Culture, Medicine and Psychiatry

, Volume 32, Issue 1, pp 66–82 | Cite as

When the Patient Remains in Danger: Psychotherapy in U.S. Combat Zones

  • Christopher Roach
Original Paper


Much of the literature on the psychological treatment of victims of violence focuses on demographic populations that do not represent the majority of victims. Part of the origin of this problem is that the prototypical victim and the prototypical perpetrator are often the same. Young, poor, minority males often constitute both the victim and the perpetrator class in America. As a group, these individuals, while disproportionately thought of as suitable for incarceration, are not thought of as good candidates for psychological treatment. However, their suffering is real, unrelenting and often not addressed. Therapists face significant barriers, in the patient, in society and in themselves, in trying to help these individuals. This article examines the issues of racism, drugs, ongoing danger, class inequalities, misogyny and the blended victim/perpetrator, all of which complicate engagement and understanding between therapist and patient.


Violence Psychotherapy Trauma Urban U.S. 


  1. Alaniz, M. 1998 Alcohol Advertising and Targeted Advertising in Racial/Ethnic Minority Communities. Alcohol Health and Research World 22: 286–289.Google Scholar
  2. American Psychiatric Association 1994 Quick Reference to the Diagnostic Criteria from DSM-IV. Washington, DC: American Psychiatric Association.Google Scholar
  3. American Psychiatric Association 2000 Diagnostic and Statistical Manual of Mental Disorders. 4th Edition. Text Revision (DSM IV-TR). Washington, DC: American Psychiatric Association.Google Scholar
  4. Anderson, E. 1999 Code of the Street: Decency, Violence and the Moral Life of the Inner City. New York: W.W. Norton.Google Scholar
  5. Austin, J. 2002 The Need to Reform Parole Board Decision Making. Address to the Association of Paroling Authorities International, Salt Lake City Conference, 2002. Available at:, accessed March 21, 2005.
  6. Babcock, J.C., and R. Steiner 1999 The Relationship Between Treatment, Incarceration, and Recidivism in Battering: A Program Evaluation of Seattle’s Coordinated Community Response to Domestic Violence. Journal of Family Psychology 13: 46–59.CrossRefGoogle Scholar
  7. Baily, D.S. 2001 Number of Psychology PhDs Declining. Monitor 132: 18.Google Scholar
  8. Bluestone, B., and B. Harrison 1982 The Deindustrialization of America: Plant Closings, Community Abandonment, and the Dismantling of Basic Industry. New York: Basic Books.Google Scholar
  9. Bourgois, P. 1996 In Search of Respect: Selling Crack in El Barrio. Cambridge: Cambridge University Press.Google Scholar
  10. Bourke, J. 1999 An Intimate History of Killing: Face-to-Face Killing in Twentieth-Century Warfare. New York: Basic Books.Google Scholar
  11. Bruce, M.A., and V.J. Roscigno 2003 “Race Effects” and Conceptual Ambiguity in Violence Research: Bringing Inequality Back in. In Violent Crime: Assessing Race and Ethnic Differences. D.F. Hawkins, ed., pp. 238–253. Cambridge: Cambridge University Press.Google Scholar
  12. Buchannan, W. 2005 More Officers on the Beat. San Francisco Chronicle, March 2: F1, F3.Google Scholar
  13. Bulwa, D., and J.H. Zamora 2005 New Light Shed on Slaying of Athlete. San Francisco Chronicle, April, 2005: A1, A11.Google Scholar
  14. Chang, J. 2005 Can’t Stop Won’t Stop: A History of the Hip-hop Generation. New York: St. Martin’s Press.Google Scholar
  15. Clue, D.J. 2000 Magic and Bird. DJ Clue: This Is It: Part 2. Universal/Def Jam Records.Google Scholar
  16. Davidson, J.R., D. Hughs, D.G. Blazer, and L.K. George 1991 Posttraumatic Stress Disorder in the Community: An Epidemiological Study. Psychological Medicine 21: 713–721.CrossRefGoogle Scholar
  17. Dishion, T., J. McCord, and F. Poulin 1999 When Interventions Harm: Peer Groups and Problem Behavior. American Psychologist 54: 755–764.CrossRefGoogle Scholar
  18. Fowles, J. 1999 The Case for Television Violence. Thousand Oaks, CA: Sage.Google Scholar
  19. Freedman, J. 1996 Violence in the Mass Media and Violence in Society: The Link is Unproven. Harvard Mental Health Letter 12(11): 4–6.Google Scholar
  20. Hare, R. 1993 Without Conscience: The Disturbing World of the Psychopaths among Us. New York: Guilford Press.Google Scholar
  21. Haritos-Fatourous, M. 2003 The Psychological Origins of Institutionalized Torture. London: Routledge.Google Scholar
  22. Herman, J.L. 1992 Trauma and Recovery. New York: Basic Books.Google Scholar
  23. Hoge, C.W., C.A. Castro, S.C. Messer, D. McGurk, D.I. Cotting, and R.L. Koffman 2004 Combat Duty in Iraq and Afghanistan, Mental Health Problems, Barriers to Care. New England Journal of Medicine 351: 13–22.CrossRefGoogle Scholar
  24. Hooks, B. 1994 Misogyny, Gangsta Rap and the Piano. ZMagazine, February. Available at:, accessed April 15, 2005.
  25. Joy, J.E., S.J. Watson, and J.A. Benson, eds. 2003 Marijuana and Medicine: Assessing the Science Base. Washington, DC: Institute of Medicine, National Academy Press.Google Scholar
  26. Kang, H.K., and K.C. Hyams 2005 Mental Health Needs among Recent War Veterans. New England Journal of Medicine 352: 1289.CrossRefGoogle Scholar
  27. Kitwana, B. 2002 The Hip Hop Generation: Young Blacks and the Crisis in African American Culture. New York: Basic Civitas Books.Google Scholar
  28. Kleinman, A. 1999 Experience and Its Moral Modes: Culture, Human Condition and Disorder. In The Tanner Lectures on Human Values. G.B. Peterson, ed., Vol. 20, pp. 357–420. Salt Lake City, UT: University of Utah Press.Google Scholar
  29. Lelchunk, I. 2005 New Hope for S.F. Public Housing as Federal Funding Disappears. San Francisco Chronicle, March 28: A1, A9.Google Scholar
  30. McCall, N. 2004 Makes Me Wanna Holler: A Young Black Man in America. New York:Random House.Google Scholar
  31. McNally, R.J. 2003 Remembering Trauma. Cambridge, MA: Belknap Press.Google Scholar
  32. National Drug Intelligence Center 2002 Kentucky Drug Threat Assessment. Available at:, accessed May 2, 2005.
  33. National Drug Intelligence Center 2001 Wisconsin Drug Threat Assessment. Available at:, accessed May 2, 2005.
  34. Ogrodniczuk, J.S. 2006 Stratagies for Reducing Patient-Initiated Premature Termination of Psychotherapy. Harvard Review of Psychiatry 13(2): 57–70.CrossRefGoogle Scholar
  35. Pasztory, E. 2005 Thinking with Things: Toward a New Vision of Art. Austin: University of Texas Press.Google Scholar
  36. Petersilia, J. 2000 Challenges of Prisoner Reentry and Parole in California. California Policy Research Center, 12, No. 3. Available at:, accessed March 25, 2005.
  37. Pitzer, J.K., and P.D. Drummond 1997 The Reliability and Validity of Empirically Scaled Measures of Psychological/Verbal Control and Physical/Sexual Abuse. Relationship between Mood and a History of Abuse Independent of Other Negative Events. Journal of Psychonomic Research 43: 125–142.CrossRefGoogle Scholar
  38. Rassmussen, D.W., and B.L. Benson 1994 The Economic Anatomy of the Drug War: Criminal Justice in the Commons. Lanham, MD: Roman and Littlefield.Google Scholar
  39. Reiss, A.J., and A.J. Roth, eds. 1994 Understanding and Preventing Violence, Vol. 3: Social Influences. Washington, DC: National Academy Press.Google Scholar
  40. Roizen, J. 1997 Epidemiological Issues in Alcohol Related Violence. In Recent Developments in Alcoholism, Vol. 13, pp. 7–40. New York: Plenum Press.Google Scholar
  41. Roug, L. 2005 Extreme Cinema Verité. Los Angeles Times, March 14: A1.Google Scholar
  42. Ryan, J. 2005 Berkeley Slashing No Surprise. San Francisco Chronicle, March 27: A22.Google Scholar
  43. San Francisco Police Department 2003 SFPD Annual Report 2003. Available at:, accessed March 1, 2005.
  44. Sawada, A., J. Chaitin, and D. Bar-On 2004 Surviving Hiroshima and Nagasaki—Experiences and Psychosocial Meanings. Psychiatry 76: 43–61.Google Scholar
  45. Schmitt, E. 2005 General is Scolded for Saying, “It’s Fun to Shoot Some People.” Los Angeles Times, February 4: A13.Google Scholar
  46. Serwach, J. 2005 Positive Emotions Slash Bias, Help People See the Big Picture. Available at:, accessed November 19, 2007.
  47. Seto, M., and H. Barbaree 1999 Psychopathy, Treatment Behavior and Sex Offenders. Journal of Interpersonal Violence 14: 1235–1248.CrossRefGoogle Scholar
  48. Shakur, S. 1993 Monster: The Autobiography of an L.A. Gang Member. New York: Grove Press.Google Scholar
  49. Sherman, C. 2000 Treatment of Psychopaths Is Likely to Make Them Worse. Clinical Psychiatry News 28(5):38.Google Scholar
  50. Smedley, B.D., S.B. Butler, and L.R. Bristow, eds. 2004 In the Nation’s Compelling Interest: Ensuring Diversity in the Health-Care Workforce. Washington, DC: National Academies Press.Google Scholar
  51. Street, A.E. 1998 Psychological Abuse and Posttraumatic Stress Disorder in Battered Women: Examining the Role of Shame. Dissertation Abstracts International 59(5): 2438B.Google Scholar
  52. Swofford, A. 2003 Jarhead: A Marine’s Chronicle of the Gulf War and Other Battles. New York: Scribner.Google Scholar
  53. Thompson, M.E., and R.K. Brown 2002 Whites and Rap Music: Is it Really All Bad? African-American Perspectives, 97–105. Available at:, accessed May 5, 2005.
  54. U.S. Census Bureau 2000 Census 2000 Urban and Rural Classification. Available at:, accessed April 24, 2005.
  55. U.S. Department of Justice 2001 Trends in State Parole, 1990–2000. Washington, DC: U.S. DOJ.Google Scholar
  56. U.S. Department of Justice/Bureau of Justice Statistics 1999 American Indians and Crime. Available at, Accessed December 18, 2007.
  57. U.S. Department of Justice/Bureau of Justice Statistics 2003a Homicide Trends in the United States. Available at:, accessed March 1, 2005.
  58. U.S. Department of Justice/Bureau of Justice Statistics 2003b Victim Characteristics. Available at:, accessed March 1, 2005.
  59. U.S. Department of Justice/Bureau of Justice Statistics 2007a Black Victim Violent Crime (NCJ-214258). Available at:, accessed August 9, 2007.
  60. U.S. Department of Justice/Bureau of Justice Statistics 2007b Crime Characteristics. Available at:, accessed November 12, 2007.
  61. White, R.W., and D.M. Gorman 2000 Dynamics of the Drug Crime Relationship. Criminal Justice 1: 151–218.Google Scholar
  62. Wilson, J.Q., and R.J. Herrnstein. 1985 Crime and Human Nature: the Definitive Study of the Causes of Crime. New York: The Free Press.Google Scholar

Copyright information

© Springer Science+Business Media, LLC 2008

Authors and Affiliations

  1. 1.San FranciscoUSA

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