Stress effects all aspects of how we feel. There is no cure for human stress we must learn to modulate its impact. The only true adjustment is taking direct action to lower tension and unrealistic expectations. The other day I was so wound up with some much stress and tension I almost cut my 12-hour day short. Things settled down but not after an 8:30 AM crisis call from a patient living on Cape Cod. All at once, my day was diverted to needing to find a hospital bed for a client with a boat load of unrealistic anger and now suicidal ideation. Not easy. At this moment, I wish I could have gone home but there are scheduled cases who expect to be seen by me later in the day. I am only one clinician and have zero office help with some resentment. I cannot blow it off. Many have waited 3-4 weeks for one hour of my time. Everyone feels stress and some manage it better than others. For me, I work out in the home gym, and play ice hockey twice a week and I share time with my special grandson Parker who is now 3 and about to have a little sister join the family. But all too often, the main stress buster for me is a glass of scotch at 6:00 PM. I try to keep it to one, but this is no guaranty and I know this is not an effective way of lowering stress.
When the body is stressed, muscles tense up. Blood pressure and cortisol levels go up. This happens because stress releases the autonomic fight/flight response that activates when we are under threat. A sudden emergency, whatever it may be, can send us into the never never land of anxiety, fear, and autonomic arousal causing a variety of physical responses and inflammatory conditions. Headaches, neck pain, and upper body tightness all are the result of omnipresent stress. Muscle tension is a reflex reaction to stress—the body’s way of guarding against injury and pain. With sudden onset stress, the muscles tense up all at once, and then release their tension when the stress passes. For some individuals under great stress this sometimes does not work. “Chronic inflammation is a deleterious to health, resilience, and job satisfaction.
“Learned resilience can be taught and leads to reduced stress and psychological hardiness rather than psychological weariness.” according to Leo Polizoti, Ph.D., my colleague at the Direct Decision Institute Inc. Dr Polizoti studies the result of high stress of job functioning among many police agencies and understands the impact of chronic stress on job satisfaction. Psychological weariness is a drain on personal coping and adaptation to situational stress. I have felt the weariness triggered by high stress times here at the hospital. Sometimes it is only me hit by the stress. Others seem so chill and content.
Most physicians know that mindfulness techniques lower subjective levels of stress and tension. However, even though paced breathing puts the brakes on sympathetic overdrive, people do not use it long enough to create habits. This robs them of the propitious sense of wellbeing espoused by the adherents of the mindful way of living. “Meditating”, according to Dr. Woolery-Lloyd, initiates the relaxation response, which activates the body’s parasympathetic nervous system and decreases cortisol and lowers inflammation.” It helps put the brakes on our alarm bells. A lot of biofeedback protocols can serve to reduce the levels of cortisol and adrenaline in the blood stream helping people feel better. Exercise in general will also afford you physical release and lowered stress and tension. As human beings, our physical health depends on our capacity to manage and lower inflammatory responses in organ systems throughout. Easier said than done.
Mindfulness has the potential to put the brakes on abnormal, elevated fight/flight activity and its pervasive role in the inflammatory and abnormal stress response. There is so much being published about the role of inflammatory disease in organ disease and failure taking a great toll on personal health. I wish we could measure it like a simple thermometer. The relaxation response is triggered when we use mindful strategies to find coherence. So, whatever your level of stress, for longevity and happiness you learn to manage it. It is nothing to ignore or laugh off and stress has been shown to cause health problems and deteriorating wellbeing. There is no cure for stress as it is everywhere. For health reasons redefining one’s emotions can be the source of coherence and greater mastery over the chronic diseases and conditions associated with unregulated stress.
There is accumulating evidence suggested that excessive inflammation plays critical roles in the pathophysiology of the stress-related diseases” such as hypertension, cardiac disease, pain, auto immune disease, depression, and anxiety. Stress reduction does not happen by itself. We are prompted about mindfulness techniques and ways to lower our tension and offload our stress one step at a time. I try this weekly with modest success. It works but people (including me) do not practice it enough.
Lloyd, C et al. (2002) Journal of Mental Health 11, 3, 255–265
Front page of Uvalde Leader following mass shooting on May 24, 2022
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 fourth graders went back to their classrooms. When a few minutes later, the school was breached by a former student – a wolf in sheep’s clothing. At 11:28 AM, Salvadore Ramos entered the Robb elementary school through an open door. The 911 system had been activated. Law enforcement was in the building and then took fire. Retreat.
Only months earlier, they had trained for this. 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 officers had to ignore victims pleading for their lives as a 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 to neutralize the threat. The FBI says as few as two officers to teams of five should enter the scene without hesitation and move to contact. Moving forward not back.
Our chief in New Braintree, MA vowed that he would drive his cruiser through the front door of the school if needed, to gain immediate access to save lives. The New Braintree elementary school was much like the school in Uvalde with many doors and easy access to classrooms.
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, 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.
A large crime scene and a heart breaking situation. At least 19 ten-year old children and 2 teachers were killed by a member of their own community. Former Uvalde High School student Salvadore Ramos was just 18 years old. He killed nineteen 3rd and 4th grade students and their teachers in tiny Robb elementary school in west Texas over the course of an hour. That hour will be carefully scrutinized by the FBI, Texas Rangers, and other active shooter experts to discern law enforcement strengths and weaknesses in the handling of this event. Had law enforcement followed the protocol as practiced?
Much of the aftermath scrutiny will catalog social media red flags that may have informed law enforcement of his disaffected 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 percolating when he purchased 2 high powered rifles after turning 18 in March. His mother, Adriana Reyes 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 Ramos’ 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. His closest friend said that Ramos was bullied in middle school because of a stutter and 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 and played violent video games with friends like Tour of Duty. These psychological underpinnings will be studied for years to come.
But Valdez (Ramos’ friend) said he was horrified when Ramos once showed up at the park with numerous slashes across his face, initially claiming the cuts had been caused by a cat scratching him. “Then he told me the truth,” Valdez said. “That he’d cut up his face with knives over and over and over. I was like, ‘You’re crazy, bro, why would you do that?'” Ramos reportedly told him he did it “for fun,” the newspaper stated.
Chloe Mayer, Newsweek Newsletter
The 18-year old high school student shot his grandmother in the face before heading for his primary target in much the same way mass murderer Adam Lanza, age 20 killed his mother in December 2012 before heading to the elementary school in Newtown, CT at 9:39 in the morning. He engaged in repetitive behaviors and exhibited behavioral elements consistent with ASD. Lanza had rigid thoughts and compulsive behavior like sock changing and tissue use due to anxiety about touching door knobs. Anxiety in middle school due to chaotic school changes – both were bullied. The two killers are seen as a similar in mental health domains. Gradually Ramos withdrew from the family and from school. Lanza too was detached and played video games hours each day. He was homeschooled at age 16 and was fixated on guns. His mother purchased him his first one. He took some college classes. Bought some guns like a Savage Mark II bolt action .22 caliber. Then back to school – Sandy Hook with his Bushmaster XM-15 E2S semiautomatic rifle Glock 20 .22 & the shiny Sig Sauer .226. There are many questions about the time line of events at Robb elementary on May 24th.
For his part, Salvadore 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.
Scope of the Problem: Police Suicide and the goal to eliminate it – modified December 28, 2022
Police job-related stress is well-identified and reported in the media daily and the rates of suicide nationwide are being debated by Aamodt and Stalnaker. They are actually less than one is led to believe but even one law enforcement officer suicide is too much. During the week of Christmas 2022, 3 police officers took their own lives at Chicago PD. Some law enforcement officer deaths may be reduced by using a stress intervention continuum. This ties the continuum of calls into a stress reduction protocol that empowers resilience and recognizes the importance of stress mentoring and the soft hand-off for defusing the growing impact of high stress and high lethality exposure. The stress intervention continuum does not single out one officer but identifies all officers – including call takers, dispatchers, and supervisors for defusing particularly abhorrent events like mass shootings. This way, personnel who played a roll in a “bad call” will not be overlooked nor stigmatized for stress reduction defusing and/or debriefing.
Stress is defined as any situation that negatively impacts an officer’s well-being. The rate of suicide and divorce among law enforcement is approximately the same or lower than the general public according to a meta-analysis conducted by Professor Michael Aamodt. But there are areas in the country and agencies that have higher rates of self-inflicted death.
When the suicide rate of police officers (18.1) is compared with the 21.89 rate for a comparable demographic population, it appears that police officers have a lower rate of suicide than the population according to Aamodt, 2008.
Incidence of suicide tend to be elevated in cities like Chicago, where chronic gun violence and a murder rate in the hundreds per year means cops see a staggering amount of traumatic events. As a result, they may gradually become numb to the exposure of pain and suffering (Joyner, 2009). A Department of Justice report found that the suicide rate in the Chicago Police Department is 60 percent higher than the national average. According to the 2018 Chicago Sun Times, in a note to department members, former CPD Supt. Eddie Johnson said in 2018, “Death by suicide is clearly a problem in Law Enforcement and in the Chicago Police Department. We all have our breaking points, a time of weakness where we feel as if there is no way out, no alternative. But it does not have to end that way. You are NOT alone. Death by suicide is a problem that we can eliminate together” CST September 12, 2018. Chicago PD is not alone with the problem of suicide among its men and women in blue. In fact, smaller departments with fewer than 50 officers often have high rates of suicide and lack the peer support and clinical resources that enable officers to find help during times of crisis.
Law enforcement officers (LEO’s) encounter the worst of all experience on a routine basis. The people who call the police may be society’s best upstanding citizens but on this occasion it could be the worst day of their lives and they seek help from police. Many times it is not the pillars of society seeking help but those people in the fringes or margins of society now victims of violent crime or abuse.
According to Hartley, et.al., 2007, “repeated exposures to acute work stressors (e.g., violent criminal acts, sad and disturbing situations, and physically demanding responses), in addition to contending with negative life events (e.g., divorce, serious family or personal illness, and financial difficulties), can affect both the psychological and physiological well-being of the LEO population.” When these officers are identified there needs to be a planned response using a peer support infrastructure that provides for a continuum of service depending upon the individual needs of the LEO and the supports available. In many agencies, especially smaller departments lacking resources, officers’ languish and sometimes spiral downward without support and without somewhere to turn. Police officers must have support available to them long before they are expressing suicidal urges.
As programs are identified and service continuum grows the risk of peer conflict over perceived betrayal of trust must be addressed. This must be addressed in the peer support training with emphasis on preservation of life over maintenance of confidentiality or the status quo of abject silence. “In itself, it’s a product of centuries of police culture in which perceived weakness is stigmatized. Cops know their brothers have their back, no matter what, but they still don’t want to be seen as the one who’s vulnerable.” according to a recent Men’s Health article written by Jack Crosbie in a report about suicide in the NYPD published during Mental Health Awareness month in May 2018.
The argument is made that the recurring uncertainty of police calls for service often leave LEO’s with low-level exposure to trauma of varying degrees. It is common that LEO’s move from one violent call to the next without time to decompress and process what they have seen. The repeated exposure to trauma can slowly whittle away LEO resilience – defined as the capacity to bounce back from adversity. In a national media study published by Aamodt and Stalnaker, legal problems were a major reason for the law enforcement suicides yet no other study separately cited legal problems. In another study, relationship problems accounted for the highest percentage of suicides at 26.6% (relationship problems plus murder/suicide), followed by legal problems at 14.8%. In nearly a third of the suicides, no reason was known for LEO suicide.
Police suicide has been on the radar of advocates of LEO peer support for months or years. The incidence of suicide has remained stable across the country but some agencies have higher rates of suicide. Smaller departments – those with less than 50 officers in general have the highest rates of suicide. This may be linked to the lack of availability of peer support programs and a paucity of local practitioners to provide professional service with knowledge in police psychology. “While police officers may adapt to the negative effects of chronic stress, acute traumatic incidents necessitate specialized mental health treatment for police officers (Patterson, 2001)”. A referral to the department EAP often falls flat and makes it more difficult to make the hand-off when peer support is not enough.
Points of entry to Peer Support – Stress Intervention Continuum
Exposure to highly stressful events in close sequence
Change in work assignment, district/station, deployment undercover or return from deployment
Increased absenteeism – over use of sick leave – missing court dates
Increased use/abuse of substances – impacting job functioning, on-the-job injury
Community – citizen complaint(s) for verbal abuse, dereliction of duty, vehicle crash
Citizen complaints of excessive force during arrest, supervisory or peer conflict, or direct insubordination
Abuse of power using baton, taser or firearm, recurrent officer involved use of force. Officers are sometimes strongly embittered and angry at this point in their career due to perceived lack of support and powerful feelings career disappointment and alienation – copyright Michael Sefton, Ph.D.
Real-time model of change The use of force continuum is well described in the LEO literature and ongoing criminal justice narrative. What does that have to do with stress intervention in police officers? It sets the tone for officer behavior whenever they meet potential resistance and or increased aggression during citizen encounters. It may also be used for initiating peer support needs whenever an incident use of force has occurred. LEO’s change the force response based on the situation they encounter in real-time in a flexible and fluid manner. In this same way, peer support programs can flexibly shift to the needs of a presenting LEO and intervene early on – rather than when an officer is at a breaking point. “This continuum (use of force) has many levels, and officers are instructed to respond with a level of force appropriate to the situation at hand, acknowledging that the officer may move from one point on the continuum to another in a matter of seconds.” NIJ publication. Peer support too, must accommodate a law enforcement officer in real-time to begin the process of building a healthy, resilient response to sometimes horrific exposures and provide a continuum of unbiased employee assistance and when necessary professional consultation.
Protective Factors begin in Academy training
What topics should addressed while LEO recruits are in training? Ostensibly, the resilience of LEO’s depends upon the opportunity for in-service training in topics of mindfulness, stress management, physical health maintenance, nutrition, and trust.
“Emotional resilience is defined as the capacity to integrate the breadth of police training and experience with healthy, adaptive coping, optimism, mental flexibility and healthy resolution of the traumatic events. In general, resilient people are self-reliant and have positive role models from whom they have learned to handle the stressful events all police officers encounter” according to Leo Polizoti, Ph.D. a police consulting psychologist (Sefton 2018).
Police programs for health maintenance
The Police Stress Intervention Continuum or P-SIC, involves a system of police support that varies in its intensity depending upon the continuum of individual needs of the LEO including physical debility or other significant components impacting career success and satisfaction. The intervention protocol is flexible and fluid as well. The entry point into the peer support continuum initiates from supervisory observations of LEO history and behavior, peer recommendations, and exposure to a range of traumatic events.
The cumulative stress associated with a career in law enforcement cannot be understated. In the setting of police stress and stress support there is an intervention protocol that relates to the peer-support program continuum. Depending on where officers enter the peer support network will impact the level of intervention they may require in the P-SIC program. Peer support is not psychotherapy but officers occasionally must hand off the officer in trouble to a higher level of care. These hand-offs are key to linking at-risk LEO’s with range of professional support needed to keep them on the job. Yet fear of reprisal for acknowledging the cumulative impact of stress and its impact often derails the hand-off to the professional. The highest risk for suicide to a LEO is when he is denuded of badge and gun because he may be a threat to himself.
The career success they have may be directly related to the application of resiliency training to build and maintain physical and emotional hardiness that lasts a lifetime according to Leo Polizoti, 2018. Before this can happen the stigma associated with reaching out must be reduced.
Aamodt, M. G., & Stalnaker, N. A. (2001). Police officer suicide: Frequency and officer profiles. In Shehan, D. C, & Warren, J. I. (Eds.) Suicide and Law Enforcement. Washington, D.C.: Federal Bureau of Investigation.
Aamodt, M. (2008). Reducing Misconceptions and False Beliefs in Police and Criminal Psychology. Criminal Justice and Behavior 2008; 35; 1231 DOI: 10.1177/0093854808321527.
Patterson, G T. (200l). Reconceptualizing traumatic incidents experienced by law enforcement personnel. The Australian Journal of Disaster and Trauma Studies, 2.
Joyner, T. (2009) The Interpersonal-Psychological Theory of Suicidal Behavior: Current Empirical Status. Science Briefs, American Psychological Association, June.
Hartley, T., et.al.(2007). Associations Between Major Life Events, Traumatic Incidents, and Depression Among Buffalo Police Officers. International Journal of Emergency Mental Health, Vol. 9, No. 1, pp.
John M. Violanti, Anna Mnatsakanova, Tara A. Hartley, Michael E. Andrew, Cecil M. Burchfiel. (2012). Police Suicide in Small Departments: A comparative analysis. Int J Emerg Ment Health. Author manuscript available in PMC 2015 Aug 14. Published in final edited form as: Int J Emerg Ment Health. 2012; 14(3): 157–162.
I authored a paper for a class I took on the interaction of stress on brain functioning among police officers. It was an awesome class taught by a physician Sabina Berretta, MD from McLean Hospital in Boston. Severe threat responses that are extended or frequently repeated can significantly raise the risk for physical and mental health conditions such as cardiovascular disease and anxiety disorders. “Although resilience — the ability to cope during and recover from stressful situations — is a common term, used in many contexts, we found that no research had been done to scientifically understand what resilience is among police.” as published in the Royal Canadian Mounted Police Gazette Magazine in 2017. Law Enforcement officers have a unique role among first responders in that they often have little time between calls for service. They face repeated stress, work in unpredictable and time-sensitive situations, and must act in accordance with the specific provincial and departmental policies according to RCMP documents.
LEO’s experience wide ranging physical conditions from hour to hour during their appointed shift work. In a study by Andersen et al. designed through looking at realistic training scenarios this variability came to life. HRs rose significantly with potential encounters from an average resting rate of eighty-two beats per minute upward to 130-140 bpm or more during high stress calls. For example, Anderson reported the following HR averages for a variety of police actions: hand on gun, no suspect (134 bpm); holster snap open, no suspect present (131 bpm); hand on gun, suspect present (134 bpm); holster snap open, suspect present (131 bpm); talking to suspect (134 bpm) (Anderson et al., 2002)”. Research shows that there is no evidence-based replacement for reality-based training. In a study comparing technology-delivered training with reality-based training and active-duty encounters, the data found that technology-delivered training didn’t mimic or prepare officers for real-world encounters as did reality-based training, according to her study Judith Andersen at University of Toronto, Canada. The management of autonomic arousal is illustrated in data obtained from officers with excessive HR given that research has shown that when HR exceeds 170 BPM, perceptual distortions (e.g., tunnel vision, auditory exclusion), freezing, and possible irrational behavior are highly likely to occur (Siddle, 1995). Siddle focuses much of his writing on having a warrior mentality and remaining focused. Autonomic systems in the body sustain us for short periods when there are threats present. The fight-flight response activates us for battle in the presence of fear, threat, and unseen danger. When these threats are no longer present the parasympathetic system needs to put the brakes on our runaway stress response. The problem lies in cases where the fight-flight system becomes unmodulated and chronically on guard. The body reacts to reality-based training by allowing for changes in heart rate, muscle tension, galvanic skin response, and respiratory rate to be ready when needed. Physical conditioning and healthy nutrition combine with stress hormones at times of high stress to aid us in battle. Similarly, it becomes essential that the burden be mitigated at the end of the day. Unless this can happen, officers may become cynical and lose resiliency needed for a hardy career. In some cases, officers who are poorly regulated may become candidates for career burnout.
Andersen, J.P., Pitel, M., Weerasinghe, A., & Papazoglou, K. (2016). Highly realistic scenario-based training simulates the psychophysiology of real-world use of force encounters: Implications for improved police Officer Performance. Journal of Law Enforcement.
The Whittier Health Network is happy to offer this recurring on-line presentation entitled: “Spring Cleaning: Strategies to Lower Stress”. Take steps to reduce stress and its impact. Learn to be resilient and do not dread the Spring into Summer. Be a part of this zoom continuing education presentation and learn the steps you need to reduce the powerful impact of stress. “Learned resilience can be taught and leads to reduced stress and psychological hardiness rather than psychological weariness.” according to Leo Polizoti, Ph.D. Psychological weariness is a drain on personal coping and adaptation to situational stress. Join us here on April 23 at Whittier Rehabilitation Hospital for CME credited zoom presentation Contact Joanne Swidersky at 508-871-2134 to reserve a place at the zoom program.
Stress management plays a crucial role in maintaining both physical and mental health. We know that. Let’s explore the importance of stress management and how it positively impacts our well-being:
1. Reduced Blood Pressure: Chronic stress is linked to changes in blood pressure, which can lead to hypertension and increase the risk of heart disease. Learning stress management techniques can help lower blood pressure and improve overall physical health1. 2. Improved Mental Health: conditions like depression and anxiety are often associated with stress. Managing stress can enhance mood, performance, and reduce the risk of developing mental health issues1. 3. Heart Rate Regulation: Chronic stress can disrupt your heart rate and circadian rhythm. Effective stress management may lead to a healthier heart rate and mitigate heart disease risk1. 4. Better Sleep Quality: Stress affects sleep patterns, making it harder to fall asleep and stay asleep. Practicing stress-reduction techniques, especially before bedtime, can promote better sleep1. 5. Enhanced Resilience: Stress management helps your mind and body adapt, preventing constant high alertness. Over time, chronic stress can lead to serious health problems, so it’s essential to address it proactively2. 6. Physical Activity: Regular exercise is an effective stress management tool. Engaging in activities you enjoy, such as walking, dancing, or yoga, can boost fitness and reduce stress34. 7. Healthy Lifestyle Choices: Prioritize sleep (aim for at least 7 hours per day), maintain a plant-based diet, and stay socially connected, be aware of risk of alcohol and drug use. These lifestyle factors contribute to stress reduction and overall well-being5.
Remember, managing stress isn’t just about feeling better—it’s about safeguarding our long-term health and quality of life. 🌟
As a member of the Direct Decision Institute, Inc in Worcester, Massachusetts, my colleague Dr. Leo Polizoti, the Institutes senior lead psychologist, are charged with doing pre-employment psychological screening for all officers heading to a regional police academy across New England. There are details about the pre-employment process at the institute website: drdecision.org. One question I usually ask is: “Why do you want to be a police officer?” As you might expect, the answers are all well-rehearsed and touch on inspiring, decorated family members who were police officers, the personal desire to help people, or a memorable encounter with a member of law enforcement early in life. There are always others too.
A more curious inquiry might sound like this: “why would you want to be exposed to fatal car crashes, domestic violence, including intimate partner homicide, completed suicide and suicidal persons, sudden infant death, violent, intoxicated subjects, random citizen complaints, professional jealousy, long hours, and sometimes decrepit leadership?” I might even add: “if you want to help people why not become a nurse or high school teacher?”
As a police consulting psychologist my goal is to offer my best judgment about candidates for police officer. I offer my two cents worth of resiliency advice by painting a portrait of how they see themselves five years in the future. When asked what they expected in the pre-employment psychological interviews one or two have said it was a “waste of time.” Now these men and women are in the minority, only 1 in 15 has said that in my last round of interviews. But just as importantly, going forward, these new officers are going to represent law enforcement and should be better prepared to embrace mental health awareness and the reduced stigma associated with behavioral health and human resilience. Most police officers are starting to understand this. To say that a one-hour meeting with the police psychologist was a “waste of time” reflects both the lack of understanding of personal wellbeing and a blind spot in progressive policing. Mental health services is everywhere in law enforcement on both sides of the badge.
I am working with a retired corrections supervisor who has known PTSD that is quite poorly controlled. He was diagnosed only 2 years ago even though he has not been in the inside for 9 years. He has dozens of traumatic experiences most of which have gone untreated. In most cases, law enforcement and corrections officers alike would undergo debriefing when officers are required to retrieve human remains or to cut down an inmate hanging from his bed rail or someplace else.
CO is cooperative and likable. I had heard about walking corpse syndrome once or twice. I have even had one or two cases of this specific delusional disorder and may have missed its significance. I was trained to think that walking corpse was usually associated with borderline personality disorder, hypochondriasis, or somatization disorder. It goes beyond the cookie cutter explanation and does not incorporate an organic cause. In a case I worked with in the summer of 2022, the 57-year-old male has a history of unstable PTSD because of his 21 years of service at a maximum-security prison here in Massachusetts. During this time, he experienced physical attacks over five times – one of which kept him out of work for 10 months. He witnessed over 100 prisoner hangings – deaths by suicide that required a special team response. He was a supervisor and was called upon to organize “teams” of men to deal with offenders who were violent and admitted with pride that he was always the first man at the scene. By doing so, he witnessed men who had cut their own throats and died before the entry team could assemble and make the save. He witnessed vicious fights among competing prison factions. And was himself attacked and lost time at work.
These experiences followed him into retirement and invade his sleep regularly even now. He sleeps only 2 hours at a time, awakened by images of his death own and embalming. He walks the house checking doors – just as he did on the block during his time on the job. For his part, he feels conflicted because he is a Christian and believes in his heart that he could help many inmates – some of whom may have taken their own lives. Instead, he could not turn the other cheek at times when inmate brutality broke the normal clamor behind bars. Correction’s officers are often seen as the last first-responders and are rarely debriefed following inmate deaths, personal attacks, or violence toward officers.
I had heard about walking corpse syndrome once or twice. I have even had one or two cases of this extremely specific delusional disorder and may have missed its significance. I was trained to think that walking corpse was usually associated with borderline personality disorder, hypochondriasis, or somatization disorder. It goes beyond the cookie cutter explanation of diagnoses and fails to include an organic neuropsychological underpinning that we now understand is important.
MIchael Sefton, Ph.D.
Cotard’s syndrome is characterized by nihilistic delusions focused on the individual’s body including loss of body parts, being dead, or not existing at all. Cotard’s is neither mentioned in DSM-V nor in ICD-10 – both diagnostic tools made for identifying nervous and mental disorders. There is growing unanimity that Cotard’s syndrome with its typical nihilistic delusions externalizes an underlying disorder. Even though Cotard’s syndrome is not a diagnostic entity in our current classification systems, recognition of the syndrome and a specific clinical understanding is essential for definitive treatment options and classification. Organic causes should be ruled out as an etiology before attribution of Cotard’s syndrome as a fully functional problem. Some papers are cited in the literature that indicate that separate typologies should be considered. The most common is a syndrome more strongly associated with major depression and its symptomatology including melancholia, nihilism, and psychotic features. A slightly different nosology abnegates depression and aligns it more closely with delusional thinking and not primarily associated with affective disorder.
Cotard delusion is a rare condition marked by the false belief that you or your body parts are dead, dying, or don’t exist. It usually occurs with severe depression and some psychotic disorders. It can accompany other mental illnesses and neurological conditions. You might also hear it referred to as walking corpse syndrome, Cotard’s syndrome, or nihilistic delusion.
Debruyen, H, et al. (2011) Cotard Syndrome.
Debruyne, Hans & Portzky, Michael & Peremans, Kathelijne & Audenaert, Kurt. (2011). Cotard’s syndrome. Mind & Brain, The Journal of Psychiatry. 2. 67-72.
First, New Hampshire, and now on July 16, 2022 the City of Chicago, IL has agreed to pay line of duty death (LODD) benefits to officers who die by suicide. Each of these cases are complex and I am sure some form of assessment of the individual officer’s case will be carefully chronicled. I can imagine this is going to be slow going as I am not sure whether there are some strings attached to the individual suicide.
“Chicago is kind of like ground zero with the number of suicides that are happening on a monthly basis now at this point,” said Daniel Hollar, who chairs the department of behavior and social science studies at Bethune-Cookman University in Florida. Dr Holler hosted Dr Doug Joiner to Chicago for a symposium in 2019. Dr Joiner taught us much of why officers kill themselves. He says they become embittered, they feel a deep sense of thwarted belongingness and grow increasingly detached with and higher risk. “These are police officers answering calls of duty to protect lives. We (need to) do our job to make their jobs safer.” After 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.” This is known as a psychological autopsy. I have been writing about this for 9 years in these pages. This must include a 3-month list of calls the decedent answered including those for which he or she were given debriefing, defusing, or time off for respite from the job. I would want to understand how the call volume may have triggered underlying acute stress of were there calls that triggered new trauma?
NH Governor Sununu signed House Bill 91 on July 8, and it goes into effect Sept. 6. Sponsored by N.H. Rep. Daryl Abbas, R-Salem, it drew bipartisan support. He is the Link:
The New Hampshire law will go into effect on September 1, 2022, and allow officers to feel that their families are secure with benefits of They should die in the line of duty which now include dying by suicide.
Dr Hollar is organizing the forum in Chicago the first of these I participated in with my colleague Dr Leo Polizoti from the Direct Decision Institute, Inc. in Worcester, MA. Among the issues up for discussion is what role Chicago’s relentless violence problem plays in officer suicide. Hollar said they will also talk about other factors, including whether familiarity with death makes suicidal officers more likely to follow through with their plans as reported in the March 2022 Chicago Tribune Sometimes a law-enforcement officer will begin to question whether they may have arrived at the scene earlier by driving faster, or whether there was something else they could have done to prevent a loss of life, said Rivera. This can add up to behavior that may place an officer at risk if he decides he needs to get on scene faster the next time around. Some begin to believe that the world may be better if without them. Many are angry and become hopeless and embittered for a variety of reasons, like feelings of resentment and misunderstanding.
I am always in awe when I drive past roadside memorials. They commemorate the place where someone was killed in a motor vehicle crash. They grew in popularity following the of MADD, Mother’s Against Drunk Driving first in the 1980’s in Austin, Texas. These are usually a white cross along with trinkets, toys, and photos that memorialize them life or lives that were lost at the location. Many are painted with the names of people who have lost their lives too. What strikes me is who maintains the site? Is there any sort of memorial at a internment site? Do the same people who maintain the shrines also maintain a grave site?
There is a psychology to the roadside memorials that are dotted across our country’s roadways commemorating the lives of people who have perished. Usually these are simple crosses sometimes emboldened by the name or names of people who may have been in fatal accidents at the location. Others grow to become memorials to a lost love one and are maintained by grieving family members. I seem to see them everywhere and wonder about the survivors. Do they visit the site? It is different then a cemetery in that this is not the place where they were laid after death, but this is the last place on earth their loved one was alive.
I am reading a couple of books about roadside memorials with interest. One is a thesis from a Canadian university, authored by Holly Everett from Memorial University in Newfoundland. These sites are also known as the “spontaneous shrines” that result from a public outpouring of grief according Everett who studied the shrines in Texas as part of her graduate work. It makes me sad when someone builds a spontaneous shrine to honor the loss of someone. On my way to work a few months go, I noticed that 2 crosses were erected in a tree near my home. A spontaneous shrine.
While working as a police officer I noticed these spontaneous shrines popping up in our town usually after a fatal accident. Fortunately, we had very few fatal crashes in the 12 years I worked. Towns everywhere, including the one in which I patrolled, were discussing regulations about the roadside crosses and all the stuff that accumulated along with them. Our chief was sympathetic but the one or two shrines in our town became a traffic hazard in his mind. Cars (I assume family members or friends) would slow or stop for a short visit. We always worried about someone getting injured or killed on the site of one of the crosses. And we had a call to the cross on Rt 67. The boyfriend of one of the victims was sleeping at the cross site. Upon further investigation we learned that he was so grieved that he wanted to stay with the girlfriend’s cross one last time. Sadly, we had to send him along because having a sleeping person on a busy road caused too much public concern. Communities are needing to regulate these sites because the grieving public tends to add more and more to them. Some family members even mow grass or shovel snow keeping the site looking prosperous. According to the draft policy posted on the BBC site, “locations and content of roadside memorials will be vetted for safety and messages that can be considered “offensive” will be banned, as will any sort of illumination or materials that can shatter, such as glass” January, 2022
It struck me that the first names were imprinted on white crosses leaving off the last names of the two boys who died at the site. I would have liked to know the last names. I wanted offer my condolences in some way. Maybe I had seen them riding bikes in the neighborhood just recently, at least until one of them earned his driver’s license.
Intractable depression now has multiple options and hope for its resolution – read on
Intractable depression is something that occurs in 20-30 percent of patients with major depression. It is called treatment resistant depression or TRD according to Zhadanava M, Oilon, D,Ghelerter I, et al. (2021). There are more medications than ever and a range of programs for treatment resistant depression that some may not have heard about. For that reason this review will be useful.
As the name implies, treatment resistant depression is highly refractory to the typical treatments that generally include psychopharmacology and psychotherapy. I have had the clinical opportunity to meet with men and women in psychotherapy who are diagnosed with major depression but for some of them, nothing has helped. They have had multiple trials on numerous medications and psychotherapy with little to no relief of symptoms. Some describe a worsening of symptoms after beginning treatment and some claim this to be signs of an allergic reaction to the medication. The British Journal of General Practice has published a list of the first line antidepressants in 2019, Kendrick,Taylor, and Johnson. The meta analysis is conducted in 2019 revealed 21 medication’s that showed efficacy and tolerability in patients with it it may be depression. They found agomelatine, (Valdoxan), amitriptyline – a tricyclic antidepressant but is prescribed for various nerve, arthritis, and muscle pain, escitalopram (Lexapro) – may treat generalized anxiety as well as depression, mirtazapine (Remeron), used for poor sleep hygiene, failure to thrive, and major depression, paroxetine, (Paxil), venlafaxine, (Effexor) may help with GAD and panic anxiety, and vortioxetine (Trintellix) more effective than others.
These patients are intractable in their sadness and become resolute that nothing will help them. Most have been talkative, intellectually curious, but deeply sad in my presence. They are often hopeless that they may never feel a few moments of joy each day, no matter what they do. Many feel embarrassed for being so overwhelmed with life and barely hold on from week to week. Others take life with little hope that things will ever change and, for them, suicide is always on the drawing board. These few patients sometimes need a more structured living arrangement, usually a hospital. Many patients with intractable depression live life with their final exit all cued up and ready to roll. Some plan to move west to states like Oregon that has physician assisted suicide – saved for when they can no longer live with themselves. For these people, I work with them to find a greater purpose upon which to focus and measure success – often one day at a time. In addition to psychotherapy it is important to get these folks moving with rigorous exercise and activities to find greater purpose. Some patients decide to return to school, work or start attending church again. This programs not only enhance dopamine transport but they also result in social interpersonal contact, something many are missing as they grow older.
There are now new and controversial treatments for treatment resistant depression that are being reported in the psychiatric literature bringing hope to families everywhere. Treatment like transcranial magnetic stimulation, ketamine treatment, stellate ganglion block, deep brain stimulation (requires a surgical procedure to set a deep brain stimuator in the area of the brain that subserves the aura of well-being, and even psilocybin, a powerful psychedelic. Family members sometimes ask why can’t we do something less invasive? The transcranial magnestic procedure is non invasive and uses strong magnetic fields to stimulate neurons within the brain in the area that underlies mood regulation. Treatment requires 15-30 sessions. Readers may have heard little about these treatments, but for families who have watched their loved ones languish, they offer a modest hope that life for their loved ones now has options and promise. These are the cases that you worry about at the end of the day. These are the cases that may not buy what you are selling when it comes to a therapeutic modality or trial of medication that they have already tried and failed. The handoff to one of theses specialty options including ECT – electroconvulsive therapy needs to be a careful one and deep brain stimulation requires sensitivity and cautious optimism about the likelihood of success. A little halo affect can go a long way in getting a good first impression, and a good start to a new treatment modality. A careful history about what medications have been tried and failed is important to document including the length of time they took the drug.
Still newer is the return of hypnotic and synthetic therapy. Scientists are using psilocybin to bring patients through their depression in one of two treatments. Reader may understand that psilocybin are the main ingredients in LSD. There is a growing literature on the use of psilocybin to improve depression resistant cases. Those participating in psychedelic studies often say the experience was among the most meaningful of their lives, on a par with the birth of a child or death of a parent. Many report feeling a sense of connectedness with the universe. “This psilocybin journey was the single most transformative experience of my life,” Mr.Fernandez wrote in a medium post in 2018 reported in a recent NY Times opinion piece by Dana Smith, Ph.D (taken 7-16-2022).
I saw the 60 minutes story on SGB a year or two ago as a possible treatment for refractory PTSD. Many patients now matter how many medications the the and even combined with hours of individual psychotherapy still have reactive symptoms of the condition. SGB stands for Stellate Ganglion Block. Ganglion simply means a bundle of nerve fibers. We have numerous ganglia in our bodies. The Stellate ganglion is different and offers a potentially serendipitous treatment option for posttraumatic stress disorder (PTSD) that heretofore has been refractory to conventional psychiatric therapy. It may hold promise for co-occurring depression as well. It involves a neurochemical blockade of the stellate ganglion. The use of a small amount of anesthesia provides a risk free blockade of the autonomic nervous system overflow that contributes to the toxic levels stress hormones like adrenaline and cortisol that directly add to feelings of anxiety and hyperarousal among people with PTSD. This elevated arousal puts them on high alert night and day. This is not sustainable.
Here in Massachusetts, the MGH has a Stereotactic Functional Neurosurgery Program that among other things does SGB for medically intractable Obsessive-compulsive disorder and Major depression under a current protocol at MGH. Surgical options are not considered until when medical options are no longer effective or side effects may be severe (Functional Neurosurgery Program, Massachusetts General Hospital website, taken August 22, 2022. DBS has been utilized for Parkinson’s disorder for many years. For people who suffer with major depression many are hopeless and believe the world may be better without them in it. These alternative treatments like: ECT, TMS, Ketamine, stellate ganglion block, and DBS afford greater options at some personal cost. While they are intensive and in some cases invasive there is a trade off in terms of quality of life. The tipping point in my view, when people are isolated, hopeless, and their depression becomes a barrier to functional living, like failure to thrive, the cost of not taking a broad approach to treatment is too great. Human suffering can sometimes be so silent that no one takes notice. The treatment resistant are sometimes elderly and often alone. It is these people that I worry about in my practice as a clinician here in Massachusetts.
REFERENCES
Zhadanava M, Oilon, D,Ghelerter I, et al. (2021). The prevalence and national burden of treatment-resistant depression and major depressive disorder in the United States. Journal of Clinical Psychiatry; 82(2):20m13699
Kendrick, T, Taylor D, Johnson, C. (2019). Which first-line antidepressant? British Journal of General Practice; 69 (680): 114-115.
Smith, Dana (2022) Taking the Magic Out of Magic Mushrooms, Opinion, NY Times, July 16, 2022
Agin-Liebes GI, Malone T, Yalch MM, Mennenga SE, Ponté KL, Guss J, Bossis AP, Grigsby J, Fischer S, Ross S. (2020). Long-term follow-up of psilocybin-assisted psychotherapy for psychiatric and existential distress in patients with life-threatening cancer. J Psychopharmacol.Feb;34(2):155-166. doi: 10.1177/0269881119897615. Epub 2020 Jan 9. PMID: 31916890.
MGH (2022) Stereotactic Functional Neurosurgery Program, Website taken 8-22-2022.
Despite the public outcry for red flag warnings as a method of mitigating gun violence and high lethality shooting incidents there is no single repository for cataloging red flag behavior when red flags are observed. In some cases, red flags are ever present in a one-sided, authoritarian relationship slug fest. One man we investigated posed with a Remington shotgun in his high school year book. A real gun guy.
Think about how difficult it would be to track and classify all the red flags we see in people all the time. As psychologists, it is something we do regularly. A dangerousness assessment is a component of every exam I do. If someone gives off signs that they may become violent, psychologists have a duty to warn potential victims and the local police. Who does the public call? Concerned citizens call police to do well-being checks almost daily – sometimes more than once. These are usually benign calls for service but domestic violence and dangerousness require greater understanding of the risks of harm to LEO’s and innocent family members. It is a fact, that someone usually knows that there is imminent risk of violence – even mass murder, and does nothing.
“I thought he might do something, like kill himself or something, but I never thought he’d take the kids”
Sister of a Maine man who killed his family and then himself in 2011
As yet, there is no repository of “red flags”. People wrongly believe there is a single place where violent intentions are stored. Yet no. There is seemingly no red line, that if crossed, someone would be deemed too dangerous to own a weapon or perhaps be brought for early dangerousness assessment. The quotation above is from the psychological autopsy conducted after Steven Lake murdered his wife Amy and their two children in Dexter, Maine. Red flags are the antemortem behaviors that indicate growing affective instability. These are suggestive of an increased level of risk to intimate partners and often the general public. They are the clues that behavioral scientists hand out whenever the topic of dangerousness is brought up – we are reminded of all the red flags. I think the American public is tired of hearing about red flags because so often they are present in the retrospective after the murder victims have been laid to rest. The prior depression, suicidal behavior, various forms of interpersonal violence, availability of firearms, forced sex, choking, pathological jealousy, violation of restraining order, and threats of death are a few red flag warnings often overlooked. We will speak about the Uvalde killer and a couple others in the next few paragraphs. But bear in mind, the best predictor of future behavior is past behavior.
Just as violent spouses manifest a behavioral purulence, mass shooters often display a similarly angry predilection that is posted on the their chosen social media platform in the form of a host of miserable, cantankerous resentments. This resentment can take many forms and is often the road map into the underpinning of their anger and growing desire for violent recompense. These are not monitored by the dangerousness police, in fact, red flags are not collected, tallied, or catalogued at all. If the ad hoc red flags are laid out and the subject suddenly comes into contact with law enforcement and all the planets align, then a high lethality event may be averted serendipitously one day. But derailing a mass casualty event on the front end has been an inauspicious foist at best. These shooters inevitably fall through the cracks and very few have been stopped in their tracks because of red flags that rose to the level of containment. How is that possible?
In 2016, the knee jerk reaction is to attribute the recent Thousand Oaks, CA nightclub shooting to a “crazed gunman” that would unfairly place the blame on the mentally ill. Psychological experts believe mentally ill persons lack the higher order planning to execute the complex steps necessary for anything more than petty crime – more often associated with co-morbid substance abuse. It is the co-occuring illness of drug or alcohol addiction that is a confounding variable in all police-mental health encounters. The interaction of substance abuse disease, like alcoholism or opioid abuse and mental illness is complex. Persons with drug and alcohol addiction must be expected to become sober with the help of substance abuse treatment and family support. The risk of violence and suicide declines when sobriety can be maintained. It goes up when depressed and angry men drink more than they should.
Some social media platforms use algorithms to predict when someone may use violence based upon target words, internet search terms, and photos that may be posted. So far, none of these have helped to intercept a shooter from his intended targets. In the aftermath of high profile mass shooting, law enforcement and the FBI uncover pages and pages of antisocial ranting, hostile embitterment, ethnic hatred, and angry beliefs along with veiled threats. These often are directed at one person or group of people who are perceived to have wronged the shooter. Virginia Tech killer Seung-Hui Cho send his diatribe to the media in 2007. In the case of Steven Lake, his daily online diatribe about the unfairness of the court order protection always drew dozens of ‘likes‘ and comments that he was a good father and should “fight for his children”. The fast action by the victim’s employer and the Dexter police on the morning of the murders is likely what prevented a rampage. It is believed that Lake had an intended list of people he planned to murder.
Some mass shooters are engaged in group chat rooms where messages of violence and hatred are shared, bringing their fetid ideas to the drawing board. In these chat rooms, like-minded antisocial men and women hoard their reactionary fantasies decayed by the never ending bluster and beset in a de facto life filled with anger and decreased empathy. Video games contribute to aggressive thoughts, feelings, and behavior in the laboratory and in life (Boffey, Dana Foundation). So among the cartoon characters in the chat rooms are young men who are searching for meaning behind the call to war or other video games. They collectively create a sense of having been the victim of injustices and being driven to seek vengeance against anyone he believed had wronged them” assuming no responsibility whatsoever, according to Peter Langman, 2017.
Each time a person strikes out in a mass shooting the people who are tasked with understanding and identifying red flags that were present signaling the impending violent combustion. These are often easy to spot by those closest to the shooter. The possibility of mandating the report red flags is being debated. Like child and elder abuse, proponents of red flag warnings want mandated reporting laws for persons with direct knowledge of violent intensions when it becomes known. “And when it comes to mass shootings, those with mental illness account for “less than 1 % of all yearly gun-related homicides” a 2016 study found. Other studies indicate that people with mental disorders account for just 3-5 % of overall violence in the US” – Paul Appelbaum, M.D. taken from BBC by Rachel Newer 11-1-2018.
In May, 2014, Elliot Rodger, 22, posted a YouTube video declaring his intention to slaughter “those with a good life”. Elliot felt like girls he had dated were unkind to him. He wrote a manifesto over over 100 pages. These pages detailed his childhood, family problems, his inability to get a girlfriend, and his hatred of women, ethnic minorities and interracial couples. And it contained his plans for a massacre according to Andrew Springer, journalist who interviewed Peter Rodger, Elliot’s father. This occurred in Santa Barbara, CA, where his murderous rampage was posted using social media sites as a prequel to the killing of 6 college students including his two room mates – one of whom he stabbed 94 times. His therapist made a valiant effort to warn the possible victims of his violent intentions as the law requires.
In a case of nihilistic violence, Vester Flanagan, a television news reportely killed a female colleague and her cameraman while live on the air. “Like dozens of mass killers before him, the shooter embodied a deadly mix of resentment, delusion, and thwarted aspiration” according to Sarah Kaplan (Washington Post, August 27, 2015). The live twitter posts, videotaping the shooting, and horrific execution of the victims by Vester Flanagan on live television will be a specter for years to come in Virginia’s Roanoke market. Just as important may be the analysis of Flangan’s devolving mental status in the months and days leading up to the terminal event.
The case in Uvalde, TX is similar in that the shooter set his sites on children and teachers. Ostensibly, selecting a soft target to amplify his intent on bringing forth chaos, pain, and historic violence, like the Sandy Hook, CT killings in 2012 and Stoneham Douglas High School in Florida. Much of the aftermath scrutiny of the event will catalogue his social media presence and its potential for understanding what triggered the despicable attack and may have informed law enforcement about potential for exploding embitterment through violence. And the police response in this event remains under investigation because of the poorly executed breach and termination of the event. No one knows how long James Ramos may have exuded his intention when he purchased two AR-15 style rifles just days after he turned 18. One could infer that his plan was hatched months before given the timing of his gun purchases. Dr. Peter Langman described an accumulation of real or imagined injustices among the causal attributes of such gun violence as Uvalde, Sandy Hook, and so many others. Shooters are deeply driven to seek vengeance against anyone they believed had “wronged” them according to Langman in 2017. Interestingly, video game violence has not risen to the top of the list as a leading cause of mass killing although, “Violent video games provide a forum for learning and practicing aggressive solutions to conflict situations,” Anderson 2000.
Let us look at the most recent event in July 2022 where Robert Crimo III, known as Bobby, climbed to the roof of a structure overlooking the start of the July 4 parade in Highland Park, IL. He had a semiautomatic AR-15 style rifle that he legally purchased himself. And yet, in November 2019, police were called to his home because he was threatening to “kill everyone in his family”. He had the means and the mindset for such a crime that the Highland Park police removed 16 knives and a sword from his home in his possession. These were returned to him sometime later. In 2021, they were called to the home once again for now-18-year old named Bobby, who wanted to kill himself. The same person. In the Chicago Post interview, the senior Crimo downplayed his son, Bobby’s threats in that incident as a “childish outburst.” Not quite right. The red flags were there and if a red flag repository existed, he should not have been allowed to purchase or poses firearms. Whether or not he should have been contained in a mental health treatment facility is not known.
Containment of violent offenders is an important component of the criminal justice system. But what about those who are exhibiting red flags? Containment of violent citizens is also something to consider before they act on violent impulses. How do we protect their individual right to privacy? Someone usually knows what is likely to happen if something isn’t done to break the cycle of coercion and violence. In the Dexter case the killer’s sister knew. 12 hours before the murders she told her brother to “go get help”. But he could not. He was a gun guy. The fact that so many mass shooters are killed by law enforcement or kill themselves prevents analysis of broad psychological factors that may have triggered the terminal rage such as early childhood instability, loss of a love object, hostile embitterment, or a desire for blazing masculinity. And those who are captured such as James Holmes who was convicted of the 2012 Aurora, Colorado theater shooting in 2015. There was nothing that could be cited that correlated with the extent of violence and victims from that night in Aurora – 12 fatal and over 40 with severe injuries. A quick review reminds us that Holmes was a bright doctoral candidate in neuroscience prior to the massacre. “Studies have shown study that exposure to violent video games is positively related to adolescent aggression; however, normative beliefs about aggression have a mediating effect on exposure to violent video games and adolescent aggression, while the family environment regulates the first part of the mediation process.” In general, the research has not consistently supported the notion that violent video games contribute to aggressive behavior or mass shootings but some have offered modest correlation without espousing causality. Massachusetts has recently enacted an emergency red flag for people who are exhibiting the most violent behavior. It allows police to remove firearms and revoke a person’s license to carry a firearm. Known as the Extreme Risk Protection Order (ERPO), also known as a red flag law, is an order from a judge that suspends a person’s license to possess or carry a gun. That said, greater emphasis on the assessment dangerousness, along with mandated reporting just like in suspected cases of child or elder abuse and a DV offender registry may be worth considering. It is not an exact science but in case after case there are undeniable red flags and someone who knows what is going to happen because of an intimate and shared relationship. Look at the red flags and make a determination of risk. Containment including: no bail holds, loss of second amendment privilege, and GPS monitoring will instill greater responsibility in both violent citizens and shared criminal responsibility with those keeping the dangerous secret.
Anderson, C, Dill, K, (2000), Video games and aggressive thoughts, feelings, and behavior in the laboratory and in life. Journal of Personality and Social Psychology, Vol. 78, No. 4.
Anderson, C. A., and Carnagey, N. L. (2014). “The role of theory in the study of media violence: the general aggression model” in Media violence and children. ed. Gentile, D. A. (Westport, CT: Praeger), 103–133.
Boffey, P (2019) Do Violent Video Games Lead to Violence? Dana Foundation, Neuroethics Viewpoint.
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