As a member of the Direct Decision Institute, Inc in Worcester, Massachusetts, my colleague Dr. Leo Polizoti, the Institutes senior lead psychologist, are charged with doing pre-employment psychological screening for all officers heading to a regional police academy across New England. There are details about the pre-employment process at the institute website: drdecision.org. One question I usually ask is: “Why do you want to be a police officer?” As you might expect, the answers are all well rehearsed and touch on: inspiring, decorated family members who were police officers, the personal desire to help people, or a memorable encounter with a member of law enforcement early in life. There are always others too.
A more curious inquiry might sound like this: “why would you want to be exposed to fatal car crashes, domestic violence, including intimate partner homicide, completed suicide and suicidal persons, sudden infant death, violent, intoxicated subjects, random citizen complaints, professional jealousy, long hours, and sometimes decrepit leadership?” I might even add: “if you want to help people why not become a nurse or high school teacher?”
As a police consulting psychologist my goal is to offer my best judgment about candidates for police officer. I offer my two cents worth of resiliency advice by painting a portrait of how they see themselves five years in the future. When asked what they expected in the pre-employment psychological interview one or two have said it was a “waste of time.” Now these men and women are in the minority, only 1 in 15 has said that in my last round of interviews. But just as importantly, going forward, these new officers are going to represent law enforcement and should be better prepared to embrace mental health awareness and the reduced stigma associated with behavioral health and human resilience. Most cops are starting to understand this. To say that a one hour meeting with the police psychologist was a “waste of time” reflects both the lack of understanding of personal well being and a blind spot in progressive policing. Mental health is everywhere in law enforcement on both sides of the badge.
I am always in awe when I drive past roadside memorials. They commemorate the place where someone was killed in a motor vehicle crash. They grew in popularity following the of MADD, Mother’s Against Drunk Driving first in the 1980’s in Austin, Texas. These are usually a white cross along with trinkets, toys, and photos that memorialize them life or lives that were lost at the location. Many are painted with the names of people who have lost their lives too. What strikes me is who maintains the site? Is there any sort of memorial at a internment site? Do the same people who maintain the shrines also maintain a grave site?
There is a psychology to the roadside memorials that are dotted across our country’s roadways commemorating the lives of people who have perished. Usually these are simple crosses sometimes emboldened by the name or names of people who may have been in fatal accidents at the location. Others grow to become memorials to a lost love one and are maintained by grieving family members. I seem to see them everywhere and wonder about the survivors. Do they visit the site? It is different then a cemetery in that this is not the place where they were laid after death, but this is the last place on earth their loved one was alive.
I am reading a couple of books about roadside memorials with interest. One is a thesis from a Canadian university, authored by Holly Everett from Memorial University in Newfoundland. These sites are also known as the “spontaneous shrines” that result from a public outpouring of grief according Everett who studied the shrines in Texas as part of her graduate work. It makes me sad when someone builds a spontaneous shrine to honor the loss of someone. On my way to work a few months go, I noticed that 2 crosses were erected in a tree near my home. A spontaneous shrine.
While working as a police officer I noticed these spontaneous shrines popping up in our town usually after a fatal accident. Fortunately, we had very few fatal crashes in the 12 years I worked. Towns everywhere, including the one in which I patrolled, were discussing regulations about the roadside crosses and all the stuff that accumulated along with them. Our chief was sympathetic but the one or two shrines in our town became a traffic hazard in his mind. Cars (I assume family members or friends) would slow or stop for a short visit. We always worried about someone getting injured or killed on the site of one of the crosses. And we had a call to the cross on Rt 67. The boyfriend of one of the victims was sleeping at the cross site. Upon further investigation we learned that he was so grieved that he wanted to stay with the girlfriend’s cross one last time. Sadly, we had to send him along because having a sleeping person on a busy road caused too much public concern. Communities are needing to regulate these sites because the grieving public tends to add more and more to them. Some family members even mow grass or shovel snow keeping the site looking prosperous. According to the draft policy posted on the BBC site, “locations and content of roadside memorials will be vetted for safety and messages that can be considered “offensive” will be banned, as will any sort of illumination or materials that can shatter, such as glass” January, 2022
It struck me that the first names were imprinted on white crosses leaving off the last names of the two boys who died at the site. I would have liked to know the last names. I wanted offer my condolences in some way. Maybe I had seen them riding bikes in the neighborhood just recently, at least until one of them earned his driver’s license.
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.
In Iceland, the first 24 hours after a report of domestic violence, the window of opportunity is open. During this window there is multidisciplinary response from police, social work, legal experts, and from the child protective service that establishes a safety plan and targets supporting the victim from her household, and sometimes away from the dangerous intimate partner.The first 24 hours after the report comes in is critical. Victims are more likely to accept help if definitive, comprehensive assistance can be offered right away. Within the window of emotional opportunity.
The Iceland Project puts together the package needed to bring charges by having a team of social service and law enforcement investigators who work together during the “call out”. One reason cases of domestic abuse seldom make it to court is because days and days go by before investigators can interview the victims. Some go to work, and some do not make themselves available to officers. “In Iceland, twice as many women are reporting incidents of domestic violence to the police than they were two years ago. This is due to an ongoing police initiative to provide women with better-timed and better-located assistance, which is bringing the problem out of the shadows” as reported in apolitical in 2017. I have called for regular aftermath follow-up in cases of domestic violence as a form of community policing. Officers work in pairs and stop during the next day to complete a check-in. Victims are contacted by their abusers or the family of the abuser or may be harassed via social media and made to feel like it is their fault this occurred. I had one victim tell me she was beaten up by her husband because the dinner she had prepared was late and unsatisfactory. I stayed in contact with her until the family quickly sold their home and moved from the area. That is pretty typical whereas the abusive partner wants to keep his wife under control. As soon as she makes friends he moves her somewhere else. Even if he takes a different job. Cases of domestic violence here in the United States skyrocketed during the pandemic quarantine that also gave birth to new higher rates of substance abuse and changes in behavioral health and well-being.
Police in Reykjavik, Iceland believe that detectives or senior police officers must intervene within the window – 24 hours from start of a call out, to put together a strong case and collect evidence. They work in teams of 4 or 5. The former protocol was often several days after the call and coincided with the honeymoon period. Bail conditions frequently fail DV victims as the abuser is often bailed out within 1-2 hours. Egregious cases of DV should be held without bail until a dangerousness hearing may be initiated. The result of this usually resulted in cases being dropped and victims staying in dangerous relationships. In theory, victims are more likely to accept support and provide meaningful evidence in the first 24 hours after their abuse. The window program is designed to link victims with programs such as housing, psychotherapy, job assistance, and financial means for a new start.
The Iceland Window Project also offers perpetrators the same assistance and supports that victims receive. Charges against perpetrators of abuse have gone from approximately 24 percent of cases to approximately 30 percent of cases. This is a modest improvement at best, according to the BBC podcast People Fixing the World who report that caseloads have increased dramatically since 2014. In spite of modest changes in prosecution numbers the Window Project’s fundamental aim is to reduce intimate partner abuse. It is a well designed project to support victims and keep them focused on the problem. Many practitioners believe that when a family is in crisis, such as when police are called to the residence, that great change is possible. There has been some movement toward prosecuting abusers even when the victim changes her mind. This is a primary reason for the Window Project’s success. By getting statements, photos, and other evidence there is greater likelihood that cases can go to court even when the victim chooses not to prosecute police are now doing this on behalf of bullied partner/victims. Children who are exposed to severe domestic violence are more likely to go on and become victims going forward. Or worse, they grow up and do exactly what their abuser did.
Here in the United States victims of domestic abuse are at great risk. Especially as they prepare to leave their abusive partners. Law enforcement is required to arrest perpetrators of DV whenever signs of physical trauma. That is generally understood by the police and the abusive spouses. But what happens just as frequently, law enforcement officers send the abuser away for the night or weekend. This makes things worse for victims and children.
Gabby Petito with boyfriend Brian Laundrie on cross country trek
By all appearances Gabby was a smart and loving companion. She wanted to impart her love for Brian Laundrie and the life she hoped they would have together using social media. They were engaged to be married but this would never occur. Now she is the victim of homicide. “The loneliest time in a life is being in the wilderness in the middle of night, with a person you once loved, now killing you. “If you scream for help in the wilderness and there is no one there to hear it except your killer, was there ever really a scream?”” Personal correspondence from B.F. Gagan. New website: http://www.arrestbrianlaundrie.com for details on the $25,000 reward for finding Brian Laundrie. Details on the site. There have been at least 11 questionable tips transmitted to the FBI tip line as of October 4, 2021. The media reports keep Laundrie’s picture in the news cycle. Just today someone reported seeing him on the Appalachian Trail where hikers go from Northern Georgia and finish at Mount Katahdin – the highest peak in Maine. Mr. Laundrie has done parts of the trail and is familiar with its isolation from society. He may feel that he can make a safe getaway while remaining off the grid. But someone recognized him today in South Carolina. Or a look alike.
Gabby Pitito is a case study for intimate partner abuse. From the outside, we saw a beautiful couple enjoying the wonders of the American West. Social media accounts updated with regularity bringing hundred or even thousands of likes. Gabby had a gift for creating an image. Only now have we learned the imagery was deeply flawed. Friends of the pair described Brian Laundrie as a jealous and controlling partner as described by Rose Davis, a friend of Gabby Petito.
Common among abusive partners is separating intended victims from their emotional support systems leaving them isolated and without friends and needed help. It is a common red flag in most cases of domestic abuse and more commonly, domestic violence homicide. In most cases the abuser has an underlying pathological jealousy and in some cases, delusions of his partner “hooking up” with someone whenever she is out of his site. Once while on duty with the police agency for whom I served, a jealous husband came crashing into town hall hoping to catch his wife in a tawdry affair while she stood in line to cast her vote in a 2015 election. He had been sending her text messages from the parking lot like “Where are you? Who are you with?” Ultimately, the man needed an escort out of the building and was given a trespass warning. For her part, she felt pangs of guilt, resentment, and fear for keeping him waiting. Shortly after Election Day the family moved away from town. It happens all the time.
“You can’t say that nothing can be done, because nothing will be done,” said Michael Sefton, a former Westbrook police officer who now works in Massachusetts and retired from the the New Braintree Police Department.
Women are kept from seeing friends and family members in an effort to disempower them of any sense of self. We now know this got worse during the pandemic where people were isolated anyway and those living in domestic fear became further inhibited and marginalized. By outward appearance Gabby Petito was terrified of her boyfriend at the time they were stopped in Moab, UT. This behavior speaks volumes about the state of the relationship just as Supervisory Agent Melissa Hulls said after they encountered Gabby and boy friend Brian Laundrie in late August 2021. I have reached out to Supervisory Ranger Hulls on two occasions without hearing back.
I am interested in hearing from few friends of Gabby Petito with their appraisal of what they saw happening to the couple during pandemic? The pair had been together over 2 years and managed to get through waves of pandemic only to be set free on the cross country junket. Both seemed physically fit and healthy. Had the pandemic and subsequent quarantine changed them in any way? How did the couple decide to embark on this journey? Whose idea was it? “Brian has a jealousy issue,” Rose Davis of Sarasota, FL said in the September 17, 2021 New York Post article. “I’m her only friend in Florida to my knowledge and that’s not because she can’t make friends, he just didn’t want her to have friends.”
Rose Davis says Gabby Petito and Brian Laundrie progressively got into “more and more arguments.”“He was always worried she was going to leave him,” she said. “It was a constant thing to try to get us to stop hanging out.” She previously described him as a controlling and manipulative boyfriend with jealousy issues, and said Petito had sometimes stayed with her to put some space between them according to the New York Post interview with Davis. These are among the most common red flag warning for DV and DVH.
Supervisory Park Ranger Melissa Hulls
The Moab city Utah police were called to a possible case of domestic violence. The interview was caught on officer worn body camera and showed Gabby in an anxious, tearful state. Any physical signs should have been met with arrest of the likely perpetrator whether or not Gabby wanted to prosecute. The police report from Moab indicated that the officer believed something was not right! But he did not move on that feeling or was untrained as to what he might anticipate could happen next. She reported that her mental health was not good. Why? Was she in fear that the relationship was fragile and taking an unhealthy turn.
Had the fuse been lit?
At the very least Gabby should have been assessed for changes in her mental health and given her history, law enforcement missed the chance to understand the underpinnings of her sudden loss of control and tearful anxiety? The care-free beginning of the exciting trip became suddenly serious enough to get on the local police department’s radar. A female national park ranger Melissa Hulls interviewed Gabby along side officers from Moab. She tried to advise Gabby that her relationship with Laundrie was had become toxic and put her in jeopardy. And just as quickly, Gabby and her fiancee fell off the police radar, leading Gabby into oblivion. Ranger Melissa Hulls saw the relationship for what it was and very likely feared for Gabby’s safety.
Most murder-suicides involve intimate partners (72%) and the vast majority of these cases are women murdered by intimate partners using a firearm (Violence Policy Center, 2015). I have experience with domestic violence and the various red flag warnings of terminal anger and have tracked the downward spiral of a sick relationship. “We knew the system had failed Amy Lake” said Brian F. Gagan, a former Westbrook police officer who helped research the first psychological autopsy report, “We did not know how.” as published in the Portland Press Herald 11/30/2011. We learned plenty over the course of 200 hours of interview data and considered only confirmable facts and presented the findings to the Maine Attorney General’s Domestic Violence Homicide Review Board in the state’s Capitol.
At very least, in the death of Gabby Petito, Brian Laundrie’s parents must be charged with harboring a fugitive, and aiding in the escape of a person of interest following a murder. The senior of the two responding officers in Moab is at risk of state decertification and may be charged criminally with statutory Utah failure to arrest. The officer will grope for the excuse that “neither party wished to charge” …which is not material to “Utah Mandatory Arrest”, according to Gagan. Gabby Petito’s body was found Sunday 9-20-2021 near an undeveloped camping area that’s surrounded by woodlands and brush, located about 30 miles (48 kilometers) northeast of Jackson, Wyoming. Her death was a murder according to the county medical examiner who has released very few details. Research has shown time and again that separating the couple for a “cool off” time out does little to stop domestic violence and often makes the violence increase.
Meanwhile, I have seen the “neither party wants to prosecute” narrative too many times in my law enforcement career until there is serious injury to one of the partners – usually the female. I am fortunate to have never had a case go to the terminal stage of DVH, aside from Albert Flick – a Westbrook, ME case from 1979, police detectives Ron Allanach and Wayne Syphers handled while I was in the Juvenile Bureau. Flick went on to kill again, within weeks of his release from prison for killing a woman while her children looked on. The domestic victim never wants to prosecute because they have been conditioned against doing so over the years and are afraid they will be killed. Those most in fear of being killed by their partner are likely reacting to a primitive warning signal in the brain. The gift of fear with a book by the same name highlights the subtle but powerful fear some women feel during courtship with violent men. So, when these fears are realized, the terminal stage of violence begins the spiral downward when a domestic partner can no longer bind his angry, jealous impulses, and need for control. In spite of what the intimate partner may report to be deep felt “love” for his wife, girlfriend, and innocent family members, it comes down to murder for the sake of owning the life of a spouse and his children and feeling justified in his action.
Gabby Patti’s cell phone has never been mentioned in published reports nor has her expansive social media reporting been studied. We have recommended that a safety plan be written omitting all social media whatsoever. Everyone has a cell phone that can be tracked using triangulation data from cellular towers anywhere there is service. People who are lost can be easily found as long as cellular service is available and phones are properly charged. This is significant given her daily social media focus. It is certain the FBI has received all cell server data from both phones. This has likely contributed to the warrant issuance and national search. The cellular data was added to toll highway data from Colorado and Texas while Laundrie was on his way to Florida from the murder scene in Wyoming. It is also likely now that the Bureau is encircling his parents who may have helped him escape. At least one of them will be convinced to tell the truth because I am certain they are now being interviewed separately. They now cannot lie to protect the killer since there is now a federal warrant on him. If they do, they are then arrested and charged with being complicit in Gabby’s death.
This case requires careful analysis once the murderer has been officially charged or found dead. By not doing so Gabby Petito’s death became another invisible young woman who wrongly believed she was safe and with the love of her life. After seeing the body worn police encounter, Dr. Ziv Ezra Cohen, a clinical assistant professor of psychiatry at Weill Cornell Medical College of Cornell University and staff member of New York-Presbyterian Hospital, told Fox News Laundrie and Petito were ‘both minimizing their argument’ and said the footage suggested the couple may have been high and having ‘a bad trip.’ (Fox News story). The psychologist cast doubt on the couple’s efforts to explain away the fight as caused by Petito’s OCD, insisting that the condition is ‘not a risk factor for violence.’ Petito expressed anxiety through her tears perhaps with an impending sense of doom.
‘People with OCD are not violent. OCD is not a risk factor for violence. If there was an altercation between them, certainly OCD would not be fodder for something that would lead her to hurt him,’ according to Ezra Cohen, MD. If anything having OCD is more apt to result in being victimized and not the aggressor.
Park Ranger Melissa Hills told Petito that her and Laundrie’s relationship had the markings of a ‘toxic’ one as reported in the Daily Mail. ‘I was imploring with her to reevaluate the relationship, asking her if she was happy in the relationship with him, and basically saying this was an opportunity for her to find another path, to make a change in her life,’ added Ranger Melissa Hulls in Moab according to writer Rachel Sharp published in the Daily Mail on 9-24-2021.
Domestic Violence Fatality Review Teams identify homicides, suicides, and other deaths caused by, related to, or somehow traceable to domestic violence and review them to develop preventive interventions (Dawson, 2017; Websdale, 2010; Websdale, 2012; Websdale et al., 2017). These frequently depend on careful communication among those who work within the field of intimate partner violence including members of judiciary, bail commissioners, district attorneys, law enforcement, and social services. Without definitive recommendations, review boards provide nothing to protect potential victims and do nothing to move the needle in the direction of improved safety plans and dangerousness assessments of potential murderers. Sadly, Gabby Petito will not grow old. She will not have children or grandchildren. She will not have a career. It is incumbent upon society to look at the similarities among cases of domestic violence homicide using case study data, aftermath review of facts, and structured interviews to intervene ahead of the secretive pattern of control, abuse, sexual violence, and murder that happens much too often and flies below law enforcement radar. By doing so, victims build new lives with safety plans and legal contingencies for those who violate those orders of protection.
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.
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.
“Today police morale and emotional health have hit rock bottom, he said, because of a number of factors, including botched policy-making when it comes to their career path that doesn’t take into consideration the officer’s needs and desires.” Bangkok Post December, 2019
And the year 2020 was not any better and very likely triggered added stress and tension among the working wounded in Bangkok and beyond. Shortly after I visited Bangkok, in early 2020 a member of Thai Army service in the Northern Province went off and killed his superior officer and over 20 people in his community. Very rare in the Thai history. My former Chief and I had met another commander from the Northern Province detail and liked him a lot. He smiled and seemed confident before returning to the Northern Province. Gun violence in Asia is rare and mass shootings are more rare still.
Next came the virus. Thailand got out in front of the contagion and closed things down and required both social distancing and masks. The total number of cases per 100,000 souls is much less than here and most other places.
Meanwhile, Thailand is offering a softer, gentler service to those officers who sign on to be law enforcement officers trying to accommodate the needs of the police service.
A new paper was just published in the Journal of Police and Criminal Psychology that has to do with high rates of depression in some police officers. It is written by Emily Jenkins (2019) who is a biostatistician and epidemiologist at the National Institute for Safety and Occupational Health in Morgantown, WV. Her co-authors include John Violante who himself is an epidemiologist and former New York State Trooper now researching police officer health and suicide. Basically, the authors say there are factors in personality and behavior that serve to reduce the new incidence of depression in LEO’s and to reduce the associated physical debility that may be co-occurring in cases where a history of depression was previously reported. One might see this protection as a ballistic vest for emotional health and career hardiness. High resilience leads to career success, satisfaction, and reduced likelihood of developing depression. Resilience refers to adaptability and flexibility in dealing with stressful situations. Resilience officers are able to tolerate highly stressful situations without becoming debilitated by stress and negativity.
I find the study interesting but it doesn’t connect with the troops in the field. For example, one feature listed as helpful against depression is “active coping” that includes things like agreeableness, conscientiousness, and having social support. Understanding protective factors leads to understanding who is most at risk of developing depression. The goal is to reduce depression among LEO’s and lessen the long-term impact of depression once it has been diagnosed. The paper cites links to depression and poor coping skills to personality features such a high neuroticism and low conscientiousness and low extraversion. These variables may lead to higher risk for substance abuse, reduced hardiness, and a host of physical signs and symptoms. These personality features are the biomarkers of chronic stress and its harsh consequences. They make sense to me but I rarely encounter a police officer, or anyone else for that matter that actively thinks about the core set of personality features that have defined them throughout life.
Officers across the country are being trained in peer support and crisis intervention training. At the Direct Decision Institute we are providing a variety of training programs designed for this same issue – increased officer hardiness and reduced risk of burnout, depression, and suicide. These are intuitive concepts and when talking with active duty LEO’s, I feel like the rank and file understand the words they hear but rarely will an officer offer up a personal example of times he or she may have had behavioral health issues. I have heard officers become very emotional when telling the stories of friends who have suffered with mental illness but rarely a personal story.
Two recent exceptions to this notion are Sergeant Mark DiBona, a recently retired sheriff’s department officer from Florida and Joe Smarro, an officer from Texas who is recently featured in an outstanding documentary entitled Ernie and Joe released in May, 2019 with great acclaim. It should not be this way and there is still great secrecy behind the veil of police service. It takes great courage to share personal struggles and one’s private experience. Police officers are most uncomfortable with this. Officers who are signing up for CIT and peer support courses are carefully chosen and may be more open to personal self-disclosure exhibiting greater positive coping skills, hardiness, extroversion and emotional resilience.
In order to reduce stigma associated with law enforcement behavioral health issues all members of the police service need greater self-awareness, openness to self-disclosure, and understanding of the effects of repeated exposure to violence and its broad ranging vicissitudes. This is nothing new and is being taught in academy training. Police psychologists who provide pre-employment screening should analyze the test data carefully and avoid selecting men and women who are most at risk of developing depression and who are outgoing, confident, and emotionally sturdy.
Among the most dramatic and menacing forms of mental illness are the psychotic disorders. These include people who have uncontrolled paranoid schizophrenia, bipolar disorder, depression with psychotic features, substance intoxication, and perhaps intermittent explosive disorder. Violence is not associated with mental illness per se. There are factors that increase violent behavior among those who are mentally ill including persecutory ideation like suspiciousness and fear, and co-occurring alcohol dependence. The most important way in which to reduce violence among citizens who are mentally ill is to provide some form of treatment to them. Those who go without substantive treatment including psychotherapy are at greatest risk for becoming aggressive or violent according to Coid et al. (2016). These are the citizens who fly above the radar and are seen pacing the street corners in cities everywhere reciting from some unwritten preamble. People walking avoid eye contact further pushing them to the margins of civility. Eventually, the bottom falls out and the preamble comes to an incoherent end. Either they move on or they are picked up for evaluation.
There are even greater numbers of psychotic people living under the radar. Making their way in society, flying by the seat of their pants. These people are often cared for by family members including elderly parents. When they relapse or “go off the rails”, caregivers often need the help of police to gain compliance with their loved ones. Sometimes the police are called to restore the peace and compel the emotionally disturbed person into treatment. For those individuals who relapse and are substance dependent i.e. alcoholic, the risk for violence is elevated. These people require special understanding and sensitivity in order to establish a trust and to help them see their behavior patterns and risk taking behavior for themselves. No easy task.
More recently, meta-analyses and case register studies concluded that psychiatric disorders are associated with violence, but that the relationship is largely or entirely explained by comorbid substance misuse. Fazel et al. (2009)
Fazel S, Gulati G, Linsell, L, Geddes, JR, Grann, M. (2009) Schizophrenia and violence: systematic review and meta-analysis. PLoS Med. 6: e1000120.
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