Mass shootings and "violent extremism" are health epidemics - and need to be treated as such

People who are affected by the escalating wave of epidemic shootings, bombings and killings in America have a health problem. This health problem includes death, injury, psychological trauma and highly toxic stress.  When rates are rising to above what is "normal" we use the word epidemic.  However this problem is not just any epidemic but a health epidemic by definition, cause, and treatment required.

Health is defined by the World Health Organization,  is a "state of total well being" - therefore not only the vicitms and families but the "perpetrators" and many of the rest of the population have a health problem if and when thinking about mass shootings causes us undue fear or stress - for example even when affected by the news. Of course the ultimate health result of death, and injury from these awful and gruesome attacks clearly puts all physical violence squarely in the category of most serious health problem possible - i.e. acute pain and body dysfunction and early death.  Violence - as in Orlando, Sandy Hook, Paris, Brussels, Iraq or Syria - lands in hospitals, and uses ERs and ICUs, chest tubes and surgeons - if available - fortunately usually so in the U.S.   People exposed to violence who don't die immediately or in the short term will more commonly have other health problems - strokes heart attacks and cancer.  Reflecting the health, behavioral and disease manifestations of violence - and the need for remedies, national and international health agencies such as the World Health Organization and the Centers for Disease Control have full divisions devoted to violence.

Besides the obvious, i.e. that violence is a health problem for those assaulted, shot or killed, it is incompletely realized but now well known in the scientific literature that persons who do violence have an untreated health problem.  Although we usually think in moral terms of a person who expresses violent behavior for example someone who kills in the community or shoots up a gay bar or church,  past histories of shooters usually reveal serious mental and psychological issues - or at a minimum a contagious - i.e. "recruiting" process.   Much of the brain processes underlying this is now known, and include cortical copying mechanisms, dopamine and pain center centers as well as the effects of prior trauma. 

Most important of all to the health frame of violence  is understanding that violence susceptible to being interrupted, prevented and epidemics reversed by the well widely applied methods by which public health professional have successfully treated and managed many of the most deadly of other contagious processes and diseases - known example from tuberculosis to AIDS. The work iof detection and interruption, prevention of spread, finding rare events, changing behaviors and norms and reducing suecetnbility among populations are the bread and butte   of public health. And furthermore most of the mmajor epidemcid which mankind has had to deal with in the past were put into the past through thesemethods.

(These problems were also seen only through moral lenses until the invisible scientific processes were revealed and new strategies applied. 

Health problem of persons who do violence

Persons who do lethal and sub-lethal violence also have health problems These lethal and traumatic events are also a health problem of the persons who do the violence. In other words, it is not only the people we call victims but also the perpetrators who have a health problem - also by the WHO definition but in lay terms we have all read and learned how the persons exhibiting the behaviors are at a minimum troubles - frequently socially isolated, some with histories of abuse, having been isolated, and with self worth and identity problems. Research has demonstrated that people who are socially isolated or rejected when scanned on brain scans show increased activity in the same areas as people with physical pain. these are people who are in need of treatment. this does not mean that they have definitive usual mental illnesses like bipolar illness or schizophrenia but some combinations of depression, anxiety, and psychological  pain. Hurt people hurt people.

They're all contagious

Mass shootings, violent extremism, terrorism and other forms of violence are all contagious. Recent research by Sherry Towers and others has shown that mass shootings are contagious - ie that prior events cause subsequent events to be more likely and more frequent. This is not new information and but statistical. It is the common experience of Americans that we are seeing these vents more commonly - ion schools, churches, theaters, clubs and workplaces. the frequency of events

Events that are called terrorism as apart from other mass deaths is a slightly arbitrary definition but it seems that this is when one identifies or we identify him or her with a group who it is thought is meant to do harm to a gorup or city or country or cause people to be afraid.  This is quite a mix of categories fro example people may do violence in the name of a group (for example ISIS or Al Qaeda or a white supremacist group - named or not named or to a minority  population - which terrorizes but we make call it hate. these categories are unlikely t help any more than considering whether someone coughed and infected persons with Tb or flu to people in a dorm, day care center, gay club church or workplace. Although the intention may be different the similarities are present.

Motives or "Reasons"

What about the motives for violence including mass violence? We've all watched CNN for hours or days trying to determine whether it was thought to be religious or hate - ISIS or not, a Muslim kid or a "White" kid.  for 20 years I've been watching listening and doing research on the reason for violence. the reasons stated or apparent are not what is gong on in the brain. People say and see what is most justifying. what drives behavior more than any other single factor is what you think others expect of you or what you might get attention for, or what cause you to feel a little less isolated or likely to be isolated or in best case, belonging to a group or at a distance with an identify representing a group. This is all evolution.

Public health methods

Stop looking for causes - we know the cause.

Its like stop looking for causes for why a number of children in a day care center came down with meningitis or - before immunization - measles.

Why did the Vietnamese and Laotian and Cambodians "bring TB to San Francisco in the 1980s.  There was a backlash then too but we were able to totally contain it.

Where it's well known work to prevent and interrupt the cycle of violence in  our communities - in the neighborhoods and in the prevention of mass shootings including those that may appear to be inspired or provoked or to be temporarily glorified by any group from white supremacist to workplace revenge to alleged sympathy with a foreign  group, or any way that someone expresses their unhappiness, vulnerability and anger? 

What's been missing is the fundamental understanding of this problem. What's been missing is interruption using public health methods. What's been missing is the use of public health methods well vesed in changing norms. Moral problem instead of contagious behavior

It's not so revolutionary. This is just what public health does all the time - detect and interrupt, change behaviors bad norms and reach people in ways that are acceptable. The only thing that is revolutionary is getting out of the moralistic box, the blame box.