Was Cain affected by some mental disorder?
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《中华医药杂志》英文版
Was Cain affected by some mental disorder?
Ben-Gurion University of the Negev. Department of Family Medicine, Faculty of Health Sciences, Soroka Hospital Medical Center, Israel
Correspondence to Prof. Ben-Nun Louba (Liubov), M.D.,M.S.，Malkhe-Israel 138 St. P.O.Box 572，KIRYAT-GAT. 82104 Israel
Fax:+ (972 ) 8 6883376,Mobile: 0505971592
E-mail: L-bennun@zahav.net.il
[Abstract] Objective Domestic violence has been present since the dawn of the history. To study the first documented case of domestic violence described in the Bible. All biblical texts were examined all verses related to the first domestic violence were studied closely. Methods The passage “When they were in the field,… Cain rose up against Abel his brother, and slew him” refers to Cain’s violent murder of his brother Abel. There are insufficient criteria to determine whether Cain’s actions were the result of some mental disorder such as paranoid type schizophrenia, schizophrenic disorder, delusional disorder, substance-induced mood disorder, some personality disorder, or intermittent explosive disorder. Later Cain married, and additional violent behavior was not recorded. Cain’s violent behavior can be characterized as a response to the damaged ego, low self esteem, lack of fear of punishment, lack of empathy towards his brother, lack of behavioral inhibitions, impulsiveness, damaged affect regulation, egoism, lack of guilt and remorse, lack of power and control and pathological jealousy. Results and Conclusion This report indicates that roots of psychiatry go back to biblical times.
[Key words] homicide;domestic violence; family violence;youths
INTRODUCTION
Domestic violence constitutes the willful intimidation, assault, including sexual assault, battery, or other abusive behavior perpetrated by one family member, household member, or intimate partner against another [1]. Domestic violence is due to a complex web of problems, in which a variety of factors such as individual relationships, physical, psychological, and societal factors play a role. These various factors are linked to inequalities and power imbalance in society, with most abusers in a position of power over their victims[2].
There is no single, definite cause of family violence, and anyone, regardless of gender, age, race, ethnicity, education, cultural identity, socioeconomic status, occupation, religion, sexual orientation, physical or mental disabilities or personality characteristics may be vulnerable to abuse at any stage of their life [2]. Violent behavior cannot be explained simply as the result of some kind of “intrinsic evil” or claiming that the aggressive person is merely a “bad seed” [3].
This research deals with a case of domestic violence as described in the Bible. Biblical texts were examined and the violent event occurring in the first biblical family was studied closely. Who was the first murderer in the Bible? What were the motives for the assassination? Who was the victim? This research aims to answer these questions by evaluating the first case of domestic violence from a contemporary perspective.
ANALYSIS
Family Violence as Described in the Bible After Adam and Eve were expelled from the Garden of Eden, Eve conceived and bore Cain and Abel: “And Abel was a herder of sheep, but Cain was a tiller of the ground” (Genesis 4∶2). One day “…Abel brought of the fruit of the ground an offering unto the Lord.Abel also brought of the firstlings of his flock and of the fat
parts thereof, and the Lord had respect to Abel and to his offering: but to Cain and to his offering he had not respect…” (4∶3~5). So, Cain was extremely angry and jealous. “When they were in the field,…Cain rose up against Abel his brother, and slew him” (4∶8). For this Cain was cursed: “And now art thou cursed from the earth… a fugitive and a vagabond shalt thou be on the earth” (4∶11,12). After these events, Cain dwelt in the land of Nod and took a woman in marriage: “And Cain knew his wife, and she conceived, and bore Hanokh…” (4∶17).
What can we learn from this story? The first biblical family was composed of the father, Adam, his wife Eve, and their sons, Cain and Abel. Abel received thanks for his offering, but Cain did not. So Cain developed an extreme hatred towards Abel that led him to kill his brother. How can this murder be defined from a contemporary perspective? What were the roots of this unnecessary killing? Was Cain affected by some mental disorder? What were the psychological characteristics of Cain’s personality?
Youth and Violence
Juvenile violence is defined as any intentional physical, sexual or psychological assault on another person or persons by one or more young people aged 12 to 19 years. It may be committed by individuals or perpetrated by groups or gangs. This violence is not confined to any one subgroup of the juvenile population, but occurs across all racial, religious, gender and socio-economic backgrounds[4].
Adolescence is a time of tumultuous change and vulnerability, which can lead to an increase in expressions of violence and other risky behaviors [5]. In general, the most common perpetrators of violence are young, heterosexual males [3,4]. In England and Wales more than 90% of violent offenders are males, and half of those are aged between 17 and 24 years [3]. Although a growing number of young females also are violent, the abusive behavior of males is more frequent and severe [4].
Since Cain and Abel were both young, Abel’s murder can be defined as juvenile violence.This unnecessary assassination can be regarded as an expression of the tumultuous changes and vulnerability of the adolescent Cain.
Types of Juvenile Violence
Types of juvenile violence include emotional, physical,and sexual abuse. Emotional abuse includes insulting or ridiculing someone or subjecting a person to verbal humiliation, threatening to use violence or murder, throwing, smashing, kicking or destroying the property of others; stalking and monitoring another person’s activities; displaying jealousy or possessiveness; and sexual, racist and homophobic verbal abuse. Physical abuse includes pushing, grabbing, shoving, slapping, kicking,punching, hitting with an object, choking,using or threatening to use a weapon against someone, and murder. Sexual abuse includes any unwanted coercive contact, threats of physical force, or actual physical force. Victims are forced to perform sexual acts against their will and suffer pain or injury during this abuse[4].
According to these definitions Cain’s violent behavior can be defined as physical abuse.
Rates of Homicide
The incidence for homicide varies among countries. There were 18，233 deaths from homicide in the United States, 3，742 in the United Kingdom, 3，751 in France, 7，906 in Japan, and 2 in Monaco in 1999[6]. In the United States, suicide and homicide are the fourth and fifth leading causes of death for persons aged 10 to 60 years, with 17，638 homicides occurring in 2002 and a rate of 6.12 per 100，000 population[7].
In 1983 and 1993, the ratios of male to female youths committing suicide were 7.4 to 1.0 and 7.0 to 1.0 respectively[8]. By 1998, this ratio had changed to 3.5 to 1.0[8]. Thus, females became more aggressive with time.
Homicide
The unlawful killing of a human being by another with malice aforethought is defined as homicide[9]. It is the willful, non-negligent, killing of one human being by another; along with robbery, aggravated assault, and rape [10].
According to this definition Abel’s assassination can be defined as a homicide.
Mental Illness and Violence
Are people with mental illness more violent than other people? In general, most patients with mental illness do not exhibit increased violence [11], even young adults, in whom the peak period for violence is observed [12], as shown by self-reporting [13], victimization reports [14], arrest data [15], and rehospitalization records [16]. In patients with mental illnesses violence, including serious violence, occurs in response to psychotic illness [17~21]. Mental illnesses such as schizophrenia [22,23], schizophrenia spectrum disorders [24], and delusional disorder [25] may be related to violence with delusions in unipolar depression as a strong predictive factor for suicide [26] and psychotic depression for suicide attempt [27]. Most patients with schizophrenia never endanger the lives of others at any time during the course of their illness [28]. However, in a minority of these patients violent behavior and threats, as mentioned above, can be related to their symptoms such as delusions of being poisoned [28]. Other mental disorders linked to severe violence include personality disorders [29,30], substance abuse or dependence such as alcohol, or marijuana dependence [29], or substance misuse [30], and conditions where substance abuse is combined with severe mental illness [31,32].
Schizophrenia, Paranoid Type
Was Cain afflicted by paranoid schizophrenia? The essential feature of paranoid type of schizophrenia is preoccupation with one or more delusions or auditory hallucinations in the context of relative preservation of cognitive functioning and affect. Symptoms such as disorganized speech,disorganized or catatonic behavior, or flat or inappropriate affect are not prominent. Delusions are typically persecutory or grandiose, or both, but delusions with other themes may also occur. The combination of persecutory and grandiose delusions with anger may predispose the individuals to violence [33].
In the absence of one or more delusions or auditory hallucinations, disorganized speech, disorganized or catatonic behavior, or flat or inappropriate affect the diagnosis of a paranoid type of schizophrenia in Cain seems very unlikely.
Schizophrenic Disorder
Was Cain affected by schizophrenic disorder? The essential features of this disorder are identical to those of schizophrenia. The total duration of the illness is at least 1 month but less than 6 months [34]. The biblical text gives no data about the time that elapsed between the disregard of his offerings and the murder. However, the absence of symptoms associated with schizophrenia excludes the presence of this disorder in Cain.
Delusional Disorder
The essential feature of delusional disorder is the presence of one or more non-bizarre delusions (i.e., involving situations that may occur in real life, such as being followed, poisoned, infected, loved at a distance, or deceived by a spouse or lover, or having a disease) of at least 1 month’s duration. Functioning is not markedly impaired and behavior is not obviously odd or bizarre [33]. In these patients, who act violently, an affect of fear and anger is common [35]. Since the disrespect of Cain’s offering was a real situation, there is no ground to suspect the presence of delusions in Cain.
Substance-Induced Mood Disorder
Did Cain suffer from a substance-induced mood disorder, characterized by a prominent and persistent disturbance in mood associated with the direct physiological consequences of a drug abuse, a medication, or another somatic treatment for depression, or toxic exposure[33]?The psychoactive substances most commonly associated with the development of psychotic syndromes include alcohol, indole hallucinogens (e.g., lysergic acid diethylamine, amphetamines, cocaine, mescaline, phencyclidine, ketamine, steroids and levothroxine [36]. In the absence of appropriate anamnestic data this diagnosis seems very unlikely.
Personality Disorder and Violence
Personality disorders are associated with occupational difficulties, marital dissolution, violence [37], and criminal behavior [38~40]. The prevalence of personality disorders is estimated as 9%~15% of the adult US population: 0.5%~2.5% of individuals had paranoid personality, 3%-schizotypal, 1%~3%-antisocial, 2%-borderline, 2%~3%-histrionic, less than 1% had narcissistic, 0.5%~1%-avoidant, and 1%-obsessive-compulsive [41,42].
The well-known criteria of DSM-IV [33] are presented here as a means for evaluating if Cain was afflicted by some personality disorder. General diagnostic criteria for a personality disorder include: an enduring pattern of inner experience and behavior that differs markedly from the expectation of the individual’s culture. This pattern is manifested in two (or more) of the following areas: criterion A(1) cognition (i.e., ways of perceiving and interpreting self, other people, and events);(2) affectivity (i.e., the range, intensity, liability, and appropriateness of emotional response);(3) interpersonal functioning;(4) impulse control. Criterion B-the enduring pattern is inflexible and pervasive across a broad range of personal and social situations. Criterion C-the enduring pattern leads to clinically significant distress or impairment in social, occupational, or other important area of functioning. Criterion D-the pattern is stable and of long duration and its onset can be traced back at least to adolescence or early adulthood. Criterion E-the enduring pattern is not better accounted for as a manifestation or consequence of another mental disorder. Criterion F-the enduring pattern is not due to the direct physiological effect of a substance (e.g., a drug of abuse, a medication) or a general medical condition (e.g., head trauma).
Of six criteria defining personality disorder, three can be attributed to Cain. These are: criterion A (1)-Cain’s perception was distorted by what he saw as disregard of his offering; criterion A (2)-his affection was deeply insulted, leading to an inappropriate response; criterion A (4)-Cain’s impulsive uncontrolled behavior led to the murder of his brother. There are insufficient data for criteria E and F. Criteria B, C, and D cannot be attributed to Cain. Thus, in spite of the presence of some criteria, in general, there is an insufficient number of criteria for a diagnosis of Personality Disorder. For this reasons various personality disorders associated with violence such as paranoid, narcissistic, and passive-aggressive personality disorders [40] are not analyzed.
Intermittent Explosive Disorder
DSM-IV [33] diagnostic criteria for this disorder include: (A)Several discrete episodes of failure to resist aggressive impulses that result in serious aggressive acts or destruction of property.(B)The degree of aggressiveness expressed during the episodes is grossly out of proportion to any precipitating psychosocial stressors.(C)The aggressive episodes cannot be better accounted for by another mental disorder, and are not due to the direct physiological effects of a substance or a general medical condition.
After assassination Cain married and no further violent behaviors are recorded. A history of just one episode of aggressive behavior makes a diagnosis of intermittent explosive disorder unlikely in Cain’s case.
Psychological Characteristics
Many violent abusers suffer from low self-esteem, and their sense of self and identity is tied to their partners. Often periods of psychological, emotional, and physical abuse intermingle with periods of respite, love, and happiness. They may attack violently, then minutes later they regret their action and buy flowers, candies and other presents in order to win favor and forgiveness. Perpetrators of domestic violence are rarely violent outside of their domicile [1].
Egocentricity, grandiosity, sense of entitlement, impulsiveness, lack of behavioral inhibitions and need for power and control characterize asocial, anti-social and criminal acts. In these individuals clear emotional bonds, fear of punishment, and guilt are absent [43]. Violence may represent a response to frustration and loss of power and control [44]. Lack of empathy or regard for the feelings of others, impulsiveness, and the inability to defer gratification are personality traits that are associated with violent behavior [44]. “Sociopathic personality” is the term which is conventionally applied to persons with a diminished capacity for guilt and remorse, who lack emotional identification with others, and who are driven by impulse and the need for immediate gratification [44]. Panic or retaliation triggers the greatest violence among neurotic men, without mental illness [18]. Other personality dimensions associated with violent behavior include poor impulse control, problems with affect regulation, threatening egoism or narcissism defined as an inflated sense of self-worth and entitlement, and paranoid cognitive personality style [45].
According to these descriptions, the presence of some type of personality disorder in Cain, including sociopathic or narcissistic personality, seems very unlikely.
Cain’s psychological characteristics include retaliation as a response to his damaged ego, low self esteem, lack of fear of punishment, lack of empathy towards his brother, lack of behavioral inhibitions, impulsiveness, damaged affect regulation, egoism, lack of guilt and remorse, and lack of power and control.
Pathological Jealousy
Emotions are regarded as conditioned and unconditioned reactions to stimuli in which reason and judgment have no part [46]. Jealousy is a common emotion that can be considered pathological in some conditions. The term “morbid jealousy” has been used to signify this abnormal or extreme emotion [47].
Pathological jealousy is another term for extreme jealousy. Desire for rivalry is the hallmark of pathological jealousy, separating it from zealous engagement in and solicitous guarding of a relationship [48]. Low self-esteem, feelings of insecurity and inferiority, poor self-image and poor self-assertion are characteristics of morbid jealousy [49,50].
Was Cain affected by jealousy due to disrespect of his offering? Was this jealousy so extreme that he was driven to murder his sibling? The disregard of Cain’s offering was a very painful situation that led Cain to severe mental distress accompanied by unreasonable thoughts and damaged judgment. Low self-esteem, feelings of insecurity and inferiority, poor self-image and poor self-assertion can be attributed to Cain. So it follows that he suffered from pathological jealousy.
SUMMARY
Domestic violence has been present since the dawn of the history. This research deals with the first documented case of fraternal violence as described in the Bible. The passage “When they were in the field… Cain rose up against Abel his brother, and slew him” indicates that Cain murdered his brother Abel. This murder can be defined as a case of juvenile violence that led to homicide. Later, Cain married, and no additional violent behavior was recorded. There are insufficient criteria to define some mental disorder relating to this assassination such as paranoid type schizophrenia, schizophrenic disorder, delusional disorder, substance-induced mood disorder, some personality disorder, or intermittent explosive disorder. Cain’s psychological dimension include retaliation as a response to his damaged ego, low self esteem, lack of fear of punishment, lack of empathy towards his brother, lack of behavioral inhibitions, impulsiveness, damaged affect regulation, egoism, lack of guilt and remorse, lack of power and control, and pathological jealousy.
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(Editor Jaque)(Ben-Nun Louba)
Ben-Gurion University of the Negev. Department of Family Medicine, Faculty of Health Sciences, Soroka Hospital Medical Center, Israel
Correspondence to Prof. Ben-Nun Louba (Liubov), M.D.,M.S.，Malkhe-Israel 138 St. P.O.Box 572，KIRYAT-GAT. 82104 Israel
Fax:+ (972 ) 8 6883376,Mobile: 0505971592
E-mail: L-bennun@zahav.net.il
[Abstract] Objective Domestic violence has been present since the dawn of the history. To study the first documented case of domestic violence described in the Bible. All biblical texts were examined all verses related to the first domestic violence were studied closely. Methods The passage “When they were in the field,… Cain rose up against Abel his brother, and slew him” refers to Cain’s violent murder of his brother Abel. There are insufficient criteria to determine whether Cain’s actions were the result of some mental disorder such as paranoid type schizophrenia, schizophrenic disorder, delusional disorder, substance-induced mood disorder, some personality disorder, or intermittent explosive disorder. Later Cain married, and additional violent behavior was not recorded. Cain’s violent behavior can be characterized as a response to the damaged ego, low self esteem, lack of fear of punishment, lack of empathy towards his brother, lack of behavioral inhibitions, impulsiveness, damaged affect regulation, egoism, lack of guilt and remorse, lack of power and control and pathological jealousy. Results and Conclusion This report indicates that roots of psychiatry go back to biblical times.
[Key words] homicide;domestic violence; family violence;youths
INTRODUCTION
Domestic violence constitutes the willful intimidation, assault, including sexual assault, battery, or other abusive behavior perpetrated by one family member, household member, or intimate partner against another [1]. Domestic violence is due to a complex web of problems, in which a variety of factors such as individual relationships, physical, psychological, and societal factors play a role. These various factors are linked to inequalities and power imbalance in society, with most abusers in a position of power over their victims[2].
There is no single, definite cause of family violence, and anyone, regardless of gender, age, race, ethnicity, education, cultural identity, socioeconomic status, occupation, religion, sexual orientation, physical or mental disabilities or personality characteristics may be vulnerable to abuse at any stage of their life [2]. Violent behavior cannot be explained simply as the result of some kind of “intrinsic evil” or claiming that the aggressive person is merely a “bad seed” [3].
This research deals with a case of domestic violence as described in the Bible. Biblical texts were examined and the violent event occurring in the first biblical family was studied closely. Who was the first murderer in the Bible? What were the motives for the assassination? Who was the victim? This research aims to answer these questions by evaluating the first case of domestic violence from a contemporary perspective.
ANALYSIS
Family Violence as Described in the Bible After Adam and Eve were expelled from the Garden of Eden, Eve conceived and bore Cain and Abel: “And Abel was a herder of sheep, but Cain was a tiller of the ground” (Genesis 4∶2). One day “…Abel brought of the fruit of the ground an offering unto the Lord.Abel also brought of the firstlings of his flock and of the fat
parts thereof, and the Lord had respect to Abel and to his offering: but to Cain and to his offering he had not respect…” (4∶3~5). So, Cain was extremely angry and jealous. “When they were in the field,…Cain rose up against Abel his brother, and slew him” (4∶8). For this Cain was cursed: “And now art thou cursed from the earth… a fugitive and a vagabond shalt thou be on the earth” (4∶11,12). After these events, Cain dwelt in the land of Nod and took a woman in marriage: “And Cain knew his wife, and she conceived, and bore Hanokh…” (4∶17).
What can we learn from this story? The first biblical family was composed of the father, Adam, his wife Eve, and their sons, Cain and Abel. Abel received thanks for his offering, but Cain did not. So Cain developed an extreme hatred towards Abel that led him to kill his brother. How can this murder be defined from a contemporary perspective? What were the roots of this unnecessary killing? Was Cain affected by some mental disorder? What were the psychological characteristics of Cain’s personality?
Youth and Violence
Juvenile violence is defined as any intentional physical, sexual or psychological assault on another person or persons by one or more young people aged 12 to 19 years. It may be committed by individuals or perpetrated by groups or gangs. This violence is not confined to any one subgroup of the juvenile population, but occurs across all racial, religious, gender and socio-economic backgrounds[4].
Adolescence is a time of tumultuous change and vulnerability, which can lead to an increase in expressions of violence and other risky behaviors [5]. In general, the most common perpetrators of violence are young, heterosexual males [3,4]. In England and Wales more than 90% of violent offenders are males, and half of those are aged between 17 and 24 years [3]. Although a growing number of young females also are violent, the abusive behavior of males is more frequent and severe [4].
Since Cain and Abel were both young, Abel’s murder can be defined as juvenile violence.This unnecessary assassination can be regarded as an expression of the tumultuous changes and vulnerability of the adolescent Cain.
Types of Juvenile Violence
Types of juvenile violence include emotional, physical,and sexual abuse. Emotional abuse includes insulting or ridiculing someone or subjecting a person to verbal humiliation, threatening to use violence or murder, throwing, smashing, kicking or destroying the property of others; stalking and monitoring another person’s activities; displaying jealousy or possessiveness; and sexual, racist and homophobic verbal abuse. Physical abuse includes pushing, grabbing, shoving, slapping, kicking,punching, hitting with an object, choking,using or threatening to use a weapon against someone, and murder. Sexual abuse includes any unwanted coercive contact, threats of physical force, or actual physical force. Victims are forced to perform sexual acts against their will and suffer pain or injury during this abuse[4].
According to these definitions Cain’s violent behavior can be defined as physical abuse.
Rates of Homicide
The incidence for homicide varies among countries. There were 18，233 deaths from homicide in the United States, 3，742 in the United Kingdom, 3，751 in France, 7，906 in Japan, and 2 in Monaco in 1999[6]. In the United States, suicide and homicide are the fourth and fifth leading causes of death for persons aged 10 to 60 years, with 17，638 homicides occurring in 2002 and a rate of 6.12 per 100，000 population[7].
In 1983 and 1993, the ratios of male to female youths committing suicide were 7.4 to 1.0 and 7.0 to 1.0 respectively[8]. By 1998, this ratio had changed to 3.5 to 1.0[8]. Thus, females became more aggressive with time.
Homicide
The unlawful killing of a human being by another with malice aforethought is defined as homicide[9]. It is the willful, non-negligent, killing of one human being by another; along with robbery, aggravated assault, and rape [10].
According to this definition Abel’s assassination can be defined as a homicide.
Mental Illness and Violence
Are people with mental illness more violent than other people? In general, most patients with mental illness do not exhibit increased violence [11], even young adults, in whom the peak period for violence is observed [12], as shown by self-reporting [13], victimization reports [14], arrest data [15], and rehospitalization records [16]. In patients with mental illnesses violence, including serious violence, occurs in response to psychotic illness [17~21]. Mental illnesses such as schizophrenia [22,23], schizophrenia spectrum disorders [24], and delusional disorder [25] may be related to violence with delusions in unipolar depression as a strong predictive factor for suicide [26] and psychotic depression for suicide attempt [27]. Most patients with schizophrenia never endanger the lives of others at any time during the course of their illness [28]. However, in a minority of these patients violent behavior and threats, as mentioned above, can be related to their symptoms such as delusions of being poisoned [28]. Other mental disorders linked to severe violence include personality disorders [29,30], substance abuse or dependence such as alcohol, or marijuana dependence [29], or substance misuse [30], and conditions where substance abuse is combined with severe mental illness [31,32].
Schizophrenia, Paranoid Type
Was Cain afflicted by paranoid schizophrenia? The essential feature of paranoid type of schizophrenia is preoccupation with one or more delusions or auditory hallucinations in the context of relative preservation of cognitive functioning and affect. Symptoms such as disorganized speech,disorganized or catatonic behavior, or flat or inappropriate affect are not prominent. Delusions are typically persecutory or grandiose, or both, but delusions with other themes may also occur. The combination of persecutory and grandiose delusions with anger may predispose the individuals to violence [33].
In the absence of one or more delusions or auditory hallucinations, disorganized speech, disorganized or catatonic behavior, or flat or inappropriate affect the diagnosis of a paranoid type of schizophrenia in Cain seems very unlikely.
Schizophrenic Disorder
Was Cain affected by schizophrenic disorder? The essential features of this disorder are identical to those of schizophrenia. The total duration of the illness is at least 1 month but less than 6 months [34]. The biblical text gives no data about the time that elapsed between the disregard of his offerings and the murder. However, the absence of symptoms associated with schizophrenia excludes the presence of this disorder in Cain.
Delusional Disorder
The essential feature of delusional disorder is the presence of one or more non-bizarre delusions (i.e., involving situations that may occur in real life, such as being followed, poisoned, infected, loved at a distance, or deceived by a spouse or lover, or having a disease) of at least 1 month’s duration. Functioning is not markedly impaired and behavior is not obviously odd or bizarre [33]. In these patients, who act violently, an affect of fear and anger is common [35]. Since the disrespect of Cain’s offering was a real situation, there is no ground to suspect the presence of delusions in Cain.
Substance-Induced Mood Disorder
Did Cain suffer from a substance-induced mood disorder, characterized by a prominent and persistent disturbance in mood associated with the direct physiological consequences of a drug abuse, a medication, or another somatic treatment for depression, or toxic exposure[33]?The psychoactive substances most commonly associated with the development of psychotic syndromes include alcohol, indole hallucinogens (e.g., lysergic acid diethylamine, amphetamines, cocaine, mescaline, phencyclidine, ketamine, steroids and levothroxine [36]. In the absence of appropriate anamnestic data this diagnosis seems very unlikely.
Personality Disorder and Violence
Personality disorders are associated with occupational difficulties, marital dissolution, violence [37], and criminal behavior [38~40]. The prevalence of personality disorders is estimated as 9%~15% of the adult US population: 0.5%~2.5% of individuals had paranoid personality, 3%-schizotypal, 1%~3%-antisocial, 2%-borderline, 2%~3%-histrionic, less than 1% had narcissistic, 0.5%~1%-avoidant, and 1%-obsessive-compulsive [41,42].
The well-known criteria of DSM-IV [33] are presented here as a means for evaluating if Cain was afflicted by some personality disorder. General diagnostic criteria for a personality disorder include: an enduring pattern of inner experience and behavior that differs markedly from the expectation of the individual’s culture. This pattern is manifested in two (or more) of the following areas: criterion A(1) cognition (i.e., ways of perceiving and interpreting self, other people, and events);(2) affectivity (i.e., the range, intensity, liability, and appropriateness of emotional response);(3) interpersonal functioning;(4) impulse control. Criterion B-the enduring pattern is inflexible and pervasive across a broad range of personal and social situations. Criterion C-the enduring pattern leads to clinically significant distress or impairment in social, occupational, or other important area of functioning. Criterion D-the pattern is stable and of long duration and its onset can be traced back at least to adolescence or early adulthood. Criterion E-the enduring pattern is not better accounted for as a manifestation or consequence of another mental disorder. Criterion F-the enduring pattern is not due to the direct physiological effect of a substance (e.g., a drug of abuse, a medication) or a general medical condition (e.g., head trauma).
Of six criteria defining personality disorder, three can be attributed to Cain. These are: criterion A (1)-Cain’s perception was distorted by what he saw as disregard of his offering; criterion A (2)-his affection was deeply insulted, leading to an inappropriate response; criterion A (4)-Cain’s impulsive uncontrolled behavior led to the murder of his brother. There are insufficient data for criteria E and F. Criteria B, C, and D cannot be attributed to Cain. Thus, in spite of the presence of some criteria, in general, there is an insufficient number of criteria for a diagnosis of Personality Disorder. For this reasons various personality disorders associated with violence such as paranoid, narcissistic, and passive-aggressive personality disorders [40] are not analyzed.
Intermittent Explosive Disorder
DSM-IV [33] diagnostic criteria for this disorder include: (A)Several discrete episodes of failure to resist aggressive impulses that result in serious aggressive acts or destruction of property.(B)The degree of aggressiveness expressed during the episodes is grossly out of proportion to any precipitating psychosocial stressors.(C)The aggressive episodes cannot be better accounted for by another mental disorder, and are not due to the direct physiological effects of a substance or a general medical condition.
After assassination Cain married and no further violent behaviors are recorded. A history of just one episode of aggressive behavior makes a diagnosis of intermittent explosive disorder unlikely in Cain’s case.
Psychological Characteristics
Many violent abusers suffer from low self-esteem, and their sense of self and identity is tied to their partners. Often periods of psychological, emotional, and physical abuse intermingle with periods of respite, love, and happiness. They may attack violently, then minutes later they regret their action and buy flowers, candies and other presents in order to win favor and forgiveness. Perpetrators of domestic violence are rarely violent outside of their domicile [1].
Egocentricity, grandiosity, sense of entitlement, impulsiveness, lack of behavioral inhibitions and need for power and control characterize asocial, anti-social and criminal acts. In these individuals clear emotional bonds, fear of punishment, and guilt are absent [43]. Violence may represent a response to frustration and loss of power and control [44]. Lack of empathy or regard for the feelings of others, impulsiveness, and the inability to defer gratification are personality traits that are associated with violent behavior [44]. “Sociopathic personality” is the term which is conventionally applied to persons with a diminished capacity for guilt and remorse, who lack emotional identification with others, and who are driven by impulse and the need for immediate gratification [44]. Panic or retaliation triggers the greatest violence among neurotic men, without mental illness [18]. Other personality dimensions associated with violent behavior include poor impulse control, problems with affect regulation, threatening egoism or narcissism defined as an inflated sense of self-worth and entitlement, and paranoid cognitive personality style [45].
According to these descriptions, the presence of some type of personality disorder in Cain, including sociopathic or narcissistic personality, seems very unlikely.
Cain’s psychological characteristics include retaliation as a response to his damaged ego, low self esteem, lack of fear of punishment, lack of empathy towards his brother, lack of behavioral inhibitions, impulsiveness, damaged affect regulation, egoism, lack of guilt and remorse, and lack of power and control.
Pathological Jealousy
Emotions are regarded as conditioned and unconditioned reactions to stimuli in which reason and judgment have no part [46]. Jealousy is a common emotion that can be considered pathological in some conditions. The term “morbid jealousy” has been used to signify this abnormal or extreme emotion [47].
Pathological jealousy is another term for extreme jealousy. Desire for rivalry is the hallmark of pathological jealousy, separating it from zealous engagement in and solicitous guarding of a relationship [48]. Low self-esteem, feelings of insecurity and inferiority, poor self-image and poor self-assertion are characteristics of morbid jealousy [49,50].
Was Cain affected by jealousy due to disrespect of his offering? Was this jealousy so extreme that he was driven to murder his sibling? The disregard of Cain’s offering was a very painful situation that led Cain to severe mental distress accompanied by unreasonable thoughts and damaged judgment. Low self-esteem, feelings of insecurity and inferiority, poor self-image and poor self-assertion can be attributed to Cain. So it follows that he suffered from pathological jealousy.
SUMMARY
Domestic violence has been present since the dawn of the history. This research deals with the first documented case of fraternal violence as described in the Bible. The passage “When they were in the field… Cain rose up against Abel his brother, and slew him” indicates that Cain murdered his brother Abel. This murder can be defined as a case of juvenile violence that led to homicide. Later, Cain married, and no additional violent behavior was recorded. There are insufficient criteria to define some mental disorder relating to this assassination such as paranoid type schizophrenia, schizophrenic disorder, delusional disorder, substance-induced mood disorder, some personality disorder, or intermittent explosive disorder. Cain’s psychological dimension include retaliation as a response to his damaged ego, low self esteem, lack of fear of punishment, lack of empathy towards his brother, lack of behavioral inhibitions, impulsiveness, damaged affect regulation, egoism, lack of guilt and remorse, lack of power and control, and pathological jealousy.
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(Editor Jaque)(Ben-Nun Louba)