Violence in Teens: A Case of Teenage Emotional Disorder
Tim Shannon, ND
Violence in teenagers is difficult to treat for many reasons. One is because teens often resist treatment. In addition, in teens or adults, there is often a great deal of denial and self-justification that makes getting an accurate assessment difficult.
Interestingly, some of my most violent patients have been quite charming. Often, they will deny any problems or minimize them incredibly. Despite having seen this phenomenon repeatedly, I can still be fooled by the teen until the parent tells me what is happening. Of course, there also are those patients for whom the violence and maliciousness are more apparent.
In many of my cases, I first see the teen separately. Then, after I’ve obtained whatever useful information I can, he or she is excused to the waiting room. It is often when the parent(s) comes in that a more realistic picture begins to form.
The following case was unique in that the patient spoke openly about his violence/rage. In addition, he was under treatment by a local psychiatrist. Many of these patients are either sent to a “boot camp” or are put on a variety of drugs. This patient had a long history of both. The off-label use of antipsychotics is common for violence and rage in teens.
“Martin” was originally put on prescription drugs and sent to boot camp because of various episodes of violence towards his mother. In one instance, he grabbed her by the throat and slammed her against the wall, choking her. His brother was there and got Martin away from her. Similar violent acts happened frequently enough that his mother sought help from a psychiatrist before bringing him to see me.
I first saw Martin in March 2003. He was 15 years old and being managed on 20mg of citalopram hydrobromide and 1.5mg of risperidone QD. Martin measured 6’2” and weighed 232 pounds. He started right off discussing the main issues:
“When really young, I was an antagonist at school, started fights, cussed at teachers. After parents divorced, I got worse. At age 8 my Dad died. Instead of just cussing at people, I got into lots of fights. I’ve always been really good at manipulating people to get my way.
“I was at a treatment center, got worse, then to detention center. I then went to another treatment center in the south, really rough for first six months. After that, things began to click, I started doing better. They diagnosed me with PDD [Pervasive Developmental Delay] and ODD [oppositional defiance disorder].
“In most areas I do above average except socially with peers. I was having a really hard time with peers – but good with adults. I want to have a good job, social standing.”
More? “Lately at school, I have a guy who I hang out with; we both have behavioral problems, good friends, but treat each other like crap. Others look at us and say, ‘Wow, they are jerks.’ Girls will comment about how rude we are to each other, and we will tell them it’s none of their business. If I feel threatened, I lock into a mode where I throw up defenses and attack and attack when people are in control of me, where they give me orders and tell me what to do. But I don’t have relationships with them.
“I want to take swing lessons and learn martial arts. I work out every day.”
Physical health problems? “I was 250lbs before I went to the rehabilitation center. I had been laying around all the time. But not feeling well, because I used to be so fat.
Asthma? “Up until 10, I could run without asthma problems. Then I stopped being athletic and got fatter, started bulking up. Then the asthma came.”
Problems when younger? “I used to throw up a lot – not to do with what I ate. If I was sad, or sometimes I’d just throw up, or if angry – in other words, if intense emotions happened, I’d vomit.”
What interests you about the military? “I’m not a huge patriot, now more interested in the experiences – like I could travel the world, do things that most people don’t do. Also allow me to get into the CIA, which is what I really want.”
CIA? “I want an ordered life, and a reasonably high secure income. Working for the government, you get crazy benefits. I’m not so interested in the spy operation, though I do want to work in a clandestine way, but more interested in the muscle work.”
Temperatures? “I like it cooler.”In the winter? “Still open window.”
Pain threshold? “I have a really high tolerance.”
Dentists? “Doesn’t bother me.”
I excused Martin to the waiting room, and invited in his mother. Here is her accounting: “Throughout his life, a tendency to be rigid in his thinking. It is difficult to get him to shift, long term. His difficulties: He doesn’t have a softness. We discussed something about having long-term relationships. He said, ‘I don’t want long-term relationships. That is not who I am.’ That concerns me highly … because he is a very hypersensitive person, very loving person, and has a big heart. He loves little kids. He is the protector spirit. But when he gets in this place … I’m not sure if it’s a defense mechanism. He’s not successful making human connections. He more often identifies with adults, but still plays with Legos. I believe he is very loving. If not successful with that, he withdraws, gets a hard edge.”
Hypersensitive? “He couldn’t have any tags in his clothes, didn’t like any wrinkles, couldn’t have much touch on him. Sounds, or tones of voice. He always has been a tone-of-voice kid. It wasn’t just what you said, but also your tone of voice. He may think I’m mad at him if I’m not careful; gets defensive very easily about the tone I use. The gabapentin settled him. It can also be in relation to his binge eating; he’ll vomit it all up after 20 minutes.”
Mother’s milk? “For a while, he had difficulties, he’d throw up a lot. I nursed him until he was almost two. Sometimes he’d give up on eating, after we’d introduced it, he’d nurse for four days in a row, and lose interest in eating. He was an all-consuming, high maintenance kid.
“We couldn’t get him to realize that something was enough unless you physically picked him up and took him out of the situation. He couldn’t have things not his way; he’d keep driving at it. If some kid decided to change to another game, he’d be trying to rope that kid to do what he was interested in. You couldn’t cue him or redirect him or distract him; you’d have to physically remove him. He was too demanding for his friends, they couldn’t tolerate him for long.
“He has always been rather large, and his anger intimidates people. He could always get himself in a lot of trouble.” Fears/Phobias? “When he was born, we lived in the woods. Didn’t do it with his brother, but every male that came up that driveway, he’d shriek or scream. We knew it was going to be a man at that door. And we didn’t have many people visiting; this was before he was one year old. We couldn’t ever figure out how he knew they were coming. He was initiating this severe reaction without any sounds that we could hear.”
Sleep? “Difficulty going to sleep, or awake for hours after everyone else was asleep. Most of his life, until 10, he slept with me or his Dad. For a while, he’d want to be in his room, but it would be up and down all night. He’d wake up at night, and say ‘momma,’ or he’d say ‘I had a dream.’
“If he can get a guy to wrestle with him … something about being very physical. Still chews on ice. He used to chew on his shirts and ruin them, right around the neck line.”
When I first saw this patient, I thought of Cuprum: He was not just violent, but he had a hero instinct and considered himself a protector. He was very concerned about injustices and wanted to right them. Martin’s mother described Martin as having a big heart and being sensitive. One thing that helps differentiate Cuprum from other metals is that the patients often have two sides to them: They can have a violent aspect as well as a more sensitive side. Martin wanted to learn martial arts and swing dancing. Physically there were also numerous expressions of contraction to confirm Cuprum – cramping, teeth grinding, etc.
Massimo Mangialavori gave a class on differentiating metals. It was his precise Cuprum profile that helped me to get to Cuprum with confidence for this patient. In addition, the repertory supported Cuprum as a possibility (see Table 1).
When I initially saw Martin, his violence was being controlled very successfully by the risperidone. That made it difficult to assess if the Cuprum remedy was working. There were changes that looked promising, but it was hard to be certain. In addition, Martin himself became discouraged, as he didn’t feel any significant changes. The patient and mother discontinued treatment in Fall 2003.
They returned for treatment in August 2005. Martin was completely off the antipsychotics; he was 17 years old and trying to get his record clean so he could get into the military. He said the military wouldn’t take him if he was dependent on drugs.
Martin: “I’ve been having trouble sleeping – mostly getting to sleep. Can get to bed at 12 but won’t fall asleep until 3, just laying there doing nothing.”
What else is of concern? “I’m pretty irritable with my mom; not so much with others, mainly with my mom.”
More? “All she is interested in talking to me about is, ‘you haven’t done this and not done that,’ so I’m always irritable when she talks to me.”
Irritable? “I’ll be snappy, I don’t care, don’t want to hear it, don’t want to talk to her. Generally, I’m rude.” (Patient is physically larger then when I saw him last). “I keep getting hives, like on the palms of my hands.”
Anything else? “The skin on my feet will peel and callous, and get a rash more often than normal. It is really frequent, large sections of the bottom of my feet will just peel off. If I grab some and pull, a whole layer of skin will come off.”
Anxiety or depression? “Definitely do get anxious, not depressed.”
In particular? “Mostly about how others think of me, or what their opinion is about me, am I saying the right thing, doing the right thing.”
Current meds? “Only escitalopram oxalate. About three months ago, I decided I wanted to join the army. They won’t take you with drugs, but without anything I got really, really depressed.”
Depressed? “I wouldn’t leave the house, just lay around in a pair of shorts, just read and sleep. Just wouldn’t leave.”
Singing/music (double checking for Cuprum)? “Oh yeah, love to sing, especially more obscure things, like musicals, gospels, old folk songs, etc. I like a lot of the songs from the ’60s, the peace songs. I have these two aspects, anger and violence, and music and enjoying singing. It’s harder during times when I’m with alpha males, but now a lot easier for me being around more flexible people. Now I can sing or dance, a lot more easy for me. Used to be totally uncomfortable with crying in public, but now it’s not a problem. I also like the teen ‘chick flicks,’ go see those by myself. I used to have lots of problems with it, ’til I became fine with who I am.”
(Case Note:The above information helped me to confirm that the patient probably did require some type of cuprum salt, so then I began to ask a number of questions to help with the differential.)
Ever have much Déjà-vu (thinking of Bromium)? “All the time – used to get it a couple times per day. Be sitting talking with someone, and ‘whoa, I’ve done this before.’ ”
Can you sleep with your back to the door (Bromium)? “I was really paranoid about crimes being committed around me, feel that someone would break into our house and steal something or kill us. I couldn’t sleep with my back to the door. It was so extreme that I would have to switch my head so that I could lay on the other side. If walking late at night by myself, I’m scoping out people, like wondering if they are a threat.”
More? “Is someone going to blow up a building? Or is someone going to see me walking alone on the street and shoot me? Or, if someone is walking behind me, I will definitely want to check over my shoulder. A lot of that has been helped by my joining the guardian angels patrol.”
Guardian angels? “We are a neighborhood thing, started in New York in 1979. I just joined like three or four weeks ago.” [Guardian Angels is a group of teenagers who are vigilantes. They patrol the streets and use their martial arts skills to protect civilians.]
Mom’s input, biggest concern? “That he is having a hard time focusing to get things done. He is incredibly messy and … focuses enough to get himself to work, but has to make calls to get to school. Also he is irritable with me, super easy. I can’t talk it out with him. I just have to ignore him, be quiet, get out of his way.
“He hasn’t been brushing his teeth for several years. Goes back and forth complaining that he needs some kind of dental care. Something is hurting in his mouth. He is grinding. Then has a tendency to get hooked on one variety of food. Ate 50 cans of a specific brand of noodle soup in two or three weeks.
“The stretch marks, when he put on so much weight; got up to 320 last year. His stretch marks are severe, really severe, all through his arms, back, all through his belly. He also does this demanding talk. If he wants something and I won’t get it for him, he’ll just get in my face and talk and talk at every level, will dominate with every conversation, with force – a driven conversation.”
I used this follow-up to confirm my original theory that this could be some kind of cuprum. In addition, I prompted him with several questions to confirm a cuprum salt. He confirmed the concept of déjà vu, as well as the idea of paranoia that someone is behind him. Mangialavori has stressed that frequent déjà vu is a common expression in bromium salts. This helped me to consider that the remedy could be Cuprum bromatum. In bromatum, the patient can have this fixation with the past or things behind him, and similar to iodatum, they can be overeaters, like Martin. I had him take Cuprum bromatum 30c QD for four days in a row. He returned for a follow-up one month later.
Follow-Up, September 2005
Martin: “When do I get more of that miracle medicine!? I’m sleeping a lot better. My sleep is very restful and contented. The days I took the remedy I was not sleeping as heavily as I usually do. It has been great. Not needing any drugs to fall asleep. Also, my mood has been more calm. Don’t know if that was part of it. The hives and acne are still there. Acne is not such a problem, but the hives are a bit of a bother, sometimes my hands get really itchy and itch until I get blisters.” (Pt shows some vesicles that have been broken open.)
Anything else? “I’ve been so much more active. Did two hours of martial arts last night, not so tired. In the past, I’d have been so exhausted. I’ve also gone on some good bike rides. My energy has definitely increased. I don’t crave sweets as much, either.”
Focus for school? “I seem to be accomplishing more. Things are definitely moving a lot more. Not relying on Mom for rides as much, doing more busing, more independent.”
Irritability? “There is much, much less irritability. My mom and I argue with some things, more normal I think.”
Mother’s input: “His sleep was better immediately. He’d been staying up for all hours of the night. He has been recovering with his irritability much quicker. He still has a pretty severe defensiveness. His responses are still very intense. I think he goes into that emotional abusive space, it is so intense. But with the rest of the world, he seems to be recovering or not even going there – beautiful. Clear improvement in both sleep and defensiveness with others.”
And his relationship with you is about the same? “It is not worse. When it is just he and I, yes he is still very angry, defensive. It is like the adolescent who wants to show he is a man, but if he hurts himself he cries like a baby because you didn’t get there soon enough – he seems like that to me.”
Anything else of note? “His skin seems pretty cleaned up. He’s a lot more willing to eat decent food. Before he was wanting to go out and eat fast food all the time. He was not a fan of fresh fruit until now.”
Case Notes, November 2005
Since the patient was doing well after four doses of 30c, I decided to let him be and give a bottle of Cuprum bromatum 30c (liquid) to hold onto for problems that might arise. This turned out to be a mistake.
The patient’s sleep declined about two months after the initial doses. He got frustrated and drank the whole bottle of the remedy. He became very edgy and dangerous after this. In one of his episodes, he got so angry that he kicked out the back windows of his mother’s car. Then went upstairs in the house and threw things out his window. It was an incredible tantrum. He cried afterwards and called his counselor. I didn’t know it at the time but the amount of the remedy given can make a difference. I’ve seen this phenomena in several bipolar and violent cases now.
Not knowing that he’d been overdosed, I had him take some 30c twice a week. But this also didn’t work. He became extra irritable just after the doses and would wake up with stomach cramps and violent vomiting. Because of this, I had him hold off on any further dosing the entire month of December.
His mother called in January 2006 saying he had been doing well in December, but had become aggressive. So I had him take a Q3 (similar to LM3) daily and scheduled to see him in March 2006.
Follow-Up, March 2006
How are you doing? “I’m doing really well. The acne has almost completely gone away. Other than the little remaining acne, everything else has been really good. Mom and I have had fewer conflicts. I’m more easygoing. Better able to focus my energy and accomplish things. I changed school to an independent study program.”
Getting along better with your mom? “Yes, definitely. Still having our snippets, but they are more friendly. I’m not so mean and rude. Now we are joking about it more, the dynamic has changed.”
What has your mom said about it? “She hasn’t, but usually would say I’m hurting her feelings, and so on, that was on a regular basis, that hasn’t been happening much at all.”
Guardian Angels? “I do it but definitely not as regularly.”
Any instances where lost temper and got a bit physical? “Definitely not since January. I’ve definitely lost my temper, but not where losing control of myself.”
Is there something you are aware of about things changing? “I’m definitely more at ease, and more empowered about how I’m in control of myself. When I was younger, I definitely had that feeling of being the slave to my emotions. Not feeling that way at all. Late January, I was a little depressed, wanted to just lay in bed, but got out and did things and was exercising. That was very good to feel that way. When I feel upset about things, I don’t have to act negatively, can do other things. Also things that would have irritated me much stronger definitely irritate me on a much smaller level.”
Sleep? “I’m sleeping, it is really resolved. Especially since exercising regularly, generally up by 7 or 8 and going to sleep early.”
Other issues you’re concerned about? “No, feel things are going well, keep doing what I’m doing.”
Déjà-vu? “That doesn’t happen much anymore. It used to be a frequent occurrence, now I can’t remember the last time that happened.”
Cramps? “I think there was one weekend, but it was because of overexercising, some cramps in lower legs.”
On guard watching out for threats? “Definitely going much better, partly because I can pick them out right away. Even when I’m out with the Guardian Angels, I worry much less. Also, I can watch horror movies, which before I never could do. I would have nightmares. Now, I realize they are more comical than anything else.”
Martin left for overseas a few weeks after this follow-up. His mother told me he took some of his remedy with him and has used it on various occasions PRN (for cramps, sleep issues, etc.). I asked her in May 2007 how he was and she said he is still doing great overall. He’s currently stationed in Afghanistan.
I’ve seen a good number of teens with this type of violence. There are, of course, many remedies where violence is expressed. In my experience, the precise remedy will quickly resolve the violence and help the patient to mature and begin to flow with life.
Tim Shannon, ND is in private practice in Portland. He specializes in the treatment of mental, emotional and behavioral health. He uses classical homeopathy to treat a wide range of mental health complaints: ADHD, OCD, PMS, autistic spectrum, depression, anxiety, eating disorders, PTSD, bi-polar, schizophrenia, etc. Dr. Shannon lectures at NCNM as well as to the local community on a variety of mental health complaints.