Tag Archives: aggression

Responding to violence in U.S. hospitals

By Kevin R. Betts

For several years, I worked at a psychiatric hospital as a mental health technician. For the most part, I found this job to be very fulfilling. Watching patients who arrived in disarray leave feeling content left me feeling that what I was doing was worthwhile, and the occasional thank you card or call from a previous patient didn’t hurt either. However, there were certainly challenges inherent to this job. One such challenge concerned how best to react to patients who became angry or aggressive. When confronted by such a patient, a common response among the staff was to corral other staff members in an attempt to intimidate the patient into submission. In contrast to staff expectations, however, these attempts were often met by the patient with obstinance, and they sometimes even appeared to encourage further aggressive behaviors.

The media has recently given increased attention to violence in U.S. hospitals like that captured in my account above. Events such as the recent shooting at John Hopkins Hospital in Baltimore, as well as a recent Joint Commission report about increasing rates of violence in hospital emergency rooms, has earned the attention of health care workers and the general public alike. Unfortunately, one thing that can be gathered from these reports and my account above is that most hospital staff members receive only limited training in how to respond to angry or aggressive patients.

Research on the interindividual-intergroup discontinuity informs us that corralling other staff members to confront an angry patient who is alone, as often occurred at my workplace, will likely be ineffective in reducing that patient’s anger or aggression. The interindividual-intergroup discontinuity suggests that interactions between groups, or between groups and individuals, will be more competitive and aggressive than interactions between individuals alone (Meier, Hinsz, & Heimerdinger, 2007). There are three mechanisms that are believed to be responsible for this effect. One mechanism suggests that we fear and distrust other groups more than other individuals. A second mechanism suggests that group members can provide social support for antisocial actions, whereas individuals cannot. The third mechanism concerns identifiability, meaning that our (antisocial) actions are more identifiable when we act alone than when we act in a group. What is the implication of this research for health care workers? When it can be safely done, angry or aggressive patients should be confronted one-on-one.

Read more:

Violence in U.S. hospitals (CNN)

Violence on the rise in U.S. health care centers (Businessweek)

Meier, B.P., Hinsz, V.B., & Heimerdinger, S.R. (2007). A framework for explaining aggression involving groups. Social and Personality Psychology Compass, 1, 298-312.

View other posts by Kevin R. Betts

The Moral Universe of Role Players in Genocide

Just after the Rwanda genocide broke out in 1994, white expatriates were speedily evacuated from the place. Adam Jones (2006) wrote of a video record at the Caraes psychiatric Hospital in Ndera Kigali showing white individuals being evacuated while Hutus were almost outside the gates, and the Tutsis begged the military men for protection. One soldier yelled, “Solve your problems yourselves!”

The UN Genocide Convention has defined genocide as “acts committed with the intent to destroy in part or whole a national, ethnic racial or religious group as such.” Staub (2000) provides the social context which makes genocide of one group by another likely—difficult life conditions and group conflict. Cultural differences also come to play such as blind respect for authority, inflexible stratification within classes, and a history of devaluation in a group.

Not all members of the dominant group become perpetrators. There were the ‘ordinary Germans’ who did nothing while the Holocaust happened, while there were also countless Germans who defied authority and managed to rescue Jewish families in peril. In a genocide setting, there are the perpetrators, bystanders and rescuers. These categories can also be fluid, as noted by Monroe, when constant bystanders turn into rescuers, or when perpetrators who have engaged in massacres, rescue an individual from the other group. Monroe defines six critical aspects gathered from summaries of reports of these three groups which play a part in the role a group or individual makes: self image, personal suffering, identity, relational identity, integration of values with the individual’s sense of self, and a cognitive classification of the other. Perpetrators may perceive of themselves as victims and justify causing harm to the other group. Bystanders and perpetrators may hold greater value for community, and authority, rather than self-assertion. Personal suffering may also cause a group or an individual to empathize with the aggrieved group, but it may also heighten fear and defensiveness. While cultural and social aspects are important in determining attitudes and behavior, self images can also determine if people will act or remain passive in the face of genocide. Individuals who feel they have control over the situation may be forced to do something about it, as opposed to bystanders who, even if they also empathize with the aggrieved group, may feel helpless over the situation.

Jones A. (2006). Genocide: A Comprehensive Introduction

Monroe K. R. (2008). Cracking the Code of Genocide: The Moral Psychology of Rescuers, Bystanders, and Nazis during the Holocaust

Staub, E. (2000). Genocide and Mass Killing: Origins, Prevention, Healing and Reconciliation

Photo: “#46/365” by Leonie, c/o Flickr. Some Rights Reserved

Guns and aggression

By, Adam K. Fetterman
A Supreme Court decision once again sparks debate of gun control. The Court decided that citizens have the right to keep guns in all states and cities in the United States challenging some strict gun bans, like those in the Chicago area, according to the Associated Press. Guns are one of the hot-button issues that always seem to lead to great division. Some proponents argue that it is their right to own and carry guns and therefore, want to exercise that right, while others proclaim they want guns for fear of victimization. Opponents of guns argue that guns cause more harm than good and sometimes fear the people that want guns for protection.

While there are some anecdotal instances when citizens carrying guns have resulted in positive outcomes, these are quite rare. However, there has been research on the negative effects of guns. For example, Klinesmith, Kasser, and McAndrew (2006) found that interacting with guns led to increases in testosterone and aggressive behavior in males. While the aggressive behavior in the experiment, adding hot-sauce to a cup of water, is not all that reflective of real-world aggression, the effects show some increase in the willingness to harm others. There are probably not many people that would promote getting rid of guns altogether, however, some questions need to be further researched. For instance, should states and cities be able to ban guns if the area is deemed particularly aggressive? What type of people cause a threat to safety if they have access to guns? And on the other side, what are the benefits to the presence of guns?

Justices extend gun owner rights nationwide, by Mark Sherman – Associated Press

Klinesmith et al. (2006). Guns, Testosterone, and Aggression: An Experimental Test of a Mediational Hypothesis. Psychological Science, 17, 568-571.

Does isolation reduce violent behavior among psychiatric inpatients?

By Kevin R. Betts

The Joint Commission, an independent health care oversight group, recently expressed alarm over violence in U.S. hospitals. Russell L. Colling, a consultant who advised the Joint Commission said, “The reality is, there is violence every day in the emergency department.” On inpatient units in psychiatric hospitals, violent behavior among patients is often met with forced isolation. A primary goal of isolating these patients is to ensure their safety, as well as that of other patients and staff. However, isolation is also thought by many to act as a deterrent for potential future acts of violence. Having been directly involved in this process as a mental health technician, I often pondered the effectiveness of isolation as a way to combat violent behavior among patients.

Perhaps counterintuitively, research on social ostracism suggests that isolation may promote later aggressive acts (Williams, 2007). In order to understand why this may be the case, imagine yourself in the position of a patient involuntarily committed to an inpatient unit at a local psychiatric hospital. Disagreeing with your involuntary admission, you verbally express your anger to the staff. Told that you may not leave, you become even angrier, perhaps trying to access locked doors. You feel an utter lack of control over your situation. Making matters worse, the staff expresses concern that you may become violent as a result of your distress and “for your safety,” escorts you to a locked room so that “you may reflect on your acting out behavior.” You are in isolation. Your anger further increases and you find yourself behaving in ways you could not previously imagine, yelling “let me out” and banging on the only door in a windowless room. You think to yourself, “They will regret this once they let me out of here.” What you (and many other patients placed in similar situations) are experiencing is an impaired sense of belonging, self-esteem, control, and meaningful existence―direct consequences associated with social ostracism (Williams, 2007). In the eyes of an isolated patient, these needs may wrongly be perceived as restorable through aggressive means.

If isolation can promote violent behavior, what should be done to combat violence among distressed psychiatric inpatients? Solutions that prevent violent behavior in the first place may be most successful. Listening to patient complaints in a timely manner is essential. Empathizing with these complaints, helping patients manage their distress, and ensuring patients that their distress is temporary should also be effective.

Read more:

http://www.businessweek.com/lifestyle/content/healthday/639936.htmlViolence on the rise at U.S. health care centers (Businessweek)

http://www3.interscience.wiley.com/journal/120185263/abstractWilliams, K.D. (2007). Ostracism: The kiss of social death. Social and Personality Psychology Compass, 1, 236-347.

View other posts by Kevin R. Betts

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Mock Mission to Mars Pushes the Limits of Human Isolation and Olfactory Sensation

A joint effort by the Russian Space Institute and the European Space Agency to simulate the lonely and potentially brutish reality of extended space travel to Mars began last Thursday as six researchers were sealed inside a windowless cylindrical chamber, which will be their home for the next year and a half.  The all-male crew consists of three Russians, a Frenchman, a Chinaman and an Italian-Colombian, who will conduct regular space operations including scientific experiments and facility maintenance. The researchers’ only link to the outside world is via an Internet connection to mission control with regular disruptions and a 20-minute delay.

These men must truly have “the right stuff” to consider such a mission. Try to imagine, if you will, what it would be like to be trapped in a small space with five other guys for over 500 days. The smell alone could be enough to deter most people. I would imagine that by the end of the mission, the stench in that place would be similar to the Men’s room after the Super Bowl—foul. Still, the smell of six men may be the least of their problems, if not a catalyst for other, more potentially dangerous and psychotic episodes. According to Harris (1989; citing Kanas, 1987) with lengthy isolation come many potential interpersonal dangers including fits of rage, crew-members vying for dominance, deviance and a deterioration of group cohesion. To deal with these potential problems, they better have true grit, a strong desire not to kill each other, and lots of potpourri and Lysol to cover that not-so-fresh odor.

520-day Mars Mission Simulation in Russia Begins

Harris, P. R. (1989). Behavioral science space contributions. Behavioral Science, 34, 207-227.