Psychological Recovery Following Mass Shootings

On October 1, 2017 in Las Vegas, NV we saw the largest mass shooting in modern US history. On June 12, 2016 in Orlando, FL we saw the largest mass shooting in modern US history. On December 14, 2012 in Newtown, CT we saw the second largest mass shooting in modern US history. On April 16, 2007 in Blacksburg, VA we saw the largest mass shooting in modern US history. The list goes on and on and on. In recent years, we have seen a surge of mass shootings and violence in the US and at the center of every shooting is one question, “why?” Today, I don’t care about the why. Why’s that you may ask? Well, as a Las Vegas resident my primary question at this point is “now what?”

Mass shootings and violence are not natural disasters. They don’t exist naturally in our world; they are created, molded, groomed, and lashed out into the world. Some of the worst types of violence are those perpetrated onto others from our fellow human being. This is what leads me to ask “now what?” Las Vegas, like many other cities and towns after such violence, is still in the early recovery phase. Like any other break, the wound needs to be covered before it can heal. Our first responders, police officers, emergency services personnel, nurses, doctors, and Red Cross volunteers are taking care of those open wounds even as they hemorrhage themselves. The psychology of mass murders is an interesting topic, but not my speciality. No, instead, I’m more interested in the psychology of mass murder survivors.

What does it mean to recover from mass violence? How do you know when you are “better?” How do you live with the new scars in your mind? The best way to start answering these questions starts with the responses. Trauma and stress responses are normal. Your body is reacting to danger, whether you were there at the shooting, know someone who was there, watch it on the news, or work with those who both survived and died. Our hearts race, our minds race, our breathing can change, we start looking up at windows of tall buildings, we don’t go where there are crowds, we begin to fear. There is no right or wrong way to respond to threat especially the surprise threat of mass shootings. In war, you are deployed. You know you are going into a war zone. You don’t know what is going to happen, but you prepare for the “what ifs” that come with that situation. Mass shootings are the unplanned warzone. You are not prepared to face them. You are not trained to control your breathing. You are not armed. You are not expecting them. This is what makes them so devastating to so many people; the unknown.

Now, here we are. After the sounds have stopped, the blood donated, the wounds packed and wrapped, we exist in a world unsure of what to do next. Some people may think “I need therapy now” or “I have to talk to someone.” As a psychologist, I am here to tell you that these instincts are natural, but slightly premature. Crisis counseling is not trauma processing. What that means is that the immediate needs after a mass shooting are specifically designed at ensuring stability. Making sure someone has proper medical care, housing, food, finances, and is alive. Crisis counseling allows you to have a safe, supported space to get these basic needs met; this is your survival mode. You may talk with someone, cry with them, shake in their arms, as you think about what happened. All of this is normal. Whatever needs you have right now are our priority. Survival mode is temporary, but temporary is subjective. Some people will feel somewhat better days after an event, for others it may take months. There is no right way to process trauma. You may notice changes in your eating patterns, you may be more cautious on your way to work, your sleep might be interrupted, you may notice yourself feeling jumpy or on edge; all of these are normal responses and, for most, they go away. Having trauma responses immediately after trauma is not pathological, it’s entirely normal.

Experiencing a trauma does not mean you are guaranteed to have residual effects. Nearly 80% of individuals experience at least one trauma in their lives, but the rate of chronic trauma responses is less than 15%. Why is that? What makes someone able to survive trauma and still be ok? Resiliency. Human beings are amazingly resilient. We have go through hell and come out kicking on the other end. We are resilient with support; knowing that how you feel is normal, that is it likely temporary, and that while this experience may change you, it does not define you. There is the old cliché that “time heals all wounds,” which I think is accurate to some degree, but I’ll extend it to “time heals all wounds, but they leave a scar.” Your scars are your battle wounds, they are your reminder that you are strong, that you are able, that you can make it through trauma, and be ok in the end. You are not alone, you are not broken, you are not crazy, and you can get better.

Can you cure PTSD?

This is a question I hear from patients on a near constant basis and one I ponder on a regular basis both personally and professionally. What does it mean to cure PTSD? Does it mean you can sleep again? Does it mean you don’t remember what happened to you? Does it mean you can smile again? The notion of a “cure” for any mental health condition is still an extremely controversial topic in the field. While there are some mental health conditions we know are not “curable” by the textbook definition of a cure such as Schizophrenia, Bipolar Disorder, or Autism, that does not mean your life is over. Think about it this way. Is there a cure for Diabetes? Is there a cure for cancer? Is there a cure for a broken leg? The standard answer is “ yes,” but when you think about these conditions, the “cure” is more about treatment not necessarily just getting rid of the disorder. With cancer, you can go into remission, but that doesn’t mean it’s cured because it can come back. With diabetes, you can manage it with insulin and still live a full life. PTSD is the same way. When I think about “curing” PTSD, I think about it just like “curing” cancer; an individual goes through treatment, their symptoms subside, and they are able to function again. Does that mean it will always be like that? No, of course not, there are no guarantees with any treatment medical or psychological. But you can have your life back in a way that you likely didn’t think possible.

Now, I recognize how Pollyanna that perspective may sound to many, but from experience with my patients and copious amounts of research done my individuals far smarter than I am, it is something I wholeheartedly believe to be true. I have seen people with PTSD symptoms for decades go through treatment and come out the other side happier, healthier, calmer, more rested, and able to live again. Their trauma wasn’t gone though, trauma never goes away, it’s the symptoms that we are trying to treat. PTSD is made up of 4 symptom clusters: re-experiencing, avoidance, negative mood and thought changes, and hyperarousal. I spent a whole lot of time getting to know these symptoms in textbook form before I got to see them in the real world and let me tell you, the textbook has nothing on the real world manifestation of this life-destroying disorder. PTSD eats away at someone, it infects their entire existence, it makes them want to die, but for most, they keep on fighting. Suicidal thoughts with PTSD are so very common as is drinking, other substance abuse, sexual difficulties, medical problems, and a whole host of other life changers, but just as Princess Leia says in Rogue One, “hope” is the answer. Hope means there is at least the smallest glimmer that things will change. Never underestimate the motivating power of hope even if it’s just to prove someone wrong. PTSD can be cured, symptoms can go down, your life can be yours again. No, your trauma will never go away, but that does not mean you cannot get better.

Treatment for PTSD sucks. I’ll be the first one in the office telling you that from meeting #1. Having to uncover your deepest, darkest, more horrid experience to a near complete stranger is an experience that inherently makes your body tense and pucker with anticipation, but that’s honestly my job. It is the job of a trauma psychologist to be your go to person, the person who sits with you while you tell every gory, bloody, scary, horrifying, disgusting detail of this horrible time in your life, and who will never recoil from a single word. Treatment means uncovering the wound, cleaning out the infection, and stitching you up. It also means going through the rehabilitation and tending to the scar. See, trauma is a scar while PTSD is the hemorrhaging bullet wound. Like any wound, you have to stop the bleeding before you put it in a cast. Your life will never be the same after a trauma, that’s the very nature of trauma, but it does not mean your life ends after the trauma. Hope exists, treatment exists, you can exist again. To learn more about PTSD, treatment, or recovery from trauma, feel free to email or call my office. There is life after trauma, there is you after trauma.