Understanding and Preventing Violence, Volume 2: Biobehavioral Influences (1994)
Chapter: Treatment of Violence - A Commentary
use of neurosurgical treatment for violence thus leads to a set of complex and controversial issues. Some of these issues are discussed in the volume edited by Valenstein (1980).
The last study in this category is the report of a single psychosurgery case seen by one of the authors over a nearly 40 year follow-up period (Mirsky and Rosvold, 1990). Immediately premorbid, the patient was in her second year of medical school. After 11 years of hospitalization and treatment, the patient was considered dangerous (she was a biter) to all health care personnel. She could not be approached safely before her psychosurgical procedure(s); postoperatively, she was extremely docile. Although the violent behavior disappeared after surgery, the apparently intractable schizophrenia was the reason for the operation, not the violence. The latter had developed as a symptom sometime during the course of the progressive deterioration accompanying her 11 year schizophrenic illness. The case is of some heuristic value in that it emphasizes that violent behavior may be part of a more complex syndrome of disorder, in this case schizophrenia. The progressive deterioration was the primary reason for the radical operation(s), and the violence presumably stemmed from that circumstance. It may be that the aggressive biting was one of the few forceful means of communication left to the patient in her deteriorated state. In this sense, this case study is similar to the reports summarized in Table 1 (suggesting no close relation between schizophrenia and violence) and points to a possible interpretation of violence as a primitive, aggressive method of communication in a person with poor or absent communication skills. This theme is developed further in subsequent sections.
Treatment of Violence—A Commentary
The view that violence and aggressiveness are disorders is not one that has been accepted universally. Some authors have criticized medical, pharmacological, and surgical approaches to violence, not only as based on incomplete, if not poor, scientific evidence, but also as part of a conspiracy by those in power to suppress individual liberties, differences, or dissent. The roots of the dissent are said to stem in part from frustration over economic inequalities in society (Breggin, 1980; Chorover, 1979, 1980). Although most of the criticisms of what might be called the neurobiologic approach to human violence have centered around neurosurgical treatment of psychiatric disorders (i.e., "psychosurgery"), some have argued that the conspiracy extends to pharmacotherapy
