• Jennifer Barnick

Is Violence Infectious?

Doctor and Patient

Photo Source: NIH

There is no doubt that violence is a crisis in our world today. “Violence cost the world $14 trillion last year [2016], 12.6% of World GDP. We are now faced with a mounting death toll and a refugee crisis of historic and unsustainable proportions, with an estimated 65.6 million refugees—and still growing.” (Violence Spreads Like an Infectious Disease. We Need to Treat it Like One by John Hewko and Dr. Gary Slutkin, Nov. 10, 2017, weforum.com [World Economic Forum])

Enter Dr. Gary Slutkin. Dr. Slutkin worked for years as an infectious disease specialist and has had a remarkable career in the field of infectious disease. Using his years of experience fighting epidemics in Africa and Asia, he came to see identical patterns with violence. “Recent scientific advances have demonstrated that violence behaves like other contagious health epidemics, yet it is the only health epidemic not primarily managed by the health sector.” (Violence Spreads Like an Infectious Disease. We Need to Treat it Like One by John Hewko and Dr. Gary Slutkin, Nov. 10, 2017, weforum.com [World Economic Forum]) Convinced that violence would best be addressed as a health care issue and primarily dealt with via health workers, Dr. Slutkin formed the non-for-profit Cure Violence. Cure Violence has set up pilots throughout the world both conducting studies as well as striving to reduce the violence in some of the most violent areas like Honduras and Chicago throughout the world. And while they have not found a magic bullet, they have been able to reduce the amount of violence and, in some areas, stamp out murder altogether.

There are reasons why not only Dr. Slutkin (and several other researchers) feel justified in labeling violence as a contagious disease. “First, a disease is defined as ‘any deviation or interruption of structure or function of a part, organ, or system of the body, as manifested by characteristic symptoms and signs (causing morbidity and mortality)’ […] Violence affects the structure and function of the brain, has characteristic signs and symptoms, and causes morbidity and mortality. Violence also demonstrates the characteristics of an epidemic type of disease, specifically through its clustering, spread, and transmission. […] What defines violence as contagious is that it can spread from person to person with one event leading to another and this it is a risk factor for itself, meaning that exposure to violence is a risk factor for the formation of violent behavior.” (Response to ‘Metaphorically or Not, Violence Is Not a Contagious Disease’ by Gary Slutkin, MD, Charles Ransford, MPP, and Daria Zvetina, May 2018, journalofethics.ama-assn.org) Essentially, the violence as a contagious disease theory rests on the idea that being exposed to violence (whether through witnessing it or being a victim of it) infects you with violence, and you become a potentially violent person (which spreads violence even further). Violence is then a contagion, and people who have been exposed to violence should be treated by the health care community as someone infected. The brains of people who have been exposed to violence do change. “The brain processes violence exposure into scrips, or copied behaviors, and unconscious social expectations. This processing can also lead to several situationally adaptive responses including aggression, impulsivity, depression, stress, exaggerated startle responses, and changes in neurochemistry.” (How the Health Sector Can Reduce Violence by Treating It as a Contagion by Gary Slutkin, MD, Charles Ransford, MPP, and Daria Zvetina, Jan. 2018, journalofethics.ama-assn.org) Not only should the wounds of a victim be dealt with but also their trauma to prevent the victim from retaliating with violence or acting out violence in other ways like domestic abuse and suicide. Witnesses too of violent events need to treated by the health care community as infected and should be screened and treated as exposure to violence not only can lead to a list of mental health disorders but also more violence.

There has been some pushback in the research and medical field regarding Dr. Slutkin’s (and many other health professionals) theory that violence is actually a contagious disease and should be primarily treated with health care professionals (versus political and law enforcement means). In the American Medical Association’s Journal of Ethics, a rebuttal in the form of a letter to the editor was published in response to Dr. Slutkin’s paper in the same journal. His argument was that while it was easy to draw a comparison to disease and violence, it was not really addressing the fundamental issues driving violence, and that to simply see violence as a stand-alone, spreadable virus-like thing was dangerous in that it would never address what the author (also a doctor and researcher) felt were the real driving forces behind violence. “The primary driver of violence is not some abstract violence germ but rather has to do with severe deprivations and oppression that the residents in such neighborhoods face on a daily basis. So, the parallel in public health should not be the contagious disease model but rather the effects of toxic environments that we know are the root of non-contagious diseases such as asthma and malaria.” (Metaphorically or Not, Violence is Not a Contagious Disease by Michael B. Greene, Ph.D., May 2018, journalofethics.ama-assn.org) I read all three articles from Dr. Slutkin’s original to Dr. Greene’s rebuttal and then back to Dr. Slutkin’s defense, and I will say that while Dr. Greene does make some fine points, it is not as sound as Dr. Slutkin’s theory, as while poverty and racial bias (another point Dr. Greene brought up) puts someone at a higher risk factor for violence, it is not the only source of it. White middle-class males are now committing suicides at epidemic proportions in the U.S., and racial bias and poverty were not connecting factors to the modern mass shooting epidemic.

The idea of violence being a contagious disease is, in my opinion, a compelling theory and has seen real results in some of the most violent areas in the world. It proposes that the best way to curb violence is actually to treat it—most effectively at the earliest exposure. Gunshot victims are primarily treated for their physical wound and then processed by law enforcement, and then set back out into the world now fully infected with violence. The argument is that the gunshot victim must also be treated for trauma and be aided by health care professionals in coping with the stress, depression, and mental hardships that come with the exposure to violence and often cause the infected individual to act out violently to either themselves or to others. There has been some pushback in the research: a 2017 study from the University of Pennsylvania says that no, gun violence is not contagious, rather, it is place-specific and requires not a health care approach but a place approach as in “greening of vacant lots” and “hotspot policing.” (Is Gun Violence Contagious? New Research from the University of Pennsylvania and the University of Oxford Points to an Answer, November 2, 2017, sciencedaily.com) However, published in the January 4, 2017 edition of Yale News was an article entitled, Yale Study Finds That Gun Violence is a ‘Contagious’ Social Epidemic (by Bess Connolly Martell). The article summarizes the study that found not only gun violence was contagious by also that it was clear that the best way to treat gun violence was: “We want to take this epidemic of gun violence out of the criminal justice paradigm and put it in a public health context that focuses on victims and the reduction of trauma,” says Papachristos, corresponding author on the study.

As depressing as an issue like violence is it is encouraging that real solutions to violence are being researched and attempted. I think it is important when writing about science to understand that science is never fixed and to be open-minded about new research that might disprove a previously believed fact. However, I think the violence as contagious disease theory is the most compelling argument how violence actually spreads and perhaps how violence might be prevented.

Jennifer Barnick

Jennifer Barnick is a painter and writer. She studied painting at the San Francisco Art Institute. She founded Twenty-two Twenty-eight. “One of the most exciting aspects of Twenty-two Twenty-eight is building a channel for artists and writers to share their work with the world.”

Check out Jennifer’s book. You can read the first short story for free on Amazon here.

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