Nel's New Day

October 3, 2014

Stop Gun Violence by Diagnosing IED

Whenever the NRA and the gun manufactures face the threat of gun restriction laws after a major event, they claim that it’s not the fault of the guns. If the government did something about the mentally ill, the whole problem would be solved. But who are the mentally ill and what can be done.

Laura L. Hayes wrote about her experiences working with the mentally ill thirty years ago. She described “one sweet, diminutive, elderly patient” who stabbed a person in a supermarket. At her commitment hearing, the patient explained that she had been hearing voices that told her not to hurt the man in front of her in line.  Yet she had become so angry because he had over 10 items in the express lane that she couldn’t keep from stabbing him. In the hospital, her medications stabilized her, but at home she didn’t take them.

The stabbing didn’t come from mental illness. It was from the inability to control anger. Violence comes from people who lack the skills to manage their anger, and most homicides are committed by people who have a history of violence. A summary of studies on murder and prior record of violence show that between 80 and 90 percent of murders had prior police records as compared to 15 percent of the general population. A study of domestic murders shows that 46 percent of the perpetrators had a restraining order against them when they killed the person or persons. Family murders are preceded by prior domestic violence more than 90 percent of the time.

Paolo del Vecchio of the federal Substance Abuse and Mental Health Services Administration has said that only five percent of violence comes from people with mental illness. Seena Fazel’s 2009 study shows a slightly higher rate of violent crime by schizophrenics but almost entirely from alcohol and drug abuse. The MacArthur Violence Risk Assessment Study found that mentally ill people with no substance abuse problem are no more violent than other people in their community.

Anger comes from the primal fight-or-flight response. People stop thinking and react as if their lives depend on their actions. Fighting was useful for survival in our ancestors’ times, but it has become a problem in our current complex world. The angrier one is, the less one can think clearly. The abilities to negotiate, find a new perspective, or handle provocation disappear.  The lack of those abilities transfers responses to repressed rage with no acceptable outlet. It usually comes from backgrounds in which adults repress anger or intimidate in a violent manner.

The anger culture in the country has developed into growing mass murder as well as violence toward children and spouses, rape, road rage, assault, and violent robberies. People who have intermittent explosive disorder (IED) tend to have been exposed to patterns of IED, often by parents who cannot control their anger. The disorder affects up to 5 percent of adults, or about 16 million Americans. The first episode of rage may occur in adolescence, about age 13 for males and age 19 for females.

People can be trained to balance the initial fight-or-flight response with the nervous system that returns the ability to reason. Some techniques include deep breathing, relaxation techniques, identification of warning cues, and listening skills that shift a person from emotional to more objective thinking.

One technique that has proved useful is mindfulness training. The incorporation of deep breathing, heightened attention to the internal state, and the acceptance of internal discomfort can reduce anxiety, depression, and stress. The goal is to observe thoughts without identifying with and acting on them. Dialectical behavior therapy incorporates these skills with instruction in distress tolerance, emotional regulation, and interpersonal effectiveness.

IED doesn’t stand alone; it can lead to depression, anxiety, and alcohol or drug-abuse as well as coronary heart disease, hypertension, stroke, diabetes, arthritis, ulcers, headaches, and chronic pain.

IED may be diagnosed with blood tests. Two inflammation markers have been found in people diagnosed with IED but not in people with good mental health or other mental heal disorders. IED may initially be viewed as merely bad behavior, but “it has strong genetic and biomedical underpinnings,” according to Emil Coccaro, chairman of the Department of Psychiatry and Behavioral Neuroscience at the University of Chicago. About his study, he said, “This is a serious mental health condition that can and should be treated.”

The two markers of inflammation are C-reactive protein (CRP) and interleukin-6 (IL-6). The liver produces CRP in response to an infection or injury to focus the immune system on dead or damaged cells. White blood cells secrete IL-6 to stimulate immune responses such as fever and inflammation as well as increasing production of CRP.

The study shows that “medications that reduce inflammation may also drive down aggression,” Coccaro said in a news release. Anti-inflammatories such as Celebrex, or even aspirin, might make a difference for those with IED. People with a biochemical and genetic predisposition for IED, at the drop of a pin could benefit from looking into treatment.

Diagnosis of IED includes a feeling of tremendous tension before the outburst, including tremors and head pressure, followed by a sense of relief. Afterwards, people feel their outbursts are justified but still suffer embarrassment and regret. Criteria evidencing IED are several anger-driven episodes showing failure to resist aggression and intentional destruction of property or assault on others or themselves. The violence is out of proportion to the stress.

IED affects more men than women and can be a particular problem in school. Children have negative feelings toward others, probably because of harsh punishments from parents, and believe that people are out to get them. Their way to protect themselves is through violence. Frequent discipline because of aggressive acts increases frustrations.

Adult IED sufferers’ inability to interact in social and professional environments leads to divorce and job loss which causes financial and legal problems. Road rage causes car accidents and, more and more commonly, assaults on other drivers.

A recent study of the military has discovered that almost 25 percent of almost 5,500 active-duty, non-deployed Army soldiers suffer from some form of behavioral disorders. About 80 percent of these (ADHD, IED, and substance abuse) existed before enlistment. IED is six times as high among soldiers as civilians.

The military largely depends on candidates to disclose their mental wellbeing histories. Between that system and the culture that does not see anger as a major problem, the violence will continue. The NRA and gun manufacturers refuse to recognize any problems in a person with IED carrying a loaded gun.

Perhaps the new discovery that IED may be caused by a physical condition can help identify people who are dangers to themselves and others. We need to address IED as a public health issue to reduce suicides and murders.


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