Post Modern Stress Disorder: Violence & Health

With mass shootings and terrorist attacks erupting randomly around the globe– from Oregon to Paris to Beirut to Colorado Springs to San Bernadino— life at the close of 2015 is violent and stressful. Hours after a husband-wife team shot up a holiday party for public health workers in San Bernadino, the Boston Globe released a story stating that the US had seen 355 mass shootings in 336 days in 2015.

Just a few weeks before the Paris terrorist attack, The American Journal of Medicine published a provocative article by Arnold R. Eiser, MD, theorizing the existence of a new disorder: Post Modern Stress Disorder.

In his review in the November 2015 issue of the Journal, Eiser contends that repeated “microtraumas” caused by exposure to violent imagery could have a lasting negative affect on individuals. He compares microtraumas and post modern stress disorder to the macrotraumas of warfare and the development of post-traumatic stress disorder (PTSD).

This disorder [post modern stress disorder] is characterized by repetitive exposure to digital images of violence in a variety of electronic media, including films, television, video games, music videos, and other online sources. This disorder appears to be a variant of posttraumatic stress disorder, and shares with it excessive stimulation of the amygdala and loss of the normal inhibitory inputs from the orbitofrontal cingulate cortical gyrus. In postmodern stress disorder, repetitive digital microtraumas appear to have an effect similar to that of macrotraumas of warfare or civilian assaults. Other elements of the disorder include the development of fixed ideas of bullying or public shaming, access to weapons, and loss of impulse control. This syndrome could explain a number of previously inexplicable murders/suicides.

Eiser contends that when investigating acts of violence that forensic procedures include a look at the alleged perpetrator’s exposure to violent video games and other violent media, so prevalent in our post modern society. He uses the Columbine High School shooters as examples of mass murderers who regularly played violent gun-related video games. Although not mentioned in the article, the Sandy Hook Elementary shooter, Adam Lanza, also was a well-known aficionado of violent video games. Eiser writes…

In contemplating the inexplicable crimes the world has witnessed recently, the murder of Brigham and Women’s Hospital cardiovascular surgeon Michael Davidson, MD by Stephen Pasceri stands out, especially to those who practice medicine. What drives a person to commit such a highly destructive and self-destructive act, apparently in a manner that is very out of character? I suspect there is a relatively new psychological disorder that afflicts perpetrators of such heinous yet inexplicable crimes. I term this condition, Postmodern Stress Disorder (PMSD), and will describe its salient features.

Electronic media saturation, with news and fictional works of a dystopic, violent, and apocalyptic nature, the 24-hour/7-day news cycle, violent video games, and social media all play, to varying degrees, a part in the development of PMSD. A crucial aspect of postmodern culture is electronic digital overload. Usually, it is accompanied by sleep deprivation and resulting fatigue that also contribute to impaired, diminished judgment and a constriction of one’s thought processes that permit the development of the notion that killing is an effective release.

A crucial component of this syndrome involves what Goleman described as the “amygdala hijack”,1 as well as diminished inhibitory inputs from orbitofrontal/cingulate cortex. A stimulus that becomes associated with fear and loathing becomes capable of activating the amygdala and eliciting violent behavior toward the self and others. Important initiating components of PMSD include such postmodern entertainments as violent films, violent music videos, violence in the news, and violent video games. Even selected social media on the Internet could be contributory. Common to all is repetitive digital input that violence (often gun violence) is the solution to a variety of diverse problems. In some sense, the violence is seen as purging or solving a problem in the game or video, when it clearly does not in actual life; quite the opposite, it may end the life of the person with PMSD, as well as the lives of others.

Processing of environmental stimuli is influenced by emotional conditioning encoded in the amygdala and other limbic system components. Normal cerebral functioning calls forth inhibitory processes from the orbitofrontal lobes, especially the anterior cingulate gyrus.2 Strenziok et al3 note that exposure to violent video games in adolescents desensitizes the individual to violence and aggression through downregulation of the orbitofrontal cortex activity, and that may promote aggressive violent behavior.

Moreover, exposure to violent television programs has been demonstrated to correlate with poor cognitive inhibition and impulse control. Most strikingly, violent television viewing by males reduced white matter volume in parts of the right parietal-frontal cortical lobe that provides “ethical” inputs to reduce anger.4 Similarly violent movie viewing among Chinese male college students demonstrated increased aggregate aggression scores that were not found in those males watching nonviolent movies or in women watching either type of movies.5Hence, men appear to be particularly vulnerable to electronic violence, its brain effects, and PMSD. Correspondingly, the vast majority of mass killings and murder/suicides are committed by males.

Violent video games have been shown to cause neural desensitization to violence, as evidenced by a reduction in the P3 component of event-related brain potentials when exposed to violent images.6 Engelhardt et al6 indicate that a brain exposed to media violence shows increased aggressive tendencies. Moreover, the size effect of media violence and aggression on public health approaches that of cigarette smoking, in terms of mortality.7

The Columbine High School massacre by Eric Harris and Dylan Klebold appears to be a prime example of PMSD. Both perpetrators were heavy users of first-person-shooter videos—to the extent that “Harris levels” became a gamer term for the game “Doom,”8—as well as fans of the very violent film, Natural Born Killers. Other factors were likely operative in this heinous crime, including bullying and psychopathology. Feeling bullied is very likely a contributor to PMSD, as both workplace shootings and school shootings suggest. In a review of 15 school shootings, researchers identified 3 factors that seemed most contributory: bullying and humiliation in school; a male student prone toward violence and poor impulse control; and fascination with, as well as access to, weapons, explosives, and death.9