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Social violence and medicine Knowing so little about the prevention and treatment of violence in the individual, we can scarcely hope to give useful advice as physicians on the growing problem of social violence. Social violence is destructive or disruptive behaviour directed against the existing order of society and ranging from vandalism to revolution. Yet a mixed panel of physicians and nonphysicians had the temerity to discuss it last March at a symposium of the Royal Society of Medicine in London.' What type of persons take part in social violence? Calvert, a man with wide experience of social violence in many parts of the world, pointed out that leaders are needed to start a campaign of violence, that they need followers and that the followers are often highly intelligent and physically active young men, mostly bachelors, whose aggression is not something to be repressed with drugs but something to be channelled into more socially acceptable areas. He did not see aggression and violence as bad per se; our achievements in this world have been made possible only by the use of such qualities. The men who take part in social violence are prepared to die for a cause they believe in and are therefore deserving of respect. He saw in the exploration of the sea bed better opportunities for diverting aggression into constructive channels than in space exploration. Howorth, a prison medical officer, took a somewhat less rosy view of social violence. Certainly violence both between species and within species has contributed substantially to species survival, to natural selection and to colonization of the world. But at the present level of human development, violence

may represent a primitive way of competing that should be replaced by a more controlled and constructive expression of rivalry. Otherwise, as we all know, the human species is endangering its social order, if not its survival on earth. Howorth reviewed what we know about violent adults, or rather what we think we know. A few have actual brain damage and some may be doomed by heredity to violence, but more are nurtured in an atmosphere of intrafamilial aggression in which they see the latter rewarded. In his experience Howorth has been impressed by the consistency with which intrafamilial violence of the father has been followed by social violence of the son. Also, a sense of alienation in the family is often followed by social alienation. Urban society is particularly suited to the cultivation of violence, for the young have no clearly marked territory but need to establish a territorial claim. Society itself also contributes to violence by condoning it. We sometimes condone child abuse or even wife abuse

without interfering, providing the violence is not excessive. The permanent presence of war, somewhere on the globe, is in itself a sign of this condoning of violence. Violence on the television screen, especially if it is shown to be rewarding, may increase the likelihood of violent behaviour, though the evidence for this belief is still flimsy. Violence as a means of acquiring bargaining power in society for those who have failed to acquire this through social skills (a far cry from Calvert's high-quality guerrillas), and as a means of readjusting the pecking order in a group, must also be taken into account. Howorth saw a long-term solution

only in prevention through the development of techniques to aid the maturation of personality. (What the world needs is more mature minds, as the late Brock Chisholm once said.) There must be more teaching about human relations to the young. Contrary to the opinions of some other authorities, this

speaker considered that therapeutically the institutional approach has much to offer in the relearning process. Peters, from the Ministry of Defence, was less concerned with the individual and more with the continuum of violence, from simple vandalism, through sit-ins, student protests, strikes, crowd aggression, riots, terrorism and guerrilla warfare to revolution. All of this is, of course, not new. Peters recalls that in 1818 two companies of troops with fixed bayonets had to be called out to suppress a riot by pupils of Winchester School, and that there were similar uprisings at Eton and Rugby schools. Much of the violence of the 20th century is on behalf of popular causes, however futile it may be in practice. There is now a need to limit the amount of publicity the user of violence seeks, and thus to limit the amount of admiration and emulation and the extent of economic support he receives. Research into techniques of discrediting terrorists and revealing them as the criminals they are is, in Peters' opinion, much needed. The means for countering much of the present wave of social violence is within the grasp of a democratic society. But this is rather removed from the sphere of

medicine. Reference 1. Roots of social violence. Proc R Soc Med 68: 181. 1975


Editorial: Social violence and medicine.

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