The following has been excerpted with permission from Violence: Reflections on a National Epidemic by James Gilligan.

That is good news; for while we cannot alter or eliminate the biological realities of age and sex, which are made by God, we can bring about fundamental changes in the social and cultural conditions that expose people to increased rates of intensities of shame and humiliation, since vulture and society are made by us. In this chapter I will analyze some of the cultural patterns, values, and practices that stimulate violence, and how they might be altered to prevent violence.

When these conditions are altered the exposure of human populations is dramatically reduced-and so is violence. Those economically developed democracies all over the world that have evolved into �welfare states� since the end of the Second World war, including all of Western Europe, Japan, Canada, Australia, and New Zealand, offer universal and free health care, generous public housing, unemployment and family leave policies, and so on. Every one of those countries has a more equitable (and hence less shame-inducing) socio-economic system than the United States does. There is a much greater sharing of the collective wealth of the society as measured, for example, by the smaller gap between the income and wealth of the most and least affluent segments of their populations. Our rate of violent crime (murder, rape) is from two to twenty times as high as it is in any of the other economically developed democracies. This is precisely what the theory presented in this book would predict.

Other cultures have also altered their social conditions so as to protect their members from exposure to overwhelming degrees of shame and humiliation, and have experienced the dramatic diminution in rates of violence that the theory espoused in this book would lead us to expect. They demonstrate the degree to which rates of violence are determined by social, cultural, and economic conditions. One example would be those societies that practice what has been called �primitive Christian communism,� and are truly classless societies whose economic systems are based on communal sharing-Anabaptist sects such as the Hutterites, Mennonites, and Amish. One remarkable feature of these societies is that the incidence of violence in them is virtually zero. The Hutterites, for example, do not appear to have had a single confirmed case of murder, rape, aggravated assault, or armed robbery since they arrived in America more than a hundred years ago. They also practice a strict and absolute pacifism, which is why they had to emigrate to America from Europe in the last century-to escape becoming victims of genocide at the hands of governments there which were persecuting them. While that aspect of their experience is one reason why I do not propose them as a model for our own society to emulate in any concrete, literal way, they do demonstrate that violence does not have to be universal; and that altering social, cultural, and economic conditions can dramatically reduce, and for all practical purposes eliminate, human violence from the face of the earth.

One apparent exception to the generalizations I am making here is Japan, which has often been cited as a �shame culture.� If frequent exposure and intense sensitivity to shame (in the absence of a correspondingly powerful exposure to guilt) stimulates violence toward others, then why does Japan have a relatively low homicide and high suicide rate-the same pattern that characterizes those societies that have sometimes been called �guilt cultures,� namely, the European and other economically developed �welfare state� democracies? There are two answers to that question, one that refers to the period before World War II, and the other, the time since then.

During both periods, Japan has been described by those who know it best as an intensely homogeneous and conformist society, with strong pressures against individual deviations from group norms and behaviors. That social pattern had, and still has, a powerful influence on the patterns of Japanese violence. Until the end of the Second World War, Japan was an extremely violent society-indeed, one of the most violent in the history of the world; they have been described, both by themselves and by their neighbors, as �a nation of warriors� since they first emerged as an independent nation two to three thousand years ago. However, that violence was directed almost entirely toward non-Japanese. Some Cultures, such as Japan�s have been more successful than others in channeling the homicidal behavior of their members toward members of other cultures, so that it is labeled warfare or genocide, rather than toward members of their own culture, which is called murder. Thus, the Japanese engaged in a degree of violence toward their Asian neighbors from 1930 to 1945 that was just as genocidal as what the Germans perpetrated in Europe. When compared to the number of suicides that Japanese citizens committed during the first half of this century, the number of homicides that they committed (in the form of warfare) during that same period was astronomical-exactly as the theory proposed in this book would predict.

However, since 1945 the social and economic conditions in Japan have changed remarkably. Japan today has the lowest degree of economic inequity among its citizens in the world (as judged by the World Bank�s measures of relative income and wealth). So it is not surprising that Japan also has a remarkably low frequency both of violent crime and of structural violence. For if socioeconomic inequities expose those at the bottom of the ladder to intense feelings of inferiority; if relative equality protects people from those feelings; and if inferiority feelings stimulate violent impulses, then it is not surprising that Japan�s current socioeconomic structure would be marked by a low level of violence toward others, as indeed it is-even if the Japanese are unusually sensitive to feelings and experiences of shame, and even if (as some observers have claimed) they are not especially sensitive to or likely to experience guilt feelings. For their socioeconomic system, even if it does revolve primarily around sensitivity to shame rather than guilt, actively protects most individuals from being exposed to overwhelming degrees of shame, and also provides them with nonviolent (e.g., economic) means by which to prevent or undo any �loss of face� that is experienced.

If the main causes of violence are these social and psychological variables (shame versus honor), an apparent anomaly lies in the fact that men are and always have been more violent than women, throughout history and throughout the world. If shame stimulates violence; if being treated as inferior stimulates shame; and if women have been treated throughout history as inferior to men, then why are women less violent than men? (And they are indeed vastly less likely than men are to commit homicide, suicide, warfare, and assault, in every culture and every period of history.)

The Making of �Manhood� and the Violence of Men

To understand this apparent anomaly, we must examine the cultural construction of masculinity and femininity, and the contrasting conditions under which the two sexes, once they have been cast into patriarchally defined �gender roles,� are exposed to feelings of private shame or public dishonor. To understand physical violence we must understand male violence, since most violence is committed by males, and on other males. And we can only understand male violence if we understand the sex roles, or gender roles, into which males are socialized by the gender codes of their particular cultures. Moreover, we can only understand male gender roles if we understand how those are reciprocally related to the contrasting but complementary sex or gender roles into which females are socialized in that same culture, so that the male and female roles require and reinforce each other.

Gender codes reinforce the socialization of girls and women, socializing them to acquiesce in, support, defend, and cling to the traditional set of social roles, and to enforce conformity on other females as well. Restrictions on their freedom to engage in sexual as well as aggressive behavior is the price women pay for their relative freedom from the risk of lethal and life-threatening violence to which men and boys are much more frequently exposed (a dubious bribe, at best, and one which shortchanges women, as more and more women realize).

The outpouring of scholarship across disciplines on the asymmetrical social roles assigned to males and females by the various cultures and civilizations of the world, including our own, has included works in history, economics, literary theory, philosophy, sociology, anthropology, psychology, science, law, religious studies, ethnic studies, and women�s studies. One thing all this work has made clear to me (and to many others) is that listening to women (for the first time), and opening up a dialogue between men and women, rather than merely continuing what has throughout most of the history of civilization been primarily a male monologue, is a necessary prerequisite for learning how to transform our civilization into a culture that is compatible with life. And to do that requires that men and women both learn to interact in ways that have simply not been permitted by the gender codes of the past.

My work has focused on the ways in which male gender codes reinforce the socialization of boys and men, teaching them to acquiesce in (and support, defend, and cling to) their own set of social roles, and a code of honor that defines and obligates these roles. Boys and men are exposed thereby to substantially greater frequencies of physical injury, pain, mutilation, disability, and premature death. This code of honor requires men to inflict these same violent injuries on others of both sexes, but most frequently and severely on themselves and other males, whether or not they want to be violent toward anyone of either sex.

Among the most interesting findings reported by social scientists is the fact that men and women stand in a markedly different relationship to the whole system of allotting honor in �cultures of honor.� For examples, one observation that has been made recurrently is that men are the only possible sources, or active generators (agents), of honor. The only active effect that women can have on honor, in those cultures in which this is a central value, is to destroy it. But women do have that power: They can destroy the honor of the males in their household. The culturally defined symbol system through which women in patriarchies bring honor or dishonor to men is the world of sex-that is, female sexual behavior. In this value system, which is both absurd from any rational standpoint and highly dangerous to the continued survival of our species given its effect of stimulating male violence, men delegate to women the power to bring dishonor on men. That is, men put their honor in the hands of �their� women. The most emotionally powerful means by which women can dishonor men (in this male construction) is by engaging in nonmarital sex, i.e., by being too sexually active or aggressive (�unchaste� or �unfaithful�) before, during, or even after marriage.

These themes are prominent in one well-known �culture of honor,� for example, the American South. Bertram Wyatt-Brown illustrated this by quoting from a letter Lucius Quintus Cincinnatus Lamar wrote to Mary Chesnut in 1861, in which he compares the men of the South to Homer�s heroes, who �fought like brave men, long and well,� and then went on to say �We are men, not women.� The real tragedy for Lamar, as Wyatt-Brown saw, was that �for him, as for many, the Civil War was reduced to a simple test of manhood.�

And women can adopt those same views of manhood, as Mary Chesnut recounts in her diary: � �Are you like Aunt Mary? Would you be happier if all the men in the family were killed?� To our amazement, quiet Miss C. took up the cudgels-nobly: �Yes, if their life disgraced them. There are worse things than death.� � These attitudes are exactly the same as those of the men I have known in maximum-security prisons.

That the same relative differences between the two gender roles can be found in many civilizations throughout history and throughout the world emphasizes the importance of understanding that it is men who are expected to be violent, and who are honored for doing so and dishonored for being unwilling to be violent. A woman�s worthiness to be honored or shamed is judged by how well she fills her roles in sexually related activities, especially the roles of actual or potential wife and mother. Men are honored for activity (ultimately, violent activity); and they are dishonored for passivity (or pacifism), which renders them vulnerable to the charge of being a non-man (�a wimp, a punk, and a pussy,� to quote the phrase that was so central to the identity of the murderer I analyzed in Chapter Three). Women are honored for inactivity or passivity, for not engaging in forbidden activities. They are shamed or dishonored if they are active where they should not be-sexually or in realms that are forbidden (professional ambition, aggressiveness, competitiveness and success; or violent activity, such as warfare or other forms of murder). Lady Macbeth, for example, realized that to commit murder she would have to be �unsexed,� i.e., freed from the restraints on violence that were imposed on her by virtue of her belonging to the female sex; and even then, she was unable to commit murder herself, but had to shame her husband into committing murder for her, so that she could only participate in violent behavior vicariously (just as she could only gain honor vicariously, through the honor she would obtain through being his queen when he became king).

Further evidence that men are violence objects and women, sex objects, can be found by examining the kinds of crimes that are committed against each sex. Men constitute, on the average, 75 percent or more of the victims of lethal physical violence in the United States- homicide, suicide, so-called unintentional injuries (from working in hazardous occupations, engaging in violent athletic contests, and participating in other high-risk activities), deaths in military combat, and so on. And throughout the world, men die from all these same forms of violence from two to five times as often as women do, as the World Health Organization documents each year. Women, on the other hand, according to the best available evidence, seem to be the victims of sex crimes (such as rape and incest) more often than men are. Both men and women seem to feel that men are more acceptable as objects of physical violence than women are, for both sexes kill men several times more often than they kill women. Even in experimental studies conducted by psychologists, both men and women exhibit greater readiness and willingness to inflict pain on men than on women, under otherwise identical conditions. Studies of child abuse in those countries in which reasonably accurate statistics are available find that boys are more often victims of lethal or life-threatening violent child abuse (being treated as violence objects) whereas girls are more often victims of sexual abuse (being treated as sex objects)- with few exceptions. Virtually every nation that has had a military draft has decided either that only men should be drafted, or that only men should be sent into combat. Again none of this should surprise us, given the competition between men for status, valor, bravery, heroism-and honor-in patriarchal societies.

We cannot think about preventing violence without a radical change in the gender roles to which men and women are subjected. The male gender role generates violence by exposing men to shame if they are not violent, and rewarding them with honor when they are. The female gender role also stimulates male violence at the same time that it inhibits female violence. It does this by restricting women to the role of highly unfree sex objects, and honoring them to the degree that they submit to those roles or shaming them when they rebel. This encourages men to treat women as sex objects, and encourages women to conform to that sex role; but it also encourages women (and men) to treat men as violence objects. It also encourages a man to become violent if the woman to whom he is related or married �dishonors� him by acting in ways that transgress her prescribed sexual role.

Since culture is itself constructed, by all of us, if we want to take steps to diminish the amount of violence in our society, both physical and sexual, we can take those steps. To speak of eliminating the sexual asymmetry that casts men and women into opposing sex roles is to speak of liberating both men and women from arbitrary and destructive stereotypes, and to begin treating both women and men as individuals, responding to their individual goals and abilities, rather than to the group (male or female) to which they belong.

There is a deep and tragic paradox about civilization. On the one hand, it has been, up to now, the most life-enhancing innovation the human species has created. The sciences have made it possible for more people to live, and to live longer lives, and to live better lives, freer of pain and illness, cold and hunger, than was ever possible before civilization was invented; and the many forms of art that could not and did not exist except under conditions of civilization are among the main things that make life worth living. But the paradox is that civilization has also increased both the level of human violence, and the scale of the human potential for violence, far beyond anything that any precivilized human culture had done. In the past, the primary threat to human survival was nature, now it is culture. Human suffering before civilization was mainly pathos; since the creation of civilization, it has become, increasingly, tragedy. In fact, it would not be going too far to say that violence is the tragic flaw of civilization. The task confronting us now is to see whether we can end the tragic (violent) element of civilization while maintaining its life-enhancing aspects.

Why has civilization resulted in the most enormous augmentation of human violence since the human species first evolved from its primate forebears? I believe that that question can only be answered by taking into account the psychology of shame. Shame not only motivates destructive behavior, it also motivates constructive behavior. It is the emotion that motivates the ambition and the need for achievement that in turn motivates the invention of civilization.

But-and this is the crux of the matter-this same emotion, shame, that motivates the ambition, activity, and need for achievement that is necessary for the creation of civilization also motivates violence. And when the enormous increase in technological power that civilization brings with it is joined to the enormous increase in violent impulses that shame brings with it, the stage is set for exactly the drama that the history (that is, the civilization) of the world shows us-namely, human social life as an almost uninterrupted, and almost uninterruptedly escalating, series of mass slaughters, �total� and increasingly genocidal wars, and an unprecedented threat to the very continuation not only of civilization itself (which brought this situation about, it cannot be emphasized too strongly) but much more importantly, of the human species for the sake of whose survival civilization was invented in the first place.

Through my clinical work with violent men and my analysis of the psychodynamics of shame and guilt, I have come to view the relationship between civilization and violence in a way that is the diametrical opposite of Freud�s. Freud saw violence as an inevitable, spontaneously occurring, natural, innate, instinctual impulse, and civilization and morality as attempts at �taming,� neutralizing, inhibiting or controlling that violent impulse. I see violence, in contrast, as defensive, caused, interpretable, and therefore preventable; and I see civilization, as it has existed up to now (because of class, caste and age stratification, and sexual asymmetry), as among the most potent causes of violence.

One of the puzzles of this century is the phenomenon of Nazism: how could one of the most civilized nations on earth have been capable of such uncivilized, barbaric behavior? (One could ask the same question about Japan�s record in World War II.) But from the perspective being elaborated here, genocide is not a regression or an aberration from civilization, or a repudiation of it. It is the inner destiny of civilization, its core tendency-its tragic flaw. Genocide has characterized the behavior of most of the great world civilizations, from ancient Mesopotamia to Rome, to medieval Europe, to the African slave trade and the conquest of the Americas, to the Holocaust and atomic weapons.

How to deal with violence, then? The moral value system (which I will call �shame-ethics�) that underlies the code of honor of those patriarchal cultures and subcultures in which behavioral norms are enforced primarily by the sanctions of shame versus honor, such as the Mafia, urban street gangs, and much of the rest of American culture, rationalizes, legitimates, encourages, and even commands violence: it does not prohibit or inhibit it.

The kind of morality that I am calling guilt-ethics (that says �Thou shalt not kill�) is an attempt at a kind of therapy, an attempt to cure the human propensity to engage in violence, which is stimulated by shame-ethics. And that was a noble attempt, which one can only wish had been successful. Why has it not worked? I think that the analysis of violence presented in this book can enable us to see the answer to that question. The reason that guilt-ethics has not solved and cannot solve the problem of violence is because it does not dismantle the motivational structure that causes violence in the first place (namely, shame, and the shame-ethics that it motivates). Guilt, and guilt-ethics, merely changes the direction of the violence that shame has generated, it does not prevent the violence in the first place. It primarily redirects, onto the self, the violent impulses that shame generates toward other people. But it does not prevent violence, or even inhibit it. Suicide is no solution to the problem of homicide; both forms of violence are equally lethal. Masochism is no solution to the problem of sadism; both forms of pathology are equally destructive and painful.

Neither shame nor guilt, then, can solve the problem of violence; shame causes hate, which becomes violence (usually toward other people), and guilt merely redirects it (usually onto the self). But to say simply that we need more love, and less shame and guilt, is vacuous. What we really need is to be able to specify the conditions that can enable love to grow without being inhibited by either shame or guilt. And it is clear that shame and guilt do inhibit love. Shame inhibits people from loving others, because shame consists of deficiency of self-love, and thus it motivates people to withdraw love from others and ration it for the self. Guilt, on the other hand inhibits self-love, or pride, which the Christian guilt-ethic calls the deadliest of the seven deadly sins. Guilt motivates people to hate themselves, not love themselves, because the feeling of guilt is the feeling that one is guilty and therefore deserves punishment (pain, hate), not reward (pleasure, love).

If we approach violence as a problem in public health and preventive medicine then we need to ask: What are the conditions that stimulate shame and guilt on a socially and epidemiologically significant scale? The conditions that are most important are relative poverty, race and age discrimination, and sexual asymmetry. If we wish to prevent violence, then, our agenda is political and economic reform.

The social policies that would be most effective in preventing violence are those that would reduce the amount of shame. To reduce the amount of shame, we need to reduce the intensity o the passive, dependent regressive wishes that stimulate shame. And to reduce the intensity of those wishes, we must gratify those wishes, by taking better care of each other, especially the neediest among us- particularly beginning in childhood, when the needs for love and care are most intense and peremptory. To quote again the phrase that Dostoevsky put in the mouth of Father Zossima, we then would recognize that �all are responsible for all.�

We have a horror of dependency in this country-particularly dependency on the part of men. No wonder we have so much violence-especially male violence. For the horror of dependency is what causes violence. The emotion that causes the horror of dependency is shame. Men, much more than women, are taught that to want love or care from others is to be passive, dependent, unaggressive and unambitious or, in short, unmanly; and that they will be subjected to shaming, ridicule, and disrespect if they appear unmanly in the eyes of others. Women, by contrast, have traditionally been taught that they will be honored if, and only if, they accept a role that restricts them to the relatively passive aim of arranging to be loved by men and to depend on men for their social and economic status, foregoing or severely limiting or disguising activity, ambition, independence, and initiative of their own. This set of injunctions decreases women�s vulnerability to behaving violently, but it also inhibits women from participating actively or directly in the building of civilization, in part by reducing them to the role of men�s sex objects.

We Americans, as a society, appear to be horrified by the thought that a man could be dependent on anyone (other than himself), and that a woman could be dependent on anyone (other than �her man�, that is, her father or husband). The extent of our horror of dependency can be seen in our horror of what is somewhat misleadingly called �welfare dependency�-whether it is the �dependency� on society of an unemployed or disabled man, of an unmarried mother, or of a child without a father. This conceals, or rather reveals, that we as a nation do less for our own citizens than does any other democracy on earth; less health care, child care, housing, support to families, and so on. So that we end up shaming and blaming those whose needs are exposed. Therefore it is not surprising that we also have more violence than does any other democracy on earth, as well as more imprisonment-since we shame some people for having needs that all people have.

For needs that are repressed do not get met, nor do they just disappear. The return of repressed needs, in unconscious, disguised form, is what the various symptoms of psychopathology consist of. One form in which repressed needs for care return is chronic institutionalization-that is, long-term imprisonment or mental hospitalization-which allows us as a society to punish massively, while we gratify grudgingly, those needs of which we are so intolerant.

In fact, the violence of our society reveals our shame at being less �independent� than we �declared� ourselves to be two centuries ago. In contemporary America, to want love, to depend on others, to be less than completely self-sufficient, is to be shamed by all the institutions of our society, from welfare offices to mental hospitals to prisons. One can pretend that one is in an institution only because one is so tough and dangerous an scary, so active and aggressive, and so independent of the community�s standards, that the courts insisted on locking one up against one�s own wishes. But nevertheless, it is true that for many men in our society it is only in prison that one is given three meals a day, a warm bed to sleep in at night, a roof over one�s head, and people who care enough about one to make sure that one is there every night.

Those are among the reasons why the most effective way to increase the amount of violence and crime is to do exactly what we have been doing increasingly over the past decades, namely, to permit-or rather, to force-more and more of our children and adults to be poor, neglected, hungry, homeless, uneducated, and sick. What is particularly effective in increasing the amount of violence in the world is to widen the gap between the rich and the poor. We have not restricted that strategy to this country, but are practicing it on a worldwide scale, among the increasingly impoverished nations of the third world; and we can well expect it to culminate in increasing levels of violence, all over the world.

Relative poverty-poverty for some groups coexisting with wealth for others-is much more effective in stimulating shame, and hence violence, than is a level of poverty that is higher in absolute terms but is universally shared. Shame exists in the eye of the beholder-though it is more likely to exist there if the beheld is perceived as richer and more powerful than oneself. In that archaic, prescientific language called morality, this gap is called injustice; but most people throughout the world still think in moral terms, and the perception that one is a victim of injustice is what causes shame, which in turn causes violence.

From the standpoint of public health, then, the social psychology of shame, discrimination, and violence becomes central to any preventive psychiatry. The causes of consequences of the feelings of shame as well as their psychodynamic parameters have become more urgently compelling as a focus of investigation, given the potential ultimacy of violence in a nuclear age, as well as the continuing high rate of violence in American society. In my analysis of the psychological consequences of the feelings of shame, I have set out to show how such seemingly trivial events as personal experiences of chagrin or embarrassment can explode into epidemics of violence, just as the physical consequences of organisms as insignificant as microbes can have the gravest implications for public health. As Rudolph Virchow, who helped to lay the foundations of preventive medicine and public health more than a century ago, put it, �Medicine is a social science, and politics is simply medicine on a larger scale.�

If cleaning up sewer systems could prevent more deaths than all the physicians in the world, then perhaps reforming the social, economic, and legal institutions that systematically humiliate people can do more to prevent violence than all the preaching and punishing in the world. The task before us now is to integrate the psychodynamic understanding of shame and guilt with the broader social and economic factors that intensify those feelings to murderous and suicidal extremes on a mass scale.

Read more from Violence: Reflections on a National Epidemic: Young Men Are the Most Violent: Is This Biological?

James Gilligan is a Clinical Professor of Psychiatry in the Medical School, an Adjunct Professor in the Law School, and a Collegiate Professor in the School of Arts and Science at New York University. Before that he was on the faculty of the Harvard Medical School for 35 years, where he was Director of the Institute of Law and Psychiatry and directed mental health programs for the Massachusetts prison system and the prison mental hospital. He was President of the International Association for Forensic Psychotherapy, and a consultant to the prosecutorial staff of the World Court's International Criminal Tribunal for the former Yugoslavia in support of their petition to declare the systematic mass rapes that occur in wartime as "War Crimes" and "Crimes Against Humanity" rather than merely individual crimes of rape. He was awarded the 2004 Achievement Award of Physicians for Social Responsibility, and is the author of Violence: Reflections on a National Epidemic, as well as Preventing Violence (Prospects for Tomorrow) .

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