Roots of Aggression – A Community Health Perspective

By Tia Will

By coincidence our City Council meeting of 3/21, at which an ordinance was passed to give the police more “tools” to deal with “aggressive panhandling” was passed, preceded the Maternal Child Adolescent Health presentation on ACES (Adverse Childhood Experiences) by one day. While the council’s action focused on one small, but highly visible, readily identifiable portion of our community, the problem of aggressive behavior in our society is much more widespread.

We see this in our lives daily. We see bullying on our playgrounds, aggressive behaviors at sporting events ( one coach was sanctioned for telling his soccer players to “go for her leg” when an opposing player was still recovering from a minor injury), on social media from our top economic class to middle school students, in deliberate sabotage of the projects and careers of others, to overt violence, in our homes, on our streets perpetrated by both civilians ( Las Vegas, Charlottesville, Austin) and by police in the form of excessive force ( Sacramento/Ashville, NC/ Davis). What I feel we have done through our recent council decision is to focus only on the tree immediately before us, the visibly poor in our downtown area, while failing to see the forest all around us.

https://www.cdc.gov/violenceprevention/acestudy/index.html

Today, I would like to focus not on the manifested aggressive behaviors of a single population, but rather upon one root cause, the inability to positively (or at least nondestructively) manage negative emotions. First, aggression is the outward manifestation or expression of negative emotion. That emotion may be anger, frustration, envy, greed or impatience. Our predominant culture teaches different subsets of people, usually segregated by gender, to manage these emotions differently. Aggression in males is traditionally funneled into overt displays such as raised voices, physical displays such as standing taller, attempting to display increased size or musculature, crude language or threats. For females, aggression frequently manifests as gossip, rumor, exclusion and shaming.

So why do some people learn to effectively channel these negative emotions which we all experience into positive actions, while others follow a path of outward aggression? One partial explanation lies in the ACES model of early childhood experience. This model, initially based on a large Kaiser Southern California study involving 17,000 patients, demonstrated the lifetime health consequences, both physical and mental, of adverse events experienced during childhood including parental death, child abuse and neglect, spousal abuse, parental depression, & drug abuse/ alcoholism. Simply put, the larger the number of these experiences, the higher the ACES score. The higher the ACES score, the more likely the patient would experience a number of health problems, both physical and mental extending into adulthood. A major consequence that we are currently seeing in our city is that of unmanaged mental health problems.

Fortunately, we have the ability to detect at risk children and families and intervene. We have identified factors which are protective even when there is an elevated ACE score. One such protective factor is maternal/child bonding which begins in utero, is encouraged by skin to skin and eye contact interactions and breast feeding. These activities can be encouraged and taught in our health care facilities and strengthened through home visitation. These services are available in our community hospitals and by referral to our county health services. Preconception, prenatal and postpartum care are all critical to diagnose and treat women’s conditions and illnesses from obesity, prediabetes, and hypertension on the physical side, to depression,  bipolar disorder, and the much less common schizophrenia on the mental side. Diagnosis and treatment of all are critical to the health of both the developing fetus and the physical and mental well-being of the infant and toddler. Synaptic formation in infancy and early childhood is critical to the individual’s ability to adapt and to their level of resilience as they mature.

It is my belief that as a city, as well as a county, we have an obligation to help our at-risk populations. Undesirable behaviors that we see in community members are frequently the result of mental illness, physical disability, or lack of coping mechanisms beyond the control of the adult individual. Many are a reflection of both parental and societal failure to provide a nurturing environment for the individual as a child.

I would suggest that rather than focusing time and effort on the “stick” of enforcement or punitive measures against a highly visible and well-defined subgroup of our population, we would do far better to help those who are now adults to reintegrate to the best of their ability into our community. One example of such help is our local Pathways to Employment Program, a collaborative city, interfaith, and business program that helps the unhoused population to earn a wage while working to clean and beautify the city.  On a number of occasions, I have stopped to chat with some of these workers on my daily walk. They seem to take pride in the work they are doing and the service they provide.

At the same time, we should be fully utilizing our primary prevention resources to ensure that all children identified as at increased risk, defined as an ACEs score of 1 or higher, have access through voluntary referral to services available to strengthen the family by eliminating/minimizing those of the adverse experiences such as domestic violence, neglect, substance abuse that we can, and minimizing the impact of those which are unavoidable such as the death of a parent.

Neither of these approaches should be seen as a panacea, or even as a solution. Neither is adequate to the scope and depth and complexity of this problem. What I am seeking is not a “cure” but rather harm reduction both for the individuals involved, and for our community as a whole. I am seeking improvement through collaborative approaches and demonstrated best practices, not utopia.

As a community, we have a choice. We can focus narrowly on a highly visible group of our population who we are uncomfortable seeing. Or we can can recognize the broader scope of the problem of outwardly directed aggression, its root causes, & its ubiquitous nature in our community. We can take preventative measures to lessen the individual’s risk of ongoing mental and physical problems in adulthood by taking steps to improve their chances of developing into resilient, well integrated members of our society able to channel their negative emotions into positive, constructive action.