The study by Coid et al. in this issue (1) is remarkable not only for its striking findings, but for the fact that it was published in this journal at all. The American Journal of Psychiatry, founded in 1844, has never before published an article with the word “gang” in the title, and has in its 169 years published only seven articles whose text included even a single passing reference to a research subject’s “gang” membership. The study of gangs, taken as a focal interest in the field of criminology since Thrasher’s The Gang in 1927 (2), has long been seen as foreign to mainstream psychiatry, and to forensic psychiatry as well.
Yet the conclusions of Coid and his colleagues strongly belie the validity of this capricious division of academic labor. The authors surveyed a nationally representative sample of young men in the United Kingdom who were in one of three groups: those who were neither violent nor in a gang; those who were violent, but not in a gang; and those who were both violent and in a gang. Not surprisingly, rates of drug dependence were 1%, 5%, and 57%, and rates of alcohol dependence were 6%, 14%, and 67%, respectively. Very surprisingly, however, rates of active psychosis were 1%, 5%, and 25%, and rates of prior admission to a psychiatric hospital were 2%, 5%, and 21%, respectively. Gang members, the authors are led to conclude, display “inordinately high levels” of psychiatric morbidity and place a “heavy burden” on mental health services in the inner-city areas where gangs are most prevalent. Given the parallels between gangs in the United Kingdom and gangs in the United States, there is little reason to think that the levels of morbidity or of burden are any different here (3).