If Gang Violence is a Disease…. What is the Cure?

One of this morning’s must reads is the Alex Kotlowitz article in today’s New York Times Magazine called Blocking the Transmission of Violence about gang violence as a public health problem.

The article is about the work of Gary Slutkin, an epidemiologist and a physician who for 10 years battled infectious diseases in Africa, and who now has founded an organization called CeaseFire. “Slutkin,” writes Kotlowitz, “wants to shift how we think about violence from a moral issue (good and bad people) to a public health one (healthful and unhealthful behavior).”

So far, so good.

And Kotlowitz is one of the writers able to assess such a program with more clarity than most. He is the author of such much lauded books as,There Are No Children Here: The Story of Two Boys Growing Up in the Other America.

According to Kotlowitz, Slutkin says that “….violence directly mimics infections like tuberculosis and AIDS,” and so “the treatment ought to mimic the regimen applied to these diseases: go after the most infected, and stop the infection at its source. …”

Slutkin’s chosen method to “stop the infection” is to use what he calls “interrupters,” hard core former gangsters and shot callers to step who step in to try to stop cycle of retaliation when violence occurs.

This method of hard core gang intervention, as it is called, is all the rage now—both in Chicago and in Los Angeles, and it is unfashionable to criticize it.

However if examined more closely, although Slutkin talks in terms of health and cures, on the face of it anyway, his approach is symptomatic, not curative at all.

Rather than stopping “the infection at it’s source,” maybe the better analogy for Slutkin’s work—and hard core gang intervention in general— is that of a tourniquet. If one stops the immediate bleeding maybe one can address the underlying illness, and there’s something to be said for that.

On the other hand, the approach is something of a slippery slope. It is a rule of thumb that to successfully mature out of the gang, most people find they need to move out of the neighborhood. Otherwise it’s just too difficult. With this in mind, metaphorically speaking, is it wise to send former alcoholics repeatedly into the bar to try to talk the other bar patrons out of drinking? Maybe. Maybe not. At present, the risk/benefit ratio still remains unclear.

There are many things about this approach that are controversial. But it is an approach that must be discussed. Here’s an excerpt:

In January, I was with Slutkin in Baltimore, where he spoke about CeaseFire to a small gathering of local civic leaders at a private home. During the two-hour meeting, Slutkin never mentioned that the interrupters were ex-felons. When I later asked him about that omission, he conceded that talking about their personal histories “is a dilemma. I haven’t solved it.” I spent many hours with Hoddenbach and the others, trying to understand how they chose to make the transition from gangster to peacemaker, how they put thuggery behind them. It is, of course, their street savvy and reputations that make them effective for CeaseFire. (One supporter of the program admiringly called it “a terrifying strategy” because of the inherent risks.) Some CeaseFire workers have, indeed, reverted to their old ways. One outreach worker was fired after he was arrested for possession of an AK-47 and a handgun. Another outreach worker and an interrupter were let go after they were arrested for dealing drugs. Word-of-mouth allegations often circulate, and privately, some in the police department worry about CeaseFire’s workers returning to their old habits.

Not all the interrupters I talked to could articulate how they had made the transition. Some, like Hoddenbach, find religion — in his case, Christianity. He also has four children he feels responsible for, and has found ways to decompress, like going for long runs. (His brother Mark speculated that “maybe he just wants to give back what he took out.”) I once asked Hoddenbach if he has ever apologized to anyone he hurt. We were with one of his old friends from the street, who started guffawing, as if I had asked Hoddenbach if he ever wore dresses. “I done it twice,” Hoddenbach told us — quickly silencing his friend and saving me from further embarrassment. (One apology was to the brother of the man whose lungs he’d punctured; the other was to a rival gang member he shot.) Alphonso Prater told me that the last time he was released from prison, in 2001, an older woman hired him to gut some homes she was renovating. She trusted him with the keys to the homes, and something about that small gesture lifted him. “She seen something in me that I didn’t see,” he told me.

So is Slutkin’s strategy a potential solution to gang violence? Or is a stop gap with blowback?

(photo by Reuben Cox, the New York Times)