MALE VOICE: I know we got to die one time, but I hope to die peacefully.

MALE VOICE #2: All I saw around me was poverty.

MALE VOICE #3: By 14, I was deep into the gang.

FEMALE VOICE: We'd get in fights, we'd shoot people and stab people.

MALE VOICE #4: No one cared, years of violence, years of being violent.

MALE VOICE #5: People don't think sometimes, they just react.

FEMALE VOICE #2: I'm scared, I'm not gonna lie.

MALE VOICE #6: I don't want to be another statistic.

MALE VOICE #7: I would like to be part of the solution.

FEMALE VOICE #3: I wanna be somebody.

MALE VOICE #8: I don't wanna die; I wanna live. (NOISE)

BILL MOYERS: I'm Bill Moyers, one study of young people ages ten to 19 found that three out of four had witnessed a robbery, stabbing or shooting. One in four had seen someone killed. This exposure to violence can traumatize children and have a lasting effect on their mental health.

The man you will meet in this broadcast has worked with thousands of youngsters who have witnessed violence, committed violent acts of been victims of violence themselves. He says they can be helped if we reach them soon enough. Doctor Carl Bell is one of the country's leading psychiatrists; he teaches at the University of Illinois Medical School and is President of the Community Health Council in Chicago. Before we hear from him, listen to the kinds of kids he will be talking about. Their nine-year-old friend and classmate was shot to death walking home from a neighborhood park. (MUSIC)

FEMALE VOICE #4: I'm fighting and — Mike is shot at somethin' — somebody, probably a drive-by shootin' or — a kidnap or anything. That's why I stay inside.

MALE VOICE #9: Everybody else getting killed at — a bullet waitin' for me —

MALE VOICE: My name on it — some — I know we gotta die one time, but I hope to die peaceful.

MALE VOICE #10: I'm just scared. It's — it's like my — my mama tell me to go — go in the house because she want me to ignore that stuff, but it's not gonna never stop.

DR. CARL BELL: I see children like that all the time.

BILL MOYERS: Tell me about them.

DR. CARL BELL: Well, they come in — for various reasons — mostly, they're stressed out. And I — I used to think that — I needed to be looking for post-traumatic stress disorder, and now — I am more clear that — that being traumatized by witnessing violence or — or experiencing violence — causes a lot of problems, a lot of different problems.

Learning problems in school — sleep disturbances, stomach upset — behavioral disturbances, fighting sometimes. High-risk behaviors, carrying weapons, drug use — all kinds of different problems.

BILL MOYERS: You had written that children exposed to a steady diet of violence, will themselves, feed into a continuing cycle of violence.

DR. CARL BELL: Yes, the bad news is that children exposed to violence frequently figure the best defense is a good offense. Better to be predator than to be prey. These kids are frequently overwhelmed with their own stress, so when they see just a little coming, they respond in kind.

BILL MOYERS: How do we help them turn from the act of vengeance to an act of reconciliation?

DR. CARL BELL: I think we've got to do a couple of things. One is, we've got to start teaching kids social skills in schools, conflict resolution — peer mediation. Teaching them the skills that I learned working in an emergency room with violent patients.

Because they're teachable skills. The other thing, though, in addition to that that we've got to do that I think is very important, is I think we have to debrief the children that are exposed to violence, either as witness or victim.


DR. CARL BELL: If I have been shot at, (THROAT CLEARING) and you come to me and tell me about — solve your problems in a nonviolent way, I'm gonna look at you like you're a fool. (LAUGH) If you debrief me about being shot at and help me with the stress of that, and then you talk to me about the — solving conflicts in a nonviolent way.

If you talk to me about using all the energy that I've gotten from my stress in a constructive way, the Batman way, rather than a negative way, I'm much more likely to listen to you, than if you just try to preach to me and it doesn't make sense.

Studies show that — having a near death experience, for example — being exposed to violence or trauma, can cause you to not perpetrate violence, use drugs, have a foreshortened sense of your future, have poor academics, fight a lot, but can actually cause you to say, "This is scary, I've gotta get out of here, I better start getting straight As."

If I've had kids who have been next to other kids who've been killed and their response was to get upset about it and want to go to medical school, so the next time they were standing next to somebody who got killed, they would be a doctor or a paramedic and they could save a life.

And when you read autobiographies of physicians and policemen and people who are engaged in trying to help solve the problem of stress, you frequently find they were exposed to stress themselves and out of their effort for mastery, they become a good guy, a Batman. Batman saw his parents get murdered and he did not turn into a bad guy; he turned into a good guy. He had relationship problems, he's a little bit strange, goin' around and doing weird stuff, but he was basically a good guy.

BILL MOYERS: Do you think violence in the media contributes to the cycle of violence in society?

DR. CARL BELL: First of all, the media — distorts the true nature of violence. You would think that all murders are drive-by shootings — because that's big news. The — the 25% domestic murders don't get a headline because they're commonplace. The 25% friend acquaintance murders — they don't get headlines 'cause that's commonplace.

But that's the person you sorta have to watch out for. We used to think in this country that sexual assault was a stranger danger issue, and with some education, we learned that sexual assault was more likely a family/friend issue.

And now, we've gotta learn the same thing about violence. It's more likely somebody you know, somebody you're acquainted with. So this — this generic fear of being outside — is — is misplaced. You probably ought to be afraid of the person you get into — you're more likely to get into an argument with. I frequently try to point this out to people by saying, "Who was the last person who beat you up? Just think about it for a minute."

"Who was the last person you got into a fight with? Was it a stranger or was it somebody you knew or somebody in your family?" Most people will tell you somebody I knew, somebody in my family. So that, the media, I think, is creating this false fear.

And as a result, the interventions are being misdirected. That's — that's one — big problem. The other is is that the studies haven't been done. I don't know how many children exposed turned into Batman and how many children exposed develop — trauma-related stress disorder or dev — develop academic difficulties or who start using drugs — to numb their — their response. I don't know what — you know, if you exposed 100 kids, how many kids would turn out okay and become doctors and Batman and how many kids would become — violent, drug using — ignorant people.

'Cause there — there have — we have not done the studies. Unfortunately, we've done more studies on television violence, which I quite frankly am not impressed with. I mean, television violence is very sanitary — real violence, there are smells, there's — there's blood. There — there are noises, loud noises. It's real different. There have been about maybe 25 studies on real violence and children, and about 20,000 studies on television violence.

BILL MOYERS: Do you sometimes get the feeling that most people out there think of as a black issue? That it's — that — it — the — the violence that threatens so many people in their imagination and in the media is the violence of the black teenager coming down the street — being mugged by a black man in the city.

DR. CARL BELL: There's always this stereotypic — cast on African-Americans that we're all violent. There's mythology that everybody African-American comes from a single-parent home, uses drugs, you know. So — so now, the reality is that if you look at the homicide rate since 1929, the black homicide rates have been six to 12 times the white homicide rates.

Recently, very recently, they began to — be able to tell the Latino homicide rate, which is about two and a half times currently the white rate, and the black rate currently is about six times the white rate. Now — so people were talking about, "Well, this is — self-hatred in black people, this is — a subculture of violence in black people," he had all these reasons. (LAUGH) They recently have done some reasonably good studies at Control For Poverty, so that if you have an equally poor white and an equally poor black community, what you find is that their homicide rates tends to be the same, so the violence issue tends to really be a poverty issue, much more than it's an ethnic issue.

But there're more poor blacks and Latinos than there are poor whites, so you see the disproportionate rates of homicide. In Chicago, for example — there are a lot of really poor black neighborhoods, (HORN) ghettos. There are a fair number of poor Latino neighborhoods.

There are some black middle-class, black working-class neighborhoods, there are working-class Latino neighborhoods. There are a fair number of white upper middle-class neighborhoods, white middle-class neighborhoods, white working-class neighborhoods. There are no poor (CAR) white neighborhoods in the city of Chicago, because if you're poor and you're white and you live in Chicago, you can live anywhere in the city; you can live next to middle-class white people, middle-class black people. So — so that poor white people are spread all over, while poor black people are surrounded by this network and this web of poor healthcare, poor education, no jobs, violence, drug use.

And a lot survive, but a lot succumb. So that the — if you're talking about primary prevention and services and support, if you're poor and you're white, you're living in a totally different context, at least, in Chicago, than if you're poor and you're black.

And that changes how people turn out. Back in the old days — in — in poor black communities, they weren't just poor, you had middle-class black people, you had everybody living together. So you had role models and you saw people having at least access out of poverty. Some people still chose — one way or the other to — to remain in their condition, but at least, there was access. Now it seems as though access is shut off for a large number of people.

BILL MOYERS: Does this lead us to simply — you know, throw up our hands and say, "Well, we don't know what to do so we can't do anything"?

DR. CARL BELL: No, no, no, no, no. People have asked me why I'm not burned out 'cause it's so bad, and I've been doing this since, I guess, '76. And the reason I don't get burned out is 'cause I'm in the football field and I keep getting the first down, 'cause there's constantly more research, there's constantly people who are going about this in a thoughtful way.

My issue is — I mean, we did a great deal about smoking, we did a great deal about auto accidents, because we put money into thoughtful studies. We've gotta do the same thing about violence, we've got to break violence into its mini, little pieces and causes, thoroughly study those pieces and causes, develop strategy — strategies and interventions, and then do outcome studies to see if those strategies and interventions work. And then, I think we'll start to see a dent. Sort for me to help the kids, I think you need to deal with what is going on in the family.

BILL MOYERS: Trying to teach parenting?

DR. CARL BELL: Parenting — giving nurturing — to single parent mothers or to families where there are two kids and everybody's off working. Teaching conflict resolution —

BILL MOYERS: So these kids don't feel that if they're going to settle a difference between them they have to go get the gun?

DR. CARL BELL: Right. Trying to figure out a win/win situation. I used to work in an emergency room, and my job every day was to go to work and not get beat up. I mean, that was my major responsibility, so I developed skills to resolve conflict with people so they wouldn't beat me up. One of the things that I would say to an agitated, angry patient is, I'd try to get them to ventilate, you know, to — to get it off, to — to — to talk about it, 'cause talking about it takes up energy and you're not physical when you're talking.

Then after they would talk about it and I'd thoroughly understand what they were so mad about — 'cause frequently, people that are angry with one another have no idea what the anger's all about, so again, to ventilate. And then, I would say to the person, "Well, what do you want me to do about the problem?"

Which then, puts me on their side, instead of — in — in a conflictual relationship. And as soon as you say, "Well, what do you want me to do?" the anger just goes away and the person gives you their request, reasonable or unreasonable, but the anger's gone at that time, so you can negotiate. And people don't know how to do that.

BILL MOYERS: How do we, as a society, how do public or private agencies intervene?

DR. CARL BELL: If — for domestic violence — emergency rooms identified battered women and intervened, the same way that they identify suicide attempts, then you've gotta — an inroad to do something about the problem of domestic violence, and possibly, domestic murder.

Well, you can do all the cutsie public health programs you want and you're not gonna touch the predatory murderer. Now if you could catch this guy when he's six months old, and being abused and neglected at the hands of his mother and — and being abandoned and growing up mean and evil, then you could prevent possibly him from being a predator of a psychopath. If — if he had — educational opportunities and job opportunities, you could prevent him from taking the route of career criminal. So there are intervention points, they're just at different times.

BILL MOYERS: I think everybody would be willing to do that if we knew how to do it and we don't know how to do it. Do we?

DR. CARL BELL: Well, they're doing it in Hawaii. There's — there's a program in Hawaii where — single, high-risk mothers having babies — get attached to another woman, who mentors her while she's pregnant, makes sure she gets good prenatal care, nurtures that mother — is with the mother when the mother gives birth, and then goes by and visits and nurtures and gives respite to the mother with her new infant. And from what I'm able to understand of the studies, the child abuse, the neglect, the abandonment is down significantly as a result of this intervention.

BILL MOYERS: You've written that the real story that's coming out of the inner city these days is the prevalence of female cocaine addicts, what are the consequences?

DR. CARL BELL: I have never seen — black women — abandon their children, I mean, that's something I'm not familiar with at all. And I — and I'm very concerned about what consequences — 'cause being abandoned is a stress — it can be extremely traumatic, and it comes out in — in many different ways, again.

Foreshortened sense of future — taking high risks, using — you know, poor educational skills. So — so I'm very concerned about these kids. Now the good news is that while I've been seeing these kids come in neglected and abandoned by crack-using mothers, I've also seen a large black support network.

I've seen sisters bringing their younger brothers; I saw a woman who was trying to get through college — this teenager, a young teenager, was abandoned by his mother, she's out using drugs. She took — the sister took the kid into her home, and she's getting him through high school.

I've seen aunts and uncles bring in kids that have been abandoned by mothers who are using drugs and they've taken these kids under their wing and they're supporting and nurturing these children. My concern is that that natural support system within the black community is gonna be overwhelmed by the number of mothers abandoning their kids.

And the — and the Department of Children and Family Services System will be overwhelmed. And so, you've got a lot of neglected, abandoned children who are very angry. Some of whom will go the Batman route; some of whom will go the negative route. I — I get the kids who go the negative route, and we — we're able to treat them, we're able to help them.

BILL MOYERS: What have you learned about the moral equivalent in all of this? Children's — ability to learn right and wrong and to act for the right instead of for the wrong?

DR. CARL BELL: Well, children — you have to look at children developmentally, and that's another problem we have in terms of solving the — the violence problem, because a five-year-old, a ten-year-old and a 15-year-old react very differently. They react very differently to traumatic stress.

The five-year-old gets stomachaches, the ten-year-old's very concerned about his ability to — help, and the 15-year-old is pretty much like an adult. Similarly, when you look at morality, the five-year-old, ten-year-old, 15-year-old, you see different levels of understanding about what's right and what's wrong. A five-year-old really doesn't have empathy because they're very ego-centric. The 15-year-old is struggling with their identity, and they really haven't had a good moral development in terms of being able to conceptualize what it really means.

They may have had some concrete lessons, which I think is very useful — but they really don't awaken to morality, until much — much later. But I think we can give them the foundation and give them concrete examples of empathy and — and being connected to people.


DR. CARL BELL: By having them go through concrete exercises. One of the things — (NOISE) you know, we were talking about conflict resolution (NOISE) and how do we reach kids, and I talked about — needing to debrief the child about the victimization. We also need to do empathy exercises, where you have the kid act out what it's like to be at another kid's shoes that they beat up. We frequently, when we've gone to kids — and the kids we've gone to are high-risk kids — in juvenile detention centers — we've — rather than — that tried to talk to them about conflict resolution, because they're perfectly willing to shoot a stranger.

But — so you don't start there. You know? I mean, that — somehow, hurting somebody that ya don't know is okay. They're harder to empathize with. But if you bring it home and talk about their own victimization or a relative's victimization, they're able to connect to that. And then, once they get well connected to that, then you extend that empathy to the stranger —

BILL MOYERS: Empathy is?

DR. CARL BELL: Empathy is the ability to understand how another person feels, essentially. It's — it's the ability to put yourself in another person's shoes. So — so we really gotta start dealing with higher risk kids. And — and I — I'm real clear that — that, you know, we psychiatrists who wear nice suits — you know, we're not going to go into the alley to get the homeless, right? We're not gonna go into the poor neighborhood to help these kids that have been exposed to violence, 'cause we don't feel comfortable.

And from that perspective, I think that what we really need to do is to draw on the resources of the homeless who have rehabilitated themselves, to go in the alley to get their colleagues. We need to draw on the resources of the alcoholics and the drug users who are now dry and clean, to treat the other drug users, to go where the shooting dens are.

We've got to rely on the resources of people who have been in gangs and who've been exposed to violence to help and go in the communities where you see a lot of violence, because otherwise, my experience is that academic and the professions are gonna be a mile away from the leper colony and they're not gonna go into the leper colony. You get a treated leper, he'll go, you know, with no problem. And — and — and that's part of the solution that I think we've gotta start looking at.

This transcript was entered on April 21, 2015.

Understanding Violence

April 21, 1995

Bill Moyers speaks with one of the country’s leading psychiatrists, Carl Bell, who focuses on children who have witnessed violent acts, committed violence or been the victims of violence. Bell argues that the cycle of violence in these children’s lives can be broken if we act early to deal with their trauma.

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