Reconsidering the "Violence-as-a-Disease" Model: Examining Violence Psychopathologies in Urban Adolescents

Objective: Owing to its immense scope and persistence in impacting health, there have been increasing, but undertheorized, calls to conceptualize and address violence as a public health issue. This violence-as-a disease paradigm has particular relevance in consideration of the deep sociomedical embeddedness of violence in minoritized communities. Given that violent ideation and actualized violence begin early in one's life, consideration of adolescent violence in these theoretical contexts is of particular utility. Method: We conducted semistructured interviews with 32 school staff members, including, school teachers, administrators, and security, at five high-risk urban public high schools in the Chicago metropolitan area. Most participants were either Black (31.3%), White (43.8%), or Hispanic (21.9%). We examined perspectives on the causes and consequences of adolescent violence, tested and reconceptualized the violence-as-a-disease model, and developed an enhanced nomenclature for this model. Abductive analysis was used to analyze the interviews. Results: Respondents identified specific co-occurring chronic and acute causes for violence, with psychosocial cognates being central to violence initiation. Chronic causes include structural forces such as neighborhood deprivation, limited resource access, and familial and cultural influences. Acute causes include situational and real-time triggers like perceived slights and a desire to meet social group performance expectations. Conclusions: In consideration of the violence-as-a disease paradigm, violence is stimulated and entrenched by socioeconomic, cultural, and environmental forces that implicate psychopathological paradigms in multiple groups and individual-level contexts. An expanded nomenclature and conceptual model for primary and secondary prevention are proposed.