The Violent Person

Chapter 2: Understanding Human Violence

Understanding Human Violence

Night and silence! Who is here?—William Shakespeare

The door to the jail cell slammed shut. He was charged with vagrancy, disorderly conduct, and two charges of assault and battery on a police officer. So be it, he thought to himself. Life was not fair, the world was a jungle, and, as his voices had correctly predicted, no one could be trusted—not even the police.
Richard had grown up in a housing project on the other side of town. Both of his parents drank heavily and physically abused each other and himself. He tried to separate them during their fights but he was small in stature and easily flung out of the way into nearby walls. He learned early on that the world was malevolent and that he should keep his head down and his guard up.
The voices had begun four year ago, when he was sixteen. These voices were his regular companions and their directives to harm himself or others were harsh and uncompromising. They particularly cajoled him to attack others first before those others came after him. He was frightened by the voices and had begun to use alcohol to calm his nerves.
Today’s dark journey had played itself out at high noon. This morning his voices had been especially intense. He had used some alcohol to self-medicate but with no measurable relief. He had gone to the park in search of solitude. However, his ill-kempt appearance and his constant pacing frightened nearby children and the police were called. The police surrounded him just as the voices had predicted that they would. This was the jungle made real.

The police told him to stand still. He was unable to stop from pacing. The police asked his name. He remained mute. One of the officers remembered the police academy instructor saying that, when communication fails, violence follows, but what do you do when the suspect will not speak? In the end, four officers rushed him. He lowered his head and fought as hard as he could. One officer sustained a broken wrist; a second, a scraped face.
Thus, the police had placed him in a cell and slammed shut the door. He wondered if they understood that in the jail cell of his schizophrenic illness the terror and loneliness were worse than anything the state had to impose.
When communication fails, violence follows.

Even though there is a good deal of violence in the world, when it erupts close to home in one’s neighborhood by neighbors that everyone considered to be normal, people become frightened and confused. Violence teaches each of us how tenuous our links are to Mother Earth and murders, rapes, assaults, and the like remind us how vulnerable each of us truly is.
This chapter focuses on the evil of human-perpetrated violence on others and examines the various theories to explain such behavior. The initial response of many nonvictims is to assume that the violent person was out of his or her mind, as is the case in our chapter vignette. Yet, only a small percentage of human violence can be attributed to mental illness. This is a cold reality with which it is difficult to come to terms. In most instances, the violent acts were committed by violent persons who were not mentally ill and who were aware of what they were doing. Some behaved impulsively (behavior without thought) and, even worse, some behaved with premeditated, calculated hatred. In the latter case, the assailants clearly knew what they were about.
Why do people commit these heinous acts, including harming helpless children? What motivates or drives them to behave this way? The answer is complicated and not yet fully understood in medicine and science. However, behavioral science has developed and researched several theories that explain what may be at work in any given person’s violent behavior. Often, more than one factor is at work in the same violent person.
Understanding what motivates a particular assailant is helpful information for those of us who respond to behavioral emergencies. Knowing, for example, that a person is intoxicated, seeking initiation into a local street gang, or suffering from infarct dementia provides us with information on how to differentially approach a particular patient or client to begin to defuse the risk for potential violence, so that safety for everyone is maintained.
There are four grouping of theories of violence: cultural, biological, sociological, and psychological and each is reviewed in due course. However, we will begin with the three basic principles of good physical and mental health because in each act of violence one or more of these domains are disrupted in the assailant. Moreover, each of these three domains also furnishes health-care providers with some basic intervention strategies to employ in defusing the potential for violence that is associated with their disruptions in behavioral emergencies.

The Domains of Good Health

Caring attachments to others, reasonable mastery in our lives, and a meaningful purpose in life are the three domains of human functioning that lead to good physical and mental health. Adequate functioning results in less anxiety and depression, less illness, and a sense of well-being. The absence of adequate functioning in these domains leads to the loss of a sense of well-being, increased illness, and a shortened lifespan. Anger and violence frequently accompany domain disruptions.

Caring Attachments to Others

Caring attachments are the meaningful bonds or links that we have with other humans. Humans are social animals and being close to others makes us feel good. The absence of others in our lives leads to a loneliness that can be very painful.
World War II in part provided the impetus to study the nature of human attachments. The war had disrupted many families through death, abandonment, and relocation. As families were torn apart, many children became orphaned and society did its best to understand how best to help these children. Ren&eactue; Spitz (Lynch, 1977) was among the first to call an attention to the importance of human contact and demonstrated how literally deadly could be its absence. In 1945-46, he studied ninety-one infants in orphanages in Canada and the United States. All of them were well cared for by staff but thirty-four died during the last three months of their first year of life. They wasted away in spite of good care and no obvious medical disease. Spitz wondered if the absence of the biological parent(s) in some way contributed to their early death.
During these same years, a British physician, J. Bowlby (1982), was also studying the importance of the mother for the growth of the child. It was obvious that a child was dependent on his or her parents for survival and for learning over time how to survive on its own. Bowlby felt that a child was born with a need to interact socially as a way of meeting these survival goals and Dr. Bowlby set about clarifying the nature of this process. Bowlby observed a child was content in the presence of its mother but, if the mother left the child, the child would scream in protest until its scream brought about the return of the mother and with her return the implications for safety. Bowlby called this mother/child bond an attachment and termed the child’s distressed screaming in her absence a form of separation anxiety. He also noted that, in those cases where the mother did not return, the child would become despondent and depressed. The child remained detached from others, as if not wanting to be abandoned again. When the attachment was secure and consistent, the child’s growth and development were normal and adaptive. In those cases where the attachment was insecure or absent, the child’s growth was not normal and a variety of problems emerged over time.
Subsequent research has studied the nature of adult attachments. Attachments to family, friends and colleagues bring us companionship, emotional support in good times and bad, information about solving life-stressful problems, and instrumental favors in the forms of money or political influence on our behalf (see review in Flannery, 2004a). Other types of attachment, however, may prove to be harmful. These include those marked by physical or sexual abuse, emotional over involvement in others, emotional demanding-ness, interpersonal skill deficiency, and the like.
One additional important component of caring attachments is mastering the skills of empathy. Empathy refers to our ability to understand the feeling states of others. This process is usually begun in childhood when parents teach their offspring how other children and adults feel. For example, a mother might say to her child; do you remember when grandma died and you felt sad? Well, Jimmy’s grandmother has died and he may feel sadness as you did, when your grandma died. This ability to walk in another person’s shoes, to understand how they may be feeling forms the basis of empathy and is learned gradually over time. It is a complex skill.
It is also important in understanding some forms of violent behavior. Empathy forms the psychological basis for moral values to take root. Without empathy, it is rare for individuals to have true moral development. In some cases, the violent person harms another because the violent person has limited capacity to appreciate the suffering that he or she is inflicting on the victim.
In addition to the psychological components of caring attachments, physiologist, James Lynch (1977; 2000), was studying the physiological components of caring attachments at the same time as the psychological studies were being conducted. He found that a person’s cardiovascular system (blood pressure and pulse), the person’s immune system to fight upper-respiratory infections, and a person’s endorphins endogenous opioid system (chemicals in the brain that make us feel good) were all strengthened in the presence of caring attachments. The reverse was true in socially isolated people. Indeed, he found that the absence of caring attachments resulted in premature death. Clearly, caring attachments are an important domain in good health.

Reasonable Mastery

Reasonable mastery refers to one’s ability to shape the environment to meet one’s needs. We learn work skills to earn money to eat, we learn social skills to make attachments, and so forth. These types of efforts enable us to pursue our goals in life and to enhance our quality of life, once we have met our basic goals.
Good problem-solvers have a basic set of cognitive strategies that they utilize to solve the issues and problems in life that confront them. First, they correctly identify the problem to be solved. If they are angry at something at work, they do take that anger out on their family. Second, they gather information about how to solve the problem. They draw on past experience, reading, advice from friends, and the like. Third, they think out carefully specific solutions for the specific problem. They have more than one solution because they know that the world is complex and that their first solution may not work. Fourth, they implement the proposed solution, and, fifth, they evaluate it to see if it actually solved the problem.
Adaptive problem-solvers know something else. They know that they have the mental capabilities and physical strength to solve many problems in life but they also realize that total mastery of everything in life is unreasonable. Some problems they know they do not have the skills to solve. In other cases, they have tried their best but the problem remains unsolved. At some point, they know enough to stop trying and they put their energies to better use.
Poor problem-solving may result for many reasons, including medical or psychiatric illness, disability, inadequate parenting, poor schooling, or being emotionally overwhelmed and unable to think clearly.

Meaningful Purpose in Life

All of us need some reason to get up in the morning and invest our energies in the world around us. This purpose provides the motivation for us to move forward, especially during life’s difficult moments. Many years ago (1979), sociologist Aaron Antonovsky was the first to establish the importance of a sense of a coherent meaningful purpose in life. One’s meaningful purpose needs to provide a sense of the world’s manageability, to make the world comprehensible, and to provide a belief that the world is worthy of our investing energy in it. The components of the sense of coherence help us keep life in perspective and buffer the stress of life.
Humans are biological in part, yet have a conscious awareness of their own physical being. We know that our physical self will die at some point, so our conscious self tries to find a way to live on in the minds of others after our deaths. Thus, many successful meanings in life revolve around concern for others. These might include one’s children, one’s life-work, a community social cause, an artistic creation. This concern for others, in our meaningful purpose in life, is more robust than some of society’s other proffered goals, such as money, power, fame, and fortune. These other worldly proffered goals all end in death and do not necessarily leave a legacy that is remembered by others. A meaningful purpose in life that is primarily centered on the self may result in an unnecessarily enhanced sense of self. This exaggerated sense of personal control will some day encounter a problem it cannot solve and at that point its sense of purpose may fail and serious depression may ensue.
Caring attachments, reasonable mastery, and a meaningful sense of purpose in life are the three domains of good health that foster normal moral childhood development and adaptive adult functioning. In the theories of violence to which we now turn, the domains are disrupted or absent and normal moral growth has not developed.

Theories of Human Violence

No one single theory of violence can explain all of the various forms of violence and often there is more than one type of violence present in any given incident, as we have noted earlier. Understanding these various forms of violence may provide health care professionals with an awareness of what to expect and how to approach any given behavioral emergency. We begin with the cultural theories of violence because the presence of cultural roots of violence exacerbate the other three forms of violence. The interested reader will find these theories discussed in much greater detail in Borak (2006), Defelm (2006), and Flannery (2000).

Cultural Theory

Culture may be defined as the customary beliefs, social forms, and material traits of a people. Although there have been many cultural theories of violence, the theory of &eactue;mile Durkheim (1858-1917) has gained the most prominence and many adherents.
Durkheim believed that culture exerted its influence through society’s five basic social institutions: government, business, family, school, and religion. He saw these five institutions as the transmitters or educators of a culture’s values and social norms. These institutions showed citizens what was expected, what was valued, how to be a productive member of society, and how to interact in socially approved ways with others. The adults then knew in turn the rules by which to raise their children. The end result of this process was an integrated social community in which people had caring attachments, reasonable mastery, and a meaningful sense of purpose. This adaptive regulation of social behavior led to a sense of cohesion in the community and a sense of belonging in the individual.
Durkheim’s theory also predicted that, when a society underwent a major social upheaval, society’s five basic social institutions would themselves undergo this upheaval, and the commonly agreed-upon set of rules to regulate social behavior among citizens would be in disarray. The sense of social cohesion and belonging would be lost. Durkheim referred to this state of loss as anomie. Durkheim supported his theory by reviewing all of the countries that had been through major social upheavals throughout history. He noted that after each upheaval the cohesion and sense of belonging were repeatedly replaced by increases in mental illness, substance use, suicides, and human-perpetrated violence toward others.
Many social scientists (e.g., Drucker, 1994) believe that we are in just such a major social upheaval in our own age. From 1850 until about 1970, our culture was referred to as the Industrial State. The Industrial State was characterized by the harnessing of energy to run machinery. At first, it was water to run spinning looms but subsequent advances in science and technology resulted in other forms of energy being coupled to machinery. Over time, coal, oil electricity, and atomic energy were harnessed to run everything from small appliances to motor vehicles and airplanes. The Industrial State became a society that produced goods and services based on ever expanding technological advances. Businesses expanded from small private ownership to multinational corporations and the general health and welfare of the people improved greatly during these years. These years were governed by a value system commonly known as the Protestant Work Ethic. It stressed concern for the welfare of others, especially the young and the elderly; hard work; honesty; self-control; self-denial to improve the lot of one’s children; and sexual exclusivity in marriage. Although poverty and various types of discrimination remained, over time an increasing majority of citizens came to have caring attachments, reasonable mastery, and a sense of meaningful purpose that was rooted in concern for others.
The 1970s marked what Durkheim would see as a major social upheaval. Society moved from providing goods and services to creating knowledge after the advent of computers. Whereas an employee in the Industrial State might have physically made motor vehicles, in this new age, known as the postindustrial state, that same employee provided services and information by means of the computer. For example, an employee might enter insurance claims on a computer. The postindustrial state has seen the rise of three groupings of citizens: the knowledge workers who use the computers to make advances in understanding; the service workers who provide the resources and support to keep the knowledge workers efficient; and the permanent underclass who are unschooled and unskilled and, therefore, unable to join one of the first two groups. Moreover, a new value system has emerged to replace the Protestant Work Ethic. Postindustrial values emphasize the self first, material goods, and instant gratification.
As Durkheim foresaw, the five major societal institutions have themselves been caught up in this transition. The common agreement on acceptable social behavior has been lost with a resultant decline in the sense of community cohesion and belongingness. Mental illness, substance use, suicide, and violence toward others have all increased in our age and many of today citizens do not have caring attachments, reasonable mastery, or a meaningful sense of purpose. It is likely that this transition to the postindustrial state will continue for several more decades before a commonly agreed upon set of socially integrated values and guidelines emerge. Without a sense of integrated community and belongingness, our cultural backdrop to violence will continue for some time to come.

Biological Theories

Many medical and behavioral scientific researchers have asked a fundamental question: Do abnormalities in biological structure and function result in violence? The answer is a complex and qualified “yes” in some, but not all, cases.
A first reasonable question is to ask whether there is any evidence to suggest that violence is genetic and inherited. The question is asked in part because some families are violent in succeeding generations and in part because some crimes are so heinous that most of us want to believe that there must have been some abnormality in the assailant at birth.
The research evidence to date is mixed. Some researchers such as Bouchard (1994) suggest that there is no known genetic basis for violence. Different violent persons committing the same crimes have no common genetic component. However, other investigators such as Guan Guo and his colleagues (Guo, Roettger, and Cai, 2008) report that the MAOA gene, the dopamine Transporter1 gene, and the dopamine D2 receptor gene in the presence of environmental stress may link adolescent delinquency to molecular genetic variants. Further genetic research is needed before conclusions may be drawn.
There is research evidence that documents that injury to the brain in the cortex or limbic system may result in violence. (See figure 5 in the first chapter.) Tumors, head injuries, viruses, birth defects, and exposure to lead are some of the events that may destroy the cortex and its cortical control centers that inhibit violent behavior. Similar injuries to the limbic system such as viruses, head injuries, and untreated psychological trauma may result in violence as well.
Certain medical and psychiatric illnesses and conditions contain the potential for violence. In addition, certain bodily conditions can elevate the risk for violence. These include states of pain, hunger, sleep deprivation, excessive heat, overcrowding, and severe life-stress (e.g., divorce, foreclosure of mortgage, loss of job, terminal illness).
Four personality disorders—antisocial, borderline, narcissist, paranoid—have been at times associated with violence (American Psychiatric Association, 1994). The level of biological involvement in these personality disorders remains medically unclear. However, unlike some medical illnesses, there is no current evidence that these personality disorders and associated violence are necessarily beyond an individual’s control. An antisocial person is one who is engaged in criminal activity toward person or property, is not governed by the prosocial values of society, and is often morally depraved. The person with borderline disorder has intense mood swings from uncontrollable crying to intense oral hostility and rage. Some researchers believe that persons with borderline personality disorder may have a limbic system dysfunction. A narcissistic person is one who values oneself above all else and continuously wants one’s own way. The individual with a paranoid personality is suspicious of most all persons and events. The world is seen as a hostile threat that requires constant vigilance to assure one’s safety.
Some acts of violence appear biologically rooted and disrupt the domain of reasonable mastery. Given the nature of our care-providing work, we may see more biologically rooted violence then the general public. However, the total numbers of these cases is small and can in no way account for the total levels of present-day violence in our society.
The biological theories have their main impact on disruptions in the domain of mastery and to some extent meaningful purpose.

Sociological Theories

The sociological theorists of violence seek to explain what social environmental events in our daily lives may contribute to violence. The research has focused on poverty, inadequate schooling, discrimination, domestic violence, substance use, easily available weapons, and the media. Since these issues are routinely discussed in the media and are familiar subjects, they will be noted here briefly.
It has been known since the time of the Romans that poverty is highly correlated with crime and violence. In some cases, individuals without financial resources are forced to steal to feed, clothe, and shelter themselves. Some without adequate prosocial problem-solving skills earn a living by engaging in criminal behaviors, such as fencing stolen goods, fraud, or drug-trafficking. Still others who learn of the emphasis on material goods through the media break and enter, snatch purses, and commit robberies to obtain the material goods that they cannot legitimately afford.
Inadequate schooling compounds the problem of poverty in the postindustrial state. Knowledge and technology continue to become increasingly complex and those who drop out of school or who come from inadequate schools do not learn the socially sanctioned skills and educational skills necessary to obtain employment in the knowledge-based state. Schools without enough teachers, without enough books for each student, without adequate computer availability, and schools in physical disrepair do not adequately prepare children for earning a living in today’s age.
Acts of discrimination are acts of hatred committed against innocent persons because of some aspect of their personhood. Age, race, ethnicity, creed, gender preference, and physical attributes are some of the more common areas of discrimination known to all of us. Every act of discrimination blocks some person or persons from equal access to basic civil rights and equal opportunities.
Domestic violence refers to violence committed by any family member or significant other toward any other family member or significant other. Such violence may involve grandparents, parents, children, extended family members and a variety of significant others who may be residing in the home. The abuse may include murder, physical and sexual abuse, nonverbal intimidation, verbal abuse, neglect, and/or mental torture. This is a serious problem encountered by health-care providers and is the subject matter of a later chapter.
Substance use is a serious national public health problem and includes the excessive use of alcohol and a variety of street drugs and prescription medications. Many times the substance use begins as a form of self-medication to soothe one’s nerves but over time it becomes a physical addiction. Substance use impairs the individual’s physical health and social well-being in terms of family disruptions, loss of employment, legal involvement, and the like. For caregivers, it is important to remember that substance use inhibits the higher cortical-control centers in the brain and increases the potential for behavioral violence.
The presence of easily available weapons, especially those for purchase by children and adolescents in school playgrounds, has led to the increased use of firearms to settle conflicts over girlfriends, boyfriends, money, loss of face, and the like. Whereas in the past, the two parties might have had a fist fight, now each party is brandishing a weapon. So extensive is the problem, that innocent children now feel they have to arm themselves for protection, when they leave home. Legitimate gun holders who are licensed and use their weapons appropriately, such as for hunting, should be supported but society needs to address the presence of easily available weapons for children in our school neighborhoods.
Finally, the impact of the media needs to be addressed. There is an extensive national debate currently about whether video games increase the marksmanship of children. For many, it no doubt does but, as with the portrayal of violence in other media forms, most children who watch these violent episodes do not then become copycat assailants. There is a small subset of children who are unduly influenced by the violence in the media, including computer games. Further research is needed to identify these high-risk children. In the interim, society in general would benefit from parents engaging in media literacy with their children. Media literacy refers to educating the child as to the true and full meaning of what is being viewed. For example, after a scene of a violent car accident, the parent might discuss the importance of safe driving, the impact of the accident on the victim’s health, the impact of the accident on the victim’s family, and so forth. Discussions such as these teach children about the painful consequences of violence that are not portrayed in the media as it cuts to commercials.
In general, the sociological theories reflect disruptions in the domain of caring attachments and often reflect lack of empathy as a component.

Psychological Theories

The psychological theories refer to two main factors: the individual’s coping skills and the individual’s motivation for violent behavior. Coping skills refer to personal self-care skills, interpersonal skills, and academic skills. Self-care skills include sound health and nutrition practices, the importance of exercise, understanding the financial system, managing time, managing life-stress, and learning how to comfort oneself in personally difficult times. Interpersonal skills refer to an ability to interact well with others and include being able to identify our feeling states correctly, having empathy for others, expressing our needs tactfully, sharing with others, grieving, and using verbal-conflict resolution skills to solve interpersonal problem