rage. Paramedic Jones certainly had problems but the repeated exposure to trauma – especially the mass shooting, activated his fight-flight response intolerably and may have been one of the demons he faced in the end.
Michael Sefton, Ph.D.
Trauma can be triggered by loss due to Coronavirus in two ways. First, by direct contact with a family member who is hospitalized and may have died. Nearly every person who contracted the virus had someone left behind that was worried about their health and eventual recovery. Many had family members who communicated with patient via text messaging and FaceTime – until the loved one could no longer do so. Families relied on the updating calls of first responder nurses, chaplains, social workers, and physicians.
Next, through secondary exposure to similar cases and media coverage that assails efforts at closure and engrains the narrative of fear, guilt and shame by reporting ever increasing case numbers, hospitalizations and deaths survivors are left feeling numb and unable to mourn. Funerals were deferred or could not be held at all as some jurisdictions required the cremation of the remains of coronavirus victims. This has a negative impact on survivor health and well-being often evoking a religious and moral crisis of faith. Survivors have enormous guilt and sadness not being with a loved one who died from the virus or waiting to go for medical at the onset of symptoms. They mourn to mourn and are left feeling numb at the lack of closure.
So whether it is early trauma associated with domestic violence or trauma from repeated exposure to work-related experiences, there is a resilience that resides within most people that guides the rise from being overwhelmed again and again to move forward with courage and hope and feelings of hardiness. These are learned responses to high stress events like a pandemic, but people who are positive thinkers, optimistic, physically fit and emotionally insightful rise up, controlling the lives they lead.
We are offering a zoom platform event entitled The Psychological Impact of the Cornavirus Pandemic: Common sense answers on November 11, 2020 at 5:30 EDT and again in December 10, 2020 at 7 PM. It is free and to be sent the zoom link contact: jswiderski@whittierhealth.com or call the Whittier Rehabiltation Hospital at 508-870-2222 in the U.S. If you plan on attending the 12/10/2020 session please drop me an email at: msefton@whittierhealth.com
“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.
Purpose in life has been introduced as benefiting people, including law enforcement officers, to find a positive sense of purpose and personal satisfaction in their work product and in their lives. It was originally espoused by Viktor Frankl in 1946. Frankl, a physician, survived the German concentration camps and the deliberate extermination of 6 million Jews during WW-II. His wife and entire family were killed at Auschwitz and Dachau. How could he possible find purpose and meaning in life after this horrific experience.
In the book Man’s Search for Meaning, first published in 1946, Victor Frankl shares the experience of seeing hundreds of people herded off to their extermination. People and members of his immediate family were horrifically gassed and sent to mass graves.
Frankl’s theory holds that “there are three primary human capabilities, or, in his words, noological possibilities: self-detachment, self-transcendence, and the ability to “spiritually be in touch” with something or someone independent of spatio-temporal dimensions” according to McGann (2016) who reviewed Frankl’s book Man’s Search for Meaning.
Officer well-being is essential for career longevity. It becomes apparent that police officers grow and remain productive in an environment of support: both within the organization and within the community in which they serve. These attributes build a sense of personal meaning and career purpose.
Leo Polizoti, Ph.D.
In Man’s Search for Meaning, Frankl described the daily demoralizing prisoners underwent both physically and psychologically. Survivors of the horrific images at concentration camp Auschwitz began to find meaning in their forced labor – even humor along with camaraderie.
Many of us glean a significant sense of well-being from what we do personally and professionally. Most cops derive great personal meaning and purpose from the job of police officer at least for the first 3-5 years. Law enforcement officers’ derive much of their identity from the work they do on a daily basis and can experience wide ranging stress from call to call. As such, it has become well-known that police work requires special understanding of one’s community and a positive sense of personal responsibility, well-being and resilience for career success and hardiness (Polizoti, 2018).
Our tour guide at the West Bank in Israel in 2019 – Rami Nazzali found great purpose in teaching visitors about the plight of Palestinians on the West Bank and Gaza Strip – He strongly believes the plight of Palestinians in the Gaza Strip and West Bank are fighting for purpose and meaning in their lives. Rami
Nazzali writes for The NY Times.
Purpose in life refers to an underlying belief that what you do for work has importance and purpose on a larger scale. Moreover, to diminish oneself as a result of career embitterment runs a risk of the erosion of purpose and loss of group membership. That is when one becomes marginalized and loses his purpose and the “why” for living. Viktor Frankl believed that once gone the purpose of life and the will to live cannot be restored.
Mark Dibona previously was a patrol sergeant for the Seminole County Sheriff’s office in Florida, where he supervised nine officers, but the memory of the June morning where he was called upon to resuscitate and dying infant still haunts him. “Other stressful situations include, but are not limited to: long hours; handling people’s attitudes; waiting for the next call and not knowing what the situation will be; and even politics within the department. Then, on top of it all, officers are frequently criticized, scrutinized, and investigated for decisions they make” said Michelle Beshears on the faculty at American Military University.
Among police officers between seven percent and 19 percent of police officers experience symptoms of Post-Traumatic Stress Disorder, compared to 3.5 percent of the general population. A colleague and friend, Sergeant Mark DiBona retired from law enforcement in 2019 has had some difficult times on the job in Florida that effect him in a profound way. He is an strong advocate for law enforcement mental health and suicide prevention.
“Until this day,” said Dibona, who admits to having contemplated suicide several times before he began counseling, “I can feel the warmth of that baby on my arm.” A child Mark believed he could save.
Dr Michael Sefton
Domestic violence homicide results when victims decide to move on with their lives and inform a jealous, insecure spouse that they no longer want a relationship. October is Domestic Violence Awareness month. The risk is greatest when victims decide to leave. At first glance one might say “Lots of people break up and do not murder their spouse and family” according to Michael Sefton shown in the photo above. That is a fair statement, but it happens enough in the United States and elsewhere that domestic violence homicide must be considered in the most egregious cases of DV. Last week in Massachusetts a family was murdered because one spouse asked to be let go and people were stunned that they saw nothing to warn them of what was brewing.
“Domestic violence is not random and unpredictable. There are red flags that trigger an emotional undulation that bears energy like the movement of tectonic plates beneath the sea.” according to Michael Sefton (2016).
At what point does a potential victims begin to wonder whether she and her children are safe? We are lead to believe that abusive intimate partners cannot be held in jail unless they are in violation of an order of protection, AKA: restraining order. This is untrue. But time and again, violent and abusive partners stalk and ignore orders of protection – especially using social media tracking software and trolling social media sites like Facebook, Instagram, and What’s App to find victims and watch their activity. It is all about control, pathological jealousy, and instilling fear and terror.
Restraining order’s are authorized by a district court judge who is on call night and day in most parts of the country. Restraining orders are not authorized unless substantial threat to the victim exists. These orders are carefully crafted by investigating police officers whose reports highlight the exact nature of the violence and the reason the victim needs protection. “Protection orders are offered to the victim after the first sign of physical violence. It has been espoused that the police are not called until after the 6th or 7th episode of domestic violence” according to Sefton, 2016. DV is a secret affair between members of a family who are often ashamed or embarrassed to come forward for help often until things gradually get worse – sometimes years into a pattern of violent dysfunction.
Research is clear that separating spouses for the night does not positively impact the level aggression and risk in the household as much as the formal arrest of the aggressor. What usually happens is the police break up the fighting couple by sending the aggressor off to the home of a friend or family member – less often to jail unless there are obvious signs of abuse. Arrest is mandated by law when physical signs of abuse are apparent. It has become all too often the case that hindsight – taken seriously – may have saved a life. It is when they are attempting to leave that 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, et. al. 2011) that occurred in June 2011. Lake’s husband and murderer was heard to state that “if you ever try to leave me I will kill you”.
In research conducted by this author and colleagues we learned that as soon as police leave the scene the risk for violence is increased. We interviewed a man who served 18 years for the murder of his wife and he described in vivid detail how he used nonverbal coercion to manipulate his wife while being interviewed by sheriff’s deputies in Maine. He admitted that as soon as the police were out of the driveway he strangled and drowned his wife for calling them. In our interview, he claimed that she was his best friend.
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. Whether this unwitting duplicity stems from the cultural belief that what happens behind closed doors is “nobody’s business” or the conscious result of intimidation should not change the proper law enforcement intervention in these cases. Early incarceration provides opportunity to draft a viable safety plan for potential victims and in some cases, will instill a desire for change in the violent partner. In the meantime, substantive buy-in from police, legislators, judges, probation, and society needs to be fully endorsed for real change to happen and for safety plans to work and violent partners to be contained.
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 (2016). https://msefton.wordpress.com/2016/07/20/the-psychology-of-bail-and-alternatives-to-incarceration/ Blog post: Taken October 9, 2019
MSefton's Human Behavior Blog 