Reflections on a City Under Stress

Recent events in Baltimore City have put many of us in a reflective mood: the death of Freddie Gray, the civil unrest and the indictment of police officers have exposed the raw nerves of citizens and leadership.

A time of questioning

Many of us are left asking ourselves: what could have been done to prevent the further damage to a community already divided along socioeconomic, racial and cultural lines? What leads people to violence and destruction in their own front yards? What leads those charged with protecting citizens to hurt them instead? And ultimately, what can be done to repair our community and its members who have experienced abuse, destruction, trauma, poverty and more? How can we help our communities to heal these painful divides?

On some level, we know the root of the problem, which is at least as old as our country’s history: people can hurt other people. We also know the solution: people can help people, too- help them to heal and to create and to thrive instead of to destroy.

The unseen damage

Violent and traumatic events in a community have a more lasting impact, well beyond the headlines. ProPublica reporter Lois Beckett wrote in a February 2014 article entitled,The PTSD Crisis That’s Being Ignored: Americans Wounded in Their Own Neighborhoods,” that “Americans with traumatic injuries develop [Post Traumatic Stress Disorder (PTSD)] at rates comparable to veterans of war.” The article reviews observations from those on the health care front lines who encounter victims of violence and who note the need for PTSD screening and education in the community. However, Beckett goes on to say, “The federal government often provides guidance to state Medicaid programs on best practices for patient care and how to fund them. But a spokeswoman for the Centers for Medicare and Medicaid Services has given states no guidance on whether or how hospitals could be reimbursed for PTSD screenings.”

Luke Broadwater, reporting in October 2014 for the Baltimore Sun points out that civilians are not the only ones affected by community violence. In the article, he writes, “PTSD is generally associated with soldiers in war zones, but is gaining more widespread acceptance as a part of many police officers’ lives. Advocacy groups say that as many as 19% of all police officers in the country suffer from PTSD, which can be brought on by the steady pressure of facing danger while enforcing the law.”

These articles give more food for thought. We can only wonder what happens when traumatized citizens meet traumatized officers. Perhaps, our cities then start to look like war zones where terminal threats and nonlethal problems become indistinguishable.

How do we create a healthy community?

There are many theories about what it takes to create an environment of health and wellbeing for our community, and for all citizens.

Some say we need to connect those people who have the capacity to help heal with those in need of healing.

Others say more needs to be done to reduce economic disparity and disenfranchisement and to promote a freer integration of society that adheres less to historical norms. But what does it really mean when the primary responses to such events are reactive and external, including racial profiling, police brutality,  looting, and rioting?

Opportunity lies ahead

When the emotional and cultural wounds are so raw and needs are so exposed, there is an opportunity for all of us to seek to understand the humanity of our neighbors and to better understand those who serve and are being served. Without this understanding, the new wounds and the old converge, and a less resilient and more traumatized community could emerge with fewer answers and diminished trust.

An educated community is the best defense against the brutalization of a culture, a people or a profession. Helping people to identify the issue and the steps they can take to address their environmentally-driven mental health symptoms, as well as to protect themselves against the further effects of stress, seems to be a humane, empowering and worthy investment in the well-being of our communities.

Fostering the learning of skills, whether in the form of therapy like Dialectical Behavior Therapy to address interpersonal effectiveness and distress tolerance deficits,  targeted community based pyschoeducation about the effects of violence and trauma and means to mitigate traumatic stress  or developing  other means to help citizens and stakeholders to develop a sense of agency in less formal ways, can only assist in the healing process.

We must also recognize that both citizens and law enforcement are prone to the same mental health conditions in traumatized communities. Ultimately, we want our entire community to be healthy, those who serve and those who are being served. We all deserve our best efforts in making this goal a reality.

Sharon Moore, M.D., is a board-certified psychiatrist with the Trauma Disorders Program at Sheppard Pratt Health System. She graduated from Howard University College of Medicine in 1993, and completed a residency in adult psychiatry at Montefiore Medical Center/Albert Einstein College of Medicine in 1997, where she was involved in treatment and research on dissociative disorders. In 1998, she completed a forensic psychiatry fellowship in the Albert Einstein College of Medicine/Bronx Psychiatric Center Division of Psychiatry and the Law. Dr. Moore has worked in a variety of settings including community mental health, forensics, and outpatient mental health for veterans.