220550289-Head injuries

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Section 1

In the United States, interpersonal violence is a significant cause of death and disability. According to Hart, Hanks, Bogner, Millis, & Esselman (2007), intentional injury is one of the major consequences caused by violence and it is estimated that 15-20% of brain injuries are caused intentionally. Intentional injuries such as traumatic brain injury (TBI), have risk factors that are linked to interpersonal violence. Such risk factors includes minority group status, lower education and income levels, unmarried status, unemployment and pre-injury substance abuse (Hart et al, 2007). According to Hart et al. (2007), it has been concluded, “the worse outcomes of intentional TBI are mediated by the pre¬injury factors that covary with etiology particularly substance abuse and poor educational and vocational background” (p. 153). The study found blame attribution issues which are markers of TBI-related to emotional distress regardless of injury cause, particularly when others are being blamed for the injury and/or concerns over cause of injury do not resolve over time (Hart et al., 2007).

Other researchers have found more of the same risk factors in a study done by Turkstra, Jones & Toler (2003). The studies were based on African American men who were convicted of domestic violence and those without criminal convictions. Criminal behavior, especially in violent crimes, can result from a complex interaction of factors. Factors include genetic pre-disposition, emotional stress, poverty, substance abuse and child abuse (Turkstra, Jones & Toler, 2003). These factors play a role in behavior of the convicted men who have shown aggressiveness due the brain injury that they have sustained. It is said that TBI impairs the ability to inhibit violent behavior. Also, TBI may increase the probability of crime for those who are already predisposed to violence.

There were also brain lesions in areas that “may influence functions such as social perception, self-control and judgment, as well as emotions and mood. An individual with TBI may misperceive elements of a situation (e.g., interpret sarcasm as a threat), make poor social judgments (e.g., behave inappropriately in public), overreact to provocative stimuli, that lacks the communications skills to verbally negotiate conflict or strike impulsively” (Turkstra et al., 2003, p. 39-40). Impulsivity is an action that takes places without thought. Brain damaged criminals get caught and end up in jail, which is usually due to to their impulsive thinking. Studies have found that domestic violence offenders have revealed that TBI is only one of many correlates of batterer status, and factors such as cognitive ability, psychosocial history and emotional distress also play a significant role (Turkstra et al., 2003). For those who are in the batterer group, the researchers have found symptom severity was associated with crime and there was more effects of anger in their daily living (Turkstra et al, 2003).

There was a study done on 279 Vietnam veterans who came back home with brain injuries. The study found that veterans with TBI had higher ratings of violence, aggression, anger, and hostility than those without TBI (Turkstra et al., 2003). The link between TBI and crime is what is thought to be the reason behind the damage in the brain’s frontal lobe. Frontal lobe injuries are associated with the loss of control over sub cortical and limbic structures that are directly related with impulsivity. A great example of frontal lobe injury would be the infamous Phineas Gage. Phineas Gage’s had a large iron rod driven through his head after a railroad construction explosion. Gage may have survived but the part of his brain that controlled his personality and behavior were affected. His injury turned him into a more aggressive person and he was not able to control his impulses. Although Gage’s accident was unintentional, the results were still the same – he became more aggressive and violent. His accident affected him and those around him greatly.

Head injuries can be helped through preventions and interventions. Leon-Carrion & Ramos (2003) mentioned that criminal behavior and violence may be the consequence of head injuries acquired during childhood and youth such as gang fights, domestic violence, small blows to the head while driving, falls and so forth. The researchers found different ways of preventing such events from happening. As researchers have pointed out, criminal behavior occurs at a young age. Youth from lower social classes are more likely to be street violent, while those coming from higher social classes are more likely to be family-violent or commit non-violent offenses (Leon-Carrion & Ramos, 2003). For example, a number of cases of violent offenders who sustained brain injuries in their youth occurred within the context of gang initiation rites, or in activities carried out to maintaining the privilege of belonging to a gang (Leon-Carrion & Ramos, 2003). Severe brain injury affects youths later in life because they are not able to meet their needs or to achieve their desires through normal channels, so they resort to motor activity such as aggression and violence. Prevention should be centered on the focus of family and social measures that will avoid youth from gathering experiences in violence such as blows to the head from a fight. With the regards of family history, family (immediate and relatives) should be informed and aware that physical punishment (spanking, slapping, etc) involving blows to the head that are potentially damaging to normal psychological functioning and could later lead to a child or youth to be involved in criminal activity. As for social measures, educational programs and mechanisms should be established in the community so the child can avoid street fights between groups and gangs. Family and social measures are forms of prevention methods that will help children stay away from violence that can affect their cognitive behavior when they get older.

As one of the risk factors previously mentioned by Leon & Ramos (2003), child abuse is a risk factor for brain injury and physical violence is not a form of punishment for a child. Parke and Gauvain (2008) concurs with this, as they stated that exposure to traumatic events can damage the brain and cause it to malfunction in an individual’s behavior. The technique used to find the brain activity and function is the PET scan (positron-emission tomography). The PET scan can show the effects on the brain in the earlier development and the changes. In abused children, both the cortex and limbic system are 20-30% smaller than those who were not abused. The limbic system is important because it is part of the brain that is involved with emotions. If the limbic system is damaged, the child may act impulsively with no control, and violence may occur much later in life.

There are psychological approaches that may help with a long period of time to achieve durable changes, this works especially for a case of head injuries (Manchester, Hodgkinson & Casey, 1997). The researchers did not find the psychiatric ward or the head injury ward effective for patients who had head injuries. The intervention is an interim unit that is based upon the principles of neurobehavioral rehabilitation in a hospital. The intervention is the “opportunity that neurobehavioral rehabilitation units have to focus on the consistent reinforcing and strengthening of adaptive behaviours” (Manchester et al., 1997, p. 614). This intervention is effective because it can identify the inconsistent management of aggression, which is almost inevitably a result in intermittent reinforcement. This reinforcement is powerful because it makes violent behavior very difficult to eliminate. The intervention will improve the quality of life for head injured patients that can increase the likelihood of greater independence in the future, so it will ease the financial pressure on local health and community services. There is potential that may reduce the overwhelming emotional burden by the families and inappropriate hospitalization can be avoided.

Section 2

On Thursday night, May 15, 2009, a 911 call was made to Polk County Sheriff’s Office on a family disturbance. The deputies found Edmond Sutton, 27, in a barn and armed. Sutton’s mother, Danita, called and told the deputies they had an argument earlier that the night and she was scared of him because he has once involuntarily committed under the state’s (Florida) Baker Act due to a previous violence with another family member. The Baker Act is a means of providing individuals with emergency services and temporary detention for mental health evaluation and treatment when required, either on a voluntary or an involuntary basis. Sutton’s mother said he became more violent after suffering a serious brain injury from a 2004 motorcycle accident. Sutton’s previous arrest history includes aggravated battery, methamphetamine possession, dealing in stolen property, grand theft and possession of a weapon by a convicted felon.

Three deputies approached the barn where Sutton was armed with a .22-califber rifle, aimed at one of the officers. When Sutton refused to drop the weapon, the three officers fired their Glocks at Sutton 24 times and hit Sutton several times. He was pronounced dead later that night. The officers are now being investigated and are on administrative leave.

Section 3

Violent behavior can provoke an individual to think impulsively, especially due to his or her own brain injury. In the example above, Edmond Sutton became more aggressive according to his mother after his motorcycle accident. However, the change after the accident proves that traumatic brain injury can lead an individual to be aggressive. As Danita Sutton admitted, she and Sutton had a violent argument earlier that night, she was afraid he was going to kill someone or herself, therefore she called the police to help. However, she never anticipated on Sutton getting killed in the process. How can Edmond Sutton’s violent behavior be explained? It is explained through Sutton’s brain injury. The brain lesions have affected his cognitive thinking, making him more aggressive, having no self-control, and created a change of perception. As Turkstra et al. (2003) mentioned about what brain lesions could do to an individual with brain injury, Sutton confirms their research findings. The research findings stated that brain lesions might have influence an individual perception, self-control and judgment, which resulted in aggressive behavior. The brain injury gave Sutton no self-control of reducing his aggression after the accident because he got in trouble with the law.

Sutton had become more violent over the past five years and doing things impulsively because of previous arrests. His mother said that he became more violent and aggressive than before. Although the Baker Act provides services for mental illness treatment, it states that a person can only be detained for no more than 72 hours. Therefore, Sutton was not able to get the help he needed to reduce his aggressive behavior. It seems that the Baker Act is not effective for those who have suffered a severe brain injury. Manchester et al. (1997) intervention has found that an individual who exhibits aggressive and violent behavior from brain injury can be helped through the temporary unit. The temporary unit located in London that helps brain injured patients to adapt to their new settings. This intervention gives a chance for those in need to learn how to adapt to their environment with their condition. It would have provided management for his aggression and strengthen the ability to live life prior to his injury. If Edmond Sutton had received the help and treatment he needed, he would be alive today and he would have been able to adapt to his daily living and reduced his aggressive behavior.

Section 4

On April 20, 1999, two students at Columbine High School had embarked in one of the deadliest school massacres in United States history. The two perpetrators, Eric Harris and Dylan Klebold, killed 12 students and one teacher, however, there was many who were injured during the massacre. How does traumatic head injuries relate to the Columbine massacre? According to Turskstra et al. (2003), the two perpetrators may have brain lesions caused by TBI in which may have caused these boys to act impulsively. These brain lesions may have changed Harris’ and Kebold’s perception, self-control and judgment, because TBI causes misperception of the situation. Both of the boys had acted in violence, anger and hostility because there was a hatred for society. However, there was no evidence of brain traumatic injuries in the perpetrators in their autopsy.


Hart, T., Hanks, R., Bogner, J., Millis, S. & Esselman, P. (2007). Blame attribution in intentional and unintentional traumatic brain injury: Longitudinal changes and impact on subjective well-being. Rehabilitation Psychology, 52, 152-161.

Leon-Carrion, J., & Ramos, F. (2003). Blows to the head during development can predispose to violent criminal behaviour: rehabilitation of consequences of head injury is a measure for crime prevention. Brain Injury, 15, 207-216.

Manchester, D., Hodgkinson, A., & Casey, T. (1997). Prolonged, severe behavioural disturbance following traumatic brain injury: What can be done? Brain Injury, 11, 605-617.

Parke, R.D., & Gauvain, M. (2008). Child psychology: A contemporary viewpoint (7th ed.). New York: McGraw-Hill.

Turkstra, L., Jones, D., & Toler., H. (2003). Brain Injury and violent crime. Brain Injury, 17, 39-47.

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