“Long haul cognitive effects of Covid-19” in those who have “recovered” Live zoom presentation by Whittier Rehabilitation Hospital – it was a lively event.

MICHAEL SEFTON

Thanks for those of you who signed on the last night’s webinar.  The Zoom presentation will be available at the Whittier Health website in the next couple weeks if interested. As we learned, even patients’ with mild infection can experience long lasting cognitive impact from the Covid-19 virus in the areas of memory, concentration, mental endurance, organization and verbal expression. There are mental health concerns as well that should not be overlooked.  Recovery from the virus can take weeks to months after the termination of treatment.  

The presentation on the impact of cognitive and behavioral functioning on ‘long haul’ cases is somewhat concerning given the 32 million Americans who have suffered with the virus. This is the second in a series produced by WRH and follows the November 2020 presentation on the psychological impact of the disease.  We will have a post here on the discussion from the webinar in the coming days.  The early studies have shown data from the population in Italy who have recovered from the virus in the first wave of the pandemic.

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

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

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

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

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

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

Peter Hermann Washington Post 2-12-2021

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

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

I have proposed a Behavioral Health initiative in conjunction with changes in police policy and transparency that has been the central posit of social clamor since the death of George Floyd this summer. The International Association of Chief’s of Police (IACP) has a broad-based Mental Wellness program it is reporting on its website that highlights the importance of this kind of support. “The IACP, in partnership with the University of Pennsylvania (Penn) and the Bureau of Justice Assistance (BJA)’s VALOR Initiative, is customizing a program specifically designed to help officers and agencies by enhancing resilience skills. The cost of such a program will reap rewards in the form of career longevity, officer well-being, officer morale, quality of community policing, and greater faith and trust in law enforcement in general.

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


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

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

Covid-19 pandemic: No more important time for resilience

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

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

Coronavirus. Ise.ac.uk

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

(Dillon, Johnstone, & Longden, 2012).

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

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

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

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

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

Michael Sefton, Ph.D.

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

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

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

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

Michael Sefton, Ph.D.

The Rise of Embitterment and its Impact on Health

September 2, 2018 Have you ever met someone who appeared chronically angry? Someone who is bitter about everything as if they have been screwed over by the entire world. Embitterment grows out of frustration and the build-up of chronic negativity, perceived helplessness, and resentment over lack of support.  They pay a substantial price for being so embittered and are likely to have chronic health-related consequences such as hypertension, chronic pain, sleep disturbance, substance abuse, risk of cerebral vascular attack, and more. Law enforcement officers develop coping skills early in their career and many are now being taught strategies to avoid becoming embittered and chronically angry over what they encounter and witness over years of policing.
     Research on the impact of high stress lifestyles is supportive of what LEO’s experience over the course of their professional career.  People who grow up in war zones demonstrate a malfunction in their system of arousal marred by hyper vigilance due to perpetual release of stress hormones and the health-related effects.  This is the result of chronic exposure to unpredictable chaos and the changing physiology associated with a lack of personal control and chronic, intermittent threat to life and well-being.  Neuroscientists can now pinpoint the impact of stress on hardwired changes in the brains of people growing up in places without lasting peace and this research approximates the experience of LEO’s who may be bored one moment and in a fight for their lives the next.
    Embitterment has large implication on LEO productivity, career satisfaction, job performance, citizen complaints, and officer health. Mentoring in the field and supervisory support reduce officer isolation and sometimes powerful feelings of negativity that can fester over time. The physical consequences are well documented and raise the specter of work-related injury from stress and untreated traumatic exposure. In Massachusetts an officer with acquired cardiac disease has presumptive work-related debility if he or she is shown to have been healthy when first hired.
     Ostensibly, resilience is the opposite of embitterment. Have you ever worked with someone who rolled with the punches – literally and figuratively?  They can have felony cases dismissed and be nonplussed maintaining a positive attitude and a “better luck next time” belief system.  They cope with a range of career inequities by having a rich family life, a healthy self-concept, and a positive sense of humor.  Resiliency requires positivity and using innate resilient coping strategies.  “By using alcohol to cope instead of resilient thinking one often develops other problems and this can lead ultimately to suicide. Alcohol is often related to suicidal behavior.” according to Leo Polizoti, Ph.D at the Direct Decision Institute in Worcester, Massachusetts. To survive these incidents one needs to have resilience also known as the psychological resources to process the experience with all of its ugliness and to know that you did what was needed with the training and experience you bring to the job every day.
     After a stressful event, your body and mind must return to its baseline calm and ready state so that the officer may again activate and serve in whatever capacity is required without the baggage of the calls gone by.  As this “baggage” builds unfettered the likelihood of a decline in officer job performance grows sometimes exponentially.  “Like anxiety, depression or other stress reactions, it can become pathological when it reaches greater intensity and is accompanied by feelings of helplessness, dysphoric mood, intrusive thoughts, aggression towards others and suicidal ideation towards oneself, withdrawal from others, phobic avoidance of places and persons that can remind oneself of the critical event, or multiple somatoform (physical) complaints” (Hauer, Wessel, & Merckelbach, 2006).
“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.” Leo Polizoti, 2018.
     Law enforcement officers work in highly stressful situations and their bodies are exposed to external threats that activate the autonomic nervous system. Many are conflicted over the need for overtime versus the need for family time.  “In times of crisis, fight-or-flight (adrenergic) responses may cause elevated heart rate and blood pressure. This can lead to hypervigilance or a feeling of being on overdrive. If the mission is extended in the case of large-scale disasters, there may be problems with sleeping, changes in appetite, irritability, and impatience. Often, there is profound fatigue caused by long shifts with limited down time and limited space for sleep and relaxation” according to Laura Helfman, M.D. in a 2018 paper on coping and trauma. The longer the mission, the greater the risk of shifting from normal to maladaptive responses.” Helfman, 2018.
     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 this 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, “learned resilience leads to reduced stress and psychological hardiness rather than psychological weariness. As the demand for police service becomes more complex, officers must adapt their physical and emotional preparation for service or risk premature career burnout.”

Helfman, L. (2018) How do First Responders Experience and Cope with Trauma. Quarterly Technical Assistance Journal on Disaster Behavioral Health. Volume 14,  Issue 1, Page 14
Linden, M. et al. (2009) Post-traumatic Embitterment Disorder Self-Rating Scale. Clinical Psychology and Psychotherapy Clin. Psychol. Psychother. 16, 139–147.
Polizoti, L. and Sefton, M. (2018) The Police Chief’s Guide to Mental Illness and Mental Health Emergencies. (In press) Decision Press, Worcester, MA
Sefton, M (2014) Stress: The human cost of Technology. Blog post: https://msefton.wordpress.com/health-psychology/stress-the-human-cost-of-technology/. Taken 8-22-2018

Uploading the Rhythms of Life

Cardiac monitoring may be an ‘event’ unto itself

Image
Listening to the fountain in Washington DC

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

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

“Don’t ever get old”

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

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

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

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

Event Monitoring

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

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

To read the former blog click on the link below.

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