We Need to Treat Gun Violence for What It Is: A Chronic Medical Condition

An article has just been published that is a must-read for everyone concerned about violence and guns because it places violent behavior in its proper context -- namely, as a disease that, in order to see it decline, needs to be handled like other chronic medical conditions. The researchers followed two groups of young men and women, ages 14 to 24, who were patients at the ER in Flint, Michigan, between 2008 and 2010. One group consisted of patients who were admitted for the first time suffering from a serious injury due to an assault. The other group were first admitted for some other medical issue.

Except for their histories in the ER, both groups were basically the same. They were mostly African-American, mostly from families on public assistance, they had the same degree of drug use and the same number who had either been convicted of some crime and/or were on parole. Finally, a majority of the members of both groups reported family incomes below the poverty line. In other words, both groups of patients shared the same social culture that breeds violence, but one group never came to the ER as victims of violent assaults, the other group not only came at least once, but many came multiple times.

The researchers characterized this latter group as suffering from what they call "recurrent violent injury," which is estimated to cost the medical system somewhere between $600 million and $1 billion per year. And in many of the instances when someone came back as the victim in a second assault, the incident took place within six months after they were discharged for the previous violent event. In other words, you can't explain violence simply as a result of the culture of poverty; there is also a culture of violence in which certain people immerse themselves in this culture even when they see others around them who do not.

In what is still the most brilliant study ever published by an American criminologist, the late Marvin Wolfgang followed the lives of every one of the 100,000 boys born in Philadelphia in 1945. He found that roughly 3 percent of these kids began committing juvenile offenses by the time they were 10 years old, by 12 they had committed multiple offenses and by the time these 300 teenagers transitioned into adulthood, they had become serial juvenile offenders who committed nearly 60 percent of all juvenile crimes committed by the 10,000 boys who were born in 1945. Looking at them into their early adult years, these same kids became, in effect, a criminal class, who not only committed endless and continuous crimes, but more important, committed the most violent crimes of all. And what is the most violent crime that anyone can commit? Crime with a gun.

Don't get me wrong. Some young men commit crime after crime but never do anything more serious than boosting a car. And other young men, like Adam Lanza, don't ever come to the attention of juvenile or adult authorities and then end up committing an unspeakable act of mayhem with a gun. But juvenile offenders start getting their hands on guns when they are 12 years old, and they "graduate" to bigger, more deadly guns by the time they are 16. These aren't usually the kids who come into the ER with an allergic reaction or a concussion from falling off a bike. These are kids who are bleeding from an assault wound because "he dissed me and I'm going to get him back."

The authors of the article on recurrent violent injuries note that we have developed outpatient plans for people suffering from chronic disease. For some conditions, like diabetes, such programs usually involve self-monitoring by the patient and timely intervention by a medical professional. Shouldn't we have a comprehensive medical strategy for dealing with violence? As long as we don't, recurrent violent injury will turn into gun violence more often than not.