parenting

The Psychological Impact of Pandemic: The best and worst of human behavior

Michael Sefton, Ph.D. Corona virus, domestic violence, Health Psychology, Human Behavior, psychological relevence, PTSD, Stress , , , , , , ,

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.

 

DVH in MA: 4-year old child begs father not to murder his mother

Michael Sefton, Ph.D. Childhood violence, Dangerousness assessment, domestic violence, domestic violence homicide, DVH, Human Behavior, Parenting, Relationships, Wanda Rosa , , , , , ,
  • “… He stood in the doorway with a loaded gun and talked about killing himself and/or children and myself. He was bringing up old verbal threats and I thought they were going to come true”

Amy Lake – July 2010

The words above were taken from a requested order of protection in the state of Maine in 2010.  The threats upon this victim and her family became a reality exactly one year to the day after this order was put in place in 2011. Amy

IMG_0771-1
Michael Sefton

Lake and her two children were murdered by her husband Steven Lake who killed himself as well. Immediately following the killings a Maine district attorney said “there was nothing we could have done to prevent these killings”. These were the words that triggered a team of professionals including myself to research the sequence of events that lead to this event.  A formal psychological autopsy was undertaken in 2011 following these murders and over 50 recommendations were generated (Allanach, et al 2011).

I am sick to my stomach as I write about another senseless killing of Wanda Rosa in Methuen, Massachusetts in late summer 2016.  The case resembles so many cases of domestic violence homicide – manipulation and control.  Ms. Rosa had a permanent order of protection but had recently modified the order to allow Emilio Delarosa to see the child they had in common. Why in the world would anyone allow Delarosa to see his son? He is no role model and the potential for terminal violence was readily apparent as depicted in the order of protection.  He expressed his intent to kill his girlfriend on more that one occasion.  Delarosa’s history of intimate partner violence had risen to the level of a permanent ban – signaling that the pattern of violence was undeniable and the red flag indicators for domestic violence homicide (DVH) were apparent in the eyes of the police and judiciary when the permanent order was granted.

Permanent orders of protection are rarely granted unless the pattern of violence was so prevalent and unremitting that the potential of harm or death to the victim and her family was unsurpassed as in this case.  It is known that Delarosa was manipulative and controlling of his girlfriend getting her to drop charges over and over and later alter the terms of the restraining order – ultimately resulting in her death.  Secondly, the person against whom the stay away  order is granted must have demonstrated a blatant indifference of the order of the court by having recklessly violated the order over and again. It should not have been altered.  In the past 18 months cases meeting these requirements (such as this one) have resulted in intimate partner violent deaths.  The Jarod Remy 2013 murder of Jennifer Martin is a despicable reminder of the need for change in cases of DV. Remy killed his girlfriend by stabbing her multiple times as the couple’s 4-year old child bear witness. In spite of laws designed to reduce the likelihood of DVH Rosa was not adequately protected.

Rosa’s boyfriend Emilio Delarosa is on the run as of September 20.  He is accused of murdering his former girlfriend after years of abuse, strangled her to death as their 4-year-old boy pleaded with him to spare her life, according to court records. “No Dad” the child was heard to say over and over. As in the Remy case, the 4-year old witnessed his father choking  Wanda Rosa until she was dead.

“I suspect there is a strong likelihood that he too will be among the deceased in the coming days as is the common eventuality among those who commit the unconscionable, violence that manifest in this terminal event” according to Michael Sefton, Ph.D., director of psychology and neuropsychology at Whittier Rehabilitation Hospital in Westborough, MA.  When some men violate the permanent protection order it is the result of unbridled rage and defiance against a “system” they believe has failed or unfairly humiliated them said Sefton in a release. They are murderous and often turn their rage inward in an act of suicide. I would look for the triggers of what set Delarosa’s terminal rage into action.  It could be something as simple as being told he needed to have monitored visitation with is son or learning that the female was seeing another man – both conjectural on my part.  After the alleged killing Delarosa was heard to say “It’s over, it’s over, it’s over” when speaking to his sister.

“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 Sefton.  A psychological autopsy should be undertaken to effectively understand the homicide and in doing so contribute to the literature on domestic violence and DVH according to Michael Sefton who with colleagues published the Psychological Autopsy of a case from Dexter, Maine where a father murdered his child, estranged wife and ultimately himself (Allanach, et al, 2011).  In the days preceding the murder there are usually red flags or pre-incident indictors that people see that signal the intentions of the murderer.  These clues provide police and the judiciary with data to craft protection plans and are the commonalities found in cases of DVH across the state and across the world.  Some red flag behaviors signal the emergence of imminent terminal anger that can be seen in the social media accounts of intimate partners who go on to kill their spouses.  I am quite interested in the compelling reasons that Delarosa may have argued that resulted in the change in the permanent order of protection.  The outstanding Boston Globe article about the slaying is a sad reminder of the early warning signs of DVH.  All the red flags were present.  In a blog published in 2013 I list the tell tale warning signs of intimate partner homicide and the need for tougher bail conditions (Sefton, 2013).

The impact on the child will be lifelong. At age 4, children are developing their sense of gender identity in the setting of developmental growth, cognitive maturity, social functioning and continued individuation. Imagine the child who is reunited with his parent after a period of mandated protection due to DV.  He is now able to see his family and may be fraught with both excitation and fear.  It would be normal for the child to have fantasies of reunification of the family and perhaps self-blame for not having stopped the action of his father. Just like the daughter of Jennifer Martin and Jarod Remy this 4-year old boy will forever be reminded of the life he will not have.

Ronald Allanach et al., Psychological Autopsy of June 13, 2011, Dexter, Maine Domestic Violence Homicides and Suicide: Final Report 39 (Nov. 28, 2011), http://pinetreewatchdog.org/files/2011/12/Dexter-DVH-Psychological-Autopsy-Final-Report-112811-111.pdf.

Sefton, M. The red flags of intimate partner violence. Blog post taken October 2, 2016.

Sefton, M. Prior history of crime not predictive of DVH. Blog Taken October 2, 2016. post: http://enddvh.blogspot.com/2013/07/prior-criminal-history-used-to.

Juvenile Firesetting

Michael Sefton, Ph.D. Childhood violence, Human Behavior, Parenting , , ,

Godzilla
Drawing produced by child being evaluated for firesetting

Fire sometimes symbolic of internal chaos

NEW BRAINTREE, MA  It was once believed that playing with fire was a normal, developmental curiosity and could be expected.  Fire is a tantalizing and visually captivating phenomena.  It was once espoused that firesetting was symprtomatic of psychopathology that included cruelty to animals and enuresis.  This triad of emotional indicators was thought to symbolize unmet needs and perhaps frustrated infantile drives states.  The current reality suggests that errant use of fire material represents one of the most lethal expressions of childhood emotional turmoil and unbridled conduct.  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 drawings of some children reveal an chaotic emotional development that may be portrayed by the violence among characters as shown in the drawing here.  Each animal is drawn shooting fire or electric rays. The two main characters shown are Godzilla and Raptor who are engaged in a confrontation.  Each character brings his crew to help eliminate the opponent using fire and electricity.

Exposure to fire and role models

What happens when the child turns one? His parents plop down a birthday cake with a burning candle set alight.  While singing Happy Birthday the toddler sits transfixed as the waxy, flickering bulb melts before his eyes.  Some believe early exposure to fire coupled with significant role models who use and misuse fire material cast the first spark of interest in fire.  Curiosity in fire may be a normal childhood attraction.  But in most cases the normal enchantment with fire represents one of many normal wonders that parents may introduce to children as they grow and mature.  Meanwhile, just as one would not give a loaded firearm to a toddler, one cannot permit an unsupervised child to handle matches or lighters.  The interest in fire becomes a parents responsibility to nurture and polish with age.  This normal interest then foments in homes where the prevailing affective conditions permit – decreased emotional warmth, access to fire starting materials, an absent parent, and frequently domestic violence.  The inconsistent and unpredictable exposure to violence contributes to excessive and unpredictable behavior.

Psychologist are frequently asked to differentiate children who light fires because of normal curiosity versus those who light fire out of a more pathognomic underpinning.  I was once asked to evaluate a surviving 3-year old who lit a house fire killing his 4-year old cousin.  The tragedy of this case transcended 4 generations living in one household and rendered them emotionally overwrought. “Just as we will not put a loaded firearm into the hands of an untrained child, so too must we guard against the unskilled, misuse of fire”, according to Michael Sefton, Ph.D.

Juvenile arson is a serious crime and has life threatening consequences.  The cost to insurance companies is measured in the hundreds of millions of dollars across the country.  The loss of life even more costly in terms of the human toll enacted upon families where children light fires.  The truth is that all “fire play” may be hazardous and life threatening when fire gets out of control so access to fire materials like lighters and matches should be carefully limited.  Just as parents kid proof their house when the baby is born so too should they make a house or apartment fire safe from the curiosity of a precocious child.

The most ominous case of juvenile fireplay occur in homes with one or both parents absent from regular, direct nurturing of the child. Why children choose fire play over other forms of acting out is not clear. There tends to be two peak ages where the incidence of fire play is peaked: 3-5 years and 12-15 years. It is far more common in boys than girls but girls tend to light fires that include personal belongings, Any use of combustibles or incendiary devices is highly significant and requires professional assistance. Programs such as that offered by YOU, Incorporated in Central Massachusetts have clinicians who understand the dynamics of fireplay and can help families deal with the risks. See the link below for a sensitive look at one particular story from the midwest.

http://www.traumaburn.org/prevention/seanstory/misuse/index.shtml

“Just as we will…

Quote Michael Sefton, Ph.D. Childhood violence, Human Behavior, Parenting , , ,

“Just as we will not put a loaded firearm into the hands of an untrained child, so too must we guard against the unskilled, misuse of fire.”

Michael Sefton, Ph.D.

Fire safety is the responsibility of all adults. Curiosity in fire may be normal but so are many things that children cannot be allowed to use.

“Falling in with the wrong crowd”

Michael Sefton, Ph.D. Childhood violence, Human Behavior, Parenting ,

kids_images
Children need consistent, firm limits with allowance for individual choices that are unique to them, according to author Michael Sefton

In recent weeks there have been a host of noteworthy arrests of juveniles who committed crimes out of bordom including the beating of a 88 year old veteran who was murdered.  How can this happen?  In past generations, when teenage children were bored they play baseball, listened to music, or rode thier bikes.  Some believe adolescents are not equipped to deal with bordom and cannot tolerate having nothing to do.   Some say this is linked to a need for “instant gratification” and hunger for stimulation triggered by computer video games.  That is the subject of on-going debate.  People ask “where are the parents of these children?”

In Spokane, WA police have charged two 16-year old boys with first degree murder for the killing of Delbert Belton, a WW-II veteran.  People have said “there is nothing to do around here in the summer” according to an NBC News report.  The Spokane police chief has called for youth programs to help mentor adolescents and provide appropriate role models.  The uncle of Kenan Adams-Kinard, 16, believed his nephew had fallen in with the wrong crowd and now needed to be responsible for his actions.  Adams-Kenard is charged as an adult with murder.  In Fort Worth, TX, a 13-year old boy was arrested in June for murdering a 5-year old boy who was found bludgeoned to death.   And in Logan, Iowa, a 17 year old boy living in foster care is alleged to have murdered a 5-year old with whom he lived.  That child was found in a nearby ravine.  The motives in each of these cases are not readily apparent.

Michael Sefton, Ph.D., author of The Evil that Kid’s Do suggests that a greater partnership between parents and the community is needed to provide for the emotional needs of teens.  “Gangs and childhood violence result from a dearth of emotional resources and connection to others often compounded by exposure to domestic violence and child abuse” according to Sefton.  Families need greater support than ever but many are living in the fringes.  In The Evil that Kid’s Do, Dr. Sefton identified mentors, treatment for drug dependence, gang intervention, community religion, and keeping guns away from teenagers as possible action for keeping adolescents from becoming bored, angry, and marginalized.  It is true that children who are bored often become frustrated and look for things to do.  But healthy children fill in those blanks with prosocial activity – while angry, marginalized kid’s choose activity based upon underlying drives, tolerance and attachment.

As a police officer we are asked to come to juvenile court to present evidence and testimony in cases we bring forth.  Some are cases of intact families with good support and others may be single parent families and still others are foster families.  Would it surprise you if I said any of these family systems might have perfectly delightful children uninvolved in crime or delinquent behavior.  We see so many of these kinds of families.  In the same way, any of these family systems may produce a dangerous felon or drug dependent addict.  It takes more than an intact family to raise self-confident, curious children who attend school with an appetite for learning.  It takes a parental dyad that sets appropriate limits and model empathy, kindness, and social skills.  Children need to learn what is right and wrong and what behavior will be accepted as they develop.  All human beings make mistakes and should be taught how to succeed and shown forgiveness.