On the Knife's Edge: Using Therapy To Address Violence Among Teens

Feb 20, 2017
Originally published on September 27, 2017 2:43 pm

The fight was over a pair of gym shoes. One teenager faces years in prison. The other — the 15-year-old grandson of Congressman Danny Davis — is dead.

We often hear stories about murders sparked by trivial disputes. And we also hear the same solutions proposed year after year: harsher punishments, more gun control.

But what if science can help us find new solutions? Can understanding how we make decisions help us prevent these tragedies?

In moments of anger, it can be hard to heed the advice to take a deep breath or count to ten. But public health researcher Harold Pollack says that "regret comes almost as fast as anger," and that five minutes of reflection can make all the difference between a regular life and one behind bars.

This week, Harold Pollack and Jens Ludwig tell us about the research they do at the University of Chicago's Crime Lab. They worked with a program called BAM (Becoming a Man) to look at what happens when teenagers participate in cognitive behavioral therapy, or CBT.

We hear from students in the program and examine the results of Pollack and Ludwig's research. They found that changing the way we think can change the way we behave — and changing the way we behave can change our lives. This week, we put that idea to the test.

Hidden Brain is hosted by Shankar Vedantam and produced by Maggie Penman, Jennifer Schmidt, Rhaina Cohen, and Renee Klahr. Our intern is Chloe Connelly, and our supervising producer is Tara Boyle. You can follow us on Twitter @hiddenbrain, and listen for Hidden Brain stories each week on your local public radio station.

Copyright 2017 NPR. To see more, visit http://www.npr.org/.

SHANKAR VEDANTAM, HOST:

The fight was over a pair of gym shoes at night on the South Side of Chicago, and this is what came of it. One teenager faces years in prison. Another, a boy of just 15, is dead. The incident might not have even made the news, except the victim was the grandson of a long-serving congressman. At a press conference, that congressman, Danny Davis, did something unusual. He grieved not just for his own grandson but for his grandson's killer.

(SOUNDBITE OF PRESS CONFERENCE)

DANNY DAVIS: I grieve for my family. I grieve for the young man who pulled the trigger. I grieve for his family, his parents, his friends, some of whom will never see him again. It is so unfortunate when these tragedies continue to occur and reoccur. And somehow or another, our society has not been able to find and exact the answers and solutions.

VEDANTAM: The solutions we do have often produce more disputes than results. Conservatives call for harsher sentencing and better policing. Liberals want gun control and more social service programs. One thing's clear. Even as we argue, people are dying. In 2016, Chicago had the highest number of killings in two decades; 762 people were murdered. What can be done? Well, one community group has an unusual idea. It believes perhaps violence can be stopped with a breath, a few moments and a tiny tweak to the way we think.

HAROLD POLLACK: Very, very often, you know, if they could only take back five minutes of their life, a lot of these kids, a lot of the people that are locked up, would have a very different life.

VEDANTAM: Thinking our way out of crime, this week on HIDDEN BRAIN.

Our story begins with another death on the South Side of Chicago. One night, in the fall of 2007, Amadou Cisse, a young Ph.D. student from Senegal, was walking home after a gathering on the University of Chicago campus. He was confronted by a stranger, 17-year-old Demetrius Warren. Warren stuck a stolen .22-caliber handgun in Cisse's chest and tried to take his water bottle and backpack.

JENS LUDWIG: And I don't think anyone knows exactly what happened. Maybe Amadou Cisse didn't let go of his backpack or his water bottle quite quickly enough. And then Demetrius Warren pulled the trigger and shot him basically at point-blank range in the chest and killed him.

VEDANTAM: This is Jens Ludwig. He's an economist at the University of Chicago focusing on social policy and crime. He says the murder of Amadou Cisse was the very definition of senseless.

LUDWIG: If they thought about it for even one second, it is very hard to imagine that anyone would think that it was a good idea to shoot someone at point-blank range in exchange for a book bag and a water bottle that would surely have a resale value of not more than a couple bucks, at best.

VEDANTAM: If they thought about it for even one second. It turns out many murders in Chicago occur because someone didn't stop for that one second.

POLLACK: We went to the medical examiner's office, and we just reviewed quite a number of case files in which young men had been murdered.

VEDANTAM: Harold Pollack is a public health researcher who works with Jens at the University of Chicago Crime Lab. Not long after the killing of Amadou Cisse, Harold decided to figure out what was behind the many homicides in the city.

POLLACK: And so many of these incidents, you just read the story, you know - and the medical examiner's report is typically, you know, pretty brief. You know, there would be - you would get a lot of details about what happened to the physical body. But usually there would be, you know, a two-paragraph report about what happened. And many of these cases, you would just read it and say, wow, I just can't believe that someone ended up dead. And, you know, there was nothing at stake here that was anywhere near the stakes of a human life.

VEDANTAM: Where most people might imagine that killings occur because of a gang hit or cold-blooded revenge or premeditated murder, the records revealed a laundry list of slights. Someone stepped on someone else's shoe or stole a coat or lobbed an insult, and from that tiny spark, things escalated into violence and murder. Harold has interviewed incarcerated young men who tell him that regret comes almost as fast as anger.

POLLACK: The kid who committed the homicide, five minutes later himself, he's thinking about, wow, this was over a jacket. You know, very, very often, you know, if they could only take back, you know, five minutes of their life, a lot of these kids, a lot of the people that are locked up, would have a very different life.

VEDANTAM: As Jens and Harold puzzled over how minor incidents could spiral out of control, they realized they were asking a question that was fundamentally psychological. Why do people do irrational things? Why do people act so unthinkingly? And then they had a flash of insight. Teenage boys on the South and West Sides of Chicago are not the only ones who act without thinking. We all do it. Psychologists even have a term for this behavior - automaticity.

POLLACK: A lot of our thinking that we do in life is very scripted and is very automatic. And, you know, we couldn't go through life if we didn't have very quick reactions to things that we don't give a lot of thought to, that - partly because it just takes too much time. You know, if someone gets in my face right away and there's an immediate threat to my safety, I have to respond automatically. If I sort of stop and conduct a little mental O.J. trial before I respond, that's not going to be very functional for me.

VEDANTAM: In other words, we often act almost unconsciously. A door is in front of us, and we open it. We don't think, how do I open this door? We just do it. If someone hits us, we might also, just as fast, hit back. Harold remembers an incident that occurred to him. He was in a Burger King, and someone else in line shoved him. Harold's not a fighter, but for a moment, he felt a primal urge to lash out.

POLLACK: And I felt that burning sensation. And then I kind of reminded myself that I'm a nerdy, middle-aged professor, and I should just throw my tray away and move on. But it was - you know, I thought about it. And I think if I were - if - the 17-year-old me might well have ended up, you know, with a gash in his head.

(SOUNDBITE OF MUSIC)

VEDANTAM: Harold didn't get into a fight because before he acted, he thought for one second about the situation and the consequences. Could it be, Harold and Jens wondered, that this simple step, think before you act, could be a solution to violent crime in Chicago?

LUDWIG: A lot of the violence problem - at least this was our hypothesis doing the study - a lot of the violence problem on the streets of Chicago is not necessarily driven by bad people. It results from bad decisions that people make in the moment. And our hypothesis was if we can identify some promising intervention that could help people avoid some of these common kind of judgment and decision-making errors, then that might be helpful in reducing the violence problem.

VEDANTAM: Researchers have spent years studying ways to get people to behave less automatically, to change the scripts in their head. One technique that's often used is called CBT, cognitive behavioral therapy. The idea is to develop new scripts and new habits to address problems. An alcoholic, for example, might need to practice taking a different route home from work, a route that doesn't go by their favorite bar. Someone with anger problems might need to practice counting to 10 before responding. A person prone to depression might need to talk to themselves about how feelings of sadness can be transient. Changing the way we behave can change the way we think, and changing the way we think can change our lives.

Mostly, this kind of therapy takes place one-on-one with a trained expert. How do you do this on a large scale with thousands of kids from some of the poorest and most violent neighborhoods in Chicago? You can't bring them all in for one-on-one psychotherapy. As it turned out, Jens and Harold found a local group called Youth Guidance that was already trying something similar. It was offering kids a kind of low-budget psychotherapy within their neighborhood schools. There was nothing fancy about the program. Kids checked in with counselors regularly, talked about issues, tried to develop new habits.

Jens and Harold wanted to find out if this low-budget effort might be effective on a mass scale in combating crime. They wanted to test the program rigorously. They wanted to conduct a randomized controlled study the same way it's done in medicine. They didn't want to be misled by their hopes and intuitions.

LUDWIG: We basically have a bunch of well-intentioned city and state governments and a bunch of well-intentioned NGOs out there innovating and trying lots and lots of different things over time but not doing that in a way where we can actually rigorously study and evaluate which things are working. And without good feedback about which of our innovations are actually helpful, it's very hard to move in the right direction.

VEDANTAM: Performing a randomized controlled study in the real world is very difficult, but Harold and Jens teamed up with Youth Guidance to study the program. Now, the specific program is called BAM, short for Becoming a Man. The researchers compiled a list of young men living in some of the most dangerous parts of Chicago. There were thousands of teenagers to choose from.

LUDWIG: We basically flipped a coin to decide which of the kids would get offered the program and which wouldn't.

VEDANTAM: Before I tell you what they found, I want to take you into the program so you can see how it works. BAM brings together young men who are barely scraping by. Most have a D average. Nearly 40 percent have been arrested. Their chances of dropping out of school and ending up in prison are extremely high, and they live in neighborhoods like West Garfield Park. It has the highest rate of violent crime in crime-ridden Chicago.

In just one random 30-day period recently, there were 34 robberies in West Garfield Park, 18 batteries, 15 assaults, six sexual assaults and one homicide. This is the home of the BAM program at Orr High School. Stay with us.

(SOUNDBITE OF MUSIC)

VEDANTAM: This is Hidden Brain. I'm Shankar Vedantam.

Can I turn the page or should I write at the bottom? Is that OK?

UNIDENTIFIED MAN: Hold on one second.

VEDANTAM: Orr High School feels like a place that was built on big dreams.

UNIDENTIFIED MAN: What's your last name?

VEDANTAM: Vedantam - V - E - D...

It was designed in the early 1970s by the firm of the legendary architect Mies van der Roh. It's huge, but interconnecting clusters was supposed to make it less overwhelming for the 2,000 students expected to attend. Maybe it worked at first, but that dream school no longer exists - or is now struggling. Vast sections sit empty. Enrollment has dwindled as kids flee to charter schools. The empty hallways echo. A police cruiser idles outside. Kids walk through a metal detector to enter a school. In one classroom, Larry Potts, a BAM counselor waits for students to arrive. Larry thinks of his job as a calling.

LARRY POTTS: Well, I'm born into this. I mean, I've been in this community 45 years, I used to be a police officer in this community, and there's nothing for me to gain but to help reach every kid.

VEDANTAM: Larry says part of what motivates him now is what he saw as a cop when he could look into the lives of the people around him.

POTTS: I saw a lot of mental illness in the families. When you would make domestic calls, you would see mental illnesses in the homes. You would see a lot of addictions. You'd see - you'll see people going to jail and being torn apart without having a mother and father. You will see a lot of poverty, people not having jobs, not having skills, not having - not being able to work and take care of their families. But one of the worst things that I've seen is that when people do make mistakes, there's no way to rewrite that mistake.

VEDANTAM: So that's what Larry is doing now, trying to keep kids from making those mistakes they won't be able to correct. Each week, 11 young men come in for a counseling session that he helps to lead. Shortly after noon, the young men file in, and then it's time for a check-in.

POTTS: Everybody OK?

UNIDENTIFIED STUDENTS: Yeah.

VEDANTAM: The sessions always begin with his check-in, a brief summary of what's going on in everyone's life. People have to talk about how they feel physically, intellectually, emotionally and spiritually. The young men give raw and honest answers.

SHAVANTE: My name's Shavante (ph) and I'm checking in. Physically, I'm feeling good. I'm tired.

JAMES: I'm checking in. My name's James. Physically...

UNIDENTIFIED STUDENT #1: Physically, I'm tired - didn't get that much sleep last night - carrying boxes all night.

UNIDENTIFIED STUDENT #2: Intellectually, I've been thinking about this math test on Friday. I've been studying hard to push my C up to a B and even better than to an A because I know that could bring my grade up a lot.

VEDANTAM: The check-in takes a lot of time, and I find myself glancing at my watch. But then I realize these are kids without a lot of emotional support in their lives. Larry says they need space to talk, to be heard, and most of all to feel they're not alone, that someone is listening, someone has their back.

POTTS: That's that's one of the things that we really value here in our groups is to gain the trust of people. Teachers come to this school all the time. Principals come to this school all the time, and they're gone. And the kids know this, and they have no one that they can depend on every day.

VEDANTAM: After the check-in the young men usually tell stories, role play and then do various exercises. On this day, they do a trust walk where one student closes his eyes and is led around various obstacles in the classroom by a partner.

UNIDENTIFIED STUDENT #3: Hold on. We going to wait. We got a little bit of traffic ahead of us. OK. We going to turn this way.

VEDANTAM: I notice something as the students are walking around the classroom. The young men who have their eyes closed start out looking tense, but then they relax. All they have to do is focus on what their friend is telling them. Their partners, meanwhile, focus on protecting them.

For a brief moment, they're not looking out for themselves, but for someone else. It's a forced kind of intimacy, but very quickly it becomes real. When it's over, there's a real happiness in the air and a sense of pride.

UNIDENTIFIED STUDENT #4: It felt good because I - it's fun doing it. But see me - I visualized the room before I did it, so I already knew where I was at. I felt the sunlight on my eyes, so I knew I was at a window. I smelled the pizza. I knew I was over here.

VEDANTAM: Another BAM exercise is the fist. Students, again, are divided into pairs. One of them is given a ball. The other is told he has 30 seconds to go get the ball. Almost always, the second student tries to wrestle the ball away. When time's up, a counselor asks did you ever consider there might have been an easier way? What about just asking for the ball? On one level, these exercises seem almost hokey. They're teaching age-old lessons. Trust your friends. Look out for each other. Think before acting.

But these are lessons we all forget. We all need reminding, especially maybe if we happen to be 17, to slow down. The BAM program tries hard not to be preachy and tell the young men what to do. It's mostly trying to show them that they have options.

POLLACK: If we tell these kids, you'll never fight, that's just so unrealistic for the world in which they live. We - what we have to help them with is the idea - you know, you may have to fight sometimes, but what else you got in the tool kit, and, you know, which tool do you reach for first?

VEDANTAM: Harold lays out a dilemma that a young man at Orr might face.

POLLACK: Well, if you're a 17-year-old kid and you have a really nice jacket, and you're walking home from school with it, you can't be the kind of kid that other kids think they can just come and take your jacket. You have to be tough. And so there's a very practical need that they have to deter the predations of other people around them.

VEDANTAM: How do you avoid fights without communicating weakness? One of the students in the BAM program says he faces this dilemma all the time.

CANTRELL: My name's Cantrell (ph). Physically, I'm happy but a little tense, palms sweaty...

VEDANTAM: Cantrell and I stepped outside so he could tell me his story. He's been in and out of trouble. For a while, he was sent to a residential behavioral health program to help him get his anger under control. Even there, Cantrell says, he sometimes lost it.

CANTRELL: I had a roommate, and he was like - he was real, like, nasty. He used to pee on the toilet seat and didn't want to clean it off. So I guess he had anger issues, too. And then I told him about so - and he kept doing it, so then we used to argue, fight. And I'd just blank out and start fighting and stuff like that. And then every time that happened, it's always - I ain't never think about the consequences.

VEDANTAM: Cantrell strikes me as a curious mixture of toughness and vulnerability. He's slender and stares at the ground a lot, but there is a coil inside him. That coil can unspring in an instant, like the time some kids tried to steal his jacket outside school. To Cantrell, it was more than just about the jacket. It was a sign of disrespect. The other kids were saying you're a punk, we can push you around.

CANTRELL: To me, like, as a man all - it's not a good thing to say, but I look at myself like a man as - I'm prideful in myself. And I feel like they downgraded my pride and didn't respect me when they did that to me. And that hurt my pride real bad and to like give - earn my pride back, I feel honored. I wanted to teach them a lesson.

VEDANTAM: Cantrell smouldered all night about the incident. The next day at school, he attacked a student he thought was part of the group that had jumped him.

CANTRELL: And I was mad, so I just ran up to him and hit him in his face like - I hit him at least like three times. And I busted his lip.

VEDANTAM: It turned out Cantrell got it wrong. The student he attacked hadn't been involved. He realized this was the kind of behavior he needed to change. He needed to make better decisions to slow down, to think. Cantrell told me his anger surged when he recently saw a guy talking to his girlfriend. Again, he saw it as disrespect. In his mind, the other student was saying you aren't man enough to keep your girl.

But instead of punching the other student as he had wanted to do, Cantrell went up and talked to him. The other student said he had no interest in Cantrell's girlfriend. They were just chatting. That was it. All of a sudden, something that could have ended in blows ended with a nod.

CANTRELL: I got to like break myself down. I know it gets me, but in my mind, I've got to think of it like the consequences. After I do something, I think far ahead.

VEDANTAM: When I say goodbye to Cantrell, I feel uneasy. I have the sense he's on a knife edge. I can see him graduating and doing well in a couple of years, but I can also see him getting into trouble. And that brings us back to Jens Ludwig and Harold Pollack, the researchers who are studying the effectiveness of the BAM program.

What they found precisely mirrors what I saw in Cantrell. Does BAM work? Will it keep young men like Cantrell out of jail? Well, the answer is yes and no. Let's start with the good news. Remember the idea of controlling automatic behavior? Well, says Harold, that works.

POLLACK: When kids are participating in BAM, they're responding less automatically to dangerous situations.

VEDANTAM: In fact, the results of the control study of BAM showed that it worked jaw-droppingly well. While students were in BAM, arrest rates plummeted by 44 percent. Here's Jens.

LUDWIG: I fell off my chair when I saw the initial set of results indicating that the arrest rates for kids in the Becoming A Man program were 44 percent lower than the non-participants.

VEDANTAM: These are massive reductions in violent crime arrest rates. Jens calls the results stunning, almost miraculous. And there was more good news. BAM even seemed to help with school.

LUDWIG: Kids were more likely to come to school. They were more likely to be enrolled at the end of the school year, they're less likely to have dropped out, and they are less likely to fail their classes.

VEDANTAM: Jens and Harold can now say with certainty that the BAM program works. It's a huge success for young men without many good options, but sadly there is a catch. The reduction in violence doesn't stick once young men like Cantrell are done with school and done with BAM.

POLLACK: They are offending at the same rates as the control group after the program is over. So if I look at their arrest rates in the year after they're done with the program, and I compare their arrest rates with kids in the control group in the same year after the program is over, I really don't see differences there.

VEDANTAM: Harold and Jens don't know why what's taught in BAM doesn't last once the program ends, but it actually makes sense. All of us need reminders of advice we've gotten many times in the past. Take a breath, look at things in perspective, talk to a friend if you're feeling down. Jens says it's hard to change behavior, especially for kids who have led traumatic lives. But he still feels the program offers more reason to be optimistic than pessimistic.

LUDWIG: I'm an economist by training and the way that I think about whether a social program is worth doing or not is I think about what the program costs and then I think about what it does to help kids and society as a whole and whether the value of the social impact is enough to justify the program cost. And a 44 percent reduction in violence involvement for at-risk kids for one year generates benefits to society that easily outweigh the program costs. So we've estimated that the benefit-cost ratio might be as high as 30-1 for this intervention.

VEDANTAM: And there are tangible benefits to the young men who stay crime-free even if it's just for a year.

POLLACK: If I have a year where I have fewer offenses than even if I commit offenses after that, it's still, you know, it's accumulating into a less destructive record for me if people are talking about does this person need to be held in a secure facility or something like that.

VEDANTAM: Of course, when you've met young men like Cantrell on the knife edge, you want more for them. A less destructive criminal record isn't enough. These teens haven't failed in any irreparable way as yet. I see it like this. A scientific study has found that you can build a new kind of bridge, one that is good and strong. It could take these young men to a successful adulthood, but that bridge is only halfway done.

UNIDENTIFIED MAN: So let's start with you, Devante (ph).

VEDANTAM: At the end of every BAM session at Orr High School, the students have to check out to say one word that is on their minds. When I hear those words, I want that bridge completed.

UNIDENTIFIED STUDENT #4: Faith and with that I'm out.

UNIDENTIFIED STUDENT #5: Sensation and with that I'm out.

UNIDENTIFIED STUDENT #6: Excited.

UNIDENTIFIED STUDENT #7: Excellent and I'm out.

UNIDENTIFIED STUDENT #8: Fantastic and I'm out.

UNIDENTIFIED STUDENT #9: Love and with that I'm out.

(APPLAUSE)

VEDANTAM: This week's show was produced by Jenny Schmidt and edited by Tara Boyle. Our staff includes Maggie Penman, Renee Klahr, Rhaina Cohen and Chloe Connellly. We had original music this week from Ramtein Arab Louie (ph). Our unsung hero today is Alfa Jabo (ph). Alfa is the IT specialist for our department, and he's a voice of reassurance when our computers inexplicably behave like computers. Thank you, Alfa, for sharing your tech savvy and your kindness.

For more Hidden Brain, follow us on Facebook and Twitter and listen to my stories on your local public radio station. If you like this episode, please tell one friend who doesn't know about Hidden Brain about our show. Tell us on social media whom you've tapped. We're always looking for new people to find our show. I'm Shankar Vedantam, and this is NPR.

UNIDENTIFIED STUDENT #10: Trust and I'm out.

UNIDENTIFIED STUDENT #11: Happy and with that I'm out.

UNIDENTIFIED STUDENT #12: Awesome and with that I'm out.

(APPLAUSE) Transcript provided by NPR, Copyright NPR.