The U.S. wants to use its public health know-how to treat the plague of violence. But critics fear that would erode civil liberties. : A Cure for Violence?

If the epidemic were cholera or diphtheria, the doctor’s remarks might not have sparked such a firestorm.

But the leading cause of death among African-American men, ages 15 to 24, is violence. So when the government’s top psychiatrist compared activity in America’s inner cities to the violent and hypersexual behavior of young male monkeys, some thought he sounded more racist than scientist.

It’s been two months since Frederick Goodwin said, among other things, that “maybe it isn’t just the careless use of the word when people call certain areas of certain cities jungles .”

Then head of the U.S. Health and Human Services Department’s Alcohol, Drug Abuse and Mental Health Administration, Goodwin caught hell for his remarks and apologized.

But neither Goodwin, who now heads the National Institute of Mental Health, nor anyone in the larger public health bureaucracy, is about to apologize for his speech’s underlying point: That the federal government has big plans for applying its public health know-how to the plague of youth violence.

Those plans, however, have stirred a fundamental debate about the causes of and cures for violence in America.

“Whenever the federal health bureaucracy addresses violence, you’re in huge trouble,” says psychiatrist Peter Breggin, director of the Center for the Study of Psychiatry in Bethesda, Md. “The tendency is for civil liberties to go out the window.”

Twenty years ago, Breggin says, he and a coalition fought back another government-funded initiative, in which three psychiatrists suggested a potential cure for the mentally imbalanced folks they believed contributed to ghetto riots: Psychosurgery.

The new plan, Breggin says, is likely to be just as insidious. He argues that the current conservative climate encourages a patchwork of misplaced Band-Aids but ignores underlying causes of violence, such as poverty and injustice.

Supporters of public health intervention don’t dispute that poverty and injustice play a major role in generating violence. But they say society can’t afford to seek Utopia while children are gunning each other down in the streets.

“We need to get down to root causes of why people don’t have hope,” says James O. Mason, assistant secretary for health, Department of Health and Human Services. And his list is similar to others’: lousy schools, a shortage of jobs, families buffeted by the stresses of poverty.

But while society ponders such issues, “we’re not going to sit there and do nothing,” he says. “If we sit around and wait, the criminal justice people will get these people after they’ve been involved in violence or homicide.”

James Breiling, a psychologist with the violence and traumatic stress research branch of NIMH, says the quandary boils down to finding a practical level at which to address the problems.

“If we wanted to do the simple thing, it would be to prevent the birth of males,” he says. “But that’s not going to happen”

As far as Breiling knows, there are no Orwellian efforts to lobotomize the nation’s youth into docile automatons. “Are we going to put Lithium in the drinking water of Watts?” he asks. “No. That’s absurd.

“Are there kids who have behavioral problems linked to depression? Yes,” Breiling says. “Should we give the appropriate medications? Absolutely.”

Similarly, “There’s no question that there’s a genetic contribution. . . . You can’t say, ‘Gee you have bad genes, don’t reproduce’; you’d eliminate the bulk of the population. But do you say that because there’s a genetic component, suddenly we can do nothing? We don’t do that anywhere else.”

Other proposed public health interventions will include teaching parents better skills, bolstering the education process, trying to build stronger communities--where parents know each others’ children--and improving nutrition and living conditions.

The U.S. Public Health Service, a division of HHS, has yet to spell out its proposed youth violence initiative in detail. But supporters say that when 2.2 million people a year are victimized by violence and 20,000 die violent deaths, it would be criminal for the government not to throw its full scientific resources into the battle for safer streets.

Not that viewing gunshot wounds and stabbings as a health problem is new. Public Health Service agencies have collected data on violence for 2 1/2 decades. This year, they will spend more than $53 million on studies of such matters as firearm injuries, biological and psychosocial determinants of aggression and prevention of conduct disorders, as well as demonstration grants, training programs and publications.

But. . . .

“Now we’re at a juncture,” says James Mercy, chief of the epidemiology branch, division of injury control, at the Centers for Disease Control, the lead agency in the initiative proposed for fiscal year 1994. “We need to switch from the analytic stage to action. . . . It’s time to try things out, see what works and what doesn’t work and do some evaluations.”

A key component of the preventive approach to any health problem is to identify and treat those who have it or the propensity to develop it. Violent behavior is no exception, NIMH research suggests.

One study cited by the Alcohol, Drug Abuse and Mental Health Administration shows that 7% of youths committed 79% of violent crime. Breiling believes it’s now possible to identify, as early as age 9 or 10, the 5% of the population who will engage in chronic violence.

Past behavior is probably the best way to identify the chronically violent, he believes: “Kids who have high-level and continuing behavior problems that can be tracked through two, three, four grades.”

Other risk factors identified by NIMH researchers are intricate and interwoven.

“There’s no doubt that there is some genetic influence,” Breiling says. In the worst case, he says, a child would have one parent with a personality disorder and one with a criminal record. “But the bulk of those kids still would not become violent.”

Include other factors, and the risk goes up. Biology plays a role, as reflected in children with fetal alcohol syndrome or attention deficit disorder or whose mothers were addicted to drugs or had poor nutrition, he says.

Breiling identifies other potential signs of trouble:

* If the baby lives in a chaotic home or has no affectionate ties.

* If the toddler hasn’t bonded with his parents.

* If his school is sub-par or if his disruptive behavior alienates him from other children who might exert a pro-social influence.

* If he fills the emptiness with hours of violent television.

Breiling adds that progress in addressing societal violence has been slowed by the “myth” that the chronically violent can be “cured.”

Rather, he says, the public health establishment must view chronic violence in the same way it views diabetes: “It’s a lifelong management problem; there will be a continuing propensity and likelihood for them to get into trouble. They’ll need intervention throughout their lives.”

By and large, youth violence experts agree, it’s probably a good idea to attempt a public health approach to violence. It’s talk of identifying the potentially violent and “treating” them that has critics worked up.

On Feb. 11, Goodwin spoke to the National Health Advisory Council and suggested that studies of monkeys might offer insight into human violence. In the uncivilized wilds, he said, male rhesus monkeys band together in adolescence and are so violent that they sometimes diminish their numbers by half. He then speculated that in parts of urban America, youth violence has doubled in 20 years because societal breakdown has created a similarly unstructured environment.

After his talk, Senators Edward M. Kennedy and John D. Dingell (D.-Mich) and members of the Congressional Black Caucus asked Health and Human Services Secretary Louis Sullivan to consider whether Goodwin was fit to keep his job. Goodwin resigned, but Sullivan immediately appointed him head of NIMH.

Yet, although almost everyone seems to agree that Goodwin was at the very least insensitive in failing to recognize his remarks’ racist implications, scientists say there is really nothing “preposterous”--as the senators contended--in using studies of other primates to gain insight into human behavior.

“We need to do good animal studies, but we need to be careful how we apply them to humans; often there isn’t a direct relation,” says assistant HHS secretary Mason. Besides, there is as much or more relevant information on violence available from studies of children and how they respond to love and affection or a lack thereof, he says. “These are as exciting as any of the animal studies.”

Violence, he points out, is the second leading cause of death among all young males, and any genetic or biological indicators of violence span the racial and ethnic spectrum.

But those who view violence as primarily a product of social and economic forces remain worried by Goodwin’s comments that the youth violence initiative will focus on predicting behavior and intervening with individuals.

“Prediction and intervention is a very tough issue, and it will become tougher and tougher as science, particularly biology, chemistry and animal studies, delves deeper and deeper into the psyche and human behavior . . ,” says Emilio Viano, a professor in the School of Public Affairs at American University in Washington. “The scientific establishment is on a collision course with the humanistic values that we hold dear as a country and that are enshrined in our Constitution.”

The foundation of those values is a belief that peoples’ actions are based on free will, rather than on biology or social pressures, Viano says.

That belief in free will also leads to questions of individual responsibility. USC’s Delinquency Control Institute explores the spectrum of possible causes of youth violence, from low self-esteem to brain chemistry. But a simple fact is sometimes lost in the big sociological and psychological discussions, says Clyde Cronkhite, associate director of the school’s Center for the Administration of Justice and a former deputy chief with the Los Angeles Police Department.

“A certain number of these people have never been held accountable for their actions--not by their parents, by society--nor have they been held accountable in school. (So) there’s a lack of emotional and mental (constraint) that allows them to commit crime.”

Officer Krupke, you’re really a slob.

This boy don’t need a doctor, just a good honest job.

Society’s played him a terrible trick,

And sociologically he’s sick!

--from “West Side Story,” 1956

Throwing public health agencies into the war on violence was a product of the Nixon Administration’s “law and order” agenda, says Jerry Miller, president of the National Center on Institutions and Alternatives in Alexandria, Va.

“Nixon was upset with so many social scientists, anthropologists, Freudians and all their psychodynamic theories of violence, and he made clear that he wanted to move in another direction.”

So he nudged the public health bureaucracy onto a path that favored a hard-nosed, strictly medical approach to delinquency, says Miller, who has little faith that the public health establishment has changed its biases during the Reagan and Bush years.

Dr. Robert Phillips, assistant clinical professor of psychiatry and the law at Yale University and chair of the American Psychiatric Assn.’s Committee of Black Psychiatrists, met with Goodwin after his remarks and is organizing efforts to get more minority participation in the way public health agencies address violence. He hopes an array of approaches including sociology, psychiatry and organic sciences will be directed at the problem.

Father Gregory Boyle, pastor of Dolores Mission in Boyle Heights and an anti-gang violence activist, has similar assessments:

“It’s always been a trap and an easy temptation to let law enforcement address the symptoms and forget about it. By the same token, I wouldn’t want people to say, ‘Oh good, public health people are going to intervene now, and treat kids at an early age’ and forget about the broader issues.

“The great disparity between poor and wealthy, the disparity between the educational opportunities of the kids in my barrio and other parts of L.A.: That’s where gang violence comes from.”

Jim Brown, who heads the Amer-I-Can Program, a grass-roots gang intervention project, questions the effectiveness of any such federal program: “They can initiative themselves to death, and it won’t work. The intellectuals are too far above the problem; the researchers can’t even go into the neighborhoods at night. . . . The job will only be done from the bottom up.”

Psychiatrist Breggin, who is trying to rally opposition to the initiative, insists there is no shortcut: “The idea that they’re going to identify 5% of young people . . . at 9 or 10 and do something intensive I find terrifying.”

Breggin, whose opinions are pretty much summed up by the title of his 1991 book, “Toxic Psychiatry,” contends that his profession repeatedly claims to have found the causes of violence and criminal behavior.

“They make up stuff,” he says. “They say violence is caused by testosterone or XYY chromosomes or genetics. Now the big thing is (low levels of the neurotransmitter) seratonin.”

Breggin doesn’t buy any such claims for predicting violence: “They don’t work. And if they did, I wouldn’t want to live in that society.”

Many who will be identified as violent or potentially violent “are going to be leaders someday, they’re the ones who are rebellious and get labeled,” he adds. “(Authorities) are going to take some poor 8- or 9-year-old boy and tamper with his mind because they say he’ll be violent.”

In fact, Breggin sighed, “he might grow up to become Martin Luther King.”