Psychopharmacological Treatment of Aggressive Behavior: Implications for Domestically Violent Men
Maiuro, Roland D., Avery, David H., Violence and Victims
In an attempt to further evolve our understanding and response to domestic violence as a public health problem, a number of investigators have begun to prioritize the development of specialized diagnostic and intervention methods from a biomedical perspective. The potential use of selectively prescribed and carefully monitored medications to help end violent and abusive behavior would be an important step toward mainstreaming the treatment of domestically violent men into the realm of modern medicine and health care. While much work remains in understanding the specific linkages and mechanisms between psychobiology and aggressive and violent behavior, there is a growing body of basic and clinical research which has important potential for expanding our intervention efforts. This article reviews this research in relation to current efforts to understand and treat domestically violent men. A biopsychosocial model which incorporates selective and adjunctive psychopharmacological treatment within the context of cognitive-behavioral and social systems interventions is outlined and discussed.
Although sociocultural and social learning approaches have exerted a major influence upon the development of both etiological and intervention models for domestic violence, psychobiological variables have received relatively little attention (Rosenbaum & Maiuro, 1989). Perpetrators and victims of spouse abuse have, by and large, been the domain of the criminal justice and social service systems, thus gaining the attention of criminologists, sociologists, and other social scientists. Only recently have health care disciplines begun to mainstream domestic violence as a public health problem (American Medical Association, 1992; Randall, 1990). In an attempt to further evolve our understanding and response to domestic violence, a number of investigators have begun to prioritize the development of specialized diagnostic and intervention methods from a biomedical perspective (American Medical Association, 1992; Maiuro & Sugg, in press). The potential use of selectively prescribed and carefully monitored medications to reduce violence would be an important step toward mainstreaming the treatment of domestically violent men into the realm of modern medicine and health care.
However, the idea of employing psychopharmacological interventions with domestically violent men also raises a number of philosophical and conceptual issues. As primarily a biological form of intervention, psychopharmacological approaches to violent behavior are sometimes criticized as being "reductionistic" and tied to "disease models" of etiology. It may be argued that such approaches run the risk of oversimplifying and underestimating the scope of interpersonal violence, promoting the disavowal of personal responsibility due to "diminished capacity," as well as ignoring important sociocultural and psychological bases for such behavior (Breggin, 1980; Dobash & Dobash, 1987).
While such concerns may be legitimate, they assume a univariate, and nonintegrated model of intervention which emphasizes biological factors as superordinate. This need not be the case. Moreover, legitimate criticisms can provide a basis for sharpening our thinking about personal accountability and models of etiology and intervention. The presence of a classifiable syndrome or disorder and what a defense attorney attempts to make of it in a court of law are two different things. Well chosen caveats, concerns, and words of caution can assist the development of more sensitive and sophisticated models and protocols.
Importantly, critical acknowledgment of limitations associated with any approach does not provide a rational basis for its exclusion in cases in which it can be justified. With regards to psychopharmacological intervention, such justification might include the identification of an etiological factor or component of risk (i.e., a demonstrable syndrome, a diagnosable condition, or a comorbid pattern of symptoms or complaints) which is known to be amenable to medication-assisted intervention. …