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 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.

Protecting the Victim’s of Intimate Partner Abuse: The aftermath of domestic violence homicide

DV_note B&W
Victim passed this note to Veterinarian staff – Photo VCSD

“You can’t say that nothing can be done, because nothing will be done,” said Michael Sefton, a former Westbrook, Maine  police officer who is a psychologist and former police sergeant in Massachusetts at the New Braintree Police Department.

Bangor Daily News

Desperate Victim’s plea for help

DV_note B&W
Victim passed this note to Veterinarian staff – Photo VCSD

WESTBOROUGH, MA  June 6, 2018 A case of domestic violence unfolded on Memorial Day weekend in Volusia County, Florida when a female victim was being held by her live-in boyfriend. The note implores staff members of the DeLand Animal Hospital to call police because her partner was threatening her and had a gun.  These kinds of desperate measures occur occasionally and are dramatic and newsworthy. The staff at the DeLand Animal Hospital are to be commended.  But there are intimate partners everywhere who live in fear just as the indomitable victim who passed this note had been living.

“From coast to coast LEO’s are caught in this moth eaten, patchwork system that lacks resources for both the mentally ill and those addicted to alcohol and drugs.” Michael Sefton, Ph.D. 2018

As the story goes, her boyfriend had beaten her and was refusing to allow her to leave the couple’s home.  To her credit (perhaps life saving) she convinced the man that she needed to bring the dog to the veterinarian.  He agreed but would not allow her to go without him. Upon arrival this note was passed to a member of the hospital staff who knew just what to do.  The man is now behind bars being held without bail – manning his defense.

There is a consensus among experts in domestic violence that victims are abused multiple times – often threatened with death – before they call police for help.

As a society, more needs to be done to fill-in the holes in the system designed to keep families safe.  Safety plans and orders of protection are not enough.  From coast to coast LEO’s are caught in this moth eaten, patchwork system that lacks resources for both the mentally ill and those addicted to alcohol and drugs. The holes in the system allow for violence prone individuals to allude police and coerce victims into silence.  But every once in a while, a silent victim writes a life saving note and gives it to the right person.

Domestic violence happens in family systems that are secretive, chaotic, and dysfunctional.  This lifestyle pushes them into the margins of society – often detached from the communities in which they live.

The abusive spouse makes his efforts known within the system by his barbaric authoritarian demands.  He keeps his spouse isolated as a way of controlling and manipulating whatever truth exists among these disparate family members.  The consequence of this isolation leaves women without a sense of “self” – alone an emotional orphan vulnerable to his threat of abandonment and annihilation.

Successful intervention for these families must slowly bring them back from the margins into the social milieu. Arguably, the resistance to this is so intense that the violent spouse will pull up stakes and move his family at the first sign of public scrutiny.

Police officers are regarded as the front line first responders to family conflict and DV.  For better or worse, the police have an opportunity to effect change whenever they enter into the domestic foray.  This affords them a window into the chaos and the opportunity to bring calm to crisis.  In many cases, the correct response to intimate partner violence should include aftermath intervention when the dust has settled from the crisis that brought police to this threshold.  When this is done it establishes a baseline of trust, empathy, and resilience.

Community policing has long espoused the partnership between police and citizens.  The positive benefits to this create bridges between the two that may benefit officers at times of need – including the de facto extra set of eyes when serious crimes are reported.  But the model goes two ways and requires that police return to their calls and establish protocols for defusing future events meanwhile processing and understanding the current actions of recent police encounters. When done effectively the most difficult families may be kept off the police radar screens for longer periods of time that can be a good thing when it comes to manpower deployment and officer safety.

Violence prediction: Keeping the radar sites on those who would do us harm

crosshairsIn response to recent acts of both terrorism and recurrent gun violence by home-grown psychopaths more should be done to maintain greater control over potentially violent persons. In the Las Vegas concert venue and the more recent Texas church massacre it becomes
increasingly clear that predicting violence is practically impossible. At least this is
what we are led to believe. And yet when it comes to domestic violence
homicide the similarities in cases are almost carbon copy.
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 duplicity stems from cultural beliefs that what happens behind closed doors is nobody’s busy change in the way in which law enforcement manages these cases is essential. The 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. 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. These behaviors toward a victim instill fear and point to the perilous danger that exists.
“Someone with a history, particularly a continuing history of violence, can be presumed to be dangerous.” Frederick Neuman, MD
Coercion and Control
Lenore Walker is a psychologist at the Domestic Violence Institute has published a theoretical description of the coercion and control model of DV. Victims are young and vulnerable to being emotionally and physically controlled. The Texas killer Devin Patrick Kelley had all the makings of a violent abuser from the time he was in high school and only now are people willing to talk about his darker side. Kelley was separated from his second wife who was just 19. Victims like this are often kept away from their families, not allowed to work, or when working are not permitted to handle their own funds. Some victims have to explain every cell phone call or text message they make or receive often being met with jealous fury. By robbing their sense of self keeps intimate partners emotionally isolated and insecure. They are often led to believe they could not live on their own and the children they share will be lost to them if they choose to leave. This “so called” male privilege keeps his partner marginalized and in servitude. It appears at first glance that Kelley was looking for the mother of his currently estranged wife likely enraged over steps taken to keep them apart as the divorce progressed through the courts.
Occasionally police or children’s services are called when intimidation and threats become violent. It is important to provide aftermath intervention and follow-up with families where domestic violence or chronic substance abuse occurs or families tend to disappear. Change is required to pay closer attention to those with whom law enforcement has frequent contact. Over and over
surviving family members speak of coercion and control on behalf of the abused.  Lives will be saved when society takes a closer look at red flag violence – these are the preincident indicators that violence and domestic violence homicide are possible. This is not new data nor are the stories very different.
I speak to police agencies and individual officers about DV and DVH offering detail from the psychological autopsy research we conducted on a sensational and tragic case in Dexter, Maine in which Steven Lake killed his 35-year old spouse after 10 years of marriage along with their 2 children. The Lake case was very much like the Kelley murders in terms of the cycle of abuse and its early onset. It was thought that Lake was intending to go on a killing spree but was interrupted in the act by an observant police officer. Recently a police officer participating in the statewide DV task force in Vermont asked whether there is a single most important factor or predictor to the risk of DVH? Some believe the fear of being killed by her spouse and abject cruelty toward step children raise the bar significantly and as such are worthy of crafting one’s DV report and request for orders of protection around. But keeping the victim and her abuser on the radar screen will also reduce her fear and loneliness and offer greater protection. Other risk factors include: choking and recurrent
sexual violence – although victims seldom disclose this out of guilt and fear of not being believed.
People knew what might happen
The Psychological Autopsy of Steven Lake consisted of over 200 hours of interviews with immediate family members on both sides. Steven’s aunt was quoted as saying “I never thought he would take the kids” in reference to an acknowledgment of his depression and anger at the impending divorce. She believed Lake would take his own life in front of his wife and children as a final act of punishment they would never forget. But he went far beyond that as we again saw in the small church in Texas this week. We are getting better at teaching children and families that if the see something they should say something. This is the trademark line of the Transportation Safety Administration in its fight against terrorism. The same might be taught to neighbors and friends when domestic violence is suspected or known to be occurring. If you see something then it is incumbent upon each of us to do something to help those in harms way.

Neuman, F.  (2012) Is It Possible to Predict Violent Behavior? Can a psychiatric examination predict, and prevent, a mass murder? Psychology Today. https://www.psychologytoday.com/us/blog/fighting-fear/201212/is-it-possible-predict-violent-behavior Taken May 12, 2018

Violence in the Workplace: Do people just “snap”?

WESTBOROUGH, MA June 2, 2018  Violence in the workplace is commonplace but has taken a back seat in the setting of recent school shootings. Research on the “lethal employee” is becoming more reliable in the aftermath of of workplace violence. Nevertheless people commit murder in their workplace more than ever.  What should people do if they are worried about a co-worker becoming violent.  There are signs that someone is loosing control and may be thinking of violence.  A list of potential factors is taken below from the U.S. Department of Homeland Security publication from 2008. The term “going postal” refers to a workplace shooter or act of violence.  It evolved from workplace violence in the U.S. Postal service in the 1980’s according to a report published in 2008.

“One theory was that the post office was such a high-pressure work environment that it drove people insane. In the years to come, other cases of murderous rages by mailmen cemented the idea in the public mind. “Going postal” became a synonym for flipping out under pressure.”

RECOGNIZING POTENTIAL WORKPLACE VIOLENCE
“An active shooter in your workplace may be a current or former employee, or an acquaintance of a current or former employee. Intuitive managers and coworkers may notice characteristics of potentially violent behavior in an employee. Alert your Human Resources Department if you believe an employee or coworker exhibits potentially violent behavior” (2008)

Indicators of Potential Violence by an Employee Employees typically do not just “snap,” but display indicators of potentially violent behavior over time. If these behaviors are recognized, they can often be managed and treated. Potentially violent behaviors by an employee may include one or more of the following (this list of behaviors is not comprehensive, nor is it intended as a mechanism for diagnosing violent tendencies):
• Increased use of alcohol and/or illegal drugs
• Unexplained increase in absenteeism; vague physical complaints
• Noticeable decrease in attention to appearance and hygiene
• Depression / withdrawal
• Resistance and overreaction to changes in policy and procedures
• Repeated violations of company policies
• Increased severe mood swings
• Noticeably unstable, emotional responses
• Explosive outbursts of anger or rage without provocation
• Suicidal; comments about “putting things in order”
• Behavior which is suspect of paranoia, (“everybody is against me”)
• Increasingly talks of problems at home
• Escalation of domestic problems into the workplace; talk of severe financial problems
• Talk of previous incidents of violence
• Empathy with individuals committing violence
• Increase in unsolicited comments about firearms, other dangerous weapons and violent crimes

U.S. Department of Homeland Security. (2008). Active Shooter – How to Respond
Bovsum, M. (2010) NY Daily News. Mailman massacre: 14 die after Patrick Sherrill ‘goes postal’ in 1986 shootings. http://www.nydailynews.com/news/crime/mailman-massacre-14-die-patrick-sherrill-postal-1986-shootings-article-1.204101 Taken May 19, 2018

Maine to Consider “Red Flag Law”

WESTBOROUGH, MA April 25, 2018  Maine is the latest state to consider a so-called red flag law. It would let family members or law enforcement officers petition a judge to take away a “high risk” person’s firearms temporarily, if the judge determines the person poses an imminent risk. In a recent post I describe the updated terminology for individuals who are a potential threat called Gun Violence Restraining Orders.  The proposed action would allow law enforcement to remove the firearms of people who are known to be threatening or physically violent toward intimate partners.  “Felons, the dangerously mentally ill, perpetrators of domestic violence – these people have demonstrated their unfitness to own a firearm” said David French, 2018.  In cases such as these police have reasonable cause to disallow gun ownership based not on prior conviction but on the elevated risk to potential victims.
Here in Massachusetts, in August 2013 I published a blog after the death of Jennifer Martell who was murdered in front of her 4-year old daughter by Jared Remy, son of Red Sox broadcaster and former player Jerry Remy.  The younger Remy had received one break after another some say linked to his celebrity father’s influence.  He was never held until a dangerousness hearing could be undertaken.  Had this been done Ms. Martell may be alive today. In 2011, Stephen Lake murdered his wife and children after he was kept from attending his son’s 8th grade graduation.  Lake had exhibited several red flag warnings prior to the murders.  In spite of these he was not held nor were his firearms removed from his control Allanach, et al. 2011.
Several states have debated similar red flag laws in the wake of the school shooting in Parkland, Florida. Supporters argue a red flag law could have prevented the Parkland shooter, but some gun owners say it’s an overreach that threatens their 2nd Amendment rights.
Like many states in the U.S. Maine has more than its share of calls for domestic violence and domestic violence homicide.  “All law enforcement personnel who respond to incidents in which an individual’s mental illness appears to be a factor receive training to prepare for these encounters; those in specialized assignments receive more comprehensive training. Dispatchers, call takers, and other individuals in a support role receive training tailored to their needs.” Communication between members of a response team with awareness and understanding of red flag warnings will reduce the impact of coercion and control that belies the secretive relationships between intimate partners.  It will also bring to light the need for danger assessment and containment of people who are high risk for violence as in the case of Jared Remy in Massachusetts and Stephen Lake in Dexter, Maine.

Red Flag Warnings (2018) https://www.necn.com/news/new-england/Maine-to-Consider-Red-Flag-Law-478687253.html Taken 4-4-18
Allanach, R.A., Gagan, B.F., Loughlin, J., Sefton, M.S., (2011) The Psychological Autopsy of the Dexter, Maine Domestic Violence Homicide and Suicide. Presented to the Domestic Violence Review Board, November 11, 2011

Gun-violence Restraining Orders

firearm-revolver-bullet-gun-53219.jpegWESTBOROUGH, MA APRIL 8, 2018 Restraining orders in cases of domestic violence have been around for decades or longer. At times people require formal court orders of protection from those who might bring forth violence to loved ones.  I have personally written over 50 requests for protection of a victim of domestic violence.  Most of these are temporary order issued by an on-call judge who listens to police officer statements over the telephone.  They are usually granted and valid through the next court day – generally within 48 hours.  The problem is that after the 48 hours is up the conflict between intimate partners has been long forgotten resulting in a waste of police resources and an irritated district court judge. Obviously this is not always the outcome.
In Massachusetts, the MGL 209-A covers orders of protection and its legal underpinning. Section 3B in MGL 209-A requires the removal of firearms from those with active RO’s taken out against them.  As many as 50 percent of restraining orders (RO’s) also called protection from abuse orders (PFO’s) are continued because the victim showed up at court and testified as to the protection she believes is needed and fear she feels living with her intimate partner.  These are not new and the complaints and dysfunction among intimate partners is a continuous drain on LEO resources.
Calls for service because of domestic violence are frequent.  Police officers are often asked to keep the peace at times when violence has occurred.  Arrests are mandatory when physical injury has occurred.  At this point police are required to remove the violent spouse and offer protection from further abuse to the victim and her family.  When RO’s are granted there is a growing belief that guns should be taken from subjects against whom RO’s are granted.  Experts say these GVRO laws are modeled after domestic-violence restraining orders that also authorize police to take away guns from people who pose threats to their partners, but with safeguards.
“Ensuring the mental wellness and health of first responders has long been an under appreciated task for the heads of police agencies. U.S. law enforcement has learned from tragic events over the years and now trains to respond to threats with the best equipment and practices known today. However, many chiefs are not prepared to deal effectively with the intense scope and unanticipated duration of the aftermath of these events, and many chiefs are unaware of the impact such events will have on their communities and the officers in their agencies.”
“These red-flag laws are a possible solution because they’re an intermediate step between doing nothing and trying to involuntarily hospitalize an individual,” said Christopher Slobogin, a law professor at Vanderbilt University.
“While LEO’s may be more resilient, law enforcement officers also quietly deal with an outsized share of our society’s violence and death. As a result, too many officers struggle with alcoholism, post-traumatic stress disorder, and depression.”
“You can’t just call up law enforcement and say this person that I’m mad at is a danger to me, it is not possible without judicial oversight,” said April Zeoli, a professor who studies domestic violence at Michigan State University. Her research shows these restraining orders reduced intimate partner violence by 13%.
“Research data provide strong evidence supporting the effectiveness of emotional fitness training to enhance resilience, positive emotions, cognitive flexibility, and emotional well-being, and more importantly, they strengthen professional pride and organizational commitment” according to Tung Au, et.al. in the Journal of Police and Criminal Psychology in 2018.
Felons, the dangerously mentally ill, perpetrators of domestic violence – these people have demonstrated their unfitness to own a firearm” David French, 2018
Supporters say the “red flag” measure—also known as a gun-violence or extreme-risk protection order—offers a way to address a legal conundrum: how to take action against people perceived as an imminent threat to themselves or others, but who haven’t done anything illegal.

Au, W.T., Wong, Y.Y., Leung, K.M. et al. J Police Crim Psych (2018). https://doi.org/10.1007/s11896-018-9252-6
French, D. A (2018) Gun Control Measure Conservatives Should Consider. National Review, February 2018
Kamp, J. and Mahtani, S. (2018) States Consider Laws Allowing Courts to Take Guns From Dangerous People  ‘Red flag’ measures are gaining ground after Florida high school shooting. Wall Street Journal
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On Police Identification of the mentally abnormal

How to recognizeWestborough, The police-mental health interaction continues to be one that neither party exhibit great confidence nor take great pride in.  Myths abound about how to treat those so afflicted – especially among law enforcement personnel. I have provided classes for LEO’s and generally they are not well attended and tend to bore the average officer. In Maine, LEO’s are required to have regular training in working with the mentally ill in order to maintain their LEO credentials. Other states in New England have similar requirements and now focus on psychological first aid and deescalation protocols.  I have presented on topics of assessment of risk and dangerousness with some success.  In- service training must be short and to the point or students will quickly lose interest.
The photograph above shows the cover of a guide book first written in 1954 that was instructional for police officers.  It was written to teach the law enforcement officers of the day to recognize signs of mental illness then defined as “abnormal people”.  It was written by 2 Louisiana State University psychologists and first used by a police agencies in the late 1950’s.  I have been trying to find a copy of this early version that was re-published in 1979 and now costs over $100.  It was written because police officers needed training and experience identifying features of psychiatric emergency. This was thought to reduce the uncertainty, fear and confusion around handling these cases by providing education including signs and symptoms.
After nearly 60 years, law enforcement is not significantly closer to understanding the mentally ill than they were in 1954. A colleague, police psychologist Leo Polizoti, Ph.D. has an original copy of this booklet although I have not seen it as yet.  Dr. Polizoti provides consultation to law enforcement, officer selection interviews, and teaches a proactive approach psychological resilience to police officers that can afford them greater career satisfaction, professionalism, and longevity. Dr. Polizoti is tasked with supporting officers who are exposed to the daily grind of violence, suicide, homelessness, and its cumulative impact on a cop’s personal narrative.  His model suggests a fundamental change in how police officers interpret their experiences over time and acceptance of what cannot change and healthy adaptation.  He is a great asset to the Central Massachusetts community and across New England and espouses a model of stress resistance through adaptation.
“In 1954, the National Association for Mental Health first issued the book “How To Recognize and Handle Abnormal People: A Manual for the Police Officer.” Included were techniques on dealing with all kinds of “abnormal persons,” from psychopaths, drug addicts, and the “mentally retarded” to civil protestors and those involved in family disturbances.”  Posted by David Pescovitz, 2015
Text from 1954 How To Recognize and Handle Abnormal People: A Manual for the Police Officer is provided below.  It points out many of the outward signs of disturbed thinking often an underlying feature of those with mental illness – in this case something called ideas of reference. These signs are common among persons with early paranoia and are sometimes missed – even by members of the immediate family. This is still a common symptom of mental illness today and is considered to be the prodrome to a more serious loss of contact with reality. Ultimately, it comes down to who is at more risk for violence?  And how can we be sure?
It takes a healthy and educated police officer to observe, understand, and control unpredictable situations. Officers are required to adapt to the demands of individual calls for service.  A colleague Dr. Leo Polizoti has identified a model for coping with the strain of police service.  He cites the importance of avoiding apathy, withdrawal and bitterness on the job.  “Understanding the 3 C’s of hardiness, Challenge / Commitment and Control will assist officers to manage stress more effectively, resulting in fewer emotional and medical problems. By viewing each new situation as a challenge, instead of a threat, you become committed to that challenge. You can readily see yourself in control and better able to deal with the situation. You will enhance your “hardiness” or resistance to stress” Polizoti, 2018.   
“He may think, for example, that announcements made over the radio have something to do with him personally. He may even hear his name mentioned. These are called ideas of reference which, of course, means that the patient thinks people are referring to him in one way or another. In the beginning, ideas of reference may occur only occasionally, but they gradually become the rule rather than the exception, and finally they may develop into definite delusions of persecution or grandeur.”
The list below are the signs of “abnormal persons” that are printed in the booklet published in 1954:
  • He shows big changes in his behavior.
  • He has strange /losses of memory, such as where he is or what day it is.
  • He thinks people are plotting against him, or has grand ideas about himself.
  • He talks to himself or hears voices.
  • He thinks people are watching him or talking about him.
  • He sees visions or smells strange odors or has peculiar tastes.
  • He has complaints of bodily ailments that are not possible.
  • He behaves in a way which is dangerous to himself or others.
Interestingly, the bullet points above remain accurate today with the understanding that too many individuals suffering with a major mental illness also have substance abuse/dependence.  It is this fact that confounds most LEO – mentally ill encounters.  “Beyond the rigors of police work, lie the demands of a personal life, specifically a wife or husband and children. Maintaining a healthy and happy family life is on its own a demanding responsibility. Add these powerful life stressors and demands to the burdens of police work and  an officer may begin to feel the weight upon his or her shoulders.” Polizotti, 2018.  Emotional and physical strength and endurance requires hardiness that comes from personal responsibility and comittment to excellence and peak performance.  Greater focus on sobriety – including opioid and alcohol dependence is essential. If this can be maintained mental illness may remit to the extent that subjects can remain in the community. Programs like A.A., N.A., and other 12-step groups are free and often afford subjects great support.  In most cities there are 12-step meetings every day morning, noon and night.  The problem is getting people to realize they have a problem.  Even airports hold A.A. meetings for travelers in need of the 12-steps. We are working on a replacement manual like the one cited in this post.


Polizoti, L. (2018) Personal Life Demands. Presentation – Direct Decision Institute.
How To Recognize and Handle Abnormal People: A Manual for the Police Officer (1954) Matthews, R. M.D. and Rowland, L. Ph.D. NATIONAL ASSOCIATION FOR MENTAL HEALTH, INC. 10 COLUMBUS CIRCLE, NEW YORK 19, N. Y.

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Protection from abuse: the role of social media in the reduction of safety

WESTBOROUGH, MA March 20, 2018  Greater protection of victims of domestic violence is needed.  When provisions for a plan of safety are executed victims are expected be afforded greater safety but not always. Domestic violence victims are at greatest risk when they make the decision to leave a violent partnership.  This often means having a safety plan – especially when specific threats have been made. Safety plans are often drawn up by women in conjunction with counselors who specialize in helping families stay off the grid and hidden from violent spouses.  In one case of familial homicide and suicide it was clear that the commonalities needed to be exposed among cases of familial homicide.
In particular, when I teach law enforcement officers about DVH,  I encourage detailed witness statements much as possible especially if the victim described the fear and belief that she will one day be murdered by her partner. These documented statements, if spontaneously uttered, are often the greatest predictor of potential harm to victims and her children. If written into a police report the decision about dangerousness and bail may be influenced.
In the 2011 homicide from Maine, Steven Lake used social media to track his wife and 2 children from whom he was mandated to stay away.  Yet, if his wife posted a photograph of his children he went to great lengths to undermine their safety by identifying anyone who “liked” the photo or commented on it. He used these posts to triangulate her whereabouts and living arrangements.  This was a large part of what marginalized Stephen Lake and in turn Lake posted his own propaganda espousing his loneliness and love for his children. Lake garnered significant support from those social media “friends” who knew nothing about what he had done to require the protection from abuse order. Many, in fact, encouraged him to fight for his children which may have been a catalyst in his festering resentment and ultimately terminal rage. He was provided information and access to his wife’s social media platforms by a family member.  For her part, Lake’s wife wanted to remain close to her in-laws in an effort to normalize her children’s life as much as possible. For example  Lake’s parents were invited to the family’s thanksgiving celebration but declined because Steven Lake could not attend.
Similarities in domestic violence
Cases of domestic violence have similarities across socioeconomic status, ethnic and cultural background, and the cycle of abuse. The growth of social media platforms affords those inclined to control and isolate intimate partners from persons who might provide them security. Cases of domestic violence share the common theme of intimidation, coercion and control.  Social media are a fun and useful medium to keep in touch with friends and family.  But it is also lends itself to sometimes nefarious trolling to gain a perceived advantage in undermining the safety plan. Social media trolling contributes to the control they seek especially when victims seek protection.  In order to limit the impact of social  media stalking victims need to shut down all social media accounts and activity. Greater protection of victims and family members requires a comprehensive plan with provisions for times when they are violated – including mandatory arrest, risk assessment and no bail containment if deemed necessary.
“That is one conclusion of four former and current police officers in a recently released report. The men, who were volunteers and had no connection to the shootings, spent the last several months interviewing 69 people about the triple homicide and suicide in Dexter in June, to suggest ways to prevent future tragedies.” Portland Press Herald, November 11, 2011
The Psychological Autopsy report suggests improvements that may prevent future domestic violence homicides:
 Use of social media platforms by people involved in conflicts should be minimized, to prevent intimidation and stalking.
 Protection-from-abuse orders and bail conditions should mandate disclosure of all firearms that are accessible to the domestic-violence offender.
 An offender who seeks, hides, uses or attempts to acquire a gun or ammunition when a protection-from-abuse order is in place should be charged with a felony and not allowed bail.
 Bail amounts should be high enough to deter abusers from violating a protection orders.
 When a protection order violation involves a deadly threat, a judge should set bail, not a bail commissioner.
 Global positioning systems should track abusers during periods of protection orders in any incidents that involve deadly threats or evidence of weapons.
 At least two officers should be sent to all domestic-violence calls when officers suspect violence is likely.
 At-risk spouses should be advised to live in as secure an environment as possible, with deadbolts on doors, secured windows, motion sensor lights and a land telephone line.
 People charged with domestic violence crimes should not wait more than a year to go to trial.
The safety of potential victims including children is the penultimate goal of protection orders but too often they are ignored via stalking efforts that include using social media to track the activities of an estranged spouse.  This overt defiance requires careful analysis and requires the arrest of the violator.  Once this takes place a dangerousness hearing must take place before he or she is released but this rarely takes place.