on adoptee violence

The following is a letter to a friend, who asked me about using DNA sequencing to find an explanation for her adopted, adolescent son’s violent behavior:

K——-,

I’ve thought much about violence from adoptees, as a woman I deeply love experiences the same behavior from her daughter(s). Interestingly, she adopted her daughters from a Russian orphanage—I know you also adopted from Russia. This similarity might matter as I’ll describe later.

Moreover, I’ve given much thought to household violence in general, having lived with an extremely abusive spouse for over a decade. I therefore have much to say on matters such as codependence, forgiveness, and unconditional love.

Finally, I carry a long and well-documented history of mental illness (bipolar disorder). For the most part I manage it well with medication and psychotherapy, but occasionally I require psychiatric hospitalization. Many of the articles on this blog document my experience with the disease—a narrative I’m constructing for researchers. My point is, I know quite a bit about different psychological treatment modalities and am going to recommend one in particular for your son, and another for you (below).

Your interest in your son’s genome as explanation is reasonable, and I’ve scoped out some options below that you can choose among (and get back to me for further guidance). However, I think the etiology of the violence is likely psychological or psychiatric. I’ll justify this statement shortly.

So I want to give you my complete thoughts on the matter, not just on mere genomics. Here is what I plan to discuss:

  • Psychology and psychiatry
    • Russia
    • PTSD and child abuse/neglect
    • Codependence
    • 911
    • Treatment options
  • Neuropsychology
  • Brain anatomy (briefly)
  • Genomic possibilities
    • Identifying genes associated with violence
      • I’ll provide you with a list to have checked
    • Identifying nucleotide variants associated with violence
    • Looking at epigenetics and violence
    • Sequencing:
      • What type?
      • How to legally analyze the data?
  • Radical love
    • Radical forgiveness
    • Compassion
    • Self-care
    • Expectations
  • Accountability

Alright, straight into it:

Psychology and Psychiatry

I hypothesize that violent adoptees underwent significant trauma and neglect in early childhood. I base the idea that such trauma may prompt violent behavior later on attachment theory (especially the learning—or lack of learning—of emotion regulation skills from a primary caregiver) [1]; and from witnessing my ex-wife’s violence, which emitted from untreated post-traumatic stress disorder (PTSD) caused by childhood abuse.

This I believe is the most likely explanation for your son’s behavior.

I also suspect that Russian orphanages aren’t usually healthy environments to start life in, to put it mildly.

If my theory is correct, your son needs to learn emotion regulation. Unfortunately, most therapy modalities I’ve seen only “process” feelings, but don’t treat management of intense feelings as a “skill” that can be learned and mastered. Dialectical Behavioral Therapy (DBT) [2], by contrast, does exactly that (and more)! Initial research suggests DBT may prove appropriate to reducing PTSD symptoms [2]. You can search for a local DBT therapist or group at [3]. Groups exist for teenagers, and I’m sure for younger children as well.

I personally attended a DBT group for adults twice in my life. Found it extremely beneficial for attenuating suicidal ideation. Therefore I highly recommend this treatment method for anything regarding emotion dysregulation.

Medication will only take you so far. But medication is a vital component.

Remember its okay to call 911 if you need to, both for violence and potential self-harm.

The other psychological issue to consider regards yourself: Codependence.

The Wikipedia article on codependency [3] sums it up well: “Codependency is a type of dysfunctional helping relationship where one person supports or enables another person’s drug addiction, alcoholism, gambling addiction, poor mental health, immaturity, irresponsibility, or under-achievement.” (emphasis mine). Essentially codependents become “addicted” to the relationship dynamic (whether they like the dynamic or not) and the “helping” role they play. Like all addicts they sacrifice themselves for the addiction. In mental health situations like yours where there is an “identified patient”, the likelihood of you developing clinical codependency traits proves high.

Take care of yourself. See a counselor. Get some rest. Have some fun. Attend a codependency treatment group or a codependency support group. (I’ve attended a codependency treatment group offered by my HMO. It proved extremely helpful).

Neuropsychology

If you haven’t yet, have a neuropsychologist run a battery of test on your son. Typical tests (as in the ones I’ve taken) include:

  • An intelligence scale appropriate for minors
  • Bender Gestalt Test of Visual-Motor Integration
  • Wechsler Memory Scale (WMS-III)
  • Intermediate Visual and Auditory Continuous Performance Test (IVA-CPT)
  • A self-assessment inventory appropriate for minors
  • A self-rating scale appropriate for minors
  • Sentence Completion Test (SCT)
  • Rorschach Inkblot Technique
  • MMPI-2

These tests quantify many mental health conditions, such as ADHD and antisocial behavior. The MMPI-2 is the most important one as it measures traits that may help defend your son if his behavior lands him in legal trouble (e.g., the “Antisocial Behavior” and “Disconstraint” scales of the MMPI-2). Also its finding might give you a “name” or two for your son’s specific conditions.

For an example of how I measured my own level of antisocial behavior and disconstraint, similar to how your son would be measured, see [4].

Brain Anatomy

I don’t know much about this subject, but have a neurologist meet with your son. If they detect an anomaly in an MRI of the brain you will gain a lot of insight, and (again) gain more data to protect your son if his behavior causes legal issues. A great article discussing adolescent violence and neuroimaging can be found at [5], which includes the following graphic:

Notice that emotion dysregulation comes up again in this graphic. If a brain anatomic explanation is found, DBT still may be indicated. Cognitive control and ability to learn will be measured by the neuropsychologist discussed above and may correlate to MRI results.

Genomic Possibilities

To benefit from DNA sequencing, you need to know what to look for. Unfortunately, I expect a gene panel for “psychiatric violence” does not exist. So I designed a gene list for such a panel to provide a basis for further work. The method and resulting gene list are discussed in a separate article on this blog:

toward a gene panel for psychiatric violence

So one way of looking at the challenge is to sequence these genes and see what aberrations appear. However, most aberrations will prove benign or related to some completely unrelated issue. So I scoped out the following strategy for identifying the aberrations to look for using ClinVar [8], a database which we can search by disease. Unlike the gene list analysis, I have not automated the procedure yet (we’ll cross that line together if you decide to proceed with sequencing analysis). However here is a manual outcome, to demonstrate that we can pull the required information together.

We first search for the term “personality disorder”, and retrieve a list of known perturbations correlated with this cluster of diseases:

Clicking on the first variation in the list, we see that it involves an aberration in gene NRXN1. As a verification, we find NRXN1 in the gene list I produced above:

And if you’re curious, here is the aberration shown in context on its chromosome:

Again, if you decide to move forward with sequencing, I’ll automate this data extraction procedure.

So now we face a major decision:  Whether to sequence your son’s entire genome or just his genes (a minor subset of the genome). What matters is the proportion of aberrations we find related to diseases involving violence that lay outside genes compared to those that lay within genes. The more of the former, the greater the need to sequence your son’s whole genome to stand a chance of finding anything.

The other thing we need to consider while identifying aberrations to search for is the strength of their known correlation to disease. We might need a cutoff threshold to remove low quality information, assume this measure is even available (I haven’t checked yet–again, right now I’m simply scoping out a strategy).

What this discussion leaves out is “epigenetics”, the science of how the environment can modify gene expression. Research suggests that PTSD causes epigenetic modification of the genome. There are ways to test for such events, and we can scope them out together if you would like. For now I’m going to skip that subject because I don’t know much about it (but can find out as needed).

Next steps:

Looking in the genome for disease markers is a crapshoot. At my last reckoning of the situation, there simply is not enough data recorded to make highly effective correlations for most diseases. However, this situation improves everyday. And, except for the case of epigenetics, your son’s genome is for all intents and purposes static. Therefore if you sequenced him now, and did not find anything, you might find something in a year or two using the same sequencing data.

So your next decision is whether to proceed with sequencing or focus on other ideas such as those suggested above.

If you do decide to proceed, your next move would be to find a genetic counselor to facilitate things. (That gives me legal protection if you use my gene list or aberration list). I’m simply not sure where the FDA stands on using a punk-ass hacker’s gene list to diagnose genetic disease causality outside a research-only environment. Don’t have a clue!

However being the complete anarchist that I am, if you handed me a whole-genome on a disk with the owner’s name removed, I can and will scan for these variants. If I find something I’ll say variant X suggests a remote possibility of condition Y for the genome on the disk, and that only a qualified medical doctor can confirm! It will be like an online MMPI-2 that tells you what you want to know but refers you to a licensed neuropsychologist for a legally defendable evaluation.

So again, think about this and get back to me if you want to proceed further down this rabbit hole.

Radical Love

The most import thing to do is commit, and constantly recommit, to love. I state the verb form of the word to emphasize that this involves a decision, a crucial choice. And let me repeat, you must continually make this choice again and again to achieve success at it.

One never knows when to turn the other cheek [6] and when to refuse to accept further abuse. This probably is a moving target that varies day by day. What I can say is that even when you accept such abuse in the short run, ALWAYS resist in the long game. This gives you an endgame—a goal of a better world for you and your son. It helps keep your head up. Again, play the long game.

I realized a few months ago that parents who adopt children that behave violently stand among the few who actually understand what love is. They walk among the best of us. What grieves me is how much their best get buried everyday by the stress of violence in the household.

For all the strategies I enumerated above, please hold reasonable expectations. Go for “good” outcomes not “perfect” ones. To demonstrate, I practice this concept with regard to my own mental health: Never managed to “cure” my bipolar disorder, just consider low daily mood-variance success.

Take care of yourself. Please heed my warning about codependency. It will not help your son if you cease to keep yourself together.

Remember that specific mental illnesses might have once held an evolutionary advantage in earlier times, and they therefore are only “illnesses” in the context of post-hunter/gatherer society. Knowing this doesn’t make things better, but it at least provides some comfort to me. For example, a popular idea is that ADHD holds an advantage during the hunt [7].

I also argue that mental illnesses, particularly those that involve occasional psychosis, exist for spiritual reasons as well. (This is not to suggest that spiritual experiences, even those due to psychosis, are not genuine). Take comfort in that possibility.

What I’m saying between the lines in these last two paragraphs is that one can learn to take advantage of their mental illness if they can attenuate its liabilities. Again, to demonstrate, my bipolar disorder offers an endless wellspring of creativity. So I fully tap that creativity at work and everywhere else.

Finally, let me talk about “radical forgiveness”, a concept I’m developing for dealing with abuse, heartbreak, etc. Essentially it’s a doctrine indicating how to practice forgiveness as a “skill” and a “discipline”, rather than treating forgiveness as some ethereal idea. Try it! This idea is best explained in my video on the topic. Please forgive the sound quality (I will re-record it soon):

Accountability

Remember that at the end of the day, your son is responsible for his actions. He can learn non-violence if he works at it (e.g., through a program such as DBT). It may require a parallel spiritual awakening.

Hold him accountable. Teach character. Set an example through your own character and through taking responsibility for your mistakes.

To demonstrate these principles in action: I’ve harmed several people whom I love due to things I’ve said while experiencing bipolar mania. I don’t blame the disease. I blame myself and commit to work on preventing the disease from motivating such action. This seemingly subtle difference drives my character.

So teach him accountability. And remember that in the grand scheme of the universe we are all equal in the eyes of God—and we all need substantial work!

References

  1. https://en.wikipedia.org/wiki/Attachment_theory
  2. https://www.verywellmind.com/dbt-for-ptsd-2797652
  3. https://en.wikipedia.org/wiki/Codependency
  4. http://genderpunk360.com/2017/06/11/scoring-my-mmpi-2-assessment-for-both-sexes/
  5. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2766784/
  6. Matthew 5:39 NIV (from the Sermon on the Mount)
  7. https://en.wikipedia.org/wiki/Hunter_vs._farmer_hypothesis
  8. https://www.ncbi.nlm.nih.gov/clinvar/
  9. https://www.ncbi.nlm.nih.gov/pubmed/21508512
I figured out this whole "ladylike" thing today
toward a gene panel for psychiatric violence

Post Author: Emily

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