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Abstract
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VioLit summary:
OBJECTIVE:
The purpose of this article by Brunsletter et al. was to research the violence literature as well as assess the clinical significance of violence for individual patients and its treatment and management in a hospital atmosphere.
METHODOLOGY:
The authors followed a non-experimental design in which past research on adolescent violence was reviewed and clinical case studies of four violent adolescents were examined. The four adolescent patients were selected for discussion based on their participation in group violence. The discussion was presented in the form of a roundtable in which the three authors discussed different aspects of their study.
FINDINGS/DISCUSSION:
Initially, the authors noted that given the backgrounds of most of their adolescent patients, it was surprising that violent behavior was not more common amongst them. Nonetheless, patients inflicted pain upon themselves and others. Yet it was an incident of group violence involving the four adolescents which led the authors to reexamine the treatment milieu. The authors described each of the patient case histories in order to determine common characteristics which might have led each to violence. Besides their all being male, some of the patients had neurological abnormalities, seizure disorders, and childhood head injuries. In addition, some of the patients had come from neglectful or abusive homes, had experienced the loss of a major object before the age of ten and was blamed for it, and finally, one of the patients was a heavy drug user. The authors discussed several antecedents to adolescent violence drawing on the backgrounds of the four sample youths. Early childhood traumas or losses were said to be precursors to later anger and its associated actions. The correlation between violence and gender was discussed but findings have been inconclusive. The authors also evaluated the somewhat more controversial association between temporal lobe epilepsy and excessive violence. Family violence as a predictor of later violence and delinquency was said to be consistently shown in the research. Finally, the authors emphasized the importance of discovering whether there was an abusive role model in a violent child's past in order to determine future behavior.
Next, the authors discussed the therapeutic environment in which the adolescent patients were being treated. One of the five functions of the therapeutic environment was said to be containment (the others being support, structure, involvement and validation) of violence. The authors argued that patients sometimes get caught up in a conflict which isn't necessarily theirs because of an inability to differentiate their own personality structure. Traumatically overstimulating a patient with intense nurturing feelings was also said to increase the likelihood of violence in some situations. Likewise, violence in the units normally escalates from verbal violence to damage to property to physical assault on another person. The authors concluded by observing that hospital riots are often proceeded by periods of tension between staff and patients.
AUTHORS' RECOMMENDATIONS:
In light of the authors' findings regarding the progression of violence from verbal violence to physical assault, the authors made several recommendations. First, unit staff skills should be developed such that they permit the early recognition of impending breakdowns and loss of control before the patient actually becomes violent. Staff training and expertise are therefore very important for effective intervention. The aim of violence intervention in a therapeutic environment should be not simply to control the patient but also to aid the adolescent in regaining and utilizing his/her own self-control. Various interventions were suggested from talking with the patient to using restraints or seclusion. Finally, the authors described a treatment strategy entitled dynamic homeostasis in which open communication between patients and staff is encouraged to produce an atmosphere of optimism and security.
EVALUATION:
The authors present an insightful discussion of precursors to adolescent aggression and the dynamics of violence in hospital therapeutic units. The presentation is both clearly written and well organized. Future research and intervention strategies would be well informed by the present study. (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)
KW - Treatment Program
KW - Violence Treatment
KW - Mental Health Institution
KW - Mental Health Treatment
KW - Mental Illness
KW - Juvenile Violence
KW - Juvenile Offender
KW - Offender Treatment
KW - Group Violence
KW - Offender Characteristics
KW - Violence Causes
KW - Case Studies
KW - Male Offender
KW - Male Violence
KW - Juvenile Male
KW - Hospital Violence |