Recognizing and preventing the health effects of violence

Exposure to violence leads to multiple types of mental and behavioral disorders :depression, post-traumatic stress disorder, anxiety, sleep and eating disorders, substance abuse and suicide attempts. Adults who experienced childhood trauma struggle with stress due to finances, family and jobs. Abused children often  commit crime as adults.

I read the newspaper article in disbelief, then grief; a family of five, parents and three children, murdered in their home in my community. Even more shocking, the assailants were their other two teen-aged children!

Things like this just don’t happen here, a suburban city that is quiet, peaceful and secure. Statistically, one of the safest cities in our state and even the country. But that doesn’t make us immune- violence can happen anywhere to anybody.

“siblings charged with first-degree murder in stabbings of family members”

I  know. Two of my husband’s relatives were murdered. One of them survived multiple wounds from a vicious assault, only to die from a second attack.  The other one died from an in-home attack, a case that is still open and cold- the killer has never been arrested and brought to justice.

I served as the doctor at a summer camp for children in foster care . Almost all had suffered physical abuse .

“Mother accepts plea deal, prison time for committing child neglect, abuse “

What is interpersonal violence?

The World Health Organization defines interpersonal violence as

“the intentional use of physical force or power, threatened or actual, against another person, group or community that results in or has a high likelihood of resulting in injury, death, psychological harm, maldevelopment, or deprivation.”

The major agencies that track statistics on interpersonal violence, call it

  • “a pervasive public health, social and developmental threat.”
  • “a leading cause of death, particularly in children, adolescents and young adults.”

“Reporter, photographer  shot and killed during live report”

Did you know that exposure to violence can

  • Cause immediate physical wounds and
  • Result in long-lasting mental and physical health conditions?

Violence matters because it 

  • Directly affects health care cost and payments
  • Indirectly stunts economic development
  • Increases inequality
  • Erodes human capital

Violence causes physical injuries many of which are fatal or leave permanent disability. Other results include sexually transmitted infections, including HIV, and unintended pregnancy and pregnancy complications.

“Elderly woman beaten to death by two people she lived with. “

Medical effects of violence

Violence contributes to several chronic medical conditions   although the exact relationship is not  clear.  These include heart disease, cancer, chronic lung disease (possibly due to smoking), diabetes, alcohol abuse and obesity.

“Rape charges filed against man accused of attacking pregnant woman “

Mental and emotional effects of violence

Exposure to violence leads to multiple types of mental and behavioral disorders :depression, post-traumatic stress disorder, anxiety, sleep and eating disorders, substance abuse and suicide attempts. Adults who experienced childhood trauma struggle with stress due to finances, family and jobs. Abused children often  commit crime as adults.

“Teen suspected in violent crime spree arrested”

Our health care system encourages prevention, but tends to focus on the prevention of cancers, heart disease, infectious disease and dementia.

But given the far reaching consequences of interpersonal violence,preventing the resulting health problems is just as important. The  multiple factors that contribute to violence makes that a daunting task.

Violence is  a public health, social and political problem. Physicians, mental health professionals, teachers, and law enforcement deal with the effects in the course of our work every day.

Opportunities for prevention

The article concludes with a summary of “opportunities for prevention.” The emphasis is on starting in childhood to address the factors than can lead to violence and to focus on the family unit and schools.

What can we do to prevent violence ?

  1. Early childhood visitation
  2. Parenting training
  3. School-based social-emotional learning approach
  4. Early childhood education , Head Start as an example
  5. Public policy; for  example , addressing laws related to alcohol sales, since alcohol consumption is associated with violence
  6. Therapeutic approaches , including CBT- cognitive behavioral therapy

“Mothers band together to protect Chicago neighborhood”

 

Read a  true story about surviving violence

( this is an affiliate link; at no extra cost to you, this blog may receive a commission if you buy through this link; thanks.)

The Rising -Murder, Heartbreak, and the Power of Human Resilience in an American Town 

by Ryan D’Agostino

The astonishing story of one man’s recovery in the face of traumatic loss—and a powerful meditation on the resilience of the soul


On July 23, 2007, Dr. William Petit suffered an unimaginable horror: Armed strangers broke into his suburban Connecticut home in the middle of the night, bludgeoned him nearly to death, tortured and killed his wife and two daughters, and set their house on fire. He miraculously survived, and yet living through those horrific hours was only the beginning of his ordeal.

Broken and defeated, Bill was forced to confront a question of ultimate consequence: How does a person find the strength to start over and live again after confronting the darkest of nightmares?

In The Rising, acclaimed journalist Ryan D’Agostino takes us into Bill Petit’s world, using unprecedented access to Bill and his family and friends to craft a startling, inspiring portrait of human strength and endurance.

To understand what produces a man capable of surviving the worst, D’Agostino digs deep into Bill’s all-American upbringing, and in the process tells a remarkable story of not just a man’s life, but of a community’s power to shape that life through its embrace of loyalty and self-sacrifice as its most important values. Following Bill through the hardest days—through the desperate times in the aftermath of the attack and the harrowing trials of the two men responsible for it—The Rising offers hope that we can find a way back to ourselves, even when all seems lost.

Today, Bill Petit has remarried. He and his wife have a baby boy. The very existence of this new family defies rational expectation, and yet it confirms our persistent, if often unspoken, belief that we are greater than what befalls us, and that if we know where to look for strength in trying times, we will always find it.

Bill’s story, told as never before in The Rising, is by turns compelling and uplifting, an affirmation of the inexhaustible power of the human spirit.

reprinted from a Goodreads review

Exploring the HEART of understanding and preventing the health effects of violence

All the quotes about violent crimes that I used in this post I found in recent news headlines. They are all from true events.

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How to survive an active shooter

Shootings in the United States have resulted in numerous casualties across diverse demographics. An active shooter poses a significant threat, necessitating preparedness. The recommended response includes three strategies: RUN to safety, HIDE if escape is impossible, and FIGHT as a last resort. Prioritizing personal and collective safety is crucial.

Aletha Cress Oglesby, M.D.'s avatar by Aletha Cress Oglesby, M.D.

How do you want to die?

If, like me, you don’t listen to rap often, you may need to watch this video more than once to get the message. Dr. Zubin Damania, aka ZDoggMD, is a “physician, off-white rapper, and purveyor of the finest medical satire.” In this video and others he uses unconventional means to educate and inform about important health issues. This video caught my attention and I hope it does yours also.

We, meaning doctors and patients, care much about how we live, but often give little attention to how we die. But death, after birth, is the single thing we all share as humans. Still, we live like it’s not going to happen, or act surprised when it does.

 

Fewer than 10% of persons with sudden cardiac arrest survive.
Fewer than 10% of persons with sudden cardiac arrest survive.
Death should never be welcome, and it will never be easy, but sometimes it is more horrible than it has to be because no one planned for it. No one asked the hard questions-

“What if you are diagnosed with a terminal illness?”

“What if you can no longer swallow or eat on your own?”

“What if you cannot breath unassisted?”

“What if you are no longer competent to make your own medical decisions?”

 

End of life planning is not synonymous with ending care or euthanasia. It is about providing comfort, controlling pain and other symptoms and supporting family. It’s about deciding ahead of time how you want to spend the last few months, weeks, days or hours of your life.

End of life care is often provided through hospice services. 

No matter how young or old you are ,it is important to consider these things, because unexpected illness and injury can happen to anyone. There are two things to do-

 

Talk- to your family about what you want. If you  already have a life threatening condition, talk to your doctors.

Write- down what you want. This is usually in the form of an advanced directive, living will or medical power of attorney. You can learn how to do this here.

 

“Advance directives are discussions or written statements which convey a person’s wishes to his or her family and physician in the event that he or she becomes unable to discuss such matters. They may

1. explain the individual’s values about health, life and death;

2. give directions to family and physician about treatment goals or the use or non-use of specific treatment modalities; or

3.  designate a surrogate to make decisions on behalf of the individual.

After completing an advance directive, the individual should discuss its content and meaning with his or her family, surrogate, and physician. Individuals should review their advance directives periodically to assure that they accurately reflect their current values and wishes.”(CMDA Ethics Statement)

My husband and I  have advance directives,and we discuss our wishes with each other periodically to confirm what our current  plans are. We both prefer to forgo aggressive treatments which are likely to be futile, but you may feel differently; it is important for your family to know.

 

 

 

It is also important to understand what your physician thinks and believes about end of life care, and how those beliefs affect one’s medical practice. Ideally, you and your doctor will agree on expectations and if not, it may be best to seek care elsewhere.

 

“Clinicians should examine carefully the verbal and written wishes expressed by their patients. They should be willing to follow these wishes provided they do not conflict with the clinician’s personal moral or religious values. If such a conflict exists, the clinician should discuss it with the patient and transfer care if the conflict cannot be resolved. ” (CMDA Ethics Statement)

 

 

“It always seems too soon until it’s too late. Talk about your end of life wishes now with those you love.” ZDoggMD

 

For further reading-

 How Doctors Die

Advance Directives and Do Not Resuscitate Orders.

 

“The End-of-Life Handbook” A Compassionate Guide to Connecting with and Caring for a Dying Loved One

(an affiliate link which pays this blog a commission for your purchase; thanks)

“This book address both the emotional and psychological issues associated with death and dying and the practical and medical realities typically dealt with at this time-unusual among titles in this subject area.

The authors, a psychologist and medical doctor, are passionate advocates for quality end-of-life care. Author Feldman’s background in positive psychology brings an emphasis on hope, inspiration, meaning, and human connection at the end of life to the book.

As medical technology progresses and life expectancies edge upward, families are being faced with ever-more-complicated choices as loved ones approach their final hours. This book offers readers much-needed guidance and support for making these often difficult decisions.”