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Part II
Papers and Commentary
from Speakers
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II.1
VIOLENCE: CONTAGION, GROUP MARGINALIZATION,
AND RESILIENCE OR PROTECTIVE FACTORS
Carl C. Bell, M.D.
Community Mental Health Council, Inc.
Department of Psychiatry, College of Medicine,
University of Illinois at Chicago
The relationships among contagion, group marginalization, and resil-
ience form a complex issue that does not lend itself to quantitative method-
ology, but rather is best studied using qualitative methods. Thus, having a
historical perspective is an important attribute to understand appropriately
the phenomenon of violence as it relates to contagion, group marginaliza-
tion, and resilience or protective factors. Furthermore, in order to have a
coherent discussion about violence, we must first understand which type
of violence we are focusing on, as violence is a very complex and multi
determined phenomenon. In addition, we must understand the science.
The Need for Good Science
To understand this complex problem, we must understand the need
for good science. Unfortunately, there is a fundamental scientific problem
with understanding violence, whether it is directed toward others or self-
directed. The reality is that these phenomena, while being the third or lead-
ing cause of death for some population groups, such as teens or young black
males, respectively, are actually rare events. The reality is that suicide rates
tend to be 11 suicides/100,000 (IOM, 2002) and homicide rates are about
9/100,000 (Douglas and Bell, 2011). Even if you focus on non-Hispanic
black people who have rates of homicide of around 33/100,000 or gun ho-
micides with rates of 58/100,000, these are low base rates and developing
statistical power to differentiate between an experimental intervention and
control is very difficult. Accordingly, the 2002 Institute of Medicine report
Reducing Suicide: A National Imperative noted that to prove a suicide pre-
vention intervention is evidence-based, a study would need 5 to 10 popula-
tion studies with 100,000 persons per study to get enough statistical power
to show that either a suicide or homicide prevention study works (IOM,
2002). Because the homicide rates are actually lower than the suicide rates,
despite many scientific claims to the contrary, apparently one would need
an equally large population to prove a homicide prevention intervention is
evidence-based, and neither of these two studies has been done.
53
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54 CONTAGION OF VIOLENCE
Types of Violence
Having formally studied the phenomenon of violence for more than 30
years, we proposed that there were many different forms of violence, which
required different prevention, intervention, and postintervention strategies
(Bell, 1997). As identified by Baker and Bell (1999), such types of violence
include
• group or mob violence;
• individual violence;
• systemic violence, such as war, racism, and sexism;
• institutional violence, such as preventing inmates from getting the
benefit of prophylactic medications to prevent hepatitis;
• hate-crime violence, such as terrorism;
• multicide (e.g., mass murder, murder sprees, and serial killing);
• psychopathic violence;
• predatory violence, also known as instrumental or secondary
violence;
• interpersonal altercation violence, also known as expressive or
primary violence (e.g., domestic violence, child abuse, elder abuse,
and peer violence);
• drug-related violence, such as systemic drug-related violence
(whereby drug dealers kill to sell drugs), pharmacological (whereby
an individual perpetrates violence because of drug intoxication),
economic-compulsive (whereby a drug addict uses violence to
obtain drugs), and negligent (e.g., a drunk driver who kills a
pedestrian);
• gang-related violence;
• violence by mentally ill individuals;
• lethal violence directed toward others (homicide);
• lethal violence directed toward self (suicide);
• violence by organically brain-damaged individuals;
• legitimate/illegitimate violence; and
• non lethal violence.
Observations About Types of Violence Regarding Issues of
Contagion, Group Marginalization, and Resilience
Culture Destroys and Culture Protects
Culture destroys Black communities in Chicago experience discrimina-
tion, stigma, and injustice at higher rates than their white counterparts.
Consider the science that illustrates white males perpetrate similar levels of
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PAPERS AND COMMENTARY FROM SPEAKERS 55
violence as black males (HHS, 2001) and engage in more illegal drug use;
however, the majority of children and young adults who are incarcerated
for these offenses are people of color. There also have been well-known
allegations that Chicago police forced confessions of murder from inno-
cent black men, several of whom were on death row until DNA evidence
proved their innocence. For example, police officer Jon Burge, fired after the
Police Board determined he had used torture, was convicted on counts of
obstruction of justice and perjury arising out of a civil suit in which Burge
was named a participant in the abuse or torture of people in custody (Stein,
1993). Structurally, we understand that most mid- and large-size cities have
more absolute numbers of low-income whites than low-income blacks, but
there are few low-income white neighborhoods because low-income whites
have scattered-site housing. Police have a more difficult time finding and
incarcerating illegal drug users when they live in scattered-site housing.
Therefore, blacks who use illegal drugs are incarcerated more often than
whites who use illegal drugs; this is one of the reasons for the dispropor-
tionate percentage of incarcerated black people.
In Canada, children from First Nations communities were removed
from their families and told their culture was not acceptable, resulting in
individuals within First Nations communities losing their cultural protec-
tive factors, which ultimately led to many of them engaging in the risky
behaviors of suicide and intragroup homicide. Within these communities,
alcoholism is common. For every one child in Canadian juvenile detention
centers without fetal alcohol syndrome, 19 children have fetal alcohol spec-
trum disorders (Popova et al., 2011). Bell (2012) has proposed that many
disruptive behaviors leading to incarceration results from fetal alcohol
exposure (FAE). It is well known that FAE is a leading cause of speech and
language disorders, attention deficit hyperactivity disorder, and other devel-
opmental or cognitive disorders (IOM, 1996). These are often responsible
for affect dysregulation, which leads to disruptive behaviors, which in turn
leads to incarceration.
These phenomena increase marginalization, thus facilitating fertile
ground for promoting the contagion of violence. A perfect example is the
victimization of Rodney King by police that spread into the African Ameri-
can community and resulted in mob violence. Thus, when we talk about
violence and the contagion of violence, we must also discuss the systemic
violence of racism and imperialism that historically spread across the world.
Culture protects While doing HIV prevention work in Durban, South Af-
rica, it was striking that 40 percent of the Zulu people were HIV positive, 6
percent of the white South Africans were HIV positive, but only 1 percent
of the Indian South Africans were HIV positive. The conclusion was that
the Indian South African culture protected them, while the Zulu culture and
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56 CONTAGION OF VIOLENCE
its protective influence had been stripped from them, making them vulner-
able to risky activities, such as risky sexual behavior, substance abuse, and
violence. The white South African culture also is eroding, resulting in higher
levels of HIV-positive individuals (Murray, 2012).
Contagion of Suicide and Mass Murder
In discussing self-directed violence, we understand the phenomena of
contagion of suicide (Phillips et al., 1992) and how the mass media can
cause what is referred to as cluster suicide, copycat suicide, and suicide con-
tagion. Accordingly, in an effort to reduce this phenomenon of contagion,
this recognition resulted in the “Reporting on Suicide: Recommendations
for the Media.”1 Given that certain types of mass murders often lead to sui-
cide (Petee et al., 1997), it is proposed that these mass murders are actually
suicides preceded by mass murder (Bell and McBride, 2010a). One could
hypothesize that when the media publicizes events such as the ones that
occurred in Columbine High School; Platte Canyon High School; an Amish
school in Nickel Mines, Pennsylvania; Virginia Tech; and Northern Illinois
University, such “suicides preceded by mass murder” are inadvertently
promoted. We understand the high level of public interest in sensational
news stories; nevertheless, unless we understand that an individual suicide
is the dynamic driving the mass murder behavior, we will continue to inad-
vertently encourage this behavior. The difficulty is that electronic media is
so ubiquitous; it would be difficult to design a study as Phillips (1974) did
when we only had to contend with local print media. We need a consensus
meeting to discuss these issues and figure out how to responsibly report on
“suicides preceded by mass murders,” or the hypothesized contagion will
likely continue.
Interpersonal Violence
Regarding the type of violence known as interpersonal violence, we
understand this type is responsible for most violence. Furthermore, al-
though different cultural, racial, and ethnic groups have different rates of
different types of violence (e.g., Latinos have more gang-related violence),
we understand that interpersonal violence is more common in the African
American community; however, from the mid-1970s to the mid-1990s, Af-
rican American domestic violence decreased from 16/100,000 to 3/100,000
(Greenfield et al., 1998). Why? Because the number of domestic violence
shelters increased dramatically, reducing the number of battered African
1 See http://www.sprc.org/sites/sprc.org/files/library/sreporting.pdf.
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PAPERS AND COMMENTARY FROM SPEAKERS 57
American women who turned to committing violence against their partner
as a means to stop being battered.
Other Forms of Violence
One form of violence that has not been studied adequately is violence
by organically brain-damaged individuals (Bell et al., 1985; Bell, 1986,
1987; Bell and Kelly, 1987). Although there is no evidence for the reason
for this lack of study, it can be hypothesized that the major reason for this
oversight is the marginalization of those afflicted with head injury that ulti-
mately results in their explosive behavior. It is hoped the recent “discovery”
of this problem in football players will reduce the marginalization of this
population resulting in appropriate study of the issue yielding more pre-
vention and treatment strategies. The issue of legitimate versus illegitimate
violence is another issue we must explore.
Protective Factors That Cultivate Resilience
Against Various Types of Violence
Social Fabric Prevents Contagion of Violence
As director of the Institute of Juvenile Research, where child psychiatry
began and where the issue of family and community violence was addressed
more than 100 years ago, I am aware of a great deal of relevant history
that pertains to contagion, group marginalization, and resilience or protec-
tive factors as they relate to violence. The lessons learned from this history
are quite instructive to this discussion. In Chicago in 1871, the Great Fire
created a lot of instability in a city with a population that was 70 percent
either foreign-born or first-generation. The results were families who, due
to being disrupted by poverty and unfamiliar community circumstances as
result of immigration, were unable to provide stable family environments
and to flourish. Evidence of this problem was the extraordinarily high rate
of European immigrant domestic violence in Chicago from 1875 to 1920
(Adler, 2003). Seeing the problem, Jane Addams made efforts to found Hull
House “to aid in the solution of the social and industrial problems which
are engendered by the modern conditions of life in a great city.” In 1889,
Addams and her colleagues established a Juvenile Court in Illinois to dis-
tinguish between delinquency and criminality. The procedures of this new
institution were not to be adversarial; rather it was “primarily protective
and educational rather than punitive, and the commission of a child to a
correctional institution is deemed to be for his welfare and not for the sole
purpose of inflicting penalty.” Ten years later, in 1909, these foresighted
women convinced the state of Illinois to discover the cause of delinquency;
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58 CONTAGION OF VIOLENCE
the Juvenile Psychopathic Institute (later called the Institute for Juvenile
Research, or IJR) was created, and neurologist William Healy was hired to
be the first director. Later, IJR researchers Shaw and McKay (1942) noted
delinquency was less due to biological, ethnic, or cultural factors and more
due to social disruption eroding formal and informal social control in spe-
cific transitional neighborhoods (delinquency areas) in a city.
Fifty years ago, the science was not as advanced as it is now. The re-
search designs were empirical and qualitative instead of being quantitative,
and much of the IJR’s research was mostly biographical. Thus, the statisti-
cal methodology was very primitive by today’s standards and multivariate
influences could not be studied well enough statistically. However, despite
this lack of scientific methodology, it is interesting that the IJR’s observa-
tions were correct. Their observations were that children’s biology was not
causing delinquency, but rather it was the lack of social fabric in the new
immigrant communities. Of course, this finding predated by 50 years the
seminal research of Sampson et al. (1997) that coined the term “collective
efficacy.”
Another example of how protective factors cultivate resiliency, which
in turn is protective against contagion of violence, specifically cluster or
copycat suicide, is found in building protective factors around vulnerable
populations of potentially suicidal individuals. Because 20,000/100,000
people in the United States suffer from depression, 5,000/100,000 attempt
suicide, and 11/100,000 actually complete suicide, something must be
protecting people (Health Care Innovations Exchange Team, 2012). Ac-
cordingly, because youth engage in multiple risky behaviors due to their
immature brain development, we have likened adolescents to be like cars
with just gasoline, but no brakes and steering wheels, that is, community
or social fabric (Bell and McBride, 2010b). These protective factors can
be cultivated (Bell, 2001) and have been proposed as a strategy of suicide
prevention. A specific example of infusing protective factors to prevent sui-
cide occurs when, in an effort to prevent copycat or cluster suicide after a
successful suicide, the victim’s friends are screened for suicidality and then
provided with preventive services (Brent et al., 1989).
Research has indicated that children who are sexually and physically
abused are more likely to engage in suicidal behavior compared to chil-
dren who are not abused (IOM, 2002). However, children with protective
factors in their lives have fewer traumatic stress drivers of suicidal and
other-directed violent behavior than children without these protective fac-
tors (Griffin et al., 2011). Thus, it is possible to cultivate resiliency in these
populations as well.
Finally, based on years of public health research and work, the Seven
Field Principles for Health Behavior Change are appropriate universal
guiding principles to infuse protective factors in populations at risk for
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PAPERS AND COMMENTARY FROM SPEAKERS 59
various types of violence: (1) rebuilding the village; (2) access to modern
and ancient technology; (3) connectedness; (4) building self-esteem (a sense
of power, uniqueness, connectedness, and models); (5) cultivating social
and emotional skills; (6) reestablishing the adult protective shield; and (7)
minimizing trauma. These efforts have led to the maxim that “risk factors
are not predictive factors due to protective factors” (Bell et al., 2008).
II.2
SCHOOL-BASED VIOLENCE AND INTERRUPTION
Patrick Burton, Ph.D.
Center for Justice and Crime Prevention, South Africa
Introduction
Crime is one of the most significant challenges facing democratic South
Africa, and young people between the ages of 12 and 21 are often at the
receiving end of this escalating violence. Figures show that young people
experience violence at rates that are exponentially higher than their adult
counterparts (Leoschut and Burton, 2006). Given that this age cohort con-
stitutes a significant proportion of the general population of South Africa,
any efforts to reduce and prevent violence should incorporate components
addressing child and youth violence. Furthermore, substantial evidence
shows that violence and victimization against young people is closely cor-
related to later violence; any attempt to adequately address violence at a
community or societal level must therefore take into account the levels and
nature of violence experienced by young people and children.2
Schools in South Africa are consistently shown to be one of the most
common sites of violence perpetrated against children and youth. This is
not surprising because children spend most of their time away from home
in the school environment. In 2005, the first National Youth Victimization
Study in South Africa revealed that 11.5 percent of youth between ages 12
and 22 feel anxious and fearful while at school. These feelings of apprehen-
sion were most frequently attributed to the fear of criminals (52.5 percent),
of being harmed (21.4 percent), of classmates (18.3 percent), and of educa-
tors (4.8 percent). Fear was not limited to the school environment, but was
2 See, for example, Farrington, D., and P. Welsh. 2007. Saving children from a life of crime.
Oxford University Press, Oxford; Haggerty, R., et al. 1996. Stress, risk, and resilience in children
and adolescents: Processes, mechanisms and interventions. Cambridge: Cambridge University
Press; and Cornell, D. G., and M. J. Mayer. 2010. Why do school order and safety matter?
Educational Researcher (39)1:7-15.
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60 CONTAGION OF VIOLENCE
also often associated with the journey to and from school, as reported by
16.8 percent of the more than 4,000 young persons surveyed.
Being raised in violent social contexts influences children’s understand-
ing of how the social world works (CIET Africa, 2004). In addition to
undermining their sense of safety and security, creating feelings of fear and
anxiety, disrupting eating and sleeping patterns, and leading to difficulties
concentrating at school, direct and indirect exposure to violence can result
in the adoption of violence as a legitimate means of resolving conflicts and
as a way of protecting oneself from harm (Boxford, 2006). All of these
factors make it extremely difficult, if not impossible, for quality learning
to occur and have thus been found to contribute to grade repetition and
the non-completion of schooling. This suggests that the vast majority of
children and youth in South Africa are deprived of their right to live and
learn in a safe environment that is free of violence or its threat.
This paper will provide insights into just one approach to addressing
school violence in South Africa, and into some of the lessons learned as
the program has evolved and adapted based on several evaluations. The
program is the Hlayiseka School Safety Toolkit, and forms the basis for
the National Department of Basic Education’s developing school safety
framework.
The Approach
The departure point for the toolkit recognizes that violence has physi-
cal, social, psychological, and environmental roots, and that, to end it, we
need to address it at multiple levels and from different sectors of society.
The complex and dynamic interactions of all the environments (e.g., com-
munities, homes) in which young people live out their life are what impact
the experience and nature of violence, within the school environment in
particular.
Another point needs to be emphasized at the outset. While the most
common reaction to the phrase “school-based violence” may lead the mind
to jump to high-profile incidents of school shootings, or increasingly maybe
highly reported cases of cyberbullying, for example, these are not the mani-
festation of violence within the learning environment that we should be
most concerned. Rather, these are isolated, high-profile, and sensationalized
incidents, and while tragic, are not where the problem lies. Rather, the real
problem lies in the apparently minor, but repetitive, acts of violence. These
acts lead to the most frequent negative consequences of violence in schools:
dropping out, truancy, school (and often social) phobia, depression, and
lack of self-confidence in students. These acts can also negatively affect
educational outcomes and attachment to schools and learning, which we
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PAPERS AND COMMENTARY FROM SPEAKERS 61
know are among some of the most significant protective factors for young
people (Debarbiaux, 2003).
The Hlayiseka Toolkit uses a training methodology built on the prin-
ciple of a “whole school approach” to school safety. This approach posits
that the responsibility for and successful approach to school safety requires
the commitment of all those who constitute the schooling environment:
learners, educators, principals, parents, and the school governance struc-
tures. It also advocates that a safe school needs to be first and foremost
a functional school. In short, the more effectively and democratically a
school is managed, generally, the higher the likelihood of a positive impact
on safety outcomes (Gottfredson, 2001). The approach provides the basis
for the South African School Safety Policy that is being developed; details
the implementation of standardized school policies regarding learner and
educator conduct, rights, responsibilities, and expectations; and requires
buy-in from principals, learners, educators, school safety teams, and school
governing bodies.
The toolkit acknowledges that each school is at a different point in its
journey toward school safety and that available resources and capacity dif-
fer from school to school. The toolkit thus allows for the least resourced
school to find an appropriate entry point into the system as well as the
most-resourced school. The toolkit is built on a foundation composed
of four building blocks: Be prepared to prevent and manage problems
and violence; be aware of what is happening at school; take action when
something happens; and finally, take steps to build a caring school. Each
building block assists the school to work systematically toward achieving
school safety. The broad objectives of the toolkit are to help the school to
understand and identify security issues and threats; guide schools to re-
spond effectively to security issues and threats; establish reporting systems
and manage reported incidents appropriately; monitor the school’s progress
over time; and integrate existing departmental policy and legislation to
ensure that school safety is not an “add on.” On a purely programmatic
level, the whole-school approach provides each school with the tools to
themselves understand and identify threats to safety; respond effectively to
violence and threats of violence (including early identification of threats);
and prevent, report, and manage threats and incidents effectively. These
effectively constitute a process of diagnosing, planning, acting, and moni-
toring. Most importantly, such an approach is designed to improve school
management rather than the range of additional activities and interventions
that may be offered. It does not serve to replace, for example, life skills,
conflict mediation, positive discipline, or after-school care activities that
may be implemented at the school level.
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