What does violence have in common with COVID-19?
Since the outbreak of COVID-19, ordinary people around the globe have become more familiar with public health organisations such as the World Health Organisation (WHO) and the Center for Disease Control (CDC) whether they wanted to or not. Contagion-related terminology, physical distancing requirements and movement restrictions have come to dominate our daily life. To some degree, we all feel less safe in our bodies around other people since lockdown. To make matters worse, some people, including small, malleable children, have been cooped up at home with their abusers for months, with no respite.
Safety is fundamental to human health, flourishing and social behaviour. Even before the pandemic, crime and violence have been increasingly viewed and responded to as public health issues in some quarters. Samira Shackle states that one of “the primary indicators that someone will carry out an act of violence is being a victim of one beforehand.”
In Creating Sanctuary, Dr Sandy Bloom, who established a specialised psychiatric unit catering to middle-class people in a semi-rural area of Philadelphia which later became the Sanctuary Model, writes that violence is “an infectious disease”. She maintains that violence perpetrated against children is the root cause of all violence.
In The Body Keeps the Score, world-renowned psychiatrist and neuroscientist, Bessel van der Kolk similarly observed that while childhood trauma is “arguably the greatest threat” to our well-being and the greatest public health issue of our time, we have yet to mobilize our collective efforts to prevent it.
The 1998 Adverse Childhood Experiences (ACE) study found that adult respondents who were exposed to four or more adversities before they turned 18 (e.g. physical abuse, emotional neglect, witnessing domestic violence against their mother and maternal depression) were 14 times more likely to have been a victim of violence, and 15 times more likely to have been violent towards another person in the previous 12 months.
The CDC published findings in November 2019 on 144,000 adults from 25 States in America. According to the report, 61% of adults had at least one ACE and 16% had 4 or more ACEs. Women, Native Americans and African Americans were more likely to experience four+ ACEs. In 2019 the CDC also published a document on preventing ACEs and violence by adopting a “multi-generation approach”. The report called for greater economic supports for families and the promotion of social norms that protect against violence and adversity. It also recommended that active steps be taken to ensure a healthy early years’ experience for children and the development of schemes connecting youth to caring adults, e.g. via mentoring programmes.
The WHO Adverse Childhood Experiences International Questionnaire (ACE-IQ), developed in conjunction with the CDC for use in all countries, contains a wider range of ACEs than the original study. It poses questions on family dysfunction; parental death; hunger; physical, sexual and emotional abuse and neglect by parents or caregivers; bullying and peer violence; witnessing community violence; and exposure to collective violence, such as warfare, terrorism and genocide. WHO states:
“[i]t has been shown that considerable and prolonged stress in childhood has life-long consequences for a person’s health and well-being. It can disrupt early brain development and compromise functioning of the nervous and immune systems. In addition because of the behaviours adopted by some people who have faced ACEs, such stress can lead to serious problems such as alcoholism, depression, eating disorders, unsafe sex, HIV/AIDS, heart disease, cancer, and other chronic diseases.”
In the criminal justice setting, higher ACE scores have been found to predict future incarceration, recidivism, substance misuse and violence as an adult.
Gregg Caruso, a philosopher who describes himself as an optimistic “free will sceptic” has argued for a “public health-quarantine model” as an alternative to retributivist criminal justice. Drawing on the Social Determinants of Health, Caruso argues that the social determinants of criminal behaviour and violence are broadly similar. In his view society should adopt a public health approach focusing on prevention and social justice.
According to Dr Stephen Porges who developed the “polyvagal theory”, human beings are on a quest for safety. As mammals our bodies need to feel safe in the presence of other people’s bodies in order for us to be healthy, and capable of reciprocal relationships and social behaviour. Feeling physiologically safe requires more than the absence of threat. Our nervous system detects danger in the environment without our conscious awareness. Fear is quickly aroused in an over-sensitised autonomic nervous system — which is also frequently referred to as the stress response system. According to Dr Dan Siegel this causes people to “flip their lids” and become ruled by their reptilian survival brains and emotional limbic system leading to the under-development of higher cortical functions which inhibit impulsive behaviour.
In Born for Love: Why Empathy Is Essential-and Endangered Maia Szalavitz, a science writer and Dr Bruce Perry, a neuroscientist, child psychiatrist and founder of the Child Trauma Academy in Houston, state that people who are repeatedly exposed to extreme threat develop faster reaction times, since delayed responses might prove fatal.
The Scottish Violence Reduction Unit (VRU) is the only police member of the WHO Violence Prevention Alliance. It operates on the basis that “violence is preventable — not inevitable.” Since John Carnochan and Karyn McCluskey launched the VRU in 2005 as an innovative response to the knife crime epidemic in Glasgow, the murder rate in Glasgow has fallen by 60%. The ACE-aware, trauma-responsive policing approach of the VRU works with community partners, including medics and Navigators (former offenders) to interrupt the spread of the contagion of violence, offering social support and employment opportunities to violent offenders.
The Cure Violence health model, which has been implemented in New York City, Chicago, Baltimore, San Antonio, New Orleans, Honduras and Cape Town approaches violence as if it were a contagious disease such as tuberculosis, cholera, HIV or, indeed the current global public health menace that is COVID-19, by:
1) interrupting transmission of the disease,
2) reducing the risk of the highest risk,
3) changing community norms.
Father Gregory Boyle, a Jesuit priest who established Homeboy Industries in Los Angeles in 1992 has stated that the most effective way of ensuring that gang members abandon violence and criminality, is to provide opportunities for healing.
Several of the 12 imprisoned men I interviewed for my PhD research in Law described themselves as “very soft-hearted”, “good”, “easy-goin’” and “nice”, but also admitted having a nasty, dangerous “feared self”, prone to violence and reckless risk-taking behaviour (including driving at high speeds), especially when under the influence of alcohol and benzodiazepines. The furious parts of these men generally lay dormant, quietly repressed by day, only to make an explosive appearance intermittently by night.
Dr Jacob Ham, a clinical psychologist and trauma specialist refers to this phenomenon as “hulking out”. According to van der Kolk, “acts of violence that the perpetrator regards as horrible may, in fact, produce somatic calm.”
Many of my interviewees voluntarily disclosed histories of abuse, neglect, community adversity and institutional violence. They also claimed that they frequently experienced blackouts and had no recollection of their aggressive behaviour while on a bender. This might well be a coping strategy to live more comfortably with themselves and the consequences of their harmful actions. The blackouts may be a means of venting their pent-up feelings that urgently need a release. If so, these men need to be assisted to find a healthier way of releasing their feelings, including their rage.
Trauma theory strongly suggests that mental health practitioners working with prisoners, whose rage surfaces with poly-drug use, should strive to help individuals address their constricted feelings consciously, so as to resolve them. By deactivating the time bomb ticking inside them, people would be better positioned to regulate their emotions, contemplate recovery, build on their strengths and desist from crime. Understanding and befriending the hulk is the way forward. If the men could face the underlying reasons for repressed rage head on, it may reduce their impulsive risk-taking and propensity for violence. Society would ultimately reap the dividends.
While access to education or a job post-release may lead to long-term positive change, healing from trauma is the true redemptive force. Relational health, being seen, known and accepted is the antidote to violence. Johann Hari states the opposite of addiction is connection, not sobriety. The opposite of violence is also connection. While punitive laws and harsh sentences have little success in reducing violent behaviour, feeling safe, loved, cherished, worthy and purposeful as a human being is transformative.
Violence starts with “relational rupture” and ends with “relational repair”. Like COVID-19, we need to adopt a global public health approach to violence prevention. We must also invest as societies in relational connectedness to foster healing in its aftermath. As Mary Glasgow stated at the ACE-Aware Nation conference in Glasgow in September 2018: “relationships are an evidence-based programme”.
