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Youth Violence, Public Schools, and Public Health

NPR is the latest outlet to focus on “what some call an epidemic of youth violence in Chicago.” It’s likely to be an issue as Rahm Emanuel selects new heads for CPS and the CPD. But research suggests that youth violence is as much a matter of public health as anything else.

NPR kicked off a new series today on youth violence in Chicago; I knew it was a problem, but the numbers still surprised me: an average of two shootings a day.

Maybe I’d forgotten how bad the problem is because it can be hard to tell where ”epidemic” ends and “ongoing problem” begins. For instance, here’s Natalie Moore, reporting on youth violence statistics in 2010:

In May 2007, Blair Holt was killed while protecting a fellow Julian High School student on a city bus. The focus on youth violence reached a new crescendo. The tragedy garnered national attention and 2,000 funeral mourners.

In 2009, Eric Holder came to Chicago to discuss youth violence and the Derrion Albert beating. In 2008 there was a “clampdown” after shootings of CPS students increased over the previous year. In 2007, Anderson Cooper weighed in.

Two weeks after the “weekend of rage” that claimed seven lives in 2008, Alex Kotlowitz profiled CeaseFire and its founder, epidemiologist Gary Slutkin (Kotlowitz recently produced a documentary on CeaseFire, The Interrupters, with Hoop Dreams director Steve James—see related link). CeaseFire emerged from a simple idea: Slutkin noticed that violence followed the patterns he was used to as an epidemiologist. In short, maybe there isn’t just an epidemic of youth violence–maybe it is an epidemic, and should be treated as one:

As CeaseFire evolved, Slutkin says he started to realize how much it was drawing on his experiences fighting TB and AIDS. “Early intervention in TB is actually treatment of the most infectious people,” Slutkin told me recently. “They’re the ones who are infecting others. So treatment of the most infectious spreaders is the most effective strategy known and now accepted in the world.” And, he continued, you want to go after them with individuals who themselves were once either infectious spreaders or at high risk for the illness. In the case of violence, you use those who were once hard-core, once the most belligerent, once the most uncontrollable, once the angriest.

As a public-health approach to violence, CeaseFire is still kind of metaphorical: violence spreads like a disease, so it should be treated like a disease. But there are other approaches more closely related to public health. In the most recent New Yorker, Paul Tough (probably best known for his book on Geoffrey Canada and the Harlem Children’s Zone) profiles Nadine Burke, a San Francisco doctor who, as Tough writes,

believes that regarding childhood trauma as a medical issue helps her to treat more effectively the symptoms of patients like Sullivan. Moreover, she believes, this approach, when applied to a large population, might help alleviate the broader dysfunction that plagues poor neighborhoods. In the view of Burke and the researchers she has been following, many of the problems that we think of as social issues–and therefore the province of economists and sociologists–might better be addressed on the molecular level, among neurons and cytokines and interleukins. If these researchers are right, it could be time to reassess the relationship between poverty, child development, and health, and the Bayview clinic may turn out to be a place where a new kind of pediatric medicine is taking its tentative first steps.

Tough’s lengthy profile is behind a paywall, but it’s well worth tracking down. The research Tough rounds up makes a compelling argument for looking at violence (and other pathologies, such as addiction) on a literally molecular level: “how early trauma creates lasting changes in the brain and body.” It’s the sort of thing that seems intuitively obvious, but the science behind it is still progressing.

Burke isn’t the first medical professional to link childhood trauma with criminality and other issues. In 1992 Steve Bogira profiled Bruce Perry, then working on a fellowship at the University of Chicago in child and adolescent psychology (Perry now runs the Child Trauma Academy and is an adjunct prof at his alma mater, Northwestern’s Feinberg School of Medicine). He began studying brain chemistry and post-traumatic stress disorder in veterans shortly after medical school, and later connected it to childhood trauma:

Many PTSD kids appear psychotic at first, Perry tells me later. Under stress people “revert to the more comfortable, tried-and-true defense mechanisms. When I get really stressed out, I go back to sort of a preadolescent stage–stomping around and fuming. But many kids will regress to incredibly primitive mechanisms–they’ll rock and they’ll go back to primary-process thinking. Primary process is the way very young children view the world. They make odd associations because they haven’t had much experience. A child sees a red fire truck for the first time and hears a siren, and the next time they see anything red they’ll say, “Oh, siren."‘ Because PTSD kids are so easily stressed, they do a lot of this primary-process thinking, Perry explains, which is what leads to them being diagnosed as psychotic and put on antipsychotics.

Perry also figured in Ronald Kotulak’s Pulitzer-winning 1993 series on neurology for the Tribune, in the piece “Why Some Kids Turn Violent”:

In children, the disorder resets the brain’s chemistry to an alarm response. They are hot-blooded, more quick to react, more impulsive, more aggressive and more likely to commit violent criminal acts.

“It is adaptive to be impulsive in that (abusive) setting,” Perry said, referring to the cult. “If you wait, very frequently you will be victimized. So it’s highly adaptive to be hypervigilant, to be overly reactive and impulsive, to actually act before you’re acted upon.”

As Burke tells Paul Tough, the effects are not just passed down in a chain of violence, they’re contagious:

“Then the pathology moves from the individual level to the household level, because that partner beats their kids, and then their son goes to a school where ten out of thirty kids are experiencing the same thing. Those kids create in the classroom a culture of hitting, of fighting–not just for the ten kids but all thirty. Then those kids get a little older, and they’re teen-agers, and they behave violently, and then they beat their kids. And it’s just accepted. It becomes a cultural norm.

The concept behind CeaseFire is that its “interrupters” stop violence before it starts. If cops respond to violence, interrupters respond to the potential for it: “for violence, we’re trying to interrupt the next event, the next transmission, the next violent activity,” Slutkin told Kotlowitz. Perry and Burke take that a step further to the root of violence, interrupting the general impulse instead of the specific one.

Burke’s quote above reminded me of the ongoing discussion about school reform in Chicago, which is likely to be the first big issue of Rahm Emanuel’s first term as mayor. The NPR report, for example, focuses on anti-violence programs in the Chicago Public Schools. But it’s a big burden for a school system to bear, or even a police department. If you believe Burke and Perry, the problems we often assign to schools and law enforcement are as much an issue of public health, in the literal, medical sense, as anything else–if not more. As the debate turns to the seemingly intractable problems of our public educational system, it’s worth keeping the public health angle in mind.

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