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Bandy X. Lee M.D., M.Div.
Bandy X. Lee M.D., M.Div.
Health

All Are Responsible to All

Preventing Violence Means Caring for the Ecology

Luca Bravo/Unsplash
Source: Luca Bravo/Unsplash

“And that we are all responsible to all for all.” -Father Zossima in The Brothers Karamazov

Human history is mired in violence, and yet, for the longest time, we have not known how to deal with it. Misunderstandings have been as ubiquitous as violence itself, and the resulting helplessness has made us accept it as inevitable, if not something one must engage in, to advance or to protect oneself in the world.

Violent policies are evident everywhere, from international politics to “the code of the street” (Anderson, 2000). U.S. gun policies are an extension of this, which come into focus after the killing of 17 people in the nation’s 30th mass shooting of the year. Politicians are quick to point out the mental health issues the gunman has been suffering from, perpetuating prejudices but dealing little with the actual source of the problem. It is about time that we have policies that reflect the evidence that is available.

There is now a wealth of scholarship and expertise, especially in violence prevention, due to rapid advances in the area. Since the World Health Organization’s launch of its World Report on Violence and Health (Krug, Dahlberg, Mercy, Zwi, and Lozano, 2002) over 15 years ago, a revolutionary shift has been taking place worldwide: from seeing human violence as an individual, criminal justice, and security issue to which we can only respond, to a preventable health problem that we can solve through systematic study.

Since applying the ecological model to violence, we have discovered that social, cultural, economic, and environmental factors are far more reliable predictors of violence than individual factors. To try to predict violent behavior in individuals is a fool’s errand, since when and how violence occurs is almost accidental, depending largely on state of mind, situational factors, attitudes, support, and access to weapons. To predict and to prevent violence in society, however, is almost surefire.

What do we mean by this? Where societal trends and epidemics are concerned, individual characteristics tell us little in comparison to social conditions: thirty years of intensive research have revealed a great deal to us in terms of what actually prevents violence. The World Health Organization and two United Nations bodies documented, for example, how 133 countries changed policies, instituted laws, offered services, strengthened law enforcement, and implemented programs to reduce global homicide rates by 16 percent in 12 years (World Health Organization, United Nations Office on Drugs and Crime, and United Nations Development Program, 2014). Cultures that experience lower violence rates are more likely to develop nonviolent social norms as well as to adopt enlightened policies that reduce violence further, while those that have not done so continue to spiral into further violence, in the opposite direction of the global trend.

First, it should be emphasized that mental illness has very little to do with violence. Media and public perception often overplay the link, but substance use aside, mentally ill individuals are no more violent than the general population. This remains so after society has stripped those who are suffering from mental illness most of their care, preferring to treat them in jails and prisons, which is further evidence of a weak link.

Secondly, as much as mass murders grab our attention, we must remember that they consist of only one percent of violent deaths, and our focus on them should be far less. The vast majority of violent deaths occur without much recognition, in intimate settings hidden from public view. To reduce the prevalence of violent deaths effectively, we should consider all forms of violence together, giving more focus to hidden forms of violence.

Thirdly, it needs to be noted that societal factors play a much larger role even in individual violence. Even the important individual factors are social: substance use, male gender, a history of violence, experiencing or witnessing domestic abuse, social connectedness, and access to firearms. The individual is part of a larger cycle of violence where the perpetrator is often also the victim, in a system where social, political, economic, cultural, or environmental factors play a much greater role in determining whether given individuals will be violent.

We can contribute to this ecology in ways that either help to promote health and well-being or to worsen our overall condition, of which violent death rates are an excellent barometer. The concept of all caring for all is none too soon: our capacity for violence has reached unacceptable levels, being the first species on earth to threaten its own extinction—either instantaneously through thermonuclear war or insidiously through the permanent destruction of our habitat. If we are not too concerned about this fact, then that should be a cause for further concern.

Violence begets violence. A major way in which society has dealt with individual violence in the past has been through escalating imprisonment and police. What we see in the biggest carceral nation of the world is that the “backfire” effects have not only promoted violence and crime but gutted the funds for education, healthcare, social improvement, and crime prevention programs. Similarly, the world’s greatest military power may believe it is “protecting” itself by investing heavily in the upgrade and development of its already enormous nuclear stockpile, but it is merely creating a global climate that could hasten the demise of all.

Having little concern for others, dividing ourselves into “us versus them,” and allowing for destructive policies to continue, as well as the social norms that they propagate, merely drive us closer to collective suicide. Gun murders in the U.S. have risen by thirty percent in the last two years, a sharp departure from steady rates in previous years (Ahmad and Bastian, 2018). A major leader’s attraction to and endorsement of violence in public speeches has insidious effects and the potential to lay out the groundwork for a culture that can give rise to epidemics of violence.

Gun laws help, of course, but we must also fix the larger social, cultural, economic, and even political system. Policies that prevent violence not only save lives, suffering, medical and mental health expenses, and criminal justice expenditures—but enhance family unity, community integration, work and school life, and the social mores of the population. We should therefore think of violence as a whole, and prevent it as if our own problem, for we are all responsible.

References

Ahmad, F. B., Bastian, B. (2018). Quarterly Provisional Estimates for Selected Indicators of Mortality, 2016-Quarter 3, 2017. Atlanta, GA: U.S. Centers for Disease Control and Prevention. Retrievable at: https://www.cdc.gov/nchs/nvss/vsrr/mortality-dashboard.htm

Anderson, E. (2000). Code of the Street: Decency, Violence, and the Moral Life of the Inner City. New York, NY: W. W. Norton and Company.

Krug, E. G., Dahlberg, L. L., Mercy, J. A., Zwi, A. B., and Lozano, R. (2002). World Report on Violence and Health. Geneva, Switzerland: World Health Organization. Retrievable at: http://apps.who.int/iris/bitstream/10665/42495/1/9241545615_eng.pdf

Wilkinson, R., and Pickett, K. (2011). The Spirit Level: Why Greater Equality Makes Societies Stronger. New York, NY: Bloomsbury Publishing.

World Health Organization, United Nations Office on Drugs and Crime, United Nations Development Program (2014). Global Status Report on Violence Prevention 2014. Geneva, Switzerland: World Health Organization. Retrievable at: http://www.undp.org/content/dam/undp/library/corporate/Reports/UNDPGVA-…

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About the Author
Bandy X. Lee M.D., M.Div.

Bandy Lee, M.D., is a forensic psychiatrist at Yale School of Medicine and project group leader for the World Health Organization Violence Prevention Alliance. She also authored the textbook Violence.

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