The underlying causal mechanisms of violence are operational in childhood (Schore, in Siegel and Solomon, 2003). An increasing body of evidence shows that traumatic childhood experiences are at the root of adult violence. When there are violent offenders still in their first decade it tells us that we must look even earlier for the causal roots – to the very beginning of life.
Most traumatised and emotionally neglected children do not turn into violent criminals or sociopaths (Schore, in Siegel and Solomon, 2003). The presence of positive relationships (with a teacher, grandparent, someone in the community) can protect against these outcomes. Those who lack this may seek to connect through destructive or disturbed relationships. Even a single, attuned positive relationship can turn someone away from this trajectory towards a sociopathic or borderline personality. Treatment and intervention needs to begin much earlier in life in order to protect against violence. This should happen in pregnancy and continue through the prenatal and postnatal period of the brain growth spurt in the first two years of life. This involves establishing ‘standardised, reliable diagnostic protocols’ that identify maternal and infant risk factors and dyads that experience strong and prolonged negative affect (p.146). These should also take gender into account.
Berry Brazelton suggests that the inability to regulate strong emotions is at the root of violence (Schore, 2003). Therefore, the developing right brain regulatory and coping capacities need to be assessed. Classifications of disorganised/ disorientated infants need to be made well before 12 months and these infants need to be followed throughout infancy as they are high risk. Harsh touch in infancy is linked with later aggressive behaviour, so early tactile experiences with low-birth weight children need to be evaluated. Screenings for dissociation and withdrawal and low resting heart rate are essential too in these high risk infants.
A “neurobiologically oriented diagnostic programme” should include “infant right frontal EEG risk markers” (Schore, 2003, p.147). It is known that right frontal system is central in mobilising and adaptive stress response so right hemispheric dysfunction combined with early abuse creates a predisposition towards violence. Neuroimaging investigations of limbic structures (orbitofrontal, cingulate, insula, amygdala) during critical periods in attachment stress and resting states would give a good picture of neurobiological development. Video assessments of the infant capacity for recognising positive and negative visual and auditory expressions need to measure the autonomic response of the infant to the mother’s face in the first year and the infant’s own face in the second year. Assessments that measure brain, behavioural and bodily changes in the dyad will provide information on the right brain regulatory functions that can guide clinical intervention.
Interventions that seek to ameliorate the impact of relational trauma should seek to improve psychobiological communications within the ‘bodily-based’ attachment relationship and aim to optimise the limbic-autonomic circuits and right prefrontal systems involved in affect regulation (Schore, 2003). Treatment programmes that interrupt the intergenerational transmission of traumatic abuse and neglect alter a growth-inhibiting environment that generates negative affect and frequent aggression dysregulation which would reduce the prevalence of personality disorders that are a high risk for violence. Home visitations should be part of these programmes. Infant mental health workers are developing interventions that alter the regulatory capacities needed for effective parenting which improves the attachment experiences and psychobiological development of infants at risk. These programmes transform insecure attachment patterns into secure ones which facilitates that development of the right brain and regulatory ability which enables the person to cope with stress and manage aggression. This effort should be multidisciplinary including developmental researchers working with social workers, child psychologist and psychiatrists, paediatrics and other professions.
The mental health field needs to move from later intervention to early prevention in order to deal with the problem of violence in society (Schore, 2003). ‘Ghosts from the nursery’ erupt in tragic violent encounters at later stages of development. These ‘ghosts from the nursery’ are “enduring right brain imprints of the nonconscious intergenerational transmission of relational trauma” (p.149). Practical solutions must involve providing optimal socio-emotional environments for larger numbers of infants.
Prevention activities aim at three goals: to deter problems that are predictable; to protect existing health; and to promote desired life goals (Bloom, 2018). Offenders are high risk groups that need better treatment. Current prison environments increase rather than decrease violence and histories of child abuse are particularly high in prison populations. Successful use of therapeutic community models have been carried out in prisons. Communities need to become better at spotting ‘trouble in the making’ so that we can intervene before it gets out of control.
Secondary prevention interventions focus on groups that are very high risk, like families that have been victimised, poor and single-parent families that lack social support or are very stressed (Bloom, 2018). Programmes need to be created to deal with children who have witnessed violence, domestic violence in particular, to prevent them following the same path. Healthcare and social care workers need to be trained to assess and intervene in situations where violence has occurred. Properly trained school staff can be central in setting up intervention programmes with at risk children.
Primary prevention refers to the development of ‘social immunity’ in increasing resistance at various social levels to violent perpetration (Bloom, 2018). Primary prevention of violence requires an active imagination in which we develop our visionary capacity. In such a society, family life would be very different: Children would be raised in communities and it would be the shared responsibility of everyone, as would taking care of other vulnerable people. Parenting would be widely shared, it would be open, not private, which limits the possibility of abuse and providing children with many options to create healthy attachments. A shared parenting model would reduce the burden on parents. Schools would be integrated with the rest of the working community and children would learn emotional and relational skills, working together to solve complex problems. The media would educate the public about everything they need to know to create safe and healthy living environments.
Dr. Penelope Leach notes that we still believe children ‘belong’ to parents and that children are each person’s private business (Karr-Morse and Wiley, 1997). More mobility means less extended families and more parents working means children have less contact with adults. Dr Kathryn Barnard writes that how people raise their children is not just a matter for the family but for all of society and so as a society we must accept responsibility for how all children are raised. Communities must support the collective need of parents.
Knowledge of trauma and attachment overturns many of our ideas about human nature and development (Bloom, 2018). Labelling people as ‘deviant’ places the problem in the individual while ignoring the causes which is dismissed as ‘making excuses’. Trauma theory challenges this because it places the aetiology of most mental health and criminal problems in the social environment. It moves from an illness model to an injury one.
As we gain more understanding that early exposure to violence may permanently damage development, what responsibility does society have for preventing that in the first place? (Bloom, 2018). Judith Herman argues that recognising and understanding the impact of violence on humans is dependent upon a social movement.
Joseph Foderaro (Bloom, 2018) writes that all efforts to prevent violence will fail without changing the social environment that breed violence: Poverty, racism, domestic violence, war, child abuse and neglect. All our cultural systems are infiltrated with this virus of violence to such an extent that we now mistake the virus for the cells – just the way we are. The cure lies in prevention – stopping the intergenerational transmission of pain and hatred.
Blocks to prevention and the limitations of programmes
Efforts to prevent violence generally involve generating lists of effective programmes and distributing information on them in order to mobilise public support – but this strategy has been ineffective in the political arena (Karr-Morse and Wiley, 1997). The best policies and programmes are often fighting to stay alive. Primary prevention programmes struggle to continue to receive funding and are vulnerable to cuts. We wait for top-down solutions but these are often not forthcoming. Until there exists an informed public that insists on change, babies will continue to suffer. Bruce Perry writes that no set of intervention strategies will solve transgenerational problems. To solve the problem of violence we need to transform our culture. We need to change our child-rearing practices and the ‘destructive’ view that children are the property of parents. This involves a revivification of the concept of community and its importance for our survival.