(abstract)                         George B. Palermo

The biblical story of Cain and Abel and other several violence facts featuring the history of humanity corroborates the thesis according to which the violence and the victimization have belonged to the collective life since the most ancient times. Today, the violence in our society, in the streets, houses, and sometimes in workplaces, has remarkably increased. Anyhow, to understand it in depth, it is required to frame the social violence into particular and cyclic situations, as Giambattista Vico described clearly. Violence is often a manifestation of frustration and hostility, due to the discontent about the kind of life one leads. Today, in the west world, the cultural environment is highly technologic and the social-economic systems trend to manipulate the members of the society, even if in a not visible way. The prevailing utilitarian philosophy has reduced man to a being whose behaviours can be foretold, manipulated and controlled. Values that have been transmitted along ages have going on disappearing more and more and the principle of authority has been mined all levels. The family, on its side - even trying to adapt itself to the new technologic discovers and cultural deformations - often is unable to transmit those traditional values of honesty and responsibility so important to form a citizen. It must not minimize, analysing the causes of certain phenomena, the extent of social and economic factors as the unemployment, the scarce educational opportunities, the research of a fast solution to problems throughout drugs. Besides that, during the past tens of years, a false “psychologism” has provided confused interpretation of the reality, making instead more complex the interpersonal relationships. Progressively the paternal figure has lost authoritativeness, and this event, along with the increasing absence of the mother, has generated in young, and specially in the very young, a certain disillusion towards life, mainly regarding its social aspect. The diffusion of ways of indifference and apathy (not only among young) goes with the dependence from social prototypes symbolizing the social success. At the same time rebel and destructive behaviour has rooted, reaching the social and familiar level: and young killing parents are ever more, parents kill sons (and vice versa), tortures and sexual violence against women and children within families have increased. Adolescents and adults use easily firearms and it increases brutal murders leaving the body horribly mutilated. Faith and religion have been object of critics and contempt. Their positive and beneficial influence over the society in general, over individuals and families has been mined for years. In this context of total desecration promoted by sociologists, psychologists and mass media, having the religious authorities themselves not succeeded in keeping still the moral principles and becoming supporters of social claiming more than spiritual values. In this situation of confusion, the creative omnipotence of man has attempted to replace God. But these omnipotence reveals its weakness by the inability to control aggressiveness by the omnipotent man, aggressiveness that the ethic and moral values have been able to canalize in the past. Man seems to have lost the ability to control himself and has produced another social disease he does not succeed in struggling and defeating: drug and alcohol addiction, bringing all the imaginable consequences as marginalization, little and organized crime and mental disease. 

Owning up? 

Must psychiatrists feel guilty for this state of things? With the coming on of the psychoanalysis, the west world has picked up theories and behaviours schemes that, even if interesting and having a practice aspect, do not exhaust surely the complexity of the human nature and of life itself, and even less of psychical disturbs. Receipting these schemes, many psychiatrists have lost the whole vision of man and that human approach required by the therapeutic work. They have became technicians and their behaviours have became permissive, deceiving themselves to help their own patients, softening the instincts of hostility and anger. At the same time they failed in judging impartially both the interpersonal relationships and the psychic and social homeostasis of their patients and their family life. Psychiatry has ended up by justifying rebel behaviours, setting with that thinking school according to which the society is the prime cause of everyone's problem, forgetting that society is not an abstract entity but it's formed by individuals. This accusation against society and authority brought to unrestrained impulsiveness, resentments, hostility and hate, social demonstrations not only abroad but also within families, destroying its relatively harmonic condition. Manifestations of hostility in our towns against the constituted authority, mindless that "natura non facit saltum"; an ever well grounded maxim along centuries. Any therapeutic direction turned to human problems must be holistic. Man is composed by body, mind, psyche, spirituality and he is placed in an environment. Psychiatry must not be only a specialist technique, but it must base over a wide humanistic acknowledgement including psychology, philosophy , sociology, religion and, why not?, common sense. That would minimise the influence of the prejudicial therapeutic directions and would aid psychiatrists to appreciate the patient as a whole put into an environment he only participates to. Psychiatrists, by the means of therapy, must be able to help patients, going with them toward the solution of problems, without interfering their values, both religious and human. Unfortunately psychiatrists are their turn men and as everybody reflect social values of the age they live.  

Crime 

The violent and crime behaviour has reached very high levels, mainly in the United States, often in the lead as regard to good and bad things. It seems it is statically proved that crime develops in a special way among those living in want, but it is diffusing ever more among persons belonging to the middle class and also high class. In the United States the number of murders is higher in the ghettos peopled by ethnical minorities and where drugs rage. The sizeable part of crimes is perpetrated by Afro-Americans. Many crimes are committed within families: the 45% of murders in USA are the result of home violence and within home, boys learn their parents' and other cohabitants' violent behaviours. The very young live in a violence and fear climate, in sadomasochism and aggressiveness most times they undergo. This environment influences them and brings them a deep uncertainty and to school and interpersonal relationships troubles. It makes them unable to get and to keep a job, prevents them from forming a family and taking the adult life responsibilities. A progressive marginalization demotivates them and makes them unable to become productive members of the society. Their dehumanization, their depersonalization, their aggressiveness and their manipulating passiveness sometimes burst into the worst kind of crime. So there are the most unthinkable crimes - and not only those committed by the so called serial killer - for example the crimes due to the sudden appearing of a mad killer making a massacre. Ever more frequent is the case of an exploding violence and it is wondered about. Maybe are the makers of this violence persons unable to accept a dehumanizating role within society? Often, persons using and misusing drugs and alcohol and undergoing the psychic troubles already mentioned perpetrate these acts of violence. Is this the consequence of having grown up without the paternal figure in a society where one feels rejected? In this confused society, it appears ever more the figure of the lascivious paedophile sexually imposing upon children that are sometimes object of pornographic pictures. Often these children disappear. In the United States nearly from 5 to 6.000 persons, children and not, every year are reported as missed and maybe a good percentage has been victim of unknown crimes. Crime is anywhere, without any doubt: there's no social class having the exclusive and none that can boast of being free from crime. A research carried out over one hundred prisoners in an American jails has revealed that criminals ascribe their behaviour to the disintegration of family and the lack of a paternal figure. It seems indeed that our society is becoming a society of fatherless sons. Anyhow, it lacks not only the father in many families, but also the mother, who, for social and economical factors, is often out of home and is compelled to leave sons alone or care of strangers. It comes out a real inability to settle a normal relationship with others. In the United States, at June 30th 1994, 484.000 adults, nearly one out of 398 USA inhabitants, peopled the towns' prisons. The state and federal prison population, instead, has been evaluated round 992.000 prisoners at the end of 1994. The number of crimes in the United States is about many millions per year, and every year enter and leave prisons nearly 2.000.000 persons. The total number of under crime guard persons was nearly 5.100.000 in 1994. Even if the number of murders in the United States seems to be decreasing, until 1995 it has been nearly 30.000 per year. It is interesting to notice that the suicide number is higher than murders one by some thousands. It's very  probable that both murders and suicides reflect the aggressiveness- directed to or others or to oneself - due to destructive hostility conditions or despair due to a serious social trouble. Marginalization, alienation, dissolution of ties, unemployment, the cancer of drugs and alcohol are all factors fostering and producing those existential and psychological nature troubles many American citizens live with. The young crime has become a drama for the United States society and constitutes a real moral dilemma even for judges. Crimes committed by very young are often for no reason and deeply destructive, and so the deliveries of courts seem an accusation toward society. There's no justification for this kind of young crime; it is simply inconceivable. It must not be made a plain psychology saying that the  

Bureau of Justice Statistics  National Crime Victimization Survey crime trends, 1973-1997 and midyear 1998  1973-1991 data adjusted to make data comparable to data after the redesign  Homicide data were calculated from the FBI's Supplementary Homicide Reports  Adjusted victimization rates  Number of victimizations per 1,000 population age 12 and over  Total Aggravated Simple  violent Murder Rape Robbery assault assault  Year crime  1973 47.7 0.1 2.5 6.7 12.5 25.9  1974 48.0 0.1 2.6 7.2 12.9 25.3  1975 48.4 0.1 2.4 6.8 11.9 27.2  1976 48.0 0.1 2.2 6.5 12.2 27.0  1977 50.4 0.1 2.3 6.2 12.4 29.4  1978 50.6 0.1 2.6 5.9 12.0 30.0  1979 51.7 0.1 2.8 6.3 12.3 30.3  1980 49.4 0.1 2.5 6.6 11.4 28.8  1981 52.3 0.1 2.5 7.4 12.0 30.3  1982 50.7 0.1 2.1 7.1 11.5 29.8  1983 46.5 0.1 2.1 6.0 9.9 28.3  1984 46.4 0.1 2.5 5.8 10.8 27.2  1985 45.2 0.1 1.9 5.1 10.3 27.9  1986 42.0 0.1 1.7 5.1 9.8 25.3  1987 44.0 0.1 2.0 5.3 10.0 26.7  1988 44.1 0.1 1.7 5.3 10.8 26.3  1989 43.3 0.1 1.8 5.4 10.3 25.8  1990 44.1 0.1 1.7 5.7 9.8 26.9  1991 48.8 0.1 2.2 5.9 9.9 30.6  1992 47.9 0.1 1.8 6.1 11.1 28.9  1993 49.1 0.1 1.6 6.0 12.0 29.4  1994 51.2 0.1 1.4 6.3 11.9 31.5  1995 46.1 0.1 1.2 5.4 9.5 29.9  1996 41.6 0.1 0.9 5.2 8.8 26.6  1997 38.8 0.1 0.9 4.3 8.6 24.9  Mid1998 36.7 0.1 0.8 4.2 8.0 23.6    Note: Estimates for 1993 to 1997 are based on collection year while   earlier estimates are based on data year. Estimates for 1998 are for   the 12 months ending June 30, 1998.

violence of these persons is the reaction against the possible violence of others, putting into act an unconscious identification with the presumed or real aggressor. Most of these young criminals live in piteous conditions; nevertheless it does not justify their antisocial behaviour. It concerns young that sometimes, under the effect of drugs or alcohol, suffer auditory hallucinations: God's voice or Satan's one appears in their confusional state, focalizing maybe the everlasting problem of all societies and men: the struggle between the good and the evil. Anyhow, only seldom such subjects seem to express a real interest toward God. Surely, religious dictates lack in their life, and the sizeable part of them has not the less spirituality or any link with any creed. Their life seems to have not any purpose. Many of them can be rehabilitated, and specially if concerning the very young, their crimes can be prevented. How may a single's problem be compared with a whole society? Society as well as individuals passes through development cycles. As in the former there are welfare and rebirth periods alternating depression and obscurantism ones, so in an individual there are emotional states and several behaviours alternating. As Dante found himself in the dark forest, symbol of depression, losing his way, so many people of our society seem to have lost their way. Many persons seem to find themselves in a dark forest, confused by social, cultural and ethical problems, while impulses foster destructive and antisocial behaviours. Let's remind us that Dante believed that reasonableness, acknowledgement and experience could help the search for truth, provided that supported by love. This must be the basis of an attempt of social re-education. 

The task of psychiatry 

How can psychiatry help to struggle crime? Psychiatrists have sometimes appointed their own prime role professionals having not very often the required diagnostic and therapeutic acknowledgements. Psychiatrists instead must try to resume the role they used to have. They must leave the laissez-faire behaviour, the relativist theories that had contributed to nullify human values and that have risen secularized religions. They must not set with that concept of human pseudo-omnipotence making nothing but increasing the unsuitability and despair feeling. Psychiatrists could be of great help with their therapeutic technique, their empathy, their comprehension, and the moral support of patients if they sometimes could succeed in not diminishing the importance of the ethical, moral and religious values the patients themselves can express in meetings. Overall, in the therapeutic meetings, they must make patients responsible. From experience I can assert that it concerns a hard work, but if motivated by that “caritas” that must be the basis of any therapy and by the sense of responsibility toward individuals and community, can give positive results. Psychiatry must look at man into his whole and give space to spirituality. Too much often we forget that the ills of the spirit causes also psychical troubles. A lot can be done and it must be done to prevent violence. The sole police forces cannot give a suitable solution; indeed the prevention of violence requires not only an enduring and long-term engagement, but also a multidisciplinary problem approach, involving several professionals. Psychiatry must be present within this social reply against crime and it must give its contribution. Indeed, Psychiatry must participate actively to individualize the potentially violent persons, giving an essential contribution to prevention. While it's hard to prevent certain individual's violence as it is for the serial killers (generally coming not into contact with psychiatrists before seizure and so being hard to individuate), for the majority of criminals - adolescents with behavioural disorders, frustrated girls, plurimurderers borderlines or depressed suicidal, or only depressed persons - a lot can be done, not only trying to relieve their existential despair, but also curing their psychopathology and putting under control their aggressiveness. It's important to try to intervene, school level and in workplaces. That involves different professions competent persons' collaboration. The psychological troubles start soon in life, it has been conjectured that they start in the uterus, but it is sure they arise during childhood. There are cross moments during growth when hostility, aggressiveness and violence are more present and it can take place an emotional and behavioural bursting. Since the antisocial behaviours is much more frequent from the sixteen up to nearly the thirty-four, and it's often anticipated by an escalation of rebellion during childhood and adolescence, Psychiatrists must try to individuate the violent traces of the rebel child, in the antagonist adolescent, in the persons committing the first antisocial acts, and also in the apathetic, withdrawn and secluded persons. In the legal field, psychiatrists must keep impartial and they must not become partisan at the utmost of their appraisals, specially if regarding crime responsibility. Psychiatrists must attend to the prisoners' situation in jails, try to organize or participate to group therapies so to put under control the prisoner's hostility, they must hold educational courses about anxiety or depression manifestation or other psychological diseases, educational courses or group therapies so to minimize and to control one's own aggressiveness, institute groups of reflection and meditation. They can't do without discussing with prisoners about the consequences, sometimes disastrous of owing firearms. In the United States, firearms represent the second cause of death and are responsible of the 72% of murders in the 10-14 years old class. Obviously, the responsible of prisons must try to institute wide psychiatric services, a kind of mini-department of mental health for prisoners, and to develop rehabilitation programs. But, overall, psychiatrists must devote themselves to cure deviant persons and the possible psychic problems featuring their background, even if it does not concern manifestly a mentally disease. 

Conclusions 

It's ever more clear the role psychiatrists could practice within society, opposing those theories proceeding from superficial analysis carried out by analysts and sociologists, that had contributed so much to create a society as the one we live in. A society that must recover (even it can seem provoking) those taboos teaching how to reach in the adolescent phase the self-control. 

George B. Palermo, 

M. D. Professore di Clinica Psichiatrica e Neurologica 

Medical College of Wisconsin