Preventing Youth Violence, Part 1


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PREVENTING YOUTH VIOLENCE
PART 1: ITS GENERAL NATURE AND WARNING SIGNS

Raymond B. Flannery Jr., Ph.D., FAPM,
Harvard Medical School,
The University of Massachusetts Medical School

Recent months have seen outbreaks of mindless violence by youth in Canada, Europe, and the United States. These acts have included homicide rape, robbery, assault, arson, and rioting among other crimes. Thoughtful adults respond in disbelief, anger, and bewilderment. How has it come to this? Why are children today so angry, when they are growing up in a period that has seen the most money, education, material goods, and other resources in human history? Were there no warning signs? Can anything be done to correct this?

This two-part series begins to respond to these concerns. Part 1 examines the various theories of youth violence and the warning signs of troubled youth, signs that have been surprisingly consistent for the past one-hundred years. Part 2 examines both individual and group interventions to address troubled youth before violence erupts. Society is not helpless in the face of youth violence. There are things that can be done. (1, 2)

Theories of Youth Violence

To understand the precipitants to youth violence, it is helpful to be first aware of the three domains of good physical and mental health: reasonable mastery, caring attachments to others, and a meaningful purpose in life.

Each human being needs to have some reasonable control over his or her environment. The skills to take care of oneself, to earn a living, to rear children, to get along with the neighbors and are examples of reasonable mastery.

Children and adults also need caring attachments to others. These attachments have many benefits that sustain life in infants and prolong life in adults. Attachments may provide us with psychological benefits such as emotional support, companionship, information-sharing, and instrumental help. These attachments also regulate and improve cardiac functioning, enhance the immune system to reduce risk of illness, and increase endorphin functioning, endorphins being brain chemicals that make us feel good.

The third needed domain is a meaningful purpose in life. Each of us needs a reason to get up each day and invest our energy in the world around us. Most people choose prosocial goals that contribute to the overall benefit of society in some fashion or other.
It is important to understand that these three domains contribute to good personal and societal health because in youth violence at least one and, often, all three domains have been disrupted.

Let us examine the four basic theories of youth violence: the cultural, biological, sociological, and psychological theories. We begin with the most prominent cultural theory, the theory of anomie by Emile Durkheim (1858-1917). (3)

A. Cultural Theories

Let us return to our earlier question: Why now? One important part of the answer has been proposed by Durkheim: anomie.

Durkheim notes that societies have five institutions that govern the behavior of its citizens and enumerate what social behaviors are expected. These institutions are the family, business, government, education, and religious-faith traditions. In stable periods of human history, these five institutions are in agreement on the basic values for a society and in this way adults know how to behave and what values to inculcate in their children. The end result is a cohesive society wherein members feel welcomed and looked after.

However in periods of profound and fundamental change, the five major social institutions are themselves thrown into short-term disarray, as they too are impacted by the change. This results in less agreement on what are the common basic values and goals for society as a whole, and there is less concern for other members of society. The sense of cohesion and concern are lost. This is anomie.

This theory of Durkheim would predict that the West is in one of these very fundamental societal shifts. It began from 1965 to 1970 with the omnipresence of computers; the worldwide impact of instant communication; and the subsequent development of the shift to a knowledge-based society, globalization, and an international economy. This postindustrial state, as it is commonly known, has seen a corresponding shift in values from the traditional Protestant Work Ethic, with its emphasis on self-control, self-denial, hard work, and concern with the welfare of others to a postindustrial value system that emphasizes the primacy of self, material acquisition, and instant gratification. As Durkheim would predict, the five major societal institutions are in a period of flux with little agreement on common societal values, and social cohesion has been disrupted.

Cultural roots disrupt mastery and attachments, and are fertile ground for violence and antisocial behaviors in troubled at-risk youth.

B. Biological Theories

Next are the biological theories. At present, there is no evidence of a predetermining genetic disposition to violent behavior. That having been said, medicine and science do indicate that injuries to the cortex, the source of higher moral reasoning and judgment, and/or the limbic system, where emotions are registered, are both associated with subsequent acts of violence in some cases. Medical conditions associated with potential violence include Alzheimers disease, traumatic brain injury, lupus, multi-infarct dementia, Parkinsons disease, seizures, and tumors, among others. Similarly, some psychiatric illnesses associated with potential violence include Attention Deficit/Hyperactivity Disorder, dementia, mental retardation, psychological trauma, serious mental illness, and suicide. (4)

In general, biological theories disrupt mastery and individuals with medical or psychiatric disorders are not held personally accountable for their medical conditions, unless the illnesses were previously diagnosed and treated and these diagnosed individuals are not currently treatment-compliant.

Violent acts stemming from medical or psychiatric conditions are relatively few in number and cannot explain the current widespread youth violence that is occurring.

C. Sociological Theories

The sociological theories receive much media attention and are widely known, so little time is spent on them in this essay and blog. The most common ones include poverty, discrimination, domestic violence, inadequate schooling, substance abuse, easily available weapons, and the portrayal of violence in the media. What is often overlooked is that each of these forms of social violence destroys caring attachments. As we see in the next section on warning signs, the absence of caring attachments is a common factor in troubled youth.

D. Psychological Theories

The focus of psychological theories is twofold: reasonable mastery and a meaningful purpose in life. Reasonable mastery is learned at home, in school, and in the larger adult community in order to cope with life-expectations of work, child rearing, and community activities. Absent adults and poor schools result in faulty learning.

Psychology is also concerned with values. Adequate parenting and schooling result in young citizens with prosocial values ready to improve their own lives and that of society. However, poor parenting and schooling may result in antisocial values that may include selfishness, revenge, the imposition of personal justice on others, and violent behavior for social (gang) acceptance. In these circumstances, children often join gangs to replace the family structure missing in their lives.

This completes the overview of various theories of violence and how they disrupt the domains of mastery, attachment, and meaning. Let us turn our attention to individual children and the warning signs of troubled youth. The roots of the theories of violence lay in the warning signs of at-risk youth long before the violence erupts.

The Continuum of Warning Signs

As noted, when violence erupts, citizens ask why there were no warning signs? In truth there are warning signs, often there are several, and frequently they have gone unnoticed for years. I have reviewed the published empirical literature over the past hundred years in psychiatry, psychology, nursing, sociology, criminology, and education, (1) and found that the warning signs of at-risk youth have been remarkably consistent. This has remained true even though society has undergone dramatic changes in the past one-hundred years. I have arranged these warning signs on a continuum of severity from early warning signs to serious warning signs to urgent warning signs. The domains of good health are absent or impaired in each of the sets of warning signs, and reflect an underlying problem for the troubled child. Since medicine and science cannot predict violence with one-hundred percent accuracy, a good rule of thumb is to assume that the more warning signs that are present, the greater the likelihood of violence occurring.

A. The Early Warning Signs

As with the theories of violence, the early warning signs are centered on disruptions in the domains of reasonable mastery, caring attachments to others, and a meaningful purpose in life.

Caring attachments can be physically broken apart when the family unit is disrupted and parents are not present. Divorce, separation, desertion, foster care, incarceration, and nonsupport are common examples. A second important way that attachments may be impaired is found in dysfunctional families. Here the family stays together but is dysfunctional in its daily operations. Physical and/or sexual abuse, gambling, substance abuse, extensive financial debt, and severe social isolation are common factors found in dysfunctional families. Further, attachments at school or in the neighborhood may not develop as well, especially in the face of street violence, street gangs, bullying, and any of the common factors in discrimination. Young people without attachments are at increased risk to become violent.

Reasonable-mastery skills are the second domain that may be disrupted. Mastery skills are necessary in at least three general areas. The first is personal growth and self-care. Children need to learn to manage stress, time, money, self-soothing skills in distress, and basic health and nutritional practices. The second mastery area is that of interpersonal growth and getting along with others. Necessary skills here include empathy, containing impulsivity, sharing and caring for others, as well as verbal-conflict-resolution skills. The third mastery area is academic growth in all subject areas, in addition to computers and other forms of electronics media. In the absence of good adult teachers, mastery skills are not learned and youth are at risk.

As noted, developing a meaningful purpose in life, the third domain for good health and the absence of violence in today’s era, is difficult. There are the competing value systems of the major faith traditions with their emphasis on caring for others; and the material-goods values of the self first, material acquisition, and instant gratification. Children need caring attachments to model the prosocial work-ethic values of concern for self and others. Young people who have learned the material-goods values will often realize in time that this is a limited solution that often seems empty, and they may become angry. Those children without the skills to obtain material goods through traditional employment may develop antisocial skills and strategies to obtain material goods in antisocial ways. Angry youth and antisocial youth are at-risk youth.

If these early warning signs of mastery, attachment, and meaningful purpose are overlooked; minimized (for example, “they will grow out of it”); left unattended; or are suppressed (for example, incest), as is often the case, the child will likely progress to the serious warning signs.

B. The Serious Warning Signs

The serious warning signs are three in number: depression, substance abuse, and psychological trauma. Each of these can further increase anger in a child with any of the early warning signs and make intervention strategies for reducing the risk of violence more protracted. (4)

Depression is a mood state characterized by feelings of sadness, guilt, irritability, anger, and hopelessness. Depression may affect both the mind (problems with concentration and memory) and the body (problems with sleep, appetite, bowels, and sexual drive). The causes of depression are beyond the scope of this essay and may be found elsewhere. (1, 2) Whereas some depression appears genetic, loss of relationships, property, and goals are common factors, as is being reared in a dysfunctional family. In some depressed children, suicidal thoughts and plans may also be present.

Substance abuse is often another common factor present in at-risk youth. Children, like adults, use alcohol and other drugs to alter mood states: to lift depression, to calm anxiety, or to create excitement. Children absorb these drugs orally, transdermally, rectally, by injection, inhaling, or insufflation (snorting). Common warning signs include poor motor coordination, shallow breathing, slurred speech, glazed eyes, dilated pupils, decreased alertness and mood states of depression, hostility, irritability, and elation. Substance abuse disinhibits the control centers of the brain that prevent violence.

The third serious warning sign is untreated psychological trauma or posttraumatic stress disorder (PTSD). (5) Psychological trauma may occur when a person is confronted with actual or threatened death or threats to physical well-being. A person can be traumatized by direct acts, witnessing these acts happening to others, or by hearing them discussed in graphic and lurid detail. Psychological trauma disrupts mastery by definition, curtails attachments as victims withdraw, and destroy one’s meaningful purpose in life by revealing a part of the world that is not orderly, predictable, nor safe. Trauma victims may have symptoms of hypervigilance, sleep disturbance, intrusive recurring memories of the event, and an active avoidance of the situation where the event occurred. If psychological trauma is not treated soon after its occurrence, PTSD will follow within one month. Untreated PTSD often results in cardiac illness, substance abuse as a form of self-medication, and violence.

Young people who become violent often grow up in dysfunctional families and take to the streets. In both settings, they are subject to experiencing psychological trauma and PTSD, with its accompanying substance abuse and potential for subsequent violence.

If the serious warning signs are also left unattended, the urgent warning signs will most likely follow.

C. The Urgent Warning Signs

The urgent warning signs occur after criminal and/or violent behavior has been engaged in. It is most commonly referred to as conduct disorder and defined as criminal behavior committed before age fifteen. It includes violence toward persons or property, forced sexual activity, cruelty to animals or people, mindless vandalism, and/or setting fires. Delinquent children fail to conform to social norms. They are deceitful, superficial, manipulative, lack empathy, and are often pathological liars. In law, this condition is known as moral depravity. (2) Children with the urgent warning signs are the most difficult to teach prosocial values and coping skills.

* * * *

As we complete the first part of this series, we want to draw the link between the theories of youth violence and the warning signs of potential youth violence that we have reviewed. Warning signs are related to the potential sources of violence in the various theories. For example, a helpless child is most likely deficient in psychological mastery skills. Similarly, a child with disrupted attachments might draw our attention to the sociological theories, such as family dysfunction related to parental substance abuse. As we address the warning signs, we reduce the risk from the relevant theories of violence.

Finally, rarely is there a single precipitant to youth violence; more commonly, there are multiple determinants of both warning signs and pertinent theories of violence. Each warning sign needs to be addressed in each troubled child to prevent the violence and to improve the quality of life. It is to these remedial individual and group interventions that our attention is turned in part 2.

References
1. Flannery, R. B., Jr. Preventing Youth Violence: A Guide for Parents, Teachers, and Counselors. New York: American Mental Health Foundation, 2012.
2. Flannery, R. B., Jr. Violence in America: Coping with Drugs, Distressed Families, Inadequate Schooling, and Acts of Hate. New York: American Mental Health Foundation, 2012.
3. Durkheim E. Suicide: A Study in Sociology. Trans. Spaulding J., Simpson, G. New York: Free Press, 1997.
4. Flannery R. B. Jr. The Violent Person: Professional Risk Management Strategies for Safety and Care. New York: American Mental Health Foundation, 2009.
5. Flannery R. B. Jr. Posttraumatic Stress Disorder (PTSD): The Victims Guide to Healing and Recovery. Second Edition. Ellicott City, MD: Chevron, 2004.

Dr. Raymond B. Flannery, Jr., Ph.D. FAPM, is an internationally recognized scholar and lecturer on the topics of violence, victimization, and stress management. Dr. Flannery is available for lectures and workshops for all types of groups, and may be reached at the American Mental Health Foundation. elomke [at] americanmentalhealthfoundation [dot] org


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