Saturday, December 29, 2012

Violence In General - Contradictions and Overstimulation

The state hospital has had contradictory attitudes over time to the idea of “blowing off steam” versus more strenuously containing behavior.  In the 1980’s there were heavy punching bags on the units which patients could use.  We found over time that some patients got even more worked up using them, and had to be pulled back, screaming, threatening, and hands now bleeding. There seemed no balance on the other side of anyone actually benefiting.  We have a gym, and for those who can already contain themselves, it seems helpful to jog on the machines, play basketball, or lift weights. But we don’t actually have measures to show that these things do help.  They just seem like normalised behaviors, so we encourage them.  Others rapidly get overstimulated with even minor activity.

Or, they can get overstimulated and get assaultive when members of the opposite sex heave into view. BTW, it was always considered so ignorant and old-fashioned to declare how sexualised dancing is since the 60’s, but it becomes startlingly clear in an environment where people are locked up in a small space and impulsive behaviors can get out of control quickly.  “Maria was dancing provocatively, so of course all the males had to come down to the day area” is said at morning report.  But Maria’s dancing is sometimes a pretty mild version of what you’d see at any wedding, so at one level it’s not provocative.  Except it is, and everyone can tell instantly.

Playing the TV or music too loud can be overstimulating.  I don’t know that particular styles are worse.  Some styles are more likely to be played loudly, but we’ve got folks who will crank up anything and get worked up.

Young males hanging around and woofing together is overstimulating, and we put a lid on that quickly.  For females with a trauma history even hearing about other trauma is overstimulating. Personality disorders activate when they see someone else getting attention, as it threatens to them that they will be cast out of the family into the darkness.

We have been less encouraging of sexual behavior or the use of pornography, though even here there has been controversy.  Psychology especially used to teach that these were normal expressions which we shouldn’t stand in the way of, however much church ladies objected.  Then women with feminist leanings objected on other grounds, of exploitation and advantage-taking, muddying the waters further.  Gay rights advocates became adamant that sexual expression was part of their humanity, and that started to bleed into mental health because most practitioners were liberals who wanted to keep up.  So the issue of whether to give out condoms became a complicated medical/moral/clinical/legal risk set of issues that is still unresolved. If people really press for it, their right to have pornography is upheld, but we make it so difficult that only the determined find it worth pursuing. I don’t think we notice anything other than whether someone is getting – you guessed it – overstimulated.

We don’t show horror movies or very violent or sexual ones, but we don’t have any data to support that.  We just figure it’s probably a bad idea, and why take the risk?  There are video games as well, some of which are a bit violent, but never the highest category of that.  Some of the line staff play those games or watch those movies, but they are considered declasse.  Not that we egalitarians would ever say that.*

We let people cross-dress, even flamboyantly if they choose, because we are very modern and it’s their right.  We only mention in whispers that this seems to occur more often when the patient is sicker, because then people might think that we think that…oh dear.  Couldn’t people just get better and go home where we didn’t have to see them and do whatever they like?  Because when they’re right here in front of us, and our professional judgment that they are much sicker on other grounds, but our politics tells us that we can’t say that, not even in front of our own staff, it creates a conflict we don’t like.

Oh, and BTW, the cross-dressers get overstimulated as well. 

Crowds overstimulate, but so does isolation, especially if one has hallucinations.
Pain overstimulates. 
So does missing on substances one has some dependence on – caffeine, opiates, nicotine, alcohol. 
Emotional rejection and a host of other things overstimulates.  

We may not know what the deep impact various things have on your psyche long term, but we are damn good at observing overstimulation, and we think it’s a bad thing that makes people violent short term.

*A lot of these discussions about whether people should play these games or look at these pictures or have these guns have a you-are-alien-to-me feeling, which is quite obvious when you look for it in the language people use. I think the pathology may be exaggerated when that happens.


Sam L. said...

"Crowds overstimulate, but so does isolation, especially if one has hallucinations.

Don't know if you've heard of Dr. Science, who does/did short bits on public radio answering science questions. There was one about driving across North Dakota and seeing the Northern Lights. His answer was something like "When the mind is without stimulation, it starts making things up. There is nothing to see in North Dakota, so you mind made up the Lights to keep you sane enough to not go off the road."

james said...

Do smells play a role?

Some folks who spent quite a while at the South Pole wrote that when they left the airport at Christchurch the smell of flowers was amazing, and the presence of a woman was dramatic--I think one said "electric".

After a few days they got used to (numbed to?) smells again and didn't notice so much anymore.

Maybe this would apply more to autism spectrum problems. It might take a while to figure out, since the researchers wouldn't be that great at noticing smells themselves: triple-blind studies, anybody?

Assistant Village Idiot said...

There is some suggestion that smells are a powerful PTSD trigger, and that could of course theoretically lead to increased violence. I don't know that anyone's made the connection.

There's a dystopian science-fiction plot for you, of smell-activated violence in groups of unsuspecting trauma victims.

Donna B. said...

I'm uncomfortable with the implied PTSD = violence vibe going on here. Though the subject is violence, it's not valid (IMHO) to link violence as PTSD's only symptom.

PTSD expresses itself as an inability to cope with stress -- but that inability is not always (nor even most likely) expressed as violence. The cases involving violence may get more attention, but I suspect that cases involving non-action are more numerous.

Assistant Village Idiot said...

I likely went to the physical acting out symptoms because that's almost entirely what I see. No one puts you in an involuntary hospital for avoidance, nightmares, or startle reflex. You have to be hurting yourself or someone else to see us.

I'd say it's 25-33% of my caseload.

Texan99 said...

It's funny about the provocative dancing. I think everyone who takes off his blinkers realizes what a potentially volcanic activity male-female dancing is. Even in the most buttoned-down society with polite little no-touching minuets, it's big-time sexual drama.

It became popular to imagine that there was neither harm nor even danger in encouraging sexual responses, so people laughed at the Church Ladies who clucked at sexy dancing. Among people leading full lives who can contain their actions, what could be more wonderful than a communal tradition that arouses powerful sexual feelings? But it's graduate-level stuff, one of the most dangerous forces there is.