WESTBOROUGH, MA April 7, 2018 The myths of mental illness come up over and over when criminal justice reform is discussed. Here in Massachusetts a significant update of the Criminal Justice laws has just been passed and await Massachusetts Governor Charlie Baker’s signature.
In truth most criminals are not mentally ill. The question is how do so many people who are mentally ill wind up in prison populations? Jail diversion projects are being introduced from coast to coast and will directly impact the number of people with mental illness who are in the state prison and county jail systems. It has worked elsewhere including San Antonio, TX. We are led to believe that as much as
40 percent of the inmate prison population has some form of mental illness although I do not dispute this. The stigma associated with being “mentally ill” calls for added resources for treating them. Just as resources are provided for those with diabetes, atrial fibrillation and COPD. These patients are not stigmatized for the maladaptive choices they make that may confound the medical complexity they experience and its cost to society. Some of the worst cases of COPD I have worked with continue to use tobacco products. Similarly, those with uncontrolled diabetes may require diseased-related surgical amputation of toes, foot, legs, yet remain non-compliant with checking their blood glucose. Why? They are not stigmatized – unless they are obese.
Each time we see something horrific we automatically assume the person to whom the acts are attributed “must be sick”. These notions have been discussed over and over in these pages. In truth, mental illness has less to do with aggression toward people than crimes such as petty theft and other nuisance offenses like disorderly conduct and panhandling. My sense is that whenever an arrest is made the differential diagnosis is all about the base – and underlying addiction and substance abuse must be considered and treated.
In the 1970’s the Massachusetts state hospital system had been deconstructed and was taken out of the continuum of care. The chronically ill fell off the treatment radar and went rogue. Importantly in Massachusetts, this triggered the swing away from hospital-based care to the community health centers that became the front line for those in crisis. At this point the myth of mental illness began its insidious transformation and jail became the containment center in the absence of the venerable state hospitals. These insights are not new. The problem is that there are not enough treatment options including inpatient mental health care to make a viable change in the current trends.
“The short version is that while people with serious mental illness are slightly more likely to commit acts of violence than people without mental illness, the risk that it creates is pretty small compared to other known risk factors.” According to Joel Dvoskin “alcohol accounts for a great deal more violence than mental illness does.” APA, 2018
“So, when somebody feels depressed, enraged, insignificant, they have access to a firearm, maybe they’re drinking too much that night, maybe they just got fired and so on – it’s like this perfect storm of despair. ” according to Dr. Dvoskin. There are several states who are taking a close look at the removal of guns from people known to be violent or threatening – even prior to formal adjudication. Until now, there was little that could be done to remove weapons from a dangerous person until he committed a crime.
Here in Massachusetts the substance abuse problem and the mental illness problem are commonly lumped together. They are not mutually exclusive and I have posted previously that mental problems are often inflamed by substance use. We have come full circle in understanding the need for intensive resources that may have been lost by closing the hospitals and letting them crumble.
Dvoskin, J. (2018) Speaking of Psychology: Dispelling the myth of violence and mental illness Episode 27 American Psychological Association
WESTBOROUGH,MA April 2, 2018 Today is Autism Awareness Day across America and the World. Persons living with autism require sensitivity and patience. Here in Massachusetts we are fortunate to have one of the world’s leaders in autistic education at the New England Center for Children in Southborough, MA. These professionals provide front line behavior planning, education, BCBA training, aquatics, and residential living.
“Autistic people find interacting with others difficult. For example, they may struggle to read facial expressions and be taken by surprise at outbursts of anger or affection.” according to Mark Goodard on the Psychology24 blog first published in 2016. Mark posts 5 poignant suggestions in dealing with those on the Autistic Spectrum.
Avoid changes in plans or routines with first warning a person with autism
Take time and explain things clearly to avoid resistance and major meltdown later on.
Be patient – expect rigid thinking and someone who can be stubborn and irritable when anxious.
Do not rely on body language and facial expressions. People with autism avoid eye contact and do not pick up social cues.
Do not be afraid to set limits and social correction. Autistic children and adults need direction in situations that require social reciprocity.
Goodard, M. (2016) 5 TIPS ON DEALING WITH AN AUTISTIC PERSON. Psychology24. Found at http://www.psychology24.org/5-tips-dealing-autistic-person/. Taken April 2, 2018.
Westborough, MA March 28, 2018 The police-mental health interaction continues to be one that neither party exhibit great confidence nor take great pride in. Myths abound about how to treat those so afflicted – especially among law enforcement personnel. I have provided classes for LEO’s and generally they are not well attended and tend to bore the average officer. In Maine, LEO’s are required to have regular training in working with the mentally ill in order to maintain their LEO credentials. Other states in New England have similar requirements and now focus on psychological first aid and deescalation protocols. I have presented on topics of assessment of risk and dangerousness with some success. In- service training must be short and to the point or students will quickly lose interest.
The photograph above shows the cover of a guide book first written in 1954 that was instructional for police officers. It was written to teach the law enforcement officers of the day to recognize signs of mental illness then defined as “abnormal people”. It was written by 2 Louisiana State University psychologists and first used by a police agencies in the late 1950’s. I have been trying to find a copy of this early version that was re-published in 1979 and now costs over $100. It was written because police officers needed training and experience identifying features of psychiatric emergency. This was thought to reduce the uncertainty, fear and confusion around handling these cases by providing education including signs and symptoms.
After nearly 60 years, law enforcement is not significantly closer to understanding the mentally ill than they were in 1954. A colleague police psychologist Leo Polizotti, Ph.D. has an original copy of this booklet although I have not seen it as yet. Dr. Polizotti provides consultation to law enforcement, officer selection interviews, and teaches a proactive approach psychological resilience to police officers that can afford them greater career satisfaction, professionalism, and longevity. Dr. Polizotti is tasked with supporting officers who are exposed to the daily grind of violence, suicide, homelessness, and its cumulative impact on a cop’s personal narrative. His model suggests a fundamental change in how police officers interpret their experiences over time and acceptance of what cannot change and healthy adaptation. He is a great asset to the Central Massachusetts community and across New England and espouses a model of stress resistance through adaptation.
“In 1954, the National Association for Mental Health first issued the book “How To Recognize and Handle Abnormal People: A Manual for the Police Officer.” Included were techniques on dealing with all kinds of “abnormal persons,” from psychopaths, drug addicts, and the “mentally retarded” to civil protestors and those involved in family disturbances.” Posted by David Pescovitz, 2015
Text from 1954 How To Recognize and Handle Abnormal People: A Manual for the Police Officer is provided below. It points out many of the outward signs of disturbed thinking often an underlying feature of those with mental illness – in this case something called ideas of reference. These signs are common among persons with early paranoia and are sometimes missed – even by members of the immediate family. This is still a common symptom of mental illness today and is considered to be the prodrome to a more serious loss of contact with reality. Ultimately, it comes down to who is at more risk for violence? And how can we be sure?
It takes a healthy and educated police officer to observe, understand, and control unpredictable situations. Officers are required to adapt to the demands of individual calls for service. A colleague Dr. Leo Polizotti has identified a model for coping with the strain of police service. He cites the importance of avoiding apathy, withdrawal and bitterness on the job. “Understanding the 3 C’s of hardiness, Challenge / Commitment and Control will assist officers to manage stress more effectively, resulting in fewer emotional and medical problems. By viewing each new situation as a challenge, instead of a threat, you become committed to that challenge. You can readily see yourself in control and better able to deal with the situation. You will enhance your “hardiness” or resistance to stress” Polizotti, 2018.
“He may think, for example, that announcements made over the radio have something to do with him personally. He may even hear his name mentioned. These are called ideas of reference which, of course, means that the patient thinks people are referring to him in one way or another. In the beginning, ideas of reference may occur only occasionally, but they gradually become the rule rather than the exception, and finally they may develop into definite delusions of persecution or grandeur.”
The list below are the signs of “abnormal persons” that are printed in the booklet published in 1954:
He shows big changes in his behavior.
He has strange /losses of memory, such as where he is or what day it is.
He thinks people are plotting against him, or has grand ideas about himself.
He talks to himself or hears voices.
He thinks people are watching him or talking about him.
He sees visions or smells strange odors or has peculiar tastes.
He has complaints of bodily ailments that are not possible.
He behaves in a way which is dangerous to himself or others.
Interestingly, the bullet points above remain accurate today with the understanding that too many individuals suffering with a major mental illness also have substance abuse/dependence. It is this fact that confounds most LEO – mentally ill encounters. “Beyond the rigors of police work, lie the demands of a personal life, specifically a wife or husband and children. Maintaining a healthy and happy family life is on its own a demanding responsibility. Add these powerful life stressors and demands to the burdens of police work and an officer may begin to feel the weight upon his or her shoulders.” Polizotti, 2018. Emotional and physical strength and endurance requires hardiness that comes from personal responsibility and comittment to excellence and peak performance. Greater focus on sobriety – including opioid and alcohol dependence is essential. If this can be maintained mental illness may remit to the extent that subjects can remain in the community. Programs like A.A., N.A., and other 12-step groups are free and often afford subjects great support. In most cities there are 12-step meetings every day morning, noon and night. The problem is getting people to realize they have a problem. Even airports hold A.A. meetings for travelers in need of the 12-steps. We are working on a replacement manual like the one cited in this post.
Polizotti, L. (2018) Personal Life Demands. Presentation – Direct Decision Institute.
WESTBOROUGH, MA March 22, 2018 The recent spate of explosive attacks on apparently random victims continues as of this blog post. People around the world are speculating about the psychological underpinning of a person or persons who can create a bomb and deliver it to some intended victim without being caught. The explosion at the FedEx depot is something new as compared to the first 4 blasts. So far 2 victims have been killed by the bombs. The initial victims were African-American and Latino raising the specter of the bombs being a hate crime.
What does the bomb say about the bomb maker? Bomb construction thought to be a characteristic of underlying ideology and may be linked to motivation. Certainly explosive devices range in their level of technology and sophistication. In 1995 Timothy McVeigh created a powerful bomb made out of a deadly cocktail of agricultural fertilizer, diesel fuel, and other chemicals that killed 168 people at the Murrah Federal Building in OKC including many children at a nearby pre-school.
The type of bomb in Austin, TX has not been described by police or federal agents but the frequency of the attacks is unprecedented. It may suggest that more than one individual is working to produce the explosives and make deliveries or the devices were constructed to stockpile before deliveries were made. The bomber likely lives alone or has a shop where the devices and their components are stored for assembly. His keen interest is in making people afraid and keeping a city in lock down. McVeigh was a former munitions soldier in the Army and may have learned his technique in the process of training with the U.S. Army.
If the Austin devices are the work of a single serial bomber than the frequency and recent change in method of detonation raise the bar in terms of sophistication of delivery but the risk of being caught or making a mistake may also be accentuated. The police chief in Austin reportedly said that by using FedEx for shipping the explosive the likelihood of capture in short order was increased. An image was obtained of a man at FedEx that eventually became a person of interest.
The person who is behind this seige is likely an angry and detached with few friends. Being marginalized lends both to his stealth and fuels his anger and resentment. He may be suicidal and ultimately he final blast is to be part of his exit plan. He quite likely enjoys the sadistic control and media attention he is getting.
The fact that there are so few deaths – versus a massive splash event is not quite clear. It speaks to ambiguous planning and perhaps unclear motive and may signal the growing disorganization associated with his terminal event. Additional personality features are uncovered with each action. These are kept from the public domain. My analyses are conjectural.
WESTBOROUGH, MA March 20, 2018 Greater protection of victims of domestic violence is needed. When provisions for a plan of safety are executed victims are expected be afforded greater safety but not always. Domestic violence victims are at greatest risk when they make the decision to leave a violent partnership. This often means having a safety plan – especially when specific threats have been made. Safety plans are often drawn up by women in conjunction with counselors who specialize in helping families stay off the grid and hidden from violent spouses. In one case of familial homicide and suicide it was clear that the commonalities needed to be exposed among cases of familial homicide.
In particular, when I teach law enforcement officers about DVH, I encourage detailed witness statements much as possible especially if the victim described the fear and belief that she will one day be murdered by her partner. These documented statements, if spontaneously uttered, are often the greatest predictor of potential harm to victims and her children. If written into a police report the decision about dangerousness and bail may be influenced.
In the 2011 homicide from Maine, Steven Lake used social media to track his wife and 2 children from whom he was mandated to stay away. Yet, if his wife posted a photograph of his children he went to great lengths to undermine their safety by identifying anyone who “liked” the photo or commented on it. He used these posts to triangulate her whereabouts and living arrangements. This was a large part of what marginalized Stephen Lake and in turn Lake posted his own propaganda espousing his loneliness and love for his children. Lake garnered significant support from those social media “friends” who knew nothing about what he had done to require the protection from abuse order. Many, in fact, encouraged him to fight for his children which may have been a catalyst in his festering resentment and ultimately terminal rage. He was provided information and access to his wife’s social media platforms by a family member. For her part, Lake’s wife wanted to remain close to her in-laws in an effort to normalize her children’s life as much as possible. For example Lake’s parents were invited to the family’s thanksgiving celebration but declined because Steven Lake could not attend.
Similarities in domestic violence
Cases of domestic violence have similarities across socioeconomic status, ethnic and cultural background, and the cycle of abuse. The growth of social media platforms affords those inclined to control and isolate intimate partners from persons who might provide them security. Cases of domestic violence share the common theme of intimidation, coercion and control. Social media are a fun and useful medium to keep in touch with friends and family. But it is also lends itself to sometimes nefarious trolling to gain a perceived advantage in undermining the safety plan. Social media trolling contributes to the control they seek especially when victims seek protection. In order to limit the impact of social media stalking victims need to shut down all social media accounts and activity. Greater protection of victims and family members requires a comprehensive plan with provisions for times when they are violated – including mandatory arrest, risk assessment and no bail containment if deemed necessary.
“That is one conclusion of four former and current police officers in a recently released report. The men, who were volunteers and had no connection to the shootings, spent the last several months interviewing 69 people about the triple homicide and suicide in Dexter in June, to suggest ways to prevent future tragedies.” Portland Press Herald, November 11, 2011
The Psychological Autopsy report suggests improvements that may prevent future domestic violence homicides:
• Use of social media platforms by people involved in conflicts should be minimized, to prevent intimidation and stalking.
• Protection-from-abuse orders and bail conditions should mandate disclosure of all firearms that are accessible to the domestic-violence offender.
• An offender who seeks, hides, uses or attempts to acquire a gun or ammunition when a protection-from-abuse order is in place should be charged with a felony and not allowed bail.
• Bail amounts should be high enough to deter abusers from violating a protection orders.
• When a protection order violation involves a deadly threat, a judge should set bail, not a bail commissioner.
• Global positioning systems should track abusers during periods of protection orders in any incidents that involve deadly threats or evidence of weapons.
• At least two officers should be sent to all domestic-violence calls when officers suspect violence is likely.
• At-risk spouses should be advised to live in as secure an environment as possible, with deadbolts on doors, secured windows, motion sensor lights and a land telephone line.
• People charged with domestic violence crimes should not wait more than a year to go to trial.
The safety of potential victims including children is the penultimate goal of protection orders but too often they are ignored via stalking efforts that include using social media to track the activities of an estranged spouse. This overt defiance requires careful analysis and requires the arrest of the violator. Once this takes place a dangerousness hearing must take place before he or she is released but this rarely takes place.
WESTBOROUGH, MA March 1, 2018 There is a fine line between civil liberties and the need to keep Americans safe. As of now that line has not been crossed in terms of built-in protections from those who are most dangerous to society. But when someone who thinks he is being commanded by the neighborhood beagle to murder young lovers as Son of Sam serial killer David Berkowitz did in the 1970’s – can remain free to ply on his dangerous delusions? Berkowitz was a more obvious case of psychotic behavior and violence although ultimately he was found guilty of murder.
“The specter of mental illness insures a convenient scapegoat” Michael Sefton, 2013
Have we have lost site of what it means to deal with mental illness and keep people from being victimized because of a threat to the civil liberties of the mentally ill? No. Everyone deserves due process but those with a proclivity toward gun violence who have expressed an intent to murder should be afforded closer scrutiny and be kept from having access to firearms. In some cases they must be contained as a means of keeping potential victims and the greater society safe.
It will be interesting to see the psychological profile that emerges moving forward although as of this posting authorities in Broward county are negotiating a guilty plea and when that is signed off we will not hear about him again – until he is lost in prison, or the next murderous episode is recorded. The local district attorney has hinted he may seem the death penalty for the perpetrator of the despicable actions taken one month ago in February, 2018.
“Civil liberties that have historically ended in mass homicide must no longer be “civil liberties” to any degree. That includes owning guns, knives, poison and baseball bats. People without criminal intentions and such homicidal hang-up’s tend to worry not about “civil liberties””. Brian Gagan 2018
How can we not collect data on someone seeking information on proclivities toward violence? Every time I shop on-line I receive hundreds of pop up ads for similar products I may like. On Saturday February 17th, CNN’s Michael Smerconish asked the question “would it not be possible to have a similar technology for data mining that looks for proclivities toward violence and capture their social media footprint” of those who might do us harm? There are algorithms used to track people’s on-line shopping behaviors why can’t there be the same data mining to bring forth those looking for weapons, those buying ammunition – as in the case of the Las Vegas shooter, and those who express their desire for committing mass murder via You Tube video’s, Facebook posts, Twitter, or any of the other regular social media platforms. In review of Cruz social media presence there were several red flag warnings of his intentions that were missed.
WHAT ARE TRIGGERS FOR VIOLENCE?
There are always triggers for violence, we believe, that sets a plan into action. So far these have not been disclosed In the ongoing investigation. Triggers differ from case to case. Triggers can be sudden emotional loss or overwhelming humiliation that is unbearable to a potential assailant. Triggers may also be the result of months or years of festering emotional baggage that explodes after some relatively benign insult such as being denied a date to the prom or loss of employment.
The red flags were well noted in his pre-incident behavior. The FBI had specific and detailed warnings about Cruz. He had been expelled from the Parkland, Florida high school because of violent behavior and threatening other students. He was sent to an alternative school about which we have learned very little. Outwardly, Cruz was living in the fringe of humanity and was known to be an angry violent person. Media reports indicate 29 visits to the Cruz household by county law enforcement officials because of conflict and fighting with adoptive parents – both of whom are now dead. Upon initial review, after his mother died in November, Cruz had been living with a family who offered to take him in after she died suddenly of pneumonia. His father had passed away several years earlier of a cardiac issue.
Certainly the death of his adoptive mother may have been an emotional catalyst – if she were important in his psychological life. Perhaps she shaped his fragile inner narrative sufficiently to delay this emotional maelstrom by providing a positive sense of self -worth. It is not yet known. But it was Cruz who fired the weapon. The evil was in him not the firearm. More will become known about the Cruz family and his adoption in the coming months. So few of these perpetrators of mass homicide survive. Moving forwsrd, I would suggest accessing police reports under the freedom of information act and see yourself what police were dealing with.
I will say that there are Nikolas Cruz copycats everywhere and we should be on guard for them – as I try to be here in Boston. In Florida, persons suspected of having mental illness may be held under the Baker Mental Health Act allowing for involuntary psychiatric exam. All states have this mental health protocol but too often law enforcement officers are not trained to make these determinations or are concerned about litigation. This is training I want to see begin to become part of the academy training for career law enforcement officers. The “see something – say something” adage may be a jump-start toward better control over individuals who brandish ideas of violence and broadcast their underlying emotional slippage on social media. These persons should have no access to firearms.
“There is broad conceptual agreement that regardless of whether you view gun ownership as a right or a privilege, a person can demonstrate through their conduct that they have no business possessing a weapon. Felons, the dangerously mentally ill, perpetrators of domestic violence — these people have not only demonstrated their unfitness to own a weapon, they’ve been granted due process to contest the charges or claims against them. David French in National Review 2018
There must be a mechanism put into place for the fluid containment of individuals who pose high risk such as the individual who pulled off this despicable event. As you see from the quote above, David French published an article in the National Review and proposed a gun violence restraining order (GVRO) that would preclude those most dangerous from owning, buying or having access to guns. Nikolas Cruz was on the fringe for a long time – perhaps his entire adoptive life. It may ultimately come down to an attachment disorder as an underpinning for his terminal rage triggered by loss and powerful resentment toward his adoptive parents and school authorities who expelled him into social and emotional oblivion. His prior behavior, mental health hospitalization, and active threats on social media posts would have likely
made him an unsuitable gun owner. According to David French, senior writer for the National Review, “the concept of the GVRO is simple, not substantially different from the restraining orders that are common in family law, and far easier to explain to the public than our nation’s mental-health adjudications. Moreover, the requirement that the order come from people close to the respondent and that they come forward with real evidence (e.g. sworn statements, screenshots of social-media posts, copies of journal entries) minimizes the chance of bad-faith claims.” in National Review on February 16, 2018. When such a data set is discovered by family, friends, other students, teachers, etcetera a court mandated mental health assessment and the gun violence restraining order may be issued. California has used a system of GVRO enactment since 2014 with success. In 2016 over 80 such restraining orders were issued. In the case of Nikolas Cruz, he was thought to be the “most likely” student to initiate a school shooting according to multiple students interviewed after the shooting last week.
The correlation between mental illness and violence is quite weak. Myths seem to exist that the mentally ill are prone to violent behavior and this is not supported in reality. Dr. Jonathan Metzl, director of the Center for Medicine, Health and Society at Vanderbilt University, said that these mass shootings highlight Americans’ desire to reaffirm a stigmatization of the mentally ill as “ticking time bombs” to avoid more difficult conversations about gun violence according to Phil McCausland reporting for NBC News. I find it extremely important and compelling that Nikolas Cruz is alive today rather than among those sleeping in the morgue in Broward county. Most serial killers have taken their own life at the culmination of the terminal event and just prior to succumbing to the police active shooter response. Perhaps, one day in the distant future, Cruz will give up his secrets to an unsuspecting correction officer with just the right stuff to earn his trust. If such a person exists.
WESTBOROUGH, MA February 15, 2018 The fact is that greater containment of high risk abusers is needed. I have spoken with police chiefs, district attorneys, and state senators here is Massachusetts about conditions of bail. Whenever someone is arrested he or she is given the opportunity for bail – usually on his own recognizance. This means he simply promises to show up for his initial court hearing usually in the next 24-48 hours. Unfortunately, no one seems to believe that a person can be held on “high bail” simply because one subject held his family hostage and threatened them with a firearm or another person tried to strangle his intimate partner.
The system of bail is directly related to a defendant’s prior history of crimes, convictions, and lastly, the nature of the crime for which he is seeking bail. The cycle of abuse is posted to the left. It is all about power and control of the victim. On average, police are called after 9 prior episodes of abuse. In general, they arrive when the couple is in crisis and he may be feeling guilt and making excuses for his behavior. Or other times, the couple is in the honeymoon phase of the cycle and one partner invariably refuses to press charges on his partner. This is what really infuriates police officers called upon to answer these potentially violent calls. “It was all a big misunderstanding” according to the dangerous partner.
I have posted several essays over the years on the topic of “dangerousness” in terms of it being considered prior to the granting of bail. The June 2011 case in Maine culminated after the abuser was released from jail on $ 2000 dollars bail. After his death the money was returned to his family. Some district attorneys have tried to withhold bail money when the defendant fails to appear in court due to death by suicide after domestic violence homicide (DVH). For many this seemed like a draconian response to families who were in pain and suffering immeasurable.
“Many believe there is a disconnect between the judiciary and the bail system.” Sefton, 2011
What can be done to assure greater containment?
Containment refers to the need to protect a potential victim and his or her family from a violent often marginalized family member who is showing red flags of impending terminal rage. A Domestic Violence review panel conducted in June 2011 concluded that “there is nothing society can do for a despondent, abusive spouse whose obsession overrides the norms of society – even his will to live”. If we believe this then we will erroneously surrender innovation in domestic violence prevention and harm reduction. When high-ranking prosecutors say domestic violence homicide cannot be prevented society is cheated out of taking steps toward containment of those who may violate protection from abuse orders. Lois Reckitt, executive director of Family Crisis Services in Cape Elizabeth, ME is quoted as saying that the wrong people are in jail when violence-prone abusers are released from custody to stalk and terrorize their family, as was the case in the Dexter, Maine tragedy in 2010. Containment and harm reduction should be the focus of the legal system and social service agencies alike. The judiciary and political machinery in states throughout America must speak out about protecting victims and families and not say there is nothing that can be done to stop DVH.