Another Origin of Violence

I’m writing in response to an article in the April 1 issue of Psychiatric News regarding the “origins of violent behavior” and featuring James Merikangas, M.D., who has served as a consulting neuropsychiatrist in more than 100 death penalty cases.

There was an extensive review of factors that Dr. Merikangas considers in forming his opinions—factors with which we are familiar or that make sense to us intuitively. There are thorough medical, neurological, and psychiatric evaluations; there is a remarkable array of lab tests, scans, and other procedures.

Years ago at an APA Annual Meeting, I attended a workshop on the predictors of violence. The main presenter was Renée Binder, M.D., now APA’s outgoing president.

To me, such sessions are a good investment of time if you take home one important point, one “pearl” that stays with you. That certainly happened in this instance. Dr. Binder went through the predictors that we know or would guess—history of violence, presence of psychosis, and so on—and along the way discussed one that had not occurred to me: perceiving oneself as a victim. Not only did I take that home with me, but it’s like a song I can’t get out of my head. I hear it playing everywhere there is violence.

Consider the spectacular, American-style killings that happen so often. (Remember that a man may lose his job or his wife or flunk out of school for good reason, but that’s not the point. It’s how he perceives it that matters here.) Consider everything from road rage and barroom brawls to terrorism and war. Consider gangs.

I wrote on this subject for California Psychiatrist, and before submitting it for publication, I asked Dr. Binder for references or anything she might add. She was very helpful and generous with her time. She said that her awareness of this point came not from a particular study or studies, but from her cumulative experience as a forensic psychiatrist.

I realize that a “predictor” is not the same as an “origin,” the latter referring to a contributing cause, while the former may be just a correlate. Things like scars, chronic subdurals, and jail terms may be more a result of a violent tendency than its cause. It is important to make this distinction. Nonetheless, as I see it, a perception of victimhood is a contributing cause of violence, and thus should be listed with “origins.” 

Walter T. Haessler, M.D. (Temecula, Calif.) ■