As a public health psychiatrist, I have been interested in trauma, such as that stemming from gun-related homicides and other forms of violence, for more than 30 years. I’ve also published extensively on these public health challenges.
A recent report prepared by the National Science Foundation makes important distinctions between the different types of violence that are helpful as we try to understand these issues.
Dr. Carl C. Bell
According to the report, rampage shootings in schools typically occur in "stable, close knit, low crime, and very rural towns." In these incidents, the shooter is usually a white adolescent male who does not have a history of medical treatment for mental disorders. These adolescents engage in antisocial behavior "to replace a damaged identity with a new and more satisfying one: the notorious, dangerous, hypermasculine antihero."
In contrast, urban shootings tend to take place in "densely populated areas with high crime levels and low social crime levels. Young people involved in these crimes "absorb a ‘code of the streets,’ which requires individuals to project ... a tough, violence-prone image in order to ward off threats they encounter in ordinary interaction."
Both categories of gun violence result in trauma, which frankly and sadly, makes our work as psychiatrists daunting.
When I hear about gun-related violence, regardless of the category, my first thought is this: We have a body of evidence that can be used to stop it. How? Let’s take a look at strategies that have worked in the past.
A little more than 100 years ago, Chicago experienced an influx of European immigrants as the city rebuilt from the Great Fire of 1871. Parents were working overtime to scrape out a living, and children had to work to contribute to the family’s livelihood. Jane Addams, the great social activist, described the children as "ill fed, ill housed, ill clothed, illiterate, and wholly untrained and unfit for any occupation." Families were disrupted by poverty and unfamiliar community circumstances. Sound familiar?
From 1875 to 1920, these conditions caused European immigrants' domestic violence in Chicago to be extraordinarily high; juvenile delinquency and violence were rampant. Fortunately, Jane Addams and her colleagues founded Hull House as a social settlement house "to aid in the solution of the social and industrial problems which are engendered by the modern conditions of life in a great city." This group of industrious women also developed the first Juvenile Court and the Institute for Juvenile Research (birthplace of child psychiatry) to strengthen families and to understand the causes of delinquency. Their methods, supported by the science of the day, proved successful for families disrupted by poverty and for disconnected communities.
A hundred years later, from 1992 to 1999, prevention researchers did research in 12 Chicago public schools. The research resulted in the Aban Aya Youth Project, a research project on violence, drug use, and early sexual debut prevention developed specifically for African American youth. In 2007, an independent team of national researchers examined 53 universal school-based programs that prevent violent and aggressive behavior, and affirmed Aban Aya as one of seven programs that had greatest design suitability and good execution. Based on the Aban Aya outcomes, seven "field principles" were created that government and community partners could use to reduce the likelihood that risk factors such as poverty and neighborhood disruption would automatically lead to violence and other negative behaviors in youth.
In short, these principles cultivate protective factors that prevent risk factors from leading to negative youth behaviors. The seven field principles are as follows:
• Rebuilding the village/constructing social fabric (known as building collective efficacy) – a good example of this is the creation of block clubs in which everyone on the block looks after one another and everyone’s children.
• Providing access to modern and ancient technology – both biotechnical and psychosocial.
• Improving bonding, attachment, and connectedness between people – resiliency research illustrates the reality that if youth have a good relationship with a caring adult who has the youth’s best interests at heart, it is protective of the youth’s successful outcome.
• Providing an opportunity to improve self-esteem – a sense of power, a sense of models, a sense of uniqueness, and a sense of connectedness.
• Increasing opportunities to learn social and emotional skills of target recipients – a good example of this is anger management skills (technically known as affect regulation.
• Reestablishing the adult protective shield and monitoring of risky behaviors by adults that can also be thought of as providing a sense of safety – a good example of these are the security procedures at the entrance of Chicago Public Schools.