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Characterizing ‘Civil Unrest’ within Public Health: Implications for Public Health Research and Practice

Characterizing ‘Civil Unrest’ within Public Health: Implications for Public Health Research and... Abstract Following the death on April 19, 2015 of Freddie Gray from injuries sustained while unarmed and in police custody, many citizens of Baltimore took to the streets and the National Guard was called into the city. A 2017 article published in the American Journal of Public Health measured the effect of this civil unrest on maternal and child health. I argue that this research does not acknowledge the full range of motivations, behaviors, aims and values that may have been inherent in this unrest. I first describe the article’s characterization of Baltimore’s unrest as community violence. I then provide a negative argument against employing this characterization alone, before providing positive arguments for two alternative characterizations—as protest and apt anger. Finally, I discuss upshots of considering these alternatives. Broadly, while viewing civil unrest as community violence focuses exclusive attention on victims of unrest, these alternatives direct attention to unrest participants, with implications for public health research and practice. While I focus on Baltimore’s 2015 unrest, the proposals raised here apply wherever civil unrest occurs. Introduction Following the death on 19 April 2015 of Freddie Gray from injuries sustained while unarmed and in police custody, many citizens of Baltimore took to the streets and the National Guard entered the city. A September 2017 article published in the American Journal of Public Health by Yimgang et al. sought to understand the effect of this period of civil unrest on maternal and child health. In this article, I argue that Yimgang et al.’s research is driven by a characterization of Baltimore’s civil unrest that does not capture the full story about Baltimore’s unrest. Going forward, it is important that public health research and practice consider a broader set of characterizations of civil unrest. First, I provide some background regarding Freddie Gray’s death and Baltimore’s racial dynamics. Next, I describe Yimgang et al.’s characterization of Baltimore’s civil unrest as community violence and provide a brief negative argument against relying on this characterization alone. I then provide positive arguments for two alternative characterizations. I re-characterize Baltimore’s civil unrest first as protest and second as apt anger. I show how the first—civil unrest as protest—arises quite plausibly from a more comprehensive consideration of the motivations and behaviors inherent in this period of unrest. The second—civil unrest as apt anger—arises as an extended response to a strong potential objection to the first characterization. Importantly, these alternatives are neither mutually exclusive nor exhaustive. Finally, I discuss possible upshots of considering these alternative characterizations within public health. Broadly, I argue that while the view of civil unrest as community violence focuses exclusive attention on potential victims of civil unrest, these alternative characterizations direct attention to civil unrest participants, with important implications for both public health research and public health practice. These discussions of implications differ significantly in methodology. In the first case, I draw on foundational concepts in social science research to identify potential ways in which characterizing civil unrest as protest may influence both public health research questions and study design. In the second case, I undertake normative philosophical analysis of the appropriateness of anger to identify how interactions might be improved between public health practitioners and the populations they seek to benefit. Though I focus in this article on Baltimore’s 2015 civil unrest, the issues I raise apply more generally. For instance, a search of the public health literature suggests that research focused on the 1992 Los Angeles unrest following Rodney King’s unjust treatment predominantly considered the violent effects of unrest on bystanders or potential victims (Evans, 1993; Golden and Baranov, 1994; Hanson et al., 1995), including local businesses (Pearson and Kirby, 1993) and police officers (Harvey-Lintz and Tidwell, 1997). In addition, while my focus here on the Yimgang et al. article allows me to illustrate my arguments with specific examples, other recent research similarly characterizes unrest as violence and measures its effect on victims (Galovski et al., 2018). As I will argue below, wherever civil unrest occurs, the tendency to characterize it exclusively as community violence should be resisted. Background Freddie Gray, a 25-year-old African-American man, was arrested on 12 April 2015. He was then transported to a local police station, after which he was found to be in a coma, possibly due to a ‘rough ride’—an effort to cause injury or pain to an unbuckled or hand cuffed suspect through unsafe driving. One week later, Gray died from injuries to his spinal cord. The officers involved were charged with various crimes including false imprisonment, manslaughter and second-degree murder. Baltimore Rising, a documentary that focuses on the aftermath of Gray’s death, situates this period of civil unrest within a larger history of unjust treatment of black Baltimoreans. One interviewee in the film states, ‘The Freddie Gray incident wasn’t the cause of the uprising, it was just probably that last straw that broke the camel’s back’, and Councilman Carl Stokes adds, ‘the condition of the community caused the uprising that we had’, (Sohn, 2017). The present condition of Baltimore has a particularly strong historical connection to the baldly racist practice of redlining, a process whereby neighborhoods were deemed ineligible for financial lending based on ‘undesirable’ racial concentrations (Hillier, 2003). In addition, the Department of Justice investigation of the Baltimore City Police Department has found significant evidence for a history of unjustified use of force and differential treatment of racial minorities (United States Department of Justice, 2016). In short, Baltimore’s 2015 civil unrest should plausibly be viewed as a response to persistent institutional oppression of predominantly black Baltimoreans by the government and police, not simply as a response to Gray’s arrest and death. While I cannot develop a full theory in this article for how to distinguish cases of civil unrest that are responses to persistent institutional oppression versus single events, two plausibly necessary, but perhaps not sufficient, conditions appear satisfied in this case: (i) clear evidence of persistent institutional oppression and (ii) good reasons (e.g., in the form of personal testimony) to believe this oppression primarily motivated the unrest. ‘Civil Unrest’ as Community Violence Yimgang et al. (2017: 1455) write that in response to Gray’s death, ‘Baltimore erupted in civil unrest: fires, property destruction, and violence’, thus explicitly characterizing Baltimore’s civil unrest in terms of community violence. In addition, the authors frame their focus within a larger discussion in the literature of the effects of community violence on physical and mental health. I will argue that this characterization does not attend to the full range of motivations, behaviors, aims and values that may have been inherent in Baltimore’s period of civil unrest. Of course, any single research aim must be sufficiently narrow to be answerable. However, I take issue with the potential implications of adopting this characterization of civil unrest to the exclusion of alternative characterizations within the larger body of public health research and within public health practice. As discussed above, the film Baltimore Rising makes it clear that many of those involved in Baltimore’s 2015 unrest were black individuals responding to a history of racism and persistent institutional oppression. Predominantly characterizing civil unrest as community violence within public health may therefore reinforce stereotypes about black individuals, especially black men, as criminals. This characterization obscures the possibility that the civil unrest was justified or nonviolent. It plays into an ongoing cultural narrative of black violence, thereby perpetuating racism and fear (DiStefano, 2018) and potentially reinforcing beliefs that the persistent institutional oppression described above is justified. Alternative Characterizations of ‘Civil Unrest’ ‘Civil Unrest’ as Protest Given the risks of characterizing civil unrest as community violence, I suggest two alternatives: civil unrest as protest and as apt anger. Protest strikes me as a noncontroversial place to begin given that so much of what is depicted in the Baltimore Rising film is clearly protest. Protest is also a plausible characterization of civil unrest. Protest aims to effect change by disrupting the status quo. Seen this way, protest aims to disrupt the resting state of a society or community. Protest is therefore reasonably understood as a form of civil unrest. Of course, not all civil unrest should be considered to entail protest. Sometimes there is merely violence where those perpetuating the violence either have no desire to effect change or are fighting on behalf of the status quo to resist change, such as state-sponsored violence to quell social movements. And not all protest involves community violence. The peaceful demonstrations organized by Martin Luther King, Jr. are an example. Characterizing civil unrest exclusively as community violence obscures the possibility that civil unrest includes peaceful protest as well as instances of protest that also entail community violence. Implications for public health research While the view of civil unrest as community violence focuses attention on potential victims, characterizing civil unrest as protest directs attention to participants in unrest (DiStefano, 2018). Community violence may affect victim health through either direct bodily harm or stress accumulation stemming from the persistent threat of community violence (Yimgang et al., 2017). Yimgang et al. are clearly focused on victims; they measure the impact of unrest on the health of mothers and infants, groups unlikely to have participated in the unrest. However, viewing civil unrest as protest directs attention to participants. On this view, there is reason for public health researchers to identify and explain potential mechanisms through which unrest may influence the health of participants. I consider one such mechanism here. I take protest to involve a demand that the current state of affairs be altered in some way and a belief that this future state of affairs is more likely because of this demand. Protesters therefore take themselves to be effective agents, or agents whose actions are felt to matter. Seen this way, protest involves an important degree of agency, which on many theories is considered central to well-being. A review of leading theories of social justice (Powers and Faden, 2006; Wolff and de-Shalit, 2007; Daniels, 2008; Ruger, 2010; Nussbaum, 2011; Venkatapuram, 2011) identified agency—the ‘ability to lead one’s own life and engage in activities one finds meaningful’—as a point of convergence in each theory’s conception of well-being (Bailey et al., 2015: 631). If, according to stress accumulation theories, the threat of violence can be harmful to health, then perhaps the loss of one’s sense of effective agency can be as well through its negative impact on well-being. There is thus an important sense in which those participating in protest are perhaps healthy (DiStefano, 2018). This is a preliminary sketch of an argument linking agency with health, but the link appears plausible. Importantly, I am not arguing that protests are harmless, all things considered. Protests are never without risk and participants or bystanders can certainly be exposed to a number of health threats. However, protests may indicate or promote a certain healthiness that is not present among some individuals in areas where protests are not occurring. In such areas, there may be a lack or total loss of a sense of effective agency—likely stemming from the persistent institutional oppression present in Baltimore. Researchers ought to consider this possibility when studying periods of civil unrest that include protest. To be sure, protest may not always indicate or promote health. Protest requires an enormous amount of physical and emotional energy to carry out in a sustained manner. A strong disposition among black individuals to actively cope with environmental stressors can magnify the negative relationship between socioeconomic status and blood pressure (James et al., 1987). Protest, as a form of active coping, could therefore be associated with worse health among protesters who are low income and black. Skeptics may argue that Yimgang et al. did measure the health of those in nonprotesting areas since distal regions (i.e., zip codes where civil unrest was not reported to the police) served as a comparison for proximal regions. However, distal regions likely also included higher-income residents and those otherwise uninfluenced by the civil unrest. A better understanding of the relationship between health and effective agency requires targeted study of relevant regions. Moreover, individuals in both regions were enrolled only after seeking health care within the University of Maryland Medical System. Individuals actively seeking health care are more likely to be those retaining a sense of effective agency; despairing individuals are more likely to stay at home, potentially resulting in selection bias. Research that aims to validly characterize the associations between protest, effective agency and health should adopt sampling methods that avoid this form of bias. The overall uncertainty described here regarding the relationship between health and participation in civil unrest demonstrates a genuine research gap in public health (DiStefano, 2018). A research agenda focused exclusively on the impact of civil unrest on victims overlooks how civil unrest as protest may indicate or promote health where it is occurring. This could lead those committed to improving public health to focus their efforts disproportionately on areas proximal to civil unrest at the expense of more distal areas. Of course, some may argue that the possibility of finding a negative effect of civil unrest on participant health is good reason to not pursue this research agenda so far as such a finding could be used to further condemn participation in protest. One response is that we should instead view such a finding as further reason to condemn the persistent institutional oppression that gives rise to the need for protest in the first place. However, even conceding this objection would not eliminate the potential value to public health research of considering civil unrest as protest. Yimgang et al. assume a causal path from civil unrest to worse mental health, but it is possible that the death of Freddie Gray confounds this hypothesized relationship. Gray’s death—a traumatic event and clearly associated with Baltimore’s unrest—may itself be a cause of negative health outcomes. Yimgang et al. do not consider this possibility, for which there is now compelling evidence (Bor et al., 2018). One explanation for this oversight is that this confounded relationship is not implied by the characterization of civil unrest as community violence. By focusing attention on victims, this characterization suggests a direct causal effect on health from unrest to bystanders. In contrast, characterizing civil unrest as protest implies the existence of a variable that precedes and precipitates the unrest (i.e., Gray’s death) that cannot be reasonably excluded from causal hypotheses. Characterizing civil unrest as protest may thus help reduce this risk of omitted variable bias when inquiring into the relationship between civil unrest and health. ‘Civil Unrest’ as Apt Anger Some may object to the view that what transpired in Baltimore in the days following Gray’s death can be considered protest. On this view, the events were far too emotional and disorganized. Such people may instead want to label the events as simply an expression of anger. In this section, I draw attention to a distinction in kinds of anger that is important to consider when evaluating this position. A common view of anger with roots in the Stoic tradition is that angry individuals cannot be reasoned with, and as such, anger can have no place in rational deliberation or politics. In contrast, Amia Srinivasan proposes and defends an account of apt anger (Srinivasan, 2018).1 Apt anger, she argues, is rationally evaluable. To show how, she grounds apt anger in a set of four necessary conditions. First, the object of an individual’s anger must constitute a genuine moral violation. Second, the reason for an individual’s anger must be known by that individual. Finally, the individual’s anger must be motivated by and proportional to that reason. These conditions therefore provide reasons which must relate to anger in a particular way for it to be apt. These reasons can be either the right reasons or not, depending on whether they in fact constitute a known moral violation and properly relate to the individual’s anger in terms of motivation and proportion. In this way, Srinivasan’s analysis of apt anger is meant to ‘dissolv[e] the false dichotomy between reason and anger’, thus making room for apt anger in politics (Srinivasan, 2018: 127). Each of these conditions is clearly met in the case of Baltimore’s civil unrest. As discussed above, Freddie Gray’s arrest was likely an instance of unjust discrimination and therefore constitutes a genuine moral violation. Regardless, Baltimore’s civil unrest ought to be viewed as a response to persistent institutional oppression and not simply to Gray’s arrest and death. It is therefore nearly impossible to deny that genuine moral violations are the object of much of the anger expressed during the civil unrest. So far as unjust police practices are experienced directly by individuals or others within that individual’s family or community, they are plausibly known reasons for anger. These reasons also properly motivate the anger expressed during the unrest. The anger is a direct response to the condition of the community and the moral violations associated with it. Finally, the anger is proportional. If anything, the anger is more restrained than it need to be given decades of unjust treatment. Some might object that a defense of apt anger amounts to a defense of violence. However, only where anger in fact involves violence would a defense of anger be tantamount to a defense of violence. Moreover, a defense of interpersonal violence is likely what concerns those who might raise this objection; a defense of nonpersonal violence (i.e., violence against structures or property) is, plausibly, more acceptable. Fortunately, we can observe that most people seem capable of getting angry without committing interpersonal violence (Srinivasan, 2018). It is of course an empirical question which type of violence was most prevalent during Baltimore’s civil unrest, but to the extent much—if not most—of it was nonpersonal violence, this potential objection loses much of its bite. To be clear, my intention here is simply to provide a pragmatic response to the unfortunate reality that there are likely many who object to civil unrest and protest as being nothing but irrational anger. I am not defending placing a greater justificatory burden on the aptness of anger versus the aptness of nonanger. Inquiring whether those participating in civil unrest possess sound reasons for their anger while not asking the same of those who stand by silently in nonanger may constitute an injustice itself. Implications for public health practice Characterizing civil unrest as apt anger also shifts our focus from the potential victims of civil unrest to its participants. Specifically, it centers attention on the reasons that individuals may have for participating in unrest, while a focus on potential victims obscures these reasons. These reasons, if seen as such, can help to improve—perhaps even fundamentally change—the relationship between public health practitioners and members of the communities in which they work. Because apt anger arises from a known moral violation, Srinivasan considers it ‘a form of emotional insight into the moral world’ (Srinivasan, 2014: 5). That is, apt anger is valuable as a means of ‘affectively registering’ or appreciating that an injustice has occurred rather than merely knowing that an injustice has occurred (Srinivasan, 2018: 132). She illustrates this claim by likening the appreciation of injustice to the appreciation of art. It is not enough to know that a painting is beautiful; rather, the art lover seeks to truly appreciate that the painting is beautiful. There is an important affective component to the value of a beautiful painting that is not captured merely by knowing that the art is beautiful in virtue of, for example, the artist’s skill in color-blending. The same is true of injustice. There is value in the affective registration of an injustice beyond the value of simply knowing there is an injustice. Apt anger is a means of tapping into such appreciation. More importantly, apt anger—as rationally evaluable—has communicative value as a form of moral address that gives others reason to share in this affective registration of injustice. Reasons can make claims on others. That is, apt anger is not only valuable for the aptly angry individual; it also calls on others to share in the affective registration of an injustice for which they may not themselves be a direct victim. An especially powerful scene in Baltimore Rising illustrates the communicative value of apt anger. Following the initial unrest in the aftermath of Gray’s death, a meeting is arranged between various community leaders and Kevin Davis, Baltimore’s police commissioner at the time. Davis’ stated aim is to ensure ‘[only] protest and no violence’ (Sohn, 2017) if the verdicts in the trials of those charged in Gray’s death are ultimately unsatisfactory. At a second meeting, Davis speaks with Shadow, a former gang member, who tearfully describes his relationship with the police as ‘the only time we ever see you all is you all taking our fathers from us’ (Sohn, 2017). He goes on to describe being strip-searched, and in a moment where Davis interrupts him, Shadow—passionate, yet restrained in his anger—responds, resulting in the following exchange: Shadow: Please let me finish. No, please let me finish. Please let me finish. I went through shit that I should not have to. I’m not even supposed to be sitting here. I got a bullet wound in my head, Chief. and that will not happen to my children. Do you understand ? This will not happen to my children. I will die doing this. OK? Davis: Your pain’s not my pain. I’ve never lived your life. But that still— Shadow: Excuse me. Davis:—doesn’t mean that… that… Shadow: It won’t happen to my children. I promise you. Davis: I… I feel your pain. (Sohn, 2017) In the first meeting, Davis was focused on reaching a productive, strategic agreement with community leaders. Something different occurs in this second meeting. Davis is visibly distraught and stumbles over his words throughout this exchange. It seems clear he is moved by Shadow’s anger. No agreement is reached or sought. Instead, Davis simply listens and expresses empathy. Despite acknowledging never having been a victim himself of the injustices Shadow experienced and describes, Davis ultimately appears to genuinely share in feeling Shadow’s pain. In this moment, Shadow’s apt anger calls for Davis’ shared affective registration of the injustices Shadow has suffered. Ultimately, this shared affective registration of the moral violations underlying apt anger can facilitate a fundamental change in the relationship between those participating in civil unrest and those to whom it is directed or who may observe it. This shared affective registration of injustice can shift these relationships from those based on an objective attitude to those based on a participant attitude. Strawson famously distinguishes the objective and participant attitudes. The former entails seeing another person …as an object of social policy; as a subject for what, in a wide range of senses, might be called treatment; as something certainly to be taken account, perhaps precautionary account, of; to be managed or hand led or cured or trained; perhaps simply to be avoided. (Strawson, 2005: 79). Adopting the objective attitude toward another means treating that person as a nonparticipant in shared moral practices. In contrast, the participant attitude entails viewing another as a morally responsible agent, that is, as a member of the moral community. In further developing this view, McGeer (2012) describes co-reactivity as an integral property of responsible agency. For McGeer, the participant attitude entails taking another person to be both capable of understanding and responding to demands for moral regard. On Strawson’s account, participant reactive attitudes appear predominantly backward-looking. They are responses to the actions or expressions of others. McGeer’s emphasis on co-reactivity highlights that the participant reactive attitudes are equally forward-looking; they call for a response from those to whom they are directed (which calls for further response), thus ‘making and sustaining moral community’ through ‘dynamic trajectories of reactive exchange’ (McGeer, 2012: 304). For Strawson, anger and indignation are emotions that compose the participant reactive attitudes. In fact, Strawson straightforwardly states that the objective attitude cannot include anger; anger is not an appropriate emotion to feel toward one who cannot participate in shared moral practices (Strawson, 2005). Characterizing civil unrest as apt anger therefore permits the conception of civil unrest as an expression of a participant attitude and a call for co-reactivity. Those who are aptly angry and participating in civil unrest are calling on others as morally responsible agents—including public health practitioners—to engage in a shared moral practice. Civil unrest as apt anger is a call to affectively understand and then respond in an ongoing practice of moral collaboration to the moral violations that provide reasons for the unrest. Characterizing civil unrest as community violence obscures this possibility and may perpetuate continued reliance on an objective attitude by those in public health. The objective attitude entails a need for further management, avoidance or harm mitigation that is evident in research that aims only to measure the effects of violent unrest on potential victims. The exchange between Shadow and Davis is an illustration of co-reactivity between two individuals who have adopted a participant attitude toward one another. While unrest as violence may be met with fear or further violence, unrest as apt anger may be met with a shared appreciation of injustice and perhaps some small measure of progress. Conclusions Wherever civil unrest occurs, the tendency to characterize it exclusively as community violence should be resisted. Widespread focus on civil unrest as community violence risks inadvertently perpetuating racist and harmful stereotypes about those involved. Instead, a greater range of possible motivations, behaviors, aims and value inherent in civil unrest should be considered. I have suggested two possible alternative characterizations and discussed how they each direct attention to participants in civil unrest, rather than only victims, with implications for both public health research and practice. Footnotes 1 Srinivasan also situates her account in contrast to Aristotle’s account of anger as a virtue, which she argues is both too demanding and too narrow in its scope as applying only to those in positions of relative power. Acknowledgements I thank Alisa Carse, Lorraine Dean, Christian Morales, Travis Rieder, Lester Spence, an anonymous reviewer and participants at the 2018 Health, Medicine & Civil Unrest Conference held in Baltimore, MD for their helpful comments. References Bailey T. C. , Merritt M. W. , Tediosi F. ( 2015 ). Investing in Justice: Ethics, Evidence, and the Eradication Investment Cases for Lymphatic Filariasis and Onchocersiasis . American Journal of Public Health , 105 , 629 – 636 . 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Google Preview WorldCat COPAC United States Department of Justice ( 2016 ). Investigation of the Baltimore City Police Department, available from: https://www.justice.gov/crt/file/883296/download [accessed 3 October 2018]. Venkatapuram S. ( 2011 ). Health Justice: An Argument from the Capabilities Approach . Cambridge, UK : Polity Press . Google Preview WorldCat COPAC Wolff J. , de-Shalit A. ( 2007 ). Disadvantage . Oxford, UK : Oxford University Press . Google Scholar Crossref Search ADS Google Preview WorldCat COPAC Yimgang D. P. , Wang Y. , Paik G. , Hager E. R. , Black M. M. ( 2017 ). Civil Unrest in the Context of Chronic Community Violence: Impact on Maternal Depressive Symptoms . American Journal of Public Health , 107 , 1455 – 1462 . Google Scholar Crossref Search ADS PubMed WorldCat © The Author(s) 2020. Published by Oxford University Press. Available online at www.phe.oxfordjournals.org This article is published and distributed under the terms of the Oxford University Press, Standard Journals Publication Model (https://academic.oup.com/journals/pages/open_access/funder_policies/chorus/standard_publication_model) http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Public Health Ethics Oxford University Press

Characterizing ‘Civil Unrest’ within Public Health: Implications for Public Health Research and Practice

DiStefano, Michael, J
Public Health Ethics , Volume Advance Article – Oct 1, 2003
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Oxford University Press
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© The Author(s) 2020. Published by Oxford University Press. Available online at www.phe.oxfordjournals.org
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Abstract

Abstract Following the death on April 19, 2015 of Freddie Gray from injuries sustained while unarmed and in police custody, many citizens of Baltimore took to the streets and the National Guard was called into the city. A 2017 article published in the American Journal of Public Health measured the effect of this civil unrest on maternal and child health. I argue that this research does not acknowledge the full range of motivations, behaviors, aims and values that may have been inherent in this unrest. I first describe the article’s characterization of Baltimore’s unrest as community violence. I then provide a negative argument against employing this characterization alone, before providing positive arguments for two alternative characterizations—as protest and apt anger. Finally, I discuss upshots of considering these alternatives. Broadly, while viewing civil unrest as community violence focuses exclusive attention on victims of unrest, these alternatives direct attention to unrest participants, with implications for public health research and practice. While I focus on Baltimore’s 2015 unrest, the proposals raised here apply wherever civil unrest occurs. Introduction Following the death on 19 April 2015 of Freddie Gray from injuries sustained while unarmed and in police custody, many citizens of Baltimore took to the streets and the National Guard entered the city. A September 2017 article published in the American Journal of Public Health by Yimgang et al. sought to understand the effect of this period of civil unrest on maternal and child health. In this article, I argue that Yimgang et al.’s research is driven by a characterization of Baltimore’s civil unrest that does not capture the full story about Baltimore’s unrest. Going forward, it is important that public health research and practice consider a broader set of characterizations of civil unrest. First, I provide some background regarding Freddie Gray’s death and Baltimore’s racial dynamics. Next, I describe Yimgang et al.’s characterization of Baltimore’s civil unrest as community violence and provide a brief negative argument against relying on this characterization alone. I then provide positive arguments for two alternative characterizations. I re-characterize Baltimore’s civil unrest first as protest and second as apt anger. I show how the first—civil unrest as protest—arises quite plausibly from a more comprehensive consideration of the motivations and behaviors inherent in this period of unrest. The second—civil unrest as apt anger—arises as an extended response to a strong potential objection to the first characterization. Importantly, these alternatives are neither mutually exclusive nor exhaustive. Finally, I discuss possible upshots of considering these alternative characterizations within public health. Broadly, I argue that while the view of civil unrest as community violence focuses exclusive attention on potential victims of civil unrest, these alternative characterizations direct attention to civil unrest participants, with important implications for both public health research and public health practice. These discussions of implications differ significantly in methodology. In the first case, I draw on foundational concepts in social science research to identify potential ways in which characterizing civil unrest as protest may influence both public health research questions and study design. In the second case, I undertake normative philosophical analysis of the appropriateness of anger to identify how interactions might be improved between public health practitioners and the populations they seek to benefit. Though I focus in this article on Baltimore’s 2015 civil unrest, the issues I raise apply more generally. For instance, a search of the public health literature suggests that research focused on the 1992 Los Angeles unrest following Rodney King’s unjust treatment predominantly considered the violent effects of unrest on bystanders or potential victims (Evans, 1993; Golden and Baranov, 1994; Hanson et al., 1995), including local businesses (Pearson and Kirby, 1993) and police officers (Harvey-Lintz and Tidwell, 1997). In addition, while my focus here on the Yimgang et al. article allows me to illustrate my arguments with specific examples, other recent research similarly characterizes unrest as violence and measures its effect on victims (Galovski et al., 2018). As I will argue below, wherever civil unrest occurs, the tendency to characterize it exclusively as community violence should be resisted. Background Freddie Gray, a 25-year-old African-American man, was arrested on 12 April 2015. He was then transported to a local police station, after which he was found to be in a coma, possibly due to a ‘rough ride’—an effort to cause injury or pain to an unbuckled or hand cuffed suspect through unsafe driving. One week later, Gray died from injuries to his spinal cord. The officers involved were charged with various crimes including false imprisonment, manslaughter and second-degree murder. Baltimore Rising, a documentary that focuses on the aftermath of Gray’s death, situates this period of civil unrest within a larger history of unjust treatment of black Baltimoreans. One interviewee in the film states, ‘The Freddie Gray incident wasn’t the cause of the uprising, it was just probably that last straw that broke the camel’s back’, and Councilman Carl Stokes adds, ‘the condition of the community caused the uprising that we had’, (Sohn, 2017). The present condition of Baltimore has a particularly strong historical connection to the baldly racist practice of redlining, a process whereby neighborhoods were deemed ineligible for financial lending based on ‘undesirable’ racial concentrations (Hillier, 2003). In addition, the Department of Justice investigation of the Baltimore City Police Department has found significant evidence for a history of unjustified use of force and differential treatment of racial minorities (United States Department of Justice, 2016). In short, Baltimore’s 2015 civil unrest should plausibly be viewed as a response to persistent institutional oppression of predominantly black Baltimoreans by the government and police, not simply as a response to Gray’s arrest and death. While I cannot develop a full theory in this article for how to distinguish cases of civil unrest that are responses to persistent institutional oppression versus single events, two plausibly necessary, but perhaps not sufficient, conditions appear satisfied in this case: (i) clear evidence of persistent institutional oppression and (ii) good reasons (e.g., in the form of personal testimony) to believe this oppression primarily motivated the unrest. ‘Civil Unrest’ as Community Violence Yimgang et al. (2017: 1455) write that in response to Gray’s death, ‘Baltimore erupted in civil unrest: fires, property destruction, and violence’, thus explicitly characterizing Baltimore’s civil unrest in terms of community violence. In addition, the authors frame their focus within a larger discussion in the literature of the effects of community violence on physical and mental health. I will argue that this characterization does not attend to the full range of motivations, behaviors, aims and values that may have been inherent in Baltimore’s period of civil unrest. Of course, any single research aim must be sufficiently narrow to be answerable. However, I take issue with the potential implications of adopting this characterization of civil unrest to the exclusion of alternative characterizations within the larger body of public health research and within public health practice. As discussed above, the film Baltimore Rising makes it clear that many of those involved in Baltimore’s 2015 unrest were black individuals responding to a history of racism and persistent institutional oppression. Predominantly characterizing civil unrest as community violence within public health may therefore reinforce stereotypes about black individuals, especially black men, as criminals. This characterization obscures the possibility that the civil unrest was justified or nonviolent. It plays into an ongoing cultural narrative of black violence, thereby perpetuating racism and fear (DiStefano, 2018) and potentially reinforcing beliefs that the persistent institutional oppression described above is justified. Alternative Characterizations of ‘Civil Unrest’ ‘Civil Unrest’ as Protest Given the risks of characterizing civil unrest as community violence, I suggest two alternatives: civil unrest as protest and as apt anger. Protest strikes me as a noncontroversial place to begin given that so much of what is depicted in the Baltimore Rising film is clearly protest. Protest is also a plausible characterization of civil unrest. Protest aims to effect change by disrupting the status quo. Seen this way, protest aims to disrupt the resting state of a society or community. Protest is therefore reasonably understood as a form of civil unrest. Of course, not all civil unrest should be considered to entail protest. Sometimes there is merely violence where those perpetuating the violence either have no desire to effect change or are fighting on behalf of the status quo to resist change, such as state-sponsored violence to quell social movements. And not all protest involves community violence. The peaceful demonstrations organized by Martin Luther King, Jr. are an example. Characterizing civil unrest exclusively as community violence obscures the possibility that civil unrest includes peaceful protest as well as instances of protest that also entail community violence. Implications for public health research While the view of civil unrest as community violence focuses attention on potential victims, characterizing civil unrest as protest directs attention to participants in unrest (DiStefano, 2018). Community violence may affect victim health through either direct bodily harm or stress accumulation stemming from the persistent threat of community violence (Yimgang et al., 2017). Yimgang et al. are clearly focused on victims; they measure the impact of unrest on the health of mothers and infants, groups unlikely to have participated in the unrest. However, viewing civil unrest as protest directs attention to participants. On this view, there is reason for public health researchers to identify and explain potential mechanisms through which unrest may influence the health of participants. I consider one such mechanism here. I take protest to involve a demand that the current state of affairs be altered in some way and a belief that this future state of affairs is more likely because of this demand. Protesters therefore take themselves to be effective agents, or agents whose actions are felt to matter. Seen this way, protest involves an important degree of agency, which on many theories is considered central to well-being. A review of leading theories of social justice (Powers and Faden, 2006; Wolff and de-Shalit, 2007; Daniels, 2008; Ruger, 2010; Nussbaum, 2011; Venkatapuram, 2011) identified agency—the ‘ability to lead one’s own life and engage in activities one finds meaningful’—as a point of convergence in each theory’s conception of well-being (Bailey et al., 2015: 631). If, according to stress accumulation theories, the threat of violence can be harmful to health, then perhaps the loss of one’s sense of effective agency can be as well through its negative impact on well-being. There is thus an important sense in which those participating in protest are perhaps healthy (DiStefano, 2018). This is a preliminary sketch of an argument linking agency with health, but the link appears plausible. Importantly, I am not arguing that protests are harmless, all things considered. Protests are never without risk and participants or bystanders can certainly be exposed to a number of health threats. However, protests may indicate or promote a certain healthiness that is not present among some individuals in areas where protests are not occurring. In such areas, there may be a lack or total loss of a sense of effective agency—likely stemming from the persistent institutional oppression present in Baltimore. Researchers ought to consider this possibility when studying periods of civil unrest that include protest. To be sure, protest may not always indicate or promote health. Protest requires an enormous amount of physical and emotional energy to carry out in a sustained manner. A strong disposition among black individuals to actively cope with environmental stressors can magnify the negative relationship between socioeconomic status and blood pressure (James et al., 1987). Protest, as a form of active coping, could therefore be associated with worse health among protesters who are low income and black. Skeptics may argue that Yimgang et al. did measure the health of those in nonprotesting areas since distal regions (i.e., zip codes where civil unrest was not reported to the police) served as a comparison for proximal regions. However, distal regions likely also included higher-income residents and those otherwise uninfluenced by the civil unrest. A better understanding of the relationship between health and effective agency requires targeted study of relevant regions. Moreover, individuals in both regions were enrolled only after seeking health care within the University of Maryland Medical System. Individuals actively seeking health care are more likely to be those retaining a sense of effective agency; despairing individuals are more likely to stay at home, potentially resulting in selection bias. Research that aims to validly characterize the associations between protest, effective agency and health should adopt sampling methods that avoid this form of bias. The overall uncertainty described here regarding the relationship between health and participation in civil unrest demonstrates a genuine research gap in public health (DiStefano, 2018). A research agenda focused exclusively on the impact of civil unrest on victims overlooks how civil unrest as protest may indicate or promote health where it is occurring. This could lead those committed to improving public health to focus their efforts disproportionately on areas proximal to civil unrest at the expense of more distal areas. Of course, some may argue that the possibility of finding a negative effect of civil unrest on participant health is good reason to not pursue this research agenda so far as such a finding could be used to further condemn participation in protest. One response is that we should instead view such a finding as further reason to condemn the persistent institutional oppression that gives rise to the need for protest in the first place. However, even conceding this objection would not eliminate the potential value to public health research of considering civil unrest as protest. Yimgang et al. assume a causal path from civil unrest to worse mental health, but it is possible that the death of Freddie Gray confounds this hypothesized relationship. Gray’s death—a traumatic event and clearly associated with Baltimore’s unrest—may itself be a cause of negative health outcomes. Yimgang et al. do not consider this possibility, for which there is now compelling evidence (Bor et al., 2018). One explanation for this oversight is that this confounded relationship is not implied by the characterization of civil unrest as community violence. By focusing attention on victims, this characterization suggests a direct causal effect on health from unrest to bystanders. In contrast, characterizing civil unrest as protest implies the existence of a variable that precedes and precipitates the unrest (i.e., Gray’s death) that cannot be reasonably excluded from causal hypotheses. Characterizing civil unrest as protest may thus help reduce this risk of omitted variable bias when inquiring into the relationship between civil unrest and health. ‘Civil Unrest’ as Apt Anger Some may object to the view that what transpired in Baltimore in the days following Gray’s death can be considered protest. On this view, the events were far too emotional and disorganized. Such people may instead want to label the events as simply an expression of anger. In this section, I draw attention to a distinction in kinds of anger that is important to consider when evaluating this position. A common view of anger with roots in the Stoic tradition is that angry individuals cannot be reasoned with, and as such, anger can have no place in rational deliberation or politics. In contrast, Amia Srinivasan proposes and defends an account of apt anger (Srinivasan, 2018).1 Apt anger, she argues, is rationally evaluable. To show how, she grounds apt anger in a set of four necessary conditions. First, the object of an individual’s anger must constitute a genuine moral violation. Second, the reason for an individual’s anger must be known by that individual. Finally, the individual’s anger must be motivated by and proportional to that reason. These conditions therefore provide reasons which must relate to anger in a particular way for it to be apt. These reasons can be either the right reasons or not, depending on whether they in fact constitute a known moral violation and properly relate to the individual’s anger in terms of motivation and proportion. In this way, Srinivasan’s analysis of apt anger is meant to ‘dissolv[e] the false dichotomy between reason and anger’, thus making room for apt anger in politics (Srinivasan, 2018: 127). Each of these conditions is clearly met in the case of Baltimore’s civil unrest. As discussed above, Freddie Gray’s arrest was likely an instance of unjust discrimination and therefore constitutes a genuine moral violation. Regardless, Baltimore’s civil unrest ought to be viewed as a response to persistent institutional oppression and not simply to Gray’s arrest and death. It is therefore nearly impossible to deny that genuine moral violations are the object of much of the anger expressed during the civil unrest. So far as unjust police practices are experienced directly by individuals or others within that individual’s family or community, they are plausibly known reasons for anger. These reasons also properly motivate the anger expressed during the unrest. The anger is a direct response to the condition of the community and the moral violations associated with it. Finally, the anger is proportional. If anything, the anger is more restrained than it need to be given decades of unjust treatment. Some might object that a defense of apt anger amounts to a defense of violence. However, only where anger in fact involves violence would a defense of anger be tantamount to a defense of violence. Moreover, a defense of interpersonal violence is likely what concerns those who might raise this objection; a defense of nonpersonal violence (i.e., violence against structures or property) is, plausibly, more acceptable. Fortunately, we can observe that most people seem capable of getting angry without committing interpersonal violence (Srinivasan, 2018). It is of course an empirical question which type of violence was most prevalent during Baltimore’s civil unrest, but to the extent much—if not most—of it was nonpersonal violence, this potential objection loses much of its bite. To be clear, my intention here is simply to provide a pragmatic response to the unfortunate reality that there are likely many who object to civil unrest and protest as being nothing but irrational anger. I am not defending placing a greater justificatory burden on the aptness of anger versus the aptness of nonanger. Inquiring whether those participating in civil unrest possess sound reasons for their anger while not asking the same of those who stand by silently in nonanger may constitute an injustice itself. Implications for public health practice Characterizing civil unrest as apt anger also shifts our focus from the potential victims of civil unrest to its participants. Specifically, it centers attention on the reasons that individuals may have for participating in unrest, while a focus on potential victims obscures these reasons. These reasons, if seen as such, can help to improve—perhaps even fundamentally change—the relationship between public health practitioners and members of the communities in which they work. Because apt anger arises from a known moral violation, Srinivasan considers it ‘a form of emotional insight into the moral world’ (Srinivasan, 2014: 5). That is, apt anger is valuable as a means of ‘affectively registering’ or appreciating that an injustice has occurred rather than merely knowing that an injustice has occurred (Srinivasan, 2018: 132). She illustrates this claim by likening the appreciation of injustice to the appreciation of art. It is not enough to know that a painting is beautiful; rather, the art lover seeks to truly appreciate that the painting is beautiful. There is an important affective component to the value of a beautiful painting that is not captured merely by knowing that the art is beautiful in virtue of, for example, the artist’s skill in color-blending. The same is true of injustice. There is value in the affective registration of an injustice beyond the value of simply knowing there is an injustice. Apt anger is a means of tapping into such appreciation. More importantly, apt anger—as rationally evaluable—has communicative value as a form of moral address that gives others reason to share in this affective registration of injustice. Reasons can make claims on others. That is, apt anger is not only valuable for the aptly angry individual; it also calls on others to share in the affective registration of an injustice for which they may not themselves be a direct victim. An especially powerful scene in Baltimore Rising illustrates the communicative value of apt anger. Following the initial unrest in the aftermath of Gray’s death, a meeting is arranged between various community leaders and Kevin Davis, Baltimore’s police commissioner at the time. Davis’ stated aim is to ensure ‘[only] protest and no violence’ (Sohn, 2017) if the verdicts in the trials of those charged in Gray’s death are ultimately unsatisfactory. At a second meeting, Davis speaks with Shadow, a former gang member, who tearfully describes his relationship with the police as ‘the only time we ever see you all is you all taking our fathers from us’ (Sohn, 2017). He goes on to describe being strip-searched, and in a moment where Davis interrupts him, Shadow—passionate, yet restrained in his anger—responds, resulting in the following exchange: Shadow: Please let me finish. No, please let me finish. Please let me finish. I went through shit that I should not have to. I’m not even supposed to be sitting here. I got a bullet wound in my head, Chief. and that will not happen to my children. Do you understand ? This will not happen to my children. I will die doing this. OK? Davis: Your pain’s not my pain. I’ve never lived your life. But that still— Shadow: Excuse me. Davis:—doesn’t mean that… that… Shadow: It won’t happen to my children. I promise you. Davis: I… I feel your pain. (Sohn, 2017) In the first meeting, Davis was focused on reaching a productive, strategic agreement with community leaders. Something different occurs in this second meeting. Davis is visibly distraught and stumbles over his words throughout this exchange. It seems clear he is moved by Shadow’s anger. No agreement is reached or sought. Instead, Davis simply listens and expresses empathy. Despite acknowledging never having been a victim himself of the injustices Shadow experienced and describes, Davis ultimately appears to genuinely share in feeling Shadow’s pain. In this moment, Shadow’s apt anger calls for Davis’ shared affective registration of the injustices Shadow has suffered. Ultimately, this shared affective registration of the moral violations underlying apt anger can facilitate a fundamental change in the relationship between those participating in civil unrest and those to whom it is directed or who may observe it. This shared affective registration of injustice can shift these relationships from those based on an objective attitude to those based on a participant attitude. Strawson famously distinguishes the objective and participant attitudes. The former entails seeing another person …as an object of social policy; as a subject for what, in a wide range of senses, might be called treatment; as something certainly to be taken account, perhaps precautionary account, of; to be managed or hand led or cured or trained; perhaps simply to be avoided. (Strawson, 2005: 79). Adopting the objective attitude toward another means treating that person as a nonparticipant in shared moral practices. In contrast, the participant attitude entails viewing another as a morally responsible agent, that is, as a member of the moral community. In further developing this view, McGeer (2012) describes co-reactivity as an integral property of responsible agency. For McGeer, the participant attitude entails taking another person to be both capable of understanding and responding to demands for moral regard. On Strawson’s account, participant reactive attitudes appear predominantly backward-looking. They are responses to the actions or expressions of others. McGeer’s emphasis on co-reactivity highlights that the participant reactive attitudes are equally forward-looking; they call for a response from those to whom they are directed (which calls for further response), thus ‘making and sustaining moral community’ through ‘dynamic trajectories of reactive exchange’ (McGeer, 2012: 304). For Strawson, anger and indignation are emotions that compose the participant reactive attitudes. In fact, Strawson straightforwardly states that the objective attitude cannot include anger; anger is not an appropriate emotion to feel toward one who cannot participate in shared moral practices (Strawson, 2005). Characterizing civil unrest as apt anger therefore permits the conception of civil unrest as an expression of a participant attitude and a call for co-reactivity. Those who are aptly angry and participating in civil unrest are calling on others as morally responsible agents—including public health practitioners—to engage in a shared moral practice. Civil unrest as apt anger is a call to affectively understand and then respond in an ongoing practice of moral collaboration to the moral violations that provide reasons for the unrest. Characterizing civil unrest as community violence obscures this possibility and may perpetuate continued reliance on an objective attitude by those in public health. The objective attitude entails a need for further management, avoidance or harm mitigation that is evident in research that aims only to measure the effects of violent unrest on potential victims. The exchange between Shadow and Davis is an illustration of co-reactivity between two individuals who have adopted a participant attitude toward one another. While unrest as violence may be met with fear or further violence, unrest as apt anger may be met with a shared appreciation of injustice and perhaps some small measure of progress. Conclusions Wherever civil unrest occurs, the tendency to characterize it exclusively as community violence should be resisted. Widespread focus on civil unrest as community violence risks inadvertently perpetuating racist and harmful stereotypes about those involved. Instead, a greater range of possible motivations, behaviors, aims and value inherent in civil unrest should be considered. 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Available online at www.phe.oxfordjournals.org This article is published and distributed under the terms of the Oxford University Press, Standard Journals Publication Model (https://academic.oup.com/journals/pages/open_access/funder_policies/chorus/standard_publication_model)

Journal

Public Health Ethics – Oxford University Press

Published: Oct 1, 2003

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