Understanding Violence

February is here and almost over. We look forward to spring and give thanks that our winter has been quite mild. February is also American Heart Month and a time to fight cardiovascular disease. Heart disease including stroke is the leading cause of death for men and women in the U.S., claiming 865,000 American lives every year. We urge you to celebrate American Heart Month by committing to eating a healthy diet and exercising regularly. Don’t smoke and limit how much alcohol you drink. Monitor your blood pressure, test your cholesterol levels, and keep your weight within a healthy range.

In this February E-letter, we present information about Understanding Violence, Our Ask the Doc question is about the death of a best friend, and our email of the month is about 15 things you should give up to be happy. We hope you find the enclosed information helpful. As always, we appreciate your questions and feedback.

Testings. If you are concerned about your child’s school placement for the next school year, this would be a good time to have them evaluated. Recent questions from parents have ranged from should their child be retained to whether they are gifted to whether they have a disability that can qualify for accommodations at school. Our practice does different types of evaluations to help answer those questions and information about these evaluations can be found on our website. If you have more specific questions, please contact Dr. Kimmel who would be happy to answer them.

Parent Education and Family Stabilization Course. We have been certified by the Department of Children and Families, State of Florida, to offer the Parent Education and Family Stabilization Course. Sometimes referred to as the Divorce Class, this 4 hour class is state mandated for divorcing parents of involved children. This course is intended to teach parents about the effects divorce has on children, to lessen the impact of difficult transitions, and to improve the ways they communicate with each other and their children. Our course is provided live and in small groups. Please contact our office at 954 755-2885 for further information.

Low cost counseling: Denise Champagne, M.S., is offering low cost counseling as a mental health intern. She is currently seeing patients and is available to take on new patients. This allows those individuals who cannot afford treatment to obtain it and allows her to get the required training. If you or someone you know is in need of counseling but just cannot afford it, please call the office and ask for Denise. All treatment provided by Denise will be reviewed and supervised by Dr. Kimmel.

Qualified Supervisor. Dr. Joel Kimmel has been certified by the State of Florida to supervise mental health counselors seeking supervision to meet the licensing requirements. If you or anyone you know needs a qualified supervisor to meet these requirements, contact Dr. Kimmel for further information.

Our E-Letter this month focuses on violence, understanding the different types, and ultimately how we can prevent it. The World Health Organization defines violence as the intentional use of physical force or power against a person, group, or community that results in injury, death, psychological harm, impaired development or deprivation. More than 1½ million people die annually all over the globe from violence and for each death, there are hundreds of visits to the hospital and thousands of doctor’s appointments. There are 3 recognized types of violence: self-directed, interpersonal, and collective.

Self-directed violence is violence turned against oneself. It includes suicidal behavior and self-abuse including acts of self-mutilation. Interpersonal violence includes intimate partner violence and community violence. In the former, violence occurs between family members and intimate partners and usually occurs in the home. In the latter, violence occurs between people who are unrelated and takes place outside the home. Collective violence includes social, political, and economic violence. Social violence occurs to advance a social agenda and includes hate crimes and terrorist incidents. Political violence includes war and state violence. Economic violence includes violence committed by groups for economic gain.  It includes violence by groups bent on disrupting economic activity and creating economic division and fragmentation.

Genocide occurs when specific groups are dehumanized so that they are viewed as being less than human. When this occurs, others can kill them without guilt as they don’t perceive that they are killing humans. Rather, they are eradicating vermin. This happened to the Jews during the Holocaust, to the Chinese during the Rape of Nanking by the Japanese, to the Cambodians under Pol Pot, in Darfur, etc.

People can also become violent to keep their power and control when faced with losing it. Others become violent when they don’t have the power or control and feel that they are entitled to take things by force if they can’t get it any other way. There are strong correlations between violence and poverty, income inequality, gender inequality, and alcohol abuse. People often become violent when they are humiliated, bullied, made fun of, or marginalized, They feel shame and can react with revenge against those who shamed them.

Traditionally, our inhibitions and fear of consequences have kept our violent tendencies under control. But in our ever-changing world, many people have an absence of safe trusting relationships. They feel that our governments are corrupt and cannot be counted on to provide justice. They often don’t feel safe and protected. Add to this the constant news coverage of violent events, violence on television and in the movies, violence in sports, and violence in videogames. We have become desensitized to a great deal of violence and tolerate a lot of it including the scapegoating of others.

But violence can be reduced and prevented. What is needed is for people to connect with and respect others so that they care about them. It is important to have empathy and understanding. Problem solving skills and non-violent means of conflict resolution should be taught in schools as a required course. Safe and trusting relationships need to be developed between children and caregivers so that they grow up with a sense of love and caring. Social, emotional, and behavioral competencies need to be developed so that people can deal with situations that do not go their way without becoming violent. Excessive alcohol use should be frowned upon and there should be more treatment programs for alcoholics. And societal values and expectations that support and tolerate violence should be changed to promoting equality and respect for all.

We offer the following information on Understanding Violence:

• Violence is responsible for 1.5 million deaths annually around the globe; just over 50% due to suicide, 35% due to homicide, and just over 12% due to war or conflict
• It is recognized that for every death, there are thousands of medical and ER visits
• Violence is defined as the intentional use of force or power against a person, group, or community that either results in or has a high likeliness of resulting in injury, death, psychological harm, impaired development or deprivation
• The “use of force or power” includes neglect, physical, sexual, and psychological abuse, suicide and self-abusive behaviors
• Self-directed violence includes suicidal acts, thoughts, and attempts, and self-abuse such as self-mutilation
• Family and intimate partner violence usually occurs within the home and includes child abuse, elderly abuse, and spousal abuse
• Community violence occurs among unrelated people and is usually outside the home and includes sexual assault, school and workplace bullying, and random violence
• Social collective violence advances a social agenda such as mob violence, crimes of hate by organized groups, and terrorist acts
• Political violence includes war, conflicts, and government violence
• Economic violence includes attacks by groups motivated for economic gain
• People often become violent when they feel shame, that is when they are humiliated, put down, made fun of or ignored, and react with revenge against those who shamed them
• People also become violent to keep their power and control when faced with the possibility of losing it
• People also become violent when they don’t have the power or control and feel entitled to take things by force if they can’t get it any other way
• Traditionally, our inhibitions and fear of consequences keeps our violent tendencies under control
• Genocide occurs when people are dehumanized to the point that they are seen as less than humans or subhuman and therefore can be destroyed without fear or guilt
• There are strong correlations between violence and poverty, income inequality, gender inequality, alcohol abuse, and the absence of safe trusting relationships

To Prevent Violence:

• Teach problem solving skills and non-violent means of conflict resolution
• Develop safe, trusting and nurturing relationships between children and caregivers
• Develop social, emotional and behavioral competencies for people to deal with life’s conflicts and frustrations
• Reduce availability of alcohol and increase treatment programs for problem drinkers
• Reduce easy access to firearms and other weapons
• Promote equality and respect for people of different ethnicities and gender
• Change societal values that support violence such as in the media and videogames
• Establish environments where expectations include non-violent behaviors
• Seek professional help if you have difficulty managing your temper or violent behaviors

R.S. writes: My best friend recently passed and I just can’t seem to get over the grief I feel. I knew him for 62 years and we had a lot of fun times together. Fortunately, he didn’t suffer but I feel like a large part of my life is missing. Other friends have passed on but nothing has affected me like this. Any suggestions how I can get over this depression I feel?

Dr. Joel Kimmel replies: Facing the death of a loved one is always difficult even if it does end the suffering from a terrible disease. You seem to have some experience with death as you have lost others and you probably know that your depressed mood is normal. Yet you are concerned about how intensely it is affecting you. I suspect that there may be some personal component to your grieving. The loss of your best friend means that you have lost a part of your history. You have lost someone who knows you like no one else does. You’ve lost that special relationship that only you and he shared. And you can never have it again. This loss is deeply profound. A part of you has died with your friend.

Your friend’s passing may make you sense your own mortality and that what happened to him can happen to you. Our society does not educate or prepare us for the inevitable for all of us. Our society’s focus is on youth and staying young. We shudder to think about our own death. Yet, ironically, if we were prepared we could handle it better. Have you thought about your own death and what that would mean? Have you done all you want to do and said all you want to say? Do you feel you are missing something from life?

Life is a journey and death is a destination. What truly matters is how you lived your life. In my opinion, your depression remains because you haven’t fully accepted that your friend has passed and that one day you will too. Once you have accepted that death is a fact of life and that you have lived your life in full, you will not fear death and accept the loss of your friend.

We would like to thank L.S.for sending us the following email:

15 Things You Should Give Up To Be Happy

1. Give up your need to always be right
2. Give up your need for control
3. Give up on blame
4. Give up your self-defeating self-talk
5. Give up your limiting beliefs
6. Give up complaining
7. Give up the luxury of criticism
8. Give up your need to impress others
9. Give up your resistance to change
10. Give up labels
11. Give up on your fears
12. Give up your excuses
13. Give up the past
14. Give up attachment
15. Give up living your life to other people’s expectations