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Abstract
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VioLit summary:
OBJECTIVE:
The aim of this paper by Bach-Y-Rita et al. was to present the findings from a study of violent psychiatric patients and their backgrounds.
METHODOLOGY:
The authors employed a non-experimental exploratory design with a non-probability sample of 130 violent patients initially seen in psychiatric emergency rooms - 106 from the Massachusetts General Hospital and 24 from the Boston City Hospital. The sample consisted of those individuals who engaged in episodic violence which was characterized by a loss of control and which included a physical attack upon another person with intent to harm or to destroy property. The age of the sample ranged from 16 to 60 years, with only 13 women in the group. Only voluntary patients were studied, and schizophrenics and those who were so violent that they required immediate hospitalization were excluded. Psychiatric histories were taken via interview, and neurological, sleep EEG and genetic studies were conducted when indicated. Specific symptomatology and behavior that consistently appeared in the histories were included for systematic questioning at a later point in the study, so frequencies for these items should be considered as lower than they would probably have actually been. Data on each patient were collected over a series of visits and consultations, and some family members and spouses were interviewed at a later stage in the study. Patients were then categorized according to the source of their violent episodes, in an attempt to understand the causes of their violent behavior.
FINDINGS/DISCUSSION:
The authors categorized their patients on the basis of chief complaint. Group 1 consisted of 7 patients who presented with a prior diagnosis of temporal lobe epilepsy, and who had been referred to the emergency ward. The second group contained 30 patients who suffered from outbursts that resembled seizures, during which time the patient lost contact with the environment and experienced amnesia, dizziness and altered states of consciousness. The largest group was the third, with 57 patients reporting high levels of anxiety and violent outbursts that were aimed at a variety of targets, ranging from walls and furniture to other people or themselves. Group 4 had 25 individuals who were categorized as suffering from pathological intoxication - people who would have a few drinks and then lose all control and become violent and psychotic, whilst remembering nothing of the incident. The final group consisted of 11 people who exhibited repeated violence aimed at a specific person. Most of the patients had a history of childhood deprivation and social maladjustment in the form of work and family instability, and many held lower middle class jobs. the home situations of the patients were usually emotionally impoverished, and alcohol played a major role in the daily routine of many; 72 of the 130 reported using alcohol prior to their violent episodes, and 12 reported chronic amphetamine use. These histories of loss of control resulted in problems holding jobs, family disruption and contact with the law for criminal behavior. 66 of the sample had been arrested for criminal charges, including 8 people for homicide and 6 for armed robbery, with many reporting multiple arrests. Many of the subjects had previously sought professional help for their problems, but this usually did not provide any solutions. 65 had been hospitalized in psychiatric facilities before, and 77 had voluntarily participated in outpatient psychiatric services; 53 had attempted suicide during a violent episode, usually when a victim of their outbursts could not be found. In relation to use of weapons, guns were not the primary source; rather, 47 of 65 questioned on the subject reported having used their automobiles as outlets for their aggressive feelings or as a weapon of self-destruction. Turning to family background. the authors found that 40 had come from families in which violence was a prominent part of life, and 42 had a parent who was either an alcoholic, had a psychiatric illness or was absent from the family. Examining medical histories later in the study, the authors questioned 50 patients and found that 29 had a history of childhood hyperactivity, and 72 had been unconscious due to illness or injury. 41 reported sexual difficulties such as impotence, abstinence or hypersexuality, and 16 had adult homosexual relations. The episodes of violence exhibited by the subjects lasted form between fifteen minutes to two hours, with the subject ending up exhausted and often sleeping. Of the 79 patients who received EEG examinations, 37 showed abnormalities, whilst of the 43 patients who had undergone psychological testing, 12 had IQ scores below normal. The patients were found generally to be males with poor masculine identity, who were very dependent upon a female figure who was considered in a mothering role. A sense of being useless and impotent and unable to effect the environment in which they lived was often a precursor to a violent episode. The authors concluded that the problems of many of the patients could have been the result of minimal brain damage during childhood. They also believed that the most effective management tool was simple physician attention, and that reduction of the frequency of violent outbursts could be achieved via a decrease in chronic and acute anxiety.
AUTHORS' RECOMMENDATIONS:
The authors suggested that such patients should not be treated with drugs alone, as it was often the interaction between the patient and the environment that caused affective changes and loss of control leading to violence.
EVALUATION:
The authors present an interesting examination of a number of their violent patients. Whilst the total sample size is fairly good, the inconsistent collection of data and the inclusion of only some of the patients and their families in all the measurements suggests that the results be interpreted with some caution. A more thorough discussion of the implications of the findings would have been useful, as would have a more detailed examination of the measures and of the findings. (CSPV Abstract - Copyright © 1992-2007 by the Center for the Study and Prevention of Violence, Institute of Behavioral Science, Regents of the University of Colorado)
N1 - Call Number: F-212, AB-212
KW - Massachusetts
KW - Adult Offender
KW - Adult Violence
KW - Juvenile Offender
KW - Juvenile Violence
KW - Mental Health Institution
KW - Mental Illness
KW - Violence Causes
Language: en |