Good morning everyone. There we go. And thank you for being here. We are going to get started right on time. I thank you for your perseverance because that's what it took to get into this room to be here on time today. So you actually should give yourselves a hand for being here on time and getting through the obstacle. Absolutely. But we are here for the Solomon Fuller Carter Lecture and I'm sure we're going to have more people join us this morning. But it is my distinct privilege and honor to welcome you to the Solomon Carter Fuller Award Lecture that will be delivered by Dr. Ron Bailey. And before we begin to the lecture I'm pleased to present him the Solomon Carter Fuller Award and after I give his bio then we will present that award to him. The Solomon Carter Fuller Award was established in 1969 and named for Dr. Solomon Carter Fuller recognized as the first black psychiatrist in America. And it honors a black citizen who has pioneered in an area that has significantly improved the quality of life for black people. The call for nominations for next year's award will close on August 15th 2024. So if you know persons who are eligible please make sure that you submit their names. We want to make sure that anyone who deserves to be recognized that you visit the APA website and look under Solomon Carter Fuller Award for instructions on how to submit a nomination. Dr. Ron Bailey serves as the Kathleen and John Bricker chair professor and head of the Department of Psychiatry at Louisiana State University or LSU Health Sciences Center and is the assistant dean for government but community engagement. He has served as chairman of psychiatry at Meharry Medical College from 2008 through 2014 at Wake Forest Medical College from 2015 through 2018 and the National Medical Association from 2002 to 2006. His work has been seminal in assisting communities in caring for the health of patients, developing strategies to improve their health paradigms, and working to enhance the lives of young professionals. It is my great pleasure to present the Solomon Carter Fuller Award to Dr. Ron Bailey. Without further ado, Dr. Ron Bailey. Let me see if we are upside down here a little bit. Good. Well, thank you very, very much, Jonathan. I'm certainly very appreciative of all of you for attending today. I'm certainly humbled and filled with gratitude. The opportunity to be recognized, I think, by our peers is a signature moment, I think, for many and all of us. I've been involved in psychiatry now for 34 years. Finished med school in Houston, Texas in 1990. Been involved in psychiatry the entire of that time period. A lot of work, but a lot of good work. I think our profession is remarkably rewarding, I think, for all of us who are endeavoring it. And I think that the benefits by far outweigh the sacrifices we engage in. I think on a day like today, and I want to thank the APA for giving me 90 minutes. 90 minutes is certainly a lot better with all the thanks you have to kind of give rather than 60 minutes. So I'll start with a few thanks. I think it goes without saying, you know, we live in a world where we acknowledge, I think, our higher power. And I certainly want to give tremendous credit to God for being the key force, I think, in my life. The people, I think, who I want to thank on a day like today. This life kind of starts, in many regards, with your parents. I'm an only child. Very, very fortunate that Edward Bailey and Sandra Bailey brought me into this world and really gave me, I think, the kind of love and attention that I think children need. And so much of my career in psychiatry really works with individuals who, unfortunately, no fault of their own, were not able to benefit from or appreciate that level, I think, of love and support by parents. And really a cocoon of support by family. That being said, it goes without saying that there's a lot to be said, I think, for strong parents, and I want to certainly honor my parents today. I think others that certainly deserve acknowledgment as well include family and friends, my own three adult kids and the like. Really nobody more so, I think, than my wife. My wife, Theresa Bailey, is actually here today. I've known my wife for, you know, a better part of 50 years. She's been a remarkable supporter. I've been married for right at about 38 years. And I should begin the day by saying that today is my wife's 60th birthday. So I sort of want to share with you, Theresa Bailey, how much I love you and appreciate all your support. Any awards that we receive, I think all the value really goes to you, and we thank you very, very kindly. You are our best attribute and win on a day like today. I think that the issue of today's discussion is one of a remarkable moment in my life, a little bit of history. For all the psychiatrists, we've been a better part of right at about 30 plus years. All of us address the issue, I think, of violence with civil commitment and things of that nature. I went to Houston, finishing in 93, for going to do a forensic fellowship, and I was fortunate to do my general training to be involved in medical legal work. We actually had a, to his credit, Judge Scanlon, who actually brought the court for civil commitment to the hospital. So throughout my general residency, I would evaluate individuals and go and testify, not knowing or calling it forensics. So I kind of came into forensics, I think, arbitrarily in that setting, but really just kind of grew to love the aspect of engaging in good quality clinical work, but then using the evaluations to kind of write reports and actually testify in court or trial, including a very big case when I was a second-year resident. That led me to a forensic fellowship. I trained at Yale, so I got high-quality training. I've really been involved in forensic work in that regard throughout the better part of, since 1995, right at about 29, 30 years. But this issue of gun violence that I'll speak about today, and we're calling this, this is our lane, and I'll speak about that next, really, I think, has galvanized so much of what I've been involved in for the better part of the last eight years. And it has an interesting, I think, story. I was called by my friend, Chris is here, Chris Adams from Maryland, called by the chairman at Maryland in, Ben Coley Johnson, who's a friend of mine. We had worked in junior faculty together in Houston a decade before, and asked to give, really, their signature lecture, here's to Maryland Med School, it was called the Dana Lecture, in January of 17. So he called me about six months earlier, summer of 16, and said, would you give this lecture on gun violence? I, like most psychiatrists, have been involved in violence, and I've been in Houston, and gun violence is a huge issue, or what have you. But it really wasn't until I did a deep dive, in the six months between June of 16 and January 17, when I gave the lecture, that I really exposed myself, I think, to the true umbrage of the consideration of how much a problem this is, I think, in our society, and I think in our community. So really, since that lecture in January 17, a lot's happened. We've written, actually, two books on gun violence, one called A Physician's Prescription, really, focused on gun violence, firearm violence, came out in 2018, and then one on domestic violence that came out in 2021. And we just started, I think, our third book in this area, that we hope to come out by the end of next year. So we've been, myself and my team, just really galvanized by better trying to understand what are many of the sociological concerns and the psychological challenges that I think the gun violence problem brings into our society. I think another key moment for me that leads to today's lecture and this work was the Sandy Hook massacre about a decade ago. Many may unfortunately remember when a young man walked in and shot at an elementary school, about 20 young children. Of all the things that happened, and much happened post that event, including our president, Obama, at the time, who actually tried to push through gun violence reform legislation, and it failed, couldn't really get it through the U.S. Congress, I began to appreciate the true resistance to understanding the problem, I think, psychologically, and addressing it by appreciating the overall concerns within our society sociologically. And I think moving forward with policy change, we try to find ways to ameliorate the problem, I think, over time. One key statement that's infamous to me that came after that, some may remember it, but there's a gun lobby, we'll call it, and one of their leaders made the argument that people like ourselves, mental health professionals, psychiatrists, psychologists, social workers, and the like, really shouldn't be involved in this business. This is really more politics and political. The Second Amendment is the term that's often used, more so than medical or psychiatric. And his term was, you guys should stay in your lane. And that was a galvanizing term for me and many in this business. We kind of talk about it a lot. I think the idea, the concern that we in organized medicine and in psychiatry in particular, should address this issue full force. I think we should bring the full weight of whatever academia can bear. Empirically based research, I think speaking, I think, with loud, active, and progressive voice, and actually using, I think, other levels of influence to affect political and effective change. So the discussion for today is entitled, This Is Our Lane. And I tempered a call to action for psychiatry in addressing violence. And today we're going to limit our discussion primarily to focus on adolescent violence. So as Jonathan points out, I've been at LSU now for two years and very thankful for their support. I only have one disclosure. I'm not a pharma company, but I'm on the SAMHSA's advisory board addressing issues regarding health in that setting. And I've been on that since 2020. Am I low? Okay. Can you hear me better in the back now? Oh, I'm sorry. If I'm talking low, just let me know. So I'll start over, okay? Absolutely not. I'll talk to the mic. My children wouldn't say that I'm accused of speaking too lowly when I'm yelling at them. So it's all good. So the first picture really addresses, I think, the theme of a discussion about what is gun violence in America on May 6th, 2024. And rather, the issue of gun violence is a heterogeneous, broad-based, comprehensively oriented schematic scheme, I think, of our society. It can affect any and all of us, northern, southern, urban rule, old or younger, black, white, male, female. It can be done by any of us, northern, southern, et cetera, et cetera. At any time and any place. So if there was a consideration, I think, in our society, historically, that this was somebody else's problem, or it wasn't likely to impact me or those important to me, those days are long past. These are reasons for political activism and policy-based change that, again, I would argue must be driven by an empirical basis. And this picture just aims to show many of the considerations, some of the victims, some of the perpetrators, but really the full array of concern that a gun violence discussion brings into America today. So we're going to start off, I think, with our first basic data slide, and the argument of a discussion about adolescence certainly has been a more recent theme, I think, in my work over the course of the last couple years. As I mentioned earlier, a six-, seven-, eight-year focus, I think, on gun violence and gun reform. An ounce of disease control shows that younger and younger people, teenagers, in their second generation of life, they're not mid-age 20 yet, so they're not in their third generation of life, have firearm violence as the number one issue regarding mortality or cause of death. Most, though, would not imagine that. When we think of what draws our emotions, we think about a young child having cancer, a young child in an accident, a car wreck, or a fall, a young child in a bad scenario, in a disaster. I'm from Texas or Louisiana now, a hurricane or a tornado, but that guns and gun violence seemingly alterable or changeable circumstances of American life are the number one causation for the death of our children, many would argue is an unacceptable model or paradigm of how we experience life in America currently. We do show clearly that some groups are affected disproportionately. In my introduction, I didn't state that really the first book we wrote about a decade ago in 2013 after the ACA came out, so-called Obamacare, was on health disparities and how they're going to be addressed during the Affordable Care Act. One key issue with health disparities in this business is that African-Americans, including African-American adolescents, are adversely, disproportionately, and unfortunately prominently this maldistribution of activism, activity, and violence and victimization of violence by African-Americans in these younger and younger age groups. These are issues that I think are amenable to change under the right circumstances, part of, I think, today's discussion. We clearly note that there's a disconnect in much of American society. I find throughout much of our hemisphere, if you will, that guns are often a focus on homicide, but actually in some areas, there are twice as many firearms that lead to death of suicide than homicide. The fact that we probably don't give enough attention to this, I think, is disturbing and adverse. I can't share with you how often in my career I'm speaking to someone in my office or in public settings like this, and the discussion revolves around the fact that one should at least be knowledgeable and aware of what it is to actually have a gun. I've learned, I've worked very diligently to get past the initial umbrage that comes at me in the tsunami of the Second Amendment. I get that, and people feel fear, and I get that, and I like, but many still are surprised to hear that there's a gun in their house, whether they want to hear it or not. It's much more likely to occur, the use of that gun, to kill one of their children via suicide than to harm or protect them or kill a perpetrator or a bad actor who breaks in to rob or harm their family. This creates a disconnect. Often, the conversation at that point stops, and it's very difficult to continue what I call an economic-oriented, empirically-based discussion. We, myself included, have just got to find a way to be better about this discussion going forward. A person certainly has all their rights, and I regularly state that Second Amendment issues are what they are, and people can certainly follow them, but to not know the empirical data is remarkably adverse, I think, for those of us who live in an economically-oriented, empirically-based society. That's the world we live in as professionals. It's a bit disingenuous, I would argue, for professionals who know this data not to kind of stay at the top of a mountaintop and speak about it very loudly and very poignantly, but I think most people in America need to know this. Huge issues for us regarding the use of guns for suicide, including an adolescent population. This population is age 13, age 22. I don't show the slide here next, but I would argue that the particular group that had the highest uptick of successful suicide with guns in the last decade have been teenagers. They've been female women, so young women are much more likely to pull out a gun and hurt themselves with it and kill themselves with it than ever before in the history of our society. That's data that's sobering, but we should know it. Once you move past some of the initial data points, and many people come to these lectures and can already know a fair amount of that, the next move of discussion becomes, how did we get here? I call this part the historical narrative, because I think that, again, when I'm going through discussions or I'm doing town halls and I'm in New Orleans now, but I've done these with the National Association and the APA, for that matter, over the last decade or more, the next series of questions that comes very often, I think, in a very defensive format, I think it's our job to find ways to address this discussion, as I pointed out earlier, is the narrative. Where did this come from? Why do people have guns? What's this process? What's this strong desire for gun ownership, I think, in our country? We point out that there has been a historical perspective. Guns, illegal drugs, gangly behavior, this has a long-term history, over a century. We know it increases, of course, several decades ago by seeing more gun use by younger and younger persons. I remember vividly in medical school, medical school in Texas, finished in 1990, 30 years ago now, 34 years ago, and the discussion then was that very often the use of guns or access to guns was a male problem. It was an adult male problem. It was really an older, white male, adult white male problem, not one for young people, young people at all, male or female, let alone young women. And that's changed. I think now with the advent of the access to so many guns, more guns than people in America, probably 400 million guns, 350 million persons, more high-magazine capacity guns. The guns are all machine guns. They can all shoot, you know, like 100 years ago where one big gun could shoot, you know, one bullet a minute. It took a while to get a musket ready to go and to use it. Now they can all shoot 100 bullets in a second. It's really phenomenal. The power of gun ownership and how it implies this idea that individuals are empowered to address, I think, very often the fear that they experience. And having a gun, I think, addresses that, but then having a gun creates the opportunity to reach out, I think, in a very aggressive and very violent way very quickly. So we know that this issue corresponds to the peak of drugs and gangs during this last period. This goes back about a half century. The media has had a pretty important role to play, I think, as our society grows and develops. It also has attempted periodically throughout my career to address this issue. Here's one example of a cover, Time Magazine, discussing what we often see both in media, but I think also in politics, this idea that if we get tough on crime, we can manage this much better. I think the data challenges that and disagrees with it very strongly. I think the idea that we can arrest our way out of this problem probably is not accurate. I think it's also clear that all too often we disproportionately, if there are health disparities again, arrest individuals who are poor or lacking resources to manage the legal system, but probably at this point in our society are not that much more likely to be adverse in this circumstance because of the access problem with guns. So we say here that a focus on getting tough on crime tactics generally sounds good. Even I can't do it to disagree with it. No one wants to have their family or relatives or others at risk. I work in a building every day that you can kind of walk in. There's no metal detector at the front of a setting that we have. But the reality is we have to figure out a way to manage the problem differently that we can arrest persons after they've engaged in a violent act. After a violent act, after a murder, after a shooting, we can never get that person back. That's someone's relative, someone's friend, someone's loved one. As I showed here, these are the terms that are used. Expansion of laws. I'm in Louisiana three years now and literally three months ago I think we just passed a new law. So now younger and younger persons can be seen and tried as adults and placed into the adult prison. Angola is the biggest adult maximum security prison in Louisiana. And I think the move now is to do it when they're 16 or 17, not just 18 and over. So the idea of adult time for adult crime. As I mentioned, it's just been a failure if the idea is to protect society. So those are key issues, I think, for us to consider what we have tried to do and what may or may not have worked well. We've had data now going back 20 years. This is a bloom cells study from 2020 showing that young and younger persons were being arrested for murder. So it is a problem, it's a conundrum. I'm the first to argue, to support the argument, that many of the challenges we've engaged in are growing. I just would make the argument that there's probably not a singular easy solution, and we probably should be mindful of that. These are complex circumstances with challenging times, but that younger persons are accessing guns or weapons and using them, I think, indiscriminately in society is very clear, and it's really not an argument that one could state does not have to be addressed in some form or fashion. It's just my consideration that the excessive arrest in this setting probably has not been helpful or shown the results that we would like. Less gun access, less shootings, and less murders in this setting. I put one of these type slides in for a lecture like this, you could have several or several dozen, and the slide just really gears to remind the audience to think about the settings you've heard about. Columbine seems to be the one that gets people's attention the most. It seems to be an earlier one, certainly in my career, that began to galvanize attention by the entirety of our society to the risk in these settings. Maybe because it was a school, maybe because it was in a suburban area, or people didn't tend to think these issues were going to happen. For whatever reason, right or wrong, and I think it's wrong, many Americans tend to think that all of the gun violence happens in urban settings, it's always Chicago. I'm not sure what it is about Chicago, but Chicago is on people's mind, they always think it's always Chicago. I promise you, it's not all Chicago, in fact the reality is there are other cities, New Orleans being one of them, that has a higher per capita shooting rate, and I'll show a study that we did, that we published later on here now, and a higher per capita murder rate than Chicago. So it's really an aberration and a misunderstanding to think that we can identify certain areas. I think that tends to have a scapegoating mindset, but it really prevents us from moving toward the models we really need to move toward to address these issues in a much more proactive and progressive fashion going forward. But that's my slide, just to argue that there are many of these. Whether there's a church shooting in South Carolina, whether there's a grocery store shooting in Buffalo, whether there's a Walmart shooting in El Paso, Texas, there are just too many. Post-nightclub shooting in Orlando. So next we do see trends, and the trends I think are notable for us. One trend that I show, and that's why I don't put a lot of heading on this slide, is that you think with all of the work we're doing, all the money we're spending, all the research that we should be engaged in, that what this slide should show you is a line that's going downward. It should start on the left, up high, and go down precipitously. A lot of police, a lot of judges, a lot of courts, a lot of arrests, a lot of jail time, a lot of capital punishment, a lot of lectures at APA, but lines that over decades don't move. To me, that should be as sobering, as humbling, I would argue, many would say, as disadvantageous to a group of professionals as much. So the least we could probably argue is that we should be doing something differently than we're doing now, or these lines are likely to look exactly the same 20 years from now in 2040 as they look now, as it looked in 2020. We have much work to do with these shootings. Pretty much a similar point, elementary and secondary school work in black, and post-secondary or after high school in red. Any thoughts or comments, you don't have to hold them to the end, that you'd like to share before we move to this bit about adolescence? If not, next we'll get to this issue of weapon carrying, period, along with adolescence. Sometimes at this point, some will raise their hand and say, well, persons carry a gun because they want to have it at home. We all saw the case of the six-year-old that had the gun in Virginia, that was this past year. I often will comment that a lot of my family is from Houston, but we spend time, because we live in New Orleans, I'm at LSU now, and you see a lot on the news in New Orleans, my wife will say, and my family, man, this New Orleans is a violent place, and I'll go to Houston for a relative, for a holiday, or an activity, I go on the morning news, and it leads with how many shootings, how many violent accidents happened there as well. Again, I don't think this issue is based on geography. I can say that for me, as a forensic psychiatrist for the last, again, 30 years, there's a lot of stories, and I'll share one with you. I was working on a forensic case years ago, and a young man had been shot, but had lived, so he's in this category of persons who are post-gun violence, but it was not a mortality. He's a morbidity statistic. Again, I'll get to a study I published on that issue shortly. Of all the things we talked about in a psychological assessment, he literally stated, words out of his mouth, Doc, if I had known it was going to hurt, like physical pain, this much to get shot, I wouldn't have been involved in this game, what you want to call it, gang banging, whatever the kind of case may be. I really struggled with that comment over years, maybe practically a decade now. First and foremost, early in my career, I heard this term, this idea of the Bugs Bunny mentality, that too many young people tend to think like Bugs Bunny on Saturday morning cartoons, there's shooting, and violence, and conflict, and then Bugs Bunny comes on it again the next Saturday. Not really appreciating the true gravity of the circumstance, of the risk, and the realism of what it's like to be on the receiving end of a violent experience. I've also been struck with the idea that the concept that these issues can happen to me. There definitely seems to be almost an adolescent-like, maybe even a pre-adolescent-like, lacking full emotional and psychological development in young people who are carrying guns, accessing them out of fear, thinking they're going to be able to prevent difficulty, protect themselves, but not even considering or conceptualizing that they're bringing themselves into the zone of danger, potentially, by having a gun. Huge issues that I think are repeated to me repetitively in these type settings. So a bit about weapon carrying and practices in adolescence. So of all the slides that we show, and I've been doing this talk now for about four months, put together over the holidays for 2024, probably the one that strikes some in the audience with the most poignancy, and typically after I give this lecture, someone will walk with me and speak about it, is this slide. And it just talks about who's simply carrying guns. It points out that there are increasingly higher numbers of persons carrying guns, boys, than perhaps many of us would think or would have considered years ago when we were in grammar school or high school, the case may be, but it also points out that there's increasingly a larger number of girls carrying guns than I think any of us would have thought or considered. So we note that youth who carry guns now have two and a half times the odds of being victims of gun violence than those who don't carry guns. So do we have empirical data so we as professionals can say to our patients and their families, we can go to school-based settings and church events and town halls and health fairs and say, you should not carry a gun, you're much more likely to be a victim of gun violence than it's going to be used to protect yourself. We absolutely have data in that setting, and I think we should use it ubiquitously. And we note the numbers. We do see more black students than others reporting carrying a gun in the last 12 months, and we see the violence prevalence over the course of a year in adolescents increasing by about age 12 or 13 in boys and probably by a little late teens, I think, in girls. But this issue that both boys and girls are carrying guns, doing so much more commonly than would have thought and doing so, I think, in a variety of settings does speak to why schools have metal detectors, and some would argue that if we historically had metal detectors in airplane airports, because early in my life, maybe in the 70s or 80s, there were hijacking of planes, now we have metal detectors in schools, because you don't know who doesn't have a gun in a book bag. So the next challenge for our society will be we have to move to having metal detectors in many other public settings. Every restaurant, every mall, every library, at some point it becomes too much, and I would argue that we are already at that point. So the question we ask in one of these surveys has been, why do you carry a gun? And as you might imagine, the answers have been kind of all over the place. There have been really a multitude of responses, but key themes continue to come up, and this is the empirical basis of the discussion, I think, for an audience such as this. The definite risk factors associated with carrying a firearm, we should actually tell people this. Just like in primary care now, the fifth vital sign is pain, in addition to blood pressure and weight and temperature, where I think a fifth metaphorically question we should ask in mental health is, do you have a gun, and are you carrying a gun? There's really no one who comes to your office that you should be reluctant to ask that question of, and you should be pretty focused on getting or receiving a reasonable answer. They may tell you, a clinician who they have a trusted relationship with, more than they would tell anybody else. And you may be the one vector to get to them information that's, again, I keep saying empirically based, but helpful and beneficial, that might lead them, I think, in a much more progressive direction. So what are some of the responses? One, there's this contagion effect. I'm carrying a gun. Everybody I know is carrying a gun. Intergenerational transmission of violence, I'm carrying a gun because my uncle always carried a gun. My grandfather carried a gun, and his relative kind of carried a gun. And violent victimization related to perpetration. So I was harmed or victimized when I didn't have a gun, so I've got to have one to protect myself are key issues. Prior violence involvement. Of course, our data shows that the three groups that are most likely to be victimized by gun violence are those people, one, who've been a perpetrator of prior violence. So we're really good at society kind of taking their guns away. Those who've been a prior victim of gun violence, because they want to have a gun now for protection, and those with SUD or substance use disorders. Those really are the three big groups. And also those with an issue of childhood trauma. There's certainly something different about childhood trauma, the most common of which is neglect. But I'm really speaking much more about physical and sexual violence and exposure to such, especially in a home-based setting, a domestic setting, that puts individuals at great risk. I think I mentioned earlier, I wrote this third book, came out in 2021, on domestic violence. I'd like to say to people, as we were writing the gun violence book, which took us two years, from 16 to 18, I kept getting information about domestic violence and doing research on gun violence. So we put a few things in the gun violence book, in the manuscript, and we put something to the side to get ready to write a book on domestic violence a little bit later. When I finished writing the gun violence book in 18, I had half a book for domestic violence going forward. So there's such an overlap and a cross-fertilization of the domestication of violence in our society, I think many of us don't even really appreciate it, because so much happens within the home, so much happens to a person we should be protecting and loving and living with, and so much happens My book is actually called I.P.V., when a personal violence is an all-domestic, that all live together, but all too often involved in a close interpersonal, whether it's loving or not, and sexually based relationship. Those are the people who you should be afraid of, if they have a gun, and the groups who are most likely to be victimized as such are women, and disproportionately African-American women. So I was doing a health fair, domestic violence program in New Orleans one night, been there about three years, so I'm the kind of gun violence guy, so I get these calls, and it was a room full of professional women, and the sheer ebb and flow of the conversation was striking. First, I think people were arguing that this data just could not be accurate, it could not be that the person who's most likely to hurt you is the one who you live with, because you live with somebody who you trust, the reason you lock your door at night is you're protecting yourself from the outside bad guys. Anybody who you let inside the house is who you trust the most, so the data cannot be accurate that the person who's most likely to hurt you, would have went out with a gun, but definitely would have gone, is the one who you chose to let inside your house when the door was locked. I assure you this is what the data shows. It's also clear that many people in our society, disproportionately men, about 90%, but there can be some domestic violence perpetrated by women against men, I'm not ignoring that, for the question I'll get at the end, but the thing that's most striking to me, one of the most striking things is that many men are involved in violent actions toward others. I've been footballing my whole life, I got a bad back now to show for it, so we do some violent kind of things, but typically the most violent thing a violent man ever does, he does to the woman he lives with. Why has that man ever engaged in a violent act nearly as violent and as serious and as strenuously hostile as the one toward the person he lives with? So clearly emotions play a role here, clearly those who you love the most, you can probably hate the most, and I think that this ebb and flow of that nature of relationship puts us at a greater risk of striking out aggressively, and when there's an access to a violent weapon, it's a volatile combination. Huge issues that I think we should be very mindful of, and one reason why, if you're a person, let alone a woman, especially a black woman, you should be very conscientious about the reason why you don't want to be in a household with a gun, unless you have trust in the person you live with, but most people say they have trust in the person they live with until there's been a violent act, and my experience has been all too often the first violent act is the last one. I think that's one of the huge unfortunate dichotomies of the risk in the gun violence exchange in America today. A bit about interpersonal trauma, persons, those who, as I state, have been victimized, ones very often reach out to try to get a gun, I think it's a misplaced concept that having a gun is protective or safety-oriented. We know that prior victimization, as shown by Spears, precedes gun carrying and gun behavior. Also, with exposure to firearm violence, doubles the likelihood of perpetrating serious violence in adolescence, so this starts early. We know that the need for safety and self-protection corresponds with a stronger desire to have a gun, so I have a later slide that will show this circular adverse circumstance, and I would argue that for professionals, knowing the data is one thing, and I think it's important, finding ways to engage in conversation with your patients, and with those who you have access to and some influence over, your relatives and nieces and nephews. If you go to public settings, like you mentioned, health fairs and town halls, I'm very happy now at this age that churches invite me to health fairs, and all of my career, they would invite a psychiatrist to the health fair, now you go to a health fair and ostensibly do depression screening, but discuss these kind of issues, so I think we're making progress in our country in this setting, even in churches, but it's probably not enough, and we probably should be a bit more ardent in our approach as professionals to push to have our voice heard and for these messages, I think, to be promulgated much more effectively, I think, across the full spectrum of discussion. The pediatric field, and I see my chief of child psychiatry is in, I'll call him by name, Chuck Coleman is in the room, good to see you, Chuck Coleman, thanks for coming. I think our vice chair of education, Margaret Bishop-Byers, is in the room as well, good to see you, Margaret Bishop-Byers, thanks for coming, but the pediatric field has done quite a bit of work in this field, trying to understand issues regarding support and safety for children. This work by Hartz actually showed, three or four years ago, 2020, about 10, 11 percent of teenagers discussing a personal possession of a firearm and asking about how did they get it, and nine out of 10 said they kind of got it as a gift, so you know, a gift is an interesting term, it's the idea that somebody who likes you is giving something to you that they think you would benefit from, it's a positive thing, it's not like somebody who dislikes you, so persons are actually engaging in gun discussion and gun receipt in a positive emotional construct, and I think it's important for us to be mindful of and aware of why access has grown so much, and why it's so easy for a young person to receive a gun, and think that it's a good thing, actually, to have it. Not that they went to get trained, not that they have any safety measures, I wrote a book early in my career where we could at least get people to not keep guns under the bed, loaded, you know, a little child couldn't get it and accidentally hurt or kill themselves, keep it up high or separate the ammunition from the gun, all kind of things you can do if you're going to have a gun, and you're allowed to have one, Second Amendment, but you do it in a safe way, I think with regular prescriptions, huge issues that are relevant. Also about half perceived that they could have access to a gun, so many persons who didn't have one thought that if they wanted to get access to one, they actually could. So this becomes an ubiquitous construct in our society, access, ease of access, and why you would actually receive one emotionally in a positive setting, i.e., as a gift from pediatrics in 2020. Any thoughts or comments about those issues before I move on to some of the neurobiology? Riley, do you ask that question twice, and somebody doesn't go to the mic. But give me an hour and a half, so we're good on questions, you don't have to hold them to the end. Go ahead. I had a question about adolescents, whether they're gang members or not, and weapons selection, not even just gun selection. You know, they, you know, why does a person, or what's the meaning behind picking a handgun versus an AR-15 versus, like in the old days, a West Side Story, a knife. Is there a meaning to the selection? Well, I'll try as best we can to be as honest as I can. I cannot say I have a perfect answer. I don't know that I can quote a study on a empirical basis. But I've got an opinion, if you will. My wife has said she said, my children would say, I always have one, so to speak. But I think it's about money. I think that the issue regarding these guns is that the sheer economy of them is remarkably vastly and disproportionately out of control, anything that most of us can appreciate. Some would argue that it's a discussion that it's a $3 billion industry. The underground gun economy is a drop in a bucket. That much money actually changes hands. I'll give you an example. There was a case, and I was practicing my cases in my head this morning in the shower, but I think I'm gonna forget this one. I think this was Wisconsin. But it was like what some would call a riot. I forget the story, what occurred. But at some point, there's video of the police armored, protective people rolling down the street. There was one lone young man who was a teenager, and he had a gun walking down the street. Supposedly he was there, had come from a different state, and he was gonna defend the society. Right, and regardless of him and his reason and rationale, another whole story we can talk about in the next lecture, what I was struck by was, supposedly he was walking down the street with $12,000 worth of guns and ammunition and the like on him and he was 16 years old and had never had a job and it was like $12,000 worth of entity. Another piece I'll share is that there really is a trimodal consideration of gun ownership in our country. I said it's a lot. I need to add a slide to this, so sorry if I didn't add it. But basically there's one bump, those people who don't have a gun. I'm in that category. But you don't really know why I don't have a gun. Maybe it's against my religion, maybe I don't have any money to buy it, maybe I have some esoteric reason. But if you don't have a gun, you don't have a gun. Second is another group that has one gun. Disproportionately, those are the people who, in my estimation, meet this idea of a Second Amendment. They're the ones very often who buy one for protection, they go and get trained, they follow all the rules, keep the gun high, separate the ammunition, all those kind of things, if you will. They recognize that first you look and identify what your police are trained to do before you shoot. You have to practice through that. Many people don't practice, just grab a gun and go to shooting willy-nilly, so to speak. Then there's this third peak, and those are the people who cause us trouble. They're called gun enthusiasts. When I started this work six, seven, eight years ago, the idea was that that group averaged 12, 13 guns each. But each time there seems to be a presidential election, there's a focus and a discussion about guns, and then there's a rush to go and buy more guns. We think now that group averages 18 to 19 guns each. So there are these pockets, like I used to show a slide, and it was in Los Angeles, I used to live in Los Angeles, where the police found one person who had 1,000 guns in his garage. I mean, they counted them, 1,000. So this idea that there's this, they're all the same is not true. I think the more we drill down deeply and think through, we get a better answer coming going forward. We may have a second question. Yes, thank you. So I'd like to ask you to comment on, because you're presenting this dichotomy between female and male. Yes. How male tend to be more involved with guns. I don't know, probably now, that those 90% of guests, I wonder if they are probably too male adolescents. I don't know if that is true or not, it's one question. But I wonder how much of this plays into how we, the different roles of males and females in society. I don't know. I don't see a teenager, a female teenager, thinking they're gonna protect society with a gun in the case that you presented. I don't know, maybe because they're thinking they need to protect themselves. I don't know. But how that plays in that we assign the male the role of protector of the society. Well, fair point. I think that's an important, esoteric question for my generation of gun reform researchers. I think we should, audiences wanna know an answer to that, and we should engage in it. So I'll make my one caveat, that one reason it's difficult, not impossible, to give an optimal answer to these questions, is that since 1996, we've had this rubric, the so-called Dickey Amendment. So I wrote a lecture when I kind of talking about it, so you guys know that Dickey was the congressman in Arkansas that pushed through legislation, or new legislation, again, 20, 25 years ago, that really put a damper on the U.S. federal government supporting and paying for what I call true gun violence research. And as a psychiatrist and a researcher, that's been such a aberration for me. First and foremost, it's always tough when politicians get involved in deciding what you should do research on at all, and it's particularly difficult if individuals want there to not be research on an area that might show results that are different than what the political directions or winds are swinging. You know, we're very different than that in our profession. I love the idea of being a scientist. Our concept is that what really matters is the so-called null hypothesis. You start everything off with a blank slate, you engage in honest and clear, well-supported and delineated data acquisition, and you let the results fall where they may. Although at times, the results may be different than what you would have surmised or what you would have preferred. That being said, I think there are three things to consider. One, we may see a blending of roles between young males and young females. And in many regards, that occurs for how they clothe and how they talk and kind of how they act. We probably don't want to hear it. There's probably some truth, I think, to that. I think secondly, access matters. If there's just a lot of guns, but if you're male or female, it's just easier than it used to be to walk into your parents' bedroom or your uncle's truck or whatever the case may be and grab a gun. And third, there may also be a differential emotional engagement among people. Maybe the tint of your question, whether I'm right or wrong, may imply that we would have thought perhaps that some people, maybe some girls, young women, may have had a different emotional attachment to other human beings, less likely to want to hurt them than in the distant past. And I think, unfortunately, that may be changing what we would have realized. Clearly, if we live in a society that's hardening emotionally and psychologically of all people, that same society will be hardening emotionally and psychologically of girls as well as boys, teenagers as well as adults. All issues I think may come into play. That being said, I'm gonna give one little story before I move to the brain, but I appreciate that very, very much. I often will tell a story and I missed telling it earlier, so it's one that I hate to miss on my big day. I can't miss telling the story because it's one of the ones that really conceptualizes and galvanizes us again, this story. So to make a long story short, I'm from Beaumont, Texas. Couldn't miss saying that on my big day. And from Beaumont, you don't say you're from Houston. You say you're from Beaumont because people in Beaumont, they don't tolerate that. I'm from Beaumont, Texas and proud of it. So although I'm not a farm boy, I don't profess to have done a whole lot, but I've done everything in one time. Rode a horse, milked a cow, planted a garden, all that kind of good stuff. My grandfather had a farm, loved his farm, worked all day at the local factory, 42 years, then went to his farm at night, hardworking people from years ago. Nevertheless, so I spent a lot of time in the summers before I got big and started playing football and spent all summer playing football. When I was a little kid, I spent a lot of time in the summer going to the farm outside of Beaumont, Texas and milked a cow, picked the tomatoes, all that kind of good stuff. So one day, and normally it's just me and my grandfather out there. He's working, I'm goofing off, playing X, Y, Z. So one day, some guy rolls up in a truck and my grandfather had six acres. So when I say we're out there, it's just the two of us, just the two of us. Some guy rolls up in a truck. I don't know him, I'm off playing, do whatever you do. And he walks up to my grandfather. I'm sure I'm watching it. I'm probably 10 years old and they go to arguing and it's a big argument. At some point, I mean, if I'm 10, my grandfather would have been 60. They go to fighting. And I almost remember them going to the ground at some point, falling and kind of getting back up. It wasn't a long fight at all. It wasn't a long fight on the ground. They get up or whatever. I'm sure they exchanged some not nice words. The guy goes to his truck and he drives off. And I can remember this image, because I'm sure I came closer by then, as vividly as I'm seeing you sitting in a blue shirt. When I saw this image at age 10, it didn't nearly mean as much to me then as it does now, tell you a story 50 years later. But this guy drives off in his truck. His truck, just like my grandfather, had a big rack in the back. And he had two of the biggest guns you could have ever imagined. And I've been telling this story for a while because the reality is A, my grandfather probably ended up with a bloody nose or something, but he didn't die that day. And not only did the guy drive off with a big gun, my grandfather didn't run to his truck and get his gun and shoot at the guys who drove off. And I would guess to each of you today, again, May of 24, that at no point did either one of them think about getting a gun and shooting the other one. 50 years ago, when you settled an argument, that was a fierce argument, led to a fight, rolling on the ground, 50 years old or whatever, get up and drive off. So to her question, I think it's a very temperate but important one, the fact that I think our minds, our thought processes, what matters to us of relative importance has changed, is striking to me. I'm not sure I have a better example of the one of my grandfather. You may have some examples on your own, but many would argue that in the old days we settled a conflict with a fist or a punch or a bad word. Now people very quickly go to a gun. Many people, males and females, adults and adolescents, have a gun to go to, and the guns are much more powerful. I didn't say it earlier, but one of the struggles we have now is that most people are not good shooters. I got a son in the military, he talks a lot about practicing and marksmanship. And I think that the gun owners have appreciated that. So if you want to be effective with a gun, if you want to hit somebody, but don't kill them, you have to shoot many bullets. Few people shoot one bullet and hit the target. In fact, we have data that shows that in one police cohort, policemen who, many were in the military, and many of whom train regularly, once a month they go to shooting range, only hit about 80%, four out of five targets that are stationary at 50 feet. The same policemen in that particular study only hit about 40%, two out of five moving targets at 50%. So imagine people who've never been in the military, never learned to shoot a weapon, don't train regularly, and the target is moving and running and is more than 50 feet away. So most people can't hit a target at all with one shot or two or three. But if you shoot 40 or 50 or 200 bullets towards somebody, you're going to hit them. And we also recognize that all too often you don't kill somebody if you hit them one time, but if you hit them multiple times. So you shoot them 200 bullets and you see it when the police come on in the morning and they say there was a shooting last night, they always have all these little things on the ground, how many bullets were shot. So that's really the unfortunate activity process that leads to the violence and results of mortality or death in our society. There's too many guns, too easy to access, a thinking related change of how you resolve conflict, to your point, I think a growth in a number of people, males and females, adults and adolescents, and I'll get to adolescents next, who will grab a gun and the number of, quantitatively, of bullets that are shot. It's a volatile, adverse, and frightening proposition in that setting when you put all those variables together. Dr. Bailey, I just want you to comment. Thank you for saying that. One of the things that I talk a lot about is the three A's, apathy, anger, and anxiety. Those are the three things that have really come out of this pandemic that we've seen a surge in. But you said something, and I just want you to comment it again, that really hit home for me, that we should be more afraid of the people that we live with than the people who live outside of our home. That struck a nerve in me. Well, what I would say is that I don't want you all to go home and be afraid of your spouse, I hope. I'm just saying. I got a wife right there, boy, I tell you, it's the good news. That struck a nerve. But I think Jonathan is right. We laugh and we laugh because I think it does break the energy level, but it's unfortunately true, and you guys all know it. By the time a woman dies in a domestic violence conflict, the man that shoots her yelled at her before he shot her, cursed her before he shot her, slapped her before he shot her, punched her before he shot her, and threw something at her before he shot her, and all that was tolerated, thinking that he loved that person, and then they keep escalating, and then there's what I call terminal violence, when a person has to do something to kind of end that progression of violence. So Jonathan is 100% right. The reality is we as professionals should be telling our students and trainees and our educational processes, friends and family and members of society, as Maya Angelou says famously, everybody's heard it 100 times, when somebody shows you who they are, you gotta believe them. And I think she was right about that. And all too often, the difficulty is it's hard to change, and there's fiscal issues, and where are you gonna go? We've had, I think, unfortunately, a deleterious undermining of the public health system, so is there a CPS, or are there public services? One of my fears often is will your family take you in if you actually move from a setting, or will they make comments that I think undermine the concept that if a person comes to you and asks for help, you should hear them, and I think you should listen to them. I think it's a remarkably timely point. So thank you very much for that question as well. Adolescent violence. So as we've been working in New Orleans to try to figure out a better way to do something of utility value, and there's no doubt I went to New Orleans three years ago, thought that this was really my issue, and there was some discussion about, there was some research in this area, we started looking at issues regarding adolescents, and why there's so much adolescent violence in New Orleans, kind of how this process started. So I took 45 minutes to get to the good part, kind of the nature of what we do. So let's talk a little bit about the developing brain, and we did some work with neurology, actually I started some of this work when I was at Wake Forest, with playing football and helmets and the whole bit, but it's key that child adolescence is a very sensitive time period, the brain is changing, there's biological changes and others, structural changes and functional changes, but I'm really focused on this term adaptive plasticity, the second bullet. It interacts with your experience, provides both risk and opportunity. I think late in my career, I came into an understanding of this term epigenetics, and we all love to give credit to our mentors and what have you, and people in this audience would very know when I say this, there's a guy named Carl Bale, Carl Bale's in heaven now, Carl Bale, he's talked about this quite a bit, from heaven, I'm giving credit publicly and the like, but he talked a lot about epigenetics, the idea that there's a genetic underpinning that you're kind of born with, but really it's not a one way street, a one way road, it's a series of forks in the road, and sociologically, what we put in the people determines which direction or which pathway they tend to go down. So we absolutely, and I'll say again, if you hear a lot of things today, I hope you will, but I want you to hear this, we absolutely have a role to play, and I think we as professionals can be instrumental, impactful, and relevant in the lives of our kids and adolescents by engaging in activity that increases the likelihood that when those forks in the road occur, they, brain function wise, move in one direction and kind of not the other. We know many of the stressors that cause problems, from maltreatment and neglect, trauma exposure, this can accelerate puberty, can alter maturity, elevated clinical depression, psychosomatic, physical symptoms, low performance academically, SUD, delinquency, risky behavior. So the two theme, thematic considerations that I think neurology talks about a lot, and I guess I'm grateful to my neurology colleagues for kind of turning me on to this, is this issue of sensation seeking and a lot about impulsivity. I spent a lot of time early in my career on the second one, so I'll start with the first one. So sensation seeking, this idea that good, fun things happen. We had a party last night that the people through, and Southern Psychiatry was there, we enjoyed it, lively, engaging, or whatever. The concept would be that at age 60, I enjoyed it in one way that a 16-year-old would have enjoyed it differently. Same party, same people, same alcohol, same food, same location. The brain engages in a sensation seeking activity differently than that same brain will post age 25 in most individuals. I'd argue later than that, if your brain matures slower and maturity is delayed. We saw this heightened attraction to novelty is key. Oh, I got a new gun. It was a gift. But we also note that this probably peaks at, what is it, 19 for males and younger for females. The impulsivity piece was not hard for me to understand. Did some work early in my career with child. Very happy to say my cousin and I published a paper on ADHD. I'm not a child psychiatrist. She is, but I'll get her on the mic here. Dionne was my cousin out of Tulsa, Oklahoma. She's a child psychiatrist, and we're working on ADHD. This was 20 years ago now. And one thing I kind of came out of that with was how teenagers have so much trouble driving vehicles and it's not their fault, it's kind of how their brain works. I was so impacted by this that I wouldn't let my children drive at age 16. And I've been telling this story for a long time, those of you who know me know this is one of my favorite stories, but the data shows that for all, if you balance all of the variables, driving at night and alcohol or not even alcohol, or other people in the car, all bad things, plus being age 17 versus age 16, you decrease your risk of dying driving a vehicle threefold. So simply giving that brain one more year to mature helps you manage the impulsive actions that you're likely inclined to engage in at an earlier and earlier age. So neurobiologically, the terms we use are reward sensitivity and cognitive control. Psychologically, which is our domain at Sykes, the sensation-seeking and ability to self-regulate or modify your behavior. We all know the story. If somebody's a teen and there's a conflict and somebody punches them, you punch them back or somebody says something mean, you say something mean back or whatever. And the exact same impulse happens to all of us when we're 30 years old or 40, but when your boss says or does something to you, hopefully they don't punch you, you don't respond back quickly, but before you can say something back to them, you think about paying the rent. And that paying the rent makes you not do so because you've got babies to feed and diapers to buy and a cartoon to make, although that same insult hurts you at the same level. So we spend time by trying to manage young people. I've told my one son, who's age 27, almost 28 now, that if I could just get him to 30, he would jump into the adult group. He's more likely to die. For all of this stuff happening, age 29 or younger, if you can get a young man to 30, his likelihood of not dying for impulsivity and accidents and these violent issues decreases substantially. So we try to put a cocoon of support around people, and we do. We put them in private school, we have them on Saturday go to Sunday school and church for a long time, and we try to make sure we manage who their friends are. One challenge in America now is that all too often your child's friend is somebody who you don't control. Your child's best friend, personal information, is a cell phone, and they're getting access to more information that you don't really know or control. These are many of the variables that I think adverse affect parental control over these very issues. But all of this leads to this idea of a behavioral construct, which imparts decision-making and can lead to more risk-taking. So the impulsivity piece is key, and it can certainly increase the adolescence, but both issues, sensation-seeking and impulsivity, are highly correlated with teenage risk-taking behaviors. These are the kinds of variables we should consider as professionals when we talk in adolescence, talking to their parents and their friends who manage their behavioral control, speaking to other entities that could actually influence them. It goes without saying, it's hard to have this lecture and not on this slide discuss football. As I mentioned before, I played football, and my daddy was a coach, and my back hurts and all that kind of business or whatever. But football is, as in Beaumont, Texas, probably much of our country, or sports in general, are as indicative of this process as most. First and foremost, there's somebody saying to you, stop, too much of that, and you get a penalty, and you're off the team, and you can't start. I mean, there's a lot of rules and a lot of lines you cannot cross. It also implies that somebody's in charge. You're going to call that person the coach or the team, and football even implies that one of the players near you has peer control. He's called the captain, he or she, and the captain can punish you or make you run extra laps, all kinds of things. There's a lot of layers of externalized control of young people in this type of setting that I would argue for many young people who use guns excessively, use them indiscriminately, those additional external controls don't exist or don't exist substantially enough until there's a big problem, and you go to jail. And then at some point, somebody's taking your freedoms away before we engage in actions that can limit those difficulties. This then leads to this idea of adolescent brain development, and you have these social emotional systems and cognitive control systems. So the concept is that we respond differently to reward and motivation. This develops early in combination with dopamine, you get surgery with dopamine, this idea of cessation seeking. Cognitive control, though, allows us to regulate these emotions, thoughts, behaviors, and this develops gradually over time. So things that parents do and people in leadership over a young adolescent is we give them graduated incremental responsibility. You can do small things at a point in time. You have to wash the dishes. You've got to cut the grass. You've got to clean your room. And what we should do is when they don't do those things, take something away, and it's something that matters to them, and this is the whole giving back and forth in parental settings. Whether it's football, coaching, whether it's parents at home, these are the actions that lead you down, when they're forking over, I talked about earlier, one pathway that manages this construct versus the other, and I would argue helps you learn as a teenager to do it yourself. What we regularly see with young persons in jail or prison is they've not learned on their own to not break the rules, not encapsulate it within themselves internally, that if I engage in this behavior, there will be a negative consequence. Those are huge issues for us, and this is, I think, what leads to this whole process that leads toward decision-making, there at the bottom of the slide. I think at the bottom right also points out, a lot of this kind of comes from executive function. We call it the prefrontal cortex, the part of the brain right behind the forehead. We're all accustomed to the typical administrative strategies, concentration and memory and attention and decision-making, but also attention and attention span, but it also addresses, I think, decision-making, and it's monumentally important in adolescence. Traumatic stress. One variable that worsens this process is an ongoing, stressful initial exposure. Heightened stress levels, we note, can increase the risky decision-making. Maybe you just kind of want to do it and kind of get it over with. You see more of that in adolescence. We also see an overacting of the social-emotional system, and then a decreasing of the cognitive control system. Too much of the good, desire for it, I'll take more risk, I really want it, I really, really want it, I really, really, really, really want it, and not enough of this internal self-control to say, stop. You don't kind of hear that little voice of your grandmother getting ready to get a, what they used to call in the old days, a switch. My grandmother, she was a little bitty lady, but I was terrified of her and that switch. People laugh about it, and it's true, but the reality is that switch stays with me today. You think about it. Now, my grandmother's in heaven now, and there's really no actual switch, but I would no more walk out of this place and bump into a little lady on the sidewalk and knock her down and keep going than I would have jumped off a bridge. It just would not happen, and I think that those are the kind of things that we see in our young people over time, not just me, so if you were doing these things, that's actually very good. The challenge is when somebody comes into your office for 30 minutes or 45 minutes once a month, how can you work to manage a process like this, I think, in your patients? These I think are the key issues for us, for me, as we move forward in community psychiatry, so this decrease in cognitive control limits one's ability to overcome that automatic response or reflex, you threaten me or you insult me, I'm going to punch your back, you step on my foot in a club, I'm going to shoot you, so to speak, in which teens then are more very vulnerable to these threatening kind of actions. This is pretty, this algorithm is actually pretty involved. I'd share that what's key, that there are a multitude of new variables in this process, which makes it kind of challenging. Why I think, although I hear criticized politicians, but why I think that the over-the-reductionistic approach of having an easy, simple answer, just lock them up and throw the key away, probably really doesn't work, and why it hadn't worked for the last 20 years, why it may not work for the next 20. Is there a question? Please, come forward. I'm a child psychiatrist from Pittsburgh, and I always call myself a lover of children. I have lots of young men of all races who, I could sit here all day and tell you a lot of interesting vignettes that illustrates all you said about sensation-seeking and impulsivity. One of the things, I also like to read a lot of sociological, anthropological stuff. In all societies, young people in their early teens, whether they're recognized as teenagers or not, have these qualities you talked about. Some sociological and anthropological studies show that the societies that do the best with people in their early teens are the ones that have programs for teens. I'm not an advocate. I'm not a big switch and beat kid. Rather, I like the idea of rights of passage programs. I read a wonderful book some years ago by a Maasai tribesman who was trying to capture his culture before it gets totally devastated by Western society. He described how when young men get around 12 or so, they take them out a mile from the village. This is obviously, they didn't have cars. They tell them they're going to have them be protectors of the village. All the adults know that what they're really doing is getting them out of everybody's hair because everybody knows that when young men start going into puberty, they cause a lot of trouble. They take them out, and they teach them how to hunt, and they have these older men. It's sort of like a little boot camp-ish. They teach them all these skills and hunting and tracking, and they only bring them back for holidays when everybody celebrates our valiant warriors. Everybody knows that this is a program to contain these natural behaviors of these young men. Some studies have shown that societies that did that had much less, because it's that young teenage that has a disproportionate amount of violence and disruption in society. Those societies do a better job of managing, and they're not beating the kids, but they give the kids some real structure, teach them some real skills, satisfy their sensation seeking by having them do these really go out and hunt the lion and the tiger, climb the mountain, and all that kind of stuff. Is there a way we can convince our society to capture some of that and have some more and put monies in those type ... What can we as psychiatrists do to make the point that that's a much better way to handle some of the innate qualities of teenagers rather than just lock them up and throw them away? Timely, timely. Let me try to take three or four of those points all in due course. First and foremost, let me just share. Could you make a very good point? I make the joke about my grandmother and the switch. My grandmother did hit me with a switch. I'm not going to say she did not, but she probably only hit me one time. I think the real power of that issue is a person remembering right from wrong. I think you make a very good point. I didn't mean to imply that there's brutality against children. You're 100% right. Parents and no one really should do that. I do think that there's got to be a way to get them back on the right tracks. You're right about that. You actually bring up another point. Like most of us, I'm a father. My boy is 28. I've tried to be a good father X, Y, Z. We did a rite of passage. Goes without saying, I'm in a fraternity. I love my fraternity. All that kind of good stuff. Give them kind of credit for it. We did two Sundays a month for six months when he was 16, four hours each time. I was struck by, as much time as I'd done in things with X, Y, Z, how much learning he grew from in this rite of passage program. I think one, it was peer-related. There were adult men saying a bunch of stuff, then a lot of young 16-year-old boys talking about it amongst their own. I think that really does drive positive, proactive behavior. I think you're right. I think it's also true that we have to show love for people and for kids. If you're there on a Sunday afternoon when you could be doing something else, I think kids realize that. I think they appreciate it much quicker than we may recognize when adults have their best interests at heart, whether they're a biological father or not, or it's some other kind of setting. I love your point. I do think that structured programming also matters. It should be structured. That's why I think people should probably cut the TV off and try to cut the phone off. I like ideas that you leave the phone at the door, so to speak, and you're in the moment. I think all too often our younger people probably don't get enough of that. We make jokes about it, but this idea that ... I guess the concept in our current generation is you're driving a car and there's two kids in the back seat, yours and the one you picked up to take them to the movie, and they're texting back and forth to each other. We kind of laugh about it, but we've lost some social skills in that, and I think some of those social skills are important. I think they kind of help you decrease risk, and they help you kind of talk down a bad circumstance. I mentioned Beaumont, Texas a lot, but in Beaumont, Texas, one thing you learn is how to decrease a fight with humor. You learn to say a little something, and the best humor is self-directed or self-deprecating. Something about myself makes that person not want to punch me in the nose anymore while I stepped on his foot. I think that that is an example of the kind of thing I think you learn in those settings and the kind of things I think we miss a lot in a different day and age. I clearly think, though, that structured programming on more proactive things matter. I'll give it back to my son. When we did the one with my son, I mean, they learned to tie a bow tie one Sunday. Some guy was there to teach them, and although I tie a tie every day, and I've done that for 30 years, I couldn't tie a bow tie. I probably still can't. My son is still laughing about it. So that day, he saw, and all the other ones saw their fathers do it X, Y, Z, whether you're tying a bow tie or trying to repair or we have to change oil on a car one day, some very pragmatic, basic things that you do. I think many people, I'll say many young men, I should have said earlier, a disproportionate many young black men need these kind of proactive activities. I think your point is right on time, and I appreciate it. On this slide, I just kind of point out this progression from pre-trauma factors, genetics, and I mentioned the whole part about epigenetics, to the actual trauma, and we try to modify the trauma early on, so the earlier you get to somebody when there's trauma, the better. I have two of my faculty, at least two in an audience today, so they both will know We brag a lot at LSU about this new contract we have with the city, where individuals are supposed to have trauma recovery. So in New Orleans, if there's a traumatic event, a lot of times it's gun violence, it doesn't have to be, it could be a car wreck or whatever, and the whole family rushes to the emergency room, and everybody's all excited, and the person has been violated, and violently, whatever the case may be, and the surgeons run in, and the anesthesia, and the nursing staff, and whatever, while our people run to the waiting room to see the nine-year-old who saw his uncle, or cousin, or father, you know, violently adverse affected. They're often with gun violence. We think the earlier that intervention, i.e. trauma recovery, the modified, the height of anger and hostility that comes out, and we can talk early about what we should engage in to decrease the concept that you think that your only action is to be violent toward that person in a retribution-type format, and you want to do that by getting your own gun and being ready to respond much more hostily to them than they responded to the person that they hurt in the first place. Huge issues in how we manage the acute trauma. And there's biology. Some people have a heightened cortisol response to stress and anxiety. There's the immune response. Everything in society now, in medicine, is about inflammation. Sleep, somebody encouraged me about how it is to sleep at our age. And then there's functional domains. I talked today about emotional regulation, reward processing, and it's actually about decision-making, which was, I think, my take-home message. So this entire concept from adolescent neurodevelopment at the top to stress-induced circuit remodeling is key. We think the brain is changing structurally in its anatomy and functionally as these teenagers are growing, and brains are changing in ways that make them more likely on their 20th birthday to respond to you violently than otherwise. I'll tell you a story. So I've been in New Orleans for three years, part of a big clinical practice. I'm a chairman, a lot of administrative meetings, et cetera. But it's also hard to be, I'll be blunt, a black psychiatrist and move to town, and you can't see any new patients. It just makes no sense. So I keep my Mondays free, and any doctor in town can call me on Friday or Saturday, happens a lot, and I'll see their patients on Monday. Now, I don't do any follow-ups, but I do all new visits on Mondays. So there's one guy in town, a good friend of mine, he may be on the camera here today. He's a cardiologist, been there 40 years. He's probably seen somebody, seems like almost every Monday, been there a long time and knows everybody in town. So one Saturday, he calls, said, Bailey, you got to see this family on Monday. Their son was shot. He probably calls me on Sunday, maybe they shot him on Saturday. I see them, and from the moment they walk in until they leave, the mother, the man shot was 41 years of age, a schoolteacher, no record, no criminal activity, that kind of business, and the mother's probably 67 years old. She cries the whole time. Her husband comes with her, worked at a post office, good state of the art, Americans and the like. He tells a story that their son, their only child, was a schoolteacher, blah, blah, nothing, didn't know the person, the whole nine yards, driving home from school one day, stops at the local 7-Eleven to get ice cream or candy or gas, what have you. There's some inconsequential discussion, debate, I don't think it was an argument, inside while they're standing in line to buy what they're going to get, and they walk outside, and the young 16-year-old walks up and increases the conflict with him, and maybe the wrong thing he said, the 16-year-old has a gun on him and shoots him. They're on the spot, broad daylight, 4 or 5 o'clock in the afternoon. We talk quite a bit then about how they engage and respond. The 65, 70-year-old father, postal worker, retarded, case-lawyer-like, whatever, even at his age, thought about responding with retribution-related violence. Other relatives, other younger African-American men, teenagers or young men, 20 and 30 as well, who wanted to get back at this other family, what had happened to theirs, and you can see how the cycle just precipitates. Hopefully, we create an intervention that day that at least helped them, as psychiatrists are engaged in, of Jonathan's points about managing the anxiety, manage theirs somewhat, and hopefully decrease any risk of ongoing violence. But this is a continuum. It's a key issue, I think, for people to be mindful of. And others are also involved, in addition to the people who might, the adolescent, who may do the shooting. I'll spend a brief time on the issue of post-traumatic stress disorder, just points out that it's kind of an in-range diagnosis of this discussion. The big issue here is just that you have these lines that are crossing, because the actual is physiological change in structure of the brain, decreased hippocampal volume, but also increased amygdala reactivity, the so-called threat promotion. So as these changes occur, there is organic physiological change, and our persons think and respond to the stressors, which are problematic. Overall, what you see is an increase in so-called threat reactivity. Also, abnormal frontal limbic development increases such, and weakens your emotional regulation. And here, pretty much, are the symptoms of PTSD. And this group will be very much mindful of that. We try to do ACEs, I think, on our people, the assertive adverse child's life experiences. I think a very valuable tool, instrument, I think, in this business, one to really get an idea earlier on, more formally, what some of the risks may be. And clearly, what we tend to see is more risk, and more risk-related behavior in persons who have been violated and traumatized emotionally earlier in their lives. I mentioned earlier that the number one form of child maltreatment is neglect, as much as direct physical abuse or sexual abuse. These rates just show that some children are more at risk than others. The point that I often make when I show this slide, I'll do some reading about it, I didn't put it on the slide, but I've read that less than 5% of the teachers in schools across America make more than 85% of the referrals to CPS. I'll repeat that. Less than 1 in 20 of all teachers are the high referral individuals who are referring 4 out of 5, or almost 9 out of 10, of black children to CPS, or Child Protective Services. So the reality is, although sometimes that may be beneficial, it's hard to know with general data like that. Somebody may be in a particularly adverse circumstance, and they're doing the best they can, but it could also be that there's some over-referrals, and once children are referred excessively, they are taken out of the regular system, regular schools, mainstream, with other kids who are acting normally, and in a setting where there's a lot more adverse behavior, bad behavior, high risk-taking behavior. We have to be also mindful, it's a very complex circumstance with that issue as well, we're much more likely to get better outcomes from children and adolescents if they're mainstreamed in settings where there's good peer support, and other people their own age are acting and engaging in behavior that's normative for their level of maturation and development. Otherwise, the maltreatment may lead to a heightened risk. I kind of make this point that complex trauma also matters. It's not just one bad event. It's quantitatively over time, it's qualitatively too severe, it's repeated. I talk a lot about repetitive messaging to my staff, I regularly say we've got to get our points out and make those points consistently, repetitively, and argumentatively. Repeated victimization with multiple traumatic events over the course of a lifespan is all-encompassing, and can be remarkably difficult to overcome, period, let alone for a young person. We know that multiple exposures can be a difficulty with emotional dysregulation, overall mental illness comorbidities, a lot of ADHD diagnosis, a chronic disorder diagnosis, some of the most co-occurring psychiatric diagnosis in all of medicine, and I think it can lead to the big issues of impulsivity, SUD, and attachment issues. I end by saying it represents complex outcomes which can intensify symptoms and increase maladaptive coping. We need young people to develop adaptive, effective coping strategies. If they don't do so, these are problems they will have a hard time getting through. I think I'm going to finish up, and I have five minutes. We took a few questions earlier, so there's been a lot. I thank you for the extra time, but it shows we go a little long here. In the last two minutes, I'll simply say, community violence exposure has direct effects on adolescent brain. I spent a lot of time on that, so I won't go into all the details, but I just want to point out that there's actual physical and emotional change in the brain, not just an individual exposure to you as an adolescent, but overall in the community. It's very difficult to live in the community. If you come outside at night, you hear, let's just say a gun shot, violent sounds, or if you come outside and there's blood on the sidewalk because of a violent act that evening, these issues have an adverse impact, we'd argue, on children. An overall violence exposure rate is higher in some groups. I showed the data earlier, minoritized groups specifically. And the big one here, the issue is that it can be one of the two times greater, the disadvantage that those persons experience, I think, in this overall type setting. I think the first bullet, over 100% higher in African American youth than in Caucasian youth with violence exposure. This leads to the resolving cycle. We will argue violence, and the cycle of violence actually shows in some groups, child trauma is 31 times greater on the second bullet in some groups than in others. So we can have two Americas based on politics and two Americas based on economics. We can have two Americas based on how we're exposing, let alone raising our children, and heightened exposures, this level of unrequited violence is argumentatively, I think, a key theme for our day. And this is a number of children who are likely to be exposed, I think, over time, I think, as our society grows and develops. The final bullet is exposure to firearm violence doubles the likelihood of perpetrating serious violence as an adult. And here's my cycle. Gun violence, you justify it because you've seen something bad happen, you engage in it, and because of those effects, you're fearful, and you've got to respond, I think, aggressively, yourself as well, going forward. And I'll really end with just community trauma. It's just pictures showing the difficulty that families and communities have in these settings. A lot of it we focus on what I'll call a mass shooting, and there's 30 or 40 people involved in a school or a mall or whatever, but we define mass shootings by the FDA as four or more. And the reality is we see that all too often, where a person goes in and shoots themselves and shoots their family. A few communities have not had that experience, I think, over time, and all issues on the left, I think, also play a role. We note lack of social capital, lack of economic opportunities, lack of education, all issues that create this risk. I think I'll write community trauma is defined as systematic, social injustices repetitively through structural violence, preventing people and communities from really meeting basic needs. Similar issues here. You've got your social cultural environment, your physical environment, the buildings you're in, you don't want lead paint, if you will, education, economic entitlements, and all these issues kind of overlap, and you see the concentric circles in that type setting. So I'll probably go ahead and end with, I think, our work, and we published this early on when I got to New Orleans in 21, and we pretty much showed that the number of gun shootings in New Orleans was about the highest in the country. I think it was 37% higher post, this was post-COVID or post the disaster. The mortality, though, was only about 2 or 3%. So more shootings, because more people actually have guns, they're probably missing a lot, but you have a lot of individuals who have been shot or who know someone who's been shot. I think that's a paradigm or model that's changing what we feel about structure and function and safety in an organized society, and we do some more work, I think, in that regard going forward. I had some stuff on COVID, we kind of post-COVID now, but about half of the children in this cohort increased the risk, I think, of gun violence after COVID. There was more violence, more domestic violence, post the COVID pandemic, and it shows, I think, in black children, about four and a half times more likely of gun violence post the pandemic as compared to before it. And I'm in with my last recommendations, and my last slide just simply shows the reality of things we should be engaged in, but most of them revolve around, and we've discussed this a lot, I think, during the discussion, so I'll be very brief. I think we've got to understand, I think, our political dynamic of our children and our society. I liked the question a little earlier. We've kind of got to love our children, males and females. We've got to understand that adolescents are not just little adults, they're different in so many ways. How their brain grows and develops, I think, is important. And they have to have both a lot of early interventions, fewer, but more specific, targeted interventions for that individual, if you will, and I think that should happen particularly right after the event. I mentioned, I think, our grant that we talked about earlier. The primary things very often are broad-based, educationally oriented. I think persons should at least be talking about what their experiences are. I think we do a valuable role as psychiatrists and psychologists and case workers, giving somebody an opportunity, active voice, to discuss those items, and we should move toward more targeted, more specific interventions for that individual. It always has hurt my heart that, as you see our work in forensic medicine, I'm a forensic psychiatrist, a wealth of resources, money, comes into play, private and public, once you hurt somebody. You go to jail, and lawyers, and judges, and cases, and courts, and XYZ. If a fraction of those monies are made available for clinical interventional strategies early on for prevention, I will believe, and I think the data backs me up, we do a much better job having the result we really want, which is a lot less violence, period, than our society. There are some politics here. Some places, like Louisiana, where I'm now, there's some laws now that may work against us in this regard. I mentioned some of that piece earlier, but these open carry laws I speak against, as you might imagine. I think more guns, more open carry, more gun violence, and that includes adolescence, and that's going to determine, I think, more overall firearm deaths. This is probably the best data. In the 10 years of the Clinton policy, that was for gun reform, we did see a decrease in gun shootings. So we do have empirical data that gun reform does work here in America. This is 94-04, and once, after 10 years, there was a lot of collapse, and now we're kind of open seasons again, which I, as you might imagine, I don't think the empirical data argues against. So I end by saying we should change the narrative. Firearm violence is not the result of mental illness. All too often, it's a disparate, key, but relevant type issue, but it's not that we should simply point fingers at and blame those who've been identified as having mental illness or depression. Individuals with mental illness are more likely to be victims than perpetrators of violence in the setting. That includes adolescence, and in most cases, it's a symptom of a variety of variables and factors that I think we, as professionals, can have a lot to do with. So in summary, I think that I thank you guys for your time. A lot to discuss in this. I kind of laugh when I give it, because we've been about a decade at this. This is pretty much what I've done, and we hope that we can find ways to move the needle, increase, I think, the likelihood that we have a safer society, and help, I think, professionals find very information-oriented, empirically-based strategies that they feel confident in, and share with their patients and their families going forward. These are strategies that are needed. This, I think, is the issue of our time. I think that, as we titled this today, I think this is our lane, and we should be effective in it. Thank you. Thank you, Dr. Ron Bailey. Just before we close, I just want to emphasize, for those who would like to ask questions, please stay and remain, but if you'd like to nominate someone for next year's Solomon Fuller Carter Lecture Award, the nominations are due on August 15th. August 15th is the due date, August 15th of 2024. Make sure you go to the APA website, look up Solomon Fuller Carter Lecture Award, and we'll gladly accept those nominations. Thank you. Yeah, thanks so much. I know we're over. If I need to leave, please feel free. If anybody wants to stay and ask questions, I'd love to hear them. A lot of work in this space. Mike, you're up. Dr. Bailey, just an excellent presentation. You get better and better in time. I just want to add one thing that you said. I'm from Michigan, the open carry state. I don't ask if there are guns, and I ask how many guns are in the world. How many guns? Right. Okay, because everyone has them at this time. Right. I'd also like you to comment. We really can consider Canada our really extended cousins. So, same television program, Canada has about the fourth highest gun rate in the world, of course, beyond the U.S. You don't see the same rates in Canada. Any comments about that in different countries? I think that's a great point. I clearly think that there's a combination of multiple factors. There's some variables here that I think are adverse. I like questions like that because it really does put on its head some of the considerations that I know even I had earlier. I thought I'd grow up in the south. I grew up in Beaumont, Texas, and been in these areas. And I was fortunate enough to see in North Carolina that in the south, a lot more rural areas, everybody kind of had a gun. But you're right, I think we're seeing rural areas with long guns, urban areas with, you know, high magazine capacity pistols everywhere. So, clearly, it's not simply an issue, I think, of geography. I clearly think that culture is changing or has changed right in front of us. Much more high risk. I think many of the internal controls that historically would have blocked somebody from taking you to the end result, again, you could punch a guy in the nose, but you weren't shooting. I think much of that has been ameliorated, unfortunately. And also, often, persons think that they have to take you to the end of the road because if they don't kill you, you're going to kill them. I mean, when I hear these discussions by teenagers, it's really striking. I share, I don't show a lot of stories today, but I do a media piece once a month. It's a podcast, basically, for my fraternity. And I always do a mental health piece. And of late, we've been doing this for about three years now. And of late, we've had, we keep trying to get young people on, young guys who are college graduates. They pledge the fraternity, and now they're young men, some go into med school, whatever, and talk about what it's like to be a young man in America, in our fraternities in general. And I'm often flabbergasted at what they'll say, the high risk that they have. These are college degreed, educated with middle class lifestyle persons, and these are also individuals, I think, all too often who have, you know, appreciated and heard these kind of messages before, you know, with families that need some support. So it's a much bigger issue, I think, than even I would have appreciated. Generally, I've been at this for six, seven years now, and it's been striking. That's, I think, how poignant the influence is on having a gun and using a gun, and it's part of your daily construct, your daily life. You don't think about it external to who you are or where you are. You always know where your gun is and how you're going to access it. That's been a problem. I think that's one of the reasons, Mike, of finding ways to get people to think differently. I think people come to see you. You're smarter than me if you're asking how many guns, but I think trying to figure out a way to get a person to think that the data shows that having a gun, as I said earlier, you're more likely to put somebody in your house to use it against themself, suicide, or if they're all going to use it against somebody else, it's going to be against one of your family members. It's going to be at the family reunion when Uncle Joe and Cousin Pete get mad. They have a little beer in them, and they're mad about something that happened 30 years ago, and they go to argue about it, that's what really happens in America with these guns, and that's why I think our gun violence rates and mortality rates are, they call, higher. We have a lot of work to do. Question? Yes, and about that, what you're saying, I mean, the common factor here is the gun, right? And we've known now for a long time what you're saying, that it's more likely that a gun will cause harm to those in the house than to be able to defend themselves, right? But that is not the message that is out there, and we hear from time to time, I mean, not too long ago, I read a story in the newspaper about this old lady who was, you know, somebody broke into her house, and she managed to get a gun and, you know, shoot the intruder, and that is all over the news, right? All over the news, right. About this old lady. And that is the narrative, right, and reinforce that narrative. But we don't see the other side. It's not on the news. Right. Very unlikely. So how do we change that? Right. Well, what I'd encourage you to do, I sort of try to do it myself. I'd encourage all of you to be proactive with media. Some like this, some don't. You have to decide what you're interested in. I hope there is a chance to engage in media, especially what I call long-me. When I'm on radio, I've got 45 minutes to an hour to go back and forth with a guy. When you're on television, you've got four minutes, and it's kind of stilted. I think we should share that. I think you're 100 percent right. There are probably nine times as many settings where somebody breaks in, grabs the old lady, beats the crap out of her, takes her own gun and shoots her with her, than any number of times. Maybe it's 99 times out of 100, not 9 out of 10, where you break in and the old lady gets to the gun. Because the reality is, just to kind of break this down the way I understand it, somebody breaks in your house, they're wide awake, their adrenaline is flowing, they're ready to go. You are asleep. You're in a parasympathetic. You're not really thinking. Sometimes I wake up and I'm trying to remember which direction do you go to the bathroom or whatever. So you're not waking up ready to go in the violent combat. Next, you've got to remember where you left the gun, because most folks don't look at their gun every day. The last time they actually looked at it may have been one or two days ago, one or two weeks ago. It may have been the same place where you thought it was. Like how often do you have to look for your eyeglasses twice? You didn't put them down where you thought they were the day before. The next thing is if you didn't really have it prepared, it may not be ready to go and that kind of business. And if you get all of that together before the person is all on top of you, have you really practiced shooting? It's a moving target. I told you earlier, one thing that I'm very impressed with is it's either the policeman at 50 feet. I'm probably, you know, 50 feet from you right now, miss a stationary target one out of five times. And they practice, and that's in a controlled environment. It's very hard to hit somebody in that type of setting. So the reality is, for a lot of reasons, this doesn't really work very well, the idea that having a gun is protective. It's not a shield. The idea that you're going to grab it and shoot them before they shoot you, when they're already pointing the gun at you, none of that has really made much sense to me. I think most people don't spend the kind of time really thinking about it, you know, parenthetically, where we are right now. That's why I think that it's a false rubric, this idea that having a gun is protective. Napoleon Higgins. I've mentioned my fraternity several times. I'm going to go ahead and say it. We are Alphas, and we are proud. Go ahead, Napoleon Higgins. Well, I mean, you make some timely points. I mean, the reality is, A, blacks, more than any other racial ethnic group, bought more guns post-COVID pandemic than any other racial ethnic group in the country, and that's what the data shows. I think, secondly, you're right, you and I are both guys from the South. One of us from a big city, you, and one of us from a small country town, but I think our experiences have been similar. Many people having a gun was a rite of passage, and having a gun you use for many other reasons. I mentioned my grandfather and having a rifle that he'd go hunting with, but would never think about shooting somebody with and hurting a human. But I think that a lot of that emotional dynamic just has changed, to the latest question just before you, and I think that's a piece that we, as professionals, have to get our hands around. I don't think we have our hands around it well now. I think that young people kind of come into my office telling me how they think and what they're going to do, not really asking. So I think that much of the mantra of information that matters to them comes from other, what I'll call, external sources. I mentioned media earlier, and cell phones, and television, and maybe somebody else who was shot. I mentioned one slide where one of the other issues is that persons know individuals who've been repeatedly victimized. So if I went home every day and Cousin Jimmy came by and kept talking about being shot, I might feel differently as well about what could I do to kind of protect myself if I couldn't do something different, move, or get people to change. So it can be quite a conundrum. I loved the comment earlier about more societal involvement with younger people, especially younger men. I think we, at our own peril, are a society that risks losing, psychologically, our young men. And we do lose our young men if they're more interested in violence, or violence retribution, or violence response, than on many of the other, what I'll call, proactive activities that allow you to function in this society. It's hard to live in a society 20, 30, 50 years if you're always on edge. There's always some high risk. There's always some likelihood that there's going to be a terminal exposure every day of your life. It's just not pragmatic to think that that's likely to work. And I end by saying, I think your point regarding where I think my thoughts are going forward, I think that going forward, this is a situation that's likely to get worse before it gets better, unfortunately. In the current political climate we're in, it's just very hyper-partisan. I mean, everything tends to be one side or the other, without much middle ground. I argue against that. I think that as professional psychiatrists and psychologists, we should represent the epitome of being middle ground, cross-fertilization, overlapping, people looking for some mutual agreeability. Next question. Hi, Dr. Bailey. I'm a psychiatrist from Melbourne in Australia, and this is just a whole new world compared to kind of our experience in Australia and really eye-opening. I really appreciate your talk. I'm conscious I'm the mother of two young boys, so they're eight and three, and we watch the news every night in Australia, and if there's a story on America about gun violence, my eight-year-old's like, what's this? What's going on? You know, there's this kind of outrage. I'm just conscious of your slide where the numbers aren't decreasing, the lines aren't going down, and I just wonder how much, in your opinion, is that kind of a fear of change or a sensitization to violence, not just within the adolescent population, but within the entire population that's contributing to kind of a lack of progress? Well, outstanding points. I think that we always appreciate, I think, our professional colleagues from other countries, parts of the world, in many regards. I think those cultures do this a lot better. I didn't mention it today, and normally I do mention it, so I'll mention it to the audience of those who've stayed, but you know, one of the wins internationally on this issue of decreasing gun violence comes from Australia, and I often smile when I say it, because I'm from Beaumont, Texas, I've said it several times, there's a little town about 10 miles from where I'm from called Port Arthur, Texas. He doesn't know about it, but Port Arthur, Australia, you're right, for all the audience that don't know it, is the epitome internationally of what you should do when there's gun violence. So in Port Arthur, Australia, they had a gun event, this may have been four or five decades ago now, whatever, and their government said, not again. They were not partisan, they found agreeability, both sides of, both parties, whatever you want to call it, whatever. So for those who, she doesn't have a mic, can you come to the mic? So she's saying that it stayed in people's minds, it was 30, 40 years ago, she's right, and you imply several things that are not happening here, and I think the people like myself have to make them happen here. One, as you state, it stays etched in people's minds. I think you are astronomically on target, and that was really the epitome of, I think, Napoleon Higgins' comment, it's not etched in people's minds every day anymore. Even I said, I'm in New Orleans, I wake up, my wife says, gun violence, gun violence every day. We go to Houston, visit relatives, go to the news, it's actually the same thing. Just the faces and the names change, but somebody got shot every day. I think Americans have been blunted emotionally from this idea that every morning somebody would have gotten shot, and that's what then led, some time ago, to people saying, well, it didn't happen in my neighborhood, and it happened in other areas, and they let me alone. I live in a gated community, so I have to start my talks by saying, it can come to your neighborhood now. That's why I purposely start off with that slide, that everybody's engaged and involved based on race and religion and age and gender and the like, or whatever, that was the reason for that slide. The other thing about Port Arthur was that what they did is they had what I call a full approach. They had policy, they made laws that you couldn't buy guns, they put money behind it, they did a gun buyback, they bought the guns, they included laws, if you're caught with a gun, they put you in jail almost forever, and they did education, so in every school they talk about it alike. I would just be happy as I could be if I could get any one of those things to happen at a high level, consistent, I mentioned repetitive messaging earlier, in my city or in my country. I had this exact same meeting with, not the mayor, I didn't meet the mayor, but the mayor's representative in New Orleans and said all those exact same things, maybe I should bring you to New Orleans to kind of talk about it, because New Orleans does what all cities in here would do, I don't blame my mayor, she's a 50 year problem around my country, she's one mayor in one town, I'll defend her, but we do all the things wrong, one, we try to address one problem and ignore the other ones, so we'll do education, we start arresting people like crazy, rather than putting something into them, if you arrest them they will get out and they're a worse criminal, so to speak. Second, we don't put any money that's over time sustainable, once Australia did that, that's continued for 30 or 40 years, it's not a one or two year issue, and the cycle changes when you get another politician, and third, everybody's on board, so you don't have a lot of naysayers, you cannot cut the television on here without somebody disagreeing what I just said. The only reason you guys didn't disagree is you came at 8 o'clock in the morning, and you probably kind of have like what we're saying, I guarantee you, in many of the settings I could go to, I couldn't have finished this lecture, that's why I like to take questions in the middle, because if there's somebody who wants to disagree, I want to get that disagreement out early, so we can kind of address it right away until the very end, but normally people are ready to disagree on one single point, it'd be very difficult to get persons to think about all of it, I don't want to hold you up Curtis, but we had the same problem with COVID, 100 years ago, or 50 years ago, we had polio, everybody agreed, get vaccinated, you know, sign the form, yada yada yada, now, even trying to get people vaccinated is a partisan discussion, we argue about it, we fight about it, there's people who will try to undermine the opportunity, that I think hurts us in addressing community wide, sociologically oriented, policy based changes in our law and society, that's I think our challenge. Curtis? Yeah, can you go back to your slide where you had the pictures of the people who were victims, it's very early on, victims and perpetrators and such, way back at the beginning, right there, that one, the picture at the top left, one of the things I want to say is that a lot of young black people pick up guns because of fear and safety, and so one way, it looks as if they're showing off their status, that's not typically what it is, and so one of the things I would ask is that if we can increase the safety and security for these precious young black men, they'll put the guns down, they'll be safe. Dr. Adams from Maryland, I think Curtis makes a remarkably timely point, I thank you for making it to the mic, I clearly think that fear by young people drives so much of this, it's always tough, I just thought that what Napoleon Higgins was saying, all of us kind of live on a pedestal, I live in a big house with locked doors myself, if you're a young guy and you can't walk to the 7-Eleven and get a popsicle without somebody threatening you or whatever, it may be as challenging for me as well to not do the one thing that seems easy, which is to get a gun, so we say academically and satirically what they should do, but I try to always be respectful that I know their life is very, very different than mine. I also think that you make a good point that because they do it in groups, one thing that's powerful about that slide, it's not one guy, it's a group, so there's group think, which I think leads to group behavior, I talked a lot in my earlier slide, that whole piece about the neurobiology, so much of it leads to risky or risk-taking, it's a risk to have a gun, that guy may think it's a risk to not have a gun if he walks to the 7-Eleven and somebody tries to hurt him. How can we figure out ways to modify, if not at least decrease, the risk that our young people live under every day, I think is our presumptive challenge, and if you've been doing this 30 years and yada, yada, yada, we've just got to be able to have some better ideas in what we're striking forward. Dr. Lang, Attorney Lang, I'm sorry. Thank you. I want to ask, what do you think it will take to get more psychiatrists, particularly involved in advocacy, both at the federal and state level, to actually help to put a clinical perspective on the desensitized nature of society that we're living in, to help to really stimulate more advocacy from the provider base, because it's very hard to get the change that you're recommending without actually having your colleagues front and center at all of these hearings and involved beyond the PAC. We need your physical presence. It's a great point. I think that there's a lot we should do. I think you said, what can we do? I think that organizations like our American Psychiatric Association, I think, has a moral responsibility to speak up. I often say it, I don't think I said it at the beginning today, but the APA has always had a position against gun violence and for gun reform. What really began to move the needle somewhat with federal dollars was when the AMA, the American Medical Association, did so in 2016, right around the time that I made my little speech about how I was getting involved in it. For eight years now, the AMA, our big, big, big boy in this game, has had a position statement. We've had some small amounts. I think one year, Biden pushed through about $50 million, and it's on the books this year for $250 million. I hope I linked this earlier to the fact that we haven't had much funding for this for 30 years, because after the so-called Dickey Amendment of 1996, the federal government was really put on lockdown, because many researchers thought that if you did research on gun violence, that might possibly show that some of the things we discussed today that's all empirically based would work, that you'd have your funding pooled. I made the point that politicians really shouldn't be calling balls and strikes and telling you what to research or not from the very beginning out of fear or partisanship, hyper-partisanship, that they don't want you to produce something that's adverse to what their political positions. As I said, what if a politician decided they don't want to know that if you eat the wrong foods, they put you at risk of cancer, obesity, or whatever? That should be something to not fund. You should fund it and let the results fall where they may. Another point I mentioned, I think that Attorney Lange is very involved in policy, I think she's right. We have to keep pushing our groups to do this better. I was on a panel yesterday, and we had a congressman on the panel, and he was making the exact same argument that APA, our American Psychiatric, should be more active and more involved. We have a government affairs group, we have a mechanism to do so, but we probably have to be more effective, because the battles, I think, are legion now. They're stronger, they're more ... The people who are against many positions that you think psychiatrists will support are much more boisterous, and they're well-funded, and they want to get their way. I think that we, as professionals, should take that seriously. I think our policy arm just must be pragmatic and effective, otherwise we stand to lose a lot. I think, worse yet, we stand to lose, I think, the heart and soul of our organization, people in the APA who want to be part of the organization for what it means. If there's no meaning, for some people, it's not really worth, I think, all that effort. Any other questions? If not, thank you very much.

Solomon Carter Fuller Award

Dr. Ron Bailey

psychiatry

adolescent gun violence

teenage brain development

societal factors

biological factors

African-American communities

gun culture

neurobiological changes

community programs

trauma response

early intervention

gun reform

policy reform