DR RAOUL GOLDBERG, BSC (MED), MB CHB, CEDH (HOM), practises anthroposophical medicine in his general family practice in Cape Town. He has been a school doctor in the Waldorf school movement for many years and has lectured widely on many subjects related to child development and health. His work is inspired by the knowledge that the foundations for a healthy life are laid down in childhood.

Acts of violence committed by children and adolescents have become commonplace events in our lives. It is estimated that between 25% and 43% of the perpetrators of violent and sex crimes against children are children themselves – some as young as six years old!1 In 2006, 82 children were charged in South African courts daily for raping or indecently assaulting other children. An increasing number of high school students now carry a knife, razor, firearm or other weapon on them on a regular basis and frequently bring these weapons to school. Teachers are having to handle aggression and violence in the classroom as part of daily school life, and school pupils stabbed to death by fellow pupils are frequently reported. While child-on-child violence is becoming endemic worldwide, self-inflicted violence among children is also increasing exponentially. Children are inflicting injuries on themselves by cutting and other means and committing suicide at a steadily increasing rate.

shades of violence in children and adolescents part1
DR RAOUL GOLDBERG, BSC (MED), MB CHB, CEDH (HOM), practises anthroposophical medicine in his general family practice in Cape Town. He has been a school doctor in the Waldorf school movement for many years and has lectured widely on many subjects related to child development and health. His work is inspired by the knowledge that the foundations for a healthy life are laid down in childhood.

Acts of violence committed by children and adolescents have become commonplace events in our lives. It is estimated that between 25% and 43% of the perpetrators of violent and sex crimes against children are children themselves – some as young as six years old!1 In 2006, 82 children were charged in South African courts daily for raping or indecently assaulting other children. An increasing number of high school students now carry a knife, razor, firearm or other weapon on them on a regular basis and frequently bring these weapons to school. Teachers are having to handle aggression and violence in the classroom as part of daily school life, and school pupils stabbed to death by fellow pupils are frequently reported. While child-on-child violence is becoming endemic worldwide, self-inflicted violence among children is also increasing exponentially. Children are inflicting injuries on themselves by cutting and other means and committing suicide at a steadily increasing rate.

Part 1 in this series looks at the escalating problem of child-on-child violence. Subsequent articles will examine self-inflicted violence and the nature of violence as a human and world phenomenon, and attempt to understand why it is happening and what we can do about it.

PICTURES OF VIOLENCE
Children and adolescents manifest many forms and degrees of aggressive behaviour, ranging from healthy defiance in a choleric 2-year-old to compulsive violent psychopathic behaviour that can be classified as an addictive tendency to violence. For reasons of clarity the various phenomena will be described in separate categories, but in reality they are often not so well demarcated and merge into one another: Natural unfoldment of the will may manifest as developmental aggression

During the first 7 years development of the will is crucial to normal development as the child asserts her will over her environment, establishing her own autonomy and identity and creating the standards and boundaries that are right for her. The screaming fits and tantrums of an infant can tyrannise a family and lead to the mental breakdown of parents.   Children who are more choleric often exhibit aggressive behaviour, pushing, pinching, hitting and grabbing toys from less assertive children. They have not yet mastered the will on the bodily level.2 The ‘terrible twos’ are a well-known, normal expression of oppositional behaviour that leads to growing independence. Children who frequently misbehave and then lie about their actions are afraid of the consequences. Young children who ‘steal’ things may still regard the world as their playground and feel they are entitled to it all. Most of this behaviour is innocent and short lived, expressing itself later in strong-willed children able to express initiative and creativity. The first 7 years is the age of imitation, with good or bad habits established through copying the morality prevalent in the environment.3 Thus a child who is often spanked will quite naturally feel it is right to hit out at his peers. In the second 7 years of life morality is established by learning to understand by example the difference between good and evil. A child who is habitually exposed to violent computer games where destruction and death are the overriding challenges, will frequently carry these lessons into his attitudes, feelings and behaviour. The tenth year, as the border between a light-filled childhood and a fearful dark unknown outer world, brings with it a new experience of the self, whereby the child is confronted with the dark and light side of his soul. This period up to puberty is often characterised by expressions of violence directed outwardly or inwardly (masturbation, petty stealing) as the teenager grapples with huge moral tensions. In the third period of 7 years the adolescent must experience inwardly the conflict between good and evil if he is to master the healthy unfolding of his will. An adolescent who does not have the good fortune to be guided by a friendly authority may fall into  periods of moodiness, hostility and  substance overuse that fortunately usually end innocently and are regarded as ‘passing phases’.

Reactive behaviour patterns4
We all know about our own reactive responses. Watch yourself closely in the course of a day and you will probably catch yourself many times reacting automatically in a defensive or aggressive manner to some outer trigger: moodiness, irritation, anger, withdrawal, judgment and guilt are but a few of the manifold reactive responses. How many times were they of an aggressive, critical or violent nature?

Reactions are reflex, compulsive and usually repetitive behaviour responses originating from survival instinct and earlier defensive coping mechanisms. On the bodily level any perceived threat results in a physiological defensive response (the fight-or-flight reaction) that ensures survival of the species.

The animal kingdom provides us with countless pictures of reactive behaviour patterns that display the relationship between a trigger and a reactive response. For instance a staffie terrier in a fight with another dog will lock its jaws on the dog and unless you know how to pull him off he will not let go.

The will nature in the form of instinct, drive and desire is pulled into action in the reactive response.

These are activities governed by the animal’s astral body. This is an organisation of forces that embrace all the sensory and feeling processes that perceive and experience danger or pleasure and the bodily apparatus that responds through the will activities in a life-preserving manner. The human being also has an astral body. In the reactive human being, this astral dimension takes over from the sober and reasoning self in an instant reflexive and unconscious action where it is invariably detrimental to human interaction.  Whereas the self can choose to refrain from eating when hungry or decide not to be angry when annoyed, the astral body simply reacts in a reflex manner. Since the development of the self is still young and immature in children and adolescents, they continuously manifest reactive behaviour patterns in one of four ways.

Explosive reactions are outer expressions via voice, gesture or body action that have a direct effect on the external environment. Outer aggression and violent behaviour fall into this category.

Implosive reactions are inner repressed expressions exploding on the inside because of the fear of the cost of exploding outwardly. For instance, a child suppresses her anger habitually for fear of upsetting her mother. This has a much more damaging effect on her internal environment, weakening organ systems such as the immune system and liver, leading to energy loss and fatigue conditions as well as a loss of self esteem and self expression. In these repressed reactions, the violence is directed inwards in a self-abusive manner taking a variety of different forms such as internalised anger or fear, self criticism or self hatred.

Secondary reactions are indirect pathways for outer expression, created for the release of implosive reactions where the feelings are expressed obliquely as an underhand action to get at the trigger: sulking, lying, ridicule, gossip, sarcasm, cynicism, etc.

Somatic reactions, seen mainly in young children, are bodily responses that express the inner hurt, for instance through tummy aches, rashes, allergic reactions, etc.

At the root of all reactions, whenever they occur and wherever they originate, lie hurt feelings and blocked expression. Understanding this provides a rational and compassionate way to deal with violence.

Disruptive behaviour disorders  
There are two main types5:
1. Oppositional Defiant Disorder: This condition of defiance, disobedience and hostility typically manifests between 7 years of age and adolescence, although it may begin as early as 3. Before puberty it is more prevalent in boys, after puberty the gender ratio is equal.

Brendan is an 8-year-old child of divorced parents who displays consistent negative defiant and hostile behaviour towards his mother and school teacher. He is an angry child. At home he is constantly doing things that he knows annoy his mother – he refuses to comply with house rules, is touchy, resentful, oversensitive, and frequently loses his temper. In class he is often argumentative, disobedient and disruptive, blames others for his shortcomings and struggles socially and academically.

This pattern of behavior may occur temporarily in response to stressful situations and alongside other disorders such as attention deficit/hyperactivity disorder. It may progress to conduct disorder.

2. Conduct Disorder.
 This is a common condition in childhood and adolescence characterised by aggression and violating behaviour and occurring at least four times more frequently in boys than girls. Six to sixteen per cent of boys and 2 – 9% of girls under the age of 18 years are estimated to show this disorder. These are very often emotionally deprived children where socio-economic factors, family dysfunction and parental personality and behaviour are significant contributing factors.
Bulani is 13 years old, and lives in an informal urban settlement with a highly dysfunctional family. His father is alcohol-dependent and physically abusive towards family members. His mother works in the day and walks the streets at night. He has a long history of aggressive behaviour. As a younger child he displayed cruelty to animals, committed acts of vandalism and was often truant from school. He is morose, verbally abusive and displays unfeeling and callous behaviour to his family. He is aggressive and defiant towards his teachers, he bullies children weaker than himself, is often involved in fights with others children, and on one occasion stabbed a fellow classmate. He is sexually active, regularly uses alcohol and tobacco, and has started using tik and hanging out with other anti-social youngsters.

The aggression may be expressed in various forms.

Animal cruelty.
 There are many shades of childhood cruelty towards living creatures: small children will chop an earthworm in two because they want to watch the separate halves squirming, pull the wings off flies and other insects or pull the cat’s tail with obvious satisfaction. The vast majority of children lose their interest in sadistic behaviour at an early age and grow up without any obvious sign of psychopathology. Although it may occur as young as 4 years of age, serious and repeated animal cruelty is most common during adolescence and is seen more often in boys than girls. It is often associated with neglect or abuse in the family and is carried out by children who have poor self esteem, few friends, have bullying tendencies and a history of truancy, vandalism and other anti-social behaviour. Studies have found that many children, teenagers and adults who commit acts of violence and murder have a history of animal cruelty. Animal torture is one of the acknowledged common indicators in the childhood of known serial and mass killers.

Bullying
. This can take place in any situation, at home, at school, outside school and in cyberspace. About one in five schoolchildren are bullied regularly and around one in five bully regularly. Boys and girls bully equally and both can be targets. The bullying continuum as described by E.M. Field6 may range  from relatively mild bullying such as innocuous social banter, hurtful teasing, mean body language and mildly aggressive physical behaviour (pushing, shoving, kicking), to malicious gossip,  social exclusion (personal or impersonal through electronic media) and harassment (sexually, racially, religious, etc.), to more serious bullying, e.g. mobbing, extortion and bribery, damage to property, physical injury and violation through unarmed fighting, to using weapons of violence and ultimately to murder. Yet even the milder forms can be extremely traumatic for some children, as was seen recently when a 13-year-old girl committed suicide after sexually revealing pictures of her were circulated to her community via cell phone.

Field describes four types of bullying: (i) Teasing: verbal violence is used in many different forms, e.g. name-calling, insulting, harassing, threatening, phone and electronic abuse. (ii) Social exclusion: the target is excluded from individual or group social interaction, e.g. the bully manipulates the group to exclude the target from social activities. (iii) Harassment: repeated interference and intimidation aimed at upsetting and hurting the target through verbal, sexual, or physical action. (iv) Physical: regular attacks of varied nature against the weaker person or her property ranging from indirect intimidation to direct aggressive action of varying degree.

The bully can only exist if he has someone to bully. The bully needs a vulnerable target and a reaction that usually invites the attack; often a co-dependent relationship develops. It is important to realise that the bully and the bullied are two sides of the same coin. The bully may become addicted to his behaviour because of the pleasure and gratification it affords him. Underneath the aggression, however, all bullies are highly vulnerable, i.e. they feel bullied themselves.

Delinquency and gangsterism. 
Children before puberty commonly have the need to form gangs and, empowered by the group consciousness, indulge in petty acts of vandalism like ringing on neighbours’ doorbells, painting on walls, stealing fruit from the neighbour’s garden, etc. These are relatively normal and innocent developmental ways of expressing their independence and emergence into the bigger world. It is only those children with more serious anti-social tendencies who will become gang members of violent street gangs. They usually join up through age-appropriate friendships. Most of these are teenagers or adolescents who have a history of earlier poor school performance, behaviour problems and psycho-emotional instability. There is usually some degree of family or social dysfunction, e.g. parental discipline may be excessively harsh or absent through lack of supervision and control.

In part 2 we shall look at other phenomena of violent behaviour and endeavour to understand the nature of violence.

References
1. Omar S, Wild A. Research into the Dynamics of Young Sex Offenders in Venda. Research conducted for Thouyandou Victim Empowerment Trust, 2005.
2. Gloeckler M, Goebel W. A Guide to Child Health. Edinburgh: Floris Books, 2003.
3. Lievegoed B. Phases of Childhood. Edinburgh: Floris Books, 1985.
4. Tagar Y. Psychophonetic Counselling Manual, Unedited.
5. Kaplan & Sadock, eds. Synopsis of Psychiatry. 8th ed. Baltimore: Lippincott Williams & Wilkins, 1998.
6. Field EM. Bullying Blocking. Sidney: Finch Publishing, 2007.