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Neurological factors in violent behavior (the dyscontrol syndrome).

The social, economic, and cultural contributions to intrafamilial violence are so many, and the role of personality disorders and mental illness is so obvious, that the part played by brain damage and metabolic disorders is often overlooked. This is unfortunate because the most dangerous symptom of organic disease-unpredictable attacks of uncontrollable rage in response to seemingly trivial provocation-can usually be prevented by appropriate medication, whereas it is resistant to psychotherapy (Goldstein and Huber, 1974). Explosive rage is part of the dyscontrol syndrome as defined by Mark and Ervin, 1970. It is one of the causes of wife and child battery, motiveless homicide, unprovoked assault on friends or strangers, sexual assault, dangerously aggressive driving, and senseless destruction of property. Even when the violence is only verbal, it can disrupt marriages and spoil careers, and has a harmful effect on children who are exposed to it in the home. Outbursts of violence also occur in schizophrenia, manic depressive psychosis, and the personality disorders, as an "acting out" of emotional turmoil, and it is only too easy to ascribe all such attacks to functional psychiatric disorders when in reality some of them are the result of structural or metabolic disease. Before considering the dyscontrol syndrome in detail, it may be mentioned that neurological disorders can disrupt domestic tranquility in other ways. Difficulty in thinking and communicating hinders the solution of interpersonal problems; this hindrance leads to frustration and anger-and it is easier to hit than to talk. Moreover, many brain-damaged individuals lack perception and miss the significance of the cues which are so essential to smooth social relationships-facial expressions, intonations of voice, and gestures. They often fail to perceive the frustration and anger of others, and sometimes they do not realize their own anger. A few display a perilous lack of a sense of fear. Moreover, as a result of diminished capacity for abstract thought, they often fail to foresee the ultimate results of their impulsive actions. Organic neurological disorders in the victim also playa part in intrafamilial violence. Whereas a brain-damaged child in a favorable family environment often excites almost excessive devotion from the parents, it is also, however, possible for an aggressive, destructive, hyperkinetic child to evoke antipathy and invite retaliation. This danger also applies to some epileptic children with behavioral problems and to children with learning disabilities caused by minimal brain damage. Needless to say, the interaction between a brain-damaged …