School Shootings Boys Will Be Boys Exploring the
“School Shootings”
Boys Will Be Boys? Exploring the link between masculinity and boyhood violence Robert Roose, MD MPH Eliana Korin, Dipl Psic Joanna Dognin, Psy. D STFM Conference on Families and Health March 3, 2007
Educational Objectives Ø Present facts about boyhood/youth violence Explore how notions of masculinity may perpetuate boyhood/male violence Ø Raise awareness about importance of utilizing a gender perspective in clinical practice Ø Suggest clinical approaches to incorporating a gender perspective into clinical practice Ø
Case Presentation 14 year-old adolescent male (CL) Ø annual “check-up” Ø accompanied by 38 year-old father Ø first-time to the clinic Ø father lives around the corner Ø father scheduled the visit
Case Presentation “I’m not getting naked…” “Yes you are. You’re gonna get checked out. ” “. . . ” [ no spontaneous conversation ] [ no eye-contact btw father and son ]
Case Presentation HEADSS “Ok. ” “No. Not good. ” Favorite class? “Gym. ” Least favorite class? “Everything Else. ” Ø Ø Ø completed ninth-grade, near-failing never held back trying to move to school in Yonkers, NY
Case Presentation “He’s getting into trouble. . . ” “…just trouble. ” “. . . ” Ø Ø Ø suspended several times; no expulsions ? police involved denied use of weapons
Case Presentation Yonkers HEADSS truck driver Abuse? Bronx
Case Presentation HEADSS Ø lifts weights (but little aerobic activity) plays video games, watches TV wants to enter army when 18 years old Ø denies smoking/tobacco/Et. OH/drugs Ø not yet having sex interested in having sex with women takes condoms Ø Ø “Don’t let my dad know…”
Case Presentation Physical Exam GEN: quiet adolescent, of few words HEENT: wnl CV/PULM: muscular chest, wnl ABD: wnl EXT: wnl GU: “Be a man!” “This is part of being a man!” “No guy is touching my nuts…!”
What issues have presented themselves? What really is the trouble here?
“Be a man!” “This is part of being a man!” Men… Yell at people Don’t cry Know about sex Don’t back down Can “take it” Have no emotions Stand up for themselves Don’t make mistakes Take care of people Push people around Men are. . . Aggressive Mean Bullies Tough Angry Successful Strong In control Active Dominant over women
What a dominant masculinity means… Ø Being insulted, weak, or out of contol IS NOT acceptable Ø Aggression IS acceptable Policing of individual behavior by name-calling, threats of violence, violence Ø Ø Ø Violence is “internalized” and learned Non-violence is (often) not rewarded
Youth Violence Prevalence Statistics In 2003, 5, 570 young people ages 10 to 24 were murdered - an average of 15 per day Ø In 2004, > 750, 000 young people ages 10 to 24 were in EDs for injuries due to violence Ø Homicide is a leading cause of death of young people ages 10 to 24 Ø #1 for Black Ø #2 for Hispanic Ø Centers for Disease Control and Prevention, National Center for Injury Prevention and Control. Webbased Injury Statistics Query and Reporting System (WISQARS) [online]. Accessed on 30 July 2006. Available from: URL: www. cdc. gov/ncipc/wisqars
Youth Violence Prevalence Statistics Ø 36% in a physical fight in past year Ø 14% in physical fight at school Ø 9% experienced dating violence in past year Ø 19% carried a weapon in past month Ø 7% carried a weapon at school Ø 5% carried a gun Centers for Disease Control and Prevention. Youth Risk Behavior Surveillance -- United States, 2005. MMWR Weekly Report, 2006 June 9; 55(SS 5).
Boyhood/Male Violence Prevalence Statistics Ø Men are most often perpetrators of violence Ø 89% of those who commit murder 90% of those who commit serious physical violence (95% of domestic violence) Ø Ø 99% of those convicted of rape U. S. Department of Justice, Bureau of Justice Statistics, Homicide Trends in the U. S. : Gender: 19762004. Accessed on Aug 1, 2006 from http: //www. ojp. usdoj. gov/bjs/homicide/gender. htm U. S. Department of Justice, Bureau of Justice Statistics, Sourcebook of Criminal Justice Statistics Online. Accessed on Aug 1, 2006 from http: //www. albany. edu/sourcebook
Boyhood/Male Violence Prevalence Statistics Ø Men are most often victims of violence Ø 5 -8 times more likely to be victim of violence Ø Of homicides among ages 10 -24, 86% are men Ø More likely to be in physical fight U. S. Department of Justice, Bureau of Justice Statistics, Homicide Trends in the U. S. : Gender: 19762004. Accessed on Aug 1, 2006 from http: //www. ojp. usdoj. gov/bjs/homicide/gender. htm U. S. Department of Justice, Bureau of Justice Statistics, Sourcebook of Criminal Justice Statistics Online. Accessed on Aug 1, 2006 from http: //www. albany. edu/sourcebook
Been in a physical fight in past 12 months Centers for Disease Control and Prevention. Youth Risk Behavior Surveillance -- United States, 2005. MMWR Weekly Report, 2006 June 9; 55(SS 5).
Carried a weapon to school in last 30 days Centers for Disease Control and Prevention. Youth Risk Behavior Surveillance -- United States, 2005. MMWR Weekly Report, 2006 June 9; 55(SS 5).
Why are men so much more violent? Ø PARADOX OF POWER Ø Compensatory violence Ø Enforcement violence Ø Reactionary violence Ø Psychological response to physical or mental illness Psychosocial response to decreased quality of life, economic instability, poverty, racism, etc. Ø
How does this affect our role as providers? …and as teachers? Ø Incorporate a gender perspective Ø need to recognize gender bias breakdown resistance to a gender perspective in biomedical model of care Ø embrace idea that living conditions, social position, and societal expectations regarding gender matter to one’s health Ø
What can we do as providers to cultivate and support a new form of masculinity? Ø Show support in both silent and vocal ways Ø Be an example of non-violence Ø Suggest conflict resolution or mediation Ask about violence or behaviors -- and be ready to intervene Ø
What can we do as teachers to support the use of a gender perspective in medicine? Ø Provide a space for introspection Ø Educate self and others Ø Support and empower men to be nonviolent
Resources Ø www. jacksonkatz. com Ø www. mencanstoprape. com Ø http: //toolkit. endabuse. org/Home Ø Paul Kivel, Men’s Work
References Hong L. Toward a Transformed Approach to Prevention: Breaking the Link Between Masculinity and Violence, Journal of American College Health, 2000 May, 48: 269 -279. Tarter R, et al. Predicting Adolescent Violence: Impact of Family History, Substance Use, Psychiatric History, and Social Adjustment. Am J Psychiatry, 2002; 159: 1541 -1547. Johnson S, et al. Urban youths’ perspectives on violence and the necessity of fighting. Injury Prevention 2004; 10: 287 -291. Borowsky I, et al. Effects of a Primary Care-Based Intervention on Violent Behavior and Injury in Children. Pediatrics 2004; 114: e 392 -e 399. Abraham A, et al. Assessing an Educational Intervention to Improve Physician Violence Screening Skills. Pedatrics 2001; 107(5). Ng-Mak, et al. Normalization of Violence Among Inner-City Youth: A Formulation for Research. American Journal of Orthopsychiatry 2002; 72: 92 -101. Sege R and Licenziato V, eds. Recognizing and Preventing Youth Violence: A Guide for Physicians and Other Health Care Professionals. Massachusetts Medical Society, Waltham, MA: 2004. Alpert E, et al. Interpersonal Violence and the Education of Physicians. Journal of Academic Medicine, 1997 Jan, 72(1): s 46.
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