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Mass shootings have far-reaching mental-health consequences, say experts

By Ilana Marcus
Medill Reports

In the weeks following the Parkland, Florida school shooting, Chicago-based psychologist Nancy Molitor noticed that the tragedy was surfacing repeatedly during sessions with her patients, even though it happened more than a thousand miles away.

“They were coming in for other issues, but it was the first thing on their mind,” said Molitor, who specializes in mood and anxiety disorders.

“This shooting in particular, I think impacted the public as a whole, even if they haven’t been witnesses,” she said.

School social worker Katie Prahin also noticed an increase in anxiety among the students at her Catholic school in Chicago.

“It doesn’t necessarily manifest itself where you see children talking directly about school shootings or gun violence,” she said. “I think that’s due to what they’re hearing about, whether it’s their exposure to the news, whether they hear their parents talking about it, whether they hear their peers talking about it.”

Trauma and post-traumatic stress disorder have become part of the American lexicon, and it is known that people who have been personally touched by disturbing events are at risk of developing these conditions. However, there is less discussion around the effect of major, high-profile tragedies on people who are several degrees removed from the actual incident.

Psychologist Tali Raviv of the Center for Childhood Resilience at Lurie Children’s Hospital noted there is a significant body of research on the effects of terrorism, which shares characteristics with mass shootings, including the disruption of societal function and a pervasive sense of fear.

Research after the September 11 attacks showed a prevalence of distress among “not only those who were affected directly, but also the first responders, and then those in the direct geographical area,” she said. The uptick in stress, anxiety, and disruption to sense of safety would usually last for three to six months, after which those without a personal connection to the event would resume typical functioning.

Even this short-term disruption could lead to negative public-health consequences if those afflicted tended to cope with their distress through reliance on behaviors such as smoking, drinking, and binge eating, said Raviv.

People who have already personally experienced trauma are especially vulnerable to re-traumatization via indirect exposure to events like mass shootings, local mental-health professionals agree.

Stories and images from coverage of mass shootings reinforce the sense that “the world is not safe, I am not safe, bad things can happen at any time,” said Raviv.

Reporting on these kinds of events is evolving and posing new questions on how mass-shootings affect the general public, said Molitor.

“We have citizen journalists, we have young people who are actually the victims shooting videos while they’re hiding behind a desk,” she said.

Some kids who are in a constant state of stress and distress lose the sense that things will ever improve, said Rev. Carol Reese, violence-prevention coordinator and chaplain with the Department of Trauma at Stroger Hospital.

“They can’t take in all the information around them because they’re hyper-aroused all the time,” which limits their executive-functioning abilities, she said.

While it may seem that people who are more sensitive to violent events due to past or present trauma compose a small segment of the population, the Adverse Childhood Experiences study administered by Kaiser Permanente in the mid-‘90s showed that by age 18, more than half of the general population has experienced a major traumatic event.

Various kinds of early experiences can count as a traumatic event, including loss of a caregiver, car accidents, and natural disasters, said Raviv. Some communities have higher incidence of traumatic events and some have fewer, but “no community is immune,” she said.

Many schools administer drills to teach students and teachers what to do in an active-shooter scenario, training which is required by Illinois state law.

Lockdown practice “raises anxiety among the staff, without a doubt,” said Prahin. “There’s just that anxious energy about even preparing for something to happen.”

An active-shooter drill “enhances our response when the time comes, and the reason we drill repeatedly is because we actually want our response to be internalized,” said Nancy Zarse, Psy.D. and full professor in the Forensic Psychology Department at The Chicago School of Professional Psychology.

In moments of high pressure, “we tend to fall to our lowest level of training,” she said.

Zarse said that even if some members of the school community may experience distress as a result of active-shooter drills, the advantages of being prepared far outweigh the risks.

“Effective drills actually decrease fear. Now people know what to expect and know how to respond. In actuality, drills empower students and teachers,” she said. She recommended making psychological services available during drills to mitigate negative responses.

While mental-health awareness is growing, more measures can be taken to create safe, effective learning environments for students with a range of life experiences and vulnerabilities at a time when the possibility of random violence is at the forefront of national discourse.

Resilience among children is influenced by “strong relationships between adults and students and students themselves, where there are interventions available for kids who might need more,” said Raviv. She added that stigma and logistical conflicts create barriers to integration of mental health care into places where kids and teenagers spend most of their time, like schools and community centers.

Zarse also said that more comprehensive measures need to be taken to keep people safe and healthy, including both an emphasis on pro-social and extracurricular activities to promote social engagement and better efforts to identify behaviors which may signify a proclivity for violence.

“We’ve become a bit of a fast-food society. So we look for the quick fix. We look for the headline. We need to go beyond that,” she said. “These are nuanced issues. Complicated problems require complicated solutions.”