Page 16
psychosis may strike out at an intimate partner. Sometimes that violence gets identified as domestic violence. An assessment will distinguish illness based violence from learning-based violence. With illness-based violence, there is usually no selection of a particular victim (whoever is present when the short circuit occurs will get attacked: health care provider, family member, friend, stranger, etc.). However, with learning-based violence, the perpetrator directs his abusive conduct toward a particular person or persons. In addition, with illness-based violence there is usually a constellation of other clear symptoms of a disease process. For example, with an organic brain disease, there are changes in speech, gait, or physical coordination. With an illness such as psychosis there are multiple symptoms of the psychotic process (e.g., “He attacked her because she is a CIA agent sent by the Pope to spy on him using the TV monitor”). Poor recall of the event alone is not an indicator of illness-based violence (see Section III. B. 2. of this chapter on perpetrator minimization and denial). With illness-based violence the acts are strongly associated with the progression of a disease (e.g., the patient showed no prior acts of violence or abuse in the 20-year marriage until other symptoms of the organic process had appeared). There has been no systematic research to determine the percentage of cases identified by police or courts as domestic violence that are attributable to illness. In a clinical sample of those individuals identified by community police and courts and referred to a medical center as domestic violence perpetrators, less than 5% were violent as a result of an organic process (Ganley, 1995). More research is needed on this issue. Illness-based violence can be most effectively managed by appropriate medical or mental health interventions and case management (e.g., instituting day treatment programs, appropriate medications, respite care, institutionalization when necessary). While attention must be given to the safety of the victims in such cases, it is more appropriately dealt with by those knowledgeable about the particular illness. While the victim may benefit from UNDERSTANDING DOMESTIC VIOLENCE 27 emergency shelter services and safety planning, the perpetrator of illness-based violence would not benefit from specialized domestic violence interventions. E. Domestic Violence Is Not Caused by Alcohol or Other Drugs Many people use or abuse drugs without ever battering their partners. Alcohol and other drugs such as marijuana, depressants, anti-depressants, or antianxiety drugs do not cause individuals to become violent. Although alcohol and drugs may be used as the excuse for the battering, research indicates that the complex pattern of coercive behaviors which comprise domestic violence is not caused by consuming particular chemicals (Critchlow, 1986; Taylor & Leonard, 1983; Pihl & Smith, 1988, Gondolf & Foster, 1991). Some people who consume alcohol or drugs are violent with or without the chemical in their bodies. An addict’s violence may be part of a lifestyle where everything, including family life, is orchestrated around the acquisition and consumption of the drug. Other addicts are so focused on their addiction that they withdraw from relationships and do not engage in any controlling behavior directed at family members. On the other hand, there is conflicting evidence whether certain drugs (e.g., steroids, PCP, speed, cocaine or cocaine’s derivative, “crack”) chemically react within the brain to cause violent behavior or whether they induce paranoia or psychosis, which is then sometimes accompanied by violent behaviors. Further research is needed to explore the cause and-effect relationship between those particular drugs and violence. While research studies cited above have found high correlations between aggression and the consumption of various substances, there is no data clearly proving a cause and-effect relationship. There are a wide variety of explanations for these high correlations. Some say that alcohol and drugs provide a disinhibiting effect which gives the individual permission to do things that they otherwise would not do. Others point to the increased irritability or hostility