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URGENT DISPATCH: CALLING ON LEADERSHIP TO RESPOND TO VIOLENCE IN BLACK NEIGHBORHOODS AS A PUBLIC HEALTH CRISIS

SHARON TOOMER AND RAQUEL MACK, MS

Before our eyes, in plain sight and in real time, the people of the United States and all of its governing bodies, academic corridors, medical institutions, and public policy arena are witnessing the great human experiment that began in the 20th century and continues well into the 21st century: one group of citizenry is plagued with unceasing and prolonged violence.

That is the real-life state of affairs for people in black neighborhoods across the nation, and that there is no effective or targeted response to end the crisis is a commentary on the contemptible political, social, and economic failure of this nation to allow such conditions to exist for any of its own citizenry.

This failure to target and respond to a public health crisis and human atrocity happening in the nation’s own backyard is a confounding and frustrating social and health injustice. What does it take for leadership in all sectors to aggressively and wholly step up and step in these impacted neighborhoods? Where is the immediate and targeted response? That is at the heart of this discussion paper.

The purpose of this chapter is not an academic, medical, or mental health examination of violence or the psychological impact of violence. Instead, our intent is to give voice to people who are suffering and overwhelmed with terrifying, life-changing, and life-ending conditions in neighborhoods across this nation as a result of the unrelenting and prolonged violence they live with day in and day out. We aim to message and appeal to the greater universe of expertise, leadership, and purse-string holders to respond to the urgent cries of the women, men, girls, and boys who are left to navigate and deal with the psychological

aftermath of violent episodes. How can a people be expected to progress and excel or even exist under these conditions, when every aspect of their life—home, work, and learning—is affected by one act of violence?

For context and out of respect for those most affected by violence, we include perspectives of people who speak from firsthand knowledge or who, in their own experience with violence, offer invaluable insight. They are the voices on the ground that are too often ignored, rejected, or altogether dismissed by experts and leaders who stand on greater platforms of influence. The voices of the people most affected are vital to a comprehensive understanding of the conditions, what’s at stake, and how to arrive at a solution.

But the overarching point of this perspective is to call attention to and present a case for why violence in black neighborhoods is a public health crisis that requires immediate, decisive, targeted, and swift action involving all sectors in a position to respond with expertise, leadership, and resources.

And, this, too, must be noted: the conspicuous absence of visible leadership and targeted response to the longstanding and progressively worsening crisis of violence in black neighborhoods is remarkable. Juxtaposed to the intervention in and response to the nation’s opiate and heroin addiction public health crisis, the absence of visible and targeted leadership is all the more glaring.

LANGUAGE MATTERS: USE OF “BLACK PEOPLE” AND “NEIGHBORHOODS”

We use language that may not be customary for the primary reading audience. For instance, we use black people to describe the human beings we focus on and we use neighborhood in place of community. From our viewpoint, black people authentically and broadly describes and includes the people we highlight. The alternatives—African American, people of color, minorities, people of African descent—do not resonate with us in style, in content, or in this context.

In many neighborhoods, black people may be born in the United States and are generationally tied to this country, yet their ancestral and cultural linkage is to the West Indies, Caribbean, Africa, or Central and South America. The same is so for newly arrived immigrants of African descent. Brooklyn, New York, is an example of a borough (town) where the diversity of black people includes representation from across the world. All in all, news reports do not identify geographic lineage of black people, and crime statistics do not parse out ethnicity or cultural data when reporting violence in black neighborhoods. We want to recognize the diversity and nuance of cultures and we believe that is accomplished in the use of black people versus the alternatives.

Also necessary in this perspective is the distinction between neighborhood and community. These are neighborhoods, human and personal spaces, where black people live and violence is happening. Community is too broad a term that tends to detach the human element. This is an important language distinction because also missing in news coverage and crime statistics is the magnified shock wave of one act of violence on whole neighborhoods. One violent episode takes with it the primary victim and then it consumes all of the human beings in that neighborhood that are connected—directly or indirectly—to the primary victim.

Much like any other neighborhood, where lifelong and multigenerational relationships are formed, in these neighborhoods human lives are intertwined and bonds are cemented; often these relationships cross multiple generations. Also, many of these violence-plagued neighborhoods are located in densely populated cities where people become lastingly connected by way of shared home space in tenements or street blocks; schools; social activity; places of worship; base care and concern for one another; and, yes, hardship and tragedy. It is a culture of one hand washes the other and it is an essential way of life. Knowing other people’s business is not always about being a nosy neighbor. Rather, it is a form of cultural communing. That culture is core to how people in black neighborhoods survive.

The people who make up these neighborhoods have dreams and aspirations and share in each other’s life milestones, hardships, and upsets. These are living and breathing neighborhoods. The people who contribute to and navigate these neighborhoods are no less human and deserving of their nation’s equal (to that of other citizenry) in measured intervention when crisis shows up and lingers.

We believe the distinction in language is vital.

DECISION TO FOCUS ON VIOLENCE IN BLACK NEIGHBORHOODS

Much thought and consideration was given to including Latinos in this paper. It is well documented that Latinos in U.S. neighborhoods are also dealing with an inordinate amount of violence resulting from street gang activity, domestic strife, and abuse of vulnerable immigrants. The intent here is not to minimize violence in Latino neighborhoods or any other for that matter. Rather than lump all groups into one issue we stand by our belief that all groups deserve a targeted approach and remedy. For those reasons we focus on black people in black neighborhoods.

In 2015, Dr. Rachel Yehuda, a professor of psychiatry and neuroscience and the director of the Traumatic Stress Studies Division at Mount Sinai School of Medicine, led a study showing the effects of trauma on generations. The team studied Holocaust survivors and their children’s response to the trauma of the Holocaust. “Holocaust survivors responded to a horrendous environmental event,” said Dr. Yehuda in a PBS interview. “In the second generation there is also a response to parental trauma [the Holocaust].”

Framing that medical research concept around the generational trauma experienced by black people and neighborhoods supports the case that an immediate

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¹ http://nypost.com/cover/post-covers-on-may-8th-2006.

and targeted public health response to violence is essential to the well-being and progress of those affected.

Complicated Grief Disorder

Severe and prolonged violence is the fixed condition for many black neighborhoods. This is common knowledge. There is a pile of evidence in the criminal justice system and in news media reports pointing to this static condition. In each and every episode of violence, without immediate and long-term care and treatment, it is hard to imagine how a family—much like 3-year-old Tajmere’s family—emotionally and psychologically recovers from a traumatic event such as the violent loss of a relative; or how a neighborhood goes about the business of progressing through life productively and successfully when it endures unrelenting violence and loss of friends and extended family. And, equally hard to grasp is why they are essentially expected to recover on their own, without the vital health care intervention and support.

Take these explicit, yet weighty, questions into consideration:

How is a child expected to focus on school course work, test taking, social development, and overall learning while wrestling with a violent episode that he is not mentally equipped to deal with on his own?

How is a parent, relative, or extended family member expected to go to work, spend a full 8-plus-hour day focused on workload and being a productive employee, while also dealing with trauma of a violent act that took or changed the life of a loved one?

How are educators expected to not only teach course study, but also manage the unpredictable responses to violence visited on the students in their classroom?

What we know for certain is that violence causes trauma.

Exposure to violent death causes psychological trauma and can result in complicated grief disorder. Complicated grief involves extreme immobilization, pronounced psychotic ideation, and severe symptoms that persist over a long passage of time. This can also cause a breakdown in psychological functioning (Horwitz and Wakefield, 2007). Being in a state of shock, experiencing denial, avoidance of loss reminders, and dysfunctional or health-compromising behaviors are indicators of complicated grief (Ogrodniczuk et al., 2002). Consequently, black people are at a greater risk of developing complicated grief disorder. Individuals who are exposed to homicidal and traumatic loss are at a greater risk for developing complicated grief (van Denderen et al., 2015). Black people experience homicide more frequently than the majority population and have elevated grief symptoms in comparison (Williams et al., 2012).

Neighborhood Violence

Violence is prevalent in the metropolitan areas of many large states. For example, as of 2015 metropolitan areas consistently had a greater number of violent crimes than suburban areas (FBI Uniform Crime Report 2015³). There are multiple factors that are associated with a highest prevalence of metropolitan crime rates, including neighborhood disadvantage. Neighborhood disadvantages include high rates of poverty, joblessness, and residential mobility (Raghavan et al., 2006). The National Child Traumatic Stress Network defines community violence as exposure to intentional acts of interpersonal violence committed in public areas by individuals who are not intimately related to the victim.

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² Visit bit.ly/ShianneNorman to watch the video.

³ View the 2015 FBI Crime Report at https://ucr.fbi.gov/crime-in-the-u.s/2015/crime-in-the-u.s.-2015/tables/table-5.

Though gun violence dominates news reports, the legislative agenda, the criminal justice system and law enforcement narrative, elected representative outcry, and even the medical community’s call for gun violence to be declared a public health crisis, firearms are not the singular method of violence in black neighborhoods. Undeniably, firearms are easily attainable and primary weapons of choice, but there is also sexual assault, use of other weapons in hand-to-hand fighting, and certainly the terrifying violence and harassment committed by law enforcement on black men and women (Noyes, 2014). There is no shortage of examples of community violence involving various methods of violence on black people.

Consider the following examples. In New York City, Glenn Wright, a 21-year-old college student helping his grandmother with chores was stabbed to death on a sidewalk by a group of boys, in a case of mistaken identity (Del Signore, 2012). In Chicago, Illinois, Derrion Albert, a 15-year-old high school student walking home from school, was beaten to death in front of many witnesses, including the person videotaping the killing (Khan, 2012). In Phoenix, Arizona, an 8-year-old girl was lured to a shed and brutally raped by a group of boys ranging in ages from 9 to 14 years old (CNN, 2009). In West Palm Beach, Florida, 12 teens kidnapped and held hostage a mother and her young son for hours, while they sodomized and raped her in one room and beat him in another room (Burdi and Diaz, 2007). In Richmond, California, a young girl attending her high school prom was gang-raped in front of witnesses outside of the school gym, where the prom took place (Netter, 2009).

Living under a stagnant cloud of community violence is traumatizing, and the immediate and long-term impacts of community violence are recognizable. Tony Herbert, a community advocate based in Brooklyn, New York, knows this too well.

Since 2003, Herbert has worked on the front lines of community violence. He has worked extensively with victims and families and publicly calls to attention the severe conditions people in black neighborhoods are living under. He is the go-to community advocate when violence disrupts a family and neighborhood. “Everybody is in survival mode,” said Herbert in conversation for this perspective. “These kids suffer from PTSD.” But, when there is a shooting, he said for instance, there isn’t a team of counselors deployed to respond as when there is a mass shooting in a suburban school.

Herbert’s observation is supported by research indicating the grim mental health effects of exposure to community violence, particularly on children and adolescents. Exposure to violence within the home and school can cause the development of aggression, internalizing, and externalizing symptoms in children

and adolescents (Calvete and Orue, 2011; Reid Quiñones et al., 2011). In addition, there are racial and ethnic disparities in access to mental health services (Lê Cook et al., 2013). There are differences in the availability of mental health professionals in rural and urban areas.

These variations in geographic availability have been connected to the utilization of mental health services. In addition, black and Latino patients have a longer course of mental illness and a higher risk of disability from mental illness. Minorities are also more likely to be misdiagnosed with mental disorders. For example, black patients with an affective disorder are more likely than white patients to be diagnosed with schizophrenia. Additionally, Latino patients are more likely than white patients to be diagnosed with affective disorders (Primm et al., 2010).

Herbert also described an alarming reality for many children between ages 11 and 18. In his work with the nonprofit organization Youth Step USA, which uses the tradition of black sorority and fraternity stepping to provide a safe environment for youth, Herbert asks students at events how many have lost a loved one to violence. “Always three-fourths of the students raise their hand,” he said. “At some events, there can be as many as 600 students.”

Predator or Prey

In the early 1990s, at the age of 19, Alvin killed Mark, the neighborhood bully.

Alvin, who asked that his last name be withheld for privacy concerns, comes from a stable, working class family with decades-old roots in the Sheepshead Bay neighborhood of Brooklyn. Both of Alvin’s parents were present in the home, where he and his two siblings lived. They were solid and engaged neighbors in the apartment development and deeply rooted in their church. Alvin, according to his mother, had started hanging out with the wrong crowd. It was a source of contention in their home. But, prior to killing Mark, he had not been in trouble with the law.

Mark was a couple of years older than Alvin and he, too, was rooted in the neighborhood. Mark, however, was infamously known to be especially brutal with violent force. His very presence instilled fear among his contemporaries and especially boys and teens. Rumors began circulating throughout the tight apartment development that Mark had it in for Alvin.

Though it may seem inconceivable that a rumor, on its own, could lead to a deadly outcome, Alvin explained the visceral reaction to being Mark’s next target. He was overcome with the expectancy of terror. “The fear factor is what caused me to kill him [Mark],” said Alvin in an interview for this perspective.

“He was 6’4”, 240 pounds and everybody was afraid of him. He was like a wild, savage animal.”

Alvin was eventually prosecuted for manslaughter and sentenced to 7 to 12 years in an upstate New York maximum-security correctional facility. He served 12 years of the sentence before his parole. But, the gravity of what he had done affected him long after he killed Mark. In our conversation, Alvin articulated the process of understanding what it means to take the life of another human being. He was burdened. On his own, without counseling or therapy, Alvin exorcised what he had done. In that process he had come to learn more about Mark’s tumultuous upbringing and life trajectory. Since the age of 7, Mark had been in and out of juvenile correctional facilities and lived a life weighed by familial instability, turmoil, and violence.

Likewise, but in a different way, a violent episode also consumes the people attached to the aggressor. Tony Herbert, who has witnessed the domino effect of acts of violence, explained how families of the aggressor become entangled and affected. “Families become victims, too. The embarrassment and being ostracized by the community you live in because your son is a killer. You didn’t raise him right.”

Herbert’s point was underscored in a conversation with Alvin’s mother Lorraine. She was 37 years old at the time and the violent episode took its toll on her and her family. She described the shock of the act itself and the fallout, which lasted throughout her son’s criminal trial and into his 12-year prison sentence.⁴

“It was traumatizing. The helplessness, guilt behind what I did wrong as a mother. I felt so bad that my son took a life.” Lorraine recalled Mark’s name and thought about his family, his mother, and how living in her beloved neighborhood weighed on her. “I was depressed and full of shame and embarrassment.” Out of fear, Lorraine and her husband made the difficult decision to break up the family unit and send their younger son to live down south with family. Their decision was a preemptive measure to prevent the path Alvin had taken.

That one violent act spiraled and rippled to impact every life it touched.

Alvin, in his own reflection, came to understand that Mark was a product of the environment he grew up in. “If you take a small child and expose them to constant violence, they will be violent. Either they will become predator or prey,” he said.

This is how life plays out for black people in violence-plagued neighborhoods across the nation. This is their normal, even when that normal would not be accepted in any other neighborhood.

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⁴ For the same reason as her son—privacy—Lorraine asked that her last name be withheld.

Alvin and Mark’s path of violence is supported by research describing outcomes of proactive and reactive aggression. Exposure to violence has a direct influence on the development of aggression in youth and adolescents (Calvete and Orue, 2011). There are two types of aggressive acts: reactive and proactive. Reactive aggression can be defined as angry and impulsive outbursts in response to a stressor (Barker et al., 2006). Examples of reactive aggression include being violent to others when one feels fear or threat. Reactive aggression is linked to negative affect and is associated with increased levels of sadness, unhappiness, depression, and suicidal behavior (Fite et al., 2009a). Proactive aggression is unprovoked, goal oriented, and predatory. Reactive aggression is associated with behavior that responds to fear or threat of violence (Barker et al., 2006). Examples of proactive aggression include bullying and premeditated assault. Proactive aggression is associated with severe forms of antisocial behavior and psychopathic traits (Fite et al., 2009b). The etiology of aggression is extremely important because aggression is one of the best predictors for future social, psychological, behavioral, and academic problems.

Violence has an effect on the development of children whether it is witnessed or experienced. Research indicates that adolescents that have witnessed violence often exhibit fear and concern about being harmed and losing others (Reid Quiñones et al., 2011). In addition, community violence has a strong impact on the mental health outcomes of children and adolescents. A meta-analysis revealed that community violence has the strongest impact on posttraumatic stress disorder and externalizing behaviors, such as deviance and aggression, in adolescents (Fowler et al., 2009). Children exhibited greater internalizing symptoms, such as depressed mood and difficulty coping with stressors (Fowler et al., 2009).

These are the catastrophic and traumatizing conditions that people in black neighborhoods across the nation are living under. There is no shortage and, in fact, there is an abundance of evidence highlighting these conditions and the emotional and psychological consequences.

CAUSE OF VIOLENCE IN BLACK NEIGHBORHOODS

Over the course of more than a decade of working in the trenches of community violence, Tony Herbert, without hesitation, identifies economic oppression, existing in a constant state of survival mode, depression, and PTSD as the root causes of violence. “Violence is a symptom of those conditions.”

Herbert’s summarization is supported, in part, by statistics recently highlighted in a University of Illinois at Chicago’s Great Cities Institute study (Great

Cities Institute, 2016). Results from this study show that 47 percent of 20- to 24-year-old black men in Chicago were unemployed in 2014 and not in school. Historically, and in broader context, the nation’s economic, social, and political injustices on black communities, which are compounded by marginalization and institutional and systemic racism, are contributing factors to the crisis of violence and ensuing trauma.

Violence occurs in many different environments, including home, school, and the community. Mrug and colleagues (2008) researched the effects on adolescents of exposure to violence in different environments. The researchers investigated the difference between the development of internalizing symptoms, such as depression and anxiety, and externalizing symptoms, such as aggression and delinquency. The results of this study revealed that higher levels of violence exposure at home and school were associated with increased aggressive fantasies. In addition, higher levels of violence at home positively predicted delinquency and overt aggression (Mrug et al., 2008). Higher levels of violence exposure at school and home predicted more internalizing symptoms. Risk factors for developing internalizing symptoms included race/ethnicity, sex, and contributing family factors (Mrug et al., 2008). For example, females reported higher anxiety, African American ethnicity was associated with higher anxiety and depression, and parental use of inconsistent discipline predicted depressive symptoms (Mrug et al., 2008). Higher levels of anxiety and depression were also related to lower family income, greater parental use of harsh discipline strategies, higher levels of friends’ delinquent behaviors, and lower school connectedness (Mrug et al., 2008). This study revealed that the environment in which violence is experienced can have a large effect on the trajectory of symptoms.

In September 2015, U.S. Senator Elizabeth Warren (D-MA) spoke before an audience at the Edward M. Kennedy Institute for the United States Senate. In an impassioned and precision-crafted speech, Senator Warren pinpointed a history of economic, social, and political barriers and excessive hardships that have done extraordinary and unparalleled damage to the black community as a whole (Warren, 2015). Her extensive and comprehensive understanding as an expert on the economy, law, history, and bread-and-butter issues positions Warren as a rare expert to tell the history and connect the dots on the social and economic conditions that plague black people, neighborhoods, and the community as a whole.

To this day, the conditions highlighted by Senator Warren continue, and until there is the political and societal will to comprehensively analyze, examine, address and, more urgently, remedy the factors leading to the present-day conditions, violence will continue to plague black neighborhoods across the nation.

In the meantime, while the great examination of how is left on the shelf, there is the urgency to address the trauma that stems from acts of violence in black neighborhoods.

“THE URGENCY OF NOW”—BOLD LEADERSHIP REQUIRED

The especially chilling rate and frequency of violence happening in black neighborhoods, and the unaddressed trauma that follows, is discriminate. The dilapidated environments that individuals are forced to live in are moderating factors to interpersonal violence. Neighborhoods with higher levels of social disorder increase women’s exposure to community violence. Social disorder can be defined as “an array of threatening acts that occur between strangers within a particular neighborhood that can lower the quality of life” (Raghavan et al., 2006). These threatening acts can include violence, public intoxication, and drug sales.

Community violence is associated with increased rates of interpersonal violence (Raghavan et al., 2006). In public and private spaces, black people have shared a common belief that this sustained condition of violence would not reach the fever-pitch level in any other community or group in the United States without intervention and response. This belief is expressed in private homes, in barber and beauty shops, in places of worship, and even on social media. These are safe places where black people have traditionally communed and engaged in discussions that acutely affect them individually and collectively.

As it should be, war veterans, for example, receive targeted care (White House, 2016) and treatment for PTSD (National Center for PTSD, 2015). Domestic violence survivors are provided access to a network of resources to assist them, and there is an ongoing public policy campaign. In instances of mass school shootings, mental health counselors are deployed to support grieving and fear-ridden students (Office for Victims of Crime, 2015).

As a responsive measure to violence against women, then-Senator Joseph Biden (D-DE), in the 1990s, championed the Violence Against Women Act (VAWA), and in his role as vice president, VAWA was strengthened and updated in 2014.

In October 2015, as a response to the rise in white suburban and rural teenagers’ addiction to prescription drugs and the illegal narcotic drug heroin, President Obama announced the White House initiative to coordinate efforts between federal, state, and local governments and the public and private sectors to address the public health and public safety crisis (Kuehn, 2014).

Following the 2012 massacre at Sandy Hook Elementary School in Newtown, Connecticut, the president, the U.S. Congress, and state and city leaders across the nation moved into action. President Obama even created a White House committee of top cabinet members, and assigned Vice President Biden to lead the group. In the border state of New York, Governor Andrew Cuomo, in less than

30 days after Sandy Hook, signed into law The New York Secure Ammunition and Firearms Enforcement Act of 2013, which is acclaimed as the toughest gun legislation in the nation.

In January 2016, President Obama moved boldly forward with executive action on gun control, yet the action is framed in response to and in the context of “mass shootings.” Black neighborhoods are not dealing with mass shootings in schools, movie theaters, and shopping malls. It is white men and boys committing mass acts of violence. Black neighborhoods are dealing with individual (neighborhood) acts of violence.

The president, in his remarks to the public announcing his Gun Control Executive Order, referred to Dr. Martin Luther King’s call for the “fierce urgency of now.” Where is the fierce urgency of now in officially declaring violence in black neighborhoods a public health crisis and forging ahead aggressively with a targeted, multidisciplined, and significantly resourced course of action?

SOLUTIONS

So far, law enforcement, the criminal justice system, and more punitive measures through legislation (e.g., gun laws) have been the driving solution. But, those systems and measures have not curbed the violence and they do not address the emotional and mental health needs of traumatized people in black neighborhoods. “You can’t arrest yourself out of the problem,” said Tony Herbert. And to address the public health crisis, he said, “proper therapeutic programming is needed.”

It is perplexing, given all there is to know about the crisis caused by extreme and prolonged violence in black neighborhoods, that there has not been urgent leadership to step up and mobilize responsive action targeting the critical health care needs of traumatized victims and survivors in black neighborhoods. A mobilized and concentrated action is needed, much like the coordinated effort to address the crisis involving suburban and rural teens, and the addiction to heroin and prescription drugs crisis.

The essential and immediate need is a declared public health crisis followed by targeted, multifaceted, and resourced action. What does that look like? For starters: visible, coordinated, and decisive leadership from all sectors and at the federal, state, and local government levels; a targeted strategy that homes in on black neighborhoods; and the unapologetic political will to boldly and publicly call this what it is: a public health crisis and social justice inequity.

In a nation of extraordinary abilities, intellectual minds, innovation, and abundance of resources, the United States and its leadership in the political, academic,

medical, policy, and philanthropic spheres could one day be judged harshly on their failure to aggressively target and address the causes and traumatic outcomes of prolonged and sustained violence in black neighborhoods.

This is not a solution founded in idealism, nor is it the imagination of a utopian society. This is the rational and logical expectation of what leadership is required to do in a crisis. Nor is this a crisis for black people and neighborhoods without resources to solely own and figure out.

Economically, socially, politically, and culturally, black people and neighborhoods are as much a part of the United States as any other group of human beings or special interests. They contribute to the economy and are a tax base; serve in the military and send sons, daughters, husbands, and wives to fight in wars; show up loyally to a political party; and they produce and deepen the cultural fabric of this nation. Yet, black men, women, and children in violence-plagued neighborhoods across this nation are expected to live, survive, and progress under the most violent conditions, unlike any other group of Americans. In plainer terms, the urgent matter of violence in black neighborhoods is a U.S. crisis.

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