When young black men are the victims of violent injuries in their urban neighborhoods, what happens next? This question haunted Dr. John Rich, who was educated at Dartmouth, Duke, and Harvard, was a primary care doctor at Boston Medical Center, and was the founder of the city's Young Men's Health Clinic. In both settings he was in constant contact with young men who had been victims of violence, and of course he was deeply concerned about the physical scars he kept treating. But as a black doctor dealing with the aftermath of violence in young Black men day after day, Dr. Rich felt a special connection with his patients and wanted to know about more than just the medical effects of the gunshot and knife wounds he was seeing. He wanted to understand their emotional and psychological impact.
Dr. Rich and his colleagues kept asking themselves why they were seeing so many victims of violence and what they could do to try to break the cycle, and he believed listening to survivors' stories might help him find an answer. He began interviewing young men in the hospital as they were recovering from their injuries, often following up after they returned home and sometimes staying in touch for months or years. He shares some of these stories and what he learned from them in his powerful new book Wrong Place, Wrong Time: Trauma and Violence in the Lives of Young Black Men.
In his preface he explains that even though violent murders often grab headlines, with violence, deaths are only "the tip of the iceberg." He notes the Centers for Disease Control and Prevention have estimated that for every homicide there are about 100 nonfatal violent incidents. He says studies have found that as deadly as guns are, "for every person who gets shot and dies, another four get shot and survive." Dr. Rich believes we don't pay enough attention to surviving victims and have "underestimated the impact that violence has on these young men and their communities."
When Dr. Rich started collecting his patients' stories, he realized that although little research had been done on trauma among young black victims of violence, their stories were echoing research on responses to trauma in other groups like rape survivors and soldiers returning from combat. These responses include hyper-vigilance and the constant feeling of being in danger; being unable to feel at all and exposing themselves to more danger in an attempt to feel something; returning to danger to prove to themselves they had mastered their fears; or using alcohol or drugs to try to ease pain. It became easy to connect the dots and see how these common responses to trauma play out in the lives of many survivors of inner-city violence, and why, in many cases, they lead to more violence. When many survivors are concentrated in a single area, it's also clear how these cycles of trauma and violence repeat themselves and infect that entire community.
Dr. Rich also came to understand more about why violence made sense to some of the patients he was treating. One epiphany occurred after 17-year-old Jimmy explained that his friends were anxious to have some sort of "rep" "[j]ust to be known. People don't like to be nobodies these days..." Dr. Rich realized, "I had gotten used to talking about senseless violence. How could violence be anything but senseless?...But Jimmy's argument, when I laid it out front of me, told me that violence made sense to him. Violence worked in his world to accomplish something that all of us wanted -- to be somebody -- but that Jimmy could not find any other way to do."
Dr. Rich believes we all need to better understand why young men like these are getting caught up in the cycle of violence -- not to excuse their behavior, but to help change it. He is now the Director of the Center for Nonviolence and Social Justice and Professor and Chair of Health Management and Policy at the Drexel University School of Public Health in Philadelphia. The Center's goal is to change the dialogue about violence "away from terms of blame and dehumanization and toward a language of injury and healing." The Center hopes to help health, mental health, juvenile justice, and education systems understand the relationship between trauma and violence and how healing is critical to serving these young people. One key program reaches out to injured youths in a Philadelphia emergency department, pairing them with professionals who can help with their trauma and a community outreach worker who helps with basic needs like enrolling in school or getting a job. This idea is starting to be replicated in other cities. In 2006 Dr. Rich was awarded a MacArthur Foundation "Genius Grant" Fellowship for his work. Scholar-practitioners like him are helping find the answers we urgently need to better understand the cycle of violence and save our children from being its next victims.