“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

Losing Saffie: The agony and loss of a precious little girl who was calling for ‘mum’ when mortally wounded

8-year old Saffie-Rose Roussos killed in Manchester, UK suicide attack

There are few things that I do not believe I could emotionally survive, like the loss of my spouse, employment, and physical and mental vitality. Certainly, the death of a child is among the worst of all human experience for any parent at any age. This story is a heart wrenching, story of depravity and loss. To this day, the loss of one of my children would leave me shattered, angry, and helpless. I hope these individual stories will all resonate with our humility as human beings. 

The chaos and emotion evoked in mass casualty events such as the Manchester, UK bombing, Boston Marathon bombing and the Sandy Hook, CT Elementary School mass shooting leave searing memories that take months to years to process.  We are reminded of the overwhelming sadness we feel when looking at photographs of people we know are no longer with us. The loss of a child is among the more gut wrenching experiences families can ever endure. Meanwhile, members of law enforcement face multiple victims including young children like Saffie-Rose Roussos during large scale mass casualty events that forever leave their marks. I am working with a former paramedic which was dispatched to a motor vehicle crash in 1990 where a family walking across the street was struck by a vehicle being pursued by law enforcement. The first victim he came upon was a 4 year old girl who had obvious signs of death that he cannot shake 30 years on. These next stories are similarly evocative.

 I recently came upon the story of the death of this little girl in Manchester, England. Her name was Saffie-Rose Roussos. From the sound of the description of Saffie, she was a special little girl with an enchanting wit and precocious love of life. All children are special and we recognize the curious joy through which they live each moment and we cherish every nuance. 

On the night of the bombing, Saffie was attending a music concert with her mother and sister when a suicide bomber detonated his bomb in Manchester, UK.  To see Saffie-Rose, one is compelled to ask whether or not there is a higher power? and if so, how could he allow this little girl to be in harms way? Saffie Roussos died on May 17, 2017 asking for her mum and wondering aloud if “she was going to die?” What child should ever ask this question? It evoked in me a tortuous and unthinkable picture of helplessness. But it was far worse for those emergency responders who were called upon to care for Saffie as her life came to an end that night along with the 21 other victims of the terrorist attack. No person who has ever been dispatched to a mass casualty event, like the Manchester bombing, ever comes away without a substantive chink in the veneer of their emotional core. Many in EMS and cops alike quit after mass casualty events.

The story of Saffie-Rose Roussos brings together good and evil and the ruination of one tiny life, one family, one city, one country, and illustrated the abject courage shown by the youngest of 22 victims that night in May, 2017. For this reason, I am sorry for not just the victims of the blast, like Saffie-Rose, and her family. They are devastated to this day, as I would be. But the heroic efforts of first responders who were called upon to provide life saving measures for this child and the hundreds of others wounded in the bombing. Without a doubt, all experience the deep sense of loss and failure at not being able to provide advanced trauma care for Saffie, so that she might live. “Losing a child feels like the ultimate violation of the rules of life” according to HealGrief.org an organization that guides parents through coping with the death of a child. In this case, Saffie is said to have been conscious after becoming injured but could not be saved given the resources available in the chaotic aftermath of the explosion. The protocols call for rapid triage of the scores of people needing help and this is done in the minutes to hours after the event. It is very likely, Saffie did not have the advanced life support needed to manage the hemorrhagic shock she sustained from massive loss of blood. The human body will compensate for loss of blood only until, in shock, it can no longer maintain blood pressure. Survival is measured when fluid can be replaced and loss of blood can be stanched. In children, this compensatory window is much more tenuous and short lived. 

When I worked as a LEO we were taught techniques for trauma intervention that we were told might save our own life or someone else’s life one day in the event of a shooting or massive trauma resulting in life-threatening loss of blood volume. By using a properly place tourniquet, rescuers can stanch blood loss at times of massive trauma such as from a bomb blast that took the life of 8-year old Saffie-Rose Roussos of Leyland, Lancashire in UK. Saffie was killed while attending a concert in Manchester, England in May, 2017. She was the youngest of 22 people killed on the night of May 17, 2017 when a suicide bomber Salman Abedi blew himself up in the lobby of a Manchester concert venue. Terrorism. 

“Medically trained people were with her. And she was asking for help. She knew what was happening. And she bled to death.” BBC 2021. “How do we carry on living with this information? How can we carry on breathing with this information?” asked Saffie Roussos’s father Andrew Roussos. BBC Judith Mortiz report January 17, 2021

BBC Judith Mortiz report January 17, 2021

Saffie’s father Andrew described his described his daughter as a “perfect, precious, beautiful daughter” who “melted people’s hearts” with those big brown eyes,” adding: “It’s like the best artists got together and drew her from top to toe.” according to a story in the BBC that was published during the public inquiry into the bombing last year. It is likely that the Roussos family is feeling the injustice of Saffie’s death. Anger is part of loss and healing and often is unresolved years after the traumatic loss of a child. Especially given the despicable nature of what caused Saffie to become gravely injured.

 All bereaved parents lose a part of themselves and often require months or years to understand the extent of their grief and anger.

“I did die that day, inside I’m dead. My heart is so heavy, it weighs me down” said Lisa Roussos, Saffie’s mum, now 3 years on. The Roussos family feels the loss of Saffie-Rose every day. 

Lisa Roussos

The immensity of traumatic loss was never more palpable than in 2012 when the Sandy Hook Elementary School in Newtown, CT came under attack by 20-year old Adam Lanza. Lanza first killed his mother with whom he lived and next drove to the largely unprotected elementary school and opened fire, killing 20 first-grade children and 6 adults trying to protect them.

Adam Lanza, 20, committed one of the most hideous acts of murder in history and is forever described as pure evil. Yet he was evaluated at the Yale University Child Study Center in New Haven. He was seen by a clinical psychiatrist, the report states. Ostensibly, the evaluation “purportedly to determine if Lanza had Obsessive Compulsive Disorder in the context of a putative diagnosis of Asperger Syndrome” in a piece written by Aaron Katersky and Susanna Kim in 2014 about the Newtown Massacre. Adam Lanza’s own father said “you cannot get any more evil” when talking about his son in the months after the shooting. Lanza openly wished that his son had never been born, raising an ironic specter between the loss of a child and being unable to love a child who commits unthinkable violence and died in the process. What possible conciliation may be find in his public statements months after the massacre? There is no denying that the Newtown shooting is among the most horrific and despicable violent crimes of the 21st century. No one will ever forget that December morning and the disbelief and horror it instilled. Other acts of violence toward children are documented. This is by no means a complete chronology.  

Perhaps the greatest sporting event in the United States takes place every April, ending on Boylston Street in Boston, Massachusetts. Martin Richard, 8, a child watching the Boston Marathon in 2013 was killed by a pressure cooker bomb filled with ball bearings, marbles and other shrapnel that was a homemade bomb made to kill and maim unsuspecting families watching the annual running event. Hundreds lost arms and legs in the two bomb explosions. 

Martin Richard, age 8

Martin Richard was a special child.  He is not shown in these bombing photographs. His parents have gone on to honor him with annual community events geared toward raising funds for parks and other community projects. In all, over 300 people were injured in addition to the initial 3 people who died in the bombing – including Martin. “The minute the defendant fades from our newspapers and TV screens is the minute we begin the process of rebuilding our lives and our family.” according to a Richard family statement in the Boston Globe as the Marathon bomber Dzhokhar Tsarnaev was being tried for the murder of Martin and 2 others on Patriot’s Day in 2013. For their part, the Martin family spoke out against the death penalty which was handed down to the surviving marathon bomber who was captured in Watertown, MA after a 4 day manhunt just a few miles from where they murdered MIT Police Officer Sean Collier in their effort to escape. 

We are all enormously impacted by events such as these and are left feeling sickened by the shear numbers of injuries and deaths.  Saffie-Rose Roussos, Martin Richard, and 20 kids at Sandy Hook Elementary School, 17 teens at Stoneman Douglas HS, and 32 students and faculty at Virginia Tech were all victims of violence and we should never forget these events and so many more, in human history.  The families remember the names and the horrors of the day.  The sadness of these losses makes our heart’s bleed and ache for all those who have lost a loved one to violence.  Even when you are the angry parent of a child you wish had never been born, a further violation of the rules of life.  No person who has ever been dispatched to a mass casualty event, like the Manchester bombing, ever comes away without a substantive chink in the veneer of their emotional core.

___________________________________________

AARON KATERSKY and SUSANNA KIM (2014) 5 Disturbing Things We Learned Today About Sandy Hook Shooter Adam Lanza. November 21, 2014

Family Of Martin Richard Opposed Death Penalty For Dzhokhar Tsarnaev, 2015. CBS TV Boston TV July 31, 2020.

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.

ca-times.brightspotcdn

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.

 

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.

Risky business: Faucci will not vote against the virus

The Corona virus has taken over 120,000 American lives since it began its tornadic viral defoliation of senior citizens and others with preexisting conditions in the Spring of 2020. The virus caught Americans unprepared. Everything has changed. The impact of the virus has been like a tsunami wave around the world whose point of origin is the giant industrial city of Wuhan, China. Only now are countries like Brazil being decimated and will soon top the United States in total cases and deaths. Countries who went into immediate lockdown were less effected like Norway, New Zealand, and Canada. The United States waited too long and the virus took hold. 

States here in North America, like Georgia, Arizona, and California, who grew weary of the economic impact of the virus and put forth ambitious reopening plans are now seeing record numbers of cases for the first time. The rate of infection is now being felt among younger citizens without pre-existing infirmity. 

Concerns about negative secondary outcomes of COVID-19 prevention efforts should not be taken to imply that these public health actions should not be taken,” wrote the CDC in one of its briefing statements. Secondary outcomes include the broad range of emotional responses to the virus including depression from loss of loved ones, sudden unemployment, increasing substance abuse, threat of homelessness, anger and existential anxiety from loss of control and loss of purpose in life. “However, implementation of supports should include a comprehensive approach that considers multiple U.S. public health priorities, including suicide prevention.” 

The Psychological toll of pandemic is beginning to show after festering for 3 months. The loss of employment, fear of foreclosure, food shortages, price gouging, addiction, and family conflict each increase the bonifide stress associated with the disease and its impact on the human family. People are becoming rattled. The President understands this and wants to exploit the opportunity by holding a campaign event. Trump brushed off concerns about the virus ahead of his highly anticipated rally in Tulsa, Oklahoma, because the number of cases there “is very miniscule”, despite the state’s surging infection of according to a report in the Boston Globe.  Instead, the rally was miniscule and embarrassed the President. 

Top physician and epidemiologist, Anthony Faucci has stated that given the unprecedented and unpredictable nature of Covid-19 that lessening of current social distancing protocols, the use of masks in public, and contact tracing are the best hope for keeping the number of new infections trending downward and to lessen the number of people who die from Covid-19. States who reopen for business without these same precautions are at risk for spikes in cases and more death. Since mid May we have heard from Dr. Faucci less and less as the White House has tried to imply that these concerns are unwarranted and there is “very little of the virus left”. 

President Trump, himself something of a germophobe, has put the needs of the campaign before public health and safety for the sake of his raucous and fervent base. In doing so, he will create a campaign spike that will be measured by new cases and deaths in the next 3-6 weeks time. That is on him and the courts who failed to put limits on the event or cancel it all together in Tulsa, Oklahoma on Saturday June 20. Since February, the president has not taken the pandemic with the kind of leadership that demonstrates his understanding of the virus and respect for those who have succumbed to the disease. 

Meanwhile states like Georgia, Texas, California, and Florida are having thousands of new cases because governor’s of those states have failed to heed the warnings of Dr. Faucci and others. The sudden conflagration of new cases is not the second wave that we have been warned about. The jump in cases correlates with opening businesses without any adherence to protocols. See Tulsa, OK. 

In Florida, the average age of new cases who are hospitalized has dropped to 37-years old. “Those thousands of new cases also signal that, in a week or two, some portion of those people will show up in the hospital, and, about a week after that, a number of them will be dead, even as clinicians have learned more about treating severe Covid-19” said the Boston Globe. For his part, albeit in a greatly reduced capacity, Dr Faucci predicts that a tidal wave of infections is coming unless we do what most medical experts agree starts with respect for social distance recommendations, sanitary hand hygiene, and mandatory quarantine for those who test positive for the virus or are feeling unwell.  

We all know this by now, and it is hard to swallow unless you are among those people who claim to have super immune functioning and refuse orders to wear a mask in public?  Sadly, many will become infected and go on to infect others, unwittingly, all the while they feel nothing and are emboldened by the President who insists the risk of getting the virus at a campaign event is miniscule. Perhaps some readers of this post or others like it do not believe the numbers and chalk it up to fake news.

The emotional impact of the virus has yet to reach its peak. But the racial unrest may be one indication that many are becoming unhinged including a small number of law enforcement officers who lack empathy and understanding of the human effects of stress on unconscious bias and veiled bigotry.  Faucci is getting on the virus. Let us leave the prognosticating to the scientists who are watching the numbers and tracking those who are carrying the virus without symptoms, and may not know it yet. 

 

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

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

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

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

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

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

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

Lorna Breen, M.D.

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

NBC News profile of Dr Breen

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

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

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

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

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

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

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

Benchmark behaviors for healthy police service

Law Enforcement flag

What are the bench-mark behaviors that are reflective of healthy police officer career development? How does a young man or woman go from a squared away academy graduate to an over burdened, irascible and embittered mid-career cop? There is a growing literature that suggests officer behavior and law enforcement culture become instilled in the field training process that takes place immediately following successful formal classroom training. The answer to the question about officer embitterment is a mystery but after spending time with members of law enforcement in Chicago in late March 2019 it begins to become apparent that police officers grow and remain productive in an environment of support: both within the organization and within the community in which they serve.

There are factors intrinsic to law enforcement that detract from career satisfaction like the risk of personal harm or death, career ending injury, time away from family, shift work, and forced overtime. This is a well known set of stressors that officers learn shortly after signing on. But things that may be unexpected include the quasi-military chain of command that often stifles education and innovative thinking, professional jealousy, arbitrary executive orders, the lack of opportunity to participate in policy making, nepotism among non-civil service personnel, and the lack of support for the sacrifice made by the field qualified troops for physical and behavioral health injuries. The period of field training differs from job to job. Field training picks up where the academy classroom education leaves off. Newly minted LEO’s all must undergo field training and are assigned to a single field training officer (FTO) who provides on-the-job training about the realities of frontline police work and closely monitors officer behavior and responses in the field.

Field training usually lasts between 12-18 weeks and was first initiated in San Jose, CA in 1972 according to research published in 1987 by McCampbell of the National Institute of Justice at DOJ (1987). “The primary objective of the Field Training and Evaluation Program (FTEP) is to ensure that all probationary police officers receive optimal field training, predicated upon staffing the Field Training Officer position with qualified officers, and to ensure through proper training and evaluation that only competent, motivated, and ethical individuals become Chicago police officers” as published in the Chicago PD Field Training Program and Evaluation Standards (2018). Field training officers have specific training in mentoring with an understanding of the demands of “street work” and the transition from classroom recruit to patrol officer. The FOR training process lasts several weeks as seasoned veterans learn how to be mentors and evaluation the training needs of individual probationary officers. 

The selection of FTO’s differs from department to department and has implication on long-term officer success. Attrition rates exceed 25 % under the FTO’s leadership and tutelage in many agencies. FTO’s can be expected to experience training fatigue and should be permitted time between assignments. “Dworak cautioned about agencies falling into situations in which they over-work their FTOs, resulting in diminished quality of work, and subsequently, decreased value delivered to the recruit being instructed” Wyllie, 2017

“The FTO is a powerful figure in the learning process of behavior among newly minted police officers and it is likely that this process has consequences not only for the trainee but for future generations of police officers that follow.” Getty et al. (2014) There is little standardization of training protocols aside from FTO catechizing war stories day after day with tales from the street followed by endless inquiry over possible decisions based on department protocol as the sometimes defiant FTO sees fit.

“New officers can be taught when to legally arrest and use force, but the academy cannot instill in each trainee the breadth of intangible, community, value-based decision-making skills that are necessary to manage unpredictable incidents in varying situations.” Getty et al. (2014)

FTO’s are closely monitored by the department training hierarchy and are required to provide daily observation report as to the demonstrated progress of probationary police officers toward developing competence in over 10 areas of police-related duties including decision making, judgment, court testimony, use of force, etc. At the end of each 28-day cycle FTO’s submit a detailed review of progress and potential deficiencies that arise. In Chicago, IL a probationary police officer (PPO) must complete a minimum of 3 28-day cycles with an FTO. It is known that FTO’s help to instill the police culture in PPO’s including policing by the book and prevailing beliefs and attitudes as they exist within individual agencies. I strongly believe that FTOs play a role in reinventing the police service and lowering the stigma associated with behavioral health and response to exposure to trauma.

Job satisfaction is greatest soon after the law enforcement officer is taken off field training and designated “field qualified”. Following the 12-18 week field training officers remain on probationary status for up to 2 years from date of hire. There is some thinking that FTO behavior rubs off on PPO’s and can impact career identity including misconduct later on long after field training has ended. Officer resilience depends upon solid field training with adequate preparation for tactical encounters, legal and moral dilemmas, and mentoring for career development, job satisfaction, and long-term physical and mental health.

Chicago Police Department (2018) FIELD TRAINING AND EVALUATION PROGRAM http://directives.chicagopolice.org/directives/data/a7a57be2-1294231a-bf312-942c-e1f46fde5fd8c4e8.html taken March 29, 2019.

Wyllie, D. (2017) Why the FTO is one of the most important police employees. Police One https://www.policeone.com/police-products/continuing-education/articles/338249006-Why-the-FTO-is-one-of-the-most-important-police-employees/ Taken March 30, 2019 Sun, I. Y. (2003a). A comparison of police field training officers’ and nontraining officers’ conflict resolution styles: Controlling versus supportive strategies. Police Quarterly, 6, 22-50. Getty, R, Worrall, J, Morris, R (2014) How Far From the Tree Does the Apple Fall? Field Training Officers, Their Trainees, and Allegations of Misconduct Crime and Delinquency, 1-19. McCampbell, M. S. (1987). Field training for police officers: The state of the art. Washington, DC: National Institute of Justice.

Officer distress in Bangkok, Thailand

“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.

Investigating domestic violence, predicting danger, and containing the anger

image_502116fc-2724-4fe0-bba0-c375c3c85c13.img_0646

Domestic violence homicide results when victims decide to move on with their lives and inform a jealous, insecure spouse that they no longer want a relationship. October is Domestic Violence Awareness month. The risk is greatest when victims decide to leave. At first glance one might say “Lots of people break up and do not murder their spouse and family” according to Michael Sefton shown in the photo on the left. That is a fair statement but it happens enough in the United States and elsewhere that it must be considered. Last week in Massachusetts a family was murdered because one spouse asked to be let go and people were stunned that they saw nothing to warn them of what was brewing.

“Domestic violence is not random and unpredictable. There are red flags that trigger an emotional undulation that bears energy like the movement of tectonic plates beneath the sea.” according to Michael Sefton (2016).

At what point does a potential begin to wonder whether she and her children are safe? We are lead to believe that abusive intimate partners cannot be held in jail unless they are in violation of an order of protection, AKA: restraining order. Time and again, violent and abusive partners stalk and ignore orders of protection – especially using social media tracking software and trolling social media sites like Facebook, Instagram, and What’sAp. It is all about control and instilling fear.

Restraining order’s are authorized by a district court judge who is on call night and day. They are not authorized unless substantial threat to the victim exists.  These orders are carefully crafted by investigating police officers whose reports highlight the exact nature of the violence and the reason the victim needs protection. “Protection orders are offered to the victim after the first sign of physical violence. It has been espoused that the police are not called until after the 6th or 7th episode of domestic violence” according to Sefton, 2016.  DV is a secret affair between members of a family who are often ashamed or embarrassed to come forward for help often until things gradually get worse – sometimes years into a pattern of violent dysfunction.

Research is clear that separating spouses for the night does not positively impact the level aggression and risk in the household as much as the formal arrest of the aggressor.  What usually happens is the police break up the fighting couple by sending the aggressor off to the home of a friend or family member – less often to jail unless there are obvious signs of abuse. Arrest is mandated by law when physical signs of abuse are apparent. It has become all too often the case that hindsight – taken seriously – may have saved a life. It is when they are attempting to leave that abuse victims are at greatest risk of death due to domestic violence as in the case of Amy Lake, a victim of domestic violence homicide whose case was carefully studied in the Psychological Autopsy of the Dexter, Maine Domestic Violence Homicide (Allanach, et. al. 2011) that occurred in June 2011. Lake’s husband and murderer was heard to state that “if you ever try to leave me I will kill you”. 

In research conducted by this author and colleagues we learned that as soon as police leave the scene the risk for violence is increased. We interviewed a man who served 18 years for the murder of his wife and he described in vivid detail how he used nonverbal coercion to manipulate his wife while being interviewed by sheriff’s deputies in Maine. He admitted that as soon as the police were out of the driveway he strangled and drowned his wife for calling them.

In the end, there is always at least a single person who knows what is about to happen and often does nothing to stop it. Whether this unwitting duplicity stems from the cultural belief that what happens behind closed doors is “nobody’s business” or the conscious result of intimidation should not change the law enforcement intervention in these cases. Early incarceration provides access to a viable safety plan for potential victims and in some cases, will instill a desire for change in the violent partner. In the meantime, substantive buy-in from police, legislators, judges, probation, and society needs to be fully endorsed for real change to happen and for safety plans to work and violent partners to be contained. 


Allanach, RA, Gagan, BF, Loughlin, J, Sefton, MS, (2011). The Psychological Autopsy of the Dexter, Maine Domestic Violence Homicide and Suicide. Presented to the Domestic Violence Review Board, November 11, 2011
Sefton, M (2016). https://msefton.wordpress.com/2016/07/20/the-psychology-of-bail-and-alternatives-to-incarceration/ Blog post: Taken October 9, 2019