The latest mass shooting in America — the largest in modern history — has us once again questioning the role of guns in our society and our willingness to allow weapons and ammunition to proliferate throughout. Until Sunday, when a gunman opened fire in Las Vegas and killed 59 people and wounded hundreds more, the deadliest mass shooting happened in June 2016 at an Orlando nightclub, leaving 49 dead and many injured. Since then, there have been over 520 mass shootings, which the Gun Violence Archive defines as an event in which four or more individuals are shot at or killed in the same general time and location.
How do these mass shootings impact all those involved as well as those who witness them from afar? We asked Sheila A.M. Rauch, Ph.D., an associate professor at Emory University School who has been providing treatment for PTSD and anxiety disorder for over 20 years, what these events are doing to the individuals involved as well as our collective national psyche.
Karin Kamp: The death of a loved one is always upsetting. But how it different for people to cope with such a loss as a result of a mass shooting like the one in Las Vegas?
— Sheila Rauch
Sheila Rauch: Coping with loss is difficult but when that loss is unexpected and due to senseless violence, it can compound the impact on those who are left behind. As people, we want to have a sense of control over our world and the people we love. When death due to violence occurs that sense of safety and comfort is ripped away and leaves the people left behind feeling vulnerable and angry along with the deep sadness that follows loss.
In times like these it is particularly important to make sure we are supporting those around us who are impacted and providing them ways to vent in a safe environment. It is also important to look for ways to prevent such events in the future through examination of why this act was able to occur and why this person was able to harm so many so quickly by using a type of weapon that can fire quickly. We want survivors to recover and we want to prevent future incidents of violence.
KK: There were also over 500 people wounded, and surely many will have very serious lasting physical problems as a result. How does this type of event impact the wounded and their families psychologically?
SR: Whether their loved ones were physically injured or killed, the impact on family and friends can be similar. As previously mentioned, violent trauma steals the sense of safety that most people take for granted in their lives for themselves and those they care about.
For those who may not have been personally injured, we will not know until a few months from now the impact on their psychological health. Trauma, such as a shooting, can lead to depression or PTSD or other mental health issues that can impede family and work function. Physical injuries may require rehabilitation and medical intervention and the psychological injuries may require care as well over time. Providing support for the survivors and their families in the aftermath of trauma can speed recovery and reduce rates of negative mental health consequences over time. Giving people a voice to express their stories as they see fit can also aid in their recovery.
KK: There were also 22,000 people in attendance at the concert. What can you say about how their lives will be impacted?
— Sheila Rauch
SR: We would expect that most of the people who survived this incident will be feeling some signs of trauma exposure — images coming into their heads over and over, sadness, anxiety, fear, problems sleeping, anger, avoidance of things that remind them. Over time, most people will see these reactions fade away naturally as they gradually get back into their lives and reengage with activities such as work and family. This time course typically sees symptoms reduce over about a year post trauma. For some, the reactions will remain or even worsen over time, leading to post-traumatic stress disorder or depression. Typically, PTSD is not diagnosed until one month after an event. Effective treatments are available including medications (such as SSRIs) and psychotherapy (such as Prolonged Exposure therapy or Cognitive Processing Therapy). However, if someone if having intense reactions prior to one month and wants assistance, starting earlier can be helpful.
KK: What is your advice to anyone who was at the event in terms of their mental health?
SR: My advice to anyone at the event is to pay attention to what you need to recover. Everyone is different and recovers at a different pace and cadence. Ensure you connect with your trusted supports including family and friends and community. Talk about it in whatever way you feel comfortable and let yourself feel the emotions that this experience may bring up for you. Make sure you are not using substances to try and avoid. Channel your energy into positive coping such as raising awareness of gun violence or telling the stories of yourself and those you love surrounding this incident.
KK: Shootings with the biggest death tolls make headlines, but according to Gun Violence Archive their have been over 270 mass shootings incidents in 2017 alone. These happen in schools, malls and other public places. How is this effecting us?
— Sheila Rauch
SR: My observation is that we seem to be becoming less outraged with each incident. This should be unacceptable and instead it seems to be shrugged off as the way things are now. I think this has a numbing effect on our society.
We have both fearful and numbing reactions over time and across people. However, as these events have become more common the intensity of the fear gets reduced each time. I think the impact of fear is that we become less trusting of each other. This especially problematic at a time when we need each other to recover and try to work together to prevent these incidents in the future.
KK: Then there are the thousands upon thousands of first responders that come to the aid of victims in such attacks. Of course they are trained to see traumatic events, but what toll does this take on them?
SR: First responders — because of the number of traumas they are closely engaged with — are at a higher risk than the general population of developing PTSD, depression and other mental health issues over time. That being said, they are also a very resilient and strong population that bears the violence of our society. I would encourage them to take advantage of their supports in their community of responders as well as the resources in the community. As a society, we need to support first responders and their families for their bravery and service.
KK: On the news you can hear the gunshots and see the horrific aftermath of the shooting. How do these kind of repeated images affect our society in general?
SR: I would caution people to monitor how much you view such images. They are not generally helpful and most of us do not need that level of detail to be aware of the event.
KK: As children become increasingly aware of these events given the proliferation of breaking news on-air in public places, cell phone ownership and social media, how is this impacting their mental health?
SR: Parents should make sure they talk with their children about this event. Discussion should focus on what the child is aware of and their thoughts about the incident at the developmental level of the child. Start with their understanding. As much as parents can provide a clear sense of safety for their children this will help to reduce the impact of the event. What are the child’s thoughts about why this happened? How do they feel this impacts their life? What do they think needs to happen now? How can they feel safe in their life?