Monday, November 30, 2009

What if You Survived the Lakewood Police Shootings?

By now you've probably heard about the murder of four uniformed Lakewood, Washington police officers in a coffee shop yesterday morning.  There seems to be no doubt that the victims were targeted because they were police officers.  Police have a suspect and have been trying to find him in a series of very visible but unsuccessful attempts today.

A lot has been, will be, and should be written about these courageous men and women and their surviving families, including nine children.  The spontaneous outpouring of grief and support is amazing.  The owner of the coffee shop chain where the shootings occurred is an ex-cop himself, and he said yesterday that since his employees were unhurt he was mostly concerned for the families.  Who can blame him?

But the fact of the matter is that there were a handful of other people in the coffee shop when the shootings occurred yesterday -- both staff and patrons.  Police have said that it took some time to get full statements from them because it was so hard for them to describe what they saw right away.  Who can blame them, either?

It is not uncommon for survivors of shootings, particularly shootings in which multiple people are killed, to feel survivor's guilt.  They wonder why they lived when others died.  They feel that if only they had done more, they might have saved others.  Most often, they find some solace in the knowledge that everyone there was a target, and had they done anything different they might well be among the dead.

This situation is a little different.  The other patrons were not, in fact, targets themselves.  It seems pretty clear that the gunman was looking to shoot cops.  It is not as simple as realizing that they had to save themselves.  But in fact, they did have to save themselves.  While they may not have been targets to begin with, had they confronted the gunman they undoubtedly would have become targets.

When all is said and done, however, four police officers are dead in a highly publicized and sensational shooting that is making the national news, and the only people in any kind of position to stop it, one might argue, were the staff and other patrons.  While we all know that we don't blame them and we don't think they could have stopped this, that probably isn't how they are feeling.  That kind of guilt can lead to isolating oneself, and that's a very bad thing to do after a traumatic incident.

Add to this the wrinkle that the gunman is still out there.  The survivors have to be concerned, at least on a gut level, for their own safety.  They are witnesses, and he clearly doesn't care much about human life.  It has to be hard to get up and go out in public under these circumstances.

Most police departments have supports in place for families of officers killed in the line of duty and also for other officers and their families who understandably have renewed fears for other officers' safety.  Fewer communities are really set up to support the civilian survivors of an incident like this.  This is a time when a community-based CISM team is critical.  I hope there is one out there, or that someone asks for one on those people's behalf.  They need our support, too.

Update:  The suspect in these murders was shot and killed by police on December 1.  Hopefully, that will alleviate some small amount of the stress the survivors are experiencing.

Sunday, November 29, 2009

Man Traveling with Family Dies at the Grand Canyon

A man fell more than 200 feet from the south rim of the Grand Canyon on Saturday and died.  His name has not been released pending notification of family members, and it is not clear how this happened.  Some of his family members, however, already know. He was visiting the park with his son and daughter-in-law and "other extended family."

If we assume this man was not pushed, there are two possible scenarios, both truly awful to contemplate.  The first is that the victim was either looking out over the edge or hiking when he fell, in which case he was almost certainly with members of his family who saw him die.  The second is that he spent the holiday weekend with his family at the park, and then went off by himself and jumped.  Obviously this is a tragedy either way, but it seems to be even more of a tragedy because his family was there in the park.  Why is that?  Why is it worse to have a loved one die while you are traveling with him than while he's off with some tour group?

Having someone die before your eyes has a particular impact.  Our naive but deep-seated belief is that we have control over what we are close to, and particularly what we can see.  When we see someone die, it very much shakes up this understanding of how the world works.  Having this particular belief shaken, furthermore, is especially damaging because trauma makes us feel helpless as it is.  It's bad enough having to deal with the notion that trauma happens and we can't control it.  It's more distressing when it happens in a way that, on a visceral level, we feel like we should be able to control.  Feelings of helplessness and loss of control are, as any mental health professional will tell you, warning signs of depression and red flags for suicide risk.  As much as traumatic incidents always put people at risk, this sort of event may be even worse.

If this were a suicide, on the other hand, it might be even messier.  Suicides leave behind a lot of guilt about what survivors could have or should have done to stop it.  They leave that sense of helplessness that can make suicide contagious.  If this man completed his suicide while traveling with family, however, it adds the additional sense that people have that they are responsible for one another when they are traveling together or even just engaged in an activity together.  "I should have known" becomes "it was my personal responsibility to know."

There are two or three deaths by falling every year at the Grand Canyon, and most of them are accidents.  In all of 2006 there were only 11 violent deaths in the entire National Park system, and only one was a suicide.    Two were people being pushed over cliffs, so, at least that year, a fall from a cliff was more likely to be a murder than a suicide.  Anecdotally there are many more suicide attempts by jumpers or people wanting to leap into the geysers at Yellowstone.  When we imagine the final scary moments for a visitor who falls into the Grand Canyon, we tend to imagine the fall itself -- particularly if we're afraid of heights and have peered nervously over that edge.  Sometimes we forget that every visitor has a family, and sometimes they're watching the tragedy first hand.

Friday, November 27, 2009

Update: Nutty Putty Cave Becomes a Final Resting Place

Officials have announced that the body of John Jones, the spelunker who died after becoming trapped in Nutty Putty Cave in Utah, will not be recovered.  The dangerousness of the spot where Jones died makes a recovery effort too perilous, and so his body will remain there as the cave is sealed off to all future visitors.  A memorial marker will be placed there.

The news stories about this indicate that the decision not to retrieve the body was made jointly this morning by law enforcement, the cave owners and operators, and members of Jones' family.  His own relatives had to make the decision to leave him where he lies.  That can't have been easy.

In the truest sense, this is not a case of missing remains.  Everyone knows that Jones is dead and they know where his remains are, they just can't get to them.  In that sense, the usual uncertainty that comes with giving up on returning the body of someone presumed dead does not apply.

At the same time, every culture has specific ideas about what should be done with the human body after death.  Whether you are used to a wake or a viewing, burial or cremation or something else, all of us have basic beliefs about how a dead body ought to be treated.  No culture on earth has, as its usual course of action, leaving a body where it falls.

Death in general, and unexpected death in particular, take away our sense of control.  One of the ways to help trauma survivors is to help them see what measure of control they do have, even if it's just over what to eat or where to sit.  Death rituals reassert control of the living over the process of dealing with death.  We may not be able to stop people from dying, but we can decide how the body will be treated and where it will go.

Officials in Utah are to be commended for including the Jones' in this discussion.  While the final decision may have been pretty much a foregone conclusion, including the family in it helps them reestablish some control.  The family is also to be commended for putting the safety of responders over their own very real, very deep needs.  Hopefully, they take some measure of comfort from having done the right thing.

Note:  The picture above is not of John Jones, but rather of one of the responders during the rescue attempt on Wednesday.

Thursday, November 26, 2009

Giving Thanks the Day After Nutty Putty Cave

At about midnight last night, John Jones, 26, died in a tiny crevice in Nutty Putty Cave in Utah.  He had been stuck upside down for more than 24 hours, and rescuers had been working feverishly to get him out.  At one point they did get him free, but after an equipment failure he got stuck again.  After hours and hours of talking to him and reporting that he was in good spirits, rescuers noted that he was not responding.  He left behind his wife, who is pregnant, a young daughter, his parents and six siblings.

Today is Thanksgiving.  I'm sure it feels very different for the Jones family, as well as for the rescue workers.  The obvious impulse, especially for the Jones family, must have been to cancel their Thanksgiving dinner.  How can anyone concentrate on turkey at a time like this?

As much as we all understand that impulse, I'm hoping that isn't what happened.  When a trauma occurs, it feels like nothing is normal in the entire world.  The mundane tasks of life appear to be completely irrelevant.  The world, it seems, ought to stop turning.  But the world doesn't stop turning, and acting like it has actually prolongs that feeling of unreality.  At times of trauma, people need exactly what they don't feel like giving or can't give themselves -- normalcy.

What I hope happened is that the neighbors, the church, or whomever else is in the Jones' lives reached out to them today.  No, they couldn't necessarily face making a turkey and all the trimmings, but they still need to eat.  What's more, Thanksgiving is always going to have a negative association for this family from now on.  Skipping Thanksgiving entirely this year would cement that feeling even more.  And it would be lonely.  At a time when the world seems to be coming to an end, these people need friends to reach out and tell them they're going to be OK.

The rescue workers are going through something else right now.  Not only have they experienced someone dying literally before their eyes, but someone has died while they were a hair's breadth from saving him.  Their deeply held belief that they are good at what they do and that they make a positive difference with their work is shaken.  We on the outside know they did all they can, but it still feels awful.  And so I'm guessing there were some quiet tables this Thanksgiving, as these workers tried to process what happened and weren't quite ready to join in the revelry.

The Jones family issued a very lovely and moving statement this afternoon.  They said, in part,
We would like to express our heartfelt appreciation and gratitude to the brave, dedicated, and selfless men and women – many of whom were volunteers – who we know did all they could to get John out. We are told nearly one hundred personnel – including sheriffs, firemen, paramedics, cavers, and other rescue workers – were involved with the search and rescue operation, and we are deeply thankful for the compassion and care they showed John and our family – even to the point of singing John primary songs to help get him through the night.
Even in their own darkest hour, the family gave the rescuers a little of what they need. 

No trauma is ever "good," but sometimes it teaches an important lesson.  When the world stops turning, everyone involved needs to reach out to and support each other, and hopefully we all remember that we have a reason to give thanks.

Wednesday, November 25, 2009

Should the President Send Condolences When a Soldier Kills Himself?

If your loved one dies while serving in the United States Military, whether they are killed in action or by accident, you will receive a letter of condolence from the President.  Presidents have been doing this since Abraham Lincoln.  If your loved one serves in the military and kills themselves, however, you will get many of the same things that other families get, but you will not receive a letter from the Commander in Chief.  That has been true at least since the Clinton administration.

There is a push on from some military suicide survivors to change that policy.  They argue that their loved ones died in service of their country, certainly as much as someone who was killed in an accident.  The injuries they suffered were not visible, but they were certainly service related.  Their families deserve the same consideration from the President as anyone else's, and to do so would go a long way towards reducing the shame that has for so long been associated with death by suicide, particularly in the military.

This is one of those issues which, spun the way these families and the press coverage are spinning it, seems pretty clear cut.  Of course being a suicide survivor should not have stigma associated with it.  These families are grieving just as much as any other, and deserve all the support we can give them.

There is a problem, however.  One of the rules of thumb in responding to a suicide and memorializing people who die by suicide is that you in no way want to glorify the act of killing yourself.  When you have grand ceremonies to honor their memory, you run the risk that someone else who is considering suicide will, consciously or unconsciously, view killing themselves as a means to get that kind of attention for themselves and their families.  This is probably more of an issue with teenagers, who aren't fully able to appreciate the consequences of any action because their brains are not yet fully developed, but it remains an issue for others, too.

I don't know that I have a good answer for this.  On the one hand, families who are survivors of military suicides should not be treated with any kind of stigma.  They deserve our honor and support in a very, very difficult and complicated time.  On the other hand, there is an argument to be made that even what is already done for these families --  receiving a folded flag, a 21 gun salute at the funeral -- let alone a letter from the President might look pretty appealing to a soldier considering suicide.  They might think that in death they can bring honor to their family that they feel they could not bring in life. 

Taking away the stigma associated with suicide in the military may well save lives by making soldiers more willing to seek help.  The question is, by honoring grieving families properly, how many lives will we lose?

Tuesday, November 24, 2009

Census Worker Bill Sparkman's Death a Suicide, Staged for the "Benefit" of Others

Back in September, William Sparkman, a part time census worker, was found hanging from a tree in rural Kentucky with the word "FED" written across his chest.  At the time, the question of whether he was killed as part of a vast right-wing reaction against the census was being bandied about in the press.  Today, word has come that Sparkman killed himself.  He apparently intentionally staged the scene to look like a homicide so his son could collect on multiple life insurance policies Sparkman had recently taken out, totaling in excess of $600,000.  Those policies would not pay in the event of a suicide.

The traumatic death of a loved one is incredibly hard.  When that death is a suicide, it is much more complicated.  When CISM teams plan a response to a suicide, we expect to hear a lot of regret and guilt.  In this instance, police report that Sparkman told someone exactly what he was planning to do, and they did not take him seriously.  That person must be feeling the weight of the world on their shoulders, although of course it's impossible to know whether, had they responded differently, it would have made any difference.

In addition, it's not uncommon for those who kill themselves to express that they think their families will be better off without them, and that sentiment complicates the situation for survivors.  Inevitably, they do not feel "better off" and often feel a combination of anger at their loved one for thinking they would be and guilt that somehow this happened because of them.  It's not uncommon to hear families say, "why didn't he care about me enough to not do this?"

Sparkman's death takes this to a whole new level.  In this instance, Sparkman quite clearly was thinking about his family when he killed himself.  He took the time and effort to elaborately stage the scene so his son could get his life insurance money.  He cared enough to make it look like a murder.

Sparkman had a son that he cared about and wanted to help financially.  He wasn't thinking rationally enough to recognize that killing himself would cause much more than monetary damage, however, or he was in too much psychological pain for that to be a deciding factor.  People who attempt suicide are like fish drowning in a bowl of water.  Everything they need is available to them, and they can't seem to see or take advantage of it.  That isn't anyone's fault, but when it happens to you, it's hard not to feel like it is.

Monday, November 23, 2009

Hope is a Double-Edged Sword: Man With Locked-In Syndrome Misdiagnosed

In the early 1980's, Rom Houben, a Belgian 20 year-old, was in a horrific car accident.  He was in a coma, and then diagnosed as being in a persistent vegetative state.  For 23 years, his family refused to accept his diagnosis and insisted he was conscious and aware of his surroundings.  Finally, with advances in brain scan technology, doctors were able to more thoroughly examine his brain and determine it was essentially normal.  Over time, they were able to help him communicate using a single finger and a keypad. 

Houben wasn't in a vegetative state at all, but rather suffering from "locked-in syndrome," a state where he was able to hear and feel and understand, but unable to move or speak.  The medical journal article that detailed his story estimates that up to 43% of people diagnosed as being in a vegetative state are actually conscious.

I'm sure this case will be the subject of much political debate.  The news coverage is rife with mentions of Terri Schiavo, the Florida woman whose husband's battle to remove her feeding tube made its way all the way to the United States Congress.  I acknoweldge that this case raises ethical questions, and I also acknowledge that I am completely unqualified to discuss them.

This story also raises questions for the families of those diagnosed as being in persistent vegetative states.  On the one hand, accepting the reality of their loved one's situation is important, regardless of what people decide to do about it.  Holding out unrealistic hope can trap people in the common trauma reaction of feeling like the situation isn't real.  On the other hand, if this study is accurate, about 4 times out of 10, it truly isn't real.

This story is very encouraging to those left behind by traumatic accident victims in vegetative states.  I truly hope that as many of them can be "unlocked" as this story predicts.  I just worry about the 6 out of 10 situations or more where this research will prevent survivors from accepting reality.

Sunday, November 22, 2009

Leak at Three Mile Island, But It's Only 1979 in Our Minds

There was a tiny radiation leak at the Three Mile Island nuclear power plant near Middletown, Pennsylvania yesterday afternoon.  The worker with the highest radiation exposure from the incident got the equivalent of about two and a quarter chest x-rays' worth.  Nobody else got any.  Workers were sent home until the building where the leak occurred could be cleaned.  No radiation escaped the building.

By any rational standard, this is not a very exciting news story.  I tried to dig up some statistics on minor nuclear accidents and was unsuccessful (mostly because people only write about major accidents).  However, I was able to discover that the Nuclear Regulatory Commission has as many as 6 reports of incidents involving misuse, mishandling or release of radioactive materials on its website every day.  This undoubtedly was on the more serious end of those, but it's not at all unheard of.  And yet, it's all over the news.

The only reason this story is a story at all is because it happened at Three Mile Island.  The name "Three Mile Island" has come to be synonymous with "major nuclear disaster."  In 1979, Unit 2 at Three Mile Island experienced a partial meltdown.  It is still the biggest civil nuclear disaster ever in the United States, and the second biggest one in the world (behind the Chernobyl disaster).  If you  lived in Pennsylvania in 1979, you certainly remember that incident.  I was nine years old at the time, living in Massachusetts, and I have a vivid memory of my parents buying powdered milk in case the dairy cows on the East coast all suffered radiation contamination.

Three Mile Island is so synonymous with nuclear disaster and so ubiquitous in the American consciousness that the coverage of yesterday's leak uniformly adheres to the following pattern:  The leak yesterday is explained.  the issue of whether there was or is danger to the public is explored.  The accident in 1979 is mentioned with absolutely no segue or connection.

Don't get me wrong, I understand that people are drawing a connection, and so it behooves the press to make that connection, too.  What I find astounding is that there is literally no effort to contrast the seriousness of the 1979 incident with the situation this weekend.  All that would be necessary would be a connecting sentence like,
This incident reminded many local residents of the much more serious accident in 1979,
Official desciptions of this event made it clear it was not nearly as serious as the famous 1979 incident at the same facility.

It may make sense for us to have the memories of those scary days 30 years ago triggered by the news today.  It may even make sense for the media to talk about that connection.  Part of dealing with people's stress reactions, however, is to put their fears in some context.  The media is utterly failing to do that.

Oh, and by the way, how many people do you think died during the incident in 1979?  And how many lives do you believe were shortened by the radiation exposure?  The answer may surprise you -- it certainly surprised me.  No one died at Three Mile Island (then or now), and official estimates are that perhaps one single solitary person may live a shorter life because of the accident.  Perspective is an interesting thing.

Saturday, November 21, 2009

Gail Schoening Found After 12 Years: The End or the Beginning?

Gail Schoening was just shy of 36 in 1997 when she vanished on the way from her home in Plantation, Florida to the airport to fly to a job interview.  She had struggled with depression, and her parents wondered if she might have driven off the road, on purpose or by accident.  Despite repeated attempts to search nearby lakes, her body was never found.  Never, that is, until August 18, when investigators using new technology located her car at the bottom of a lake about a football field away from her house.  Her body was inside.  It appears she drove through a narrow space between two cars and out into the lake.  Her car flipped on the way into the water, trapping her inside.

We still don't really know what happened to Schoening.  The original investigation didn't turn up any sign that a car had gone off the road where it did. Family and investigators are staying quiet on the question of whether this was an accident or a suicide.  It's not clear if they know.  Her family released a statement saying they were glad to know what happened but sad about the circumstances.  A memorial service is planned for Christmas.

When a family member is missing and presumed dead, it can be very hard for the family to heal.  No one wants to give up hope, but no one wants to deny reality, either.  It seems like Gail Schoening's parents had made their peace with the idea that she was dead long before her body was found, to the extent that that is possible.

When a family suffers a traumatic loss, each new piece of information can compound a trauma when they come in rapid succession.  In a case like this one, the discovery of the body could  be a brand new trauma of its own.  To the extent that Schoening's family had dealt with the idea that she was dead, they did not, until August, confront how she died.  Before the discovery, they did not know they had driven around the lake where her body was numerous times, never knowing she was right there.  If there are other details of the accident that the family has, those may be traumatic as well.

Everyone is there to support a family when something has just happened.  I'm sure Schoening's family had friends surrounding them when she first disappeared, and hopefully they also got some early crisis intervention.  The trouble with situations like this one is that those same, well-intentioned people, may expect them to feel "closure" with the finding of her remains.  It's hard to believe you could be traumatized and grieving all over again after all these years, but you can, and if they are this family needs all the support they can get.

Friday, November 20, 2009

Predicting PTSD Ahead of Time

The U.S. military is undertaking a large research project using its own soldiers to see if there is a way to predict who will suffer from Post Traumatic Stress Disorder.  They are screening hundreds of soldiers before they deploy, including their baseline stress rate, brain scans, family histories and past history of mental illness, and will be looking to see if any factor or combination of factors can predict who is at highest risk.

This is a very new way to look at PTSD, and raises interesting issues for those of us who work in trauma response.  The conventional wisdom which we learn in training is that the factors that affect whether someone will develop PTSD are mostly  things that occur with the trauma.  We are taught that people who are more closely and directly exposed to an incident are more likely to have PTSD.  People who experience dissociation and/or depression immediately surrounding the trauma are at increased risk.  In addition, the more closely held beliefs, expectations and worldviews are violated, the more likely you are to have PTSD down the line. 

This experiment aims to short-circuit most of those factors.  What if we could predict who is most likely to experience those predictors?  What if we knew that this person is at increased risk for dissociation, and that person will react particularly strongly to the violation of their worldview?  What would that mean for trauma responders?  What would that mean for the people themselves?

Let's suppose, for the sake of argument, that we discover that certain people have a particular kind of activity in a particular part of their brain, and that if you have that activity you are more prone to PTSD.  Do we allow those people to serve in the military?  Can they be police officers or firefighters?  What if it turns out that that same anomaly is associated with bravery and calm under pressure, so these people also make especially good soldiers and first responders?  How will we decide?

We also have to think about how we treat those people.  Traumas will always happen, even if we exclude those most at risk for PTSD from serving.  If we come upon someone at increased biological risk who has, say, witnessed a murder, will they immediately be referred for further care, or can early intervention still help?  Will we be doing brain scans at the scene?

I often say that I love crisis work and I hate that I love crisis work.  I feel guilty that I get so much satisfaction out of helping with other people's misery -- shouldn't I be hoping they aren't miserable?  If this research is successful, it's possible that the whole way we proceed with this work will change.  It's hard to imagine, though, that we won't need to do it at all.

Wednesday, November 18, 2009

Missouri Incest Case Raises Questions for All of Us

In the last week, six members of a single family in Independence, Missouri have been arrested on charges based on absolutely horrifying allegations of child molestation, incest, and abuse.  The allegations come from adult children in the family, and involves years and years of abuse, child pregnancy, forced abortion, and possibly murder.  The accused are a father, his four sons, and his brother.  I would describe my own reaction to this case as revulsion.

As with the Shaniya Davis case, these allegations turn our ideas of how parents and families are supposed to work on their heads.  We don't fear for our own safety or the safety of our children, so much as we are repulsed by what a parent whose job it is to protect a child is accused of doing to that child.  Our reaction is not to the bogey-man who endangers our kids, but more to a sense that the world has gone crazy.

This case adds another layer, however, that has taken me a week of reading the coverage to put my finger on.  Whenever someone does something horrible to someone else, we have to face the notion that there are people out there who do awful things.  But in this case, there wasn't just one bad guy, there were, allegedly, six.  While we can imagine that there are six people with these disgusting proclivities out there in the world, furthermore, these six are related to each other.  That means that they did not form a group around their criminal activity, but entered into that activity as a group.

The natural conclusion is that people can be taught to behave this way.  The two oldest accused were brothers, and either were taught this by someone else or learned it together.  The four sons, it would seem, learned it from their father and uncle.  These actions, which we all perceive instinctively as evil, were not mutations that happened in a single person.  They were passed from one person to another.  And if that is possible, then, on a gut level, we must realize that all of us have the capacity, under the right circumstances, to do that kind of evil.

This case doesn't make us fear for our children.  It doesn't make us fear for our safety.  What is, perhaps, the most revolting thing about this case is the possibilities it points to in ourselves.

Tuesday, November 17, 2009

A Deadly House Fire, and Blame Gets in the Way

Last month, three adult members of a single family died in an early morning house fire here in Ann Arbor.  When firefighters arrived, the house was fully engulfed in flame.  They could not get in to rescue the occupants.  The Alexandropoulos family was first reported as missing, and later in the day three bodies were found.  From the beginning, this story seemed odd.  Firefighters took more than 10 minutes to arrive, and the stated reason was that they were on the scene of another call.  But the other call was around the corner and wasn't a fire at all.  Something wasn't right.

Now the City Council has been briefed on a fuller version of the story.  Apparently, neighbors a few blocks away awoke to the smell of smoke and went out into the neighborhood looking for the source.  A large amount of smoke was coming out of a chimney in an unoccupied house, and they called 911 at 2:53 AM to report it.  Meanwhile, neighbors on the same street as the fire, and west of the first callers, reported smoke coming from the east.  Firefighters were dispatched to the house where the smoke was reported, but found it was not the source of the smoke.  Finally, at 3:06 AM, a caller gave the correct location of the house, but it was too late. 

Last night, the City Administrator, Roger Fraser, briefed the City Council and blamed confusion over the address for the slow response.  Meanwhile, rumor has it that 911 operators did not know where the correct address was located even once they had it.  Tapes of the calls have not been released.  Everyone agrees that the house had no smoke detectors and there is some speculation that the house was fully involved before the first call was ever made.  The local press quotes Fraser as saying,
Our request is that if you have such an incident that you're unfortunately involved with, please give us as specific information as you can when you call, because at that time, in the context of what was going on, our firefighters knew nothing more than the fact that that [wrong] address could have been the location that they were all talking about.

I think we can all agree that this fire is a tragedy.  It is also natural that our minds turn to blame when something like this happens.  The city blames the callers, the callers blame the city, and everyone blames the victims.  I think, however, that Fraser is missing an opportunity to do some very helpful crisis communication.  He is so busy circling the wagons to deflect any blame from the city, that he isn't actually helping anyone who is upset.

When something goes wrong, it is only natural that we want to prove that we didn't do it or weren't at fault.  However, following a traumatic incident, what people most need to hear is not, actually, who is to blame, but rather what is being done to prevent it from happening to them.  As much as our minds go to blame, they are really going to protection.  If we can blame someone, we think we can prevent that someone from doing anything to us.  How much better would it be if we knew that that someone is working on it themselves? 

So here's what Fraser should have said:
We've discovered three factors that may have contributed to this tragedy:  a lack of smoke detectors, confusing information about the address, and difficulty finding the house.  Our job now is to work on each of these factors to try to make sure they don't happen again.  We are stepping up our efforts to educate the public about smoke detectors.  We are retraining our 911 dispatchers to make sure they ask for very specific information when they receive a call.  And we are looking at our GPS systems and reverse 911 capabilities to see if anything can be done to improve our ability to find difficult addresses.  We hope that the public will help us by installing smoke detectors and being very specific when they call 911.  Together, we can prevent this from happening again.
What we most need, at a time like this, is not to feel mad.  It's to feel safe.  This is a great example of how, so often, our public officials have the opportunity to do that for us, and don't.

Monday, November 16, 2009

The Unthinkable: Shaniya Davis' Body Found

The body of 5 year-old Shaniya Davis was found in Fayetteville, North Carolina this afternoon.  She had been missing since Tuesday, when her mother reported she disappeared from their home.  Since then, a man has been arrested for kidnapping and Shaniya's mother has been arrested for human trafficking and felony child abuse involving prostitution.  In other words, her mother is accused of selling her into the sex trade.

Usually when I blog about a situation in the news that gives you a kick in the gut, the reason has to do with our own safety.  We lead our lives believing the world is safe, and when something shakes that belief it upsets us.  When someone is killed in a mass shooting or a plane crash, it damages our understanding of how the world works as a generally safe place.  We know it could have been us, and we feel scared, or we blame, or we push it away.  These are all healthy defense mechanisms.

This case is different.  Almost no one will learn of little Shaniya Davis and think that it could have been them.  Very few of us will worry for the safety of our own children based on what happened to her.  We feel no personal connection for her particular circumstances.  We don't say, "There but for the grace of God."

But make no mistake about it -- this case very much disturbs a deeply held worldview most of us share.  That belief is that everyone understands that children are special and deserve our protection.  We know there are people who beat their children.  We even reckon, when we have to, with the notion that people sometimes kill their own children.  But the idea that someone would sell their own child for sex at the age of 5 goes beyond that.  It represents not just anger and disdain for human life.  It represents a complete and total disregard for the value of that little girl's life by her own mother.  And we don't believe that mothers are supposed to act that way.

Shaniya Davis' murder may not leave us feeling scared, but it does leave us shaken.  It overwhelms our ability to understand.  We have no convenient space in our minds under which to file this incident.  No schema we have allows us to process it.  That's what makes it traumatic -- for her father, who allowed her to go live with her mother; for the searchers who found her body; and for all of us who think of parenthood as a sacred trust.  This isn't how the world is supposed to work.

Sunday, November 15, 2009

Goodbye to the D.C. Sniper

The adult half of the team of criminals known as the "D.C. Sniper" or the "Beltway Sniper" was executed by the Commonwealth of Virginia this week.  His accomplice, who was 17 at the time of the murders, was ineligible for the death penalty and is serving a life sentence.  From a specially fitted car trunk, they sited a rifle and shot 10 people in 17 days throughout the Washington, DC area.  Their victims were chosen at random as they walked through parking lots, pumped gas, or otherwise went about the mundane business of day-to-day life.  The entire Washington area was captivated and terrified.  The rest of the country was pretty scared too.  Prosecutors claimed it was all part of a scheme to terrorize the country and extort money from the government, although something I read recently said it was actually an unfinished plot to kill one of the sniper's ex-wives and mask the fact that she was the one real target.

Whatever the reason, for 17 days in 2002 people were afraid to go about their normal business.  Soon, we were all -- even those of us who didn't live anywhere near Washington -- on the look out for a white utility van.  I had never realized how ubiquitous white utility vans are until these murders happened, and every deliver truck made me jump.  And of course, it turns out the shooters didn't even have a white utility van -- it's just that there was one at almost every murder scene because these vans are everywhere.

Then, as quickly as the shooting started, it stopped.  Two suspects were under arrest, and our attention turned from our own safety to questioning why on earth anyone would do this and what could have or should have been done to stop them.  That is the news cycle of a serial killer or a mass murder -- we fear, we capture, we wonder, we blame.  We see it happening now with the alleged shooter at Fort Hood.  Most of us aren't scared anymore, but we are at best curious and at worst really, truly angry.

And yet, something bothers me about this case and about this natural news cycle we seem to go through again and again.  These cases scare us because they point out that our lives are always somewhat precarious.  We go through our day with the assumption that the person next door, or next to us in line, or in the next car, is not a homicidal maniac.  We do what we can to avoid obvious perils, but we can't avoid the danger posed by the truly imbalanced and determined killer, who could strike at any time.  We just ignore it.

Then a string of murders or a single mass murder happens, and we realize how much at the mercy of these people we truly are.  We realize that when we get into an elevator with someone we don't know, we're trusting that he or she isn't going in there with the idea of killing us.  We realize that we pump our gas on the presumption that no one has a sniper rifle aimed at us.  So we're scared. Then they catch whoever it was this time, and we breathe a sigh of relief.  Now the crazy person is no longer out there in circulation.  We can go back to normal.

Here's the thing, though.  If we really thought it through, we might realize that in fact there is nothing truly preventing someone else from doing exactly what the killer did.  The day after the snipers were caught, it wasn't any harder to be a sniper in the D.C. area than it was the day before.  And the day after the snipers were caught, the odds of someone doing what they did were exactly the same as we believed they were the day before they started shooting.  So either we ought to be terrified all the time, or we ought to be relatively calm all the time.  The only thing that really changes is how much the danger has come to our attention.

During the D.C. Sniper killings, mystery author Patricia Cornwell wrote in the New York Times (in a piece they reran on their website this week) about the fear caused by serial killers.  She wrote of a question she asked the mother of the victim of a serial killer in Louisiana:
We live in a world of terrorist cells, or serial killers, of spree snipers, and as hard as we try, we can't seem to catch them. What can we do? "Get involved," she answered. "People should notice a strange car or truck or person in their neighborhood. People need to be neighbors again and care for each other. You can't hole up in a house and not get dressed and not go out."

This was good advice in 2002, and it still is.

Saturday, November 14, 2009

9-11 Trial in New York: How Do You Pick a Jury?

Attorney General Eric Holder announced yesterday that five people involved in the 9-11 terrorist attacks, including the mastermind, will be tried in civilian court in downtown Manhattan.  I am not going to weigh in on the politics of this decision, nor on any security concerns or interrogation techniques.  What I am going to weigh in on is the chances for these people to get a fair trial by an impartial jury in New York City.

Picking a fair jury is always somewhat tricky.  Anyone can have a bias and not tell, or have a bias that they themselves don't know about.  Figuring out who will truly be fair is an art, not a science.  Still, we have some basic and uncontroversial understandings of which people should definitely not serve on a jury. 
The lawyers get a certain number of so-called "peremptory" challenges -- that is, a certain number of times they can say they don't want someone on the jury and not give a reason.  They also get an infinite number of challenges "for cause" -- meaning that the juror is obviously biased or unsuitable in some way, and the lawyers have to say why. Among the people typically excused for cause are the victims of the crime, their family and friends, and anyone else directly impacted by it.

By way of example, let's imagine we were picking a jury for a typical murder case in which someone was shot in the parking lot of a convenience store.  In the jury pool that day, we happen to have the victim's mother, fiance and best friend, as well as two people who work in the convenience store, one who lived across the street and had to stay in her house "locked down" while police sought the shooter, and someone who was in the parking lot.  Aside from wondering how we got such a biased group of folks all on one day, the lawyers would challenge all of these people for cause, and almost certainly all of them would be excused.

Now, let's see how that affects the jury in a 9-11 trial in New York.  This means we have to find 12 citizens of Manhattan, over 18, who were not in the twin towers, did not have a family member or friend killed, and were not nearby to see what was happening first hand.  This would be hard, but not impossible.

But wait, we also need to exclude anyone who was endangered by the attacks, and anyone who had good reason to think they were endangered, as well as anyone who suffered traumatic stress related to the attacks.  All of these people are like the neighbor across the street from the convenience store.  They didn't see it, they weren't directly "in it," but they were deeply affected by it.

Just where exactly does the US government think it will find 12 acceptable people?  It seems to me that the jury will have to be made up entirely by people who did not live in Manhattan in 2001.  The secondary trauma from that attack affected the whole city.  Everyone saw the smoke and breathed the air.  Everyone was scared.  The entire lower portion of Manhattan had to evacuate on foot.  The local firehouses in all of the neighborhoods suffered catastrophic losses.  Everyone had nightmares.  There is no way that anyone who was in Manhattan on 9-11 can serve on this jury.  In fact, there's a very large percentage of the US population who can't because so many of us suffered secondary trauma.

I'm sure the Justice Department has reasons, maybe even good ones, for trying this case in Manhattan.  If I were a defense attorney, however, the first thing I'd do is ask for a change of venue.

Thursday, November 12, 2009

The CDC and H1N1: What if We Threw a Panic and Nobody Came?

The Centers for Disease Control is out with its weekly update on the H1N1 pandemic, and that means it's time for another round of alarmist headlines from our friends in the mainstream media:
Here's the headline you are not seeing, but should:
H1N1 on Pace to Kill Far Fewer People Than Typical Seasonal Flu

So, here's what happened today. The CDC reported its statistical estimate of how many people have been infected with novel influenza A H1N1 in the United States in the 6 months since the first cases emerged last spring. Up until now, they have reported confirmed cases, hospitalizations, and deaths. Today they used the very same formulae that they use every year to figure out how many people have the flu, and came up with an estimate of 22 million cases of H1N1 and 3,900 deaths over the last 6 months. They also reported that the percentage of visits to doctors for influenza-like illnesses is now the highest it has been since they started counting back in 1997.

There are two angles from which you can look at these numbers. The first, and the one that the media seems to have jumped at, is that these numbers are significantly higher than what has been reported previously. In fact, this death toll is about quadruple the last death toll number that was announced. That makes it appear that H1N1 is much, much worse than anyone suspected before, and that's news. What's more, more people are going to the doctor than ever before for flu-like illnesses. H1N1 is making quite an impression out there.

The other angle from which you could view today's numbers is to consider exactly what it is that is being reported here, and how it compares to similar numbers we know about. Under this analysis, you are definitely still left with a very large number of doctors' visits for the flu. It isn't clear at all whether that means more people are actually sick or whether when people get sick they are more likely to go to the doctor this time around, but it does seem like the flu is a real problem out there. 22 million people have gotten H1N1. That's less than 10% of the population, which really isn't all that many people as these things go, although I haven't been able to find a decent number on how many people get the flu in an average year.

Furthermore, 3,900 people have died. And while that is 3,900 tragedies, it is also about 11% of the annual death toll from seasonal flu. In order for H1N1 to kill anywhere near the number seasonal flu does each year, more than 5,000 people are going to have to die every month from now through April. Oh, and the death toll didn't triple -- this is a totally different statistic than the previous reports. This is an estimate of the total. The lower numbers were the actual number they had counted.

So yes, you can look at the numbers and say they are much worse than anything we've heard before, or you can look at them and say they are much, much, much better than we feared. In fact, the thing that makes this flu season bad is not any of these numbers at all, but the fact that so many younger people are getting sick and even dying. But while we need to take H1N1 seriously and try to prevent its spread as best we can, I'm kind of wondering at what point the media and, to a lesser extent, the CDC will wake up to the fact that this just isn't the horrible crisis that was predicted. At what point will the evidence outweigh the need to have been right and to continue the high alert? Whenever that point is, it obviously isn't now.

Tuesday, November 10, 2009

Hostage Situation at Stissing Mountain Middle School: Send in the Peers

This morning, a man walked into Stissing Mountain Middle School in Pine Plains, New York, assembled a gun in the bathroom, and took my colleague, Principal Bob Hess, hostage. The standoff lasted two hours before the suspect surrendered, releasing Mr. Hess. The entire bulding locked down for those two hours, with children hiding in locked classrooms, the school kitchen and even under the desk in the counseling office right next door to where the gunman was.

The fact is, we all know it's a possibility. Any school Principal who has given any detailed thought to an armed intruder coming into the school has already realized that the most likely target is the Principal. An angry parent, a custody dispute that we intervene in, a trespasser we ask to leave, or a disturbed child, if they took out a gun, could all very well be aiming it at us. In places where, as in Michigan, we practice locking down the school, we practice it with the administrator directing the rest of the staff and taking the lead. We try not to think about the possibility that we would be shot or held hostage ourselves.

Counseling will now be offered to the students, staff and families at Stissing Mountain. In the official curriculum I teach on Critical Incident Stress Management, they say that peers may not be necessary in delivering CISM services to schools. If there's anyone from Pine Plains out there listening, I want you to know that I think a peer is absolutely critical in assisting Mr. Hess.

If this were me, I would not want to talk to a counselor or a social worker or a psychologist. I would want to talk to someone else who has lived with the knowledge they walk around with a big target on their head every day. I would want my person to understand that in an emergency I take pride in being able to keep everyone calm and safe, and who can imagine that being the one person least able to do anything in this situation was horrible. I would want someone who has had their own child in the building when something bad happened, and had to worry about the group, not the individual. I would want someone who knew the significance of having something happen "on your watch." I would want to talk to a really well trained Principal.

I hope they have one in Pine Plains. And Principal Hess, I'm glad you're safe.

Monday, November 9, 2009

The Children of Fort Hood

As everyone knows by now, 13 people died and 30 were injured in a mass shooting at Fort Hood last Thursday. There has been a lot of focus, quite appropriately, on the people who died and on their families. There has also been some given to those who were wounded, some quite critically. And of course there has been an inordinate amount of speculation about the alleged shooter, who, reports say, is now awake and talking in the hospital.

It is impossible to predict how any individual person will be affected by Thursday's events. Some who you might expect to be very emotionally impacted will bounce back quickly, and some who seem to be on the periphery of the incident may be profoundly affected. As the CISM personnel work to triage those traumatized by the shooting -- those who lost a loved one, those who were shot, those who knew the shooter, those who witnessed the shooting, etc. -- there is one group that is probably giving them a little pause: the children.

To my knowledge there were no children present when the shooting started on Thursday. That means no children saw the scenes of violence first hand. But that in no way means that the children at Fort Hood aren't impacted, and they are going to need a lot of support. But we all know intuitively that helping children through these moments is different than helping adults, and few early crisis interventionists have any training at all in working with kids.

CNN reports that officials at Fort Hood have called in child psychologists as well as disaster management experts. That means the impact here is big -- bigger than what their town of 60,000 can handle on their own. It is a disaster, just as surely as a building collapse in a large-ish town that killed 13 and injured 30 would be, only probably worse, or at least different, for the families.

So why are the children impacted? There are numerous factors. First, these kids were on lockdown for several hours on Thursday. During that time, they did not know what was going on, where their parents were, if anyone in their family had been injured, or when they would see them again. If they looked out the window they saw what amounted to a live military operation going on outside of their schools, and for all they knew the "bad guy" was coming for them next.

Some of these children, of course, lost a parent in the shooting or have a parent who was injured. If not, they almost certainly have a neighbor or friend who was impacted. They went to school on Thursday morning believing that they were OK in school and their parents were OK at work, and came home knowing that very well might not be true at any given moment.

I've often said that trauma violates our world view. For these kids, that is doubly true. All of us need to believe that the world is generally a safe place, and this incident took away that belief from these children. But it also took away something else. It took away their visceral understanding that soldiers -- parents -- who are stateside are safe, and that danger lies in the war zone. A big part of how they can cope with having parents who put themselves in harm's way for a living is by telling themselves that the fact that they come home means they are OK. Now, 13 people who were stateside, who were home, are not coming home any more.

So what do we do for these kids? That depends, of course, on what they need. I suspect the days, weeks and months ahead will hold a lot of crayons and paper, a lot of tissues, and a lot of nightmares for some of these kids. Watching parents ship out is going to be really hard. Watching them come home is going to be surreal. So while we're honoring the dead and thanking our troops, particularly during Wednesday's Veteran's Day celebration, let's take a moment to remember their kids, and to thank them for all they give up in service to our country, too.

Sunday, November 8, 2009

Deer vs. Lion at the National Zoo

Visitors to the National Zoo in Washington, DC today got a little more of an idea of what life in the wild might be like than they were probably expecting. A baby deer wandered out of Rock Creek Park and into the zoo, wandered around for a while and then jumped a fence into the moat of the lion enclosure. After the deer had been captured by the lions three times and escaped them three times, zoo officials removed the lions from the enclosure and rescued the deer. It was too injured to survive, however, and was euthanized.

Reading about this brought me back to my own first experience assisting a person following a critical incident. The social worker at my school and I completed my first Critical Incident Stress Management class on a Wednesday, and the incident occurred on Friday at our building. For those who've never been there, it would help to understand that one whole wing of Ann Arbor Open School is an open library surrounded by a semicircle of classrooms, most of which are linked by internal doors.

On the day in question, one of the teachers had brought her dog in for a piece of classroom instruction. The dog had spent the last couple of hours of the day asleep under the teacher's desk, and in her hurry to get home for the weekend she forgot he was there. She was halfway home when she realized it, and she turned around to go back.

Meanwhile, the dog woke up from his nap and went exploring. He wandered through the internal doors into the 1st and 2nd grade classroom next door, and then through the next set of doors into the Kindergarten next to that. It was there that he met Mr. Wiggles, a long-haired guinea pig who was the class pet.

Shortly thereafter, just before the teacher came to claim her dog, blood curdling screams could be heard through the building. The social worker and I came running and found the kindergarten teacher standing in the door of her classroom, screaming. The sight was truly ghastly -- blood and guinea pig fur was everywhere, and Mr. Wiggles was no more. It truly looked like a crime scene.

The social worker and I found ourselves drawing heavily on what we had learned that week to stabilize the teacher, help her identify resources and coping techniques, and make sure she would be OK when she got home. When it was over, the social worker said to me, "this isn't really what I envisioned when I took that class." It was funny, but it wasn't.

Which brings us back to the National Zoo. We go there to see things that we, in our industrialized society in North America, could not see otherwise. But two lions attacking a baby deer are not really what we have in mind. Undoubtedly many in the crowd found the scene fascinating. To others, it may well have been traumatizing. Living in modern society, the natural course of a predator and prey -- whether it's lions and fawns, or dogs and guinea pigs, or something a little more common -- is not within our experience, and we may not have an emotional framework with which to understand it when we see it. Or we may have one, but only in the wild, so the sight of guinea pig fur in a classroom or a fawn in the moat of the lion enclosure at the zoo is especially upsetting.

All of this goes to prove the wisdom that early crisis intervention is not about responding to incidents, it's about responding to reactions to incidents. Any time an incident overwhelm's someone's usual emotional coping skills, it is critical. One person's fascinating scene is another's critical incident, and violence doesn't have to be criminal to qualify.
Saturday, November 7, 2009

Fort Hood: What Compassion Fatigue Is, and Isn't

As we all know by now, the alleged shooter in the Fort Hood massacre is a psychiatrist. There is a lot of speculation in the media right now that he suffered from "compassion fatigue," "vicarious traumatization," "secondary trauma" or "secondary PTSD." In many of these articles these terms are used interchangeably. The basic idea of all of these articles is that the shooter's treatment of people who had been traumatized caused his own traumatization. However, since virtually none of the reporters involved had ever heard of compassion fatigue before Thursday, there is a lot of oversimplification of the facts in the search for answers.

I have no first-hand information about whether this man suffered from compassion fatigue or anything else, and I (unlike both those who think he did and those who think this was religiously-motivated terrorism) am not going to speculate. We have absolutely no facts at all on which to base a diagnosis. What I do have, however, is some information about compassion fatigue that might be helpful at least in understanding what everyone is talking about.

There are two big risks that people who work with trauma victims face: burnout and compassion fatigue. Burnout is just what it sounds like, and just what it is in any line of work. It's the slow and steady deterioration of satisfaction with your job and your willingness and ability to do it well. It's what makes you not want to get up and go to work in the morning. Burnout can be associated with the stressfulness of the job, and listening to people's trauma is stressful. Among trauma interventionists, burnout manifests in not caring much about the stories you hear or the people who tell them, in not doing what you know needs to be done for them, and in quitting your job or volunteer position.

The second risk is compassion fatigue. Compassion fatigue, unlike burnout, usually comes on fast. A single story or a small set of them get to you in a serious way, and you start showing the same symptoms you would if you were exposed to a traumatic event: trouble sleeping, irritability, impaired judgment, appetite changes, nightmares, startling easily, etc. This is not the person who says, "Gee, I really don't feel like going to work today." This is the person who is afraid to get out of bed.

One of the most commonly used screening tools for burnout and compassion fatigue, as well as job satisfaction, in those who work with traumatized people, is the Professional Quality of Life Scale Compassion Satisfaction and Fatigue Subscales—Revision IV (Pro-QOL R-IV). Interestingly enough, when I went looking for a copy for reference for this post, I found it on the website for the Army Behavioral Health Provider Resiliency Training program.

Some of the questions on the Pro-QOL that relate specifically to compassion fatigue can help you understand what exactly it is:
  • I jump or am startled by unexpected sounds
  • I find it difficult to separate my personal life from my life as a helper
  • I feel as though I am experiencing the trauma of someone I have helped
  • I avoid certain activities or situations because they remind me of frightening experiences of the people I help
  • As a result of my helping, I have intrusive, frightening thoughts
  • I can't recall important parts of my work with trauma victims
Clearly, this is serious stuff. And clearly, it needs to be addressed. But just as most people exposed to trauma experience these symptoms and recover, most of us who work with them recover if we show signs of compassion fatigue.

Compassion fatigue and secondary PTSD are not synonymous. Post traumatic stress is a typical reaction of a normal person to an abnormal event. Post traumatic stress disorder is when it lasts, does not resolve, and interferes with functioning. Similarly, compassion fatigue is a normal hazard of the job. The vast majority of people who experience it get some support, back off their work for a while, and return to normal functioning.

So, could the shooter at Fort Hood have had secondary PTSD? Sure. Do we know that he did? No. And is it inevitable that someone in his position would be in that much trouble psychologically? Certainly not. Trauma is contagious, yes, but the contagion is also avoidable, given the right supports. What we don't know is whether this particular psychiatrist had those supports in place.

Quick Aside: You can now follow MMCQuarterback on Twitter!
Friday, November 6, 2009

No Easy Answers: The Why's and Wherefores of Fort Hood and Orlando

He had compassion fatigue. He was a Muslim. He had money problems. He was depressed. He was disgruntled. He didn't want to deploy. He was a terrorist. He was harassed. He faced discrimination. He hated his boss. He was turned down for unemployment. He blamed the company. He blamed the army. He should have been stopped.

Today, as America reels from the second mass shooting in as many days, the blogosphere and the traditional media are lighting up with commentary on why the shooters in the Fort Hood and Orlando killings did what they did. If you google the stories, you find headline after headline with various speculation about motive, interspersed with the occasional article referring to the motives in each shooting as a "mystery."

Human beings don't like uncertainty, as I discussed yesterday. And the media doesn't like to report anything nuanced, and certainly not "we don't know." Where's the human interest in that? So we look for answers, and sometimes the answers we come up with sound good . . . until you think about them.

The shooter at Fort Hood is a psychiatrist. He had treated many people who suffer from Post Traumatic Stress Disorder. Now there is speculation that this experience caused him to be traumatized himself, and in turn caused yesterday's shootings. No sooner had that theory hit the airwaves then we had articles arguing the opposite -- that PTSD is not contagious, and we are just making excuses.

The truth is, PTSD is indeed contagious, in a documented phenomenon called "compassion fatigue" or sometimes secondary or vicarious traumatization. People who work with the traumatized are susceptible to symptoms of trauma themselves -- this is a documented phenomenon and there are documented ways to try to prevent it. But as much as compassion fatigue is a real thing, most people who have it don't shoot people. Saying that is the cause is much too simplistic.

The shooter is also Muslim, true. And yet, most people who are Muslim don't shoot people either. And if mass shootings are caused by being Muslim, how do we account for the Orlando shooter, who certainly wasn't, or the perpetrator in the Pittsburgh gym shootings, or at Virginia Tech, or Columbine? Why is the Fort Hood shooting "terrorism" and those are horrible violent crime?

In Orlando, the shooter almost certainly was a disgruntled former employee with money problems. This is all true. But how many thousands of people fit that description, and never hurt a fly? How many hurt themselves but not others? How do you know who is who and which is which. Unfortunately, you don't.

There is a lot of commentary today suggesting that we as a country are hesitant to admit the "truth" about Fort Hood, and I think they are right. But that truth isn't that the shooter was a Muslim terrorist. That truth is that we just don't know. We may someday, or we may not. And if we don't know, we can't know it won't happen again, and that scares us.

We want to think that if we exclude certain ethnicities or nationalities or religions from our lives, we will prevent the next shooting from happening to us. We want to believe that if we know the Fort Hood shooter was a terrorist, we can protect ourselves by staying away from terrorists. But in Orlando, we discovered that that isn't true either. And that scares us more, so we pretend there's no inconsistency there, no nuance. It seems we'd rather live with our bigotry in this country than with our fear of what is random.

Thursday, November 5, 2009

Fort Hood: The Waiting is the Hardest Part

At least 12 people are dead and at least 31 injured in a shooting or shootings at Fort Hood, Texas this afternoon.  One gunman, a soldier, is dead.  Two others are in custody.  By the time you read this -- indeed, by the time I finish writing it -- all of that information may turn out to be wrong.  As the press says, this is a "breaking news story."

The shooting occurred almost two hours ago, but we still don't know what happened.  Fort Hood, is on lockdown, or at least it was within the last half hour.  So are the neighboring schools.  Reports differ on how many gunmen there were and whether they are all accounted for.  News like this, where the details are coming out piecemeal and the information is changing, are both extremely scary and also extremely hard to tear oneself away from. 

This story is compelling for lots of reasons -- a lot of people are dead, the possibility of terrorism is on our minds, the dead are possibly servicemen and women who we presume to be safe before they are stateside.  The fact that it's changing means that we don't want to turn off the news, because we want to know what happened and we aren't sure that we do.  We have one set of facts now, and we might miss the next change if we break away.  We want to understand.

The constantly changing nature of the story also adds to what is so traumatizing about an incident like this.  Instead of hearing the news and reacting to it, we go through a seemingly infinite series of exposures.  We hear the story, we experience the trauma or secondary trauma of it, and then new facts are announced and we experience it again. 

This phenomenon was painfully obvious to me this afternoon as I drove with my daughter.  When we got in the car I explained to her that there had been a shooting at a military base and a lot of people were dead, and that the news would be talking about it.  At that time, the number of known dead was 7 with 20 injured, but I didn't tell her that.  When the headlines came on, they announced that 12 people were dead and 31 injured, and I involuntarily winced.  My daughter, on the other hand, was completely unphased.  I was reacting to the new information, but for her the information hadn't really changed.  I was traumatized again -- she wasn't.

Aside from that increase in the numbers, the most poignant and compelling part of this story thus far for me came in an offhand sentence in coverage by USA Today:
A spokeswoman for the City of Killeen, where the base is located, tells USA TODAY's Donna Leinwand the Army is "asking for EMTs because it's a mass casualty event."
The term "mass casualty event" isn't one you hear in the newspaper a lot.  If you work in emergency services or in crisis response, on the other hand, it is a term that has a lot of emotional charge.  We talk about car accidents as having "multiple fatalities."  Mass casualty events are huge.  9-11 was a mass casualty event, and even though this clearly has none of that scope, the seriousness of that kind of incident is invoked by using that term. 

Another way to look at it is this:  There are roughly 60,000 people at Fort Hood, and they have their own police, fire and ambulance service.  Imagine what would have to happen in a town of 60,000 -- roughly the size of St. Cloud, Minnesota -- to completely overwhelm their ambulance service.  It's bad.

This event will actually become less traumatic for everyone -- people there and people hearing about it on the news -- the minute the information stops changing.  It may even feel anticlimactic.  And then the real work begins.

Wednesday, November 4, 2009

Why Can't We Blame Those Who Most Deserve It?

Two high profile cases are in the news today. The first is the kidnapping of Jaycee Lee Dugard, the 11 year old who was kidnapped, raped, and held in a California backyard for 18 years. The second is the discovery of at least 11 women's bodies at a house in Cleveland. If I asked you who is to blame for Dugard's kidnapping, you would probably say her kidnappers are. If I asked you who was to blame for the murders in Cleveland, you would probably pin them on the serial killer. Yet today's coverage points the finger squarely at law enforcement in both cases.

A report from the California Inspector General, which was issued today, says that parole officers had numerous opportunities to discover Dugard during the 10 years they were in charge of supervising her alleged captor. They failed to follow their own procedures in some cases, and in others failed to have decent procedures in the first place. In the Cleveland case, neighbors are coming forward to say that they reported assaults by the alleged perpetrator on their street, and the police did not take them seriously. They also say that there was an odor -- presumably of decomposing bodies -- coming from the property, which was reported but never addressed. At least today, it seems like the answer to whose fault these crimes were is not the perpetrators at all, but law enforcement officials.

So what's going on here? Why have we shifted from outrage at the people who did these things to outrage at the people who didn't catch them? I think what we're seeing is the evolution of people's world view as they try to cope with the horrible things that have occurred.

When the Dugard case first broke, for example, comments on blogs and news sites said things like, "I hope you rot in h*** you sick b*****d." This represented people confronting the idea that there are people out there who do evil things, and we don't know who they are. We heard about the case and conceived of the suspect as sick, twisted, mentally ill, or just plain evil. That scared us, because it seemed so random. If this man could be like this, couldn't anyone? If his neighbors didn't know, do we know about our neighbors?

If there are this sort of person, and/or the alleged murderer in Cleveland, in the world, and if we cannot know who they are, then the world is random. We don't like random. So, as we process these traumatic events, we must move on to the question of how this could have been prevented. If we can't know who is evil, we must rely on those whose job it is to know for us -- the police, the corrections department, etc. We may come to accept that evil people exist, but we don't want to accept that the police can't protect us from them. So now it is their fault.

It's not that there is no logic to investigating what went wrong in these cases. Obviously, we would like to prevent these things from happening again. But in our rush to investigate and prevent, we shouldn't take our eye off the fact that the people most to blame for these crimes are the people who commited them. No one else should suffer solely because we can't accept the randomness of what they did.

Tuesday, November 3, 2009

Fayetteville, NC: Murder is Murder

A well-respected real estate developer in Fayetteville, North Carolina shot and killed his wife and two teenage children on Monday before completing the act of suicide. As frequent Quarterbackers know, family annihilation murders, as this type of incident is called, are rare but news-grabbing. They follow a particular pattern in which the perpetrator is almost always male, and they may be the culmination of escalating domestic violence, or not.

I first read about this incident on, before it was confirmed as a murder/suicide. The article quoted a news release from the Chief of Police which read, in part,
At this time, there is no reason to suspect foul play; however the investigation remains in its early stages.
I had to go back and read this several times because I couldn't believe it. "There is no reason to suspect foul play." How could he possibly say that?

I would like to chalk this up to a slip of the tongue. What he meant, obviously, was that there was no reason to believe there was a suspect at large, and that makes sense. He meant that no one else was in danger. Fine. Except that this wasn't a slip of the tongue. It was a written press release. This leaves just two possibilities: that it was an incredibly sloppy job of writing the release coupled with poor or no editing (and this is why you should take your time when you are communicating in a crisis), or that he meant what he said. What if he really meant that a husband and father killing his wife and children does not count as foul play?

You may say that I'm overreacting, and maybe I am. All I have is this one snippet from the release. I don't know this man, nor has he been asked what he meant as far as I know. But I also think that little things like this add up, so that the death of one person seems less tragic, less violent, less important than another. It wasn't really a murder, it was, well something else. And that kind of rhetoric makes it that much easier to look the other way when a family is in trouble.

The New Oxford American Dictionary defines foul play as
unlawful or dishonest behavior, in particular violent crime resulting in another's death.
This wasn't "just" a domestic dispute. It was a crime. The fact that the perpetrator is dead does not change that. There was foul play, and this wife and these children deserve the same respect and memorial they would get if they were killed by strangers. Murder is murder.

Monday, November 2, 2009

Protecting Us from Hamburgers and News About Hamburgers

Two people have died and close to 30 are ill, apparently from eating beef products infected by e.coli bacteria. New York meat company Fairbanks Farms has recalled over half a million pounds of beef, largely on the east coast. A complete list of recalled products is available here.

Presuming that there is evidence linking these illnesses to the recalled beef, the recall makes a lot of logical sense. And there is no point in having a recall if people don't hear about it, so the publicizing of the recall also makes sense. But there is a tension here. Less than 30 people are sick and 2 have died, but now millions are worried. Everyone is looking in their freezers to see if they have the dreaded patties, and eyeing their fast food a little more suspiciously. After all, you can control what's in your freezer, but not what McDonalds or Burger King have in theirs.

In balance, the level of panic caused by the publicity is probably worth it, at least in adults. Most of us are able to keep things in perspective, realizing that this is a threat we can control. There are exceptions to every rule, however, and exhibit A in this is the commenter over at Huffington Post who wrote:
Obama should declare a Pandemic in the Meat Industry. Processed meat that people buy in supermarkets have [sic] killed people. This is a bigger threat than that swine flu.
I can only hope this person has their tongue planted firmly in their cheek, because the death rate from H1N1, as we all know, is a lot higher than it is from Big Macs, even with the current outbreak.

We know that. The thing is, our kids don't. Our children, particularly those in the roughly 7-10 age range, are old enough to know that bad things happen in the world, old enough to understand the basics of a news story, and old enough to know that, as much as they rely on adults to keep them safe, that isn't always possible. Now they hear that ground beef is killing people, and we assure them that either we don't have any of it or we've thrown it out, but they can't help but wonder. If your child is a particular worrier, he or she may be able to come up with numerous scenarios under which they will still ingest contaminated beef. This is how vegetarians get their start.

So what's a parent to do? Most of us naturally become exasperated after a while and start brushing their concerns off with "don't worry about it." This is a sure-fire way to increase children's concerns. The minute we indicate we don't want to talk about it, kids believe we aren't talking because we have something to hide. The best thing we can do is be honest and upfront about what is going on and what we have done to keep them safe, and promise them that if there is a reason to worry or any more information to share, we'll talk about it some more.

And then, ultimately, we have to hope they believe us. In the end, that's what parenting so often comes down to.

Sunday, November 1, 2009

Keeping it Surreal: 9 Declared Dead Off California Coast

The search for 7 members of the Coast Guard and 2 Marines who went down in a collision between a plane and a helicopter off the coast of California last week has now been declared a recovery mission. The Coast Guard announced that, after 60 hours, the chances of survival were negligible. In a forgotten detail of this story, the missing boater whom the Coast Guard was searching for when their plane went down is also still missing.

Far and away the most common reaction people have when receiving news of a traumatic death is one of disbelief. I have seen people who have been notified of a loved one's death by someone who has seen the body still demand "proof." The mind can only handle so much, and refusing to believe bad news is one of the many ways we protect ourselves from the pain that sudden death of someone we care about can bring. Even once the news has "settled in" a little more, survivors report feeling like they are in a nightmare, waiting to wake up. It just doesn't seem real.

The Associated Press reports that the father of one of the missing, Marine 1st Lt. Thomas Claiborne, confirmed that his son has been "declared deceased." That very fact is surreal by itself. It's hard enough to accept that someone could be here one moment and dead the next. In this case, the divider between life and death is not a biological fact, but a decision by a superior officer. How can someone be declared dead? They either are or they aren't.

So it is no surprise and no shame that the mother of another missing sailor, Coast Guard Lt. Adam W. Bryant, is not accepting this news right now. She told the Associated Press,
Miracles do happen. Miracles every day.
After all, how would she live with herself if he were found and she had given up hope? And how will she carry on knowing that he is dead? Clearly, denial is a lot easier. Acceptance will come slowly. Our hearts go out to these families. Even if they find the remains of these servicemen, healing is going to take a long, long time.

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Naomi Zikmund-Fisher
is a clinical social worker, former school Principal and a Crisis Consultant for schools and community organizations. You can learn more about her at
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