Strange Contagion

by Lee Daniel Kravetz

  Along with cataloging the trains, I roll through the components of the strange contagion I’ve been able to identify over these past two years, the hysteria, the work ethic, the greed, the self-fulfilling prophecy of fear, as well as the ways to counter each of them, and some of the problems inherent in doing so. I’ve also learned that primes number so many that categorizing them all is virtually impossible. With my trip to Chicago, though, I’m searching for something a little bit different, an all-encompassing solution. I have reason to believe that Sherry Towers’s work in gun violence points the way to one, a unique framework for us to model.

  And that’s where Gary Slutkin factors in.

  As a young epidemiologist, Slutkin was fascinated by something he’s since come to call the invisible—the realm where infectious diseases exist, and where social contagions thrive, all beyond the scope of the human eye. It is in this realm that Slutkin, a specialist in communicable illness control, has learned to exist as well. While he facilitated the containment of a rampant tuberculosis outbreak in San Francisco in the early eighties, he came to understand the invisible. He fought the invisible to stop the spread of cholera among refugee populations in Somalia. He worked to tame the invisible, and when he couldn’t tame it, he learned to work with the invisible by creating interconnected systems of local outreach workers that kept his team abreast of symptoms that signaled new occurrences of disease. These networks helped Slutkin persuade resistant populations to accept medication, to change the way they prepared the bodies, to purify their water, to hydrate their children, and to quarantine the sick—the sort of behavioral changes that, in the context of poverty, low resources, traditional thinking, and political corruption, often presented insurmountable boundaries to eradication. These victories were slow and hard-won, and after a decade in the field he felt it was time to return home to the United States.

  Slutkin tells me his story as we sit across from each other in his personal office at the University of Illinois at Chicago. I’d taken the L to the school of public health and an elevator to a floor lined with subway tiles and green lockers. It’s a friendlier-looking place than Peter Gollwitzer’s Motivation Lab, replete with windows and reception areas and well-lit corridors. Slutkin himself strikes me as someone with a low center of gravity, both in looks and disposition. His shoulders are sturdy, his face perpetually offering up a kind of determined regard, even with that softening glint of delight in his eye. At ten in the morning he has already rolled his dark blue shirtsleeves to the bends of his elbows. There is a small United Nations flag mounted on the sill behind his desk, and his window overlooks a brown-gray urban skyline. Outside, the murder rate is higher than it is in New York or Los Angeles. Armed robbery, gang violence, aggravated battery, and rape clock in at rates well above those of most US cities. “When I got back, this problem of violence in Chicago—and all throughout the country, really—was staring me in the face.” There was a familiar pattern about it, he says, the way the violence moved from person to person, from one community to the next. “Violence was sharing characteristics of bacterial spread.”

  Cultures under an electron microscope show individual germs adopting similar morphologies, colors, and chemical characteristics of those around them. Each eats the same way, eliminates the same way, and multiplies the same way. The closer he looked at patterns of violence, the more Slutkin saw that people operate similarly to bacterial cultures when they’re exposed to this specific social contagion.

  There were other similarities, too. For instance, the biggest barrier to eradicating both infectious diseases and social contagions is none other than the contagion itself. Just as cholera leads to more cases of cholera, violence leads to more cases of violence. In both turf wars and civil wars, aggression is the fuel that spreads further acts of brutality. Exposure to violence in the community increases the likelihood that a person will act violently in the home; exposure to violence in the home increases the likelihood that a person will act violently in the community. “We are not separate from nature. We are nature. Behavior catches for the same reason that bacteria does. It’s the most efficient way to continue its evolution. What has been learned over generations is most easily transferred by modeling, copying, or imitating.” He adds, “And hardly any of it is done consciously. We have an idea that as individuals and as a species we are making decisions about how we behave, but the world is too complex for that. In terms of brain function, we’re talking about 100 billion neurons, 100 trillion connections, all firing below our consciousness.”

  This is the invisible.

  It’s the method of contraction. It’s the process of spreading. It’s the pattern that emerges once we modify our perspective, once we speed things up, once we slow them down, once we examine the phenomenon piece by piece as one might explore the complex nature of a strange contagion event.

  After chasing the invisible for years across the continent of Africa, Slutkin took his medical model for tracking epidemics of disease and applied it to a growing epidemic of violence in the US. With both disease control and behavioral change methods in mind, Slutkin designed the Cure Violence framework. Where in Africa he relied on networks of local monitors to alert his team to symptoms of cholera or TB, Cure Violence creates hyper-local networks of regional social workers, former gang members, and trusted leaders of the community.

  He calls these his interrupters. They stop the spread. Kill the progression. Sever the pathway.

  I ask Slutkin how you become an interrupter. He says that you explain to people how one incident of violence spreads to others, how to spot the signs of potential spread, and how to de-escalate it before it multiplies.

  At the first sign of violence, interrupters fan across the hot zone. Where Slutkin once distributed medication to infected populations, violence interrupters apply immediate social and educational interventions to stop the spread of retaliatory aggression. They show up at the hospitals treating victims and connect with their friends, family members, and any gang affiliations to cool heated emotions, mediating conflicts before they grow more lethal.

  Slutkin turns his laptop to me. He’s pulled up a screen full of stats. In Baltimore, implementation of the Cure Violence model has reduced killings by 56 percent and shootings by 44 percent. People in program sites are four times more likely to show little or no support for gun use. Saturating the most violent New York neighborhoods, the model has lowered monthly shooting rates by 6 percent; in Puerto Rico’s communities, shooting deaths have diminished by 50 percent; and participating communities in the UK have seen a 95 percent reduction in group violence. More than half of the communities that have adopted the model in Chicago experienced a 100 percent reduction in retaliation homicides. In each case, the program has created an infrastructure of police outposts, doctors, social workers, and teachers. Cure Violence has not only trained interrupters to recognize the symptoms leading to outbreaks, it has also taught them to maintain the fortitude to confront them, as well as the presence of mind to pull in the proper resources. Slutkin’s premise is a simple but important one. By explaining to people how this social contagion works and why it spreads, the Cure Violence model gives control back to communities. Understanding the way that this social contagion affects our behaviors, our feelings, and our thoughts allows people-as-interrupters to better influence and operate their own destinies.

  “We’re making the invisible visible,” he says.

  I take a moment to sort my thoughts. All right, I think, Slutkin figures out that if he builds an infrastructure of highly trained interrupters, educated in how to recognize the signs and treat the symptoms of violence, he can effectively put a stop to a widespread social contagion. Gone are his days of working alongside the invisible. He’s now exposing the invisible. Showing people how it works. Explaining why it works. Teaching them ways to stop it from working. Sherry Towers was, in her own way, doing her part to expose the invisible, too. She identified the social contagion; Slutkin identified the cure.


  I turn this all over in my head: contagion, cure, exposing the invisible. There’s a greedy part of me that wants to buy Slutkin’s idea completely, to believe that a cure is within reach, to trust that awareness, that volatile and important ingredient, is ultimately the most effective and influential of weapons against components of a strange contagion. Thus far in my search, Slutkin’s approach to awareness is perhaps the most logical of responses I’ve yet heard. But my reservations rest in what I’ve thus far learned about social contagions, how they are singularly driven by design to spread. They are dependent on awareness, even on an unconscious level, to thrive. Gerald Russell and Anne. E. Baker highlighted the damaging power of awareness with eating disorders, even as prosocial media campaigns to spread treatment led to other people catching the illness in greater numbers. Yet, there’s the argument of awareness as a counterbalance, particularly when we use fact to dampen fear-based contagions like hysteria. Is Slutkin’s model strong enough to outsmart the nocebo effect of expectation, where facts fail to supplant superstition, myth, and false beliefs and create a self-fulfilling prophecy?

  “Can we talk about Silicon Valley?” I ask. “Can it use your model to treat its symptoms?”

  I find myself looking at Slutkin now as though urging him with my gaze to offer up another clue. In response, his eyes flash with confidence.

  “Silicon Valley already is.”

  Chapter 19

  If It Can Stop Violence, It Can Stop This

  The sister towns of Palo Alto and East Palo Alto are connected by University Avenue and divided by an interstate that is ostensibly the gateway to Silicon Valley. Despite proximity and their names, the two communities couldn’t be more different. Palo Alto is one of the wealthiest places in the country. On the west side of the interstate, University Avenue is lined with estates, tree-shaded sidewalks, suites occupied by technology companies, and high-end shops and restaurants. It’s basically a fiber-optic cable shuttling modernity out to the world. Continue to follow University Avenue in this direction and it stabs at the heart of Silicon Valley, where ten of the planet’s richest people own homes and where the median household income at the time the suicide cluster began was a staggering $120,000 a year.

  On the opposite side of the interstate, University Avenue feeds into the unincorporated town of East Palo Alto, a community both surrounded by innovation-driven wealth and untouched by it. Property values during the dot-com boom remained dormant. The median household income stagnated at a little less than $45,000 a year, with more than 22 percent of families existing below the poverty line. East Palo Alto is known for its high rate of violent crime and gang activity. The town registers more than two hundred assaults annually, while its neighbor, Palo Alto, registers a fifth of that.

  Given its proximity, one has to wonder what’s preventing the contagion of violence from jumping eight lanes of interstate to infiltrate Palo Alto. It’s not as though Palo Alto is impervious to the social contagion of violence. In 1995, police responded to a 911 call reporting gunshots fired amid a group of teens gathered on Channing Avenue. Palo Alto didn’t have a gang problem, yet this isolated event worried people that the troubles of East Palo Alto had finally jumped the freeway and were now spreading into this quiet community. Police downgraded the offense from a gang confrontation to a disagreement between two wannabe gangs, made up of about a dozen or so students from Palo Alto area schools. One of the kids involved told the Palo Alto Weekly that he and his friends wanted to go to Penn State, not the state pen. Even the so-called gang members of Palo Alto aspire to four-year institutions of higher education.

  Responding to this singular incident, the Palo Alto city council passed a curfew. A task force on gangs and violence formed in a town where, as one official put it, violent activity often happens by coincidence, not on purpose. East Palo Alto, meanwhile, remained the true center for gang activity with a flourishing drug trade and high murder rate. It’s easy to conclude that Palo Alto at best overreacted and at worst fed its reputation in some circles as a rich and entitled community with very little connection to the real world. But a dive into the socioeconomic and cultural data of the region suggests a third explanation. Palo Alto has a very low threshold of tolerance for violence, while East Palo Alto’s threshold of tolerance is notably higher.

  When she was looking into the spread of gun violence on US campuses, Sherry Towers noted the effect of this threshold of tolerance. Why, for instance, wasn’t gun violence also catching in neighboring Canada, where the rate of mass shooting fatalities remains at a remarkably low 0.01 per hundred thousand? The per capita incidence of mental illness in both countries is relatively similar. Both have broad exposure to the same media. Firearm ownership is the same, although the normative culture associated with them in Canada is overwhelmingly hunters and not self-defense. A culture’s threshold of tolerance, Towers concluded, is one of the most important factors regulating the spread of gun violence. Canada’s worst mass shooting occurred in 1989 at the Université de Montréal, resulting in the deaths of fourteen students. After a single national catastrophe, Canada underwent a cultural reexamination that led to the passing of stringent gun control laws. Towers concluded that Canada’s tolerance threshold for campus shootings was much lower than in America, where gun-related deaths remain far higher than in any other developed country.

  Like Canada, the town of Palo Alto has a particularly low threshold of tolerance for violence and therefore moved swiftly to end it the moment it occurred. Decades of exploitation and mistreatment by the region have resulted in East Palo Alto conversely developing a high threshold of tolerance for violence. In the fifties, the county replaced the depressed farming community with cheap housing. The surrounding wealthy suburbs fleeced the East Palo Alto workforce. The expansion of the highway eliminated forty-five major businesses. My town annexed nearly a quarter of East Palo Alto, divesting the community of property tax revenue. At the same time, the county levied significant utility taxes on East Palo Alto. Crime rates rose and the middle class fled. Make no mistake: an area with so few education opportunities and such immense poverty was doomed to cultivate an environment perfect for the spread of this social contagion and a higher threshold of tolerance for violence.

  When East Palo Alto adopted the Cure Violence model, it trained violence interrupters to identify and deescalate conflicts. Police and outreach workers infiltrated key points of this vulnerable community. They converted parks and known gangland hangouts into Fitness Improvement Training (FIT) zones, public spaces for power walking classes, mindfulness groups, and aerobic dance to help citizens regain control of their neighborhoods. Within a year of implementation, the campaign led to a 60 percent reduction in shootings.

  After finishing his story, Slutkin turns his laptop back around to face him and closes the screen. I look at him again as I consider my next question. I know it’s hypothetical, and I know it’s beyond the scope of his considerable expertise, but I ask it anyway, because the puzzle piece is in hand, and it has been in hand all this time, working its methods in East Palo Alto without most people’s knowledge.

  If the Cure Violence model can stop one social contagion, can we retool it and use it to stop several? Building a Cure Violence–style infrastructure to support treatment seems like a viable way to interrupt social contagions beyond aggression and brutality.

  Then again, stopping violence is one thing, but using his system to stop a perfect storm of varying social contagions—fear, hysteria, harmful work ethic, greed, and the primes that cue them all—is a task I fear is far grander in scope. Educating people to become interrupters of the strange contagion is to educate them on the signs and symptoms of at least half a dozen components, maybe more. It’s an enormous undertaking, and one, I suspect, that’s virtually impossible to execute.

  “Is it, though?” I ask him.

  The question piques his interest; he approaches it with theoretical aplomb. Is it possible to overlay Palo Alto’s strange contagion with an exp
anded version of his Cure Violence model? His head tilts in consideration, and his mouth flattens as his mind works. The ability to consider hypotheticals is a special skill set, a contradictory mix of truth and yearning, and I find myself deeply appreciative that he’s indulging me. His eyes glimmer with empathy.

  To build out this theoretical infrastructure, he says, requires creating language to normalize the conversation about contagious thoughts, behaviors, and emotions. Promoting deep emotional talks between families and friends of those at risk. Providing outlets for people to express themselves. Educating the community on all of the mental health resources at its disposal, then scaling the infrastructure by establishing more clinics and hospitals and beds for practitioners to utilize for their patients. Engaging policy makers to mandate adequate insurance reimbursement for outpatient services. Then increasing the number of trained mental health professionals, specifically in suicide risk assessment and treatment.

  We will train our teachers, students, and school administrators to be interrupters. They will identify the warning signs of problematic social contagions in play and intercept the chain long before it leads to tragedy. For it to work, literally everyone in these settings must become an interrupter of the invisible. Creating so many interrupters becomes a kind of social contagion in itself. We will educate the holders of high prestige and let them spread the contagion of interrupters through primes, through body language, through fertile memes, “parasiting the mind,” turning it, as Richard Dawkins writes, into a vehicle for propagation. Through them, others will contract the social contagion of vigilance. Resilience. Fortitude. They will catch the will to act. Because the more people begin to look out for one another, the more of a chance there is to stop this strange contagion for good.