Saluting a fallen brother and bringing him home

WESTBOROUGH, MA March 18, 2017 Most people leave their homes and go to work.  Many work in sales or IT or perhaps they teach school.  It doesn’t matter because that all changes when you are a member of the fire service or a brother police officer. Then you become a member of a family that many say takes a hold of you like no other.  There is a bond among fire fighters and a respect that runs deep within the fire service – the family of firemen.  The bonds are forged in the hours of training, answering calls, and sitting chewing on the issue of the day.  And then one day someone goes down.  In police service it’s called the “oh shit” moment when something happens so quickly that your response is purely defensive sometimes too late as in the case of the Flagstaff, AZ 24-year old officer whose body camera recorded the oh shit moment that took his life last year.

tlumacki_watertownfirefighter_metro118
Boston Globe photo

Firefighter funeral traditions show our deep gratitude and respect for the honorable contribution they make to society. When a firefighter dies, he is considered a “fallen hero” and his funeral will indicate such an honor.    D. Theobald

The fire service is even more protective of its ceremonial reverence for the ultimate sacrifice made by a heroic fallen firefighter.  Everything stops. Every one steps up and does whatever is needed to support the surviving family and each other. Someone is usually assigned to stay with the bereaved family 24 hours a day. The ritual of bringing home a fallen fire fighter is age-old. Firefighters remain with the body and bring it home with care and reverence afforded a fallen hero.  This custom was once again brought to bear when Watertown, MA firefighter Joseph Toscano, 54 died while fighting a 2-alarm house fire this week.  The death of a fire fighter is a rare occurrence but happens frequently enough that most people can remember the show of reverence from members of the fire service everywhere.  In 2014, 2 Boston firefighters were killed in a wind-driven conflagration on Beacon Hill and who can forget the 6 Worcester firefighters who lost their lives in December 1999, or the Hotel Vendome fire in Boston that took the lives of 9 Boston firefighters over 40 years ago.

Watertown, Massachusetts has seen its share of catastrophe in recent years in the police and now fire services. The funeral will be attended by thousands of local firefighters and those from across the United States. Fire houses in Watertown, Boston, and elsewhere will make accommodations for out of town brothers and sisters attending the funeral. No member of the fraternal family is ever turned away.  The coffin will be on display for those of us so moved to pass by and offer a final salute to the firefighter and his family.  The honor guard will stand at head and foot in solemn deference for the ultimate sacrifice. The surviving spouse will be strong as she has been for many years over many calls for service.  Her husband has helped so many people.  He has seen much and has dealt with this before.  But as the flag draped coffin is moved into place the release of emotion will be palpable for all.  The fire chief will present the folded flag to Maureen Toscano his wife of over 20 years.  He will offer words of comfort to his five children. They will never be forgotten because they are part of the extended family of firefighters.  The 150-year old ritual of bagpipes will play Amazing Grace while men from Newton, Boston and Cambridge stand guard at the Watertown fire houses to allow every Watertown firefighter to attend the service. To grieve and begin the healing process.

A Catholic Mass will be held.  The streets of Randolf where the family lives will be lined with a sea of blue uniforms each one holding back tears – having been through this before.

As Watertown firefighter Joseph Toscano knows it could well have been any one of his brother officers who fell that day and he would never have stood by for that.  A heroic effort was made to save the life of Joseph Toscano by members of the Watertown Fire, EMS and Police departments. He was rushed to Mount Auburn Hospital in Cambridge – the same place where MBTA Officer Richard “Dic” Donohue was rushed after the 8 minute firefight during the search for the marathon bombers in 2013.  Officer Donahue survived but lost nearly all of the blood in his body. Donahue retired from the Transit Police in 2016 after his promotion to sergeant and deals with chronic pain on a daily basis.  Emergency crews at Mt. Auburn were not able to revive Joe Toscano.

His body was carefully moved from the chief medical examiner’s office in Boston – just 5 miles away to Randolf – but he was never alone. Members of his department including his chief rode on Watertown Engine 1 and a ladder truck leading the hearse and a legion of police officers.  Firefighters from neighboring cities stood along highway overpass with hand salute as Firefighter Toscano was headed home. Among the most powerful of ceremonial rituals is “the last call.”  This occurs when the fallen officer is called on the fire band radio for all to hear – “Firefight Toscano come in….” there is silence.  The fallen officer’s call sign is again dispatched – silence once more.   Finally, the dispatcher indicates that the fallen officer has gone “10-7” signaling that he is no longer on duty – in this case signaling – the end of his watch.  A bell sounds 15 times indicating the firefighters final call.  Often the dispatcher will say something like “You have served your community with honor and reverence, good sir, we will take the watch from here.  Rest in peace – Firefighter Toscano and know you are a hero and will never be forgotten.”


Firefighter’s Prayer


When I am called to duty, God,
wherever flames may rage,
give me strength to save a life,
whatever be its age.
Help me embrace a little child
before it is too late,
or save an older person from
the horror of that fate.
Enable me to be alert,
and hear the weakest shout,
quickly and efficiently
to put the fire out.
I want to fill my calling,
to give the best in me,
to guard my friend and neighbor,
and protect his property.
And if according to Your will
I must answer death’s call,
bless with your protecting hand,
my family one and all.
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Police as therapist: the inherent risk of unconditional positive regard 

WESTBOROUGH, MA January 12, 2017 Changes in the responsibility for those afflicted with major mental illness must remain in the hands of medical and psychiatric providers who are trained in contemporary diagnosis and treatment models. Yet a growing mental health strategy has emerged to train and educate first responders – including the police to deescalate and divert those with mental illness from jails into treatment.  The problem with diversion here in Massachusetts and New England is that a continuum of care is lacking. Since the closure of the state hospital system here in Massachusetts the community-based treatment centers have been overwhelmed by the volume of cases they must see.  To say they have failed is shortsighted and disingenuous and behalf of the Globe Spotlight team.

Make no mistake about it, putting police officers in the place of psychotherapists and psychiatrists is not going to happen here or anywhere. But cops are being asked to act as mediators to diffuse encounters with persons with suspected mental illness. The intention is to reduce violent encounters between the police and those with mental health issues. “Most people with mental illness are not dangerous, and most dangerous people are not mentally ill” according to Liza Gold, 2013. Yet in the past several years there have been many high profile officer-involved shootings involving people afflicted with a variety of psychiatric conditions including major depression raising the specter of suicide by cop.

POLICE ACT AS CRISIS MEDIATORS WITH MENTALLY ILL

It is very risky putting the police in the role of crisis intervention specialists to manage those who may be emotionally distraught. For one thing the high incidence of drug and alcohol intoxication in these cases makes any negotiation or mediation almost impossible. I was always taught that until the patient is sober there is no meaningful assessment or interaction is possible.  Police are the front line responders to crises of all kinds. Asking them to serve in this new role presents a level of officer specialization like never before.  Some officers are being asked to offer unconditional positive regard to those encounters in an effort to slow the scene giving time for intervention to take hold.  In some places like San Antonio, TX and Vancouver, BC it works.  But it has taken a long time to gain traction. If the goal is to avoid incarcerating those with mental illness this is especially difficulty in the absence of a treatment continuum as I have said.  In the cities just mentioned there is a well established mental health infrastructure that affords the police various options for the unstable citizens they are asked to assist.

In most larger communities a dearth of mental health services exist resulting in a large number of mentally ill persons being held in custody – sometimes a county house of correction or any one of

Dr. Michael Sefton brought out myths of mental illness while serving as a police officer retiring in 2015

16 prisons in the Commonwealth of  Massachusetts. The Spotlight team at the Boston Globe has featured the plight of those who are sent to prison with comorbid mental illness and substance abuse. The fact is that criminality and mental health are often difficult to disentangle.

The National Alliance for the Mentally Ill believe as many as 20 to 40 percent of prison inmates may have severe mental illness and may not be receiving the needed treatment to allow them to rehabilitate.  Yet in the absence of the mental health infrastructure needed to provide treatment – including hospital care for those most unstable, few viable options were put forth.

The Boston Globe fails to inform readers that criminality and mental illness are not mutually exclusive.  Drug addicts break into homes to feed the hunger of their addiction.  In prototypic fashion, the Globe offers no alternative and no solution aside from casting blame on the Commonwealth of Massachusetts. Without a doubt the stories they report are heart wrenching and emotionally palpable for the readers. But not all those in custody who are suspected of preexisting mental illness are helplessly suffering without therapy.  Most are not.  In many cases being incarcerated allows an addict to become clean and sober and begin the first steps of recovery. Those who are most resistant to therapy and fail to attend psychotherapy, anger management, and medication monitoring have a higher risk of violence and substance abuse. This fact must be considered when responsibility for treatment failure is studied.  

Those relationships that suppress the normal, effusive, life force are detrimental to health much like a toxin said Sefton in 2013.

ALTERNATIVE SENTENCING

With so many incarcerated persons with suspected mental illness change must be initiated  by having services available to those on the front lines.  The criminal justice system and the department of mental health have an opportunity to work together now that the pendulum once again swings toward a treatment model. The police can be trained to control the scene through intervention and mediation strategies by slowing things down. When charges are brought alternative sentencing models may offer leverage that include mandated treatment in lieu of jail time.  Studies show that those who remain in treatment are less violent than those who fail or drop out of treatment, Torrey, et.al., 2008.

Mental health patient often rely on community services and social welfare including housing, disability payments, medical care and more.  Access to these services may be tied to participation in treatment including psychotherapy, medication, if prescribed, and substance abuse treatment.  Here is Massachusetts M.H. Advocates reject this notion as unfair a response that remains unique across the country.

The interaction of substance 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.  The 12-step programs have great success and are free to anyone willing to attend. Family members may attend Al-Anon or some drug-specific family support group.

Mental health infrastructure is necessary for the system to work.  In San Antonio it has taken 15 years to establish a system that works and saves lives.


Torrey, CF et. al. The MacArthur violence risk assessment study revisited: Two views ten years after its initial publication. Psychiatric Services, vol. 59, issue 2, February 2008, pp. 147-152.

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

  • “… 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

WESTBOROUGH, MA September 15, 2016 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. 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.

Is a DV registry an abuse of rights?

“The implementation of a domestic violence registry would inform potential victims that they are at risk and greatly reduce the cases of domestic violence in New York state.”  NY State Senator Michael Nozzolio

WESTBOROUGH, MA April 4, 2016 The prospect of mandated reporting in cases of domestic violence will add to already the over burdened state and federal bureaucracy. It cannot be done and may be a violation of the privacy rights of those accused of domestic violence.  Or at least that is what they tell us.  I have encountered abusive men who I have escorted off someone’s property after a verbal argument – before it became a physical encounter. In conducting my investigation, I learned that the guy had active protection from abuse orders that were taken out by three different women. That should be fuel for thought and the first question asked on the dating websites.  

In New York, state Senator Michael Nozzolio has proposed a bill that would create a registry for those convicted with violent felony domestic violence.  The bill entitled Brittany’s Law after a 2009 murder in which Brittany Passalacqua and her mother were killed in a domestic violence homicide. It has been passed in one form or another by the NY State Senate four times but the state legislature has yet to take up the bill.  Why? Some believe that a published list of abusers is a violation of human rights – like if a guy shows up on the list he may not be able to get anyone to date him anymore.  That seems like a reasonable consequence for beating up an intimate partner or two.

Are childhood sports becoming venues for expression of unencumbered anger?

WESTBOROUGH, MA January 20, 2016  “Childhood sport represents an opportunity for children to learn the value of teamwork, sensible competition, winning, and loosing. Some important lessons in life emerge from the spirit of youth competition,” according to Michael Sefton, Ph.D., Director of Psychology at Whittier Rehabilitation Hospital in Westborough.  “I have coached youth hockey up through high school-age boys and have found 99 percent of the families I worked with to be very reasonable and respectful,” remarked Sefton in preparation for the blog post.  Just as importantly the games must be fun or children will not want to play. In recent years there has been a growing notoriety of fan behavior while attending the sporting events of children.  It is almost a “mob mentality” as parents shout at referees over botched calls, yell at other players, and become obstreperous toward the opposing fans.  Sometimes this becomes violent as it did in Reading, MA in 2002 when two men squared off and fought over a youth ice hockey practice resulting in the death of one.  “The fight was less about hockey than about the loss of control and unencumbered anger” according to Sefton. For his part, Thomas Junta who outweighed the victim by over 100 pounds was sentenced to 8 years for manslaughter.  He was released from the state’s prison in Concord, MA in 2011.

Social scientists have been interested in mob behavior for years and when it comes down to what the underpinnings of fan behavior experts cite alcohol, adrenaline, and blind team loyalty as primary culprits. But as far as parent behavior at childhood sporting event goes some parents become delusional and behave out of some overdriven striving on behalf of their child. Some parents see scholarship money in a child as young as 5-years old when in actuality only 2 percent of athletes will ever receive scholarship funds for playing football for example, according 2008 NCAA published data – most receive only a partial scholarship package and not the coveted “full ride” – published in the NY Times.  As a parent I took my children to an NCAA ice hockey playoff event that was so much fun. The kids were given ice time to skate with coaches and players from the playoff teams.  During this time I attended a parent education seminar on scholarships and the lengths to which some parents will go to get their child athletes noticed.  How is it possible that an angry father might physically attack a volunteer referee over a missed call or become enraged at a youth coach over the amount of playing time a son or daughter receives?

According to Brooke De Lench, Mom’s Team executive director, parents lack the basic coping skills to respond to the ups and downs of their kid’s competition and are injured when their child does not succeed. De Lench seeks a shift from an adult-centered model to a child-centered philosophy as a way of eliminating unruly and sometimes outrageous fan behavior. When fans loose control the results can be deadly. “We lose ourselves when we watch our children play sports” said Sefton who regularly attends high school parents’ night in Massachusetts speaking on concussion.  But becoming lost as children play youth soccer or football must never include losing control as it sometimes does. Because for some parents, a child’s failure, or even the perception of failure may evoke strong emotions.

In 2002 during a youth hockey practice 2 children jostled and battled for the puck.  One parent, confronted the coach, whose son it was involved in the on ice scrap.  He objected to the rough play during the on ice scrimmage.  A shouting match ensued followed by the 270 pound Thomas Junta, 45, jumping the much smaller Michael Costin, 44, and punching him violently and killing him in front of his child and other players in the ice arena in Reading, MA.  Junta was charged and served 8-10 years in the state’s prison for manslaughter.  The lives of both families were destroyed by this event.  Both Junta’s and Costin’s boys have grown into troubled men and have themselves served time in prison.  This sensational story left quite an impression on me as an outrageous exemplar of state of the art parenting.

Most of us know there is much psychology in youth sports including developing core beliefs about winning and loosing, team cohesion, mastery of physical skills, and the growth of healthy competition. Balance is needed pushing children to become something for which they are may not be physically or emotionally equipped. Just as important parents must recognize their own feelings at their children’s games and accept that some things should not be worthy of the fight to end all fights.

Dr. Michael Sefton is a neuropsychologist and former police sergeant in Westborough, MA .  He along with 3 colleagues published a psychological autopsy on the Dexter, ME domestic violence homicide from 2011 and presented the research before the Domestic Violence Homicide Review Board at the state house in Augusta, Maine in November 2011.

via Are parents at kids’ sports games harmful? (Opinion) – CNN.com.

 

The cumulative impact of dementia on caregivers

WESTBOROUGH, MA January 20, 2015  Dementia is a life changing affliction for both the patient suffering with the neurocognitive decline and spouse and family members alike. Caregivers have a particular cross to bear – especially those without support. It is a highly stressful role for any spouse that requires both education and support. They are at high risk for burnout otherwise known as caregiver fatigue. For anyone who has had a loved one suffer with this disease “it is like seeing a family member die slowly, daily, withering away into an empty vessel” according to Michael Sefton, Ph.D., Director of Neuropsychology at Whittier Rehabilitation Hospital in Westborough, MA.  “It is very important to obtain a careful and sound neuropsychological assessment of patients’ suspected of having dementia because so many conditions mimic dementia and may be treatable” according to Sefton.

When a caregiver is overwhelmed something must be done to provide emotional respite for the spouse or family member. Caregiving spouses frequently have powerful feelings of guilt, anger, and sadness as a result of seeing a loved one become forgetful, detached, and confused. They can be extremely difficult to managed in the home setting and sometimes require specialized day treatment.  The decision to hospitalize or seek nursing home admission for a family member is an individual one. It is critical to look at the functional change in the afflicted family member and see what placement options make the most sense.  Caregiver fatigue places afflicted patients at greater risk for neglect, battery and abuse than other medically complex cases. It places caregivers at risk for health problems of their own.

Throughout America, physicians and psychologist alike are mandated reporters for cases of suspected abuse – regardless of whether the caregiver is experiencing caregiver fatigue or not. Family members are strongly encouraged to support parents, e.g. respite care for afflicted parent, whenever one is suffering from a severe illness like dementia. Read the post at link below.

The cumulative impact of dementia on caregivers.

Watch for the flying of the flags

Terminal rage dissembled by increased red flag threats and violence

WESTBOROUGH, MA  November 2, 2014 A group of my colleagues and I were drawn into the chilling events of June 13, 2011 after Stephen Lake killed his family and then himself.  During the final moments of his life Lake laid out the death scene ostensibly to torture his spouse from whom he was estranged and ordered to stay away.  While police closed in, Lake killed and attempted to burn his victims in an act of emotional mayhem.

Arguably, the murderer in this case became blinded by anger and resentment at perceived disrespect and exclusion from the lives of his children. This anger had grown over the year since a protective order was issued following a violent episode in the family home. The perpetrator grew marginalized during the coming months becoming resentful and humiliated at missing key events like Christmas and an 8th grade commencement.  All the while he posted on social media sites his love for his family he grew depressed and disorganized.  12 hours before the violent ending he tearfully described feeling depressed to a family member and was advised to seek help.  Lake wrote 9 suicide notes that were found in the days after his death.

Renewed interest in retrospective study

The psychological autopsy revealed an increasing pattern of red flags in the weeks before the murder-suicide in Dexter, Maine. Greater awareness of these red flags may serve as a stopping and containment point for perpetrators of intimate partner violence.  In a sad retrospective, the Maine state Chief Medical Examiner cited that “in spite of some mental health treatment the extent of (the perpetrator’s) anger was not fully appreciated”. The research led to a call for no bail holds for some violent abusers and GPS monitoring for others.  After 3 years, these recommendations are finally beginning to emerge in the protection of victims of domestic violence in Maine. Mr. Lake was alleged to have violated the protective order more than twice.  His reported view of the “cost of divorce was the price of one bullet”.

Who can be expected to bear witness to red flags?

It is well documented that domestic violence is a secret happenstance that effects far too many families across the country.  Victims are expected to remain loyal servants of their spouses under the dissembling guise of love and devotion.  The findings published in the Dexter, Maine study reveal that people knew what to expect from Mr. Lake.  His unwinding was clear to some of his closest family members.  A paternal aunt was quoted as saying “I never thought he would take the kids” suggesting an awareness that Lake might kill his spouse and then himself – sparing the children.  Others believed Lake might commit suicide in front of his wife and children leaving them with the emotional specter of his violent death.  Instead, as the chief medical examiner cited the full extent of Lake’s anger was not appreciated.  In this case, as in many other retrospective studies of DVH red flags were not appreciated. Many believe that an order of protection is not effective in protecting victims from violent spouses who seem to ignore “stay away” orders seemingly at will and without consequence.  These are the red flags that require containment of the abuser and must serve as the frank evidence of elevated risk for domestic violence homicide.

The team of people helping 22-year old Elliot Rodger, a young man who went on a shooting rampage at the University of California at Santa Barbara in May 2014, all reached out to police and the media when they could not reach the estranged and overwrought man.  But they were too late as he had made his mark on history by then.  The the Virginia Tech shooting some red flags were missed.  Had the subtle clues the Rodger’s underlying mood been recognized the shooting may have been averted.  To read the blog from the UCSB shooting click here.

Mandated reporting for domestic violence 

As a civilized society there should be mandated reporting for those most at risk for domestic violence and the penultimate DVH as it becomes apparent.  Just as practitioners are mandated to report cases of suspected child abuse and elder abuse so too must we begin to take heed of the signs of domestic or intimate partner abuse and take action.  By doing this we may save the lives of those most effected by DV and arguably break the recurring cycle of domestic violence.  Some people wrongly believe there is nothing that can be done about domestic violence homicide. Others remark that “what happens behind the closed doors in a dysfunctional and violent household is no business of anyone else”.  To the extent that this draconian belief system prevails in the public understanding of DVH there is little chance of preventing this scourge.  As a result states are slowly changing their response protocols for DV and the police response to signs of abuse with mandated arrest for suspected perpetrators.

Risk assessment of those arrested for domestic violence is often overlooked.  However, police departments are teaming up with agencies serving the population of abuse victims like never before and are adopting tools to assess the likelihood of future violence when determining bail amounts. Bail commissioners must be educated about the cycle of abuse and domestic violence when assessing bail amounts.  The average abuse victim experiences 5-7 episodes of DV prior to calling the police. Police response to DV has slowly started to include a careful analysis of the history of aggressive events including the number and type of physical assaults that have taken place.  Some events are clearly more foreboding like choking to a point of unconsciousness, sexual aggression, threats of suicide, and the use of veiled threats of death if the spouse ever tries to leave. Other behaviors such as unrealistic jealousy may be the underpinning of current or domestic violence.  One victim told me that the abuse started as soon as she said “I do” 16 years earlier.

REFERENCES

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. (2011) The Psychological Autopsy: Provides a host of pre-incident indicators. Blog:  http://www.enddvh.blogspot.com/2011/11/psychological-autopsy.htm, taken May 26, 2014.