THE VIOLENT PATIENT IN THE COMMUNITY

I shall begin with a discussion of violence in America in general, and then proceed to the various categories of patients wherein violent behavior is more frequent and conspicuous; although it must be stressed that most surveys of civil and criminal violence show that less than 20% is associated with a diagnosable mental illness of either a psychotic or neurotic type.' Violence seems to have been increasing steadily over the past several decades, not only in America, but throughout the Western world. The nature of violence, too, seems to have grown more vicious, impersonal, and almost random-such as impulsively pushing someone off a subway platform, or killing someone old and helpless after robbing them. This increased violence has risen in all areas of the country and in all social strata. Certainly it pervades the consciousness of everyone to become a profoundly disturbing social concern. This concern weighs heavily on the raw edge of our consciousness, bidding us to bar our windows, to look warily over our shoulders, and to keep to well-lighted streets when we are out at night. This ambience of fearful anticipation of violence pervades all our conyersation, plans, outings to restaurant and theatre, and even our walking the dog at night. Churches have begun to provide escorts to the elderly for security during their shopping for food and necessities. Violence conditions our lives and social behavior in ways inconceivable to earlier generations. Our drama, popular literature, press, podium, and pulpit and the powerfully persuasive mass media of film, radio, and television all bring the spectre of epidemic irrational violence home to us. Youngsters today apparently take this for granted-not familiar with any other atmosphere. Older folks share nostalgic memories of times, just a few decades past, when no one locked his door in suburbs or rural areas; when no one thought twice about cavorting in Central Park after midnight; when crime and violence seemed far away and sharply limited to the poor, culturally deprived, and politically disinherited population areas of slums and shantytowns. Today violence knows no boundaries; it is in the marketplace, the schools and suburbs, the farms and villages, just around any corner, in our home and community. It is clear now from recent statistical research that the increase is actual and not simply derivative of more thorough record keeping, sampling, and accounting; although for family violence between spouses, parents and children, or siblings, there may be no actual increase, but rather a lessened tolerance for it as reflected in the laws regarding spouse abuse and child abuse. The complex causes of violence change, to be sure, with the social