Violence Toward the Mentally Ill

A female bus driver choked a mentally ill student after he engaged in a screaming tirade and threw a can at her. You can watch the video here.

Broadly speaking I view violence in two major categories. Emotional Violence is the lashing out physically due to a build-up of anger, anxiety and/or other emotional states. “Crimes of Passion” are put into this category as are many instances of domestic violence where a partner strikes another during a heated dispute. There is often regret and/or embarrassment at the action. Most mental health professionals believe that this type of violence is amenable to intervention.

Instrumental Violence, on the other hand, is considered by many to be a pre-meditated, less emotionally-aroused action. It’s not a function of one going off the handle; rather, it seems like the individual gets off on it. A husband who backhands his wife, unprovoked, could fall into this category. Sociopaths who are violent are often considered to be instrumentally violent and many practitioners believe this type of behavior is not likely to be helped by therapeutic intervention.

After watching the video, my interpretation was that the woman’s behavior had elements of both types of violence. The student was clearly unruly, loud and having an attack of distress. Hell, he even threw a can at her. There was a build-up of emotion and she reacted poorly. And yet I sensed hints of Instrumental Violence as well. She engaged in a prolonged choke rather than a knee-jerk slap or kick, and her voice sounded calm at one point. She even asked him if he wanted his ass beat. Finally there was what might have been an element of bragging about her behavior after she returned to the driver’s seat, all of which suggest an undercurrent of Instrumental Violence.

I railed against the hospital that let the mentally ill woman die on the waiting room floor (and then went on a small tirade in the Comments thread), but this situation isn’t quite so cut and dried. Did the woman act with poor judgment? Of course. But why? Is she a sociopath? Does she have an anger management problem? Was she poorly trained to handle children with mental illness and, if so, would that have even mattered? Also, was the child on any medications, or should he have been? Was the driver warned about the child’s behavioral problems earlier in the day, if any? Has this child ever had similar problems when there is only one adult on the bus?

I don’t have extensive experience working with children who might need to be restrained or controlled. A colleague of mine does, however, and agreed to share some thoughts on the topic. For reasons that will become obvious this person has requested complete anonymity:

“Original Applied Behavioral Analysis (ABA) practitioners got pretty violent with the autistic children with whom they were working. There was a lot of slapping and yelling and they even used electric shock to stop some of the self-harming behaviors–some old videos show the data charts on the electric shock administration and there is pretty compelling evidence in support of pain-inducing aversives when it comes to changing behavior.

ABA has evolved so that currently we don’t use too much physical intervention, but this isn’t 100% the case. I had an eleven year-old who used to spit upwards of 300 times per session. We got him to stop by applying tabasco sauce every time he spit (this is an ‘aversive’). It was pretty effective unless he was in a really pissy mood and then nothing would work (we tried vinegar, Wasabi paste and a number of other things, but nothing would deter this kid if he was in a certain mood). He was also pretty violent (frequent punching or clawing of the face–he drew blood from me a couple times) and would sexually violate female therapists. In these instances we would usually do a ‘response cost’ where we physically blocked him and made him do calisthenics until he was on a behavioral momentum and under control. There was definitely a lot of physical involvement in terms of maneuvering him. When he got really violent (throwing furniture, punching really hard, etc.) we were instructed to do a hold, which is a physical maneuver to prevent him from moving. I know the other therapist who worked with this particular child once slammed his head into a desk because he was behaving so badly (that was her version of a hold), and I probably overdid it on the blocking during response costs.

One thing that really influenced the outcome in the above situation was medication. This kid’s parents were pretty low socio-economic status and had awful healthcare and limited access to services. A Psychiatrist at _______ Hospital put him on Risperdal (an antipsychotic) and it was awesome–like all of his violent behaviors stopped overnight–but the doctor neglected to tell the parents that they couldn’t stop the medication without her supervision and once the prescription ran out they didn’t refill it. He had a super-sensitive rebound and his previously manageable behaviors escalated to the point at which he was physically hurting everyone around him. Add to that the shadiness of the agency I worked for (a lot of the agencies that cater to low-income families are in it for the benefits and couldn’t give a fuck about the kids), and I was left completely without assistance for this child because all of his other therapists quit. I would have to go into a lot more detail about the way ABA works, but essentially this kid was screwed once it got to this point. He was approaching puberty and was getting physically bigger than most of his therapists so none of the standard ABA responses really worked anymore.

As far as the parents of this kid were concerned, they encouraged whatever it took to get him back on track. They were cool with the tabasco sauce and with the physical manipulation because nothing else worked. Basically it was either that or institutionalization, and I wouldn’t be surprised if I heard that he was living in a home at this point. He had to wear physical restraints on the bus ride to school and his bus driver gave the parents a ton of shit. I wouldn’t be surprised if she smacked him around at times like the woman in the video.
One more thing–on the flip side there are lots of parents who wouldn’t hear of physical interventions with their children, but what I described to you above isn’t unheard of with very severe cases.”

The point here is that even doctoral-level mental health professionals are capable of violent outbreaks with patients. This doesn’t vindicate the bus driver of anything; rather, it exposes the limits of human restraint, as well as the limits of my field. We clearly do not know enough, both from a psychiatric and psychological perspective, how to treat these extreme cases. And until we do, events like these are inevitable.

(Visited 126 times, 1 visits today)

5 Responses to “Violence Toward the Mentally Ill”

  1. Anonymous says:

    Working with anger management kids is tough. I have an 11 year old girl right now who is taller than me who gets restrained at her therapeutic day school at least once a week. She punches and threatens teachers all the time.
    The worst she has done to me in our sessions is tell me that I get on her nerves and ask too many questions, but I still sit by the door just in case.

  2. Colleen says:

    My college roommate was a mental health worker in a home for severely mentally ill children. She routinely came home with bruises, scratches, belt marks, bite marks, you name it. She would sometimes lead field trips for the kids who were more well adjusted but once ended up restraining one of them in public. I guess the policy was that she had to call the police to file a report about it so that it wouldn’t get wrongly reported as child abuse. They also had to file detailed reports about the incident for filing at her work, but she’d often complain about workers being lazy about it and either not reporting escalations or only describing them briefly.
    Frankly, any person who is in such bad shape that they need to be physically restrained for their own safety is just a sad case. And part of why I work in research, not clinical (though that’s still no guarantee of anything!)

  3. Anonymous says:

    This is a ridiculous comparison, a child who throws a mostly harmless fit on the bus isn’t as dangerous as a psychotic child who throws furniture and sexually assaults women. A professional restraining a child, even when they use too much force in their restraint, isn’t anything like a BUS DRIVER CHOKING A CHILD. I don’t get it, is a a job requirement that all bus drivers have to be bigger psychos than the bipolar children they drive around?
    My autistic sister used to be violent, but we put her on medication and she stopped. She’s off medication now and she acts normal.
    During a few years of her violent stage, she attended a school where they would restrain her. There were some occasions where the restrainment was necessary, like when she hit a teacher, but often they would restrain her when she showed the slightest most inconsequential sign of disobedience. If got distracted from doing her work, they would pin her down on the floor for several seconds. She was only a 10 year old girl. She could barely talk at that age, so I didn’t fully understand the situation until years later when she began talking normally and telling me stories about her horrible childhood. Those experiences of being restrained were very traumatic for her. At the time when it was happening, she would come home sometimes and complain that they restrained her at school, but she wouldn’t elaborate so I assumed the school had good reason to do so.
    My sister’s behavior improved immensely when my parents removed her from that school and sent her to a school where they didn’t pin her to the floor, and simply sent her to a time out room when she became angry. I think the restraint only aggravated her more. I know that some children really require restraint and not everyone is like my sister, but you have to be skeptical about these things.
    It’s horrible how much responsibility for these matters falls on the parents. Fighting the school system is like a full time job for the parents, and many of the parents of special needs students are too poor and uneducated to do much.

  4. Anonymous says:

    Though I understand the comparison, there is a huge difference between a trained mental health professional implementing physical interventions (whether you believe it is ethical or not) than an untrained bus driver taking discipline into her own hands….and then bragging about it. Often times this population doesn’t have the voice to report these kinds of abuse. If not for the video, I don’t doubt that this driver would have continued her form of “discipline” and I wonder how many other students she handled in this manner as well.

  5. Zack says:

    So the entire point of this article, or at least the explanation, is that despite decades of indoctrination that striking or using any sort of physical violence against children was harmful, that some of the most useful techniques for dealing with these kids is to use violence?!?!
    Hell, I could have told you that! This whole ordeal pisses me off, not because of the bus driver who I see as blameless, but because society is so weak and fearful that it is either unable or unwilling to accept the idea that kids need a beating sometime. And no, the fact that he has bipolar, which I am suspect to believe considering he is in MIDDLE SCHOOL, doesn’t change anything.
    As for the bus driver having any sort of Instrumental anger, that is bull. Asking if the kid wants a beating has nothing to do with “getting off” to violence. It was a threat. It was a threat made out of passion. Just as the choking was an act of passion.
    As for the gloating, well, it wasn’t gloating. It was reassurance. Her commenting to others, bus drivers I assume, was her way of validating her actions to herself. It wasn’t bragging.
    Last thing, has anyone ever wondered why the parents didn’t take time to take this kid to school themselves? If he has such behavioral problems, if he is so difficult, why not take responsibility and handle him yourself? The answer? Because these parents, like most others, are irresponsible and careless as hell. They are just as responsible for this as the bus driver.