Tolerance Isn’t Built in a Day

As many of you know, I serve as a clinician at the Tom Waddell Health Center for the Homeless.  Over the last few years the staff has become increasingly concerned about threats and violence from the patients.  This is concurrent with the progressive de-funding of mental health care and substance abuse treatment facilities within the city and county of San Francisco.  This year signs went up all over the clinic announcing Zero Tolerance; anyone using abusive profanity, verbal threats, or physical violence will be denied clinical services other than emergency care.  When I initially saw these signs I’ll admit they offended my sensibilities.  Firstly, as a promoter of primary prevention, I classify this kind of signage as a secondary prevention method for tackling violence.  It doesn’t address the reasons people are getting abusive, offering threats, or becoming violent.  Many people are mentally unstable and easily frustrated.  And honestly, the medical system can very often be incredibly aggravating for patients and equally trying for the staff trying to offer the care, especially in understaffed settings.  The other dispute I have with Zero Tolerance is that what we actually need in our world is more tolerance.  We need more understanding, more patience, more acceptance, and more forgiveness.  We need to cultivate a feeling of friendliness with each other, an attitude that we are on each other’s’ side.

Although OSHA (Occupational Safety Health Administration) recommends Zero Tolerance policies for healthcare settings, there are no studies that support the effectiveness of these policies in making the workplace safer.  In fact at least one study published in the Australian and New Zealand Journal of Psychiatry indicates that Zero Tolerance policies for patients increase rigid attitudes among staff in managing aggression in the health workplaces.  Rather we need to understand the motivations for the behavior, consider the individual(s) involved, take into account the underlying mental un-wellness, improve access to mental health services, and incorporate community services to take care of the needs of people.  Whenever patients get denied services, my first reaction is that actually those patients likely need more services than they are getting, even as we require responsible and respectful behavior from everyone involved.

Zero Tolerance policies in schools have been extensively studied and the overwhelming evidence is that they are not constructive, and in fact may even be destructive.  Ironically, Zero Tolerance in schools became widely implemented in schools just as it was losing favor in the criminal justice system from which it was adopted.  In fact Zero Tolerance policies are being cited as being responsible for what has become known as the “school-to-prison pipeline.”  Kids are being suspended from school in droves; the numbers have doubled from 1.7 million in 1974 to 3.1 million in 2000, with nearly one in every fourteen students suspended at least once during 2006.  What’s worse is that kids are at a higher risk of getting arrested at school than they were a generation ago.  Not surprisingly, children of color are being removed at disproportionately higher rates than whites from mainstream educational settings for non-violent violations of Zero Tolerance policies that formerly would have been considered typical childhood mischievous behaviors.  Only half of the states in the USA require alternative assignments for expelled or suspended students, and as one might expect, those assignments are generally not as rigorous the ones in mainstream schools.  Child Trends, a nonprofit, nonpartisan research center, as well as the American Psychological Association have reviewed the existing literature on the effects of Zero Tolerance in the school setting along with the evidence for promising non-punitive alternatives to ensure safety in the school setting.  The findings indicate that Zero Tolerance policies don’t effectively deter misbehavior.  Furthermore, suspension and expulsion from school tend to reinforce distrust of adults and negative behavior while denying opportunities for positive socialization at school, all of which inhibit adolescent development.

While there is no solid evidence that these policies actually decrease school violence, Child Trends found that there is good evidence from experimental and quasi-experimental studies that non-punitive measures have been effective in reducing school violence and improving academic achievement.  These programs take a preventive approach to misbehavior and violence by emphasizing social, behavioral, and cognitive skill-building; character education; and/or targeted behavioral supports for kids at risk for illegal or violent behavior.  We ought to be prioritizing the primary prevention of school violence (and workplace violence) by investing in these strategies.  Let’s work to deny the words of George Bernard Shaw who said, “Schools and schoolmasters, as we have them today, are not popular as places of education and teachers, but rather prisons and turnkeys in which children are kept to prevent them disturbing and chaperoning their parents. ”

November 16th was designated International Day of Tolerance by UNESCO (United Nations Educational, Scientific, and Cultural Organization) in 1995 with the purpose of increasing our understanding of the dangers of intolerance and to launch a worldwide campaign for tolerance and non-violence.  We’ve got about a month to prepare and practice so that the day actually becomes meaningful and productive.  Last year on the occasion the UN General Secretary Ban Ki-moon said, “Our practice of tolerance must mean more than peaceful coexistence, crucial as that is.  It must be an active understanding fostered through dialogue and positive engagement with others….Practicing tolerance can serve as the antidote to prejudice and hatred.”

Tolerance, however, isn’t built in a day.  Tolerance takes time, patience, and education to ameliorate the ignorance, fears, and exaggerated sense of self-worth in which intolerance is rooted.  People often fear what they do not know.  That’s why exposure to diversity is so important.  Cultivating curiosity about those who are different than yourself is vital to peace on the planet.  Tolerance is not only important for violence prevention but also for the preservation of the human rights of indigenous people, immigrants, disabled people, mentally unwell people, and anyone vulnerable to discrimination whether on the basis of race, gender, religion, or sexual orientation.  While we are at it, let’s not forget the human rights of plants and animals as well.

The irony of the state of affairs we’re in is that while what is needed to foster tolerance and non-violence in the world is a rich education and healthy exposure to diversity, our schools are deteriorating and becoming bastions of punishment.  The mentality fostered by our various wars on Terror/Drugs/Poverty/Women/Kids discourages the attitude of forgiveness and patience required for tolerance and non-violence.  Teaching Tolerance offers an antidote to this pervasive punitive attitude by providing free teaching materials dedicated to reducing prejudice and increasing respect for differences.  They view tolerance as “a way of thinking and feeling — but most importantly, of acting — that gives us peace in our individuality, respect for those unlike us, the wisdom to discern humane values, and the courage to act upon them.”  The Center for Non-Violent Communication is an international organization that also teaches us how to listen deeply to ourselves and others, understand our mutual needs, and thus discover the depths of our natural state of compassion.  Practicing tolerance requires a concrete set of skills and a clear set of funded priorities based on the principles of primary prevention.  Ultimately, embodying tolerance becomes a spiritual practice that can heal the rifts between us and our planet.


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Jayshree Chander

Doctor Chander