Friday, May 11, 2018

A Psychiatric Perspective on Beatdowns

My opinion on this is probably long overdue.

A beatdown is popular vernacular for beating someone mercilessly - often into an unconscious state. From the video I have seen of these scenarios - it is at least implicit that the person had done something to "deserve" the beatdown.  The best source of this video materiel is that follows the hip hop culture more closely than most mainstream television.  In watching those videos it is apparent that even the wealthiest and most influential celebrities are not averse to being affiliated with these activities, encouraging them, or even commenting on them.  Any casual observation of what happens during a beatdown illustrates that it is a situation with a very high likelihood of serious injury or death to the person who is being assaulted.

Take for example this TMZ clip entitled Cardi B Security Accused of Post-Met Gala Beatdown.  You see two young men punching a man who is on his back on the ground.  They are punching him rapidly and repeatedly.  When they finish another man runs in and kicks the victim as hard as he can while the victim is still laying defenseless on the ground.  I listened to the TMZ pundits analyze the situation.  One of those pundits is Harvey Levin who is the co-host and is also an attorney.  The consensus seemed to be that nobody had any problem with this man being repeatedly punched by two men when he was paying defenseless on the ground.  Only Harvey Levin thought that the kick was a little extreme and could result in legal charges.

The very first assault case that I was involved in occurred at a University Hospital outpatient clinic.  I was on the consult team and the clinic called to say that they had detained an outpatient who assaulted one of their clerical staff.  When she wasn't looking the patient hit her over the head with a cane as hard as he could.  I went down to assess the patient.  He was very calm and had no evidence of major psychiatric disorder.  He explained that he got impatient because the receptionist was not working fast enough and that was why he struck her. He had absolutely no remorse for injuring her. He minimized the potential for injury by hitting someone over the head with a relatively heavy object when they were not expecting to be hit.  He used the familiar rationalization: "If she didn't want to get hit she should have worked a little faster."  He was not intoxicated at the time.  I discussed the case with my attending and we both agreed that there was no psychiatric disorder and no reason why he should not go to jail to be charged for assault.

My attending psychiatrists at the time always tended to analyze the aggression. Punching or kicking someone when they were unable to protect themselves was viewed as a particularly negative sign and an event more commonly seen in antisocial individuals.  It led me to reflect on people I had known in my peer group who had been killed in fights.  One guy I played sports with who went away to college and ended up getting in a brawl at a large college bar.  He was apparently kicked in the side when he was on the ground. He went back to his dorm room and died that night of a ruptured spleen.  In another fight resulting in a kick to the head - that student went home and expired from a cerebral hemorrhage.  Both students were very bright, full of promise, well-liked and had no history of aggressive behavior but they were killed by blows that are commonly observed in movies and television shows. There are thousands of men incarcerated in this country for punching or kicking someone in a fight and killing them.  I can almost guarantee that at some point in their court proceeding somebody said: "I did not believe that hitting him that way could kill him."

There are mitigating factors in some of these situations.  Psychiatric disorders usually are not.  Personality disorders and intoxicated states are but not from a legal standpoint. Being intoxicated or a sociopath is not a defense in the American legal system.  The best chance to beat the charge is to appeal to sub-cultural mores: "Boys will be boys - it was just a fight gone bad and somebody died.  Nobody is to blame here!"  Or claim it was an accident or there was no intent to do harm.  In both of the cases I was personally aware of there was no case in one and in the other charges were dismissed by the court even though the victim in the case never threw a punch or acted in an aggressive manner.  American law is highly subjective and it is not likely that these cases can be decided in a consistent or necessarily rational manner. 

A medical and psychiatric perspective allows a different analysis.  The human brain has a gel like consistency and it floats inside the skull in cerebrospinal fluid. Any sudden force applied to the skull leads to a shock wave that is initially dispersed as the brain impacts the inside of the skull where the forces was applied (coup injury)  and then when the brain rebounds and strikes the opposite inside area of the skull (contre coupe injury).  Which each violent movement thousands of axons are sheared off in the white matter adjacent to cortical areas.  Some forces shear veins and even arteries that can lead to very rapid death if not treated.  Treatment may consist of neurosurgery that requires opening the skull to remove large blood clots and repair blood vessels.  In extreme cases a piece of bone needs to be removed and stored to allow for the expansion of brain swelling to reduce the chances of death.   Lesser forces lead to more persistent cognitive, personality, and neurological changes.  From a strictly medical perspective - given the amount of damage, morbidity, and mortality that a beatdown can cause it is obviously not a good idea to engage in this kind of activity.  Even widely approved activities like football and boxing can lead to brain damage and death from severe brain  injuries.

I have seen plenty of the victims in clinical practice.  People whose lives has been altered by being exposed to this kind of violence.  Traumatic brain injuries, cognitive disabilities, and post traumatic stress disorder.  Careers and marriages lost from these effects. 

From a psychiatric standpoint, the only acceptable reasons for using force against another are self-defense and stepping in to assist a person who cannot defend themselves.  The latter situation can be difficult to assess and personal safety is always a priority. Those criteria rule out a lot of common altercations based on insults or taunts.  If that happens -  the safest solution is to walk away.  These criteria also rule out violence and aggression as a solution to problems.  If that is an issue, find help for anger control and problems with aggression.  The criteria rule out intoxicants as a reason for using physical force.  If that happened repeatedly with alcohol or drug induced intoxication states - get help with the drug or alcohol problem.  Even self defense may not be an adequate excuse for becoming aggressive and injuring or killing someone.  If you are bigger, stronger, a better fighter, or armed and you can easily handle the aggressor - killing or injuring them might make a self defense strategy less likely to succeed.  The initial example would appear to be a case in point.  Two men on top of the man vigorously punching him at the outset of this clip for pursuing an autograph would violate the acceptable reasons. The next man kicking him is far worse if these blows resulted in significant injury. It is tempting to put these situations in a legal framework - an individual's conscious state is probably more applicable. If you kill or permanently disable someone as the aggressor in one of these situations your conscious state is permanently altered.  You have become a person who is capable of excessive violence and that is remembered the rest of your life. Your entire moral development up until the time of that incident is called into question.  Guilt, shame, doubt, and regret become a major part of your life.

Age is certainly a factor in these situations. I have not seen any statistics but most of the protagonists seem to be in their 20s and 30s.  That is not universal.  I have seen many videos of older assailants beating the elderly or assaulting people randomly on the street.  The vigor, poor judgment, problematic peer pressure, and excessive use of intoxicants make this demographic group the likely perpetrators of beatdowns.

If you like my standard spread the word. There should be no beatdowns of any kind.  They endanger lives, lead to disability, and and can have far ranging effects for perpetrators and victim - both physically and  psychologically. They are unnecessary in what are typically nuisance situations where there are better ways to resolve the problem, including just walking away.

Beatdowns can kill people. They are a throwback to ancient civilizations when conflicts were resolved by violence and the object was to kill all of the adjacent tribes members.  The toll is great and the next time somebody asks you if someone "deserved a beatdown" - let them know that nobody does.

And let them know that two or three people hitting someone when they are down and vulnerable is unconscionable.       

George Dawson, MD, DFAPA


  1. In this case there was no excuse for a beatdown, but I can see exceptional cases where it might be applicable.

    For example if someone were trying to blow up a plane or invaded your house and tried to kill your family, it would be imperative that you make absolutely sure they are not getting up again. Yes, I would have beatdown the shoe bomber had I been a passenger on that plane. And I would try to choke out anyone who attacked my family without hesitation.

    I've been in fights as a kid where I the other party said "give" and when I relented they got up and went right back after me. This puts you in a horrible situation when you get the upper hand a second time. And if they get the upper hand you feel like a fool.

    You're right that most beatdowns are morally unjustified but I can come up with a few exceptions so I don't think you can say never. Those involve cases where the risk of the party playing possum or fake tapping out could be fatal to you or others. Obviously that was not the case with an overeager fanboy.

  2. No surprise here: Axis 2 cluster B disorders that involve repeated extreme and unjustified violence, and the fact that one of the most consistent factors in predicting violence is substance abuse, well, why we have prisons and graveyards.

    Shame I seem to be the only psychiatrist in my travels who continues to question why psychiatry has to be the frontline for addiction and antisocial issues.

    Oh well, we get our beatdowns, just more subtle and drawn out...

    1. Part of what I see is the old sensational headline that psychiatrists are going to "get people off" in some of these situations.

      That attitude of course indicates ignorance of what really happens - the NGRI defense is rarely successful.

      It also misses the fact that when it comes to violence and aggression - few people know more about it than psychiatrists. I have been talking about violence prevention for about 15 years. People would rather listen to talking heads, politicians and others who know considerably less. The most dangerous precedent is putting some of these people in charge of facilities that should know how to manage and treat violence and aggression.

      The current cultural swing toward drug permissiveness also does not bode well.

  3. It's also noveaux riche from rough backgrounds playing old tapes. She was a former stripper/gang member and that's how the law was enforced because its not like the police and the courts were stepping in. Thuggishness is slow to adapt and we see this all the time going back to Death Row Records and Suge Knight.

    I'd say some psychiatrists understand violence and aggression...I'm not sure the humanists/utopians/Rosseauists/Rogerians among us do. I would say those of us in the Freudian realist camp do. I've met too damn many who believe that violence would go away if we held hands and had one world government or whatever. They don't even get the basics of the human condition right.