ISIH S3 E23 / Gun Violence in America: Lives in Blue

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Celine Gounder: The past week has been shocking. Gilroy, California. Brownsville in Brooklyn. El Paso, Texas. Dayton, Ohio. We've all got to do our part to end gun violence in America. That starts by learning about the problem... and the solutions. Over the past year and a half, I've devoted myself to this cause. If you agree that more people need to learn about the science of gun violence and what we can do about it, please share this podcast with them. These are important conversations we all need to hear. Thanks for listening. Now… on with the show.

Celine Gounder: Welcome back to “In Sickness and in Health,” a podcast about health and social justice. I’m Dr. Celine Gounder. This season we’re looking at gun violence in America. 

Mark Jones: Have you ever been pulled over for a traffic violation?

Celine Gounder: Oh, once, in probably my early 20s.

Mark Jones: You probably, didn't register that much on you or make a big impact, but I can tell you that every traffic stop I made… I approached every traffic stop as if the guy in the car could shoot me.

Celine Gounder: Mark Jones is a Senior Policy Advisor to the Illinois Council Against Handgun Violence. He started his career in law enforcement as a patrol officer in Illinois.

Mark Jones: I was trained to do this. I was trained to walk up to the car, press down on the trunk to make sure the trunk’s closed, because if the trunk’s not closed, it could pop open suddenly, and a guy could get out and shoot you... Then you look in the back window, and if it's at night, you put your flashlight in the back window… and you look around, and then you get up to the driver's door, but you never get next to the driver's door, you stand a little behind the driver's door, make it hard for the driver to turn around and shoot you…

Celine Gounder: What Mark’s describing… isn’t just “best practice” on the job. It’s a way of life.

Mark Jones: We have 300 million guns, more or less, we don't know who has them… We have to assume, as a law enforcement officer in this country, that every civilian you approach is armed. 

Celine Gounder: On this episode, we’re going to look at Lives in Blue… how living and working around guns affects law enforcement officers, physically and mentally. Both on the job... and outside of it. What it’s like to live with the possibility of a shooting right around the corner… and with the memory of past shootings behind you.

Celine Gounder: Mark Jones understands why police are trained this way… to think that every civilian they meet could have a gun. The risks, he says, are real. But he also says the longer he stayed in the force and rose through the ranks, the better he understood where the risk was really coming from. As a newly minted patrol officer though, Mark was oblivious to all of this. He just really liked guns.

Mark Jones: As a young man, I was very much into firearms and tactics and SWAT team and all that stuff. And I learned it. I internalized it. And I sought it and got more and got better.

Celine Gounder: Mark says this is a common experience for young officers.

Mark Jones: Mostly when you see this sort of urban gun loving, it's coming from young men… There's a percentage that they get into it, they become firearms instructors and tactics instructors. This is what I was. I'm describing, basically describing myself to you. … And at some point, through the enforcement work I was doing, the supervision I ended up getting into, the professional path I've been on, has let me see the truth of the firearms industry. But a lot of these folks don't get there. They stay in local police agencies for their entire careers. They don't get out of that. Their livelihood comes from this. Their friends, their socializing comes from these relationships that build around hunting, firearms use, target shooting…

Celine Gounder: So when you were a young officer, why were you so into guns and tactics and SWAT teams and all of that? How did it make you feel?

Mark Jones: Powerful, strong, handsome, charismatic… 

Celine Gounder: Mark says that his motivation for joining law enforcement was related to being neglected... and feeling powerless as a child.

Mark Jones: A lot of me leaning towards the law enforcement stuff was the realization of a lifelong desire to have agency in my life…

Celine Gounder: And while he’s hesitant to project too much of his own personal experience onto colleagues, he says there are parallels in terms of what joining law enforcement did for them. 

Mark Jones: I went from being nobody in the society I came from to being suddenly a public figure with authority… and granted responsibility by the state. This was all new for me. I don't think that part of it is that uncommon.

Mark Jones: Young cops get a lot of approval for being good with a gun. Firearms are seen as an integral part of police work in America… you're rewarded if you're the best shot in your class… or if you do it enough times, like you get a perfect score five times, and you get a letter from your agency head, where I came from that said, "Great job, Mark. Great job agent Jones, you shot perfect five times in a row and so we're going to give you $100 bonus and put the senior permanent record,” kind of thing.

Celine Gounder: Mark rose in the ranks. He took on leadership roles with various federal agencies. And he went through a similar transformation that many in law enforcement leadership do.

Mark Jones: They see it, the toll that gun violence takes on their communities. And not just in the body's falling--the dead and the wounded--but the cost of business, the cost of… medical care. All of the things that we are starting, finally, to realize that go into the cost of gun violence. These chiefs see this, they see its impact on their bottom line.

Celine Gounder: As his views on gun policy changed, Mark began making a connection between... the number of firearms on the streets... and the risk to police officers’ lives… risks that included being shot by a civilian… or shooting one.

Celine Gounder: These connections, it turns out, are much harder for those of us outside of law enforcement to make.

Celine: Here’s Franklin Zimring. He’s a criminologist and law professor at UC Berkeley.

Franklin Zimring: …there really are a whole series of rather gentle controls that 80% of the population supports that when you add them all up, would have a modest, at best, reduction in the death rate attributable to the use of firearms and violence. That is to say, everything that we're willing to do, even if the NRA didn't exist, is at best a 10% reduction in additional death rate because of the instrumentality effect of all the guns that are out there that get used…

Celine Gounder: ...because guns are such lethal weapons…

Franklin Zimring:  ...then there are the things that could cut our homicide rate in half… but those involve very substantial reductions in the availability of concealable firearms.

Celine Gounder: According to Frank, what we should be focusing our efforts on... is reducing the availability of handguns, and more specifically, of concealable firearms.

Celine Gounder: Frank says that in the U.S., we like to talk about the ready availability of guns and prevalence of gun violence… and then… we have a separate conversation about police killings… about Black Lives Matter… and about how Blue Lives also matter…

Franklin Zimring: These two universes of discourse take place almost as if they were on separate planets.

Celine Gounder: ...when in reality they are very much linked. 

Franklin Zimring: Police in the United States kill between 1,000 and 1,100 civilians a year, which is about twenty-five times as much killing of civilians as in other developed countries. … Why is that?

Celine Gounder: In the U.S. there’s a high rate of civilians killed by law enforcement officers… in part because cops are more preemptive... and the reason for that, Frank says, is that in the U.S. a combination of civilian gun ownership and concealed guns in public... place the lives of police officers... at risk. Black Lives Matter and Blue Lives Matter are… in some respects... two sides of the same issue… and both are very much linked to the prevalence of guns in America.

Celine Gounder: I asked Frank why rank-and-file police officers aren’t more outspoken advocates in favor of gun regulation… given the very real threat to their own lives. Frank says it’s often because there are misconceptions about where police officers are highest risk… and who’s the biggest threat.

Franklin Zimring: They’re thinking: high crime neighborhoods, repetitive violent offenders, robbers, and street gangs. They're not thinking 52-year-old men fighting with their wives or failing to take their antidepressants… and lithium.

Celine Gounder: According to Frank, some police officers might hesitate to support gun regulations because they don’t believe criminals will obey the law. But… Frank points out that it’s typically not criminals who are shooting at police. if you look at the data on gun violence against police officers, you’ll see that the assaults don’t follow incidents of crime. Instead…

Franklin Zimring: They follow gun ownership. … There is an ideological blockage for a lot of in-service rank-and-file police officers because they think that… the risks of assaults against police with guns is criminality instead of Uncle Eddie off his meds or violently pressured domestic disturbance cases where loaded guns are present.

Celine Gounder: Similarly, civilian killings by police often involve what are called disputes or disturbances… often domestic arguments.

Franklin Zimring: Those are about 25% of all the circumstances that produce killings of civilians because what they are is the combination of unhinged people and firearms in their possessions.

Celine Gounder: David Swedler is an epidemiologist and statistician who studies how people get injured on the job. In 2015, he published a paper on the relationship between gun ownership and assaults against police across the United States.

David Swedler: And in the paper, we made maps of gun ownership and officer homicide rates. And if you look at it, the two maps, there's a lot of states that line up in the same category in each: high gun ownership and high officer homicide, low gun ownership and low officer homicide.

Celine Gounder: According to Dave’s research, the states with the most guns had a three times higher rate of officer homicides than the states with the fewest guns. And, like Frank, Dave found something interesting about when these homicides occur.

David Swedler: According to the Law Enforcement Officer Memorial page, in 2017, and this has been consistent through previous years, domestic disturbance is the most common situation that precedes an officer homicide by counts.

Celine Gounder: And, in states where there are high rates of gun-ownership, domestic disturbance calls are even more dangerous to police officers. Here’s how Dave explains it:

David Swedler: Officers are showing up to these calls in every single state. An officer in a state with more homes with civilian gun ownership, will more often enter homes where a gun is present. … These officers in these high gun states, are more often entering armed domestic disturbance situations than their counterparts in low gun states. And so the officer becomes at risk for what's called a corollary homicide. Corollary homicide is someone who's not the primary victim of the intimate partner violence, but a secondary victim of the main abuser.

Richard Myers: When you are sending an officer on a call, where shots have been fired, alcohol is involved, people are armed, they know they're going into a high-risk situation.

Celine Gounder: That’s retired Police Chief Richard Myers, who’s now the Executive Director of the Major Cities Chiefs’ Association. Richard says police officers can be trained to identify and minimize risks in potentially dangerous situations. And they’re very good at it. However…

Richard Myers: The real risk is when everything seems to be going great, and suddenly out of the blue, they missed some cues that someone is turning from a nice person to interact with to a deadly person that they're interacting with.

Celine Gounder: And this is why domestic violence, intimate partner violence situations are so risky... if not lethal.

Richard Myers: When two people that have a significant relationship engage in conflict, emotions are absolutely at their peak. It can be a highly traumatic experience, emotionally, for both parties. And then you inject into the middle of that a third party who neither individual trusts, likes, or really wants to be there at the time… We train officers to be very mindful that these domestic situations can look very innocent on the surface, but deep down could involve extreme violence.

Celine Gounder: But if training is supposed to help officers in situations like these, it should include more than how to properly use a handgun or other traditional aspects of policing. It should include training on relationship-building and human-to-human interaction.

Richard Myers: Policing is a relational business. It really is.

Celine Gounder: In other words, all policing is done through relationships. And strong relationships equal less risk of violence... for everyone involved.

Richard Myers: Fear of the police, or fear by the police, both end up with potentially really dangerous circumstances. And if people are afraid of the police, and they're armed, they're going to be more likely to jump to using force if they have an interaction with an officer, and they feel frightened about it. … Likewise, if cops are so afraid to get out of their car, and go on a call, or go on a foot patrol in a downtown area, or make a traffic stop, that worries me equally as much…

Celine Gounder: In addition to the prevalence of firearms, which often fuels both fear of the police and fear by the police, there’s another dynamic at play.

Mark Jones: …the militarization of the civilian population has caused the militarization of the police population, and it's not the other way around.

Celine Gounder: This is Mark Jones again.

Mark Jones: …technologies developed for the military. They get implemented by the military. Once the company that's made them has squeezed as much money out of that military application as they think they can, they figure out a way to civilianize the technology, and they push it to the civilian population…

Celine Gounder: Police officers are then forced to up-the-ante to keep up with what they may encounter on the streets.

Mark Jones: It's a really disturbing trend, and you're seeing it all over the place… The idea that we’ve armed the civilian population at the equivalent level of the police population. And now, we're seeing those arms being turned on the cops.

Celine Gounder: And, while mass shootings with military-style weapons still represent a small percentage of gun violence in America, they’re still a phenomenon police officers have become the first responders to… exposing them to a different kind of risk.

Jennifer Carlson: In the aftermath of September 11th and Columbine, you actually have a big shift in police training.

Celine Gounder: Jennifer Carlson is a sociologist at the University of Arizona. She’s been interviewing police officers across the country about their use of guns, as part of her research for an upcoming book.

Jennifer Carlson: So the way to go about an active shooting when Columbine happened was to contain and wait. So you arrive on the scene, you secure the perimeter, and then you wait for SWAT to arrive, and then SWAT goes in, and they deal with the threat. … And that's something that came up in my interviews, where police would talk about, "Now we're trained to step over the dead bodies, to step over the victims, to run to the threat," and that's really hard to do because you want to stop and help someone, but that's not how we're trained now. We have to run to the threat. … you don't wait for SWAT, you form a team to go in and deal with the active gunfire.

Celine Gounder: Jennifer says these changes in training… expectations of what the job is… also influence how police think about carrying their guns off-duty.

Jennifer Carlson: That I think has also changed their relationship with their own personal firearm because it's no longer just about work. You take off the badge, you take off the gun, you go home. Now it's the sense of, an active shooting could happen at any time, any place, and so, you should be armed.

Celine Gounder: As the demands of the job have changed... along with the weapons law enforcement officers carry… so have the risks. Risk goes beyond physical injuries… and they include a real toll on mental health… that some officers are only now… slowly…  beginning to speak about.

Celine Gounder: Jeff McGill is the co-founder of Blue H.E.L.P. Blue H.E.L.P. is an education and advocacy organization that tries to reduce mental health stigma and raise awareness about suicide and mental illness in the law enforcement community.

Celine Gounder: Jeff conducts trainings for law enforcement units all over the country. During these trainings, he often tells the story of a shooting incident his partner Steve was involved in... and the psychological aftermath they both endured.

Jeff McGill: For me and him, we had been through everything together. So, we had worked together as partners for about ten or twelve years… And so, it's something that changes… It changes who you are and how you think about things.

Celine Gounder: Jeff and his partner, Steve, were serving a search warrant with the U.S. Marshal Service. They arrived at the address. They set up a perimeter around the home and waited for the search warrant to arrive.

Jeff McGill: After holding a perimeter for about two hours, the suspect came out the front door… He didn't have anything in his hands at that point. 

Celine Gounder: The suspect walked to the front yard, then went back inside.

Jeff McGill: He was doing a little recon. Immediately after going in the house, he kicked the door back open with his foot, and he came out the front door with two guns, one in each hand, and firing.

Celine Gounder: Steve was positioned at the front of the house. He was the only cop the suspect could see from the front door, so he aimed directly at him. Jeff, was in the opposite corner near the rear of the house and couldn’t see the suspect… but... he had a clear view of Steve.

Jeff McGill: In the less than ten seconds of this shooting occurred, there were sixty shots fired… The way I describe it to people, head wounds bleed a lot to begin with, but the way I described it is it looks like somebody turned on the kitchen faucet, full blast. There was a trail of blood that came out of his face, and he was able to move to cover from there. As he was moving to cover, he took two more rounds in the right leg… And strange things start happening to your mind during high-stress situations like this.

Celine Gounder: Eventually, the shooter was subdued, and Steve was taken to the hospital by a SWAT medic. Jeff followed right behind them.

Jeff McGill: As cops we’re taught, and we're prepared to get shot. We know that if we get shot, this is how we're going to react. We’re always think through this process of what if. And if this occurs, then we're going to do this. I'd worked my way through this process for myself. Never once had I ever considered having to stand over my friend in an ER, hold his hand, and take what could be his last words…

Celine Gounder: Around that time, Jeff says, his agency had lost three other officers with gunshot wounds to the head... in a very short stretch of time. None of them had survived. All of this was playing in the back of Jeff’s mind…  as the nursing staff started handing him Steve’s personal items.

Jeff McGill: They hand me his wedding ring, and they hand me his wallet. None of this had ever crossed my mind as to what would occur if this was ever to go on. 

Celine Gounder: Steve was flown from the emergency room to a trauma center. Jeff wasn’t allowed on the helicopter so he followed in his car… driving... lights and sirens ablaze... through traffic.

Jeff McGill: He is treated, stabilized. The trauma surgeon works their magic. He is put into a critical care unit for an extended period of time.

Celine Gounder: At 5 AM the morning after the incident, Jeff decided to drive the hour and a half back home, shower and rest. But soon after he got back, Steve’s brother called him... telling him Steve was asking for him. So Jeff rushed back to the hospital. On the drive…

Jeff McGill: I start sweating profusely. I start breathing really heavily. And I have no idea what's going on. So, I’m fairly well fit. My resting heart rate's usually about 50 or 60 beats a minute. I'm sitting in a car pushing 140 beats a minute, and can't stop sweating., and can't stop breathing heavy, and have no idea.

Celine Gounder: Jeff was having a panic attack.

Jeff McGill: Never had panic attacks before. I didn't know what it was, but I knew that I was lacking control.

Celine Gounder: And it was this lack of control that made things especially stressful for Jeff.

Jeff McGill: That's one of the things that we teach officers from day one is you always have to be in control of the situation… it doesn’t matter what the situation is. So not having control and not having current information as to how my partner was doing and whether or not he would live was a tremendously stressful event for me.

Celine Gounder: As time went along and Steve recovered physically, it was clear his mental health had taken a big hit.

Jeff McGill: He had his jaw broken in three places so his jaw was wired shut. That resulted in a trach(eostomy) being required… The cleaning of the trach, the insert and removal the trach made trigger response to him. Different things would cause him to having flashes.

Celine Gounder: Jeff says that what weighed so heavily on Steve was the effect his injury had on his family... and colleagues like Jeff.

Jeff McGill: He was the only officer within the agency that we were at to survive a gunshot battle. And we had officers within the agency who couldn't go visit him in the hospital, because they couldn't face that. They couldn't face their own mortality… His brothers were both in law enforcement, working the streets. One took a transfer to get off the street initially, one left law enforcement completely. It was a life-changing event for many more people than just him.

Celine Gounder: About eleven months after the incident, after multiple surgeries as well as psychological and psychiatric treatment, Steve went back to work in his old unit.

Jeff McGill: The fact that he was able to come back after such a traumatic injury and get back in the game says huge things about his character and his level of persistence, not only to physically recover, but to mentally bring yourself around.

Celine Gounder: Jeff is really clear when he speaks at trainings that Steve didn’t do that on his own.

Jeff McGill: And I tell people all the time... we have officers who have their partners killed in the line of duty. And the survivor's guilt that's associated with that's tremendous for many of these officers, "Why wasn't it me? Why couldn't I protect them? Why didn't I make sure they get home?"

Celine Gounder: Jeff says it’s, unfortunately, not uncommon for that guilt to lead many officers to quit the job… or even... to take their own life.

Jeff McGill: I dealt with that level of guilt. And I can understand and relate to the idea that had my partner not survived, I know my career would've been over. I would've turned in my badge and gun and been done.

Celine Gounder: The big problem, Jeff says, about mental illness… is that cops… don’t talk about it. Things are changing, he says, but very slowly.

Jeff McGill: I came up in a time where the standard was suck it up and drive on. Doesn't matter what the incident was. You responded to the death of a baby, or sudden infant death syndrome, or you responded to a massive motor vehicle accident, we have multiple bodies. It was okay. "That's great. Go write your report and go on to the next call." 

Jeff McGill: You might be able to stand one, two, three. But ultimately, that stuff builds up over time. You're talking about traumatic stressors… When you're having this build up over a cumulative time of twenty, twenty-five years within an agency or within a career, how are you dealing with that? 

Celine Gounder: Jeff told me back in his day, the way officers in his unit handled the stress was through what he called “Choir Practice.”

Jeff McGill: Everybody would meet. They get off shift and have a few drinks. And I'm not a fan of drinking to solve the problem…

Celine Gounder: However looking back, the benefits of those informal gatherings are clear.

Jeff McGill: It was peer support and there was debriefing time. You would sit around with your fellow officers and talk about the calls you went on. You wouldn't necessarily talk about the feelings associated with it, but you could get some of those out by explaining what you saw and what you did.

Celine Gounder: But Jeff says that… aside from “Choir Practice,” it wasn’t really part of the culture for officers to talk about what was going on with them… their feelings… or the trauma. Again, a lot of it goes back to the way officers are trained to think about their job… and their identities as police officers.

Jeff McGill: If I'm supposed to be in control the situation, and now all of a sudden, I can't deal, I can’t even control my own emotions associated with the death of a child… then can I be trusted to do anything else?

Celine Gounder: Jeff’s description of “Choir Practice” sounded familiar to me.

Celine Gounder: …in medicine, we call it “Liver Rounds.”

Jeff McGill: Oh, nice.

Celine Gounder: Once a week or we go to the local bar… There's a similar language also about are you in control of the situation? How do we change that culture?

Jeff McGill: I can't speak to the medical side, but I will speak to law enforcement…

Celine Gounder: Jeff says the problem is that the system doesn’t give the same weight to psychological trauma as it does to a physical injury.

Jeff McGill: If I went and told the chief, "Hey, I got shot in the line of duty, and I'm physically injured," I'm going to get a medal, and I'm going to get days off, and the agency's going to take care of me, and everybody's going to rally around me to fix my physical injury. If we're talking about a mental injury, it's not like that.

Celine Gounder: Police agencies, Jeff believes, need to start recognizing traumatic stress as a line-of-duty injury. And they need to start talking about it. The earlier, the better.

Jeff McGill: We know that trauma, and what officers see can change the way… the brain works… All of these things are physical changes that are occurring in the brain as a result of trauma, but we don't want to talk about it.

Jeff McGill: And so, as it's becoming more culturally accepted, and we're seeing some changes, we're seeing police chiefs step up and go, "Hey, I had this problem when I was a young officer." ...and being willing to speak about... about how they got that point.

Celine Gounder: Jeff says we need to talk about it early on, so that when the old guard, people of his generation retire, the young officers coming up will be in better shape.

Jeff McGill: They will have gotten mental health information earlier. And they will have known about it from day one of the Academy, and they'll have it reinforced throughout their entire career that they need to watch out for it, they need to prepare for it, they need to go to checkups, and so that will become the norm within the culture.

Celine Gounder: Another important thing to change the culture, Jeff says, is to make getting help normal.

Jeff McGill: You don't go to the see the dentist only when you have a toothache. We all go to see the dentist every six months, get our teeth cleaned, whether we need it or not… That's the norm. Why aren't we doing this with psychologists or peer supporters or the chaplain, or anybody else that is perfect for you?

Celine: Mental health professionals should be better prepared to care for police officers. He’d like to see them go out on patrol cars, for example, so they see what police officers see.

Jeff McGill: Because cops don't trust people. We are a very closed community, and we trust our own because we count on each other to bring each other home every day. It's an issue of life or death for us. And so, if you're an outsider, you're going to have to establish some kind of rapport with us, and you're going to have to show us you understand where we're coming from and what our culture is before we're willing to talk to you.

Celine Gounder: Jeff points out there’s a shortage of cops all across the country, so many police departments recognize it’s in their interest to take responsibility for the mental health of their officers. They realize they need to have a plan to help them through recovery and get them back to work. They’re not replaceable. There are simply not enough applicants.

Celine Gounder: But there’s another reason law enforcement leadership sees it as a necessity.

Richard Myers: All of us who have been in policing, have had colleagues go down at their own hand. I know as a chief, I've had to bury an officer or two for suicide, and… it creates an empty spot in your soul…

Celine Gounder: The suicide rate among police officers is well above the general population. An officer is twice as likely to die by suicide… as to be shot in the line-of-duty… In just the last two months, five NYPD officers have died… by suicide.

Jeff McGill: We try to tell people that every time you're dealing with a traumatic event, or a significant stressor, you're picking up a rock and putting it in your bag, and how many of those rocks do you think you can carry? Certainly, you can carry some. Most of us can, and some of us can carry more than others, but everybody breaks at a certain point…

Celine Gounder: In our next few episodes, we’re going to shift… from urban gun violence… to mental illness.

Celine Gounder: Gun violence is a mental illness problem… but not in the way most people think. The number one cause of gun violence in this country? Suicides. About two thirds of gun violence deaths are suicides. So we’re going to spend the next few episodes talking about the links between mental illness and gun violence… starting off with some level-setting. There are lots of misconceptions about suicide: Is it preventable? Is it impulsive? Who’s at risk? Is everyone with a mental illness at risk? That’s next time on “In Sickness and in Health.”

Celine Gounder: Today’s episode of “In Sickness and in Health” was produced by Virginia Lora and me. Our theme music is by Allan Vest. Additional music by The Blue Dot Sessions. If you enjoy the show, please tell a friend about it today. And if you haven’t already done so, leave us a review on Apple Podcasts. It helps more people find out about the show! You can learn more about this podcast and how to engage with us on social media at insicknessandinhealthpodcast.com. That’s insicknessandinhealthpodcast.com. I’m Dr. Celine Gounder. This is “In Sickness and in Health.”