Some Perspectives on Violence and Therapy

By Dr. Art O’Connor, Consultant Forensic Psychiatrist with the Central Mental Hospital and the Eastern Health Board. His book ‘Criminals, inside the minds of criminals and victims’ is published by Marino Press, £6.99.

Violence has always been with us and seems to be an unfortunate part of our human make-up. There is nothing new about people maiming and killing each other and archaeological remains seem to support this sad reality. Many ancient skeletons have skulls with holes probably criminally inflicted for some reason. Some experts put forward the view that the killings were as a result of a robbery and others suggest sacrificial and, consequently, religious motivation.

The next constant issue about violence is that it is nearly always perpetrated by males. This is not a new piece of information and can be traced through the history of the human race. Less than five percent of violence is caused by women, but this fact is seldom referred to by commentators or writers. It seems that if men were not around in society, then violence would not exist or, at least, it would assume a minuscule profile.

Violence in War

The most monstrous expression of violence in our present, and in our history, is war. This is usually on a local and small scale internationally, but is also seen on a grand scale with world wars. Very rarely is war caused by women. War seems again to be a male phenomenon which is sometimes put down to territorial issues, racial problems, international feuding and also economics. All of these matters are male dominated preoccupations. Of course sometimes a war can be initiated and maintained simply because national leaders hate each other and want to dominate like children in a school yard, but the weapons they use are armies. Men are sent to their deaths often for some bizarre reason and their wives, mothers and daughters suffer for ever.

An interesting manifestation of human nature was witnessed in the gruesome war in Bosnia which gives insights into civilization and what is under its surface. People usually assume that violent crime is something that has always been with us, but it is really only perpetrated by a small minority. War is an exception to this, but it seems honourable, and there is morality and reasonableness about it. Bosnia and all the other involved regions were civilised areas and communities much like our own before the conflict. However, overnight, people became as barbaric and animalistic as it is possible to be. One day people were living side by side peaceably. The next day hundreds of people were being slaughtered, tortured, maimed, raped and murdered by their friends and neighbours. It was as if the gloss of civilisation was removed and the real face of our nature revealed. This sort of behaviour is not just the aberration of the criminal few, but the potential that it seems is there in all of us.

Potential for Violence

If this is the case then the idea of looking for the cause of crime or violence seems futile since it may be part of everyone. There is no cause, just as there is no cause for the majority of our actions and activities. Many are just part of normal civilised behaviour and others are concerned with our individual desires of the moment. If a person decides to go for a walk or a drive in the country, we do not spend hours of reasoning and calculation to find out why he behaves in this way because we know there is no real reason. There may be no real reason, but there is usually a decision before action.

A person decides to act in a certain way because he wants to. If he decides to rob an old person in an isolated area this is the first choice. There may be a background such as alcoholism or drug addiction, and one could argue that he has a need for money. But while everybody has a need for money, only a minority feel justified in robbing, mugging or otherwise relieving the owner of his property or money. The decision to act in a criminal way is the criminal’s own decision and it is not his addiction, education or lack of it, his parents’ shortcomings, housing difficulties or unemployment that is responsible.

Personal responsibility is an extremely important issue in any therapeutic input with offenders. Sadly, many offenders in the prison setting are never encouraged to look at their imprisonment in this way, or their offending behaviour. For many prison institutions the goal is just to encourage the offender to spend his time in the least troublesome way possible. This means with as little pain or as few problems for the institution, himself, his family and other offenders as possible. It is impossible for someone to change if they do not see that it is their own behaviour, and not society at large, that has caused them to be incarcerated. Nobody has control over their behaviour except themselves. These ideas are pretty much self evident, but sometimes carers in a custodial setting forget to get this message across. Often offenders see themselves as victims of the state and they view society as responsible. They are encouraged in this view by peers and sometimes families as well.

Influences affecting violence

Different classes of violent offending have different ranges of backgrounds and problems attached. Homicide is the most serious crime in any jurisdiction, and it is the commonest offending category associated with mental illness. Up to thirty percent of homicide perpetrators have a serious psychiatric problem at the time of the offence such as depression, and a smaller number have schizophrenia. In Ireland about one case per year is found to be guilty but insane because the jury finds that the offender did not know what he was doing at the time of the offence, did not know it was wrong or was unable to refrain from acting as he did because of the presence and influence of a ‘disease of the mind’. The mentally ill killers who do best in terms of long term outcome tend to be those who maintain their own guilt although a court has formally acquitted them.

Alcoholism is the next main influence in murder cases with over sixty percent of offenders having a serious problem. The association between alcohol and violence is very well known and is mostly related to intoxication, fights and violent tendencies coupled with diminished control. Very little useful work can be done with actively alcoholic individuals until they get the drinking problem sorted out. A proportion claim they do not remember the offending, and they seem to think that this absolves them of blame or responsibility. Of course our courts do not accept this reasoning nor do therapists within the offender environment. If the intoxication is voluntary then the consequences of that is the offender’s own responsibility. Very occasionally prolonged alcohol excess can induce mental illness but this is rare. Drug abuse is much more likely to produce mental illness problems and well known examples are Amphetamines, LSD and Marijuana. The latter is often assumed to be harmless, but prolonged use can produce severe and protracted paranoid psychoses which have resulted in seriously violent offences. Again, the substance problem needs to be tackled before the person can be helped in any meaningful way.

Heroin creates a different kind of problem in the offending arena. Many heroin addicts claim that they had to steal or burgle to ‘feed their habit’. People often accept this until they are victimised by violent offenders wielding syringes, or are beaten by muggers, or stabbed by an addict with a knife during the course of a burglary. Not all heroin abusers are criminal and only a small minority are violent. The addict may be under pressure because of his addiction, but the heroin does not beat up the old man or woman or throw them to the ground. Drug addiction needs to be controlled before any useful work can be done on personality and offending problems. The current approach to drug addiction is quite simplistic and seems to focus on the supply of physeptone (methadone) to almost any addict who requests it. Unfortunately, many users are not interested in any meaningful therapy as their whole way of relating to the world is drug related.

Sexual Crime

Sexual crime against adults, rape and related offences, usually ranks next to homicide in the criminal hierarchy. Alcohol problems are present in about sixty to seventy percent of offenders. A striking feature of sexual crime in general is the very high rate of denial of guilt. Many offenders proclaim their innocence throughout their sentence and see themselves as innocent men. Many maintain that the activity with the woman was consensual. This is often in the face of horrific forensic evidence of injury and abuse. Only a very small minority of rapists come forward tor any form of therapy, and they sadly leave prison completely unchanged. Their attitudes to women, victims, drinking, violence and so on persist, and in some cases they are even more angry as individuals.

Child abuse seems to be always in the media in recent years. Members of the clergy, teachers and sports people were highlighted. Several dreadful cases of institutional abuse were uncovered and the most recent outrage has been the discovery of paedophile rings and murders in Belgium. Who are these paedophile offenders and what makes them act in such an evil way? Paedophilia seems to be a sexual orientation and these men are only interested in children as their sexual objects. The role of any therapy is to help the paedophile to understand his sexuality, his offending and his victim’s experience. This can be on an individual or group basis. Sometimes anti-testosterone drugs are helpful in controlling sexual drive. Not all paedophiles offend and the only ones who come into contact with the services are those who act on their sexual desires.

Incest offenders, especially where a father is abusing a daughter, tend to be men who had a relatively normal heterosexual relationship until their children come near to puberty. Sexual abuse, most frequently of girls, starts with fondling and usually goes on to sexual intercourse. Again, alcohol problems are common. In a group therapy setting up to fifty percent can be helped to understand themselves, their sexual orientation issues, and they can learn about the suffering they have caused. The family dynamics in these situations are always interesting and there are many forms. Abusing fathers are usually not allowed home until every child in the family is old enough to defend himself or herself. I have been the director of our sexual offenders unit at the Central Mental Hospital which was opened in 1989. We have dealt with more than 650 cases since then. Approximately thirty percent of referrals are rejected by us because of denial and many of these men claim the accusations are all lies.


Therapy with offenders, whether in the community or in a prison setting is concerned with all the individual and family issues that exist in any interpersonal intervention. The extra dimension in the offender world is that the therapist is trying to encourage the offender to take responsibility for his own criminal acts. It is vital that they develop some understanding of the victim’s situation as well. Family support is frequently not available and often when it is it can give the wrong type of support. The big obstacles to success are alcoholism and drug addiction. Formal mental illness is only a little more common than in the general population and it is usually only in the homicide situation that it is a central issue.