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.
It is well known that law enforcement can be called to the homes of domestic violence victims only one in seven occurrences of abuse. That means there are possibly 6 times when victims are traumatized by intimate partners to which LEO’s are not privy. Why is this? In my experience, perpetrators of intimate partner abuse are secretive and forbid their partners to call police. They are manipulative and want to control the interview such as when first contacted by law enforcement. They frequently act surprised that police were called sometime saying “are you sure you are at the right place?” But in reality they silently simmer, waiting for police to take the bait and run. Often back on their spouse as soon as they are alone. The entire basis for the relationship is all about coercion and control of one spouse over another. It all starts as secret manipulation fueled by jealousy and insecurity.
Many victims of DV are coerced to feel afraid of calling for help. Police need to see all members of a household when called to a case of domestic assault. This bullying by perpetrators results in a pattern of threatening and control that is coercive to victims who learn to remain silent, in spite of fears of being killed. Red flags are often missed with the arrival of police officers as intimate partners pull it together trying to avoid angering their tormentors who control by making veiled threats. These investigations sometimes require more than one visit.
Follow-up intervention is recommended once the dust settles. This is sometimes hard to achieve. Whenever an aggressor is taken to jail, whether for the night or weekend, contingencies for his safe re-entry must be negotiated. When the risks to spouse or family members remains elevated, then an order of protection should come together based on the details of the call and written so as to bring to life all documented red flags. Either way, the investigation is not completed until there is an understanding of what happened (why the police were called) and what comes next for this couple? Specific issues like: threats of death, forced sexual contact, physical abuse leaving marks, any kind of strangulation, threats with a firearm or other deadly weapon, and threats of suicide are all the details written into a protective order. These are big ticket items and raise a victim’s level of risk substantially and usually become part of a stay away order. Each of these crimes are a red flag warning to cops looking at charges for domestic violence.
Larger departments across the United States have experienced greater numbers of domestic violence since the initial quarantine in 2020. As the months went on adaptive coping broke down resulting in larger numbers of domestic violence with maladaptive coping behaviors such as: excessive use of alcohol, threats of physical violence, frustration, and boredom increased greatly. Some, like Portland, OR actually saw a reduction in officers assigned to the DVERT – the multidisciplinary unit that investigates DV in Multnomah, County, Oregon in which Portland is the County seat.
The Portland (OR) Police Bureau’s Domestic Violence Enhanced Response Team (DVERT) and Domestic Violence Reduction Unit (DVRU) have been reduced in manpower according to information poached from their website. They now have about half the number of officers they did 10 years ago – five officers assigned to the DVRU and two officers plus a Multnomah County Sheriff Office detective assigned to DVERT according to a 2015 Blog post written by Emily Green. With this staffing level, they have the resources to investigate only about 7 percent of domestic violence reports received by the department each year. In 2013, out of a total of 8,179 domestic violence reports, only the 586 most serious cases were assigned to the domestic violence unit. DVERT strives for a “best practices” model of interagency collaboration by coordinating several forms of intervention for domestic violence victims and offenders as reported on the department website. As of this writing no more recent numbers are available.
Other cities struggle with DV and its social fallout. In 2017, San Diego law enforcement received 17,306 reports of domestic violence. This number was four percent higher than the previous year, according to the Criminal Justice Research Division. There were eight domestic violence-related homicides in 2017 that involved current or former intimate partners. Domestic violence incidents involved a death in four other instances. Five domestic violence offenders killed themselves according to a domestic violence blog maintained by a local attorney in San Diego. Likewise, San Diego saw changes in the rate of DV during and after the pandemic. The Alliance for Hope in San Diego provides support for police investigating crimes such as strangulation with supportive end empathic care for victims of domestic assault.
I wrote about #24hourwindow project in my description of the Icelandic response to DV in Rejkavik and beyond. 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. I agree with this approach and strongly urge local agencies use it as a model. They work in teams of 4 or 5 as described in a BBC story. The former protocol was often several days after the call and coincided with the honeymoon period where violent partners try and kiss and make-up. Bail conditions frequently fail DV victims as the abuser is often bailed out within 1-2 hours. Egregious cases of DV, those particularly life threatening should be held without bail until a dangerousness hearing may be initiated.
To the un-trauma-informed investigator, many behaviors exhibited by someone who’s just experienced a traumatic event double as signs of lying. Behaviors such as an inability to remember the chronological order of events, nervousness, avoiding eye contact or of recalling sounds and smells with more ease than physical details about his or her attacker, are all the result of effects trauma has on the brain.
Emily Green 2015
Specially trained Portland (OR) Police Officers review and follow up on reported incidents of domestic violence. Their responsibilities include reviewing reports from the initial responding officers, assessing each case in order to prioritize incidents requiring follow-up investigation, making attempts to contact the victims and witnesses to obtain additional information, providing referrals to victims for appropriate services, and attempting to contact and arrest perpetrators of domestic violence. This should be done during an 8-10 hour shift or by the next regular day shift by law enforcement who understand intimate partner abuse and its dysfunctional, cycling nature.
“In Iceland, twice as many women are reporting incidents of domestic violence to the police than they were two years ago. I wrote about this a couple months ago and had reached out to the #windowproject @IslForce and the #Rejkavikpolice commander without much fanfare. Like Portland Oregon, Iceland uses a multidisciplinary unit that enters the case in call-out fashion by each discipline rolling on scene called the 24 hour window project. 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. Some victims are contacted by their abusers or family of the abuser and can be dissuaded or intimidated not to press charges. This resumes the honeymoon and cycle of violence is renewed.
In Maine, Texas, and across America, the criminal justice system – including prosecutors, too often fail to protect victims of domestic and family violence from their abusers — even when the “red flag” warning signs are obvious as they were in both these cases. In this post, and the March 15 post, I talk about the importance of report writing and truly understanding DV on a visceral or gut level. To truly understand what is going to happen requires a realization that just below the surface may lie a wolf in sheep’s clothing.
In early 2021, the police in Austin,Texas were beset by a horrific case of domestic violence homicide. On April 18, 2021, a former police officer killed the family while picking up his son for a monthly supervised visit. The child’s mother encouraged these visits as important to the boy’s development and relationship with his violent and sadistic father. While exchanging pleasantries, the child’s father shot and killed his former wife and step-daughter. And he killed his daughter’s young boy friend and immediately fled. Detective Broderick was captured 20 hours later and is being held. Yes, the abused was a former law enforcement officer.
Common sense look at facts
Following the 2020 arrest for sexual assault of a child, Broderick resigned from the Travis County Sheriff’s Department. He was initially held on $100,000 bond. A family friend remarked, “I kind of had a feeling that this is where he was going, because he was lost,” she explained. “He lost everything. He lost his family. There was a protective order for a reason.” He was lost? That gives him the right to violently kill his former wife, adopted daughter, and her male friend? Many in our society are lost and do not go on to commit violent homicide.
The 16-year old child, who was among the victims, begged for a more restrictive supervision of her step-father who had been released from jail and was not required to wear an ankle bracelet after only a period of 3 months. An order of protection was brought against former police detective. There was a protection order in place but even the teen knew that orders of protection were “not worth the paper they were written on.”
“Because Mr. Broderick committed this heinous crime after he paid a money bond to be released on charges related to sexual assault against a child, Texas law permits his detention without bail.”
Wes Wilson, KXAN television Austin, TX
There is a case to be made for careful analysis of behavioral health functioning of abusers. That seems to be common sense right? But this sometimes does not occur. As a law enforcement officer in Massachusetts, I made an effort to introduce risk assessment tools to quantify a subject’s dangerousness. This is important but is not yet universally adopted here in Massachusetts. Nearly 10 years on, the psychological autopsy conducted in 2011, looked at the red flag warnings that are common to DVH everywhere – including the case in Austin. What brought my attention to the case in Maine was the purported prosecutorial impotence argued by Christopher Almy, the county district attorney, that there was “nothing that could be done to protect the victim, Amy Lake and her two children, from her estranged husband Stephen Lake. That statement was inspiring. Imagine if you and your family were depending upon the police to protect you as Amy Lake was? Everything that could be done was in place. But the protection order had no teeth. So Steven Lake snuck into the Amy’s home at 5 AM and staged a despicable murder scene, ultimately killing the children he claimed to love while Amy was forced to watch. Ending with her shotgun murder and is own death by suicide.
“Domestic violence is not random and unpredictable. There are red flags that trigger the emotional undulation that bears energy like the movement of tectonic plates beneath the sea.”Michael Sefton (2016)
In an article on the 8th Amendment regarding bail in cases of domestic violence, the Maine Law Review, first in 2012 and an updated second publication in 2017, cited the importance of carefully crafted conditions of bail especially among men who are found to have violated the conditions often by stalking and using social media to intimidate and contact potential victims also by trolling family members in an effort to locate estranged spouse and her children who may be in hiding. Both Amy Lake and Austin, TX mother of 3 expressed an interest in having children remain in contact with extended family in spite of pending serious criminal charges. This opened up access to the perpetrator to information about current living arrangements, employment, after school activities, and other potential clues that raised the risk of further domestic violence and ultimately DVH. In Austin, the victim expressed a wish to allow her estranged husband to have contact with the little boy – his son in spite of pending felony charges brought forth by the 16-year old step-daughter who rightfully feared for her life. Why was her fear ignored or minimized given her history of having been sexually assaulted by her adoptive father and his animosity toward her for reporting the abuse to law enforcement. He blamed her for his loss of career and status as a local detective with the Travis County Sheriff’s Department.
Firearms are a major cause of DVH and in every state are required to be taken from men with active protection orders in place. This was the default expectation in the two cases described here but in the case of Stephen Lake his arsenal of 22 firearms were not removed from his possession in spite of court orders. Similarly, the Austin killer was left with at least one firearm used to kill his family. Lake left 9 suicide notes many of which were rambling, angry tirades toward his wife and in laws. The Austin killer did not take his own life and was captured. This is atypical especially among law enforcement officers raising the specter of possible psychological analysis of his motives. This make the two cases in this post very different at this level. To what extent Texas authorities will endeavor to understand the events that preceded the murders remains unclear although, like the Aurora theater shooting, having a bad guy to study is rare. This means nothing, aside from an opportunity for personality and psyhopathology to be brought up at trial perhaps allowing Mr Broderick to avoid death row. There is not much in the public media since the crime and his capture. However, gaining a comprehensive understanding of the red flag warnings in this case is recommended and will add to the body of literature on domestic violence. Why he chose not to kill himself is itself a mystery.
Domestic violence homicide risk factors
Threatens to kill spouse if she leaves him – pathological jealousy
Actual use of firearm or other weapon anytime during domestic violence incident
Access to firearms even if he never used them – veiled threats
Attempt at strangulation ever during fight
Forced sex anytime during relationship
Unemployment of perpetrator
Stalking via social media – one or both spouse use social media to intimidate or garner support
Presence of unrelated “step” child in home
Spouse finds new relationship soon after separating
Low bail release from custody – high bail holds are essential in DVH mitigation
The 8th Amendment guarantees that people will not be faced with unfair conditions while in custody nor should they have undue hardship following adjudication. But when victim safety requires it then some modification of this rule must be considered. Dangerousness to possible victims requires some abusive subjects (usually men) be held without opportunity for bail at least as long as it takes to confirm that there is no immediate danger to possible family members. This evaluation sometimes takes hours to days to complete. In Massachusetts, here in the US, some courts have court clinics that can assess persons in custody for risk of suicide and dangerousness. The pandemic has reduced this option significantly and arraignments were conducted virtually for months. Many district courts work with domestic violence agencies on a regular basis sometimes in the court buildings near court rooms.
Not much has changed since the Maine Law Review cited our work in its 2012 in Nicole Bissonnette’s review of bail conditions following domestic violence. Ms. Bissonnette published second paper in 2017, in the same MAINE Law Review that gives some quick and easy fixes for the 8th Amendment conundrum as it pertains to domestic violence. It is a fact that victims generally do not call police when the abuse first begins. It is also a fact that if a victim has been threatened with death if she “leaves” or “asks for a divorce” then her risk is substantially elevated and a safety plan must be provided including an order of protection.
The 8th amendment guarantees that excessive bail nor excessive fines shall not be required when someone is in custody and when found guilty of a crime. In many cases of domestic violence assault, abusive spouses are released on personal recognizance – essentially no bail is taken. Abusers are required to show-up on the next court day (usually Monday morning) and answer to charges of assault, domestic abuse, or whatever the evidence shows. The 8th Amendment also specifies that punishment for crimes shall not be excessive, overly punitive or harsh. It is frequent that abusers may have no criminal record whatsoever. Given that fact, it is hard to argue for high bail in a case where the defendant is unlikely to skip out on an initial hearing. This is precisely the reason why officer reports must include detailed statements from victims and witnesses – especially children.
I agree in principle that bail should not be punitive but neither should a family be faced with constant fear and danger because of the arrogant defiance of an abusive spouse. People without means do not have money for bail and some individuals are unfairly kept in jail simply because they or their families do not have cash for release from custody. So, a person who may be unemployed and was picked up for shoplifting and has 2 prior arrests may have an artificially high bail so he sits for weeks in a county jail awaiting trial. There are times when dangerous supersedes the right to be released from custody. This requires close scrutiny for making bail conditions that reflect risk to community and red flags for individual families.
In the 2017 Maine Law Review, Nicole Bissonnette restated her 2012 premise that bail conditions must be considered carefully when it comes to letting violent intimate partners out of custody. Ms.Bissonnette smartly cited the work done by this author and colleagues that brought these issues into sharp focus (Allanach et al. 2012). The importance of orders of protection cannot be understated in preventing domestic violence homicide. “The purpose of this follow-up comment is to evaluate the existing (PFA) system and assess methods of improving outcomes while avoiding prohibitive fiscal impacts” according to Ms. Bissonnete, 2017. The process, structure and failings of the existing system will be illustrated by the tragic deaths of Amy Lake and her two children, who were murdered by Steven Lake, despite the PFA in effect at the time. It was this case that brought domestic violence homicide into national prominence and provided substantive recommendations for mitigating DVH. Information is often unavailable to bail clerks or even judges when PFA’s are needed most. Information such as whether the defendant has previously violated conditions of release, probation or other orders, including, but not limited to, violating protection from abuse orders according to Jennifer Thompson, 2004. When these factors are affirmed then bail conditions must be revised in real time accordingly. Substantial bail for violation of protective orders is but one of them. Some believe that having non-refundable, very high bail is the only sanction to prevent recurring violations of the PFA. The 8th Amendment informs that bail may not unfairly impact people without employment and those who do not have financial means to buy there way out of jail.
There are cases, as recently as 2021 where a protection order was denied and domestic violence escalated into death of the New Hampshire suspect and critical injuries to intimate partner who became the victim. A judge did not think a protective order was warranted. Similarly, in Austin, TX, a disgraced police officer shot and killed his step-daughter, the teen’s boyfriend and his former wife in April 2021, even after the teenage girl begged for a protective order with the option to hold the abuser in jail. Her fear was palpable. The shooter was required to wear an ankle bracelet for 90 days after which he was free to stalk his former family who were trying to move on. There were several flaws in the safety plan in this case that ultimately triggered the terminal event such as coming together for planned visitation so the former police officer could visit his son who was not murdered. In New Hampshire, a judge denied a protective order on the basis that the abuser had not been violent since 2016 although acknowledged that the man was coercive and controlling. The victim, Lindsay Smith, was shot and critically wounded in Salem, MA in November 2021. Her former boyfriend, who had stalked the victim for the years since the break-up reportedly said he intended to forever “turn her life upside down” died from a self-inflicted gunshot wound. This may have been avoided if the temporary restraining that had expired had been approved to become a permanent restraining order as the victim had petitioned.
The desire to mitigate police discretion in domestic violence cases stems, in part, from problems relating to “the inherent ambiguity of the police-citizen encounter in the context of domestic violence.”
Jennifer Thompson, 2004 Maine Law Review
The domestic violence literature suggests that after 5-7 beatings victims will reluctantly summon police – especially if they fear either they or their children are about to be murdered. The details Calais, ME case of domestic violence are being carefully guarded even today. It is known that Daniel Phinney, 26 was out on bail after being arrested and charged with domestic violence and criminal threatening in May 2013. At that point he must have both physically assaulted his significant other and threatened to kill or maim his family resulting in the charge of criminal threatening. Police are quick to say that Phinney had “no prior criminal history” perhaps in an effort to obfuscate public outrage evoked by the system of bail in Maine that releases violent abusers over and over again on low bail. Had anyone made an effort to determine the degree of risk posed by Daniel Phinney prior to his release? Had anyone registered safety concerns based on the defendant’s behavior and history? If there had been routine aftermath follow-up then this may have been a known fact. A psychological assessment of Phinney may have provided important details about his impulse control, substance use, coping skill, and proclivity toward violence and had been charged previously with domestic violence. Phinney was killed by police in a stand-off in Calais, Maine shortly after being released from custody.
The case is reminiscent of the 2011 Steven Lake homicide in Dexter. Lake had twice been released on bail before murdering his family. The medical autopsy concluded that “in spite of psychological counseling (the state) failed to appreciate the degree of anger and violence in Steven Lake”. He had also been charged with criminal threatening after holding his family at gunpoint as he drove home the point about how much he loved them but he could not let Amy move on.
Using a firearm in the commission of a domestic violence incident is defacto evidence of dangerousness and no bail shall be considered until such time as all firearms are collected and a viable safety plan is in place for potential victims including police protection.
Michael Sefton, Ph.D. 2021
I was a member of a team that conducted a psychological autopsy on Steven Lake that resulted in over 50 recommendations to the esteemed Maine Attorney General’s Homicide Review panel in November 2012. At first glance there appears to be brash indifference toward the court protection order and the failure to remove firearms held by the defendant. It is now important to study the case of Daniel Phinney and others, so we ma learn from the many red flags exhibited in the weeks prior to his death. These red flag events must lead to stopping and containments points in future cases of domestic violence and domestic violence homicide. No family should be kept in fear by a spouse whose loathsome behavior derails all human spirit and sense of dignity.
At what point does the well-being of victims and potential victims rise above the abuser’s right to bail?
Michael Sefton, 2014 on the 8th Amendment and PFA orders
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.
Police agencies expend a great deal of LEO resources dealing with citizens with mental illness. The Washington Post (2015) and the Boston Globe (2017) both did large feature stories on police use of force against mentally ill persons. The profiles were gut wrenching but only one example illustrated the emotional toll on law enforcement officers who are involved in fatal use of force situations. This fact fails to illustrate the emotional toll officer involved shootings has on member of law enforcement. The Boston Globe Spotlight Series entitled The Desperate and the Dead was published in 2016. I have written about officer involved use of force for over 5 years now.
The interaction between poly-substance abuse or dependence and exacerbation of underlying mental health symptoms is complex. It must be studied. The interaction of the two is sometimes lethal as reported by the Globe Spotlight team. The focus of mental health advocates and criminal justice experts nationwide is to provide options for jail diversion. Programs like alternative restitution have reduced sentencing and have not reduced the police use of force. Lethal force results as a function of the behavior of the subject. His capacity to listen and follow directions guides the force that will be used against him when confronted by law enforcement. It is impossible to utilize de-escalation techniques in all cases of police-mental illness encounters.
I have featured some very troubling cases including a case of patricide in Vermont. In that case, Kryn Miner, 44 was shot and killed by his son in 2014 after threatening his wife and stating that he was going to kill his family. Ironically, Miner and his wife has just returned from a wedding. Kryn Miner was intoxicated and had both PTSD and a traumatic brain injury. He was on a waiting list for care at the local V.A. Miner threatened his family with a gun a year before his death but the event was never reported to police. Current and former police chiefs said that without large-scale police retraining, as well as a nationwide increase in mental health services, these deadly encounters will continue. The loss of veterans from suicide remains a significant moral shortcoming.
“When officers are faced with a deadly situation, when there is a gun pointed at a cop, there is no time to go into mental health measures,” SFPD Chief Grace Gatpandan said in 2015.
Washington Post (2015) Lowery, W. et al. DISTRAUGHT PEOPLE, DEADLY RESULTS: Officers often lack the training to approach the mentally unstable, experts say
Gun violence is a public health problem. The American Medical Association is now recommending physicians ask their patients whether there is a firearm in the home. Especially among older adults, divorce and substance abuse contribute to the risk of suicide by means of a firearm. This information may raise physician awareness and set off warning signs especially in patients without social support. According to David Rosmarin, M.D. at McLean Hospital in Belmont, MA – Rampage violence or spree violence is rare but always sensational- “violence is the currency of what we do” so MD’s need to become comfortable with the conversation about violent intention. The serious mentally ill account for only 3-5 % of all US violence – substance abuse is a big factor in violence according to Rosmarin. Violent intention is frequently communicated in advance. “There were signs along the way that were ignored” according to Rosmarin. These signs may be important when building systems of care and training LEO’s who are expected to de-escalate dangerous citizens and with limited training.
“I called 911 so they could disarm him, not kill him,” Joan Hart told a reporter in 2007 after her suicidal husband, James, 65, was fatally shot by Quincy police in their backyard after charging officers with a knife.
Boston Globe Spotlight Team 2016
The quote about is heart breaking because the outcome of that call for help was not good. All officer involved shootings are carefully investigated as part of normal protocol. People fail to appreciate the impact the OIS has on the officers involved. No police officer leaves his house with the intention to get into a gun fight. “There will always times when police officers encounter those with mental health needs especially in times of crisis and social disorder. Training and education offer the best hope for safe and efficient handling of cases. A continuum of options for detox, dangerousness assessment and symptom management must be readily available – but sadly here in Massachusetts they are not” Sefton, 2016
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.
Two Capitol police officers have taken their own lives since the insurrection at the U.S. Capitol on January 6, 2021. This information came after the two officers spent 5 hours fighting the insurrectionists sometimes in hand to hand combat often being humiliated and threatened. Jeffrey Smith, a Metropolitan D.C. Police officer, and Capitol Police Officer Howard Liebengood both “took their own lives in the aftermath of that battle” of January 6, according to an article in Politico on January 27, 2021. A third officer, Brian Sicknick, age 42 collapsed while on duty the day of the attack. He died in the aftermath of the insurrection a day or two later.
The manner of his death has been determined to be natural causes. Officer Sicknick died from multiple strokes according to the medical autopsy. Some reported seeing Officer Sicknick being struck in the head with a fire extinguisher during the riot. The official cause of death was stroke – or cerebral vascular attack and it is well-known that high stress situations can lead to stroke such as an insurrection or even shoveling one’s drive following a snow. Sicknick was only 42 years old and in good health prior to the Capitol attack. Officer Sicknick was afforded the honor of laying in honor in the Capitol Rotunda after death. Antoon Leenaars, past president of the American Association of Suicidology, described the patterns of thinking among depressed or suicidal persons, and explained how the use of “psychological autopsies” can uncover the key elements that are present in many suicides. This is an important first step in the battle to change officer suicide to become more attributed to line of duty death. This determination is owed to many of these brave men and women who died as a result of the recurring emotional trauma to which they were exposed.
“Jeffrey Smith was still fighting to defend the building when a metal pole thrown by rioters struck his helmet and face shield. After working into the night, he visited the police medical clinic, was put on sick leave and, according to his wife, was sent home with pain medication. Smith returned to the police clinic for a follow-up appointment Jan. 14 and was ordered back to work, a decision his wife now questions. After a sleepless night, he set off the next afternoon for an overnight shift, taking the ham-and-turkey sandwiches, trail mix and cookies Erin had packed. On his way to the District, Smith shot himself in the head.
Smith’s wife Erin reported after her husband took his own life
“On April 2, 2019, PERF and the New York City Police Department took an important step to elevate the national conversation on police suicide and to identify concrete actions that agencies can take to address this public health and public safety crisis. Our two organizations hosted a one-day conference at NYPD headquarters that brought together more than 300 law enforcement professionals, police labor leaders, researchers, mental health care and other service providers, policymakers, and others—including three brave officers who themselves have dealt with depression, PTSD, and suicidal thoughts in the past and who were willing to tell us their stories” according to published executory summary 2019. “The NYPD is making use of psychological autopsies, a research-based approach that attempts to better understand why someone took his or her life. Following an officer suicide, personnel try to reconstruct what was going on in the person’s mind by systematically asking a set of questions, in a consistent format, to the people with the greatest insights into the person’s life and mind—family, co-workers, and friends.” The psychological autopsies contribute to the existing database of information about law enforcement suicide in general, and they help guide individual prevention programs and establish in the line of duty rewards for those whose death’s may be directly associated with their recent tours of duty as in the example of the Capitol officers who died immediately following the trauma of the insurrection where each of them was prepared to die.
The multiple deaths by suicide have renewed attention on another troubling and often hidden issue: Police officers die by their own hands at rates greater than people in other occupations, according to a report compiled by the Police Executive Research Forum (PERF) in 2019, after at least nine New York City police officers died by suicide that year. I was involved in the April 2019 presentation at 1 Police Plaza on the impact of LEO suicide as it related to the high incidence of police officer death by suicide. Police Commissioner James O’Neill gave an impassioned presentation imploring officers to get help and promising to “listen and eliminate stigma” of having trauma-related illness.
Regrettably, first responder suicide is generally not considered a line of duty death and as such, fails to yield the honor given to officers who die in car crashes, shoot outs, or other direct line of duty incidents. “Now, the surviving families of the courageous defenders of democracy, Jeffrey Smith and Howard Liebengood — who were buried in private ceremonies, want the deaths of their loved ones recognized as “line of duty” deaths”. These deaths lack the honor and pageantry that accompanied Sicknick’s memorial service in the Capitol Rotunda — Why is the distinction made between the many ways LEO’s die?
The denial of this recognition diminishes the honor of one man’s service and by doing so, fails every man or woman who puts on a uniform by saying “your experience is yours alone”. And even worse, it amplifies the stigma attached to law enforcement deaths at a time when all else has failed them.
Michael Sefton, Ph.D. 2022
The careful analysis of antimortem exposure and actionable behavior that follows and event like January 6 or September 11 draw the clear, indisputable facts that link officer suicide to line of duty traumatic exposure. The denial of this recognition diminishes the honor of one man’s service and by doing so, fails every man or woman who puts on a uniform by saying “your experience is yours alone”. And even worse, it amplifies the stigma attached to law enforcement deaths at a time when all else has failed them. I cannot stand by this exception to what may be obvious line of duty exposure and police officer death especially after 9-11 and after the Capitol insurrection. But it should in no way minimize the loss of life attributed to suicide when years of exposure have gone unnoticed and even unreported by a law enforcement officer.
After the September 11, 2001 attack on the World Trade Towers there was an increase in LEO suicide. Men and women who witnessed the enormity of the attack coupled with the deaths of hundreds of police officers and fire fighters lost the will to grudge onward by no fault of failure character of their own. They swam in the muck and got wet and could not recover from darkness that engulfed them. The psychological autopsy would quantify these wounds just as the pathologist counts entry and exit wounds from an ambush.
The juxtaposition of these facts cannot be ignored. Every one of the hundreds of police officers put their lives on the line as a result of the former president’s truculent narcissism. It would be a dishonor to the men who gave their lives by denying the causal underpinning of their deaths. Suicide by law enforcement officers exceeds the number of officers who die in in gun fights, car accidents, on-duty heart attacks, attacks by citizens, calls for domestic violence, and other police calls for service. “This fact thrust these most private of acts into the national spotlight and made clear that the pain of the insurrection of January 6 continued long after the day’s events had concluded, its impact reverberating through the lives removed from the Capitol grounds” as written in a recent Washington Post report. “It is time the District recognized that some of the greatest risks police officers face lead to silent injuries,” Weber said. “Why do we say that one person is honored and another person is forgotten? They all faced the exact same circumstances.” according to a report in the Washington Post by Peter Hermann in February 2021.
There are things that must be done when law enforcement officers die as a direct result of the the calls they take and the trauma they experience that directly results in their death. Neither of these officers would have died if they had not jumped into the crisis taking place at the U.S. Capitol. Both men were solid members of the Capitol and Metropolitan Police Departments and had no history of behavioral health claims. Neither officer was in trouble with finances, gambling or substance abuse, internal affair investigation, or marital trouble. In the days that followed, Erin said, her husband, Capitol officer Jeffery Smith seemed in constant pain, unable to turn his head. He did not leave the house, even to walk their dog. He refused to talk to other people or watch television. She sometimes woke during the night to find him sitting up in bed or pacing. Her husband was found in his crashed Ford Mustang with a self-inflicted gun shot wound that occurred on his way to the job.
Peter Hermann Washington Post 2-12-2021
Rioters swarmed, battering the officers with metal pipes peeled from scaffolding and a pole with an American flag attached, police said. Officers were struck with stun guns. Many officers were heard screaming into their radios “code-33” the signal for “officer needs help”. This usually is a signal bringing an “all hands” response to the scene of the emergency – in Metro DC, that would mean hundreds of officers would roll. Situations like this send chills down the spine of officers responding to calls for help – some are injured in car crashes racing to back-up officers in danger. It is always hoped that when the call for help goes out as it did that day that enough manpower will respond with enough force to push back on the crowd, however large. In this case, the crowd far exceeded the number of LEO’s available for duty and many officers expected to be killed by the mob.
The psychological autopsy is a single case study of a death event that serves to uncover the psychological causes of death. This study would answer these questions and establish an understanding of worst case scenario of frontline exposure to trauma and possibly offer insight into underlying history that may have been anticipated and stopped. Without its use men and women die alone and often flooded with shame and loss of dignity. When law enforcement officers take their own lives this careful analysis of the hours and days preceding their time of death is essential to understand. “From this information an assessment is made of the suicide victim’s mental and physical health, personality, experience of social adversity and social integration. The aim is to produce as full and accurate a picture of the deceased as possible with a view to understanding why they killed themselves.This would answer the question as to whether or not the deaths may be considered to be line of duty, as they must. Psychological autopsy is probably the most direct technique currently available for determining the relationship between particular risk factors and suicide” Hawton et al. 1998
The evidence on Crisis Intervention Team (CIT) programs is thin, in part because these programs vary widely, with some representing basic officer awareness training and others composed of full-fledged and well-funded co-responder programs. However, the evidence on the impact of de-escalation training, which includes instructing police in how to identify and respond to people in crisis, is relatively strong.
I have proposed a Behavioral Health initiative in conjunction with changes in police policy and transparency that has been the central posit of social clamor since the death of George Floyd this summer. The International Association of Chief’s of Police (IACP) has a broad-based Mental Wellness program it is reporting on its website that highlights the importance of this kind of support. “The IACP, in partnership with the University of Pennsylvania (Penn) and the Bureau of Justice Assistance (BJA)’s VALOR Initiative, is customizing a program specifically designed to help officers and agencies by enhancing resilience skills. The cost of such a program will reap rewards in the form of career longevity, officer well-being, officer morale, quality of community policing, and greater faith and trust in law enforcement in general. Without psychological autopsy systemic failures in training and support often go unnoticed leaving men and women without a life saver to hold on to.
This investigation is an individually designed case study that elicits a broad range of factual data regarding the antemortem behavior of a decedent in the immediate day or days leading up to the suicide. In this case, what are the events that transpired in the days before the two Capitol police officers took their own lives? The fact is that both men were exposed to incidents and participated in protecting the Capitol on January 6, 2021. Both men were engaged in hand to hand combat. It is known that the insurrection resulted in the death of a fellow officer and the deaths of 4 other people engaged in violent mayhem in which these men and hundreds others may have been killed. Both men believed the insurgency was potentially deadly to them or their fellow officers. The psychological autopsy is especially important when first responders and essential workers are involved and die soon after. When LEO’s and first responders are put in fear of death or see other officers being placed in the direct line of fire, are vastly outmanned, and have no way in which to stop an attack, they are at high risk for the “hook” that comes from an acute stress reaction and over time and soon becomes a monkey on the backs of so many fine men and women.
Some agencies, such as the Fairfax County, VA Police Department, are beginning to implement periodic mental health check-ups for their officers and other employees. The goal is twofold: 1) to “normalize” the act of visiting a mental health professional, thus reducing the stigma against seeking mental health care, and 2) to identify and address potential issues early on. (PERF 2019)
“This heroic sequence of behaviors is besmirched by the bias against mental health responses to events that would bring any one of us to our knees. Men and women of law enforcement walk in the darkness, always in death’s shadow. It is time to recognize these officers and help them and their families to know they do not walk alone.”
Michael Sefton, Ph.D. 2018 Direct Decision Institute, Inc.
Departments should consider flexible job assignments or adding exercise to work schedules as a way to release stress. Mental health should be regularly addressed at roll calls, and departments generally have to reduce the stigma — in part by acknowledging the deaths. According to Dr. Leo Polizoti at the Direct Decision Institute, Inc. in Worcester, MA, an annual stress inventory should be conducted as part of the official officer evaluation program. This may be easily done by tracking high lethality calls that may be followed by mandatory defusing/debriefing as close to high stress incidents as feasible. Officers in Worcester, MA are given paid time for these aftermath behavioral health sessions.
Hawton, K., Appleby, L., Platt, S., Foster, T., Cooper, J., Malmberg, A. & Simkin, S. (1998). The psychological autopsy approach to studying suicide: a review of methodological issues. Journal of Affective Disorders 50, 269–276.
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.
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 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.
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”
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.
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.