Tuesday, June 09, 2009

Types Of Violence

A psychiatrist I work with is considering writing a guide for PCP's and ER docs that gives an overview of the neurobiology of types of violence. They often have to make evaluations based on little hard information. At acute psychiatric hospitals we mostly earn our daily bread by treating violence: containing it when we must, evaluating its cause, recommending and starting treatment, so that the patient can return to the better treatment of interacting with reality and seeing outpatient providers. (Our next largest category would be inability-to-care-for-self.)

He offers the following four categories as a jumping-off point. Consider them as you will, on individual, group, or international levels. (Notice that all four have good and bad expressions)

1. Defensive and paranoid violence, where the person feels under constant threat and lashes back in protection.

2. Hierarchical violence, establishing individual dominance, or group enforcement of ingroup/outgroup.

3. Calculated violence, to accomplish a particular goal. The military, or gang leaders, or SWAT teams use this.

4. Impulsive, reactive violence - those situations where people go from 0-60 in response to events.

I'm just interested in your thoughts.


jaed said...

Types 1 and 4 seem very close, perhaps the same thing. Both are impulsive and emotional.

Type 2, it strikes me, might be characterized as ritualized violence - deliberate violence with symbolic meaning.

Type 3 might easily be confused with Type 2 - it is deliberate, not impulsive - but in Type 3 the violence is a means to an end, where in Type 2 it is the end. Type 3 violence can be averted if there is another method that will accomplish the end, but not Type 2.

Donna B. said...

What about violence for "fun"? I'm thinking of the girls who trashed a friends apartment and then put her kitten in an oven and turned it on before leaving.

They were, if I read the story correctly, not angry at the friend.

bs king said...

Donna makes a good point. One of the papers my brother did for the National Coalition for the Homeless was on "homeless bashing" or basically the phenomena of younger men killing homeless people for fun or "to see how it felt". It wasn't total social dominance either, they just wanted to pick some one who was accessible who wouldn't be missed.

Retriever said...

Interesting to read it beside your 2005 one on the boys in "Orphanages and Terrorists" when Chris was talking with you about why one fights. To win or to hurt.

Reflecting on the topic, as the parent of a currently stable but developmentally disabled and sometimes deeply disturbed and violent kid (now 220 pounds and six inches taller than me), I would add a few notes to your categories.

--violence that is the culmination of a ritualized pattern of behavior that can be set in motion by sensory insults, overwought reactions to stimuli with bad associations, or just bad luck, Just a particularly awful perseverative behavior in autism.

In our family, when the kid is in a bad state, we all dread the domino effect: once a certain set of responses and behaviors get triggered, there is a whole chain of worsening ones that follow without expert diversion, soothing, limits, and the management rituals we paents and his siblings have evolved over the years to keep eveyone alive and from serious physical harm. It is a bit like a ballet at times. When the rest of us are rested, fed, reasonably energetic and confident, we respond appropriately and basically control the situation eventually. But it takes tact, diplomacy, and the ability to read the verbal and non-verbal cues and know when to act and when to retreat to a locked closet or bathroom with a cellphone.

While all of you in hospitals and ERs see people when their families or law enforcement have run out of ideas,and things are usually at their worst, famlies (no less than clinicians) also need to learn how to discern different types of violence, severity, and discern when they can contain it at home and when to call in for help.

In our town, the vile newspaper prints the name of the family and address if the police are called for a domestic dispute. So if the kid were so violent that we had to call for help, the siblings and the whole family would be stigmatized. Punished. For this reason, I have NEVER called except when kid was suicidal aged eight. Then it was ambulance and hospital.

Another category of violence that I wonder about. There are times when some people seem almost not there when they are being violent. Some theorize that certain kinds of seizure disorders may underly these types of fits of rage. Certainly, if certain types of drugs can induce such behavior, it might well be that messed up brain signalling because of a seizure that doesn't register often enough to be picked up in standard monitoring for 24 hours, might be partially to blame?

Some people simply attribute such fits to possession. Possible, if your theology allows for such a thing. I wondered this at times when we were looking after my mother in law in our house when she was first diagnosed with Alzheimer's. One minute she was a warm, loving presence. The next, her eyes would go blank and it was as if something cold and dark had hooded her soul. And then she would whack the cat or a kid without warning, with great fury. Demonic

I think there is also a kind of unconscious violence that is as biologically based. Simpler than codes of gang violence. About stuff like ruffs, and flared nostrils, and grunts, and bared fangs. People talk about Lord of the Flies, but it's more basic than that. You see it in groups of hateful alpha girls bullying and tormenting girls on the outs. In the way that female groups are incessantly jockeying, (because the betas are never content with their status and will betray and scratch the alphas to take their place). In the way groups of men will embrace each other then without a word lash out at an outsider.

Most people are completely unaware of such group dynamics. Perhaps one of the reaons that so many people are disturbed by sociobiology? So threatening to one's self-conceit as a rational, civilized being.

Tavistock workshops used to be interesting ways to observe such unconscious processes emerge in groups.

Assistant Village Idiot said...

#1. Could your newspaper (or PD) be persuaded to list it as a medical call?

#2. I have posted on Tavistock before. I am fascinated by it, and ask you to write something, which I will dutifully link to.

Retriever said...

On the calls, Avi, in practice I have a well rehearsed spiel that I will use if necessary to stress medical. But the problem is, the fears of stigmatizing the rest of the family (and the kid) definitely make one hesitate before giving up and calling in the troops....er....the pros.

Right now, he's no more and no less trying than any other difficult teen boy. Years of a TDP have helped. I tend to be reasonably optimistic about my own ability to manage the periodic outbursts, given how much he has improved in the last 8 years.

Yup, Tavistock stuff was cool. To post on when the latest shenanigans of one of the other kids settle down. Sigh. The blessings of several children: no matter how hard you juggle and try to be a good parent, at any given point in time at least one puppy is disgracing the family or telling one (or a shrink) what an awful parent one is. God gave us children to pummel out any remnants of pride left after drill sergeants or old maid school teachers or sadistic bosses left behind...

A couple more random thoughts on violence. When I was in grad school all the family systems stuff was hot, and notions of the identified patient being the scapegoat for family sins/weaknesses/pathology. It always sounded like blaming the victim, a retreaded mother blaming to me, but I have definitely seen that when others in the family are angry, in conflict, or there is other great stress, some people prone to violence act out more. Enfleshing the angry or distraught feelings beneath the surface.

Or act crazy/violent so Mom and Dad stay together to take care of crazy kid.

And some violence is just a howl of misery made physical. Or doing to someone else what one felt has been done (at least psychically) to oneself.

Plus, one lashes out at those who hurt one's feelings.

In our family, we frequently talk about letting the Wookie win. Because our Wookie gets so upset when he loses that he's liable to...