Perpetrator trauma

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Perpetrator trauma, also known as perpetration- or participation-induced traumatic stress , both abbreviated to PITS, occurs when the symptoms of posttraumatic stress disorder (PTSD) are caused by an act or acts of killing or similar horrific violence.

Contents

Perpetrator trauma is similar but distinct from moral injury, which focuses on the psychological, cultural, and spiritual aspects of a perceived moral transgression which produces profound shame.

As a psychiatric disorder

Status

The DSM-5 addresses the idea of active participation as a cause of trauma under the discussion accompanying its definition of PTSD, and adds to the list of causal factors: "for military personnel, being a perpetrator, witnessing atrocities, or killing the enemy."

There has been some study with combat veterans, [1] [2] [3] [4] [5] people who carry out executions or torture, police who shoot in the line of duty, people who commit criminal homicide, and others. [1]

Severity

All studies that have considered the question of severity, have indicated that symptoms tend to be more severe for those who have killed, than for other causes of traumatization. One study [6] using the U.S. government database of American veterans of Vietnam [7] has suggested that the pattern of symptoms in combat veterans may be different in those who said they had killed, as opposed to those who said they had not. Symptoms include intrusive imagery, dreams, flashbacks, unwanted thoughts, being more prominent, along with explosive outbursts of anger, and concentration and memory problems being less prominent. [8] [9]

To a lesser extent, hypervigilance, a sense of alienation, and the non-PTSD symptom of a sense of disintegration were found to be greater for those who answered yes on killing. alcohol and cocaine use disorder appeared to be more severe. [10] [11]

Dream motifs

Compared to the victim form of being traumatized, there are different dream motifs reported. While the eidetic dreams – that is, those that are like a video of the event playing in the head – can be experienced as they are with traumatized victims, other motifs also appear more commonly. [1] [12] [13] One is of having the tables turned and being the one killed, or being very vulnerable in the same situation. Another motif is that of the victims accusing the dreaming person, or demanding to know why he or she did it. Also possible, is a motif of the self being split in two, so that the killer part of the person is seen as actually being a different person.

Therapy

Therapies that have shown some effectiveness in the treatment of perpetrator trauma include group therapy, eye movement desensitization and reprocessing, [14] Time Perspective Therapy [15] and understanding how common the problem is. [16] Those who suffer, many of whom participated in violence as a matter of social expectation, find it beneficial to know that they are having a normal reaction to an abnormal situation, and are not uniquely cowardly or crazy. Traditional remedies of atonement, forgiveness, and bearing witness have also stood the test of time as being helpful. [17] More vigorous studies are needed for all these suggestions, as well as common PTSD therapies that have not yet been thoroughly explored, with the distinction of perpetration versus victimization in mind.

Other proposed treatments have been proven to be ineffective. The "flooding" technique, technically called Prolonged Exposure, which desensitizes the sufferer of trauma by repeated exposure to reminders of it in controlled settings, appears to be a bad idea, counter-indicated when the trauma involved being active in inflicting harm. [18] It may be that expressive writing, which most people find helpful in working through their traumas, instead increases anger in soldiers. [19] Differences in what physiological mechanisms in what pharmaceutical drugs might be useful in therapy are not yet known.

Cycles of violence

Several of the symptoms are capable of causing or allowing for renewed acts of violence. [1] [20] The outbursts of anger can have an impact in domestic violence and street crime. The sense of emotional numbing, detachment and estrangement from other people can contribute to these, along with contributing to participation in further battle activities or to apathetic reactions when violence is done by others. Associated substance use disorders may also have connections to acts of violence.

Examples

Perpetrator trauma has been documented among the perpetrators of the Holocaust, [21] the Indonesian Communist Purges, [22] the Cambodian genocide, [23] the South African apartheid, [24] and among slaughterhouse workers. [25] [ better source needed ] [26] In writing about the experiences of American soldiers during the Iraq War, the psychiatrist R. J. Lifton claims in the aftermath of the Haditha massacre:

The alleged crimes in Iraq, like My Lai, are examples of what I call an atrocity-producing situation—one so structured, psychologically and militarily, that ordinary people, men or women no better or worse than you or I, can commit atrocities. A major factor in all of these events was the emotional state of US soldiers as they struggled with angry grief over buddies killed by invisible adversaries, with a desperate need to identify an 'enemy.' [27]

Referring to the definition of "atrocity-producing situation", Morag (2013) was one of the first scholars to theorize perpetrator trauma and delineate the victim-perpetrator distinction in the context of the twenty-first century new war on terror. [28] According to Morag's theorization, perpetrator trauma as an ethical trauma has been documented among Israeli soldiers during the Intifada as well US soldiers in Iraq and Afghanistan. [29] Authors from the PTSD Journal have documented perpetrator trauma among slaughterhouse workers, stating that "these employees are hired to kill animals, such as pigs and cows that are largely gentle creatures. Carrying out this action requires workers to disconnect from what they are doing and from the creature standing before them. This emotional dissonance can lead to consequences such as domestic violence, social withdrawal, anxiety, substance use, and PTSD." [30]

See also

Related Research Articles

Post-traumatic stress disorder (PTSD) is a mental and behavioral disorder that develops from experiencing a traumatic event, such as sexual assault, warfare, traffic collisions, child abuse, domestic violence, or other threats on a person's life or well-being. Symptoms may include disturbing thoughts, feelings, or dreams related to the events, mental or physical distress to trauma-related cues, attempts to avoid trauma-related cues, alterations in the way a person thinks and feels, and an increase in the fight-or-flight response. These symptoms last for more than a month after the event. Young children are less likely to show distress, but instead may express their memories through play. A person with PTSD is at a higher risk of suicide and intentional self-harm.

Psychological trauma is an emotional response caused by severe distressing events that are outside the normal range of human experiences. It must be understood by the affected person as directly threatening the affected person or their loved ones with death, severe bodily injury, or sexual violence; indirect exposure, such as from watching television news, may be extremely distressing and can produce an involuntary and possibly overwhelming physiological stress response, but does not produce trauma per se. Examples include violence, rape, or a terrorist attack.

Eye movement desensitization and reprocessing (EMDR) is a form of psychotherapy that is controversial within the psychological community. It was devised by Francine Shapiro in 1987 and originally designed to alleviate the distress associated with traumatic memories such as post-traumatic stress disorder (PTSD).

Complex post-traumatic stress disorder is a stress-related mental disorder generally occurring in response to complex traumas, i.e., commonly prolonged or repetitive exposures to a series of traumatic events, within which individuals perceive little or no chance to escape.

Prolonged exposure therapy (PE) is a form of behavior therapy and cognitive behavioral therapy designed to treat post-traumatic stress disorder. It is characterized by two main treatment procedures – imaginal and in vivo exposures. Imaginal exposure is repeated 'on-purpose' retelling of the trauma memory. In vivo exposure is gradually confronting situations, places, and things that are reminders of the trauma or feel dangerous. Additional procedures include processing of the trauma memory and breathing retraining.

A trauma trigger is a psychological stimulus that prompts involuntary recall of a previous traumatic experience. The stimulus itself need not be frightening or traumatic and may be only indirectly or superficially reminiscent of an earlier traumatic incident, such as a scent or a piece of clothing. Triggers can be subtle, individual, and difficult for others to predict. A trauma trigger may also be called a trauma stimulus, a trauma stressor or a trauma reminder.

Memory and trauma is the deleterious effects that physical or psychological trauma has on memory.

Cognitive processing therapy (CPT) is a manualized therapy used by clinicians to help people recover from posttraumatic stress disorder (PTSD) and related conditions. It includes elements of cognitive behavioral therapy (CBT) treatments, one of the most widely used evidence-based therapies. A typical 12-session run of CPT has proven effective in treating PTSD across a variety of populations, including combat veterans, sexual assault victims, and refugees. CPT can be provided in individual and group treatment formats and is considered one of the most effective treatments for PTSD.

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PTSD or post-traumatic stress disorder, is a psychiatric disorder characterised by intrusive thoughts and memories, dreams or flashbacks of the event; avoidance of people, places and activities that remind the individual of the event; ongoing negative beliefs about oneself or the world, mood changes and persistent feelings of anger, guilt or fear; alterations in arousal such as increased irritability, angry outbursts, being hypervigilant, or having difficulty with concentration and sleep.

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A moral injury is an injury to an individual's moral conscience and values resulting from an act of perceived moral transgression on the part of themselves or others. It produces profound feelings of guilt or shame, moral disorientation, and societal alienation. In some cases it may cause a sense of betrayal and anger toward colleagues, commanders, the organization, politics, or society at large.

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References

Citations

  1. 1 2 3 4 MacNair, R. M. (2002). Perpetration-Induced Traumatic Stress: The psychological consequences of killing. Westport, CT: Praeger Publishers
  2. ↑ Grossman, D. (1995). On killing: The psychological cost of learning to kill in war and society. Boston: Little, Brown and Company.
  3. ↑ Maguen, S., Metzler, T. J., Litz, B. T., Seal, K. H., Knight, S. J., & Marmar, C. R. (2009). The impact of killing in war on mental health symptoms and related functioning. Journal of Traumatic Stress, 22, 435-443.
  4. ↑ Maguen S., Lucenko B., Reger M.A., Gahm G., Litz B., Seal K., Knight S., Marmar C.R. (2010). The impact of reported direct and indirect killing on mental health symptoms in Iraq war veterans. Journal of Traumatic Stress, 23, 86-90.
  5. ↑ Baalbaki, Zenobia S. (2010) Perpetration in combat, trauma, and the social psychology of killing: An integrative review of clinical and social psychology literature with implications for treatment. Dissertation Abstracts International: Section B: The Sciences and Engineering, Vol 70(10-B), 2010, 6537
  6. ↑ MacNair, R. M. (2002). Brief Report: Perpetration-Induced Traumatic Stress in Combat Veterans. Peace and Conflict: Journal of Peace Psychology, vol. 8, no. 1, pp. 63-72.
  7. ↑ Kulka, R. A., Schlenger, W..E., Fairbank, J. A., Hough, R. L., Jordan, B. K., Marmar, C. R., & Weiss, D. S. (1990). Trauma and the Vietnam war generation: Report on the findings from the National Vietnam Veterans Readjustment Study. New York: Brunner/Mazel.
  8. ↑ MacNair, R. M. (2002). Brief Report: Perpetration-Induced Traumatic Stress in Combat Veterans. Peace and Conflict: Journal of Peace Psychology, vol. 8, no. 1, pp. 63-72.
  9. ↑ Kulka, R. A., Schlenger, W..E., Fairbank, J. A., Hough, R. L., Jordan, B. K., Marmar, C. R., & Weiss, D. S. (1990). Trauma and the Vietnam war generation: Report on the findings from the National Vietnam Veterans Readjustment Study. New York: Brunner/Mazel.
  10. ↑ MacNair, R. M. (2002). Brief Report: Perpetration-Induced Traumatic Stress in Combat Veterans. Peace and Conflict: Journal of Peace Psychology, vol. 8, no. 1, pp. 63-72.
  11. ↑ Kulka, R. A., Schlenger, W..E., Fairbank, J. A., Hough, R. L., Jordan, B. K., Marmar, C. R., & Weiss, D. S. (1990). Trauma and the Vietnam war generation: Report on the findings from the National Vietnam Veterans Readjustment Study. New York: Brunner/Mazel.
  12. ↑ Glover, H. (1985). Guilt and aggression in Vietnam veterans. American Journal of Social Psychiatry, 1, 15-18.
  13. ↑ Lifton, R. J. (1990). Adult dreaming: Frontiers of form. In R. A. Neminoff & C. A. Colarusso (Eds.), New dimensions in adult development (pp. 419-442). New York: Basic Books.
  14. ↑ Lipke, H. (2000). EMDR and psychotherapy integration. Boca Raton, FL: CRC Press
  15. ↑ Zimbardo, P.G., Sword, R. M., & Sword, R.K.M. (2012). The time cure: Overcoming PTSD with the new psychology of time perspective therapy. San Francisco: Jossey Bass
  16. ↑ [Yalom, I. (1995). The theory and practice of group psychotherapy. New York: Basic Books
  17. ↑ Foa, E. B., Meadows, E. A. (1997). Psychosocial treatments for posttraumatic stress disorder: A critical review. Annual Review of Psychology, 48, 449-480.
  18. ↑ Pitman, R. K., Altman, B., Greenwald, E., Longpre, R. E., Macklin, M. L., Poire, R. E., & Steketee, G. S. (1991). Psychiatric complications during flooding therapy for posttraumatic stress disorder. Journal of Clinical Psychiatry, 52, 17-20.
  19. ↑ Munsey, C. (2009, October). Writing about wounds. Monitor on Psychology, 58-59
  20. ↑ Silva, J. A., Derecho, D.V., Leong, G. B., Weinstock, R., & Ferrari, M. M. (2001). A classification of psychological factors leading to violent behavior in Posttraumatic Stress Disorder. Journal of Forensic Sciences, 46, 309-316.
  21. ↑ Mohammed 2015, pp. 1190–1191.
  22. ↑ Mohammed 2015, p. 1193.
  23. ↑ Mohammed 2015, p. 1196-1200.
  24. ↑ Mohammed 2015, p. 1207.
  25. ↑ Dorovskikh, Anna (2015). Killing for a Living: Psychological and Physiological Effects of Alienation of Food Production on Slaughterhouse Workers (BSc). University of Colorado, Boulder.
  26. ↑ "Confessions of a slaughterhouse worker". BBC News . January 6, 2020. Retrieved January 13, 2020.
  27. ↑ Robert Jay Lifton (June 14, 2006). "Haditha: In an 'Atrocity-Producing Situation' — Who Is to Blame?". Editor & Publisher. Retrieved January 13, 2020.
  28. ↑ Morag 2013, pp. 1–32.
  29. ↑ Morag 2013, pp. 211–218.
  30. ↑ "The Psychological Damage of Slaughterhouse Work". PTSDJournal. Archived from the original on 25 May 2019. Retrieved 23 May 2019.

Bibliography

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