violence


The answer is no, it isn’t. Please stay home.

Don’t get me wrong. I don’t think that getting sick is that big of a deal. I can handle the discomfort of a flu, and so can you. But if I had a choice between you punching me in the face and you giving me a flu, I would prefer the punch as long as you didn’t break anything.

Why is the relatively mild punch to the face clearly unethical and going to work sick is not? It’s because when it comes to getting sick, we suffer from magical thinking.  When it comes to mysterious misfortunes, we tend to rely on magic potions, magic words, magic thoughts, or magic feathers. If punches to the face were a mysterious misfortune that struck with no clear puncher or intended punchee, we would probably have a whole range of face-punch invulnerability talismans, herbs, and spells. And going to work when you might punch someone would not seem like an ethical question.

Remember how everyone in your office got the flu this winter and it was so bad that it was funny and you sat in a meeting and sympathized with a sick colleague as they described their distress, and then later joked about how you probably got it from them? That was possible only because neither of you could see the mechanism of infection or feel the viral load enter your bloodstream when you rubbed your eye. The vivid experience of a perpetration would limit the possibility of magical thinking, and going to work sick would become an obvious ethical question.

I investigated this question as part of my Family Violence class last spring. It was one of a very long list of questions that clinicians should know about the area they work in. There are three organizations that offer some financial support in Lane County:

“Not much,” according to the woman who answered the phone at the Oregon Department of Justice, at 541-682-4523. But if the crime is a person crime, victims can get financial assistance for counseling, medical bills, rehabilitation, funeral benefits, grief counseling, and dental through the Oregon Department of Justice, after conviction.

Victim Services Program of Lane County, part of the Department of District of Attorney, does not have financial resources for crime victims but they do provide advocacy that can result in restitution in court.

Department of Human Services

[This copied directly from the DHS website.] Financial assistance to persons fleeing domestic violence or a person trying to stay safe from domestic violence whose safety is at risk because of domestic violence or the threat of domestic violence. The person must also fit the following criteria:

  • Be a parent or relative caring for a minor child or a pregnant woman
  • Meet the income criteria for the program. (This program looks only at income on hand that is available to meet any emergency needs.)
  • Be a resident of Oregon.

The program provides temporary financial help to support families whose safety is at risk due to domestic violence. Most often this is when the domestic violence survivor and the children are fleeing domestic violence or at risk of returning to an abusive situation.

The program can help with up to $1200.00 over a 90 day eligibility period. Payments are given directly to the landlord or other service provider.

  • The program can help with housing related payments when there is or has been a domestic violence situation. (including deposits, rents and utilities)
  • Relocation costs. (including moving costs and other travel costs)
  • Replacement of personal or household items left behind when the victim and children have fled if items are not available from another source. (clothing, hygiene items, essential furniture items)
  • Purchase of items that help address safety. (including new locks, motion detectors, P.O. Boxes)

Another unfortunately common situation I will have to assess for in the families I see (in addition to drug & alcohol abuse, domestic violence and many other things) is sexual or physical abuse. One of my texts (Patterson’s Essential Skills in Family Therapy: From the First Interview to Termination) estimates that 1 in 5 women and 1 in 9 men were sexually abused as kids. My other practicum text, Brock & Barnard’s Procedures in Marriage and Family Therapy, gives this list of indicators of abuse(p. 52):

The presence of an alcoholic parent

The family with poor mother-daughter connections/bonds

A mother who is very dependent either psychologically or physically as the result of illness or accident

A father who appears to be very controlling and possessive of his daughter(s)

An acting-out adolescent girl engaging in sexual promiscuity or suicidal gestures who is a frequent runaway or drug abuser

A child who appears to be very overresponsible and parentified in the family context

This is another DSM-IV-TR Mental Disorder diagnosis that is commonly given to children. The DSM says that its prevelence has been increasing for a few decades now and that up to 10% of kids, mostly boys in “urban settings”, have it. It’s a pretty serious label to give a kid. It’s linked with suicide, homicide, various criminal acts, and is thought of as a precursor to Antisocial Personality Disorder. Here are the criteria, quoted word-for-word from the DSM-IV-TR (pp. 98-99):

Diagnostic criteria for Conduct Disorder

A. A repetitive and persistent pattern of behavior in which the basioc rights of others or major age-appropriate societal norms or rules are violated, as manifested by the presence of three (or more) of the following criteria in the past 12 months, with at least one criterion present in the past 6 months.

Aggression to people and animals

(1) often bullies, threatens, or intimidates others

(2) often initiates physical fights

(3) has used a weapon that can cause serious physical harm to others (e.g., a bat, brick, broken bottle, knife, gun)

(4) has been physically cruel to people

(5) has been physically cruel to animals

(6) has stolen while confronting a victim (e.g., mugging, purse snatching, extortion, armed robbery)

(7) has forced someone into sexual activity

Destruction of property

(8) has deliberately engaged in fire setting with the intention of causing serious damage

(9) has deliberately destroyed others’ property (other than by fire setting)

Deceitfulness or theft

(10) has broken into someone else’s house, building, or car

(11) often lies to obtain goods or favors or to avoid obligations (i.e., “cons” others)

(12) has stolen items of nontrivial value without confronting a victim (e.g., shoplifting, but without breaking and entering; forgery)

Serious violations of rules

(13) often stays out at night despite parental prohibitions, beginning before age 13 years

(14) has run away from home overnight at least twice while living in parental or parental surrogate (or once without returning for a lengthy period)

(15) is often truant from school, beginning before age 13 years

B. The disturbance in behavior causes clinically significant impairment in social, academic, or occupational functioning.

C. If the individual is age 18 years or older, criteria are not met for Antisocial Personality Disorder.

Code based on age at onset:

312.81 Conduct Disorder, Childhood-Onset Type: onset of at least one criterion characteristic of Conduct Disorder prior to age 10 years

312.82 Conduct Disorder, Adolescent-Onset Type: absence of any criteria characteristic of Conduct Disorder prior to age 10 years

312.89 Donduct Disorder, Unspecified Onset: age at onset is not known

Specify severity:

Mild: few if any conduct problems in excess of those required to make the diagnosis and conduct problems cause only minor harm to others

Moderate: number of conduct problems and effect on other intermediate between “mild” and “severe”

Severe: many conduct problems in excess of those required in excess of those required to make the diagnosis or conduct problems cause considerable harm to others

Elizabeth Gilbert, in her book about marriage, Commitment, lays out her interpretation of a Rutgers report on divorce statistics. Here’s her list of things that correlate with divorce, in the order she mentions them. She lays them out with a lot more subtlety, humor, and personality, but read the book if you want that.

Your parents are divorced

You are alcoholic

You are mentally ill

You cheat on your spouse

You gamble compulsively

You are violent

You are younger than 25

You have not gone to college (especially the woman)

You have children

You lived with your spouse before marriage

You have different racial backgrounds

You are different ages

You have different religions

You have different ethnic backgrounds

You have different cultural backgrounds

You have different careers

You don’t know your neighbors

You don’t belong to social clubs

You don’t live near your families

You are not religious

The man does not do housework

I read the following, by Steven Wolin, in Froma Walsh’s Spiritual Resources in Family Therapy, and it brought tears to my eyes. The “DSM” he mentions is the Diagnostic and Statistical Manual of Mental Disorders, the medical-style Bible of human psychological problems:

“Now, the DSM-IV was written by people , many of them psychologists, who have figured out every conceivable thing that can go wrong with us, which is very impressive. But I would like to suggest that it’s fundamentally, unintentionally, and insidiously violent to name someone by what’s wrong with them.”

I underlined that quote and thought I’d want to write something about it here. In class that week, it became clear that just about every other person in my cohort had underlined the same passage. We have all just taken a class on DSM diagnosis, because we will have to do it, out there in the world. Insurance companies won’t pay for problems that don’t have medical-sounding names. Major depressive disorder? Here, have some money. Isolated from any kind of supportive community, except for your mom, who you can’t stand for some reason? Hey, get a real problem, preferably one that we have a pill for.

Anyway, I think we all underlined that passage in part because it was so refreshing, after thinking so much about diagnostic categories. It’s also because that quote captures the spirit of the Couples and Family Therapy program we are in, and we were selected by our faculty because quotes like that would resonate with us. It’s also because it’s so dang true. When you hear how many mental health professionals talk about their clients, it can be awful. “I’ve got a Borderline at five o’clock,” as if what really matters about that human being is that their behavior fits the diagnostic criteria for Borderline Personality Disorder.

Or one in four, if you prefer a less “conservative” definition of rape.

I learned this in my training for the University of Oregon Crisis Hotline. It makes me sick. The statistics are from the US Department of Justice. Here are three others, from the USDJ as reported in my training manual:

80-90% of these rape victims know the perpetrator.

Though it meets the legal definition (basically, forced sexual intercourse, vaginal, anal, or oral, with a body part or object, though it varies some by state) half of rape survivors do not label their experience rape.

Less than 5% of rapes are reported.

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