Sunday, March 22, 2015
That may seem like an odd topic for a psychiatry blog but I did not know where to put this. Earlier this week my wife and I decided to stop watching a popular television show called The Following. It is basically a fictional show about a death cult that involves a charismatic psychopath who engages other psychopaths to do mass killing. They typically use knives as murder weapons and kill large numbers of innocent people at public gatherings like book signings in book stores. In one episode last year, the main psychopath in the show happened across the camp of another death cult run by a different psychopath and it was the expected lethal battle for leadership. The dramatic tension is created by a group of FBI agents trying to catch and stop the psychopaths and the personal stories in that group. In the opening show this year, there was a murder scene that was explained to the audience and then implicitly done that was so sadistic and so sick that we decided to shut off the show and never watch it again.
Violence and aggression are always in the background in America. We take violence and aggression for granted and it seems surprising when they are excluded from entertainment. What no car chases or shootings? And it has been there a long time. I can remember being in East Africa in the 1970s and at that time many of the Africans that I met, had the idea that most Americans carried guns. That conclusion was from watching American films. There has always been the debate about whether or not the display of all of this violence affects people. Like practically all research of this type, I would expect the results to reflect the biases of the researchers. Typical research would look at a large group exposed and not exposed to violence in the media and the results are mixed. Mixed results lead to the status quo, but the status quo has gradually gotten worse. Television shows commonly have sadistic serial killers as their plot line and in one case a serial killer is the main character and hero.
According to a 2012 report by the Media Violence Commission (1) major medical (including the American Psychiatric Association) and the major psychological organization in this country support the argument that there is a casual connection between media violence and aggressive behavior. This report also looks at the biases that may be in place that might obscure that connection. The authors mentioned the belief that the effects must be immediate and severe is a common bias. In other words, I see a violent movie and perpetrate a violent act within the next day or two. Instead over time, exposure may decrease prosocial behaviors. This report briefly summarizes the literature on possible psychological mechanisms that occur with exposure to violence but the most important conclusion is:
"One conclusion appears clear-extreme conclusions are to be avoided. Not every viewer or player will be affected noticeably, but from understanding the psychological processes involved, we know that every viewer or player is affected in some way."
Many clinical psychiatrists have talked with people who have perpetrated violence based on some act that was portrayed in the media. These stories are also described in the media with some regularity. I think that if there are any factors containing a media effect it is the moral development of most people and that fact that a lot of the violence is hypothetical and it could not be enacted without considerable resources. Factors that may facilitate violence after exposure would include a developmentally immature brain or a brain that would be more susceptible to the priming effects of violence. That would include various forms of severe mental illnesses or personality effects like psychopathy or antisocial personality disorder. In many cases the perpetrators of violence has no idea about how devastating injuries can occur from fictional portrayals where people get up after being hit over the head with a pipe. They don't realize that in many cases that results in a fatal or disabling brain injury.
The overriding dimension affecting violence that needs to be addressed is at the cultural level. A critical recent development is the resurgence of the death cult. The concept of death cult is poorly defined at this time and as far as I know there are no definitive scholars. They seem to come in two forms. The first requirement is a cult or an organization with a charismatic leader and followers who are willing to uncritically follow the edicts of the leader. There have been various studies of the dynamics of these groups and who might be susceptible to becoming a cult member. Jerrold Post, MD has analyzed the dynamics of charismatic leaders and describes them as "mirror hungry" personalities that require constant admiration, convey a sense of omnipotence and grandeur, have the appearance of certainty, and rely heavily on splitting as an adaptive psychological defense (2). Death cults seem to come down to 2 varieties - those predisposed to mass suicide and those that are predisposed to homicide and mass homicide or in some cases genocide. For the purposes of this post, I am focused on the latter, because they seem to pose the most immediate danger to the most people.
Prototypical homicide focused cults or movements in my lifetime have included the Nazis and Pol Pot. The concept of "charismatic leader" can probably extend to larger groups of extremists that have been described as being responsible for genocides (3). Over the past 30 years, we have seen many of these cults or movements commit homicide to various degrees often with loose religious rationalizations. The killings have become increasingly vicious and sadistic. The killings have reached a level of intensity that all of the religious justifications no longer seem to apply. The international solution has been to mobilize against these groups and in some cases, explicitly threaten to kill them. The media is always complicit with death cult propaganda and the resulting desensitization may have been one of the factors in the escalation. This is an interesting parallel with television entertainment that seems to be in the same cycle of escalating to the most horrifically sadistic and brutal types of killing and torture.
What is missing in all of this mass exposure to violence and killing is an explanation of the driving forces and a plan for change at a cultural level. There is a current and shocking increase in antisemitism spreading across Europe, to the point that one author has suggested that it may be time for the Jews to leave Europe (4). There don't seem to be any pacifists any more. There is no peace movement like there was in the 1970s. I have not seen any explanations for this primitive behavior and why it occurs even though many explanations have been around for years. Here is one from Lifton that has been available since 1986 and it is accessible to any psychiatrist trained in psychodynamics or any good student of English literature:
"Fascist ideology can have particular appeal for the survivor self fighting off disintegration because it holds out, at all levels, a promise of unity, oneness, fusion. It deals with death anxiety, moreover by glorifying death, even worshiping it. While one's own death as a warrior is idealized, the self mostly escapes death - achieves the death of death - by killing others. There can readily follow a vicious circle in which one kills, needs to go on killing to maintain one's cure, and seeks a continuous process of murderous, deathless, therapeutic survival. One can then reach the state of requiring a sense of perpetual survival through the killing of others in order to re-experience endlessly what Elias Canetti has called the "moment of power" - that is the moment of cure." p. 499.
Lifton knows full well that the fascist thought process that he describes is not a diagnosis, but it is the way that large groups of people can think. It has been present since the time of ancient man. You can find theories about how it is "hardwired" into the human brain with suggestions that it is adaptive. The only real way we can combat it is through educating people about what is really going on, improving critical thinking and changing popular culture. Teach them how to recognize biases and overcome them. A basic skill would seem to be able to recognize a death cult and realize why participation may not be in your best interest. It goes without saying that it could not be in the best interest of civilized society, but the philosophy behind that probably needs teaching.
When I turned off my TV set the other day, I was not seeing it as a protest. But if media producers realize that abhorrent violent content is less interesting that may be an important cultural change.
George Dawson, MD, DFAPA
1: Media Violence Commission, International Society for Research on Aggression(ISRA). Report of the Media Violence Commission. Aggress Behav. 2012 Sep-Oct;38(5):335-41. doi: 10.1002/ab.21443. Epub 2012 Aug 10. Review. PubMed PMID: 22886500 (full text available online).
2: Jerrold Post, MD. Personality and Political Behavior. Door County Summer Institute July 21-25, 2003.
3: Alan J. Kuperman. The Limits of Humanitarian Intervention - Genocide in Rwanda. Brooking Institution Press. Washington, DC (2001) p. 12.
4: Jeffrey Goldberg. Is It Time for the Jews to Leave Europe? The Atlantic. April 2015.
5: Robert Jay Lifton. The Nazi Doctors. Basic Books, New York (1986) p. 499.
Supplementary 1: I would not encourage anyone to watch the television program in question that I mention in paragraph 1. I have seen plenty of media violence, but consider this depiction to be the worst.