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In "Survival Mode," "Fault Lines" examines the psychological toll of gun violence on children growing up in Chicago’s most dangerous and neglected communities. The film airs on Sunday, Feb. 14, at 9 p.m. Eastern time/6 p.m. Pacific on Al Jazeera America. | Click here to find Al Jazeera in your area.
In 2015, an average of one person every three hours was shot in Chicago, more than than any other city in the U.S. Over the course of the calendar year, there were nearly 3,000 shooting victims in the Windy City.
According to an American Academy of Pediatrics study released this past June, 14 million, or 1 in 5, children in the U.S. is exposed to violence involving a weapon between the ages of 6 and 17.
"Fault Lines" spoke to several young people living in some of Chicago’s most dangerous neighborhoods who say the threat of violence is ever-present. is certainly home to a sizeable chunk of that number. “If you don’t know somebody that’s gotten shot or that’s gotten killed, you’re weird or something,” said Rosalyn Collins, a 15-year-old high school student from Englewood.
Nearly two decades ago the Centers for Disease Control and Prevention and Kaiser Permanente initiated a groundbreaking investigation in the field of childhood trauma, the Adverse Childhood Experiences (ACE) Study. The research showed that traumatic experiences such as emotional and physical abuse during childhood are major risk factors for adult onset health problems including substance abuse, depression, heart disease, diabetes and cancer—making them a public health concern.
A hospital-based program aimed at helping victims recover from trauma, Healing Hurt People, is attempting to sever the connection to those illnesses, as well as to help sufferers regain their lives. Bradley Stolbach is the clinical director for Healing Hurt People-Chicago, as well as a psychologist at The University of Chicago Medicine Comer Children's Hospital. The effort is split between Comer on Chicago’s South Side and John H. Stroger, Jr. Hospital of Cook County on the Near West Side.
Stolbach says the program, which serves about 250 people per year, is based on a model developed at Philadelphia’s Drexel University after doctors began noticing a pattern among patients who would go to the hospital with gunshot or knife wounds.
“The common thread for many of them was that they were exposed to so much violence in their communities and for so much of their lives that they were, a lot of them, walking around traumatized,” Stolbach said. “And yet the impact of the violence that they had been through was never addressed.”
"Fault Lines" spoke to Stolbach about the effect of the frequent violence on young people in some of Chicago’s most dangerous neighborhoods. An edited version of the conversation follows.
The real goal in engaging people at the time of their injury is to try to connect them with services that are going to support trauma recovery. And the idea is that, if they can address the trauma and have some support around it and somewhere to go with how to deal with it, that they will be in a better position to make changes that will lower their risk for future violence.
What were you seeing in the hospitals of Chicago that illustrated the need for this kind of program here?
Well, what I’ve seen over the years that I’ve been there and working exclusively with children who’ve experienced trauma, is that over the years the violence goes up and down, but what seems to have been increasing in the last decade or so is how many very young people are involved, how many very young people are getting hurt and also how random some of it seems. And so, this has really moved to, you know, for me and my work, a central place and a priority in terms of addressing the violence that’s going on in Chicago, on our South Side and West Side.
Over the years I’ve worked with many children who’ve been injured in a lot of different ways, and I’d say again, in the last decade, it’s almost all of them have been touched in some way by the violence that’s going on our streets. So they know somebody who’s been shot or killed or they have a member of the family who’s been shot or killed or they themselves have been directly injured or they’ve witnessed something. So it really affects, in addition to the thousands of people who are being shot every year, there are thousands and thousands who are directly affected by those shootings, even though they may not be injured.
What is at the root of the violence on Chicago’s streets?
We’re in the most economically and racially segregated place in the United States. We have people living in communities where they have very little opportunity, they have no access to a lot of the services that people in other communities have—the health care, education. So they are doing their best to survive. And for a lot of our young people, they would love to have viable, legitimate, legal ways to earn a little bit of money, to be teens, and those are not available. And even for older people, jobs are not available. The likelihood of some of our youth in our program being locked up is greater than the likelihood that they could have a job, even a half-time, 20-hour-a-week job.
Many of our youth and our families would meet the diagnostic criteria for PTSD, and there’s actually, a lot of parallels to PTSD in people who’ve been in combat.
clinical director, Healing Hurt People-Chicago
What is the impact of the trauma that you’re seeing young people go through? What are they likely to experience?
One thing that’s almost universal after something like that happens is that people will have reactions in their bodies as if they’re back there at the time that happened. That can be having almost like a panic attack kind of feeling. It can be feeling all of a sudden like you need to fight. It could be having almost like a flashback. It could be all the sudden feeling like you need to get away. And when people are having these reactions in their bodies, they can feel like they’re going crazy. And it’s not crazy at all. It’s a completely normal, physiological reaction to a life-threatening event.
So one of the things that we’re trying to do with people who’ve been traumatized, whether by an acute situation like this or by multiple types of trauma over long periods of time, is to help them know what’s in the past and what’s in the present. And if people can help their bodies to remember where they are now and to be in the present and to help themselves know whether they’re in danger or not, then they’re in a much better position to, number one, to remain calm, and number two, to make decisions about how and what they should be doing at any given time.
How does this trauma impact a young person’s development, especially if it’s cumulative and perpetual, as opposed to just one incident?
For a lot of our young people, their development is really shaped around trauma and shaped around violence, and so really what a young person should be doing as they’re developing in childhood is taking in all kinds of information and using that information to figure out themselves and the world and figure out what the future could be. So their main purpose in childhood, should be learning.
When you’re constantly exposed to violence or constantly under threat, or you feel as though you’re constantly under threat, the parts of the brain that are involved in learning get shut off, and what happens is the surviving brain takes over. And so they’re constantly in survival mode. That means the future is irrelevant, and in some ways the past is irrelevant, except as the looming threat. All that matters is “What do I need to do now to survive?” And not just here in Chicago, but anyplace where there’s ongoing conflict, that is how people have to live. But it’s virtually impossible for a child to live that way and develop the skills and capacities that, under different circumstance, would be their main focus.
Under conditions like those in Chicago, what happens to their concept of safety?
Many of our youth have either the concept that there’s no safety available to them ever or that they think they’re safe when they’re not. So they end up having their capacity to identify cues related to safety and danger accurately, gets impaired. They may respond to things that don’t pose a threat to them as if they are a threat.
When a person has been through a lot of trauma, almost anything can be a trigger—and by trigger that means that it’s something that’s going to bring the trauma to the forefront, whether consciously or unconsciously. So the traumatic experience and the reactions to the traumatic experience are going to take priority over whatever else might be going on. That can be almost anything. It can be a smell for someone who’s been in a fire, for example. They may be walking down the street and go by the barbeque place and get a certain whiff of the smoke coming out of there. That could trigger them. And then once you’re triggered it can manifest in a lot of different ways. It could be complete shutting down. We have young people who talk about literally shutting off their feelings. Just completely shutting them off. And they can do this at will. But they also do it when it’s not under their voluntary control. So that’s one reaction. Another reaction could be to be all of a sudden very frightened, to need to get away. It could be, again, wanting to fight or being ready to fight.
When people are traumatized in their homes or in their neighborhoods, they’re reminded all the time. So someone who is shot or who witnesses a homicide around the corner from where they live or around the corner from their school literally can’t do anything day-to-day without being reminded of that trauma. And when there’s no support for the processing of that experience, the integration of that experience, when there’s no place to go with it, no one to talk to about it, it can take on a life of its own.
Is it fair to say that a lot of the young people you work with have post-traumatic stress disorder (PTSD)?
Many of our youth and our families would meet the diagnostic criteria for PTSD, and there’s actually, a lot of parallels to PTSD in people who’ve been in combat. PTSD is not the best descriptor for a lot of our young people, because PTSD is a diagnosis that was originally created to describe adult combat veterans. There are a lot of young people who don’t actually meet the criteria for PTSD because the criteria are really about adults—the demands of day-to-day life that are put on adults—and they don’t really take into account the development. We have been involved in an alternative diagnosis for young people dealing with complex trauma that’s called “developmental trauma disorder.”
Developmental trauma disorder is an attempt to describe the impact of trauma on young people who’ve been through ongoing repeated, extreme violence—and that can be violence in the community, it can be violence in the home, but the main thing is that it’s not a single episode kind of thing, it’s ongoing. So the violence and the threat of violence is ever-present. And then, in addition to that, they’re in attachments systems that are unable to provide protection, care and comfort.
What are “attachment systems?”
Generally speaking, the infant’s connection to a primary attachment figure, initially the biological mother. That attachment system is evolved to promote the protection and safety of the attached person. There are lots of things that can compromise that system, and one of those things is trauma. So a traumatized attachment figure is not in a good position to provide protection, safety for their offspring. When you take ongoing trauma and stress and you combine it with an attachment system that is compromised, then what you get is people struggling to develop the capacity for emotional and behavioral self-regulation and struggling to be in a relationship with other people. That’s really what is central for our young people who are coming from that kind of background.
It’s less the flashbacks that are kind of the hallmark of PTSD. It’s less the nightmares and the re-experiencing of a particular event. It’s really about, “How do I know what’s happening inside me? How do I put words to what’s happening inside me? How do I manage when I feel angry or when I feel sad?” Or, “How do I experience pleasure?” “How do I deal with it when another person is upset?” And, “How do I think about myself in relation to other people?” And, “How do I plan for a future?” These are things that get compromised and get shaped by the violence and the trauma and that really better explain a lot of what we see in some of the young people we work with than simply a diagnosis of PTSD.
How could this trauma that young people are experiencing now manifest later in terms of perpetuating violence?
If people are essentially walking around in survival mode all the time, and they haven't been given the support that they need to develop the capacity to regulate their own emotions and behavior adequately, then they are at any moment ready to go off and do something. Many of our young people will tell us, “I don't know what I'm going to do. If something doesn't change, somebody's going to get hurt.” They actually will express this themselves. They don't want to hurt people. But they're walking around with rage, they're walking around with incredible pain, loss, sadness, grief that is so tightly contained all the time, that when something triggers it, it can blow with a tremendous amount of force.
So we have to stop pretending, number one, that they don't have this going on inside them, and number two, that it's not reasonable and justified that they feel the way they feel. As long as we're pretending that, we can't help them with it. But we've got to figure out ways to help them with the righteous rage and grief that they feel day to day. Or it will be expressed in ways that are destructive to them and to the people around them.